Methods for exploring implementation variation and local context within a cluster randomised community intervention trial
- 1Department of Community Health Sciences, University of Calgary, Canada and School of Public Health, La Trobe University, Australia
- 2Centre for the Study of Mothers’ and Children’s Health, La Trobe University, Australia
- Correspondence to: Dr P Hawe Department of Community Health Sciences, University of Calgary, 3330 Hospital Drive NW, Calgary Alberta T2N 4N1, Canada;
- Accepted 28 December 2003
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.
Conflicts of interest: none declared.