Optimizing the development and evaluation of complex interventions: lessons learned from the BetterBirth Program and...

Area of Science:

• Health Services Research
• Implementation Science
• Global Health

Background:

• Complex interventions often fail to achieve desired health outcomes in large-scale evaluations.
• The BetterBirth Program, aimed at improving maternal and neonatal health using the WHO Safe Childbirth Checklist, serves as a case study.
• Lessons learned from BetterBirth can guide future complex intervention development and evaluation.

Purpose of the Study:

• To identify key lessons for developing and evaluating complex interventions.
• To use the BetterBirth Program as a case study to illustrate these lessons.
• To provide practical guidance for researchers to enhance intervention effectiveness.

Main Methods:

• A matched-pair, cluster randomized trial of the BetterBirth intervention in Uttar Pradesh, India, was conducted.
• Published and internal materials from three development phases of BetterBirth were reviewed.
• Barriers to identifying an optimal intervention package were identified, and corresponding lessons learned were extracted.

Main Results:

• Three critical lessons were identified: 1) Develop a robust theory of change (TOC). 2) Define optimization outcomes and success criteria for intervention assessment. 3) Create and capture variation in implementation intensity of intervention components.
• Applying these lessons to BetterBirth demonstrated how a TOC could improve data collection and how optimization criteria could guide development.
• Analyzing implementation variation could identify effective intervention components.

Conclusions:

• The identified lessons are applicable to both early and advanced stages of complex intervention development and evaluation.
• Real-world examples from BetterBirth illustrate the practical application of these lessons.
• Encouraging robust data collection and analysis can lead to more effective complex interventions.