Social Medicine, AMC/UvA, PO Box 22660, Amsterdam 1100 DD, The Netherlands.
Health Promot Int. 2011 Mar;26(1):23-36. doi: 10.1093/heapro/daq045. Epub 2010 Aug 12.
Our objective was to evaluate whether the limited effectiveness of most community programs intended to prevent disease and promote health should be attributed to the quality of the conceptualization of their program theories. In a retrospective multiple case study we assessed the program theories of 16 community programs (cases) in the Netherlands (1990-2004). Methods were a document analysis, supplemented with member checks (insider information from representatives). We developed a community approach reference framework to guide us in reconstructing and evaluating the program theories. On the whole, programs did not clearly spell out the process theories (enabling the implementation of effective interventions), the program components (interventions) and/or the impact theories (describing pathways from interventions to ultimate effects). Program theories usually turned out to be neither specific nor entirely plausible (complete and valid). The limited effectiveness of most community programs should most probably be attributed to the limited conceptualization of program theories to begin with. Such a failure generally also precludes a thorough examination of the effectiveness of the community approach as such.
我们的目的在于评估大多数旨在预防疾病和促进健康的社区项目效果有限，是否应归因于其项目理论概念化的质量。在一项回顾性多案例研究中，我们评估了 16 个（2004 年）在荷兰开展的社区项目（案例）的项目理论。方法是文件分析，并辅以成员检查（代表的内部信息）。我们开发了一个社区方法参考框架，以指导我们对项目理论进行重构和评估。总体而言，项目并没有明确阐明过程理论（使有效的干预措施得以实施）、项目组成部分（干预措施）和/或影响理论（描述从干预措施到最终效果的途径）。项目理论通常既不具体也不完全合理（完整且有效）。大多数社区项目效果有限，很可能首先应归因于项目理论概念化的局限性。这种失败通常也排除了对社区方法本身有效性的彻底审查。
