[Qualitative research in evaluation of health promotion programs in the context of health and disease paradigms].
The authors analyse selected aspects of evaluation research in relation to the changing paradigms of health and disease. The process of change in the biomedical paradigm, gradually becoming the biopsychosocial (socioecological), holistic model, is discussed. A short description of the two paradigms is given, including a critique of the biomedical model of health and disease based on evidence from social science research. In particular the wide definition of evaluation and the effectiveness of evaluation studies in health promotion are discussed. Selected practical consequences of accepting the democratic role of evaluation are analysed. The significance of the formative aspects of evaluative procedures for creating, modifying and implementing health promotion programmes is discussed. Another issue included in this analysis is the problem of objectivity of evaluation studies and the status of the evaluator in relation to other persons involved in programme implementation. The effectiveness of evaluation studies in relation to the biomedical and biopsychosocial paradigms are discussed in the context of differences between quantitative and qualitative evaluation methods. More detailed discussion concerns qualitative evaluation using selected methods, in particular participatory observation and, to a lesser degree, individual and group interviews. The reasons for the relatively low popularity of qualitative evaluation studies in health promotion programmes, especially in the field, are analysed. Moreover, the relation between health promotion and prevention (the so-called problem prevention) in relation to the biopsychosocial paradigm is analysed; also a short reference is made to the issue of the changing status of the patient (from "object" to " subject" ) in contacts with medical institutions, in context of the changing image of health and disease.