Health Education Research, Vol. 17, No. 1, 133-134,
February 2002
© 2002 Oxford University Press
BOOK REVIEW |
Evidence-based Health Promotion
Elizabeth Perkins, Ina Simnett and Linda Wright (eds) John Wiley & Sons, Chichester, 1999 448 pp. ISBN 0 4719 7851 5
University of Glamorgan
The search for evidence of effectiveness of health promotion interventions has had a relatively short and concentrated history, but at least as long as the discipline itself, and continues unabated to this day. Articles on the subject have mushroomed in recent years, in all the appropriate periodicals and, in the last 5 years or so, whole text books on the subject have emerged.
The security of the evidence remains, however, a little illusory and so it is somewhat surprising that a book of some 430 pages has been published with the seductive title of Evidence-based Health Promotion. Not, you notice, the `search for', or `approaches to', or `methods for', but a much more categorical and emphatic title, which implies the search is over.
However, on closer inspection, the book isn't really about the evidence base for health promotion at all. It certainly does not cover the same ground as the recently published text on the evidence of health promotion effectiveness published by the IUHPE and recently reviewed by me in this journal. It is more an attempt to provide practitioners with a conceptual basis for the evidence debate with a peppering of case study examples of how other practitioners have evaluated local interventions.
This is a laudable idea and something I am sure many practitioners welcome, but the book only achieves this objective in parts. Many of the sections and chapters reflect the aim of the book, i.e. to `know and understand what being an evidence-based practitioner means', but many do not.
The book is divided into three parts or sections. Introducing all three parts is an excellent chapter by the three editors (all independent consultants) pointing out contemporary tensions within health promotion practice, but it creates a false impression of what is to come. They discuss imaginatively and analytically the possible tensions between evidence and practice, between evidence and values, and between evidence and inspiration or innovation.
The first part proper, supposedly covering theories and approaches for health promotion, kicks off with a useful summary on the role of theory in health promotion by Perkins. However, the other chapters, or sections as the Editors call them, rarely reflect this theme. Many, such as Rolls' `The challenge of evidence based practice', Warks' `Improving mental health in women with breast cancer' or Poulter's `Applying the evidence to work place catering', ignore theory altogether; other chapters such as Lawrences' are more appropriate.
The second part looks at evidence-based work in settings, but is largely confined to descriptive studies of interventions that had an element of evaluation tagged on. Some, such as Joyce's, whilst interesting, don't address evaluation at all and remain too brief to critique.
The final part, which is really to my mind the core of the book, looked more promising. Here we had contributions on `Gathering, assessing and using evidence'. Some of the chapters lived up to this promising subtitle. MacVicar's chapter on `Integrating research into nursing practice' is a useful guide that should alleviate concerns nurses might have in relation to research and evidence-based practice. However, Perkins's chapter on surviving literature searches remains at a fairly basic and slightly patronizing level for readers of this supposed level of book.
The quality of the contributions is therefore variable. Some like Batten's chapter on the usefulness of `The trans-theoretical model; profiling smoking in pregnancy' or Balding et al.'s chapter `From evidence to action using health behaviour surveys' offer a rigorous evaluation of the evidence they have collected concerning their area of interest. Other chapters, such as Harrison's `Social System intervention' or Moon's `Rationale of work in school settings', offer a perspective on particular aspects of health promotion, but don't really consider the arguments for and against evidence. Whilst some of these are addressed adequately by the editors both in the opening chapters and at the beginning of each section, the themes they explore rarely touch on some of the key issues discussed in current health promotion literature, i.e. on a suitable evidence base. Not only that, many of the chapters in each of the three parts to the book don't necessarily pick up on or reflect the editors introductory comments.
The book has some 16 chapters with a further 35 sections within them. Some of these sections are extremely short (3–4 pages) and offer little in terms of constructing an evidence base. However, it might be that since most of the sections and chapters are written by practitioners, the book will appeal to those practising public health at the local level.
The search for an appropriate and relevant evidence base for health promotion continues to occupy the minds of both practitioners and academics, and of course is of central importance to policy makers. Policy makers expect to be able to plan and develop programmes on the basis of sound and irrefutable evidence, but we all know this is rarely to be found, especially in health promotion. The evidence base for health promotion can be coloured by the values of those seeking it, and inevitably it will always be open to interpretation and judgement. This book offers a view of the evidence base that will be of use to practitioners, but it needs to be read in conjunction with other texts and articles to get a more rounded view on the whole debate in this vital area.
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