Creating a dialogue between the concepts of complexity paradigms and the pragmatic approaches proposed for evaluating complex interventions
Trois conceptions de la nature des programmes: implications pour l'évaluation de programmes complexes en santé publique
This article discusses three perspectives on the nature of programs to clarify the purposes of an evaluation. An empirical realist program design views programs as real objects that allow dysfunctional and problematic objects to be repaired. In that view, the purpose of the evaluation is to determine the efficacy of programs to solve problems. An idealist design views both programs and the problems they address as representations, which leads to evaluation intended to reconcile the players' representations.
Evaluating complex interventions requires an understanding of the program's logic of action. Logic analysis, a specific type of program theory evaluation based on scientific knowledge, can help identify either the critical conditions for achieving desired outcomes or alternative interventions for that purpose. In this article, we outline the principles of logic analysis and its roots. We then illustrate its use with an actual evaluation case. Finally, we discuss the advantages of conducting logic analysis prior to other types of evaluations.
The Realist approach suggests a way to grasp the complexity of social interventions, through questioning what works, for whom, and under what circumstances. We present here some challenges and discussion on the use of this methodological innovation, based on an analysis of our own experience and an examination of the scientific literature. Although the Realist approach seems The Canadian Journal of Program Evaluation Vol. 26 No.
L'évaluation des interventions complexes: Quelle peut être la contribution des approches configurationnelles?
This article shows the added value brought by configurational approaches in the field of evaluation of complex interventions. First, we analyze the work in the scientific literature that has addressed this issue to identify epistemological considerations. The first part shows our finding that the evaluation of complex interventions needs to go further in terms of theorization. We then explain how productive the configurational approach is in the theorization of evaluation. Third, we discuss methodological issues and the operationalization of this approach.
Theoretically, evaluation should help decision-makers address contemporary health system challenges. Paradoxically, the use of evaluation results by decision-makers remains poor, despite rapid development in the evaluation field. The level of use depends on the evaluator's ability to account for the complexity of health-care systems. The complex nature of an intervention often compels evaluators to adopt unconventional approaches to account for the roles of the players.