Institute for Health & Wellbeing, Leeds Metropolitan University, Leeds, UK.
Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK.
J Epidemiol Community Health. 2014 Jul;68(7):692-6. doi: 10.1136/jech-2013-203742. Epub 2014 Mar 26.
Community participation and leadership is a central tenet of public health policy and practice. Community engagement approaches are used in a variety of ways to facilitate participation, ranging from the more utilitarian, involving lay delivery of established health programmes, to more empowerment-oriented approaches. Evaluation methods within public health, adapted from clinical medicine, are most suited to evaluating community engagement as an 'intervention', in the utilitarian sense, focusing on the health impacts of professionally determined programmes. However, as communities are empowered and professional control is relinquished, it is likely to be harder to capture the full effects of an intervention and so the current evidence base is skewed away from knowledge about the utility of these approaches. The aim of this paper is to stimulate debate on the evaluation of community engagement. Building on current understandings of evaluation within complex systems, the paper argues that what is needed is a paradigm shift from viewing the involvement of communities as an errant form of public health action, to seeing communities as an essential part of the public health system. This means moving from evaluation being exclusively focused on the linear causal chain between the intervention and the target population, to seeking to build understanding of whether and how the lay contribution has impacted on the social determinants of health, including the system through which the intervention is delivered. The paper proposes some alternative principles for the evaluation of community engagement that reflect a broader conceptualisation of the lay contribution to public health.
社区参与和领导力是公共卫生政策和实践的核心原则。社区参与方法以多种方式被用于促进参与，从更实用的角度，涉及到由非专业人员提供既定的卫生计划，到更注重赋权的方法。公共卫生领域从临床医学中借鉴的评估方法最适合评估社区参与作为一种“干预”，从实用的角度出发，侧重于专业确定的方案对健康的影响。然而，随着社区获得权力和专业控制的放弃，捕捉干预的全部效果可能变得更加困难，因此当前的证据基础偏向于这些方法的实用性。本文旨在就社区参与的评估问题引发辩论。基于对复杂系统内评估的现有理解，本文认为，需要从将社区的参与视为公共卫生行动的一种偏差形式的范式转变，将社区视为公共卫生系统的重要组成部分。这意味着从评估完全集中在干预措施与目标人群之间的线性因果链，转变为寻求了解非专业人员的贡献是否以及如何影响健康的社会决定因素，包括干预措施实施的系统。本文提出了一些社区参与评估的替代原则，反映了对非专业人员对公共卫生贡献的更广泛概念化。
