Nakaima April, Sridharan Sanjeev, Gibson Rachael
The Evaluation Centre for Complex Health Interventions, Dalla Lana School of Public Health, University of Toronto, 155 College St Room 500, Toronto ON M5T 3M7, Canada.
Social Science Research Institute, University of Hawaii at Mānoa, United States.
Eval Program Plann. 2023 Apr;97:102259. doi: 10.1016/j.evalprogplan.2023.102259. Epub 2023 Feb 17.
This paper highlights how learnings from exploring assumptions can be strengthened by taking an evolutionary approach to theory building and analysis. We discuss theory-driven evaluation applied to a community-based intervention implemented by Dancing With Parkinson's in Toronto, Canada, targeting Parkinson's disease (PD), a neurodegenerative condition affecting movement. A major gap in the literature is understanding the mechanisms by which dance might make a difference in the daily lives of people living with PD. This study was an early exploratory evaluation to better understand mechanisms and short-term outcomes. Conventional thinking generally favors "permanent" over "transitory" changes, and "long-term" over "short-term" effects. Yet, for people living with degenerative conditions (and also people experiencing chronic pain and other chronic symptoms), transitory and short-term changes may be highly valued and welcomed relief. In order to study and link multiple longitudinal events to explore key linkages in the theory of change, we piloted the use of diaries, with brief entries filled out daily by participants. The aim was to better understand the short-term experiences of participants using their daily routines as a means of learning about potential mechanisms, what matters to participants, and to see if small effects could be observed on days when participants danced versus days when they did not dance and also longitudinally over several months. Our initial theoretical stance began with a view of dance as exercise and the well-established benefits of exercise; yet, we explored through the diary data collected, as well as client interviews and literature review, potential other mechanisms of dancing (such as group interaction, touch, stimulation by the music, and esthetics including "feeling lovely"). This paper does not develop a full, comprehensive theory of dance but moves towards a more comprehensive view that locates dance within the routine activities of participants' daily lives. We argue that given the challenges of evaluating complex interventions comprising multiple, interacting components, there is a need for an evolutionary learning process to understand heterogeneities in mechanisms -- what works for whom -- when faced with knowledge incompleteness in the theory of change.
本文强调了如何通过采用进化方法进行理论构建和分析，来强化从探索假设中获得的认识。我们讨论了理论驱动的评估，该评估应用于加拿大多伦多帕金森舞蹈症组织实施的一项基于社区的干预措施，该干预措施针对帕金森病（PD），这是一种影响运动的神经退行性疾病。文献中的一个主要空白是了解舞蹈可能对帕金森病患者日常生活产生影响的机制。本研究是一项早期探索性评估，旨在更好地理解相关机制和短期结果。传统思维通常更倾向于“永久性”变化而非“短暂性”变化，以及“长期”效应而非“短期”效应。然而，对于患有退行性疾病的人（以及经历慢性疼痛和其他慢性症状的人）来说，短暂性和短期变化可能是非常值得珍视且令人欣慰的缓解。为了研究并将多个纵向事件联系起来，以探索变革理论中的关键联系，我们试点使用了日记，参与者每天填写简短记录。目的是通过参与者的日常活动更好地了解他们的短期经历，以此作为了解潜在机制、对参与者重要事项的一种方式，并观察在参与者跳舞的日子与不跳舞的日子相比，以及在几个月的纵向过程中是否能观察到微小影响。我们最初的理论立场始于将舞蹈视为一种锻炼以及锻炼所带来的既定益处；然而，我们通过收集的日记数据、客户访谈以及文献综述，探索了舞蹈的其他潜在机制（如群体互动、触摸、音乐刺激以及包括“感觉愉悦”在内的美学因素）。本文并未构建一个完整、全面的舞蹈理论，而是朝着一个更全面的观点迈进，即将舞蹈置于参与者日常生活的常规活动之中。我们认为，鉴于评估包含多个相互作用成分的复杂干预措施存在挑战，在面对变革理论中的知识不完整性时，需要一个进化学习过程来理解机制中的异质性——什么对谁有效。
