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Exploring the Intervention— Context Interface

A Case From a School-Based Nutrition Intervention

School of Psychoeducation, GRES (Groupe de Recherche Environnemental Scolaire), Université de Montréal, Québec, Canada, sherri.l.bisset{at}umontreal.ca, Centre de Recherche Léa-Roback sur les Inégalités Sociales de Santé de Montréal, Université de Montréal, Québec, Canada, CHSRF-CIHR Chair Community Approaches and Health Inequalities, Université de Montréal, Montréal, Québec, Canada, Département de Médecine Sociale et Préventive, Université de Montréal, Québec, Canada

Mark Daniel

Département de Médecine Sociale et Préventive, Université de Montréal, Québec, Canada, Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Axe Santé des Populations, Québec, Canada, School of Health Sciences, University of South Australia, Adelaide, Australia

Louise Potvin

Centre de Recherche Léa-Roback sur les Inégalités Sociales de Santé de Montréal, Université de Montréal, Québec, Canada, CHSRF-CIHR Chair Community Approaches and Health Inequalities, Université de Montréal, Montréal, Québec, Canada, Département de Médecine Sociale et Préventive, Université de Montréal, Québec, Canada

It has been acknowledged for several decades that programs interact with context. The nature of this interactivity, and how it defines a program, has not been adequately addressed. We view this lacuna as a function of the dominant theoretical perspectives guiding knowledge of program operations. We propose the actor-network theory (ANT) and its conceptual apparatus, the sociotechnical network, as suitable for guiding the acquisition of general knowledge on program operations. We tested this proposition with an instrumental case study of health professional practices during the implementation of a nutrition program into an elementary school setting. Data collection and analysis were guided by the ANT. Data were derived from semistructured interviews completed with six health professionals (nutritionists). Analysis procedures focused on the nutritionists’ collective representation of the microprocesses by which they aimed to build a sociotechnical network of alliances with educational stakeholders. Findings identified nutritionists as preoccupied with three overarching goals during the implementation of the nutrition program, whereby goals were found to take form interactively with the interests of the program participants (primarily students) and stakeholders (primarily teachers). Nutritionists strategically translated program components as a means of negotiating with participants and stakeholders. The findings of this study support the theoretical proposition that program implementation is a process of expanding a sociotechnical network. Beyond simply reaffirming that programs do indeed adapt to context, we interpret this adaptation through the lens of a social theory that suggests why and how adaptation is an inevitable component of program implementation.

Key Words: program implementation • school-based nutrition intervention • community health promotion • program evaluation

American Journal of Evaluation, Vol. 30, No. 4, 554-571 (2009)
DOI: 10.1177/1098214009349792


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