Prevention Science, Vol. 7, No. 1, March 2006 (
The Role of Behavior Observation in Measurement Systems
for Randomized Prevention Trials
and Wendi Cross
Published online: 30 March 2006
The role of behavior observation in theory-driven prevention intervention trials is examined.
A model is presented to guide choice of strategies for the measurement of ﬁve core elements
in theoretically informed, randomized prevention trials: (1) training intervention agents,
(2) delivery of key intervention conditions by intervention agents, (3) responses of clients
to intervention conditions, (4) short-term risk reduction in targeted client behaviors, and
(5) long-term change in client adjustment. It is argued that the social processes typically
thought to mediate interventionist training (Element 1) and the efﬁcacy of psychosocial
interventions (Elements 2 and 3) may be powerfully captured by behavior observation. It
is also argued that behavior observation has advantages in the measurement of short-term
change (Element 4) engendered by intervention, including sensitivity to behavior change
and blinding to intervention status.
KEY WORDS: prevention trials; behavior observation; mediators; short-term outcomes.
It is as important to know how intervention
works as it is to document that it works (Follette,
1995). The most informative randomized ﬁeld trials
of preventive or clinical interventions are theory-
driven. That is, they are guided by two integrated
sets of theoretical concepts. The ﬁrst set reﬂects a
theory of risk and protective processes, and provides
guidance about cognitive, emotional, and behavioral
Department of Psychology, Box 34, Wichita State University
Oregon Social Learning Center, 160 East 4th Avenue, Eugene,
Research and Statistical Consulting, 3084 Lakeshore Blvd,
Psychiatry and Human Behavior, George Washington
University, 2300 K Street NW, Warwick Bldg Room 303,
Washington, District of Columbia.
Department of Epidemiology and Biostatistics, College of Pub-
lic Health MDC-56, University of South Florida, 13201 Bruce B.
Downs Blvd, Tampa, Florida.
Department of Psychiatry and Pediatrics, University of
Rochester Medical Center, 300 Crittenden Blvd, Rochester,
Correspondence should be directed to James Snyder, De-
partment of Psychology, Box 34, Wichita State University
Wichita, Kansas 67260-0034; e-mail: firstname.lastname@example.org.
targets for change and the conditions that inﬂuence
their expression. Theory-driven trials are also guided
by an explicit theory of change. Both the content
and process of intervention are shaped by hypothe-
ses about the psychosocial conditions needed to
systematically alter targeted risk and protective
mechanisms. Intervention theory speciﬁes models
of learning and skills attainment, and mechanisms
of social inﬂuence. In summary, theory-driven pre-
vention trials have two interlocking goals: to test the
efﬁcacy of intervention in terms of reducing risk for
future disorder and to ascertain whether the theo-
retical mechanisms hypothesized to mediate change
as a result of intervention account for the observed
reduction in risk (Eddy et al., 1998). Achievement of
both goals requires careful attention to measurement
issues (Reid, 2003).
This paper examines the role and potential
utility of behavior observation as a measurement
tactic in theory-driven intervention trials. First, a
model of the core elements comprising theory-driven
trials is presented. Second, observational methods
are described and contrasted with other measure-
ment methods such as ratings, self-reports, and clin-
ical judgments. Third, the potential advantages and
2006 Society for Prevention Research