Step 3 Develop and Test Interventions

Once the magnitude of the problem and its associated risk factors are identified, a variety of countermeasures may be considered for implementation. Careful attention must be given to the characteristics of the target population, the feasibility of the countermeasure(s), their acceptability to the target population, and cost. Pilot intervention programs are often helpful to test various strategies. The most promising program can then be selected for more widespread implementation.

Community education programs are often tried first because they are relatively easy to initiate, attract motivated volunteers, and are invaluable for raising public awareness. They can also help build public support for legislative changes at a later time. It is essential to take the views and values of the community into consideration at every step of the process. Citizen involvement is crucial to any program's success.

Most programs set milestones and predefined measures of success. For example, a campaign to prevent deaths and injuries in residential fires may identify selected measures of structure (staff hired, office space, cooperative agreements reached), process (number of pamphlets distributed, number of home visits made, total smoke detectors installed), or outcome (reductions in the rate of fire deaths, or a decline in hospital admissions due to burns and smoke inhalation).

It is not always feasible to demonstrate major impacts on rates of morbidity or mortality with small-scale demonstration projects. When this is the case, surrogate measures may be used to demonstrate program impact. For example, preintervention rates of smoke detector use in a target neighborhood can be compared with rates noted after an educational campaign. Telephone surveys can seek evidence of changes in knowledge, attitudes, and self-reported behavior. Self-reports do not guarantee long-term behavior change, but they confirm that a program is reaching the target group.

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