Planning Behavior Change

Programs

An Intervention Mapping Approach

http://interventionmapping.com

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 Planning

Health
Promoting
Goal

Health
Promoting
Program

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 Theory of Change

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 Intervention Mapping (IM)
• IM is a planning framework that provides a
systematic process and detailed protocol for
effective, step-by-step decision-making for
intervention development, implementation, and
evaluation.
• Assessing community health needs
• Designing/redesigning program to be more effective
• Evaluating new/existing programs

• It is grounded in community based participatory

research methods to ensure that the intervention
matches priority population needs and intervention
contexts.
Bartholomew-Eldredge LK, Markham C, Ruiter RA, Fernandez ME, Kok G, Parcel G. Planning Health Promotion Programs:
An Intervention Mapping Approach. 4th ed. San Francisco, CA: Jossey Bass; (2016).
 Intervention Mapping

• Logic model of the problem

• Program outcomes and objectives (logic
model of change)
• Program design (methods for change)
• Program production
• Program implementation plan
• Evaluation plan

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 Intervention Mapping

• Problem HIV+: therapy adherence

• Objectives Planning skills
• Methods Modeling
• Program Hospital
• Implem. Nurses
• Evaluation Self-report; observations

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 Intervention Mapping

• Problem HIV meds stock out

• Objectives Outcome expectation
• Methods Advocacy
• Program Community action
• Implem. Patient community/NGO’s
• Evaluation Observations

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 Perspectives

• Theory and research; multi-theory

• Ecological model; environment, system

• Participations of all stakeholders

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 Intervention Mapping

• Defining Program Objectives

Who, What, Why?

• Selecting Methods and Applications

How?

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 Intervention Mapping

• Problem Assessment
• Defining Program Objectives
• Selecting Methods and Applications
• Designing the Program
• Planning for Program Implementation
• Planning for Program Evaluation

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 Behavioral
factors

Health Quality of
Problem Life

Environmental
factors: Agent

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Environmental Factors: Agents

ü Society

B Community

F Organization

” Interpersonal

€ Individual

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 Worksheet 1: Problems
Behavior: Person

Environmental factors:
Behavior Family

Health Problem Quality of Life

Environmental factors:
Behavior Community

Environmental factors:
Behavior Policy

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 Intervention Mapping

• Problem Assessment
• Defining Program Objectives
• Selecting Methods and Applications
• Designing the Program
• Planning for Program Implementation
• Planning for Program Evaluation

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 Behavioral
factors

Health Quality of
Problem Life

Environmental
factors: Agent

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What will the priority population do as a result of the health
promotion program?

Behavioral
outcomes

Health Quality of
Problem Life

Environmental
outcomes

How will an environmental condition change as a result of the

health promotion program?

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 Worksheet 2: Outcomes
Behavior: Person

Environmental outcomes:
Behavior Family

Health Quality of Life

Outcomes Outcomes

Environmental outcomes:
Behavior Community

Environmental outcomes:
Behavior Policy

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 Logic Model

Why? What? Who?

Change Personal Performance Behavioral

objectives determinants objectives outcomes

Quality of
Health
Life

Change Personal Performance Environmental

objectives determinants objectives outcomes

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 Logic Model: Performance Objectives

Change Personal Performance Behavioral

objectives determinants objectives outcomes

Quality of
Health
Life

Change Personal Performance Environmental

objectives determinants objectives outcomes

• What do the participants in the program need to do to

perform the behavior?
• What do the agents in the environment need to do to
(perform the behavior to) make the environmental
change?

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 Therapy Adherence for HIV+ Patients
Follow and integrate the treatment plan into daily routine
Handle situations in with the medication is difficult to take
Cope with side effects
Interact and deal with health professionals
Maintain relationships with resource person and immediate social circle

Page 257
 Performance objectives for the environment

ü Society

B Community

F Organization

” Interpersonal

€ Individual

What do the agents in the environment need to do to make

the environmental change?

