El Ansari W, Phillips C J, Hammick M
Public and Community Health Department, School of Health Care, Oxford Brookes University, Oxford, UK.
Health Soc Care Community. 2001 Jul;9(4):215-27. doi: 10.1046/j.0966-0410.2001.00299.x.
Despite the growing literature that collaboration is a 'good' thing, there are calls emphasising the need for evidence of its effectiveness. However, the nature of the evidence to assess effectiveness is less clear. This paper examines the components that contribute to the challenges that confront evidence on collaboration. It considers the differing interpretations that have been placed on evaluation and explores how ways of determining the outcomes of collaboration and the levels of outcome measurement to assess collaborative effectiveness are influenced by the multifactorial nature of the concept. Evidence on the impact of collaboration is influenced by the diversity of perspectives and conceptual facets, and difficulty in measurement of the notions involved. Other factors discussed are the choice of macro or micro evaluation, of proximal or distal indicators, of short and long-term effects, or of individual-level or collective community-level outcomes. The suitability of randomised controlled trials for the measurement of collaborative outcomes as well as the requirement of mixed methods evaluations are highlighted. An evaluation of five community partnerships in South Africa is employed as an example to link the evaluation concepts that are discussed to a real enquiry. If collaboration is to be successful in making a difference in the lives of people, then increasing the precision and context of appraising its effectiveness will reduce the nature of inconclusive evidence and is likely to improve the practice of partnerships, coalitions and joint working in health and social care.
尽管越来越多的文献表明合作是一件“好事”，但仍有人呼吁要强调其有效性的证据。然而，用于评估有效性的证据的性质却不太明确。本文探讨了导致合作证据面临挑战的各种因素。它考虑了对评估的不同解读，并探讨了合作结果的确定方式以及用于评估合作有效性的结果衡量水平是如何受到这一概念的多因素性质影响的。合作影响的证据受到观点和概念层面多样性以及所涉概念测量难度的影响。讨论的其他因素包括宏观或微观评估的选择、近端或远端指标的选择、短期和长期影响的选择，或个人层面或集体社区层面结果的选择。强调了随机对照试验在测量合作结果方面的适用性以及混合方法评估的要求。以南非五个社区伙伴关系的评估为例，将所讨论的评估概念与实际调查联系起来。如果合作要成功地改善人们的生活，那么提高评估其有效性的准确性和背景信息将减少证据的不确定性，并可能改善健康和社会护理领域的伙伴关系、联盟及联合工作的实践。
