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Issues in the design and interpretation of studies to evaluate the impact of community-based interventions

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Increasingly, epidemiologists are faced with the need to evaluate the impact of an intervention that is delivered at the level of a community or cluster of individuals, rather than at the individual level. This has profound implications for the design and interpretation of a study to evaluate its impact. We start by discussing the issues arising in the extension of the randomized double-blind controlled trial methodology to the evaluation of interventions delivered to clusters of individuals, or to whole communities, where the unit of randomization is a cluster of individuals rather than an individual. We then consider alternative approaches to design, discuss their relative strengths and weaknesses and present a framework of design options. Finally we propose a pragmatic approach to evaluation design in this setting. We believe that the answer lies in the judicious selection of different design elements, combined in such a way that when the evidence from each is presented together, a clear picture of the impact of the intervention emerges. We illustrate this using an example from the recent literature.
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Keywords: Study design; community-based interventions; developing countries; evaluation

Document Type: Original Article

Affiliations: 1: Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK, 2: Departamento de Medicina Social, Universidade Federal de Pelotas, Pelotas, Brazil, 3: Department of International Health, School of Hygiene and Public Health, Johns Hopkins University, Baltimore, USA

Publication date: November 1, 1997

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