Evidence based health promotion: recollections, reflections, and reconsiderations.

I mproving the evidence base of health promotion is high on the agenda of the international health promotion community and it is becoming increasingly apparent that evidence is needed by practitioners for effective health promotion interventions. It is generally accepted that with quality findings from intervention studies, practitioners can make better decisions to achieve effectiveness in their interventions. Moreover, without evidence of effective health promotion, it may be difficult to obtain policy support. Over the past few years, the debate on the concept or nature of evidence in health promotion effectiveness and its appraisal has focused on the design of a study and other related methodological issues such as validity of indicators, efficacy of the intervention, and context in which the intervention operates. To a great extent the quality of the evidence has been determined by using the hierarchical structure established by those working in evidence based medicine adopting a positivist paradigm.