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WHO Regional Publications

European Series, No. 92

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Evaluation in health promotion

Principles and perspectives

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Evaluation in health promotion

Principles and perspectives

Edited by:

Irving Rootman, Michael Goodstadt, Brian Hyndman, David V. McQueen, Louise Potvin, Jane Springett and Erio Ziglio

WHO Regional Publications, European Series, No. 92

Health Canada

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Part 1 Introduction and framework

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Introduction to the book

Irving Rootman

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1 A framework for health promotion evaluation

Irving Rootman, Michael Goodstadt, Louise Potvin and Jane Springett

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Table 1.1. Definitions of health promotion

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Source and date Definition (emphasis added)

Lalonde, 1974 (3) Astrategy “aimed at informing, influencing and assisting both individuals and organizations so that they will accept more responsibility and be more active in matters affecting mental and physical health”

US Department of Health, Education, and Welfare, 1979 (19)

“A combination of health education and related organizational, political and economic programs designed to support changes in behavior and in the environment that will improve health”

Green, 1980 (20) “Any combination of health education and related organizational, political and economic interventions designed to facilitate behavioral and environmental changes that will improve health”

Green & Iverson, 1982 (21)

“Any combination of health education and related organizational, economic, and environmental supports for behavior conducive to health”

Perry & Jessor, 1985 (22) “The implementation of efforts to foster improved health and well-being in all four domains of health [physical, social, psychological and personal]”

Nutbeam, 1985 (23) “The process of enabling people to increase control over the determinants of health and thereby improve their health”

WHO, 1984 (24), 1986 (4) and Epp, 1986 (25)

“The process of enabling people to increase control over, and to improve, their health”

Goodstadt et al., 1987 (26)

“The maintenance and enhancement of existing levels of health through theimplementation of effective programs, services, and policies”

Kar, 1989 (27) “The advancement of wellbeing and the avoidance of health risks by achieving optimal levels of the behavioral, societal, environmental and biomedical determinants of health”

O’Donnell, 1989 (28) “The science and art of helping people choose their lifestyles to move toward a state of optimal health”

Labonté & Little, 1992 (29)

“Any activity or program designed to improve social and environmental living conditions such that people’s experience of well-being is increased”

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Table 1.2. Definitions of health promotion deconstructed

Source and date Activities

(programmes, policies, etc.)

Processes

(underlying mechanisms)

Objectives

(instrumental outcomes) Goals

(ultimate outcomes) Winslow, 1920 (2) “Organized community effort for the edu-

cation of the individual in personal health, and the development of the social machinery”

“... to ensure everyone a standard of living”

“... the maintenance or improvement of health”

Sigerist, 1946 (1) “... by providing a decent

standard of living, good labor conditions, education, physical culture, means of rest and rec- reation”

“Health is promoted”

Lalonde, 1974 (3) “... informing, influencing and assisting both individuals and organizations”

“... so that they [individuals and organizations] will accept more responsibility and be more active in matters affecting mental and physical health”

US Department of Health, Education, and Welfare, 1979(19)

“A combination of health education and related organizational, political and economic programs”

“… designed to support changes in behavior and in the environment”

“… that will improve health”

Green, 1980 (20) “Any combination of health education and related organizational, political and economic interventions”

“... designed to facilitate behavioral and environmental changes”

“... that will improve health”

Green & Iverson, 1982 (21) “Any combination of health education and related organizational, political and economic supports”

“… for behavior” “… conducive to health”

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Perry & Jessor, 1985 (22) “The implementation of efforts” “... to foster improved health

and well-being in all four domains of health [physical, social, psychological and personal]”

Nutbeam, 1985 (23) “The process of enabling peo-

ple to increase control”

“… over the determinants of health”

“... and thereby improve their health”

WHO, 1984 (24), 1986 (4) Epp, 1986 (25)

“The process of enabling people to increase control over [their health]”

“… and thereby to improve their health”

Goodstadt et al., 1987 (26) “… through the implementation of effective programs, services, and policies”

“The maintenance and enhancement of existing levels of health”

Kar, 1989 (27) “… and the avoidance of

health risks by achieving optimal levels of the behavioral, societal, environmental, and biomedical determinants of health”

“The advancement of wellbeing”

O’Donnell, 1989 (28) “The science and art of helping people choose their lifestyles”

“... to move toward a state of optimal health”

Green & Kreuter, 1991 (7) “The combination of educational and environmental supports for actions and conditions of living”

... conducive to health”

Source and date Activities

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Processes

(underlying mechanisms)

Objectives

(instrumental outcomes) Goals

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2 Beyond process and outcome evaluation: a comprehensive approach for evaluating health promotion programmes

Louise Potvin, Slim Haddad and Katherine L. Frohlich

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3 What counts as evidence:

issues and debates

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WHO Regional Publications

European Series, No. 92

Evaluation in health promotion

Principles and perspectives

Evaluation in health promotion

Principles and perspectives

Edited by:

Irving Rootman, Michael Goodstadt, Brian Hyndman, David V. McQueen, Louise Potvin, Jane Springett and Erio Ziglio

WHO Regional Publications, European Series, No. 92

Acknowledgements

Abbreviations

Organizations

Specific studies and technical and other terms

Foreword

WHO European Working Group on Health Promotion Evaluation

Contributors

Contents

Part 1

Introduction and framework

Introduction to the book

Irving Rootman

WHO European Working Group on Health Promotion Evaluation

Process

Guiding principles

Limitations and strengths

Structure

References

1 A framework for health promotion evaluation

Irving Rootman, Michael Goodstadt, Louise Potvin and Jane Springett

What is health promotion?

Recent origins

Definitions

Practice

Conclusion

Meaning and practice of evaluation in health promotion

Fundamental issues and challenges

Social programming

Valuing

Knowledge construction

Knowledge use

Evaluation practice

Conclusions

A framework for the evaluation of health promotion initiatives

Step 1. Describing the programme

Step 2. Identifying the issues and questions

Step 3. Designing the data-collection process

Step 4. Collecting the data

Step 5. Analysing and interpreting the data

Step 6. Making recommendations

Step 7. Dissemination

Step 8. Taking action

References

Part 2

Perspectives

Introduction

Louise Potvin

References

2 Beyond process and outcome evaluation: a comprehensive approach for evaluating health promotion programmes

Louise Potvin, Slim Haddad and Katherine L. Frohlich

Programmes

Programmes as living systems

Programme–environment interactions

Programme components

Fig. 2.1. programme components and evaluation questions

Programme evolution

Fig. 2.2. Programme phases and evaluation questions

Evaluation questions

Analysing programme coherence

Box 2.1. The Kahnawake School Diabetes Prevention Project

Analysing programme achievements

Analysing programme relevance