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Intervention Mapping: A Process For Developing Theory- and Evidence-based Health Education Programs


In early April, I [Alison Stirling] read the following notice on CLICK4HP list-serv:

* ~ * ~WORKSHOP ON INTERVENTION MAPPING all day on Wednesday April 29 at Laval University, Quebec City, by Dr. Gerjo Kok, internationally well-known researcher in Health Promotion, especially in the field of AIDS. The workshop, in English, is limited to a maximum of 25 people (priority to graduate students in public health, nursing, etc. and to practitioners with basic knowledge in health promotion).

Assuming a basic knowledge of planning and programming approaches in Health Promotion (like the PRECEDE-PROCEED model for instance), the workshop emphasizes the integration of theoretical models in the planning of preventive or health promoting activities. [message posted by Prof. Michel O'Neill on behalf of Professor Gaston Godin, Faculté des sciences infirmières, Université Laval tel.: +1- 418-656- 2131 # 7900; courrier électronique:]~ * ~ * ~

I was able to attend this one day workshop - which is the only workshop or presentation on this interesting topic that will be given in Canada this year. The workbook that Professor Gerjo Kok used for this session is being revised and prepared for publication within the next year by co-authors L. Kay Bartholomew and Guy Parcel of University of Texas at Houston, and also Gerjo Kok. The workbook, and the whole approach, provides an extremely useful systematic process for health promoters to

develop interventions and implementations, using the PRECEDE-PROCEED model (or any other behavioural science theory).

Professor Gerjo Kok is Professor of Health Education and Professor of AIDS prevention at Maastricht University and Director of the Dutch Research School HEALTH. He notes that any program plan requires:

*data/evidence that is available,

*definition of objectives - performance, program changes that are desired

*theories (more than one theory usually) and methods or processes related to these theories

*any systematic process of method and theory must consider parameters, context and evidence

*most important is to look at the Implementation phase.

Before Intervention Mapping:

The workbook begins with an outline for a complete needs assessment to help define the health problem and related behaviours. In the workshop at Laval University, we worked in small groups on identified topic/problem areas and wrote brief descriptions of the population of interest and the health problem. We then worked through a task of community/social analysis and health problem analysis, which in work-life would require combining data from a variety of sources, qualitative and quantitative. When we could define the specific population and write goals for change, we were ready for the first step in Intervention Mapping.

Step 1: Creating Matrices Of Proximal Program Objectives

The tasks:

*to specify the performance objectives (a fairly daunting task!)

*specify important, changeable determinants

*differentiate the target population

*write learning and change objectives (the proximal program objectives) and create matrices linking the performance objectives with determinants.

For example - if the performance objective is to choose low fat food:

*For a learning objective regarding self-efficacy, it may be "What do people need to learn in order to choose low fat food?"

*For a change objective regarding social norms, "What needs to change in the environment for a person to choose low fat food?"

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3) Step 2: Selecting Theory-Based Intervention Methods And Practical


The tasks

*brainstorm methods to achieve the proximal program objectives

*use the theoretical and empirical literature to further delineate the methods and the relevant parameters for methods

*identify the new data needed to complete the analysis

*translate the methods into strategies, linking up learning and change objectives with strategies and methods. For example a method of Modelling may include strategies of:

role models, testimonials, role-playing, and demonstrations - and these are linked to objectives.

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4) Step 3: Designing and Organizing Programs

The tasks:

*operationalize the strategies into plans considering implementors and sites

*design instruction materials

*pretest instruction materials with the target group

*design program components and produce the materials

The working documents express the messages, themes, and motifs of the product. An example of a substantive theme would be a theme about condom use in an AIDS prevention program, or a theme about relationships. Consider: type of strategy, length, feasibility, salience, production qualities.

This section was the part where most health promotion and education planners stopped. The consideration of the implementors - such as teachers in school settings; parents in a child injury prevention program; managers and workers in a worksite program - can often change the use of and design of programs that may have been designed with a different target population in mind.

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5) Step 4: Specifying Adoption and Implementation Plans

Ask yourself: "What needs to be done to ensure delivery of the program with acceptable levels of completeness and fidelity?" You will move back and forth between Steps 3 and 4.

The tasks:

*develop a linkage system - identify the individuals or groups who make decisions to adopt programs and understand their important characteristics and needs

*identify program implementors and list their needs that influence programs and

*incorporate representatives into a linkage system - find out immediately if implementators are with you (and part of the design process) - if not, start again

*specify adoption and implementation performance objectives and determinants

*write the implementation plan

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6) Step 5: Generating An Evaluation Plan

The tasks:

*develop an evaluation model using information from the previous steps of Intervention Mapping and information from the needs assessment

*develop effect evaluation questions from the needs assessment and proximal program objective matrices. Refer to the matrices as blueprints for instrument development

*develop process evaluation questions from intervention mapping methods, strategies and implementation plans.

