Is reporting on interventions a weak link in understanding how and why they work? A preliminary exploration using community heart health exemplars

Barbara L Riley¹ , JoAnne MacDonald² , Omaima Mansi³ , Anita Kothari^*⁴ , Donna Kurtz^*⁵ , Linda I vonTettenborn^*⁶ and Nancy C Edwards²^,7

¹Centre for Behavioural Research and Program Evaluation, University of Waterloo, Waterloo, Ontario, Canada

²School of Nursing, University of Ottawa, Ottawa, Ontario, Canada

³School of Nursing, McGill University, Montreal, Quebec, Canada

⁴Bachelor of Health Sciences Program, University of Western Ontario, London, Ontario, Canada

⁵School of Nursing, University of British Columbia Okanagan, Kelowna, British Columbia, Canada

⁶Bachelor of Science in Nursing Program, Faculty of Health Sciences, Douglas College, New Westminster, British Columbia, Canada

⁷Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, Ontario, Canada

author email corresponding author email* Contributed equally

Implementation Science 2008, 3:27doi:10.1186/1748-5908-3-27


Published:	20 May 2008

Abstract

Background

The persistent gap between research and practice compromises the impact of multi-level and multi-strategy community health interventions. Part of the problem is a limited understanding of how and why interventions produce change in population health outcomes. Systematic investigation of these intervention processes across studies requires sufficient reporting about interventions. Guided by a set of best processes related to the design, implementation, and evaluation of community health interventions, this article presents preliminary findings of intervention reporting in the published literature using community heart health exemplars as case examples.

Methods

The process to assess intervention reporting involved three steps: selection of a sample of community health intervention studies and their publications; development of a data extraction tool; and data extraction from the publications. Publications from three well-resourced community heart health exemplars were included in the study: the North Karelia Project, the Minnesota Heart Health Program, and Heartbeat Wales.

Results

Results are organized according to six themes that reflect best intervention processes: integrating theory, creating synergy, achieving adequate implementation, creating enabling structures and conditions, modifying interventions during implementation, and facilitating sustainability. In the publications for the three heart health programs, reporting on the intervention processes was variable across studies and across processes.

Conclusion

Study findings suggest that limited reporting on intervention processes is a weak link in research on multiple intervention programs in community health. While it would be premature to generalize these results to other programs, important next steps will be to develop a standard tool to guide systematic reporting of multiple intervention programs, and to explore reasons for limited reporting on intervention processes. It is our contention that a shift to more inclusive reporting of intervention processes would help lead to a better understanding of successful or unsuccessful features of multi-strategy and multi-level interventions, and thereby improve the potential for effective practice and outcomes.