Using theories of power and place to evaluate community health promotion

There is some consensus that better ways of evaluating complex public health programmes are needed as experimental methods are limited in explaining the 'how' and 'why' of change. Methods like 'theory-of-change,' 'realist evaluation,' and 'systems evaluation' try to give a more complete picture of change by looking at the context of the programme. However, when these methods are used to study programmes that aim to reduce health inequalities, they often miss a crucial issue: how power affects people's health and engagement with programmes. This paper addresses that gap by reporting an ethnographic study of a community health promotion programme that was informed by a social theory of power (figurational sociology). When looking at how power dynamics played out in the targeted community, we could see why residents often did not trust the people running the programme, and why local status was so important to them. When programme staff understood these power dynamics, they were better able to connect with residents and help them improve their wellbeing. We argue that combining this way of looking at power with our observational approach gives us a much clearer understanding of how complex public health programmes work and why they succeed or fail in their aims.