Exploring the conceptualization of program theories in Dutch community programs: a multiple case study

Our objective was to evaluate whether the limited effectiveness of most community programs intended to prevent disease and promote health should be attributed to the quality of the conceptualization of their program theories. In a retrospective multiple case study we assessed the program theories of 16 community programs (cases) in the Netherlands (1990-2004). Methods were a document analysis, supplemented with member checks (insider information from representatives). We developed a community approach reference framework to guide us in reconstructing and evaluating the program theories. On the whole, programs did not clearly spell out the process theories (enabling the implementation of effective interventions), the program components (interventions) and/or the impact theories (describing pathways from interventions to ultimate effects). Program theories usually turned out to be neither specific nor entirely plausible (complete and valid). The limited effectiveness of most community programs should most probably be attributed to the limited conceptualization of program theories to begin with. Such a failure generally also precludes a thorough examination of the effectiveness of the community approach as such.