Community-based programmes have become an important strategy to enhance health and safety. These programmes have their roots in the North Karelia, Stanford Five City, Minnesota Heart Health, and Pawtucket Heart Health programmes, initiated in the 1970s and 1980s to reduce high community rates of cardiovascular disease. Since then, the belief that the community-based approach is beneficial appears to have become a deeply held conviction in public health. As noted by Cheadle and colleagues (1997, page 240), “It is almost an article of faith that locating programmes in the community and involving community members in planning, implementation, and evaluation can be an effective strategy for improving population health.”
However, despite the wide application of community-based health andsafety programmes during the last 30 years, there is a paucity of evaluations from which to obtain evidence regarding effectiveness of community-based health and safety programs. The present evidence from both the health promotion and injury prevention field is inconsistent, with many programmes demonstrating modest or no effects at all (Nilsen, 2006). This weak evidence has been attributed to a number of reasons, including insufficient resources, poorly implemented programmes, lack of programme reach, methodological difficulties in study design and analysis that lead to problems in demonstrating convincing results, and unrealistically high expectations of what can be achieved through these programmes (Gielen & Collins, 1993; Fisher, 1995; Feinleib, 1996; Fishbein, 1996; Klassen et al., 2000; Merzel & D’Afflitti, 2003; Nilsen, 2004; Hoffmeister & Mensink, 2004; Nilsen, 2005).
This paper examines whether there are shortcomings in the theoretical underpinning of the community-based approach that could explain the lack of strong evidence of the effectiveness of health and safety programmes. Drawing upon the literature, a theory is constructed by elucidating explicit and implicit assumptions of community-based programmes. The theory is then put to test by analysing the extent to which the assumptions are supported by empirical evidence and the extent to which the assumptions have been applied in community-based injury prevention practice.
Linköpings universitet , 2007. 28-45 p.