Methods for exploring implementation variation and local context within a cluster randomised community intervention trial

J Epidemiol Community Health. 2004 Sep;58(9):788-93. doi: 10.1136/jech.2003.014415.

Abstract

Insignificant or modest findings in intervention trials may be attributable to poorly designed or theorised interventions, poorly implemented interventions, or inadequate evaluation methods. The pre-existing context may also account for the effects observed. A combination of qualitative and quantitative methods is outlined that will permit the determination of how context level factors might modify intervention effectiveness, within a cluster randomised community intervention trial to promote the health of mothers with new babies. The methods include written and oral narratives, key informant interviews, impact logs, and inter-organisational network analyses. Context level factors, which may affect intervention uptake, success, and sustainability are the density of inter-organisational ties within communities at the start of the intervention, the centrality of the primary care agencies expected to take a lead with the intervention, the extent of context-level adaptation of the intervention, and the amount of local resources contributed by the participating agencies. Investigation of how intervention effects are modified by context is a new methodological frontier in community intervention trial research.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Community Health Services / organization & administration*
  • Female
  • Health Promotion / methods*
  • Health Services Research / methods*
  • Humans
  • Infant, Newborn
  • Maternal Health Services / organization & administration
  • Program Evaluation
  • Randomized Controlled Trials as Topic / methods*
  • Research Design