Abstract
BackgroundSchools are key settings for health promotion (HP) but the development of suitable approaches for evaluating HP in schools is still a major topic of discussion. This article presents a research protocol of a program developed to evaluate HP. After reviewing HP evaluation issues, the various possible approaches are analyzed and the importance of a realistic evaluation framework and a mixed methods (MM) design are demonstrated.Methods/DesignThe design is based on a systemic approach to evaluation, taking into account the mechanisms, context and outcomes, as defined in realistic evaluation, adjusted to our own French context using an MM approach. The characteristics of the design are illustrated through the evaluation of a nationwide HP program in French primary schools designed to enhance children's social, emotional and physical health by improving teachers' HP practices and promoting a healthy school environment. An embedded MM design is used in which a qualitative data set plays a supportive, secondary role in a study based primarily on a different quantitative data set. The way the qualitative and quantitative approaches are combined through the entire evaluation framework is detailed.DiscussionThis study is a contribution towards the development of suitable approaches for evaluating HP programs in schools. The systemic approach of the evaluation carried out in this research is appropriate since it takes account of the limitations of traditional evaluation approaches and considers suggestions made by the HP research community.
Highlights
Schools are key settings for health promotion (HP) but the development of suitable approaches for evaluating HP in schools is still a major topic of discussion
This study is a contribution towards the development of suitable approaches for evaluating HP programs in schools
The systemic approach of the evaluation carried out in this research is appropriate since it takes account of the limitations of traditional evaluation approaches and considers suggestions made by the HP research community
Summary
Schools are key settings for health promotion (HP) but the development of suitable approaches for evaluating HP in schools is still a major topic of discussion. Evaluation in the field of HP has raised particular issues [5] These issues are illustrated by Merzel and D’Afflitti (2003) who conducted a systemic literature review of 32 community-based HP programs. They identified five main issues: (1) methodological issues including the choice of the unit of assignment and analysis (individuals, communities, etc) and design and sampling issues; (2) the influence of secular trends and the difficulty of separating the impact of HP programs from these trends; (3) smaller-than-expected effects, i.e. relatively small effects are to be expected from community-level programs; (4) limitations of the HP programs including their duration, insufficient tailoring to reflect local conditions and the difficulty for community-level programs to ensure sufficient community penetration; and (5) limitations of theory because of the complexity of conceptualizing the relationship between multiple interventions and multiple levels of influence which makes it difficult to develop integrated explanatory theories as well as testable models [6]
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