Why Do Evaluations of eHealth Programs Fail? An Alternative Set of Guiding Principles

Why Do Evaluations of eHealth Programs Fail? An Alternative Set of Guiding Principles
Much has been written about why electronic health (eHealth) initiatives fail. Less attention has been paid to why evaluations of such initiatives fail to deliver the insights expected of them. PLoS Medicine has published three papers offering a "robust" and "scientific" approach to eHealth evaluation. One recommended systematically addressing each part of a "chain of reasoning", at the centre of which was the program's goals. Another proposed a quasi-experimental step-wedge design, in which late adopters of eHealth innovations serve as controls for early adopters. Interestingly, the authors of the empirical study flagged by these authors as an exemplary illustration of the step-wedge design subsequently abandoned it in favour of a largely qualitative case study because they found it impossible to establish anything approaching a controlled experiment in the study's complex, dynamic, and heavily politicised context.

The approach to evaluation presented in the previous PLoS Medicine series rests on a set of assumptions that philosophers of science call "positivist": that there is an external reality that can be objectively measured; that phenomena such as "project goals", "outcomes", and "formative feedback" can be precisely and unambiguously defined; that facts and values are clearly distinguishable; and that generalisable statements about the relationship between input and output variables are possible.

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Citation: Greenhalgh T, Russell J (2010) Why Do Evaluations of eHealth Programs Fail? An Alternative Set of Guiding Principles. PLoS Med 7(11): e1000360. doi:10.1371/journal.pmed.1000360

Copyright: © 2010 Greenhalgh, Russell. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

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