Hoddinott et al. BMC Public Health 2010, 10:800 http://www.biomedcentral.com/1471-2458/10/800 Page 5 of 9 Table 2 Designing interventions in group settings Table 3 What happens within a group What is the intervention and what quantity will be delivered? System maintenance: ○ The group itself as the intervention ○ The group leader delivers the intervention ○ The group as a vehicle for delivering the intervention to a wider population ○ The group size, frequency, duration and lifetime How does someone become a group member? ○ Are there gatekeepers and how do they operate ○ Self or professional referral, with or without criteria ○ Advertising: general or targeted ○ Access to attend meetings: open (anyone can drop in and out of attending meetings); closed (membership registration on attendance, in advance or for a fixed period) ○ Access during a group meeting: open (drop in and out); closed (fixed start and finish) ○ Barriers, facilitators and entry rituals ○ Incentives and costs (financial and non financial) - joining, recurring, optional, refundable What social and behaviour theories inform the intervention? ○ Education: factual, tacit or experiential knowledge ○ Support: for a specific behaviour, attitude or belief ○ Cognitive approaches: to change thinking about a behaviour ○ Performing a behaviour or activity ○ Rewarding a behaviour or group attendance ○ Competition between groups or group members How are the group influencing attitudes, beliefs and behaviours? For example: ○ Social comparison theory ○ Social support theory ○ Social learning theory ○ Social impact theory What are the outcomes? ○ Initiate or sustain a desired behaviour ○ Reduce, stop or prevent a relapse of an undesirable behaviour ○ Substitute a desirable for an undesirable behaviour ○ Change how an existing behaviour is enacted ○ Change attitudes or beliefs which might predict or mediate a behaviour e.g. self-efficacy What is the target population for intervention delivery and outcome measurement? ○ Who is targeted? People with specific behaviours, socio- demographic characteristics or diseases; from particular geographic areas or organisations ○ Whose outcomes will be measured? Individual group attenders, pooled group outcomes, wider population some participants valued the flexibility and autonomy offered by groups where you could drop in just to be weighed and leave with minimal group interaction whereas others preferred leader facilitated discussion [21]. Relationships between professional gatekeepers and “the group” can both facilitate or hinder attendance, for example infrequent midwife participation led to limited attendance by pregnant women in a trial of breastfeed- ing support groups [18]. ○ Who organises and leads the group? Is he/she internal or external to the group? How is he/she appointed or elected? ○ The leader’s role in initiating, planning, setting up, organising and running the group ○ One or several group leaders/co-leaders? Similar or complementary leader attributes; continuity or rotation of leadership; fixed or flexible? ○ Is group content: flexible; repetitive; different over time; leader or participant determined? ○ Is there group member feedback? Formal or informal? How does feedback change group processes? Leader attributes: ○ Socio-demographic characteristics, professional qualifications, training, personal experience of the behaviour or problem, interpersonal communication skills ○ To what extent is the leader able to attend to both the group task and the socio-emotional aspects of the group? ○ What is the leadership style: directive/nondirective; proactive/ reactive; led (hierarchical)/facilitated (co-operative)/present (autonomous)? ○ How flexible is the leader and how does the leader change over time? ○ What are the benefits/rewards and costs/burdens of being a leader and how are they manifest? Relationship between the leader and group: ○ How does the leader have legitimacy in the eyes of the group: e. g., expert knowledge; skills; competence; personal attributes; personal experience; conforming to group norms; acting fairly; group identity; geographical residence? ○ What techniques does the leader use: education; persuasion; providing a practical task or service; advocacy; advising: supporting; empowering; counselling; listening; providing vision; inspiration or motivation; selling? ○ What do the group initiators, leaders and group members view as the purpose (aims and objectives) of the group? How similar or different are their perspectives? Attributes of the group participants ○ To what extent are the group task/goal or socio-emotionally orientated? ○ To what extent are there shared goals? ○ What does it mean to be a group member/non-member in terms of personal and social identity? ○ Do participants categorise themselves; adopt specific group roles or a hierarchical status? ○ What is the level of anonymity or public performance within the group? High with each individual speaking in turn or low as in a crowd where anonymity can be maintained? Group relationships ○ To what extent are socio-emotional interactions positive or negative? ○ How do intra-, inter-group and non-group member relationships change over time? ○ Do group attitudes, beliefs and behaviours become more or less extreme over time? ○ How similar or different are the attitudes and behaviours of group members? ○ What are the group norms, how are the limits of acceptable behaviour defined and is difference tolerated? ○ Do the group norms encourage or inhibit goal attainment and/ or positive socio-emotional interactions?