Background In 2008 Department of Health commissioned nine the ‘Healthy Towns’ (HT) in England to implement and evaluate community-based environmental interventions to prevent obesity. Healthy Towns were encouraged to test whole-town approaches to tackling the obesogenic environment, which included ‘innovative’ interventions. This research examines the role evidence played in the development and implementation of the HT programme at the national and local level, and the stimulation of innovative interventions.
Methods Participants were purposively selected to represent successful HT bid and management teams and key national policy actors involved in the implementation of the HT programme and allocation of funds. During July and October 2010, twenty qualitative interviews with local programme stakeholders and national policy actors were conducted. The majority of interviews were face-to-face, with one conducted over the telephone. Interview transcripts were coded and thematically analysed. Initial analyses were guided by research questions regarding the nature and role of evidence in the development and implementation of the Healthy Towns programme and the capacity for evidence generation to inform future policy and practice.
Results Local anecdotal and observational evidence, rather than empirical evidence, was considered abundant and influential and was predominantly used to guide intervention development. While the programme was seen by stakeholders as an opportunity to pilot new and innovative approaches, the requirement to predict likely health impacts and adopt evidence-based practice was viewed as contradictory to this goal. These difficulties were exacerbated by political change and the impact of austerity measures during programme delivery. Overall stakeholders believed opportunities to add to the existing empirical evidence base were missed due to a lack of clarity and planning, particularly around timing, in local and national evaluations.
Discussion The development of innovative population-level programmes to tackle obesity is beset by tensions and contradictions. Because of fear of failure, a strong emphasis on relying on existing evidence based practice and producing positive outcomes may have impeded the opportunity to implement truly innovative programmes. As determinants of obesity are complex and multi-factorial, governments should be realistic about the likely effects of single interventions and allow for the formative piloting of innovative projects that are not necessarily driven by targets.
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