ABSTRACT
There is a growing recognition that health policies, practices and processes require clear evidence about effectiveness. When resources are scarce and the potential exists for interventions to do harm as well as good, there is a strong ethical case for requiring that new policies should be evidence-based. But in areas such as health promotion there are real questions to be asked about what constitutes an appropriate evidence-base. Traditional approaches to evaluation that emphasise the primacy of experimental approaches are often, although not always, inappropriate for complex, community-based health promotion programmes (Gillies 1999; Speller et al. 1997; Green and Tones 1999). We take the pragmatic view that all research methods have their strengths and their weaknesses, and we agree with Chen (1997: 63) that ‘a method’s usefulness depends on the contextual circumstances surrounding the specific programme to be evaluated’. In our view, mixed methods and the careful triangulation of evidence offer the best way forward in learning about complex health promotion initiatives. From this perspective, theory-driven approaches to evaluation havemuch to offer. The aim of this paper is to outline the potential benefits of one particular approach to theory-based evaluation that was employed to generate learning about Health Action Zones in England.
