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J Epidemiol Community Health 58:788-793 doi:10.1136/jech.2003.014415
  • Theory and methods

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

  1. Penelope Hawe1,
  2. Alan Shiell1,
  3. Therese Riley2,
  4. Lisa Gold2
  1. 1Department of Community Health Sciences, University of Calgary, Canada and School of Public Health, La Trobe University, Australia
  2. 2Centre for the Study of Mothers’ and Children’s Health, La Trobe University, Australia
  1. Correspondence to:
 Dr P Hawe
 Department of Community Health Sciences, University of Calgary, 3330 Hospital Drive NW, Calgary Alberta T2N 4N1, Canada; phaweucalgary.ca
  • Accepted 28 December 2003

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.

Footnotes

  • Conflicts of interest: none declared.