Adapted from "Conducting intervention research: The design and development process" by Stephen B. Fawcett et al. You've brought together people who want to improve conditions in the community. Perhaps the goal is to increase opportunities for physical activity, improve students' success in school, reduce exposure to violence, strengthen access to services, or address another community priority. The desired outcome may be relatively clear. The more difficult question is what combination of actions is likely to produce that outcome. That is the purpose of intervention development. What is an intervention? An intervention is a deliberate action or set of actions designed to create positive change. Interventions can take many forms, including: Programs Policies Organizational practices Changes in services Environmental or infrastructure changes Communication or education efforts Community initiatives Partnerships or coordinated systems changes What makes something an intervention is not its form, but its purpose: to influence conditions, practices, behaviors, systems, or environments in ways expected to improve outcomes for individuals, organizations, or communities. Effective interventions often go beyond asking individuals to change their behavior. They may also address: Access to resources or services Organizational procedures Policies Physical environments Economic conditions Information and communication systems Social relationships Institutional or structural barriers An example A community that wants to prevent sexual violence might consider several intervention approaches. Depending on the local problem analysis and available evidence, these could include: Education and skill-building that support healthy relationships, consent, bystander action, and violence prevention Organizational policies and reporting systems that strengthen accountability and response Accessible services and support for survivors Changes to transportation, lighting, or other environmental conditions where those conditions are shown to affect safety Work with schools, workplaces, community organizations, and other institutions on practices that promote safety and respect The appropriate combination depends on the problem, evidence, community context, authority, available resources, and the mechanisms the intervention is intended to influence. More components do not automatically make an intervention more effective. The intervention should be complex enough to address the important contributing conditions without adding activities that do not serve a clear purpose. Why should you develop interventions? Intervention development provides a structured way to move from understanding a problem to taking action. A deliberate process can help an organization: Connect proposed activities to the problem they are intended to address Use available research and practice evidence Incorporate community knowledge and priorities Make assumptions about how change is expected to occur more explicit Compare alternative approaches Identify implementation requirements before launch Plan evaluation and monitoring Learn and adapt as evidence changes A well-designed intervention is not guaranteed to succeed. Implementation conditions may change, evidence may be incomplete, participation may differ from what was expected, or the intervention may produce effects that were not anticipated. Intervention design should therefore include a plan for learning as well as a plan for action. When should you develop or redesign an intervention? It may make sense to develop, adopt, adapt, or redesign an intervention when: A clearly identified community or organizational condition warrants action Existing approaches are not producing sufficient results Evidence suggests that another approach could improve outcomes Community priorities or conditions have changed Policy, technology, funding, or other contextual changes create a new opportunity An existing intervention needs to be adapted for a different setting or population Decide whether your organization should lead the intervention An organization may be capable of doing something without being the most appropriate organization to lead it. Ask: Does the issue fit our mission and responsibilities? Do we have relevant authority? Do we have or can we obtain the necessary expertise and resources? Is another organization already responsible for this work? Would partnership be more effective than acting alone? What other priorities would receive fewer resources if we take this on? Are there legal, ethical, or safety responsibilities that require us to act? The answer may be to lead an intervention, partner with another organization, support someone else's effort, refer the issue to an appropriate authority, or address only the portion that falls within your organization's role. How do you develop an intervention? Intervention development is often iterative rather than strictly linear. New evidence may change how the problem is understood. Community engagement may reveal a barrier that was previously overlooked. Pilot testing may show that a proposed activity is impractical. Evaluation may show that the intervention's assumptions need to be revised. The steps below provide a useful structure while allowing the process to change when the evidence requires it. 1. Clarify the desired change Begin with the condition or outcome the intervention is intended to improve. Ask: What is happening now? What outcome do we want to improve? Who or what is affected? What evidence shows that the issue warrants attention? What would meaningful improvement look like? Do not begin by assuming that individual behavior must be the primary target. Depending on the problem, meaningful change may require changes in: Individual knowledge or behavior Relationships and social support Organizational practice Services Access Physical environments Funding or resource allocation Policies or regulations Larger systems 2. Establish a baseline and understand the scope of the issue Gather enough information to understand the current condition and to