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 HIV-Stigma: Which Behaviors?
”• Relatives and friends support person with HIV
when disclosing
F• Managers develop policies against
stigmatization
B• Opinion leaders
communicate norms for
treating every community
member with respect
regardless of HIV status
ü• Elected officials support
programs that provide
education and enforcement
for nondiscrimination of people with HIV
Page 261-262
 Worksheet 3: Performance Objectives

• What will the priority population do (as a result

of the intervention?)
-
-
• What will the Community do?
-
-
• What will the Policy makers do?
-
-

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 Intervention Mapping

• Defining Program Objectives

Who, What, Why?

• Selecting Methods and Applications

How?

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 Why? - Integrated Behavioral Model / RAA

Environmental
levels
Attitudes
Expectations
Barriers

Social
Intention Behavior
norm

Skills
Self-
efficacy

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 Determinants: Automaticity

Social-cognitive determinants predict

‘reasoned action’

Not all behavior is reasoned

action

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 Intervention Mapping

• Defining Program Objectives

Who, What, Why?

• Selecting Methods and Applications

How?

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The Matrix of Change Objectives: Who, What, Why?

Determinants
Target group/Agent X
&
Behavior Y Determinant A Determinant B

Performance
Objective 1 Change Objectives:
What does the target
have to learn (determinant)
Performance
to do the performance objective?
Objective 2

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 The Matrix of Change Objectives'

Determinants
Parents:
Managing asthma
in their children Attitudes Self-Efficacy/Skills

P.O.1: 1.A: Expect that if 1.SE: Express

Observe child for symptoms are confidence in being
specific symptoms monitored, asthma can able to recognize
be managed symptoms
P.O.2: 2.A.: Expect that if they 2.SE: Demonstrate
Identify and give give medicine it will not identifying appropriate
medication for harm the child medicines for different
symptoms symptoms

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 Change Objectives: Who, What, Why?

• Answer to the question:

What does the target have to learn
(determinant) to do the performance
objective?

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 Worksheet 4a: Determinants

What are the relevant determinants of the

target behaviors/performance objectives?
Brainstorm
Literature
Theories
Additional research

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 Worksheet 4b: Change Matrices
Target group/Agent X & Determinants
Behavior Y

Determinant A Determinant B

Performance Objective 1 Change Objectives: What does the target have to learn
(determinant) to do the performance objective?

Performance Objective 2

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 Intervention Mapping

• Needs Assessment
• Defining Program Objectives
• Selecting Methods and Applications
• Designing the Program
• Planning for Program Implementation
• Planning for Program Evaluation

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 Intervention Mapping

• Defining Program Objectives

Who, What, Why?

• Selecting Methods and Applications

How?

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 How? - Logic Model of Change

Change Methods & Personal Change Performance Behavioral

Program objectives Applicationsdeterminants objectives objectives outcomes

Quality of
Health
Life

Program
Change Methods & Personal Change Performance Environmental
objectives Applicationsdeterminants objectives objectives outcomes

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 The Matrix of Change Objectives'

Determinants
Parents:
Managing asthma
in their children Attitudes Self-Efficacy/Skills

P.O.1: 1.A: Expect that if 1.SE: Express

Observe child for symptoms are confidence in being
specific symptoms monitored, asthma can able to recognize
be managed symptoms
P.O.2: 2.A.: Expect that if they 2.SE: Demonstrate
Identify and give give medicine it will not identifying appropriate
medication for harm the child medicines for different
symptoms symptoms

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 The Matrix of Change Objectives'

Determinants
Parents:
Managing asthma
in their children Attitudes Self-Efficacy/Skills

P.O.1: 1.A: Expect that if 1.SE: Express

Observe child for symptoms are confidence in being
specific symptoms monitored, asthma can able to recognize
be managed symptoms
P.O.2: 2.A.: Expect that if they 2.SE: Demonstrate
Identify and give give medicine it will not identifying appropriate
medication for harm the child medicines for different
symptoms symptoms

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 Definitions

• A theoretical method is a general technique or

process for influencing changes in the
determinants of behaviors and environmental
conditions.

