title: Maintaining evaluation designs in long term community based health promotion programmes: Heartbeat Wales case study.
abstract: OBJECTIVE
  To examine the difficulties of developing and maintaining outcome evaluation designs in long term, community based health promotion programmes.
  
  
  METHODS
  Semistructured interviews of health promotion managers.
  
  
  METHODS
  Wales and two reference health regions in England.
  
  
  METHODS
  Nine health promotion managers in Wales and 18 in England.
  
  
  RESULTS
  Information on selected heart health promotion activity undertaken or coordinated by health authorities from 1985-90 was collected. The Heartbeat Wales coronary heart disease prevention programme was set up in 1985, and a research and evaluation strategy was established to complement the intervention. A substantial increase in the budget occurred over the period. In the reference health regions in England this initiative was noted and rapidly taken up, thus compromising their use as control areas.
  
  
  CONCLUSIONS
  Information on large scale, community based health promotion programmes can disseminate quickly and interfere with classic intervention/evaluation control designs through contamination. Alternative experimental designs for assessing the effectiveness of long term intervention programmes need to be considered. These should not rely solely on the use of reference populations, but should balance the measurement of outcome with an assessment of the process of change in communities. The development and use of intervention exposure measures together with well structured and comprehensive process evaluation in both the intervention and reference areas is recommended.
authors.affiliation: Health Promotion Authority for Wales, Cardiff.
authors.forename: D
authors.initials: D
authors.lastname: Nutbeam
authors.forename: C
authors.initials: C
authors.lastname: Smith
authors.forename: S
authors.initials: S
authors.lastname: Murphy
authors.forename: J
authors.initials: J
authors.lastname: Catford
mesh_terms: D002318:Cardiovascular Diseases / Q000517:prevention & control*; D003142:Communication; D003153:Community Health Services; D004739:England; D006293:Health Promotion / Q000379:methods*; D006295:Health Resources; D006801:Humans; D015397:Program Evaluation / Q000379:methods*; D012107:Research Design; D012189:Retrospective Studies; D014852:Wales