Community Leaders: Adoption of Health Behavior Interventions

Definition: The absolute number, proportion, and representativeness of settings and intervention agents (people who deliver the program) who are willing to use a program.

Is it enough to evaluate the impact of interventions solely at the individual-level (i.e., reach and efficacy)?

Different settings (e.g., worksites, medical offices, schools, communities; governing agencies) and agents (e.g., teachers, physicians, health educators) can vary based on their available resources, level of expertise, and commitment to interventions. Because we want to design and deliver interventions that have a positive public health impact, it is critical to understand these differences.

Except for the absolute number of settings involved, researchers seldom report on adoption issues. As with reach, not having information about representativeness creates problems. Differences between sites or agents that participate and those who do not indicate different degrees of adoption.

As you compare results, consider resource availability, setting size or location, and the expertise of people who deliver the intervention.

Ways to increase adoption and have a greater positive impact

Choose your settings carefullly.
Where do you want to offer your program — in churches, worksites, or doctor’s offices? How many of such possible settings will be willing to participate and offer your program?
Provide different cost options.
Many organizations like to have a ”basic” or “economy” version. Other organizations feel it’s important to offer “only the best” or the ”luxury version.”
Allow for customization.
Customize as necessary, but don’t abandon the intervention’s critical elements that make the strategy most effective.

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Encourage flexible modules.
As much as possible, let people who deliver the program (agents) and participants start and stop the program as needed.

Don’t, for example, require five uninterrupted hours for an activity. Imagine that you want doctors and nurses to act as agents. It wouldn’t be cost effective for them to spend five uninterrupted hours delivering an intervention.

Spending five uninterrupted hours is also a barrier for participants. Think about how difficult it would be to participate on a typical work day. Likewise, most people won’t forego a vacation day to participate in a health behavior intervention.

Making modules easy to finish in a short amount of time increases the likelihood that people will participate. For example, you might need to make it an easy option for people who spend two hours each week at a community center.
Talk to people in settings who adopt your program and those who don’t.
Interview them or conduct focus groups. By some method, get feedback!

Examples of Adoption from recent literature:

An exemplar study for reporting on Adoption was by Lazovich, et al. In their evaluation of a dietary intervention conducted in primary care practices, they reported on participation at both the site level (6 of 22 clinics) and at the intervention agent level (39 of 193 family practice physicians). Unfortunately, the authors didn’t report whether the clinics and physicians who participated were representative of those they targeted.

The SPARK physical activity and fitness trial is another good example of the proportion component of adoption (Sallis et al., 1997). This study targeted elementary school students. Principals of 16 elementary schools were asked to participate. Twelve of the 16 schools were willing to participate. However, limited funding meant that only seven of the 12 were selected to participate. The authors did not test the representativeness of school resources, location, staff-to-student ratio, or other school-level variables, but they did document that they selected the seven smallest schools to participate. With this information you might conclude that the effects of the intervention could generalize to other small schools with similar resources. But, you would be less confident that effects of the intervention would be similar in larger schools.