Evidence-making interventions in health: A conceptual framing

Area of Science:

• Health Services Research
• Implementation Science
• Sociology of Science

Background:

• Current evidence-based intervention (EBI) approaches often treat evidence, intervention, and context as separate and stable entities.
• Implementation science, while advancing understanding, can maintain a 'within-limits contingency' that overlooks the performativity of scientific practices.

Purpose of the Study:

• To propose a novel framework for conceptualizing health interventions as 'evidence-making interventions' (EMIs).
• To differentiate the EMI approach from mainstream EBI and implementation science by emphasizing local knowledge-making practices.
• To explore the theoretical underpinnings and practical implications of the EMI approach.

Main Methods:

• Conceptual analysis of health interventions, contrasting EMI with EBI and implementation science.
• Identification of key concepts for the EMI approach, including relational materiality and performativity.
• Illustration of EMI concepts through case examples and theoretical positioning within relational materialism.

Main Results:

• The EMI approach conceptualizes health, evidence, and intervention as dynamic outcomes of local knowledge-making practices.
• EMI highlights 'open contingency' and the performativity inherent in scientific and intervention practices.
• Key EMI concepts include 'objects and practices,' 'effects and events,' and 'concerns and care.'

Conclusions:

• An EMI approach offers a more critical and careful method for understanding and enacting health interventions.
• This framework moves beyond the limitations of traditional implementation science by focusing on the generative processes of evidence and intervention.
• Relational materialism provides a theoretical basis for the EMI approach, enhancing its critical and practical dimensions.