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7) Conclusion

The Intervention Mapping Workbook appears to offer a very practical way for health promoters to research, plan, formulate programs with organizations and people who will be delivering them - linking theory and practice and the people most affected. Unfortunately, it is difficult in one-day to convey all the steps in a meaningful way, even with small group work using the well-laid out workbook. Professor Kok is used to offering this approach in a course of 5 days to 6 weeks in length. Below you will find a brief description of a course offered by the Continuing Education Network of U. of Texas (at Houston). I look forward to seeing this workbook published in its final form, with the case studies and theory reviews as well as the practical worksheets guiding the user through the steps.

As much of the Intervention Mapping process is based upon the PRECEDE-PROCEED model; it is also useful to look at the resources developed by Lawrence Green at the Institute of Health Promotion Research (IHPR) in British Columbia, to build on his model. In the past 5 years, the IHPR has had a summer institute on Health Promotion Planning and Evaluation. The 3 day program focused on a comprehensive framework of the Precede-Proceed model, and the use of EMPOWER software as a planning tool. See the next message (OHPE 53.2) for more information.

- submitted by Alison Stirling

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B. Related Course:

By the University of Texas at Houston, Continuing Education Network - this year to be offered in Santa Fe, New Mexico:

Intervention Mapping: Developing Theory- and Evidence-based Programs for Health Education and Health Promotion

Instructors: L. Kay Bartholomew, M.P.H., D.Ed.(coordinator) Tel: (713) 500-9630; Guy S. Parcel, Ph.D.; Gerjo Kok, Ph.D.; Maria Fernandez, Ph.D.; Jan Groff, M.D., Ph.D.

Overview of 1997 course: The purpose of this course is to integrate and extend behavioral-science theory to planning models for health-promotion programs. The participants will have hands-on individual and group experience in developing projects from their own work settings. Teaching methods include case studies and guided practice in health-promotion planning from school, work-site, health-care, and community settings.

Audience: Health professionals who are confronted with the challenge of developing effective behavioral- and environmental-change programs; university faculty who want to enhance instruction in health-education and health- promotion planning and in application of behavioral-science theory. All participants are asked to bring a project from their work settings and will be grouped with other students according to project topics and settings.

Performance Objectives for Participants:

* Assess individual and community needs for health promotion.

* Analyze a community's health and quality-of-life problems, including their behavioral and environmental causes.

* Use behavioral and social-science theory, empirical literature, and new data to hypothesize determinants of behavior and environment related to a health problem.

* Design intervention methods and strategies consistent with specified program objectives.

References [by Gerjo Kok]:

*Bartholomew, L. K. (Revision 4 - 1996). (Center for Health Promotion Research & Development, ), Parcel, G. S., & Kok. G. Intervention Mapping: The workbook. In press.

*Kok, Gerjo. "Barriers to successful implementation of model programmes." Maastricht University, The Netherlands. Promotion of Mental Health. Volume 7-1997. Ashgate Publishing.

Abstract: Model programs for prevention should be based on theory and data. If so, they may contribute to better prevention practice. Theory and data provide guidelines, principles and protocols for program development, but standardized programs may be too rigid for general application. Model programs need a certain flexibility, without loss of the essential elements in the program (fidelity). Efficacy is not effectiveness: often implementation of potentially effective programs by intended program users is very limited. Implementation can be improved by participation of program users in program development (linkage) and by systematic interventions aimed at program users.

*Kok, G., den Boer, D-J., De Vries, H., Gerards, F., Hospers, J., Mudde, A.N. (1992) "Self-Efficacy in the Adoption and Maintenance of Health Behaviors: Theoretical Approaches and a New Model."

Chapter in Ralf Schwarzer (Ed.) Self- Efficacy: Through Control Of Action Washington, DC: Hemisphere.

*De Vries, H., Backbier, E., Kok, G., and Dijkstra, M. (1995). "The Impact of Social Influences in the Context of Attitude, Self-Efficacy, Intention, and Previous Behavior as Predictors of Smoking Onset."

Journal of Applied Social Psychology. p237.

*Kok, G. (1992). "Quality of planning as a decisive determinant of health education effectiveness." Hygie: Int J Health Educ. 11(4):5-9.

*Kok, G. (1991). Health Promotion Planning: An Educational and Environmental Approach (Second Edition)...[book review]. Hygie 10(2):48.

*MORE RELATED RESOURCES IN OHPE #53.2 [next message]