Assessing the evaluability of complex public health interventions: Five questions for researchers, funders and policymakers
Assessing the evaluability of complex public health interventions: Five questions for researchers, funders and policymakers
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评估复杂公共卫生干预措施的可评估性：研究人员、资助者和政策制定者面临的五个问题
DOI：
10.1136/jech.2011.143586.6
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发表时间：
2011
影响因子：
6.3
通讯作者：
Kathryn Wheeler
中科院分区：
文献类型：
--
作者：
David Ogilvie;Steven Cummins;M. Petticrew;Martin White;Andy Jones;Kathryn Wheeler
背景 改善公共卫生的政府政策和计划通常可以被视为复杂的干预措施，因为它们通常涉及在各种环境中灵活或有针对性地实施多种相互作用的活动，以实现人口行为改变和健康改善。然而，支持其制定和实施的证据往往很薄弱。对这种“知识差距”的认识导致人们一再呼吁对这些复杂的“自然实验”对健康的影响进行更多、更好的评估。原则上很少有人不同意评估性的“战斗号召”，但其实施引发了许多科学、实用和优先顺序问题，特别是在公共部门财政紧缩的环境下。目标 开发一种评估复杂公共卫生干预措施可评估性的方法，激发和组织研究人员、资助者和政策制定者之间的辩论，并帮助他们在干预措施内部和干预措施之间从最初概念发展到全面干预措施的推出过程中做出评估决策。方法 使用英国健康社区挑战基金（“健康城镇”）作为复杂干预计划的案例研究，并以该计划中的两种具体干预措施为例，我们本着布拉德福德山标准的精神提出了一组五个问题：（1）特定干预措施位于总体干预计划的演变流程图中的什么位置？ (2) 对这种干预措施的评价研究会对政策决策产生什么影响？ (3) 干预措施的假设影响的合理规模和分布是什么？ (4) 评价性研究的结果将如何为现有的科学证据增加价值？ (5) 在可用时间内评估干预措施是否可行？结果 使用“家庭健康中心”和“健康城市规划”的具体工作示例，我们展示了如何使用我们的方法来识别可能从任何可能的评估中产生的知识类型，考虑到回答这五个问题中每个问题的现有证据的强度，并支持根据所需知识类型对资源分配决策进行更系统的考虑。结论 我们的方法原则具有潜在的普适性，可以在其他复杂的公共卫生和更广泛的社会干预的背景下进行测试和完善。
Background Government policies and programmes to improve public health can often be regarded as complex interventions, in that they typically involve the flexible or tailored implementation of multiple interacting activities in a variety of settings to bring about population behaviour change and health improvement. However, evidence to support their development and implementation is often weak. Recognition of this ‘knowledge gap’ has led to repeated calls for more and better evaluation of the health impact of these complex ‘natural experiments’. Few may disagree in principle with the evaluative ‘call to arms’, but its implementation raises a number of scientific, practical and prioritisation issues, especially in a climate of public sector financial restraint. Objectives To develop an approach to appraising the evaluability of complex public health interventions, which stimulates and structures debate between researchers, funders and policymakers and helps them make decisions about evaluation within and between interventions as they evolve from initial concept to roll-out of full-scale intervention packages. Methods Using the Healthy Community Challenge Fund (‘Healthy Towns’) in England as a case study of a complex intervention programme, and worked examples of two specific interventions within that programme, we have developed a set of five questions in the spirit of the Bradford Hill criteria: (1) Where is a particular intervention situated in the evolutionary flowchart of an overall intervention programme? (2) What difference will an evaluative study of this intervention make to policy decisions? (3) What are the plausible sizes and distribution of the hypothesised impacts of the intervention? (4) How will the findings of an evaluative study add value to the existing body of scientific evidence? (5) Is it practicable to evaluate the intervention in the time available? Results Using the specific worked examples of ‘family health hubs’ and ‘healthy urban planning’, we show how our approach can be used to identify the types of knowledge that might be generated from any possible evaluation given the strength of evidence available in response to each of the five questions, and to support more systematic consideration of resource allocation decisions depending on the types of knowledge required. Conclusions The principles of our approach are potentially generalisable and could be tested and refined in the context of other complex public health and wider social interventions.
影响因子：
5.5
作者：
Sallis, James F.;Story, Mary;Lou, Deborah
通讯作者：
Lou, Deborah