Health Promotion – Intervention Mapping

Written By Sarah Schwaller, MPH and NARO Region – U.S. Coordinator

Acquiring the skills to use Intervention Mapping, a health promotion program planning framework, is one of the most important things that I gained during my graduate studies in public health. Other ISECN members who are students or recent graduates have perhaps felt like me; overwhelmed by a multitude of new theories, models, and approaches to plan the most effective and efficient health promotion or education program. Upon entering the public health workplace, however, I realized that program planning is never as easy and straightforward as we think it is, and time, personnel and financial constraints add to the complexity.

The Intervention Mapping approach guides planners step-by-step through the entire process of program planning, implementation and evaluation.  Although the process can be cumbersome, intervention mapping is helpful because it essentially forces the user to stay true to theory and evidence-based practices throughout the entire decision-making process. In a world of complexities, this is helpful, especially to early career professionals.

Intervention mapping has been in use since the late nineties and applied in a variety of settings around the world (1). Intervention Mapping is a comprehensive process that guides interventions to be evidence-based, rooted in theory, and culturally sensitive with a heavy emphasis on stakeholder involvement.

The intervention mapping process begins with a needs assessment. A logic model of the problem is derived to identify the determinants that influence behavioral and environmental risk factors related to the health problem (2). Next, a logic model of change is developed. In Intervention Mapping, ‘change objectives’ are identified that will lead to our desired behavioral and environmental outcomes. Change objectives explain who and what will change as a result of the intervention at each ecological level; individual, interpersonal, community and societal (1).

All information is organized in a series of matrices, which serve as the foundation for the intervention. A separate matrix is developed at each level in which we want to see a change. For example, a physical activity intervention targeting children may have a separate matrix for the child, parent and school officials.

The intervention mapping process then takes the planner step-by-step through a detailed process to design an approach to address each specific determinant in order to affect the problem. This includes identifying theory-based methods and applications. Finally, the process guides the processes of program adoption, implementation and evaluation.

The steps in Intervention Mapping are informed by ‘core processes’ (1). The core processes begin by posing a question. Next, program planners respond to the stated question by using brainstorming to determine what is already known. Planners then add to the list of answers by searching the literature for empirical evidence and applying theories. The evidence is assessed, and then new research is conducted for any unanswered questions. Finally, all the lists of answers to our original question are compiled, assessed and summarized to inform our decision (1).

Intervention Mapping has been used to plan evidence-based interventions that target nutrition, physical activity, sexual health, alcohol abuse, AIDS prevention, cervical and breast cancer screening (3,4,5,6,7)

Our research team at the Texas Elder Abuse and Mistreatment Institute recently used intervention mapping to design an intervention study to address medication adherence among older adults who self-neglect. The lengthy planning stage was worth it, as the Intervention Mapping helped to create a roadmap for the study that has served us well thus far.

For example, one of our objectives is for older adults to improve their ability to communicate with their health providers. We determined that certain things related to their knowledge, self-efficacy, skills, outcome expectations, and perceived control needed to change in order for the older adults to communicate appropriately with their health care provider.

Performance Objectives of Elder Self-Neglecters

Personal Determinants

Knowledge Self-Efficacy and Skills Perceived Control
Consult with healthcare provider and family/social support network when needed. State the contact information for the health care providerExplain scenarios in which it is important to reach out to provider. Demonstrate how to communicate with provider about uncertainties or difficulties with health or medication regimen Explain how communication facilitates better control of health.

Sample Matrix Excerpt: Matrix of Performance Objectives, Personal Determinants and Changes in Personal Determinants for the Self-management of Medications for Independent Living Elders who Self-neglect (SMILES Study) (8)

Then, using the ‘core processes’ we identified the specific things that the older adults needed to do in order to meet the objective. This served as a guide for how we designed the program approach, curriculum and training materials. For example, we later developed a curriculum that was delivered in the homes of the older adults that included visual reminders, goal setting, guided practice, role playing and weekly check-ins to reinforce previous sessions and important key points regarding provider communication along with the other performance objectives.

The textbook Planning Health Promotion Programs: An Intervention Mapping Approach is an excellent resource to learn more about intervention mapping. Topic specific guides for resource-limited settings also exist, such as the IM Toolkit for Planning Sexuality Education Programs (9). This guide is designed for programs in Asia and Africa. Two universities offer semester-long or intensive week-long courses in intervention mapping, including the University of Texas School of Public Health and Maastricht University (see www.interventionmapping.com for more information on courses).

References

  1. Bartholomew K, Parcel G. Kok G, Gottlieb N, Fernandez M. Planning Health Promotion Programs: An intervention mapping approach. San Francisco: Jossey-Bass Inc; 2011.
  2. Bartholomew, K. Intervention Mapping. Bridging Theory and Practice in Health Promotion Michael and Susan Dell Lectureship in Child Health. [Internet]. 2013. [updated 2013 March; cited 2013 October 19]. Available from https://sph.uth.edu/dellhealthyliving/files/2013/03/Bartholomew_Intervention-Mapping.pdf
  3. Voogt C,  Poelen E,  Kleinjan M, Lemmers L, and Engels R, The development of a web-based brief alcohol intervention in reducing heavy drinking among college students: An Intervention Mapping approach. Health Promotion Int. 2013 March. In Press.
  4. Corbie-Smith G, Akers A, Blumenthal C, Council B, Wynn M, Muhammad M, Stith D. Intervention Mapping as a Participatory Approach to Developing an HIV prevention Intervention in Rural African American Communities AIDS Educ Prev. 2010 June; 22(3): 184–202.
  5. McEachan R, Lawton R, Jackson C, Conner M, Lunt J. Evidence, theory and context: using intervention mapping to develop a worksite physical activity intervention. BMC Public Health. 2008 Sep 22; 8:326.
  6. Fernández M, Gonzales A, Tortolero-Luna G, Partida S, Bartholomew L. Using Intervention Mapping to develop a breast and cervical cancer screening program for Hispanic Farmworkers: Cultivando La Salud. Health Promot Pract. 2005 Oct; 6(4):394-404.
  7. Van Kesteren N, Kok G, Hospers H, Schippers J, De Wildt W. Systematic development of a self-help and motivational enhancement intervention to promote sexual health in HIV-positive men who have sex with men. AIDS Patient Care and STDs. 2006 Dec 27; 20(12): 858-875.
  8. Burnett, J. Intervention to reduce medication non-adherence in community dwelling elders who self-neglect. 2012.
  9. Leerlooijer J IM Toolkit for Planning Sexuality Education Programs [Internet]. 2008 [updated 2008 July; cited 2013 Oct 20]. Available from    http://www.rutgerswpf.org/sites/default/files/IM_Toolkit.pdf

Published: October 2013, HPC

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