When selecting a program, it is important to involve a steering committee made up of representatives of the target audience. This committee can offer guidance on which issues have the highest priority. The chosen intervention should be aligned with these issues. The committee can also play a central role in selecting, adapting, and guiding implementation of the intervention approach.
Finding an appropriate intervention program can bring several challenges, due to both the nature of obesity, and the challenges of identifying evidence-based practices appropriate for rural settings.
Challenges related to the nature of obesity
- Cross-disciplinary literature base
- Differing study designs that are hard to compare
- A long timeline for measuring prevention
- Difficulty of maintaining weight loss
Challenges related to practice in rural settings
- Published rural studies often focus on specific rural regions or subpopulations
- Few interventions have been tested in rural settings
- Evidence produced through systematic reviews is often presented in “generalizable” terms, and is not context-specific
Factors in Choosing Interventions
Rural communities need to invest time and effort in choosing an intervention strategy. Decisions about an intervention approach are often based on pragmatic factors such as the guidance of peers or resource availability. When making a decision, communities should consider several factors:
Communities need to have the right resources available to support the intervention. Organizations need to be able to cover costs such as annual licensing fees, training, program materials, and evaluation and tracking.
Existing community capital and networks
Many rural communities already have networks that can be used to plan a comprehensive approach to preventing and addressing obesity. Groups that have been working together for years may be best prepared to implement evidence-based interventions, as they already understand community assets and needs, and can quickly mobilize resources.
Ecological level targeted
Approaches vary based on what is being targeted, whether it is individual, community, or organizational behaviors, or systems and policy. Individual behavior happens within the social and physical context in which people live their lives. Comprehensive approaches that address multiple “levels” of these contexts at once are more likely to be effective. It should be noted that there is more evidence for approaches addressing individual behavior than policy, systems, or environmental change.
Rather than simply relying on findings from other projects, rural organizations may consult other organizations serving similar populations. These organizations can offer guidance and insight on the best way to engage residents of the community, or for model curricula and materials. Issues related to population needs can include availability of reliable information, access to healthy foods and physical activity.
Finding Programs that Fit
Rural communities can take specific steps to identify evidence-based, effective, or promising practices to help accomplish their goals. Process steps include:
- Define goals and objectives for the planned intervention
- Match goals and objectives of the evidence-based or promising practice model when possible
- Analyze the extent to which the context (e.g., community structure and values, resources) and target audience characteristics (e.g., language, socioeconomic status, culture) are similar to those of the model
- Review program materials and implementation protocols for the model interventions
- Speak with the project team to gain insight into whether a model intervention can be successfully replicated in a new community
According to the University of Wisconsin-Madison and the University of Wisconsin Extension Service, questions to ask when choosing an appropriate program can be categorized under program match, program quality, and organizational resources.
- How well do program goals and objectives match those that the community hopes to achieve?
- Is the program “strong enough” (e.g., of sufficient length and intensity) to be effective with this group of participants?
- Are potential participants willing and able to make the time commitment necessary to take part in the program?
- Has the program been shown to be effective in a target population similar to yours?
- To what extent might you need to adapt this program to make it appropriate for your community?
- Does the program allow for adaptation?
- Has the intervention itself been shown to be effective?
- Is the program listed on a respected registry of evidence-based programs? If so, what rating has it received?
- For what audiences has the program been found to work?
- Is there information available about what program adaptations are acceptable if it is not implemented exactly as designed?
- Is adaptation assistance available from the developer?
- What is the extent and quality of training offered by the developers?
- Do the program’s designers offer technical assistance? Is there a charge for this assistance?
- What are the training, curriculum, and implementation costs of the program?
- Can your community afford to implement this program, both now and in the future?
- Does your staff have the capacity and training to implement this program? Do they have the recommended or required qualifications to implement it?
- Is your staff willing to make the needed time commitment to implement this program?
- What is the likelihood that this program will be sustained?
- Are your community partners supportive of your implementation of this program?
More guidelines on these factors can be found in this article from the University of Wisconsin Extension Service.