7. Discusión
7.7. Manejo del dolor: tratamiento farmacológico
To introduce utilization-focused evaluation, Patton (1997) explains that the way in which: “… evaluations are used affects the spending of billions of dollars to fight problems of poverty, disease, ignorance, joblessness, mental anguish, crime, hunger, and inequality. The issue of use has emerged at the interface between science and action, between knowing and doing. (…) often the central problem, is getting people to apply what is already known. ”
(Patton 1997, p. 4) According to Patton (1997, pp. 20-22), a comprehensive framework should be in place first in which evaluation is developed and implemented and the focus placed on the use of the evaluation. This framework allows for decisions to be made in order to enhance the utility and actual use of an evaluation. Utilization- focused evaluation has its emphasis on the primary intended users of the evaluation who will get to take up the responsibility to apply its findings and implement its recommendations. These are meant to work closely with the evaluator who acts as a negotiator and facilitator in the process. Likewise, utilization-focused evaluation is open to any form of evaluation content, model, method, theory, or use. It assists the primary intended users in the selection of these to suit their specific situation. This means that situational responsiveness guides the interactive process between them and the evaluator. The intended users are more likely to own the evaluation process and the findings if they are actively involved in the process. The evaluator trains them in use of the findings, prepares the foundation for this use and reinforces the intended utility of the evaluation in each step.
Patton (ibid., pp. 382-384) also emphasizes that the selection of the primary intended users should be carefully and thoughtfully done ensuring that their varied and multiple interests of their project and of the evaluation are considered. Since no evaluation can meet all these needs, through negotiations priority of questions and issues should be set. It is important that
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the intended use of the findings is done based on deliberate and thoughtful choices. Primary uses of evaluation findings may include judging merit or worth (summative evaluation), improving a program (instrumental use) and generating knowledge and lessons learnt (conceptual and formative use). Process use of evaluation may include enhancing shared understandings, reinforcing interventions, supporting participant engagement and developing programs or organizations. It is important to note that uses can change and evolve with time as the program develops. For an evaluation to be useful, it must be designed and adapted for each specific situation since no blue print approaches work. The relative value of a particular utilization focus can only be judged in the context of a specific program and the interests of intended users. The situational factors such as community variables, organizational characteristics, the nature of the evaluation, evaluator credibility, political considerations, and resource constraints all affect use. The evaluator who takes an active-reactive and adaptive role works with the intended users to assess how various factors and conditions may affect the potential for use. Involving the intended users in decision-making in evaluation is one way of supporting their using the evaluation results. Through this it is possible to increase the relevance, understanding, and ownership of the evaluation leading to informed and appropriate use of the findings. The goal should be to facilitate for high quality participation of the intended users in evaluation as opposed to an increased level of participation. This is supported by having skilled group facilitators who will ensure this takes place. The quantity of group interaction time depends on the quality of the evaluation process. This high quality in participation contributes to high quality and useful evaluations. To this, Patton (1997) emphasizes:
“Many researchers worry that methodological rigor may be sacrificed if nonscientists collaborate in making methods decisions. But, decision makers want data that are useful and accurate. Validity and utility are interdependent. Threats to utility are as important to counter as threats to validity. Skilled evaluation facilitators can help nonscientists understand methodological issues so that they can judge for themselves the trade-offs involved in choosing among the strengths and weaknesses of design options and methods alternatives.”
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The role of evaluators cannot be underestimated when it comes to utilization of evaluation findings. Their credibility and integrity is also important to them since these factors are normally at risk. They therefore need to be active, reactive and adaptive in their role. This means that they should be active in facilitating the evaluation process in a professional way by giving their best judgments about appropriate evaluation focus and methods. As reactive facilitators they should listen attentively and respectively to the concerns of those they are working with in the evaluation process. They also need to be adaptive in selecting ways to design evaluations that incorporate the multiple and varying interests, including their own, while still maintaining the required evaluation standards of professional practice. The evaluators should ensure users are trained in the evaluation process as well as in the uses of evaluation. The training of stakeholders in evaluation methods and processes contributes to evaluation uses both in the short- and long-term. It is important to note that there are differences in reporting and dissemination of evaluation results. Both may be means to facilitate use but they should not be confused with such intended uses as making decision, improving programs, changing thinking, empowering participants, and generating knowledge. In addition, serious attention to use involves financial and time costs that cannot be underestimated. The benefits of these costs are manifested in greater use. Therefore these costs should be clearly included in evaluation proposals and budgets to ensure that utilization follow-up is not omitted due to lack of these resources.