Evaluation of health interventions at area and organisational level. British Medical Journal 319: 376-37

Healthcare interventions are often implemented at the level of the organisation or geographical area rather than at the level of the individual patient or healthy subject. For example, screening programmes are delivered to residents of a particular area; health promotion interventions might be delivered to towns or schools; general practitioners deliver services to general practice populations; hospital specialists deliver health care to clinic populations. Interventions at area or organisation level are delivered to clusters of individuals.

The evaluation of interventions based in an area or organisation may require the allocation of clusters of individuals to different intervention groups (see box 1).[1 2] Cluster based evaluations present special problems both in design and analysis.[3] Often only a small number of organisational units of large size are available for study, and the investigator needs to consider the most effective way of designing a study with this constraint. Outcomes may be evaluated either at cluster level or at individual level (table).[4] Often cluster level interventions are aimed at modifying the outcomes of the individuals within clusters, and it will then be important to recognise that outcomes for individuals within the same organisation may tend to be more similar than for individuals in different organisational clusters (see box 2). This dependence between individuals in the same cluster has important implications for the design and analysis of organisation based studies.[2] This paper addresses these issues.

Link

Panagopoulos I & Ricciardelli (2005) Harm reduction and decision making amongrecreational ecstasy users. International Journal of Drug Policy 16: 54-64

Recent research indicates that 3,4-methylene-dioxymethamphetamine (MDMA), also known as ‘ecstasy’, is becoming increasingly popular as an illicit drug among young people. This study investigated risk and harm reduction practices among recreational ecstasy users. A semi-structured interview with 40 participants was designed to investigate how ecstasy users identify and manage the harms associated with their drug use, and the underlying decision-making process. Overall, the participants identified both positive and negative effects. The reported positive effects predominantly centred around enhanced psychological, physiological and social experiences. However, there were a number of factors that contributed to regulating ecstasy use. These included specific in-group and out-group practices executed within the peer group, preventative harm-reducing practices, shared decision making, and shared responsibility for harm prevention. Recommendations for promoting harm reduction strategies and suggestions for future research are discussed.

Link

Shaw C (2001) DPAS Briefing 7. Drugs Scene: an evaluation of a drugs prevention project in South London. London: Home Office

This briefing evaluates a drugs prevetion project in South London.  The project targeted 14 primary schools and nine youth projects across Wandsworth, Lambeth, Southwark, Lewisham and Greenwich.  The study examines whether the project's integrated package of education, training and resources for the community addded value to drugs education delivered in the classroom.

Link

Smith L (2001) DPAS Briefing 9: Stimulating drugs prevention in local communities. London: Home Office

This report examines models of community involvement operating within housing estates in England.

Between 1996 and 1998 project monitoring took place in six drug prevention team areas covering London, the South East, Midlands and the North of England. The report focuses on five sites from those areas where, following community consultation, a number of projects were set up aiming to integrate drugs prevention within the agenda of other local initiatives.

Activities undertaken included youth projects, community skills workshops, schools’ work, training parents, supporting and developing tenant associations and peer group work.

The study identified a number of good practice points.

• A need to ensure that the type of intervention offered is appropriate and acceptable to local people, who believe that they have a contribution to make.
• Working at a local level requires sensitivity to the divisions that may exist within the community. It may be necessary to rebuild relationships between different groups to create the conditions for developing a holistic approach to tackling the estate’s problems as a whole.
• A core group of volunteers, supported by a skilled community development worker, is invaluable in developing work and sustaining activity.

link

Ward J & Rhodes T (2001) DPAS Briefing 12: Drugs prevention through youth work. London: Home Office

This research was carried out between October 1996 and October 1998 and examined the delivery of drugs prevention through youth intervention. It concentrated on a drug prevention programme using a structured education programme or through direct intervention with the community via street-based outreach and detached work.

Available from: public.enquiries@homeoffice.gsi.gov.uk