provide a baseline against which later change can be assessed. Depending on the question, sources may include: Administrative or program records Public datasets Surveys Interviews Focus groups or community listening activities Direct observation Research evidence Geographic information Policy and organizational documents Community and lived experience Ask: How large is the issue? How severe is it? Where does it occur? How has it changed over time? Are some groups or locations affected differently? What information is missing? Examine the quality and limitations of the evidence rather than assuming that every available measure describes the problem equally well. 3. Identify who is affected and who needs to be involved An intervention may affect more people and organizations than the people who directly experience the desired outcome. Identify: People and communities directly affected People who use or receive the intervention Staff or volunteers who would implement it Organizations whose practices may need to change Decision-makers with relevant authority Partners who control needed resources or infrastructure People who may experience unintended costs or burdens Avoid defining people as "targets" simply because the intervention is intended to influence a behavior or decision. Be specific about what the intervention is trying to influence and why. 4. Engage people and communities meaningfully People affected by an intervention may have knowledge about barriers, resources, implementation conditions, history, and priorities that planners do not have. Engagement should begin early enough to influence important decisions rather than being used only to obtain approval for a plan that has already been developed. Clarify: What participants can influence What has already been decided Who has final decision authority How participant input will be used How the organization will report back on what happened Meaningful participation does not automatically create "ownership" or guarantee support for an intervention. Participants may contribute substantially and still disagree with the final decision. Make engagement accessible Depending on the context, consider: Language access Disability access Transportation Childcare or caregiving demands Meeting schedules Technology Remote participation Compensation for substantial community time or expertise where appropriate Anonymous or confidential input where power differences create risk 5. Analyze contributing conditions Examine why the issue exists and what conditions maintain or reduce it. Do not assume that one underlying cause explains a complex community problem. Ask: What conditions contribute to the problem? What conditions protect against it? What policies or institutional practices matter? What environmental or infrastructure conditions matter? What individual or interpersonal factors matter? What economic or resource conditions matter? How do these factors interact? Which explanations are well supported? Which explanations remain hypotheses? Example Suppose a community is trying to reduce housing instability. The analysis might examine: Rental prices and housing supply Income and employment stability Eviction practices Availability of emergency assistance Disability and health-related needs Domestic violence Discrimination Reentry from institutions Access to legal assistance Local and state housing policy An intervention based only on employment training would miss many of these pathways. 6. Define goals and objectives Describe what the intervention should accomplish before deciding exactly which activities will be used. Goals describe the broader desired outcome. Objectives describe specific changes the intervention intends to produce. Strong objectives identify: What will change For whom or what By how much, where appropriate By when How the change will be measured Objectives should reflect outcomes the intervention can reasonably influence. Avoid writing objectives that place responsibility for complex outcomes entirely on individuals when important system or environmental barriers remain. 7. Describe how change is expected to occur Before choosing activities, make the intervention's logic explicit. A logic model, theory of change, program roadmap, or similar tool can connect: The identified problem and context Contributing conditions Resources or inputs Intervention activities Immediate outputs Short-term outcomes Intermediate outcomes Longer-term outcomes Important assumptions Ask: If we carry out these activities, why do we expect these outcomes to change? The answer should be supported by a reasonable combination of evidence, theory, local knowledge, and clearly identified assumptions. 8. Learn from existing evidence and practice Before creating a completely new intervention, examine what has already been tried. Sources may include: Systematic reviews Evidence-based recommendations and guidelines Peer-reviewed research Government and professional guidance Evaluations of similar programs Local and regional initiatives Community experience Consider both successful and unsuccessful efforts. An intervention that worked elsewhere may not produce the same results in a different setting. 9. Assess whether an existing intervention fits the context When considering an established approach, ask: Does it address the contributing conditions identified here? What evidence supports its effectiveness? In which populations and settings has it been studied? How similar are those conditions to ours? What resources and expertise does implementation require? Is it accessible to the people intended to benefit? What effects has it had on equity? What unintended consequences have been reported? Can our organization implement it with adequate quality? Does it fit our legitimate mission and authority? 