Community Leaders: Implementation of Health Behavior Interventions

Definition: At the setting level, implementation refers to how consistently staff deliver the program as intended.

Ways to improve implementation of an intervention and to have a greater positive impact

Be sure that intervention protocols are clear and easy to follow.
If you are able to choose an intervention, be sure to choose one that fits well with your target audience, your setting, and your resources.
If the intervention has been chosen for you, be sure that you understand the protocols and can identify what components and protocols are critical to implementing the intervention successfully. If you don’t understand something, get help from the agency or organization that provides the intervention.

Automate part(s) of the program when useful or necessary.
Let’s say that you don’t have enough staff members capable of delivering the intervention according to its protocol or you have more participants than you can accommodate. You might have to be creative in how you deliver the intervention. If possible, helpful, and effective, use alternate methods of delivery.

For example, if providing a live presentation isn’t critical to the intervention’s effectiveness, consider using methods of delivery that participants can use with little or no assistance, such as an interactive CD, a multimedia presentation on a computer, or a video.
Monitor and provide staff with feedback and recognition for successful implementation.
Do we know the extent to which different parts of the program were delivered as intended?
Implementation is assessed by reporting on what percentage of process objectives was achieved (e.g., what proportion of pamphlets were distributed, how many class hours were taught, or prescribed phone calls completed). Very few studies report costs or specific staff time commitments associated with intervention implementation. This information is often very important for predicting if others will try a program.

Baranowski and colleagues rigorously documented implementation rates of the “Gimme 5 Fruit, Juice, and Vegetables for Fun and Health Trial.” The study’s participants were fourth and fifth grade students. The intervention involved the school and the students’ homes. Students received lessons at school and newsletters at home. The newsletters provided family activities and instructions for intervention at home.

At least once during the 6-week intervention, researchers observed every teacher to document whether they delivered the curriculum as intended. They also asked teachers to self-report. Researchers noted that only 51% and 46% of the curriculum activities were completed in the fourth and fifth grades, respectively. In contrast, teachers self-reported that delivery was 90%.
Resnicow, et al. (1997) also demonstrated the need to track implementation. Their self-help smoking cessation program included a telephone booster call. Of the 650 participants who received the intervention, only 31% received the booster call. People who received the call had a significantly higher abstinence rate than those in the control and those in the intervention who had not received the booster call. If the authors had not documented implementation, the results could have mistakenly been attributed to an ineffective intervention.