DEVELOPING METHODOLOGIES FOR EVALUATING COMMUNITY-WIDE HEALTH PROMOTION

There has been growing recognition that health promotion programs whic h target whole communities are more likely to be effective in changing health behaviour. However, studies evaluating the impact of community wide health promotion programs rarely use adequate methodology. Random ised control trials where multiple whole communities are randomly assi gned to control and intervention groups are optimum if evaluators hope to validly attribute changes in health behaviour to the intervention. However, such trials present a number of difficulties including cost and feasibility limitations and the evolving nature of statistical tec hniques. This paper proposes applying a fairly well-accepted phased ev aluation approach to the evaluation of community participation program s, using three defined phases. Phase I consists of small-scale studies to develop the measures and assess acceptability and feasibility of t he intervention; Phase 2 consists of studies in a small number of comm unities designed to trial the intervention in the real world; Phase 3 studies use an appropriate number of entire communities to provide val id evidence of efficacy of the intervention. It is suggested that crit eria be resolved to identify adequate studies at each stage and that a dvantages and limitations of Phase I and 2 studies be clearly identifi ed. The paper describes the major design, sampling and analysis consid erations for a Phase 3 study.