Cheryl Ford, MPH 2010
Health promotion can play a significant role in improving health at both local and population level and is an emerging profession within the health sector. Health promotion is perceived, however, to lack credibility in some quarters. As an emerging profession, it must establish an accepted evidence base if it is to successfully compete for limited resources and be seen as a credible entity. In practice, however, there are few robust evaluations that are methodologically sound and which contribute to this evidence base. This research explores the barriers to health promotion evaluation from practitioners’ perspectives. In-depth interviews were conducted with ten practitioners involved in chronic disease health promotion in Christchurch, New Zealand. Thematic analysis of the verbatim transcriptions revealed that many of the barriers to evaluation were related to the power dynamics arising from interprofessional relationships and the difficulties associated with establishing health promotion’s credibility. This research highlighted the paradox that although evidence of effectiveness of health promotion programmes is required, the necessary resources to establish this are often not available, especially for outcome evaluation. This makes establishing credibility problematic and is compounded by the controversy of what constitutes evidence. Health promoters work in a sector where the medical model is dominant and because health promotion is an emerging profession, it has little credibility or legitimacy. There is an increasing need to work collaboratively, often in intersectoral groups, which introduces challenges to evaluation. This study concludes that whilst the professionalisation of health promotion would improve the field’s credibility and address some of the challenges identified in this research, it could also introduce some detrimental aspects that would be at odds with health promotion’s practices and philosophies. Recommendations on ways of mitigating these barriers in the New Zealand context will be made.