The spirit of the intervention: reflections on social effectiveness in public health intervention research

This paper suggests that public health intervention research would benefit from more thorough considerations of the social dynamics in which public health interventions are embedded. Rather than simply asking 'What works?', researchers should examine the social effectiveness of intervention programmes; i.e. (i) the creation of shared understandings among researchers and practitioners and (ii) the ways in which programmes reconfigure social relationships. Drawing on the theoretical work of philosopher Charles Taylor and sociologist Marcel Mauss, we suggest that the term 'the spirit of the intervention' may enable researchers to further articulate - and hence discuss - the source of an intervention's social effectiveness. The empirical impetus of the paper lies in our experiences as an interdisciplinary team of researchers, trained in social science and public health and now working within intervention research. We describe our attempts at reconciling the methodological requirements of an effect evaluation, modelled on the randomised clinical trial, with a process of intervention development grounded in ethnographic methods. In particular, we discuss how we have grappled with the schism between fidelity and adaptation, which is a key methodological issue in intervention research. While public health intervention research tends to conceptualise programmes as fixed and bounded entities, we argue that 'the spirit of the intervention' offers a conceptual starting point for reflections on programmes as on-going social processes. In order to capture and explore this dimension of public health interventions, a great deal of potential lies in a further engagement between intervention research, ethnographic methods and social theory.