The spirit of the intervention: reflections on social effectiveness in public Health intervention research

This paper suggests that public health intervention research would benefit
from more thorough considerations of the social dynamics in which public
health interventions are embedded. Rather than simply asking ‘What works?’,
researchers should examine the social effectiveness of intervention
programmes; i.e. (i) the creation of shared understandings among researchers
and practitioners and (ii) the ways in which programmes reconfigure social
relationships. Drawing on the theoretical work of philosopher Charles Taylor
and sociologist Marcel Mauss, we suggest that the term ‘the spirit of the intervention’
may enable researchers to further articulate – and hence discuss – the
source of an intervention’s social effectiveness. The empirical impetus of the
paper lies in our experiences as an interdisciplinary team of researchers,
trained in social science and public health and now working within intervention
research. We describe our attempts at reconciling the methodological
requirements of an effect evaluation, modelled on the randomised clinical trial,
with a process of intervention development grounded in ethnographic methods.
In particular, we discuss how we have grappled with the schism between
fidelity and adaptation, which is a key methodological issue in intervention
research. While public health intervention research tends to conceptualise
programmes as fixed and bounded entities, we argue that ‘the spirit of the
intervention’ offers a conceptual starting point for reflections on programmes
as on-going social processes. In order to capture and explore this dimension
of public health interventions, a great deal of potential lies in a further
engagement between intervention research, ethnographic methods and social
theory.