Professional Documents
Culture Documents
Adapted from "Conducting intervention research: The design and development process" by Stephen B.
Fawcett et al.
WHAT IS AN INTERVENTION?
WHY SHOULD YOU DEVELOP INTERVENTIONS?
WHEN SHOULD YOU DEVELOP AN INTERVENTION?
HOW DO YOU DEVELOP AN INTERVENTION?
You've put together a group of motivated, savvy people, who really want to make a difference in the
community. Maybe you want to increase adults' physical activity and reduce risks for heart attacks; perhaps
you want kids to read more and do better in school. Whatever you want to do, the end is clear enough, but
the means--ah, the means are giving you nightmares. How do you reach that goal your group has set for
itself? What are the best things to do to achieve it?
Generally speaking, what you're thinking about is intervening in people's environments, making it easier and
more rewarding for people to change their behaviors. In the case of encouraging people's physical activity,
you might provide information about opportunities, increase access to opportunities, and enhance peer
support. Different ways to do this are called, sensibly enough, interventions. Comprehensive interventions
combine the various components needed to make a difference.
WHAT IS AN INTERVENTION?
But what exactly is an intervention? Well, what it is can vary. It might be a program, a change in policy, or
a certain practice that becomes popular. What is particularly important about interventions, however is what
they do. Interventions focus on people's behaviors, and how changes in the environment can support those
behaviors. For example, a group might have the goal of trying to stop men from raping women.
However, it's clearly not enough to broadcast messages saying, "You shouldn't commit a rape." And so,
interventions that are more successful attempt to improve the conditions that allow and encourage those
behaviors to occur. So interventions that might be used to stop rape include:
By designing and implementing interventions in a clear, systematic manner, you can improve the
health and well-being of your community and its residents.
Interventions promote understanding of the condition you are working on and its causes and
solutions. Simply put, when you do something well, people notice, and the word slowly spreads. In
fact, such an intervention can produce a domino effect, sparking others to understand the issue you are
working on and to work on it themselves.
For example, a grade school principal in the Midwest was struck by the amount of unsupervised free time
students had between three and six o'clock, when their parents got home from work. From visiting her own
mother in a nursing home, she knew, too, of the loneliness felt by many residents of such homes. So she
decided to try to lessen both problems by starting a "Caring Hearts" program. Students went to nursing
homes to see elders after school once or twice a week to visit, play games, and exchange stories.
Well, a reporter heard about the program, and did a feature article on it on the cover of the "Community
Life" section of the local newspaper. The response was tremendous. Parents from all across town wanted
their children involved, and similar programs were developed in several schools throughout the town.
To do what you are already doing better. Finally, learning to design an intervention properly is
important because you are probably doing it already. Most of us working to improve the health and
well-being of members of our community design (or at least run) programs, or try to change policies
such as local laws or school board regulations, or try to change the things some people regularly
practice. By better understanding the theories behind choosing, designing, and developing an
intervention, you will improve on the work you are currently doing.
There is a community issue or problem that local people and organizations perceive as an unfilled
need
Your organization has the resources, ability, and desire to fill that need, and
You have decided that your group is the appropriate one to accomplish it
The last of these three points deserves some explanation. There will always be things that your organization
could do, that quite probably should be left to other organizations or individuals. For example, a volunteer
crisis counseling center might find they have the ability to serve as a shelter for people needing a place to
stay for a few nights. However, doing so would strain their resources and take staff and volunteers away
from the primary mission of the agency.
In cases like this, where could does not equal should, your organization might want to think twice about
developing a new intervention that will take away from the mission.
You don't need to have answers to all of these questions at this point. In fact, it's probably better to keep an
open mind until you gather more information, including by talking with people who are affected (we'll get to
that in the next few steps ). But thinking about these questions will help orient you and get you geared in the
right direction.