10. Decide whether to adopt, adapt, combine, or develop The group may decide to: Adopt an established intervention largely as designed Adapt an established intervention to fit the local context Combine compatible strategies Improve an existing local approach Develop a new intervention when available approaches do not adequately address the problem Adapt thoughtfully When modifying an intervention with existing evidence, distinguish between: Essential functions or mechanisms believed to produce the outcome Delivery details that can reasonably be changed to improve local fit An adaptation that removes the mechanism responsible for effectiveness may no longer be the same intervention. Document significant adaptations so their effects can be interpreted during evaluation. 11. Generate additional intervention options Existing evidence may not provide a complete answer. Generate additional options when necessary. Useful approaches include: Individual idea generation Brainwriting Structured brainstorming Community design sessions Process mapping Systems mapping Generate broadly while respecting legal, ethical, safety, rights, and scope boundaries. 12. Compare intervention options Compare potential interventions using explicit criteria. These may include: Relevance: Does the intervention address the problem and contributing conditions? Evidence: What is known about effectiveness? Equity: Who is likely to benefit, and who may experience additional barriers or burdens? Accessibility: Can the intended participants actually use or benefit from it? Feasibility: Can it be implemented with available or obtainable staff, authority, time, technology, partnerships, and other resources? Safety: What harms or risks might occur? Ethics and legality: Is it consistent with rights, professional responsibilities, law, and organizational policy? Cost: What resources are required? Opportunity cost: What other work may receive fewer resources? Acceptability: How do relevant participants and communities understand the intervention and its effects? Sustainability: What would be required to maintain it if it proves useful? Reversibility: Can it be modified or stopped if assumptions prove wrong? Evaluation: Can meaningful implementation and outcome measures be collected? Several intervention options may remain reasonable after evaluation. Document important tradeoffs and the reasons for selecting the approach. 13. Understand implementation facilitators, barriers, and concerns Before launch, examine what may help or interfere with implementation. Possible factors include: Staffing Training Funding Leadership support Community trust Technology Facilities Transportation Language and disability access Policy or legal requirements Partner capacity Competing priorities If people or organizations oppose the proposed intervention, determine why. Opposition may reveal: Legitimate risks Conflicting priorities Rights or legal concerns Accessibility problems Unanticipated costs or burdens Inadequate communication or engagement Misinformation Respond to the substance of the concern rather than treating all resistance as an obstacle to overcome. 14. Identify intervention components and activities Break the intervention into the major components necessary to carry out its theory of change. Possible intervention strategies include: Providing information or skill-building Strengthening services and supports Removing access barriers Changing organizational procedures Changing policies or regulations Modifying physical environments Improving infrastructure Changing resource allocation Improving coordination among organizations Using communication or outreach strategies Monitoring implementation and providing feedback Not every intervention needs every type of strategy. Select components because they address identified contributing conditions and support the expected pathway to change. 15. Specify the intervention clearly For each major component, describe: What activity will occur Who or what it is intended to influence Who will deliver or implement it Where and when it will occur What resources are required What level or amount of activity is expected What implementation quality is required How accessibility will be addressed How the component connects to the intended outcome Specific intervention descriptions make implementation, replication, adaptation, and evaluation easier. 16. Develop an action plan Translate the intervention design into specific implementation responsibilities. The action plan should identify: Components and activities Responsible owners Required approvals and decision authority Supporting partners Timelines and milestones Dependencies Resources Accessibility requirements Communication responsibilities Major risks and contingency plans Monitoring and evaluation responsibilities 17. Plan evaluation before implementation Do not wait until the intervention is finished to decide how success will be assessed. Identify: The purpose of the evaluation Who will use the findings The questions the evaluation needs to answer Indicators and measures Baseline information Data sources How and when data will be collected Who is responsible for collection and analysis Privacy, confidentiality, and ethical requirements Distinguish types of evaluation Different questions require different approaches. Formative evaluation can examine whether the intervention is feasible, appropriate, understandable, accessible, and ready for implementation. Process or implementation evaluation examines how the intervention was delivered, who was reached, how much was delivered, what adaptations occurred, and what helped or hindered implementation. Outcome evaluation examines whether the intended outcomes changed. Impact evaluation uses designs intended to determine whether the intervention caused observed changes. Economic evaluation can examine costs in relation to results. Match evaluation rigor to the questions, stakes, available resources, intervention maturity, and claims the organization hopes to make. 18. Pilot or test when appropriate A pilot can help determine whether an intervention or implementation process works as expected on a smaller scale. Pilot testing can be useful when: The intervention is new Important implementation assumptions remain uncertain The organization is adapting an approach substantially Accessibility or usability needs testing A limited test can reduce the risks of a larger rollout A pilot may not be appropriate when urgent protective action is required or when delaying a well-supported intervention would create unnecessary harm. Before the pilot, decide: What is being tested Who will participate How long the test will run What data will be collected What unintended effects will be monitored What findings would support expansion What findings would require modification, another test, or stopping Use participant and implementer feedback alongside other evidence. 