3.5 Evidence-Informed Strategies and Intervention Mix

Choosing strategies that fit the problem and the setting

Evidence-informed planning does not mean copying a published program word for word. It means using the best available evidence while also considering assessment results, community preferences, resources, ethics, and local constraints. A CHES professional should know how to ask whether an intervention worked, for whom, under what conditions, and which elements appear essential.

Sources of evidence may include systematic reviews, practice guidelines, peer-reviewed studies, surveillance reports, evaluation findings from comparable programs, professional standards, and local pilot data. Community evidence also matters. If residents describe safety concerns, language barriers, distrust, or scheduling conflicts, that information should shape the plan even when a journal article does not mention those conditions.

Strategy selection begins with the determinant. If the main determinant is limited knowledge, education may be appropriate. If the determinant is low skill, the plan needs practice and feedback. If the determinant is access, the plan may require navigation, transportation, hours, cost reduction, or policy change. If the determinant is social norm pressure, peer leaders and credible messengers may matter. If the determinant is environmental, individual counseling alone will be too narrow.

A well-designed intervention mix often includes more than one strategy. For example, a colorectal cancer screening program might combine plain-language reminders, patient navigation, provider prompts, faith-community outreach, and a clinic workflow change. Each part should have a purpose. The goal is not to add activities until the plan looks busy. The goal is to address the most important and changeable determinants with available resources.

Planners should also consider dose and reach. Dose refers to how much of the intervention participants receive, such as number of sessions, minutes of coaching, or reminders. Reach refers to how many and which members of the priority population participate. A high-dose program for a small group may build strong skills but miss many people. A broad communication campaign may reach more people but produce less individual practice. The selected approach should fit the objective.

Cultural fit is part of quality, not an optional add-on. Materials should use appropriate language, reading level, examples, images, channels, and messengers. Strategies should respect community strengths and avoid blaming individuals for conditions shaped by social determinants. When adapting an evidence-based program, document what changed and why. Preserve core components such as the behavior-change method, sequence, minimum dose, or skill practice that made the original program effective.

Feasibility screening prevents plans that look strong on paper but fail in practice. Questions include: Do we have trained staff? Can partners deliver the activity? Is there enough time in the exam cycle, school semester, grant period, or clinic workflow? Are costs covered? Is the site accessible? Are privacy and consent issues addressed? Can evaluation data be collected without burdening participants?

The CHES exam may ask for the best strategy after describing constraints. If transportation is a barrier, adding a lecture may not solve the problem. If participants have low literacy, a dense handout is weak. If the objective is policy adoption, individual knowledge change is not enough. Look for the answer that uses evidence and local fit together.