Evaluation by Jackie Green, Jane South

By Jackie Green, Jane South

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Milburn et al. (1995), for example, note that the combination of methods is often pragmatic and unreflective, and insufficient attention is given to the actual way in which findings are combined. Achieving internal validity: triangulation and the judicial principle Notwithstanding the association between randomized trials and scientific rigour, we have argued that such experimental and quasi-experimental methods have little, if any, role in evaluating public health and health promotion interventions in view of their serious limitations in relation to their: 28 Principles • practical feasibility • tendency to focus on individual behaviour rather than macro-level determinants of health • ability to deal with complex interventions • ability to address the complexity of change • utility in informing policy and practice.

It can arise because the type of measurement used is insufficiently sensitive to detect change or because we are trying to measure the wrong thing. We will consider appropriate outcome indicators more fully in Chapter 3. However, it is worth noting here that experimental and quasi-experimental designs in public health frequently rely on epidemiological indicators such as changes in morbidity and mortality. This need not be the case, but the association reflects a common epistemology underpinning the selection of methods and outcome measures.

It requires a methodologically plural approach which combines methods traditionally associated with different epistemological positions. Notwithstanding widespread support for and adoption of this approach, there remain critics. For some, alternative epistemological positions reflect real differences in views about the nature of reality. For example Guba and Lincoln (1989: 17) argue that ‘no accommodation is possible between positivist and constructivist belief systems’. In contrast, while acknowledging the contribution of constructivist interpretations, Pawson and Tilley (1997: 23), arguing from a realist perspective, recognize that there are structures and institutional features which are ‘independent of the individual’s reasoning and desires’ which would therefore be open to other forms of inquiry.

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