Abstract
In 2016, Brazil hosted the 22nd International Union for Health Promotion and Education World Conference (Robertson, 2017). Its delegates produced a document addressing the relationship between social determinants of health and the health promotion agenda, both in terms of political engagement and the production of valid knowledge concerning processes and consequences of interventions. The “Curitiba Statement” (Expo UNIMED, 2016, p. 3) makes several recommendations, including some for health professionals and researchers in the field, such as the adoption of interdisciplinary, intersectoral approaches, and “use evidence as an instrument for positive social change.”
This subject of evidence-based health promotion also appeared in Carter et al. (2011), who discussed what kind of evidence should inform health promotion practices. They question to what extent clinical epidemiology methods (such as randomized controlled trials) are suited to provide evidence for decisions that deal with cultural, social, and political variables, and they criticize the hierarchy between “levels of evidence” that favors the study of individual behavior via application of questionnaires to large samples of people. What counts as evidence, the authors argue, is based on values: “Values are also inherent in the generation and evaluation of evidence, although this is not always evident in the rhetoric of evidence-based practice” (p. 468). Here in Pedagogy in Health Promotion: The Scholarship of Teaching and Learning (PHP), in her article about the scholarship on teaching and learning in health promotion, Glanz (2017) observes how evidence-based knowledge that informs health policy and promotion initiatives ought to remain sensitive to community-based interventions and to local knowledge—for example, how to seek solutions to concrete problems or raising nuanced local questions that help shape research projects.
Sensitive to the interplay between theory and practice, the editors of PHP decided to publish a “best practices” section that disseminates what teachers, faculty, or instructors wish to share to the community of practitioners. As McBride and Kanekar (2015) observe in the journal’s first issue, To be scholarly, good teaching must also include assessment and evidence gathering, be informed not only by the latest ideas in the field but also by current ideas about teaching the field, and be open to peer collaboration and review. (p. 10)
The challenge remains of how to produce and integrate qualitative data in the debate of evidence-based health promotion, in order to produce “a science that is both compassionate and culturally sensitive,” in the words of the Curitiba Statement (Expo UNIMED, 2016). To Glanz (2017, p. 7), there are those “scholars who exemplify strategies for creating bridges between and among theory, research, practice, and teaching,” and given their contribution to mediate between different worlds she calls them “translational teachers.”
In attempting to match readers’ needs and to maintain editorial quality and our scholarly pursuits, the editorial board of PHP reviews manuscripts in order to prioritize those that demonstrate some level of evaluation, systematic study, and reflection. The rationale is that description and interpretation of the meaning of experiences are, to some extent, intrinsic to the very selection of situations to be presented in an academic journal. Even if “Descriptive Best Practices” do not claim to produce theory nor (dis)confirm hypothesis, its readers benefit from explicit statements about why a specific piece of experience was chosen to be described, or what does the situation in hand provoke in terms of reflection. It is nice to be inspired by one’s peers, stories, and insights about (“best”) teaching about health promotion interventions, but what does inspiring and useful material look like? In debating the issue of generalizability in qualitative research, Wolcott (1990) and Merriam (1995) argue that qualitative studies do not claim statistical representativeness of their samples, but they might foster theoretical insight: The readers infer the consequences of findings to their own context/situation, in case they observe analogies between the situation under study and their own.
It deserves emphasis here that the notion of positive deviance, that names phenomena with little prevalence, has inspired effective interventions based on the knowledge of community members that guide them to adopt some sort of protective behavior regarding health status. This approach targets a community’s assets for which Morgan, Ziglio, and Davis (2010) note “requires discovering uncommon positive examples” that are “costly to identify” (Marsh, Schroeder, Dearden, Sternin, & Sternin, 2004, p. 1178). Good descriptions may help us understand, for example, “the additional unintended benefits accrued by communities that have taken part in positive deviance programmes” (Marsh et al., 2004, p. 1178).
Good examples and best practices matter because humans do generalize based on stories they learn. But what are the characteristics of a good “story,” when we think about research methods and the production of valid knowledge? Let us think about the place and value of descriptions to new knowledge and theorizing. All descriptions are, to some extent, interpretations. The very selection of aspects in a given situation rests on an interpretation about how to depict the most important components of the situation. Several assumptions operate in the interpretation and selection of what is good or bad. Regarding the relationship between theory and practice, so important in health promotion, practitioners and researchers strive to build theory based on adequate description of (and reflection upon) practice and this has to continue, if not start, with the pedagogical approaches we use in the formation of the next generation of health promotion practitioners.
