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      Health promotion and the randomised controlled trial: a square peg in a round hole?

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      1 ,
      BMC Oral Health
      BioMed Central

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          Abstract

          In their paper published in BMC Oral Health in March, Barker and Horton present qualitative data which explored Latino parents' main concerns regarding accessing dental care for their pre-school children. In the radical discourse of health promotion the use of participant narratives is a first and essential step in community development interventions. While there is agreement regarding the development and implementation of health promotion, the means by which it is evaluated or the type of evaluation design used, is hotly debated. This commentary outlines the rationale of adopting a randomised controlled trial methodology, contrasts it with realistic evaluation and considers design evaluation in the light of the Medical Research Council's (MRC) guidance of 2000 and 2008. It is at this juncture that the commentary suggests that, despite the MRC's acknowledgement of the limitations of its 2000 guidance, there remains, in the 2008 guidance, an underlying insistence to use design evaluations which control for selection bias and confounding extraneous factors. For the evaluation of health promotion interventions it may remain a case of fitting a square peg into a round hole.

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          A planning framework for community empowerment goals within health promotion.

          Health promotion often comprises a tension between 'bottom-up' and 'top-down' programming. The former, more associated with concepts of community empowerment, begins on issues of concern to particular groups or individuals, and regards some improvement in their overall power or capacity as the important health outcome. The latter, more associated with disease prevention efforts, begins by seeking to involve particular groups or individuals in issues and activities largely defined by health agencies, and regards improvement in particular behaviours as the important health outcome. Community empowerment is viewed more instrumentally as a means to the end of health behaviour change. The tension between these two approaches is not unresolvable, but this requires a different orientation on the part of those responsible for planning more conventional, top-down programmes. This article presents a framework intended to assist planners, implementers and evaluators to systematically consider community empowerment goals within top-down health promotion programming. The framework 'unpacks' the tensions in health promotion at each stage of the more conventional, top-down programme cycle, by presenting a parallel 'empowerment' track. The framework also presents a new technology for the assessment and strategic planning of nine identified 'domains' that represent the organizational influences on the process of community empowerment. Future papers analyze the design of this assessment and planning methodology, and discuss the findings of its field-testing in rural communities in Fiji.
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            Understanding social inequalities in health.

            A prominent feature of health in all industrialized countries is the social gradient in health and disease. Many observers believe that this gradient is simply a matter of poor health for the disadvantaged and good health for everyone else, but this is an inadequate analysis. The Whitehall Study documented a social gradient in mortality rates, even among people who are not poor, and this pattern has been confirmed by data from the United States and elsewhere. The social gradient in health is influenced by such factors as social position; relative versus absolute deprivation; and control and social participation. To understand causality and generate policies to improve health, we must consider the relationship between social environment and health and especially the importance of early life experiences.
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              Doinggrounded theory: Issues and discussions

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                Author and article information

                Journal
                BMC Oral Health
                BMC Oral Health
                BioMed Central
                1472-6831
                2009
                5 January 2009
                : 9
                : 1
                Affiliations
                [1 ]Oral Health and Health Research Programme, Dental Health Services Research Unit, University of Dundee, MacKenzie Bld, Kirsty Semple Way, Dundee, DD2 BF4, UK
                Article
                1472-6831-9-1
                10.1186/1472-6831-9-1
                2631450
                19123942
                8929947a-679c-47a9-994a-267e8f39415c
                Copyright © 2009 Freeman; licensee BioMed Central Ltd.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 13 October 2008
                : 5 January 2009
                Categories
                Commentary

                Dentistry
                Dentistry

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