Planning and Implementing Health Interventions : Extrapolated Theories of Health Education and Constructed Determinants of Risk-Taking

Sammanfattning: Health interventions are usually preceded by calculations of risks, i.e. ascribed or supposed problem(s). An initial series of meta-reviews (n=5+14) revealed that there is a lack of research that problematises the planning and implementation of educational health interventions, and that reviews in the area of health interventions overwhelmingly focus on effectiveness and outcomes. Based on this, two systematic reviews, a total of 42 peer-reviewed articles, describing educational sexual health interventions targeting youths, have been conducted. The aim of the initial meta-reviews (n=5+14) was to investigate how to improve search and analysis techniques and then in a first systematic review (n=21) to analyse how risk-taking adolescents, from Europe and North America, were ‘constructed’. A further aim was to extrapolate explicit and/or implicit theoretical premises and possible divergences among them. On the basis of the first analysis, methods were refined and a second review (sample n=21) from the same population was carried out. Results revealed that causal relations regarding risk were presented as operating non-mutually, as one-sided or as reciprocal causes between environmental, behavioural and personal determinants or antecedents. Normative descriptions of ascribed problems were shown as possibly legitimating interventions. Pedagogical strategies embraced more or less conscious use of pedagogical theories. Some articles, where an explicit theory was presented, were regarded as not convergent when comparing the explicit theory with tacit assumptions extrapolated from the text. Other texts combined different theories without any apparent reflection. The results of this study could contribute to improved review techniques, enhance quality assessment of empirical research and extend the review-approach by emphasising how theoretical premises are reflected on in the planning and implementation phases of health interventions. Results also offer an opportunity for reflecting on how risk-taking is constructed. A protocol of critical questions that ought to precede planning and implementing of health interventions is proposed.