EVALUATION RESEARCH IN PUBLIC-HEALTH - BARRIERS TO THE PRODUCTION ANDDISSEMINATION OF OUTCOMES DATA

Health outcomes are becoming the currency of health care exchange, and a call for evidence dominates decision making at all levels. This dis cussion paper reviews methodological and sociopolitical barriers that impede the production and dissemination of outcome research in public health, with particular reference to nursing. Barriers to the producti on of high-quality research evidence include inaccessible graduate edu cation and inadequate research funding. Also, randomized controlled tr ials (the ideal design for interventions studies) are uniquely difficu lt to implement for public health services. Practical and ethical diff iculties arise in defining the intervention, implementing random alloc ation methods, selecting and measuring outcomes, and articulating adeq uate theoretical frameworks. When health care activity is defined as o utput, there is a tendency to exclude the ethical standing of preventi ve, supportive and communitarian functions. The production and interpr etation of research results must remain part of a social, political an d ethical debate, not a purely scientific one.