Health Education Research, Vol. 16, No. 3, 383-384,
June 2001
© 2001 Oxford University Press
BOOK REVIEW |
Evaluating Health Promotion, Practice and Methods
Margaret Thorogood and Yolande Coombes (eds) Oxford University Press, Oxford, 2000174 pp. ISBN 0-19-263 169-1 (pb)
Primary Nurse, South Leeds Community Unit Day Hospital, Community & Mental Health Services,Leeds
Health promotion, as a `newly emerging discipline', is at the forefront of media attention and this book arrives at an opportune time. Morris' Foreword sets the tone for this highly interesting paperback—citing `a more rational comprehensive view of the potential for improving the people's health', Morris suggests that this shift in opinion has become evident since power in the UK moved from Major to Blair.
The promotion of health is viewed as being of paramount importance, and by adopting an honest approach this appraisal anticipates developments and improvements, despite potential—some might say inevitable—problems. Indeed Florin and Basham, in a later chapter, identify health professionals themselves as being part of the `problem'.
Thorogood and Coombes have divided their book into three distinct parts, and they have co-written the first and the final chapters, as well as contributing to others. The overview covers two chapters, methods of evaluation six and evaluation in practice the last five. Every chapter concludes with a boxed summary of key points. The editors argue on p. 3 that health promotion now requires `credible demonstrations of the value of its activity...and effectiveness...in order to sustain and expand'. By highlighting practical and theoretical issues they contribute to the debate.
Background history is well covered, where didactic concerns have been usurped by a growing acceptance that health should not be considered as a goal in itself, but as a condition that enables everyone to achieve their individual goals. The common aim, Thorogood and Coombes assert, is to enable people to have more control over their health. Inevitably clarity demands that evidence must be effectively evaluated, by the most appropriate methodology.
Having established some parameters, Berridge's chapter summarizes the wide historical understanding of how and why related policies have developed. As examples of 18th century thought, centrist politics, pauperism and `residuum' (a race of `degenerates') are discussed systematically (as separate entities). Never has the political agenda behind health issues been more clearly analysed, the 30-year rule on government records notwithstanding.
While accepting that health is indeed multi-dimensional, as we are reminded on p. 31, it is only fair to point out that occasionally, slightly clumsy sentences have slipped by the editing team, as in the paragraph that begins `Theory triangulational has tended to have been avoided. Related to this avoidance has been the avoidance of the fact that triangulation may yield contradictory finding' (p. 35).
Conversely, a double-blind trial is effectively explained 8 pages later, as the reader is led to consider the role of focus groups within the evaluation process. Branigan and Mitchell take the opportunity to remind us using such groups is not necessarily a quick, easy or cheap option. Data can take years to collect and collate, but at the other extreme politicians can attempt to gain the initiative by consulting focus groups, during whistle-stop tours, from open-topped, balloon-festooned buses.
Pressures within focus groups are itemized and the information is deftly handled, with a hint of humour, as might befit the subject matter. Seriousness returns when presentation of the evidence is considered—where great care is recommended.
The importance of the presentation of evidence is stressed and the discussion of the pressures that arise during research is deftly handled. There are instances of `group think', where hierarchies may be established when sensitive topics are discussed. Here the value of the skilled moderator's abilities are emphasized, along with the virtues of thorough editing—some service users are less articulate than others. Truisms abound—that `adequate training will be important to ensure reliable research' (p. 67) is undeniable. A case study of smoking cessation programmes is evaluated and the discussion encompasses financial matters. This fiscal examination looks at the economic evaluation by comparing CEA (cost-effectiveness), CUA (cost-utility) and CBA (cost-benefit) analyses. It is a particular strength of this book that the studies are suitably high profile within the NHS at the moment.
Similarly, when Stewart evaluates the Terrence Higgins-led CHAPS initiative (note should perhaps be made that the acronym originates from Community HIV/AIDS Prevention Strategy—a rare example of suitability). In using this example, the process of evaluation is covered with some expediency. Here, as in most chapters, diagrams are kept to understandable proportions and that clarity is echoed by the need to `move away from health promotion work performed by statutory agencies, with the restrictions placed on them, and to use voluntary organizations which are freer in the kinds of campaigns they could produce' (p. 89).
The concluding five chapters look at the issues of evaluations in practice settings. Wellings and Macdowall consider the role of mass media in the process, and the many obstacles to effective evaluation. This paradox that the act of encompassing a wide audience invariably makes feedback (or `surveillance') problematic as observed effects will be smaller and effects are more difficult to attribute to mass media intervention.
Thorogood and Coombes have gathered a group of contributors who are highly experienced researchers, and their assembled expertise offers both knowledge and reassurances. Aimed at graduate and postgraduate students of health promotion and public health, this paperback is able to entertain as well as inform. Practitioners in health promotion will find the points raised will generate discussions with other team members, whatever their specialism.
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