Implications of the Results of Community Intervention Trials

Abstract

This paper examines the results of population-level interventions conducted in three settings: entire communities, worksites, and schools. Four major conclusions are discussed: (a) Directions for the next generation of community-based interventions include targeting multiple levels of influence; addressing social inequalities in disease risk; involving communities in program planning and implementation; incorporating approaches for "tailoring" interventions; and utilizing rigorous process evaluation. (b) In addition to randomized controlled trials, it is time to use the full range of research phases available, from hypothesis generation and methods development to dissemination research. (c) The public health research agenda may have contributed to observed secular trends by placing behavioral risk factors on the social and media agendas. (d ) The magnitude of the results of community intervention trials must be judged according to their potential public health or population-level effects. Small changes at the individual level may result in large benefits at the population level.

Increasing Use of Mammography Among Older, Rural African American Women: Results From a Community Trial

“…50,51 Small changes in behavior, however, may have a large impact when they are observed in a population, and clinical standards for effect sizes may not be appropriate in the case of population-based research. 52 In future population-based studies, detection of these small but important changes probably will require very large sample sizes.…”

A Historical Framework for Social Epidemiology

“…Environments place constraints on in dividual choice. Incorporating the social context into behavioral interventions has led to a whole new range of clinical trials that take advantage of communities, schools, and work sites to achieve behav ioral change (see Sorensen et al 1998 and Chapter 11).…”

Reducing unhealthy weight gain in children through community capacity-building: results of a quasi-experimental intervention program, Be Active Eat Well

“…[8][9][10] It is clear that innovative approaches that work and are flexible, effective, cost effective, equitable and sustainable are urgently needed, and comprehensive community-wide interventions hold promise as one such option. 6,7,[10][11][12] We are currently evaluating a capacity-building approach to community-wide interventions aimed at reducing childhood obesity in six controlled intervention demonstration projects in a broad range of contexts, age groups and ethnic groups across four countries (Australia, Fiji, Tonga and New Zealand). 13 It is rare that communities have sufficient resources or capacity to promote health, and therefore a process of capacity building is required.…”

“…This capacity-building approach provides the flexibility to account for local contexts of target age groups, ethnicities, socioeconomic backgrounds, rural/urban contexts and existing community activities. 10,11,16 The aim of this article is to report the results from the first of these demonstration projects, Be Active Eat Well (BAEW), which was situated in Colac, a town of about 11 000 inhabitants in rural Victoria, Australia. The primary outcomes were differences in the increases in anthropometry (weight, waist and body mass index (BMI)-z score) over time and the relationship between baseline indicators of children's household socioeconomic status and changes in children's anthropometry.…”