USE A MEASUREMENT SYSTEM TO GATHER INFORMATION ABOUT
THE LEVEL OF THE PROBLEM
You will need to gather information about the level of the problem before you do anything to see if it is as
serious as it seems, and to establish a standard for later improvement (or worsening).
Measurement instruments include:
Direct observations of behavior. For example, you can watch whether merchants sell alcohol to
people under the age of 21.
Behavioral surveys. For example, the Youth Risk Behavior Survey of the U.S. Centers for Disease
Control and Prevention asks questions about drug use, unprotected sexual activity, and violence.
Interviews with key people. For example, you might ask about changes in programs, policies, and
practices that the group helped bring about.
Review of archival or existing records. For example, we might look at records of the rate of
adolescent pregnancy, unemployment, or children living in poverty.
The group might review the level of the problem over time to detect trends--is the problem getting better or
worse? It also might gather comparison information-- how are we doing compared to other, similar
communities?
DECIDE WHO THE INTERVENTION SHOULD HELP
In a childhood immunization program, your interventions would be aimed at helping children. Likewise, in a
program helping people to live independently, the intervention would try to help older adults or people with
disabilities. Your intervention might not be targeted at all, but be for the entire community. For example,
perhaps you are trying to increase the amount of policing to make local parks safer. This change of law
enforcement policy would affect people throughout the community.
Usually, interventions will target the people who will directly benefit from the intervention, but this isn't
always the case. For example, a program to try to increase the number of parents and guardians who bring in
their children for immunizations on time would benefit the children most directly. However, interventions
wouldn't target them, since children aren't the ones making the decision. Instead, the primary "targets of
change" for your interventions might be parents and health care professionals.
Before we go on, some brief definitions may be helpful. Targets of change are those people whose behavior
you are trying to change. As we saw above, these people may be--but are not always--the same people who
will benefit directly from the intervention. They often include others, such as public officials, who have the
power to make needed changes in the environment. Agents of change are those people who can help make
change occur. Examples might be local residents, community leaders, and policy makers. The "movers and
the shakers," they are the ones who can make things happen--and who you definitely want to contribute to
the solution.
INVOLVE POTENTIAL CLIENTS OR END USERS OF THE INTERVENTION
Once you have decided broadly what should happen and who it should happen with, you need to make sure
you have involved the people affected. Even if you think you know what they want--ask anyway. For your
intervention to be successful, you can't have too much feedback. Some of these folks will likely have a
perspective on the issue you hadn't even thought of.
Also, by asking for their help, the program becomes theirs. For example, by giving teachers and parents
input in designing a "school success" intervention, they take "ownership" for the program. They become
proud of it--which means they won't only use it, they?ll also support it and tell their friends, and word will
spread.
Again, for ideas on how to find and choose these people, the section mentioned above on targets and agents
of change may be helpful.
IDENTIFY THE ISSUES OR PROBLEMS YOU WILL ATTEMPT TO SOLVE
TOGETHER
There are a lot of ways in which you can talk with people affected about the information that interests you.
Some of the more common methods include:
Informal personal contact - just talking with people, and seeing what they have to say
Interviews
Focus groups
Community forums
Concerns surveys
When you are talking to people, try and get at the real issue--the one that is the underlying reason for what's
going on. It's often necessary to focus not on the problem itself, but on affecting the cause of the problem.
For example, if you want to reduce the number of people in your town who are homeless, you need to find
out why so many people in your town lack decent shelter: Do they lack the proper skills to get jobs? Is there
a large mentally ill population that isn't receiving the help it should? Your eventual intervention may address
deeper causes, seeming to have little to do with reducing homelessness directly, although that remains the
goal.
ANALYZE THESE PROBLEMS OR THE ISSUE TO BE ADDRESSED IN THE
INTERVENTION
Using the information you gathered in step five, you need to decide on answers to some important questions.
These will depend on your situation, but many of the following questions might be appropriate for your
purpose:
What factors put people at risk for (or protect them against) the problem or concern?
