1. Challenges in Providing Evidence for the Effectiveness of Health Promotion Irving Rootman, Professor Public Health Sciences University of Toronto

2. About Irv Rootman Chair of WHO- EURO Working Group on Health Promotion Evaluation Former Director, Centre for Health Promotion, University of Toronto

3. Sources for Presentation WHO-EURO Working Group on Health Promotion EvaluationWHO-EURO Working Group on Health Promotion Evaluation Centre for Health Promotion Program on the Effectiveness of Health PromotionCentre for Health Promotion Program on the Effectiveness of Health Promotion

4. The 51 st World Health Assembly Urged all Member States to: “adopt an evidence-based approach to health promotion”

5. Challenges of Evidence- Based Health Promotion Defining what it means Finding the relevant evidence Assessing the evidence Using the evidence appropriately Creating new evidence Sharing the evidence

6. Health Promotion “The process of enabling people to increase control over, and to improve, their health” (Ottawa Charter for Health Promotion)Ottawa Charter for Health Promotion)

7. What is “Evidence”? “Apparent, manifest, obvious, palpable, clear, plain” “Something that has occurred with certainty” “The product of observation” “The product of experiment”

8. Is Evidence an Appropriate Idea in Health Promotion?

9. Is Evidence an Appropriate Idea in Health Promotion? (Cont.)

10. Conclusion-Recommendations Evaluation Working Group The use of randomized control trials to evaluate health promotion initiatives is in most cases inappropriate, misleading and unnecessarily expensive Support the use of multiple methods Support further research into the development of appropriate approaches to evaluating health promotion initiatives

11. Conclusion-Recommendation Evaluation Working Group Health promotion initiatives should be evaluated in terms of their processes as well as their outcomes Ensure that a mixture of process and outcome information is used to evaluate all health promotion initiatives

12. What Is “Acceptable” Evidence in Health Promotion?

13. “We should assemble evidence of success using a kind of ‘judicial principle’ -- by which I mean providing evidence which would lead a jury to committing themselves to take action even when 100% proof is not available” (Tones, 1997)

14. How Do We Obtain the “Evidence” We Need? Creating new evidence Collating existing evidence

15. Scientific Rigor in Health Promotion Research “The process of systematically studying a phenomenon, using an appropriate design and methods for the problem, and often including the development and testing of theory” (Allison and Rootman, 1996)

16. Components of Scientific Rigor in Health Promotion Research Theoretically grounded Sound research design Ethically appropriate

17. Principles for Evaluation of Health Promotion Initiatives Participation Multiple methods Capacity-building Appropriateness

18. Principles for Evaluation of Health Promotion Initiatives Participation Multiple methods Capacity-building Appropriateness

19. Collating Evidence on Health Promotion Effectiveness Centre for Health Promotion U.S. Task Force on Community Preventive ServicesU.S. Task Force on Community Preventive Services Health Development Authority Cochrane Collaboration

20. Collating Evidence on H.P. Effectiveness (Cont.) International Union for Health Promotion and EducationInternational Union for Health Promotion and Education

21. Ways of Sharing Evidence on Health Promotion Effectiveness Learn to talk to our audiences

22. Ways of Sharing Evidence (Cont.) Package what we know properly Use appropriate media

23. Ways of Sharing Evidence (Cont.) Involve everyone

24. Using the Evidence Effectively To make the case To improve practice

25. Approaches to Improving Practice in Health Promotion Quality assurance

26. Approaches to Improving Practice in Health Promotion (Cont.) Best practices

27. Criteria re. best practices in HP initiatives 1. HP values, principles, goals, ethics 2. HP theory, concepts, beliefs, assumptions 3. Context 4. Evidence

28. Conclusion We face many challenges We are making progress We can progress faster if we work together

29. References Cited Allison, K. and Rootman, I., “Scientific Rigor and Community Participation in Health Promotion Research,” Health Promotion International,” 11:4, 333- 340, 1996. Davies, J. and Macdonald, G. Quality, Evidence and Effectiveness in Health Promotion, Routledge, 1998. Kahan, B., and Goodstadt, M., “Continuous Quality Improvement and Health Promotion, Health Promotion International, 14:1, 83-91, 1999. Kahan, B. and Goodstadt, M., “The Interactive Domain Model of Best Practices in Health Promotion,” Health Promotion Practice, 2:1, 43-67, 2001., Marmot, M.G., “Social Inequalities in Mortality,” In R.G. Wilkinson (ed.), Class and Health, London: Tavistock, 1986.