• Practical applications are specific techniques

for practical use of theoretical methods in ways
that fit the intervention population and the
context in which the intervention will be
conducted.

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 HIV+

• Performance objective
• Patient plans coping responses
• Determinant: Self-efficacy
• Theoretical methods: Modeling
• Practical application
• A videotaped step-by-step demonstration by
patients how to find solutions for difficult
situations

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 Individual-Level Methods / BCTs

Method Definition
and Theory

Modeling Provide an appropriate model being

Social Cognitive reinforced for the desired action
Theory

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 Using Methods Correctly

• Translating methods into applications

demands sufficient knowledge of the
theory behind the method, the conditions
or parameters

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 Using Methods Correctly

Theoretical method
Parameter

Method Determinant

Parameter

p. 309
 Using Methods Correctly

Modeling
Theoretical method
according to
Parameter Social Cognitive
Theory
Method Coping model Relevant skills Determinant
(not mastery) are present

Parameter
Modeling Self-efficacy

Identification Positive
with model reinforcement

p. 309
 Methods at all Levels

• Methods at the individual level

• By determinants, e.g. attitude
• Methods at the environmental level
• By level, e.g. organization
• Combinations
• Persuasion directed at management of
organization

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 Select or Design Practical Applications

All program components must have

theoretical methods!

Parameters/Conditions

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 Methods for Skills and Self-Efficacy
Methods, Definitions, Theory
Modeling: Providing an appropriate
model being reinforced for the
desired action.
e.g. Social Cognitive Theory
Planning coping responses:
Prompting participants to list
potential barriers and ways to
overcome these.
e.g. Relapse Prevention Theory
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Parameters for use
Self-efficacy and skills,
reinforcement of model,
identification with model, coping
model instead of mastery model.
Identification of high-risk
situations and practice of coping
response.
 Methods to Change Communities
Methods, Definitions, Theory
Social action: A form of community
organization, based in conflict, in
which disenfranchised people wrest
power from the official power.
Theories of Power; Stakeholder
Theory
Forming coalitions: Forming an
alliance among individuals or
organizations, during which they
cooperate in joint action to reach a
goal in their own self-interest.
Models of Community Organization
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Parameters for use
Starting where the community is;
may be grassroots or professional
driven. Will often include
consciousness raising,
information about others’
approval and modeling.
Requires collaboration across
various agendas; requires
attention to stages of
partnership development. Will
often include persuasive
communication, consciousness
raising, goal setting, and
facilitation.
 Methods to Change Policy
Methods, Definitions, Theory
Media advocacy: Expose
environmental agents’ behaviors in
the mass media to order to get them
to improve health-related conditions.
A type of advocacy.
Models of Community Organization
Agenda setting: Process of moving
an issue to the political agenda for
action; may make use of broad policy
advocacy coalitions and media
advocacy.
Multiple Streams Theory, Advocacy
Coalition Theory, Theories of Power
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Parameters for use
Requires the media to approve
the news value of the message
and accept the message without
changing its essential content.
Requires appropriate timing (see
policy window) and collaboration
of (media) gatekeepers. Will
often include persuasive
communication and
consciousness raising.
 Worksheet 5: Methods & Applications
Determinants & Methods Parameters Applications
Change objectives

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 Intervention Mapping

• Needs Assessment
• Defining Program Objectives
• Selecting Methods and Applications
• Designing the Program
• Planning for Program Implementation
• Planning for Program Evaluation

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 Program

• Consult with participants

• Create program sequence, themes,
delivery channels, and materials
• Review available materials
• Develop materials: Collaboration
• Pretest materials

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 Structure & Organization of Program

• Program Theme: General organizing construct

• Program Components
• Scope: Breadth & Amount
• Sequence: Order
• Channels and Vehicles:
• Interpersonal: face-to-face
• Mediated: print, TV, Internet, et cetera
• Program Materials

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 Select or Design Practical Applications

All program components must have

theoretical methods!

