Behavior change intervention research in community settings: how generalizable are the results?

This review examines the extent to which recent behavioral intervention studies conducted in community settings reported on elements of internal and external validity, with an emphasis on whether research has been conducted in representative settings with representative populations. A targeted review was conducted on community-based intervention studies that promoted good nutrition, physical activity or smoking cessation/prevention, and were published in 11 leading health behavior journals between 1996 and 2000. The RE-AIM framework (reach, efficacy, adoption, implementation and maintenance) was used to evaluate the extent to which each paper reported on elements of reach, efficacy/effectiveness, adoption, implementation and maintenance. A total of 27 publications were reviewed. Although most studies (88%) reported participation rates among eligible members of the target audience ('reach'), only 11% of studies reported the participation rate ('adoption') among eligible community-based organizations or settings. Few studies reported if participating individuals or settings were representative of those found in the broader population. Although a majority of studies (59%) reported whether the intervention was delivered ('implementation'), few reported whether individuals maintained behavior change (30%) or whether organizations maintained or institutionalized interventions (0%). To increase the potential to translate community research findings to practice, studies should place a greater emphasis on obtaining and reporting external validity information, such as representativeness. The lack of external validity information limits researchers' and practitioners' ability to judge the generalizability of effects and the comparative utility of interventions. Improved reporting will facilitate implementation of proven and broadly applicable intervention strategies in communities. To make significant progress, all parties, including researchers, reviewers, editors and funders, need to take responsibility for increased emphasis on external validity information and ask what role they can best play to facilitate this process.