Centre for Social Research in Health, University of New South Wales, Sydney, Australia; London School of Hygiene and Tropical Medicine, UK.
Centre for Social Research in Health, University of New South Wales, Sydney, Australia.
Soc Sci Med. 2019 Oct;238:112488. doi: 10.1016/j.socscimed.2019.112488. Epub 2019 Aug 10.
We outline a framework for conceptualising interventions in health as 'evidence-making interventions'. An evidence-making intervention (EMI) approach is distinct from a mainstream evidence-based intervention (EBI) approach in that it attends to health, evidence and intervention as matters of local knowledge-making practice. An EMI approach emphasises relational materiality and performativity, engaging with interventions, and their knowing, as matters-of-practice. Rather than concentrating on how 'evidenced interventions' are implemented 'into' given 'contexts' - as if evidence, intervention and context were stable and separate - an EMI approach focuses on the processes and practices through which 'evidence', 'intervention' and 'context' come to be. There are two strands to our analysis. First, we identify concepts to think-with in an EMI approach; and second, we illustrate their implications through case examples. We first reflect on developments in 'implementation science' to distinguish how an EMI approach thinks differently. We note a 'within-limits contingency' of implementation science in contrast to the 'open contingency' of an EMI approach. This helps notice the performativity of science and intervention as evidencing-making practices. We next conceptualise an EMI approach in relation to: 'objects and practices'; 'effects and events'; and 'concerns and care'. We position an EMI approach in relation to theories of 'relational materialism', arguing that this affords a more critical, as well as more careful, way of knowing and doing health intervention.
我们概述了一个将健康干预措施概念化为“证据生成干预措施”的框架。与主流的基于证据的干预措施（EBI）方法不同，证据生成干预措施（EMI）方法关注健康、证据和干预措施，将其视为地方性知识生成实践的问题。EMI 方法强调关系物质性和表现性，涉及干预措施及其知识，作为实践问题。它不是关注“有证据的干预措施”如何“融入”给定的“背景”，就好像证据、干预和背景是稳定和独立的，而是关注通过哪些过程和实践，“证据”、“干预”和“背景”才得以产生。我们的分析有两个方面。首先，我们确定了在 EMI 方法中可以思考的概念；其次，我们通过案例示例说明了它们的含义。我们首先反思“实施科学”的发展，以区分 EMI 方法的不同思考方式。我们注意到实施科学的“限制内偶然性”与 EMI 方法的“开放偶然性”形成对比。这有助于注意科学和干预措施的表现性，将其视为证据生成实践。接下来，我们将 EMI 方法与“对象和实践”、“效果和事件”以及“关注和关怀”相关联来进行概念化。我们将 EMI 方法置于“关系唯物主义”理论的背景下，认为这为了解和实施健康干预措施提供了一种更具批判性和更谨慎的方式。
