The need to promote healthy active ageing in
order to offset the impact of an ageing population
on national resources and ensure a high
quality of life in older age is well recognized. In
2001, the English Department of Health established
a national pre-retirement health initiative
involving the development of eight pilot
projects. A national evaluation using a ‘theories
of change’ approach embedded within a realistic
evaluation design was commissioned to draw
out the lessons from across the projects. In this
article we describe the methods used to identify
and test out the projects’ theories of change,
and the results obtained. The theories of change
identified revolved mainly around engaging
clients and empowering them to take action
through the provision of information. Two
projects also saw providing opportunities for
social interaction as a means to engaging and
empowering clients. Theory testing indicated
that health improvement services could be
effectively targeted at people in mid-life and
that service settings and style played an important
part in engagement. In particular contexts,combining free health checks with financial
advice was a significant motivator for engagement,
as was perceived health need in two
deprived areas. Gains in knowledge were also
important for empowerment in some contexts,
but validation of existing knowledge could be
more important in others. Opportunities to
engage in social activities were a potent mechanism
for empowerment amongst women living
in two deprived areas. Further work is required
to test these conclusions in other contexts, and
to ascertain how people from minority ethnic
groups and men, particularly those outside the
labour market, can be engaged in health
improvement initiatives.