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social and political nature of public health

Identification of outcome information needed by important stakeholders

Given the social and political nature of public health, an appraisal of evidence should determine whether the outcome variables cover the interests of all the important stakeholders, not just those who conduct or appraise evaluative research.Important stakeholders include those with responsibility for implementation decisions as well as those affected by the intervention. Some of the latter may be in disenfranchised groups, and it is not always clear whose interests have been (or should be) considered in evaluative research. This recommendation is in keeping with a long tradition in the social sciences known as utilisation focusedevaluation.6

Identification of the appropriate range of outcomes that should be included in a piece of evaluative research is one part of a pre-evaluation procedure known as “evaluability assessment”.This was developed in the programme evaluation field more than two decades ago and has been popularised widely within health promotion.4 Evaluability assessment requires a priori agreement about the successful outcomes of an intervention from important stakeholders’ perspectives, including agreement on the types of evidence deemed to be adequate to reach a conclusion on the value of an intervention, and the questions to be asked in evaluating the intervention.