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Table 6 Summary of data reported for modification of interventions during implementation (propositions seven and eight)

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

Operational Definition

Information Reported on Propositions

Illustrative Examples

Proposition seven: Adaptation to the contextual environment

Descriptions regarding the adjusting or tailoring of interventions to ongoing and unpredictable contextual changes, while maintaining theoretical underpinnings and integrity. Changes include such factors as: demographics, political priorities; organizational changes or priorities; economic environment; community events; network/coalition development, etc.

Authors described the importance of context and need for flexibility in intervention delivery

'Even when the framework of an intervention is well-defined...the actual implementation must be flexible enough to respond to changing community situations and to advantage of any fresh opportunities' [30: p.33]

 

Details regarding what modifications were made to initial intervention implementation plans were vague, most often reported as part of the discussion for findings

'Project leaders and staff immersed themselves in the community and among the people, where they developed and adjusted programme activities according to the available local options and circumstances' [30: p.33]

Proposition eight: Responsive to evaluation feedback

Descriptions regarding the collection and utilization of information about the process of intervention implementation, intervention outcomes (preliminary or later stage), or broader trends on risk factors or conditions, demographics, morbidity and mortality, etc.

Importance of process evaluation described as a tool for improving programs.

'Process evaluation '...is intended to identify features of a project which enhance or hinder its chances of success as the project develop' [38: p.14]

 

Some description of how interventions were guided in response to preliminary evaluative information and population trends

'The project field office is actively involved with many aspects relating to process and formative evaluations. The health behaviour surveys have questions about the person's exposure to various intervention activities, which provides immediate feedback. The health education materials and media campaigns rely heavily on the result of the monitoring' [30: p.71]

'The 1987 population survey found that the decrease in population cholesterol means had leveled off. Novel and intensified activities began in North Karelia and across the country, coinciding with new national cholesterol guidelines' [30: p.108]

 

Reporting on formative evaluation as post hoc activities in an attempt to explicate why expected outcomes were or were not achieved.

'There was suggestive evidence, however, that innovative modification in format could lead to renewed interest in contests' [35: p.204]