Erasmus School for Health Policy and Management, Erasmus University Rotterdam, Burgemeester Oudlaan 50, 3062 PA, Rotterdam, The Netherlands.
Amsterdam Public Health Institute, VU University, Amsterdam, The Netherlands.
Health Res Policy Syst. 2017 Nov 23;15(1):100. doi: 10.1186/s12961-017-0258-9.
In several countries, attempts are made to improve health promotion by centrally rating the effectiveness of health promotion interventions. The Dutch Effectiveness Rating System (ERS) for health promotion interventions is an improvement-oriented approach in which multi-disciplinary expert committees rate available health promotion interventions as 'theoretically sound', 'probably effective' or 'proven effective'. The aim of this study is to explore the functioning of the ERS and the perspective of researchers, policy-makers and practitioners regarding its contribution to improvement.
We interviewed 53 selected key informants from research, policy and practice in the Netherlands and observed the assessment of 12 interventions.
Between 2008 and 2012, a total of 94 interventions were submitted to the ERS, of which 23 were rejected, 58 were rated as 'theoretically sound', 10 were rated as 'probably effective' and 3 were rated as 'proven effective'. According to participants, the ERS was intended to facilitate both the improvement of available interventions and the improvement of health promotion in practice. While participants expected that describing and rating interventions promoted learning and enhanced the transferability of interventions, they were concerned that the ERS approach was not suitable for guiding intervention development and improving health promotion in practice. The expert committees that assessed the interventions struggled with a lack of norms for the relevance of effects and questions about how effects should be studied and rated. Health promotion practitioners were concerned that the ERS neglected the local adaptation of interventions and did not encourage the improvement of aspects like applicability and costs. Policy-makers and practitioners were worried that the lack of proven effectiveness legitimised cutbacks rather than learning and advancing health promotion.
While measuring and centrally rating the effectiveness of interventions can be beneficial, the evidence based-inspired ERS approach is too limited to guide both intervention development and the improvement of health promotion in practice. To better contribute to improving health promotion, a more reflexive and responsive guidance approach is required, namely one which stimulates the improvement of different intervention aspects, provides targeted recommendations to practitioners and provides feedback to those who develop and rate interventions.
在一些国家，尝试通过集中评估健康促进干预措施的效果来改善健康促进。荷兰健康促进干预措施效果评估系统（ERS）是一种以改进为导向的方法，其中多学科专家委员会将现有的健康促进干预措施评定为“理论上合理”、“可能有效”或“已证明有效”。本研究旨在探讨 ERS 的运作情况，以及研究人员、政策制定者和实践者对其促进改进的看法。
我们采访了来自荷兰研究、政策和实践领域的 53 名选定的关键知情者，并观察了对 12 项干预措施的评估。
在 2008 年至 2012 年期间，共有 94 项干预措施提交给 ERS，其中 23 项被拒绝，58 项被评定为“理论上合理”，10 项被评定为“可能有效”，3 项被评定为“已证明有效”。根据参与者的说法，ERS 旨在促进现有干预措施的改进和实践中健康促进的改进。虽然参与者期望描述和评估干预措施能促进学习并提高干预措施的可转移性，但他们担心 ERS 方法不适合指导干预措施的制定和改善实践中的健康促进。评估干预措施的专家委员会发现，缺乏关于效果相关性的规范，以及关于如何研究和评定效果的问题。健康促进从业者担心 ERS 忽略了干预措施的本土化调整，也不鼓励提高适用性和成本效益等方面。政策制定者和实践者担心缺乏已证明的有效性会使削减而非学习和推进健康促进合法化。
尽管衡量和集中评估干预措施的效果可能是有益的，但基于证据的 ERS 方法过于有限，无法同时指导干预措施的制定和实践中健康促进的改进。为了更好地促进健康促进，需要采用更具反思性和响应性的指导方法，即激发不同干预措施方面的改进，向实践者提供有针对性的建议，并向开发和评估干预措施的人员提供反馈。
