Background: The persistence of health inequalities within high-income societies such as the Netherlands indicates the importance of researching effective ways to reduce those inequalities. Multiple strategies for reducing health inequalities have been identified. Specifically targeting health-related behaviors among lower socioeconomic status groups is one of those strategies. All in all, it seems relatively clear what types of approaches in general lead to health-related behavior change. However, it is still unclear how these approaches, in interaction with context, trigger a specific desired change. In the Netherlands, the private funding organization, Fonds NutsOhra, funded 46 small-scale projects under the umbrella of the Healthy Futures Nearby program. The projects aim to reduce vulnerable families’ health deprivation by triggering lifestyle changes.
Objective: This study aimed to outline and justify the protocol for the overall evaluation of the program. The evaluation aimed to find out to what extent and how the small-scale projects and approaches within the program affect (or not) health-related behaviors and improve perceived health.
Methods: The approach to the overall evaluation of the 46 projects builds on a combination of 3 frequently used evaluation models; it is theory-based, realist informed, and uses a mixed methodology design. Methods include analysis of quantitative project data, document analysis, focus groups, and interviews. A study design has been drawn up that values and uses the multifaceted development of the projects and the influence this might have on implementation and project outcomes. Also, it respects the complex nature of the projects and is suited to studying health promotion mechanisms in depth. Finally, it optimizes the usage of all—quantitative and qualitative—project evaluation data available.
Results: This study protocol included the design of at least 4 different studies. The results will hence provide information on (1) building and defining theories of change in health promotion practice, (2) mechanisms at work in promotion of healthy behavior among vulnerable families, (3) what works and what does not in professionals’ practices in health promotion among those vulnerable groups, and (4) what works and what does not in health promotion projects with a participatory approach. In addition, data will be collected on the overall effectiveness of the 46 initiatives. Data collection started in 2016. Data analysis is currently underway, and the first results are expected to be submitted for publication in 2019.
Conclusions: This overall evaluation provides a unique opportunity. The diversity of projects allows for a study protocol that answers in greater depth questions of how specific health promotion approaches work while also elucidating their effectiveness in a more traditional way. Using a theory-based complexity-sensitive approach that is mainly realist informed, this study also provides an opportunity to see whether combining assumptions from different evaluation perspectives yields relevant information.