Developing an Intervention
Health interventions aim to address a health need or gap within a given population. Often, interventions are developed around three main criteria: the target (the entity on which the action is carried out), the action (a deed done by an actor to a target), and the means (the processes and methods by which the action is carried out).
According to the Canadian Institutes of Health Research:
“Population health interventions are policies, programs, and resource distribution approaches that impact a number of people by changing the underlying conditions of risk and reducing health inequities.”
DEVELOPING AN INTERVENTION
Planning a health intervention involves a sequence of steps to ensure that the intervention is sustainable over time, is ethical, and effective.
Learn about each stage of prevention.
STEP 1
Step 1: Identify and Assess the Level of the Problem
The first step in developing an intervention is identifying and assessing the level of the problem. This can be done using a needs assessment. Common needs assessments include questions such as:
* What is the extent of the problem (including quantifying the difference in the selected population compared to a population that has the “target state”)?
* What are potential root causes for the health problem (often choosing one root cause to focus on
when planning the intervention)?
* What are barriers and enablers to addressing the root cause through intervention?
STEP 2
Step 2: Develop a Solution to the Problem
After identification and assessment of the problem, a solution is developed. Solutions can be built upon existing interventions and/or best practices.
STEP 3
Step 3: Describe the Action Plan for the Intervention
This step involves determining the details of the implementation of the proposed solution. Questions that are addressed at this stage include:
* What specific change or aspect of the intervention will occur?
* Which groups will benefit from this intervention?
* Who will carry it out?
* When will the intervention be implemented? How long it will be maintained?
* What resources (money, staff) are needed? What resources are available?
* What is the feasibility of the plan?
STEP 4
Step 4: Assess the Potential Impact
Once the action plan has been described, the potential impact must be assessed. Questions asked in this step include:
* What are the intended and unintended outcomes of this intervention?
* How will ‘success’ be measured?
* Will the impact be positive or negative?
FROM THEORY TO PRACTICE
- Many interventions are built upon existing evidence to ensure that the intervention is not only warranted but that it is well-founded based on best practices. However, despite rigorous planning that occurs in developing an intervention, it is important to understand that once implemented in reality, the intervention might not always be as effective as anticipated.
- Therefore, it is important for researchers to investigate any intended (planned outcomes) or unintended (unplanned) consequences of their proposed intervention plan.
IS THERE A QUATERNARY PREVENTION?
- The idea of an additional quaternary prevention was initially proposed by Marc Jamoulle in 2015, and it relates to the “primum non nocere” principle of medical ethics. Quaternary prevention is defined as “action taken to identify patients at risk of overmedicalization, to protect them from new medical invasion, and to suggest to them interventions which are ethically acceptable”.
- This type of prevention is important so that doctors are conscious of the harm they may cause to their patients, even unintentionally. One relevant example involves the current opioid crisis, which was initially caused by the overprescription of opioids for patients with chronic pain. The opioid crisis has historically burdened marginalized and racialized people disproportionately, including Indigenous people.
Primum non nocere
Latin term that translates to “first, do no harm”
COMMUNITY INPUT IN NEEDS ASSESSMENT
- Recall that the first step in developing an intervention is to identify the problem in a community. Conducting a needs assessment of the community is the most critical component of this step. It informs health promoters of the most pressing needs within a community, as described by its own members, and it also ensures that the intervention being planned is aligned with the needs that are perceived by the community.
- One of the biggest benefits of involving community members throughout this process is a higher likelihood that the community will support the process and engage with the intervention, resulting in improved chances of a successful intervention
CASE STUDY: THE IMPORTANCE OF CONSULTATION AND PARTICIPATION
As you have just learned, community participation and input during a needs assessment is central to the success of an intervention. However, if this step is not taken into consideration, the intervention might be unsuccessful at best, and at worst, have unintended consequences in the community.
Read an excerpt from a TED talk by Ernesto Sirolli who describes his experience planning an intervention for a local community in Zambia.
“We arrived in Zambia, and we taught the local people how to grow vegetables. We were amazed that the local people, in such a fertile valley, would not have any agriculture. But instead of asking them how come they were not growing anything, we simply said, “thank God we’re here. Just in time to save them from starvation”. We were telling them, “look how easy agriculture is”. When the tomatoes were ripe, overnight, some 200 hippos came out from the river and ate everything. And we said to the Zambians, ‘my God, the hippos!’. And the Zambians said, ‘yes, that’s why we have no agriculture here’. So we exclaimed, ‘why didn’t you tell us?’, and they replied with, ‘you never asked’.”
What did Ernesto Sirolli and their team do wrong, and what could have they done differently to
ensure the success of their health intervention?
Dr. Carpenter’s Response:
In this situation, Ernesto Sirolli’s team approached the Zambian people with a paternalistic and patronizing attitude, which hindered their ability to learn and work in collaboration with them. They didn’t stop to seek the community’s approval and attitudes towards the intervention they were about to implement.
Additionally, Sirolli’s team could have consulted with the local community to understand what their needs really were, and how they could enable them to take control over their situation and further meet those needs.
VIDEO: CURATING AN INTERVENTION
- Successful interventions are often the result of effective collaboration between people, departments, and disciplines. Molly Flindall-Hanna is an Occupational Therapist who graduated from Queen’s University. She has worked on many interventions that support Indigenous families who have children under the age of six, living with complex needs.
- The majority of these children live in foster care as a direct result of complex family situations, history of colonization, and a lack of culturally safe practices in health care and social services. When creating interventions that support these children and families, it is critical to include a sense of cultural safety and awareness
PROBLEMATIC ATTITUDES WHEN PROVIDING AID
- As you just learned, paternalistic and patronizing attitudes when carrying out an intervention can be extremely dangerous, as they may be disguised as a well-intentioned approach to take while it is actually doing harm. These attitudes are often found in the white saviour complex, and it serves to build a helpless and demeaning image of marginalized and vulnerable communities, which further disempowers them.
- As a health promoter, it is crucial that one does not engage with a community in this way. The most important aspect of providing aid involves listening to the community one is working with, and further work in complete collaboration with them.
White saviour complex
The situation where a white person acts to help non-white people in a self-serving context
FIGHT MALARIA OR STARVE
Sometimes, proper consultation and understanding the needs of a certain community can lead to the implementation of an intervention. For example, insecticide-treated bed nets were distributed throughout Africa to prevent the spread of malaria. However, what was not anticipated was that people in the community began using the bed nets to gather food and for other purposes.
As you learned in the “Fight Malaria or Starve” video, the health intervention conducted in Africa to distribute bed nets as a way to prevent malaria turned out differently than planned.
What were the unintended consequences of this health intervention, and what could the health
promoters have done differently to prevent them?
Dr. Carpenter’s Response:
Unintended consequences included:
* Use of nets for fishing practices and an increase in food accessibility.
* Destruction of natural ecosystems by contamination via insecticide treated bed nets.
* Some people choose not to use the nets because they believe the nets are poisoned and will cause impotence.
* Ways to prevent them included:
* Addressing starvation first (or at least simultaneously), as this seems to be a more urgent need in the community.
* Conduct a needs assessment in order to understand the true needs of the community.
* Work with the community leaders to provide culturally appropriate education.
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