THEORY AND METHODS

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

Penelope Hawe¹, Alan Shiell¹, Therese Riley² and Lisa Gold²

¹ Department of Community Health Sciences, University of Calgary, Canada and School of Public Health, La Trobe University, Australia
² Centre for the Study of Mothers’ and Children’s Health, La Trobe University, Australia

Correspondence to:
Correspondence to:
Dr P Hawe
Department of Community Health Sciences, University of Calgary, 3330 Hospital Drive NW, Calgary Alberta T2N 4N1, Canada; phawe{at}ucalgary.ca

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.

Keywords: community intervention trial; context evaluation; complex interventions; implementation evaluation

Abbreviations: CDO, community development officer; PRISM, Program of Resources, Information and Support for Mothers

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