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Cited by 671Evaluation and Performance AssessmentPublic Health Policies and EducationCommunity Health and Development

Evaluating health promotion—progress, problems and solutions

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Nutbeam, D.·1998·Health Promotion International
DOI 10.1093/heapro/13.1.27
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Abstract

Several issues of current debate in health promotion evaluation are examined. These include the definition and measurement of relevant outcomes to health promotion, and the use of evaluation methodologies which assess both the outcome achieved and the process by which it is achieved. Considerable progress is being made in understanding the complexity of health promotion activity, and in the corresponding need for sophisticated measures and evaluation research designs which reflect this complexity. The more powerful forms of health promotion action are those which are long term, and least easily predicted, controlled and measured by conventional means. Against this, important and valued advances in knowledge and credibility have come from more tightly defined and controlled interventions, which have been evaluated through the application of more traditional experimental designs. This tension between ‘scientific rigour’ and the perceived advantages (in longterm effectiveness and maintenance) coming from the less-well-defined content and methods of community controlled programmes continues to pose technical problems in evaluation. It is important to foster and develop evaluation designs which combine the advantages of different research methodologies, quantitative with qualitative, in ways which are relevant to the stage of development of a programme. The use of a diverse range of data and information sources will generally provide more illuminating, relevant and sensitive evidence of effects than a single ‘definitive’ study. Evaluations have to be tailored to suit the activity and circumstances of individual programmes—no single methodology is right for all programmes.

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  • This tension between controlled experiments and more complex, community interventions is highlighted elsewhere in the literature, with no single methodology being advocated.

    “This tension between controlled experiments and more complex, community interventions is highlighted elsewhere in the literature, with no single methodology being advocated (Nutbeam, 1998; Domegan et al., 2016; Komro et al., 2016; Wong et al., 2017).”

    From Blue care: a systematic review of blue space interventions for health and wellbeing (2020) · cites this paper as Nutbeam, 1998

  • A tendency to focus on short-term outcomes is typical of health-based interventions in general.

    “but a tendency to focus on short-term outcomes is typical of health-based interventions in general (Nutbeam, 1998; Campbell et al., 2000).”

    From Blue care: a systematic review of blue space interventions for health and wellbeing (2020) · cites this paper as Nutbeam, 1998

    The ‘Measurement of outcomes in health promotion’ section distinguishes immediate from intermediate outcomes and says greater attention is needed to measure immediate effects. The ‘Health outcomes and definitions of success’ section describes attention to health outcomes, but neither section says that health-based interventions generally tend to focus on short-term outcomes. A search for short-term outcomes found no passage establishing that tendency. (LLM, conf=0.70)

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Research works printed but not linked: 12

  1. De Vellis, R. F., Alfieri, W. S. and Ahluwalia, G. (1995) The importance of careful measurement in health education research, theory and practice (Editorial). Health Education Research, 10, i±iv. [This edition of the journal (Vol. 10, No. 1) was a special issue on measurement in health education.]
  2. De Vries, H., Weijts, W., Dijkstra, M. and Kok, G. (1992) The utilisation of qualitative and quantitative data for health education program planning, implementation and evalua- tion: a spiral approach. Health Education Quarterly, 19, 101±115.
  3. Epstein, A. M. (1990) The outcomes movementÐwill it get us where we want to go? New England Journal of Medicine, 323, 266±270.
  4. Fisher, E. B (1995) The results of the COMMIT Trial. American Journal of Public Health, 85, 159±160.
  5. Kaplan, G. A., Pamuk, E. R., Lynch, J. W., et al. (1996) Inequality in income and mortality in the US: analysis of mortality and potential pathways. British Medical Journal, 312, 999±1003.
  6. Noack, H. (1988) Measuring health behaviour and health: towards new health promotion indicators (Editorial). Health Promotion, 3, 5±12. [This edition of the journal (Vol. 3, No. 1) was devoted to health promotion indicators.]
  7. Nutbeam, D., Macaskill, P., Smith, C., et al. (1993b) Evalua- tion of two school smoking education programs under normal classroom conditions. British Medical Journal, 306, 102±107.
  8. Perry, C. L., Murray, D. M. and Griffen, G. (1990) Evaluat- ing statewide dissemination of smoking prevention curri- cula: factors in teacher compliance. Journal of School Health, 60, 501±504.
  9. Rychetnik, L., Nutbeam, D. and Hawe, P. (1997) Lessons from a review of publications in health promotion journals 1989±94. Health Education Research, in press.
  10. Schwarz, R., Goodman, R. and Steckler, A. (1995) Policy advocacy interventions for health promotion and educa- tion: advancing the state of practice (Editorial). Health Education Quarterly, 22, 421±426.
  11. Steckler, A., McLeroy, K. R. and Goodman, R. M. (1992) Towards integrating qualitative and quantitative methods: an introduction (Editorial). Health Education Quarterly, 19, 1±8. [This edition of the journal (Vol. 19, No. 1) was devoted to examining issues concerning the use of qual- itative and quantitative research in health education.]
  12. Stone, E. (1994) Foreword to Special Supplement on the process evaluation in the multicenter Child and Adolescent Trial for Cardiovascular Health (CATCH). Health Educa- tion Quarterly, S2, S3±S4.

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Authors
Nutbeam, D.
Affiliations
The University of Sydney (AU)
Corresponding author
Nutbeam, D.
ORCID
Nutbeam, D.
Venue
Health Promotion International
Publisher
Oxford University Press (OUP)
Published
1998-01-01
Volume
13
Issue
1
Pages
27-44
ISSN
  • 0957-4824 (ISSN-L)
  • 1460-2245
DOI
10.1093/heapro/13.1.27
OpenAlex
W1988789415
Cited by
671
References
58
Citations by year
2026: 6 · 2025: 10 · 2024: 17 · 2023: 20 · 2022: 12 · 2021: 10 · 2020: 34 · 2019: 19 · 2018: 21 · 2017: 22 · 2016: 26 · 2015: 31 · 2014: 43 · 2013: 34 · 2012: 34
FWCI
31.15
Type
journal article
Language
en
Open access
Locations
Health Promotion International (publishedVersion)
Topics
  • Social Sciences › Decision Sciences › Management Science and Operations Research › Evaluation and Performance Assessment
  • Health Sciences › Health Professions › General Health Professions › Public Health Policies and Education
  • Health Sciences › Health Professions › General Health Professions › Community Health and Development
Keywords
health promotion evaluation, outcome measurement, process evaluation, community-controlled health services, long-term effectiveness, mixed methods evaluation, scientific rigor

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