Applying logics of change to the evaluation of community development in health promotion

Abstract

Evaluation of community-oriented health promotion programs require that professional evaluators clearly distinguish between exogenously and endogenously defined goals and definitions of ‘success’. Acknowledging the different dynamics which underpin community-led change and externally initiated health programs and interventions is essential to this task. It will be argued that the intersection of, and boundaries around, exogenous and endogenous change can best be understood and clarified through the application of ‘logics of rationality’, adapted from social theory. Community activity is characterised by what we have called ‘lifeworld rationality’ community-based health promotion interventions are characterised by ‘formal ratonality’. In addition, we suggest that the value dimensions (‘substantive rationality’) underpinning programs and interventions may be overlooked by policy makers, program planners and professional evaluators under pressure to demonstrate cost-effectiveness and efficiency. Key requirements for successful and appropriate evaluation of community-based programs which are sensitive to the needs and success criteria of communities include a shared understanding by the researchers, program sponsors and community actors of the nature of the changes sought. The co-production of health promotion standards and of indicators to judge the performance of the program or intervention by all stakeholders should be preferred over the trend for establishing community-controlled process evaluations to coexist alongside expert-controlled impact evaluations. It is argued that current approaches to standard setting and indicator development to judge the processes and impacts of interventions are inadequate and several principles for improving their content are given. A locally controlled ethnographic approach to evaluate endogenous community-led change is described in the hope that program planners and evaluators may become more sensitive and receptive to local knowledge. We suggest that engagement with what we have termed the ‘community story’ should be a fundamental requirement for the planning and evaluation of community health programs.