'Dark logic': theorising the harmful consequences of public health interventions
'Dark logic': theorising the harmful consequences of public health interventions
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DOI：
10.1136/jech-2014-204671
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发表时间：
2015-01-01
影响因子：
6.3
通讯作者：
Cummins, Steven
中科院分区：
文献类型：
--
作者：
Bonell, Chris;Jamal, Farah;Cummins, Steven
虽然人们可能认为，涉及社会或行为干预而不是临床干预的大多数公共卫生方案不太可能是医源性的，但它们有时会造成严重伤害，这是公认的。然而，在评估公共卫生干预措施时，不良影响的评估仍然是一个被忽视的话题。在本文中，我们首先论证了评估公共卫生干预措施的重要性，不仅旨在检查潜在危害，而且还旨在检查可能构成这些危害的机制，以便在未来避免这些危害。其次，我们从经验上考察公共卫生干预措施评估方案是否检查有害结果和潜在机制，如果是，如何检查。第三，我们提出了一个新的评估过程，评估者可以开发“暗逻辑模型”来指导潜在危害和潜在机制的评估，其中包括：机构-结构相互作用的理论化；通过对等和反驳翻译，在类似的干预措施中建立比较理解；并与当地行为者协商，以确定机制可能如何偏离轨道，从而导致有害后果。我们参考了对青少年工作干预的评估，该干预出乎意料地增加了其旨在减少的少女怀孕率，并回顾性地应用我们提出的过程，以了解这可能如何加强评估。我们得出结论，暗逻辑模型的理论化对于防止危害的复制至关重要。它的目的不是取代，而是为经验评估提供信息。
Although it might be assumed that most public health programmes involving social or behavioural rather than clinical interventions are unlikely to be iatrogenic, it is well established that they can sometimes cause serious harms. However, the assessment of adverse effects remains a neglected topic in evaluations of public health interventions. In this paper, we first argue for the importance of evaluations of public health interventions not only aiming to examine potential harms but also the mechanisms that might underlie these harms so that they might be avoided in the future. Second, we examine empirically whether protocols for the evaluation of public health interventions do examine harmful outcomes and underlying mechanisms and, if so, how. Third, we suggest a new process by which evaluators might develop 'dark logic models' to guide the evaluation of potential harms and underlying mechanisms, which includes: theorisation of agency-structure interactions; building comparative understanding across similar interventions via reciprocal and refutational translation; and consultation with local actors to identify how mechanisms might be derailed, leading to harmful consequences. We refer to the evaluation of a youth work intervention which unexpectedly appeared to increase the rate of teenage pregnancy it was aiming to reduce, and apply our proposed process retrospectively to see how this might have strengthened the evaluation. We conclude that the theorisation of dark logic models is critical to prevent replication of harms. It is not intended to replace but rather to inform empirical evaluation.