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

Betty R. Kirkwood, Simon N. Cousens, Cesar G. Victora, Isabelle De Zoysa

Research output: Contribution to journalArticlepeer-review

57 Scopus citations


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 hag 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.

Original languageEnglish (US)
Pages (from-to)1022-1029
Number of pages8
JournalTropical Medicine and International Health
Issue number11
StatePublished - 1997
Externally publishedYes


  • Community-based interventions
  • Developing countries
  • Evaluation
  • Study design

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health
  • Infectious Diseases
  • Parasitology
  • Immunology


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