EMMIE and engineering: What works as evidence to improve decisions?

While written by a proponent of realism, this article argues in favour of a pragmatic approach to evaluation. It argues that multiple sources of evidence collected using diverse research methods can be useful in conducting informative evaluations of programmes, practices and policies. It argues in particular that methods, even if their assumptions appear incommensurable with one another, should be chosen to meet the evidence needs of decision-makers. These evidence needs are captured in the acronym, EMMIE, which refers to Effect size, Mechanism, Moderator (or context), Implementation and Economic impact. Finally the article questions evidence hierarchies that are inspired by clinical trials, and suggests instead that, notwithstanding the clear differences in the physical and social worlds, engineering may provide a superior model for evaluators to try to emulate. And engineering is, above all, a pragmatic field

Handwashing with soap - a new way to prevent ARIs?

impressed by the beneficial effects of water supply on child mortality, also discussed with some curiosity what came to be called the Mills–Reinicke phenomenon. By this they referred to the surprising fact that the reduction in child mortality accompanying improvements in water supply was greater than what could be accounted for by the fall in mortality caused by enteric, waterborne diseases. A satisfactory explanation was never found, but with the continuing decline in mortality caused by infectious disease and the passing of the decades, the question was forgotten. An unexpected explanation has now appeared and it results from recent work on handwashing. Ever since Semmelweiss documented the efficacy of handwashing in the prevention of puerperal fever in the nineteenth century (Semmelweiss 1983), this simpl