Opening the Black Box of Community-Based Injury Prevention Programmes : Towards Improved Understanding of Factors that Influence Programme Effectiveness

Despite wide application of community-based programmes to prevent injuries and promote health over the last 25 years, there is a paucity of evaluations from which to obtain evidence regarding the effectiveness and critical factors contributing to achieving effectiveness of these programmes. Research on community-based injury prevention programmes thus far has been driven by the question “does it work?” However, merely establishing whether a programme works or not provides insufficient information to generate new knowledge about these programmes. Many programme evaluations have been characterised as “black box” evaluations, with inadequate information about the intervening and contextual factors that mediate the relationship between the programme and its effects. Opening the black box is essential to developing the best evidence in relation to community-based programmes. Keeping the question “does it work?” in mind as a departure point, the seven studies of this thesis address different aspects of the questions “why does it work?” and “how does it work?” The aim is to aid in the understanding of factors that influence the operation and effectiveness of community-based injury prevention programmes. The findings from the studies support a number of conclusions with regard to the three research questions posed. There is limited evidence for the effectiveness of communitybased injury prevention programmes. Some of the problems of providing convincing evidence are due to the methodological difficulties of evaluating these programs. Contextual conditions and the amount of financial resources available to a programme are key factors associated with the effectiveness of community-based injury prevention programmes. There is inconclusive evidence regarding the importance of some of the socalled success factors described in the scientific literature for achieving effectiveness. While many programmes have access to locally collected injury data, they devote limited time to the analysis of this ssembled data. When selecting interventions, many programmes rely upon tuitive and subjective methods, e.g. discussions in networks, feedback from the general public, and experiences gained in their own work. This style of decision making is “experience-based” rather than evidence-based. The theoretical underpinning of the community-based approach has certain shortcomings, which could explain some of the difficulties in demonstrating effectiveness seen with many of these programmes. Programmes overwhelmingly define geographical units as communities. However, these entities can be highly heterogeneous and characterised by a weak sense of community, which can yield insufficient community member participation and intersectoral collaboration, as well as inadequate reach for many programmes. At the same time, none of the most plausible assumptions of the community-based approach appears to be fully or widely applied in programme practice. The implication is that many community-based programmes do not function at an optimum level