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You are here: Home Modules Module 3: Optimize Potential Impact Module 3 Introduction
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Module 3: Optimize Potential Impact

iStock_000008542224XSmallIn this module, you’ll consider how the impact of interventions can be combined to ensure maximum impact. Interventions can be sequential or simultaneous, within and across socio-ecological system levels, which may go beyond your sector and jurisdiction. Examples and activities in this module will help you consider the benefits and challenges combining interventions may present and how to plan to sustain change.

Plan to combine and stage interventions to enhance potential synergies

It’s called synergy when the interaction of two or more interventions produces a combined effect greater than the sum of their individual effects; an antagonistic effect is the opposite — the combination makes the individual interventions less effective. An intervention that works in isolation will not necessarily work combined with another, whether it’s launched at the same time, or part of a staged implementation. Multiple intervention programs deliberately combine interventions to optimize their potential impact — if it works, you’ll benefit from synergies. For more information please refer to Example 15 - Synergistic and antagonistic effects: Tobacco reduction interventions and Example 19 - Falls prevention and the elderly - evaluating synergy: How were synergies assess?

Preventing falls and the elderly - Optimizing impact with synergies

Researching the power of synergies among different interventions was no part of the Community Health Research Unit's plan for our falls-prevention project. Rather, our initial randomized controlled trial of two fall-prevention interventions (Edwards et al., 1995) tried to minimize contextual influences - that is, reduce the potential for co-interventions. We randomized 48 apartment buildings into three groups: a control group, the ‘falls clinic and risk reduction' group and the ‘community action' group.  We deliberately didn't set up a regional fall prevention coalition or do political advocacy during the intervention trial. We thought they might act as co-interventions, adversely influencing the results of the study. Now we see these co-interventions would likely have been synergistic - they would have added strength to the intervention.

We could have achieved several things if we'd included community advocacy initiatives in our work. Regional advocacy strategies led by a coalition would have provided experience for community organizers. Public health officials and partner organizations could have signalled their political support for local advocacy through the policy work of the coalition. Since policy change is usually incremental and long-term, it's unlikely a community coalition could have produced a substantial co-intervention during the 24 months of our study. But it might have had time to create cross-level synergies in the community-action buildings.   Allowing synergistic strategies gives planners and evaluators the chance to document how synergies happen and how community-wide processes can become part of intervention programs.

Use evidence to decide how to combine interventions

The Module 2 Activity will have helped you list expected synergistic effects and identify a range of scenarios that might increase synergy or decrease antagonistic effects. Multiple intervention programs must target more than one system level, but can do that in different ways:

Combine interventions implemented at the same time. That could be providing counselling for homeless youth (which is the intrapersonal system level) while simultaneously building a homelessness coalition in the community.

Stage, or sequence, your interventions. For example, a campaign on head injuries could provide media messages about the need for helmets to increase public support and then start advocating for legislation to make helmets mandatory.

Last Updated on Sunday, 03 May 2009 08:11