Community Leaders: Efficacy/Effectiveness of Health Behavior Interventions

Definition: The impact of an intervention on important outcomes, including potential negative effects, quality of life, and economic outcomes.

Is efficacy important? Do we have information on negative or unintended consequences of interventions?

Efficacy and effectiveness reflect the success of an intervention when implemented according to intervention guidelines under optimal conditions or in real-world situations, respectively. It is critically important to determine the efficacy or effectiveness of a given intervention.

If an intervention is not minimally efficacious or effective, measuring its reach becomes moot. Within the RE-AIM framework, efficacy and effectiveness are measured at the individual level.

Recent reviews of the scientific literature concluded that potential quality of life or adverse outcomes are rarely included in study designs. When evaluating efficacy or effectiveness, it is important to document the possible negative or unintended consequences of the intervention on quality of life and related factors.

Incorporate more tailoring to individuals.
Let’s say that an intervention expects participants to walk briskly for 30 minutes on 5 days each week. If a woman wants to participate but is in a wheelchair, find a comparable activity that she can do.

For people who already exercise at a higher level than the initial recommendation, consider having them increase the frequency, duration, or intensity of their activity.

If you want participants to read material about the benefits of physical activity, but a man cannot see or read, provide him with an audio tape of the text.

Make it easy for staff members to implement the program.
Provide staff members with options for providing participants what they need. Have a list of suitable alternative activities. Be sure that all staff members, even if they have varying levels of skill and knowledge, can effectively deliver the intervention.

Use a “stepped care” approach.
Deliver the intervention in such a way that people gain basic knowledge and skills and then build upon that foundation to make greater gains. Have all members start with the simplest and least costly actions- like walking daily. Then for those for whom this is insufficient, add more intensive and more costly components to an overall program.

Realize that solving an algebraic equation is impossible without first learning to add, subtract, multiply, and divide. You can’t expect someone who has been sedentary for two decades to run a marathon by the end of the first week. Start with the basics and build upon them.