A critical realism approach to public health interventions that aim to prevent obesity in selected european countries

• Main Author: Kolovou, Vasiliki
• Format: Dissertation
• Language: English
• Published: ProQuest Dissertations & Theses 01-01-2015

The aim of this thesis is to understand the important components of a set of sustainable interventions to prevent obesity at the community level by using realistic evaluation, which draws on the philosophy of critical realism. From the application of a structured set of criteria based on critical realism, three interventions emerged, which were selected as the case studies of my thesis: the ‘Healthy Weight Communities’ project in Scotland, the ‘Bewegung als Investition in Gesundheit’ (Movement as Investment for Health) project in Germany, and the ‘Walking for Health’ project in England. Based on the key concepts of critical realism an interview topic guide was developed, which was tested by the help of the pilot project ‘Paideiatrofi’ in Greece. Key personnel involved in the organisation of each of the three selected interventions were identified and qualitative research and data analysis was carried out. The framework of critical realism and the application of the key concepts of realistic evaluation: ‘generative mechanisms’, ‘context’ and ‘outcomes’, enabled the disentangling of which mechanisms from each case study, were most related to outcomes and under which contexts. A number of common themes emerged from the analysis of the three interventions. Reflecting on these common themes, I connected them to a set of more abstract categories associated with the social structure, the human agency and the emergent outcomes with their distinguished properties. Critical realism and realistic evaluation provided a conceptual guide which allowed me to explain how the effects of the interventions were produced by the interplay between structural conditions and people as agents. The study of the contextual factors and of the generative mechanisms that enabled or constrained the production of certain outcomes, constituted a novel approach to explain how and why the selected interventions worked to prevent obesity.