The how and why of community-based injury prevention: A conceptual and evaluation model

Abstract

Evaluations of community-based injury prevention interventions and programs thus far have been predominantly outcome-oriented, using quantitative data to demonstrate effectiveness, measured as injury rate reductions. Many of these evaluations have been characterised as “black box” evaluations, with inadequate information about the intervening and contextual factors that mediate the relationship between the program and its effects. This paper develops a model for evaluating community-based injury prevention programs which draws on ideas from theory-based evaluation, an approach to evaluation that has been advocated when the objective is not just to discover whether a program works, but to establish how and why it works. The purpose of this model is to offer a way of thinking about community-based injury prevention programs, as well as a structure and useful indicators for evaluating these programs. The model specifies the presumed causal chain of a multifaceted injury prevention programme, illustrating the causal assumptions linking six elements, from programme resources via delivery of and exposure to programme components to attitudinal effects, injury risk effects, and safety effects. In addition, the context may influence any or all steps of the pathway. The paper proposes a set of possible indicators relating to the elements. The description and measurement of the indicators require both quantitative and qualitative data.