Framework for identification and measurement of spillover effects in policy implementation: intended non-intended targeted non-targeted spillovers (INTENTS)

If you plan to implement/evaluate a health intervention/policy, you may want to check this out!

The #framework for identification and measurement of spillover effects in policy implementation (Intended Non-Intended Targeted Non-targeted spillovers, #INTENTS) is out on Implementation Science Communications #ImpSciComms

The #INTENTS framework builds on a scoping review of the health(care) literature since 1991 led by myself and Jack Elliott, which aimed to understand how the term #spillovers has been used. The review resulted in a taxonomy and in the interesting finding that spillovers are discussed when significant rather than systematically, suggesting a substantial publication bias.

With an excellent team effort of co-authors Rachel Meacock (University of Manchester), Jack Elliott (University of Manchester), Søren Rud Kristensen (University of Southern Denmark), Philip Britteon (University of Manchester), David G. Lugo Palacios (London School of Hygiene and Tropical Medicine), Paul Wilson (University of Manchester) and Matt Sutton (University of Manchester), we distilled a comprehensive #framework which comprises 4 main steps. The goal of the framework is to identify and measure #spillover effects.

Here are the questions to ask yourself when designing an intervention or an evaluation in health(care).

Step #1: What are the expected intervention outcomes? Once a list of intervention outcomes or a logic model is available, one can start to iteratively apply steps 2-4.

Step #2: At what level can spillover effects take place?
a) Who is targeted by the intervention?
b) Who is expected to change behaviour as a result of the intervention?
c) Whose behaviour/outcomes may change as a result of the intervention?

Step #3: Which spillover effect could the intervention generate?
a) Within-unit spillovers (non-intended effect on a targeted unit)
b) Between-units spillovers (intended effect on a non-targeted unit)
c) Diagonal spillovers (non-intended effect on a non-targeted unit)

Step #4: What is the nature of the potential spillovers?
a) Is the spillover different from the intended outcome?
b) Is the spillover related to the goals of the intervention?
c) Is the spillover consistent with the intervention time frame ?
d) Is there a credible mechanism?

More details and a worked example in the paper. We hope that the application of the INTENTS framework will enable spillover effects to be addressed appropriately in future evaluations and decision-making, ensuring that the full range of costs and benefits of interventions are correctly identified.


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