When we are trained in grad school about intervention design the
emphasis (at least as I remember it!) is on fashioning the
strongest effect possible.
We start with a particular behavior change theory, move from
constructs to variables, operationalize the variables by adopting
or adapting or god forbid creating our own measures so that we'll
have something to get us through the hurdles of a doctoral program
and submit for publication. We write it all up for a class. Stand
up and describe what we wrote before our professor and classmates.
And then, this creeping feeling comes on that perhaps we've
forgotten something, that there's something missing, something that
in our rush to turn in our paper and make it through another
semester we put on the back burner and...
Oh yeah! The intervention. The thing that's supposed to induce the
behavior change in the way that we so carefully justified in our
On paper we can do a lot with an intervention. There can be
interactive online training. Efficacy building exercises. Support
groups in peer networks. One on one counseling. Diaries.
Performances. Reminders and checklists and placards. PSAs and paid
advertising and social modeling. And of course full participatory
involvement with our intended beneficiaries and their service
providers so that whatever gets designed is going to generate not
just attention but-- dare I say it--demand.
Anything's possible on paper. But the real-world intervention game
has different rules than the game of learning about research
through specifying mock interventions in classrooms or even real
interventions in academe.
In practice settings--communities or organizations where services
are provided for people at risk of something undesirable--the real
game is figuring out what's not only effective but also efficient
and, when those objectives collide as they often do, what's
efficient while also achieving an acceptable degree of positive
effect. In communities and organizations where there's never enough
money nor enough staff nor enough time and where there are always
competing demands just as worthy as the objectives of your
intervention, it's a cost-benefit question. Always.
My friend Chris Dede, in the Graduate School of Education at
Harvard, describes this challenge eloquently as "the trap of
perfection". We keep trying to define, test, and publish the gold
standard of interventions. Then we complain why no one in the
worlds of practice has picked up and run with our truly excellent
programs, products, and protocols. In the realm of public health
and health services research, the National Cancer Institute scholar
and methodologist Russ Glasgow has long argued the same thing.
Excellence is not the objective; "good enough" interventions which
come in at low cost is the place out on the horizon where we should
set our sights. That way, us students and teachers and writers have
a shot at helping real people in real communities and