19. Implement the intervention Implementation is a major phase of the work, not simply the execution of a finished design. During implementation, monitor: Whether activities are occurring Whether they are being delivered with appropriate quality Whether the intended participants are being reached Whether staffing and resources are sufficient Whether important barriers have emerged Whether adaptations are occurring Whether unintended consequences are appearing 20. Adapt deliberately when necessary Real-world implementation often requires adjustment. Adaptation may be appropriate when: Community conditions change The intervention is not accessible as designed Implementation barriers emerge New evidence becomes available A component is not functioning as expected Document important adaptations. Record: What changed Why it changed Who approved the change Whether the theory of change was affected How the change affects evaluation 21. Evaluate outcomes and unintended effects Evaluation should answer more than whether the intervention was completed. Ask: Was the intervention implemented as intended? Who was reached? Who was not reached? Did the intended outcomes improve? For whom did they improve? Under what conditions? Were important disparities reduced, maintained, or increased? What unintended positive or negative effects occurred? What did implementation cost? Outcome change by itself does not necessarily establish that the intervention caused the change. The strength of the causal conclusion depends on the evaluation design and available evidence. 22. Use the findings Evaluation should inform action. Based on implementation experience and findings, decide whether to: Continue the intervention Improve particular components Adapt delivery Expand or scale the intervention Reduce its scope Test an alternative Stop the intervention Avoid continuing an ineffective or harmful intervention simply because substantial resources have already been invested in it. 23. Communicate what happened Report findings to the people and organizations who need them. If community members or participants helped shape the intervention, close the feedback loop. Explain: What was implemented What was learned What outcomes occurred What limitations remain What was changed because of participant or community input What will happen next 24. Continue monitoring and learning An intervention that works today may need to change as community conditions, resources, policies, technology, or participant needs change. Continue to monitor: Implementation quality Reach Outcomes Equity Cost Sustainability Context Unintended effects Use those findings to refine the intervention and its underlying assumptions. In Summary Developing an intervention means moving systematically from an identified problem or desired outcome to a practical, evidence-informed approach for creating change. Begin by understanding the problem, its context, the people and communities affected, and the conditions that contribute to it. Do not assume in advance that individual behavior is the main cause or that behavior change is the only appropriate intervention. Engage people affected by the intervention early enough for their knowledge and priorities to influence important decisions, while being transparent about decision authority and how input will be used. Define clear goals and objectives, describe how the proposed activities are expected to lead to outcomes, and examine existing evidence before deciding whether to adopt, adapt, combine, improve, or create an intervention. Select intervention components because they address identified contributing conditions and fit the evidence, context, authority, resources, accessibility needs, equity considerations, and implementation capacity. Plan implementation and evaluation together. Establish responsibilities, timelines, resources, indicators, data sources, and criteria for adapting, expanding, or stopping the intervention before implementation begins. Finally, treat intervention development as a learning process. Monitor how the intervention is actually implemented, evaluate intended and unintended effects, communicate results, and be willing to revise both the intervention and the assumptions behind it when the evidence changes. Contributor Jenette Nagy Stephen B. Fawcett Resources Online Resources Community Health Advisor from the Robert Wood Johnson Foundation is a helpful online tool with detailed information about evidence-based polices and programs to reduce tobacco use and increase physical activity in communities. The Society for Community Research and Action serves many different disciplines that are involved in strategies to improve communities. It hosts a general electronic discussion list as well as several by special interest. The U.S. Dept. of Housing and Urban Development features "Success Stories" and gives ideas for ways to solve problems in your community. The National Civic League provides a database of Success Stories. The Pew Partnership for Civic Change offers several resources for promising solutions for building strong communities. The World Health Organization provides information on many types of interventions around the world. Print Resources Fawcett, S., Suarez, Y. Balcazar, F., White, G., Paine, A., Blanchard, K., & Embree, M. (1994). Conducting intervention research: The design and development process. In J. Rothman & E. J. Thomas (Eds.), Intervention research: Design and development for human service. (pp. 25-54). New York, NY: Haworth Press.
