Developing a Multi-Criteria Decision Analysis Tool to Support the Adoption of Evidence-Based Child Maltreatment Prevention Programs.

Abstract

Decision-makers need to consider a range of factors when selecting evidence-based programs (EBPs) for implementation, which can be especially challenging when addressing complex issues such as child maltreatment prevention. Multi-criteria decision analysis (MCDA) frameworks and tools are useful for evaluating such complex decisions. We describe the development and testing of the first MCDA tool to compare EBPs for child neglect prevention. To develop the tool, we engaged stakeholders (n = 8) to define the problem and identify 13 criteria and associated weights. In a pilot study, we tested the MCDA tool with decision-makers (n = 11) who were asked to rank three evidence-based child neglect prevention interventions both with and without the tool. The MCDA's weighted sum intervention ranking differed from the ranking without the tool in the majority of the sample (55%). Decision-makers provided guidance on criteria that should be clarified or added, resulting in 16 criteria in an iterated tool. The most frequent criterion suggestions related to community acceptance of the intervention, health equity, implementation supports, and sustainability. Decision-maker feedback guided user interface refinements. The MCDA tool was generally well accepted by decision-makers due to their trust in the stakeholder engagement process. More research is needed to understand the acceptability of MCDA approaches in additional contexts and whether EBPs adopted with decision support have different population health impacts compared with EBPs adopted without support. MCDA tools could facilitate evidence-based responses to federal policy and funding opportunities such as the Families First Preventive Services Act.