Specific Intervention Design Document — Sample

Use this table or one like it to specify the elements in your intervention design and explain it to the larger group.

You can also download an interactive Microsoft Word version of this tool, which you can fill out on-screen and then save to your computer or print, but you cannot save changes back to the CD-ROM or website.

Gap/Cause	Requirement	Element	Specification	Due Date
Explanation: Describe the gap, remembering that it must be specified in measurable indicators. The gap is often expressed in terms of the desired versus actual performance. Secondly, describe the cause of the gap.	Write a requirement that the intervention should accomplish in order to close the gap.	Write one element of the intervention that will meet the requirement in the second column.	Write the objective, or how we will know that the intervention element is successful.	Write when the intervention will be completed.
Example: Desired performance: Providers always (100 percent) explain at least three contraception methods to each client that appears for FP services Actual performance: Providers explain three or more contraceptive methods only 33 percent of the time Gap: 67 percent of providers do not explain at least three contraception methods to each client that appears for FP services Cause: Lack of information in the form of clear expectations about how many methods should be explained	Must provide clear information about the MOH’s expectation that all providers explain at least three contraception methods to each client that appears for FP services.	Written protocol section that specifies that providers explain at least three contraception methods to each client that appears for FP services.	After reading the protocol section, any provider who can read will be able to correctly state how many contraceptive methods should be explained to each client that appears for FP services.	02/15/99