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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 class paper!

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 organizations.

Jim Dearing
Director/PI, CCRC
KPCO

Written by CCRC at 13:18

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