Methods for exploring implementation variation and local context within a cluster randomised community intervention trial.
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.
Hawe
Penelope
P
Department of Community Health Sciences, University of Calgary, 3330 Hospital Drive NW, Calgary, Alberta T2N 4N1, Canada. phawe@ucalgary.ca
Shiell
Alan
A
Riley
Therese
T
Gold
Lisa
L
D003153:Community Health Services / Q000458:organization & administration*; D005260:Female; D006293:Health Promotion / Q000379:methods*; D006302:Health Services Research / Q000379:methods*; D006801:Humans; D007231:Infant, Newborn; D008427:Maternal Health Services / Q000458:organization & administration; D015397:Program Evaluation; D016032:Randomized Controlled Trials as Topic / Q000379:methods*; D012107:Research Design