Whose behavior (or lack of behavior) caused the problem?
Whose behavior (or lack of behavior) maintains the problem?
For whom is the situation a problem?
What are the negative consequences for those directly affected?
What are the negative consequences for the community?
Who, if anyone, benefits from things being the way they are now?
How do they benefit?
Who should share the responsibility for solving the problem?
What behaviors need to change to consider the problem "solved"?
What conditions need to change to address the issue or problem?
How much change is necessary?
At what level(s) should the problem be addressed? Is it something that should be addressed by
individuals; by families working together; by local organizations or neighborhoods; or at the level of
the city, town, or broader environment?
Will you be able to make changes at the level(s) identified? This question includes technical
capability, ensuring you have enough money to do it, and that it is going to be politically possible.
See what local examples are available. What has worked in your community? How about in nearby
places? Can you figure out why it worked? If possible, talk to the people responsible for those
approaches, and try to understand why and how they did what they did.
Look for examples of what has been done in articles and studies in related fields. Sources might be
professional journals, such as the American Journal of Public Health, or even occasionally, general
news magazines. Also, look at interventions that have been done for related problems--perhaps they
can be adapted for use by your group. Information and awareness events, for example, tend to be
general in nature--you can do a similar event and change what it's for. A 5-K race might be planned, for
example, to raise awareness of and money for breast cancer, to protest environmental destruction, and
so on.
National conferences. If you can, attending national meetings or conferences on the problem or issue
you are trying to solve can give you excellent insight on some of the "best practices" that are out there.
A comprehensive intervention will choose components for each of these four categories. For example, a
youth mentoring program might choose the following components:
For providing information and skills training, a component might be recruitment of youth and
mentors
For enhancing support and reinforcement, a component might be arranging celebrations among
program participants
For modifying access and barriers, a component might be making it easier to volunteer
For monitoring and giving feedback, a component might be tracking the number of young people and
volunteers involved
Next, decide the specific elements that compose each of the components. These elements are the distinct
activities that will be done to implement the components.
For example, a comprehensive effort to prevent youth smoking might include public awareness and skills
training, restricting tobacco advertising, and modifying access to tobacco products. For the component of
trying to modify access, an element of this strategy might be to do 'stings' at convenience stores to see which
merchants are selling tobacco illegally to teens. Another element might be to give stiffer penalties to teens
who try to buy cigarettes, and to those merchants who sell.
DEVELOP AN ACTION PLAN TO CARRY OUT THE INTERVENTION
When you are developing your action plan, you will want it to answer the following questions:
IN SUMMARY
Designing an intervention, and doing it well, isn't necessarily an easy task. There are a lot of steps involved,
and a lot of work to be done, if you are going to do it well. But by systematically going through the process,
you are able to catch mistakes before they happen; you can stand on the shoulders of those who have done
this work before you and learn from their successes and failures.
Contributor
Jenette Nagy
Stephen B. Fawcett
Online Resources
Community Health Advisor from the Robert Wood Johnson Foundation is a helpful online tool with
detailed information about evidence-based polices and programs to reduce tobacco use and increase physical
activity in communities.
The Society for Community Research and Action serves many different disciplines that are involved in
strategies to improve communities. It hosts a general electronic discussion list as well as several by special
interest.
The U.S. Dept. of Housing and Urban Development features "Success Stories" and gives ideas for ways to
solve problems in your community.
The National Civic League provides a database of Success Stories.
The Pew Partnership for Civic Change offers several resources for promising solutions for building strong
communities.
The World Health Organization provides information on many types of interventions around the world.
Print Resources
Fawcett, S., Suarez, Y. Balcazar, F., White, G., Paine, A., Blanchard, K., & Embree, M. (1994). Conducting
intervention research: The design and development process. In J. Rothman & E. J. Thomas
(Eds.), Intervention research: Design and development for human service. (pp. 25-54). New York, NY:
Haworth Press.
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