Strategy Solution

Matching intervention strategies to fit needs, objectives, and context is critical for the success of community change and improvement efforts.  Few community mobilization efforts have developed and implemented the kind of "upstream" environmental changes (e.g., social and policy influences) that can provide the necessary strength and penetration to effect population-level improvements (Merzel & D'Affliti, 2003).  For example, many substance abuse prevention partnerships in the 1990s gravitated toward "Red Ribbon" and other public information and awareness campaigns (despite no evidence that these information-provision strategies reduced alcohol or drug use); and these activities often occurred at the expense of more intensive social policy or regulation efforts to reduce access to alcohol and other drugs (Florin, Mitchell, & Stephenson, 1993; Kreuter, Lezin, & Young, 2000).  Yet, through assessment and strategic planning activities, other groups such as a Minnesota farm injury prevention coalition determined that farmers in their area first needed to understand and believe that farm injuries were not random acts of fate; accordingly, their public information interventions occurred simultaneously or sequentially with other strategies to change worker behaviors (Lexau et al., 1993).  Similarly, Project Northland, a community and school-based alcohol prevention study, targeted community and policy levels, and achieved significant reductions in alcohol and tobacco use among youth populations (Perry et al., 1996).  In addition, Project ASSIST and Tobacco Policy Options for Prevention reported reductions in smoking prevalence rates, suggesting that effectively implementing policy changes provided the basis for a health-promoting environment (Sorensen, Emmons, Hunt, & Johnston, 1998).

Adapting interventions to fit population and context also appears to be a critical factor related to effectiveness. Many interventions aim to target multiple levels for change such as individual, family, organizational, state policy.  This ecological approach is based on the idea that communities are made up of individuals who interact in a variety of social networks and within various contexts (Brownson, Baker, Leet, & Gillespie, 2003; Roussos & Fawcett, 2000).  In Project COMMIT, community planning boards and coalitions were involved in public education, media programs, policy changes, and other programmatic strategies for smoking prevention (Thompson, Corbett, Bracht, & Pechacek, 1993; Thompson, Wallack, Lichtenstein, & Pechacek, 1991).  Yet, standardized intervention and research protocols mandated program activities. The program had no impact on quit rates or the smoking behaviors of heavy smokers, the primary target population (COMMIT Research Group, 1995a, 1995b).  Herein, protocols may have constrained communities from adapting the program to meet local needs (Merzel & D'Affliti, 2003; Sorensen, Emmons, Hunt, & Johnston, 1998).  Similarly, in the absence of effects, community members criticized the South Carolina Heart to Heart Project for not tailoring physical activity programs to reach African Americans who represented 35% of the target population (Goodman, Wheeler, & Lee, 1995).

For more information about evidence-based programs, policies and practices, please consult the resources at the University of Kansas Community Tool Box for Prevention, or, at the Center for the Application of Prevention Technologies

 


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