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Improving the evidence base of health promotion is high on the agenda of the international health promotion community and it is becoming increasingly apparent that evidence is needed by practitioners for effective health promotion interventions. It is generally accepted that with quality findings from intervention studies, practitioners can make better decisions to achieve effectiveness in their interventions. Moreover, without evidence of effective health promotion, it may be difficult to obtain policy support.
Over the past few years, the debate on the concept or nature of evidence in health promotion effectiveness and its appraisal has focused on the design of a study and other related methodological issues such as validity of indicators, efficacy of the intervention, and context in which the intervention operates.1–4 To a great extent the quality of the evidence has been determined by using the hierarchical structure established by those working in evidence based medicine5 adopting a positivist paradigm.
THE RULES OF THE NATURAL SCIENCES
To this end, emphasis has been placed on achieving the three rules of scientific inquiry: predictability, repeatability, and falsifiability, when determining the strength of evidence. These are based on widely recognised principles stemming from discussions in the philosophy of science. Predictability is said to be met when a properly implemented intervention will bring about an expected outcome, given that the key elements of the intervention and the cause-effect interaction among those elements are known. The elements of the intervention and the causal relations of those elements thus need to be specified. Repeatability, sometimes referred to as replicability, refers to universal application of the intervention, regardless of time and place. The intervention is therefore required to yield the same result wherever and whenever it is carried out. To be falsifiable, the intervention must be capable of being disproved as an effective intervention. Once implemented, the intervention is …