In his well-known article “Understanding and Validity in Qualitative Research,” Maxwell (1992) dissects the concept of validity in a way that places great value in the description of data. Maxwell reminds us “that not all possible accounts of some individual, situation, phenomenon, activity, text, institution, or program are equally useful, credible, or legitimate” (p. 282) and that a description that is not accurate will damage the interpretation and theorizing that follows. On the other hand, there might be more than one single valid description, since “as observers and interpreters of the world, we are inextricably part of it; there is no way for us to step outside our own experience to obtain some observer-independent account of what it is that we experience” (p. 283). Maxwell reflects on data gathering, questioning the relationship between one account and the circumstance that the account “claims to be about” (p. 283), given that, in qualitative research, data might be “a description at a very low level of inference and abstraction” (p. 284). In this sense, data are shaped by authors/researchers, in the process of selection and naming parts of a given phenomenon, but there is no way to include every single detail in a description: Some parts of the situation under examination will be omitted.
Moreover, language is a major factor in the accurate description of phenomena, even those that “pertain to physical and behavioral events that are in principle observable” (Maxwell, 1992, p. 286). Ambiguity or disagreement about the terms employed to describe the situation should be avoided, but the terms the author chooses to name components of the account will depend on the authors’ participation in the situation the account intends to describe. The so-called “primary descriptive validity” concerns the description of circumstances and actions that the author of the account experienced personally (observed, participated, etc.). On the other hand, there is the issue of “secondary descriptive validity,” which depends on inference the author makes based on phenomena that could have been observed but for some reason was not (Maxwell, 1992, p. 286).
In our Descriptive Best Practices section of the journal, when authors assess some practices as best, they apply some judgment of value on what is good or bad. They make meaning of the experience itself, and they often make meaning about the meaning others make about the same experience—what leads us to examine the interpretive validity of accounts that benefits from adopting unambiguous language and from placing value on participants’ explicit words and concepts. Nevertheless, “accounts of participants’ meanings are never a matter of direct access, but are always constructed by the researcher(s) on the basis of participants’ accounts and other evidence” (Maxwell, 1992, p. 290). A nonproblematic description acknowledges the meanings of the situation for those involved, using terms that those involved would agree in order to name aspects of “time, space, physical objects, behavior, and our perception of these” (Maxwell, 1992, p. 290).
Therefore, to enhance PHP manuscripts’ chances of being published, it is nice to be attentive to how other people’s perspectives are presented. For example, in education it is quite common to read descriptions of “innovations” that argue how students (or participants, in general) appreciated it, but one could question how the evidence to claim such a positive accomplishment was gathered: The distribution of some sort of questionnaire to those students/participants in the end of the activity may be based on good will, but still acknowledge the selection bias inherent in gathering opinions from those students (or participants) who are particularly motivated or close to the teacher.
Good descriptions and interpretations benefit from offering elements of context so that readers can do their own interpretations, as well as from the disclosure of those elements of authors’ assumptions and (implicit or explicit) theories. Also, quantity matters: How frequent or typical something is in a given context might be a major criterion for the shaping of the account, and informing the reader the data are derived from basic counting—“quasi-statistics” (Becker, 1970)—is a good idea. These simple quantitative data provide the reader elements to understand why the author has given emphasis on this or that component of the larger picture. Besides, resources employed, things that did not go so well, unexpected but meaningful aspects of the situation, and observations on possible biases given the authors’ position and interests are possible examples of self-critical and analytical competence, so important for “translational teachers” and health promotion practitioners.
As the editor and board members of PHP look at the types and quality of manuscripts submitted, we recognize the hard work and enthusiasm that authors show about their work. PHP is the first major comprehensive journal disseminating information about how we teach about how to conduct health promotion among populations. As this editorial explains, it is important to keep “The Scholarship of . . .” in the minds of prospective authors. With that hard work and enthusiasm we are looking well beyond a “one and done write up” of work. We look for the same rigor, synthesis, analysis, insight, and reflection that have come to be the hallmark of academic writing.