Community Leaders: Reach of Health Behavior Interventions

Definition: The absolute number, proportion, and representativeness of individuals who are willing to participate in a given initiative, intervention, or program. Will a program reach the number and types of people for which it is intended? Will it reach people who will benefit most?

Why is it important for participants to be representative of those eligible to participate?

Representativeness is defined as the similarity or differences between those who participate and those who are eligible but do not. If differences exist, it may be impossible to determine how these variables affect the impact of a given intervention. If differences don’t exist, you’ll have stronger evidence to suggest that results of the intervention can be generalized to real-world settings.

You should compare participants and non-participants on basic demographic characteristics. For example, you might compare results among people in different age groups, between males and females, or among people at various levels of socioeconomic status.

It is not uncommon for a program to have great reach and to be effective among financially secure clients. Not testing programs on audiences who are poor and less likely to participate in research, evaluate the program, or use the intervention may lead to disparities in whether people use health care services. Be sure that participants are representative of the population you seek to help.

When possible, you should also compare participants and
non-participants on primary outcomes. Primary outcomes might include
weight loss, increases in physical activity, and changes in what people
eat.

The purpose behind examining primary outcome is to know whether
your participants are, for example, less or more active than non
participants. If you are only reaching the active individuals, then
your program may be missing the mark in recruiting those most in need.

Use formative evaluation with users and non-users.
Seek to discover how users react to the intervention and why non-users opt out. Apply what you learn to increase the rate of participation and to enhance reach.
Conduct small-scale experiments.
Do test runs to determine what works before conducting a large-scale intervention.
Identify and reduce barriers.
Find out what causes people to choose not to participate and what makes participants less likely to follow the program. As much as possible, eliminate or diminish the effects of the barriers that you uncover.
Use multiple channels.
In other words, deliver the program or intervention using several formats and/or venues. Consider using such things as posters, brochures, live presentations, videotapes, interactive multimedia presentations on CD-ROM, and a website to deliver the program or intervention.

Regardless of your delivery method, provide participants what they need to gain knowledge, develop skills, and habitually engage in healthy behaviors.