Parameters/Conditions

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Worksheet 6: Program Structure and Organization

Theme:
Components:
1
2
3
Scope:
Sequence:
Channels & Vehicles:
Interpersonal:
Mediated:
Materials:
1:
2:
3:

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 Intervention Mapping

• Needs Assessment
• Defining Program Objectives
• Selecting Methods and Applications
• Designing the Program
• Planning for Program Implementation
• Planning for Program Evaluation

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Evidence on Implementation Phases

100
90
80
70
60
50
40
30
20
10
0
Aware Adopt Implement Maintain

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Why think about program implementation?

• Because program usefulness or success

depends both on

- Effectiveness &
- Exposure

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 Implementation
=
Behavior

Actor (organizational level), performance

objectives, change objectives, methods,
applications, program, implementation,
evaluation

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 Program Implementation

• An Intervention stimulating Implementation

=
• An Intervention stimulating Behavior Change

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Environmental Agent & Implementers

Implementers
Agents
Target
Agents
Objectives
Objectives
Methods
Methods
Program Implementers Program
Implementation Objectives Implementation
Evaluation Methods Evaluation
Program

Implementation

Evaluation

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Linkage- Orlandi et al, 1990

Linkage
Group

Program Program
Developers Users

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Performance Objectives Patient Education

• Adoption - Nurse
• Review the program
• Identify barriers
• Gain support from administrators
• Implementation - Nurse
• Participate in training
• Deliver all modules

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 Performance Objectives

• Maintenance – Hospital management

• Include program in budget
• Include program in standard training

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 Worksheet 7:
Adoption, Implementation & Maintenance

Who:

What (behavior):

Why (determinants):

How (intervention):

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 Determinants of Implementation Behavior

• Awareness:

• Adoption:

• Implementation:

• Maintenance:

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 Methods to Change Organizations

Methods, Definitions, Theory Parameters for use

Organizational diagnosis and feedback: Methods appropriate to
Assessing of organizational structures and organizational characteristics,
employees’ beliefs and attitudes, desired for example, size, and
outcomes, and readiness to take action, information technology
using surveys and other methods
Organizational development theory

Technical assistance: Providing technical Must fit needs, culture, and

means to achieve desired behavior resources of the recipient
Diffusion of innovations theory

pp. 352-353
Environmental Agent & Implementers

Implementers
Agents
Target
Agents
Objectives
Objectives
Methods
Methods
Program Implementers Program
Implementation Objectives Implementation
Evaluation Methods Evaluation
Program

Implementation

Evaluation

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 Intervention Mapping

• Needs Assessment
• Defining Program Objectives
• Selecting Methods and Applications
• Designing the Program
• Planning for Program Implementation
• Planning for Program Evaluation

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 Evaluation: Planning

• QoL, Health:
• Behavior:
• Environment:
• Determinants of behavior:

• Evaluation: ?
 Evaluation: HIV+ Adherence

• QoL, Health: HIV, HIV+

• Behavior: Therapy adherence
• Environment: Support (Hospital)
• Determinants of behavior: Skills

• Evaluation: Self-report or observation

 Specify Evaluation Design

Effect evaluation:

• How do indicators compare before and

after the program?
Ü pretest and posttest
• Can we attribute changes to the
program?
Ü random assignment, control group
 Conclusions

• Planning

• Theory & Research

• Participation
• Environment

• Implementation
• Evaluation

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“This study has found that disease prevention
interventions that have used the intervention mapping
approach have generally reported significant increases in
the uptake of disease prevention programs.”

https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0174438

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