Chapter 8 Lecture

Chapter 8:
Interventions

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 Intervention

• An intervention (or treatment) is an activity or set of

activities that help to achieve the outcomes stated in the
goals and objectives.
• A theory-based strategy or experience to which those
in the priority population will be exposed or in which
they will take part
• Occurs between two points in time
• An intervention should be effective (leads to desired
outcome) and efficient (uses resources in a responsible
manner).
• Multiplicity – number of components or activities
• Dose – number of program units delivered; how many
times offered
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 Types of Intervention Strategies

• Strategy – “A general plan of action for affecting a health

problem. A strategy may encompass several activities”
(CDC, 2003).
• CDC system of classification for strategies
• More common strategies used by planners
• Categories not independent of each other
• Categories include:
1. health communication
2. health education
3. health policy/enforcement
4. environmental change
5. health-related community service
6. community mobilization
7. other
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 Health Communication Strategies – 1

• Health communication strategies are designed

to inform and influence individual and community
decisions to influence health.
• Usually a part of most interventions and are
useful in reaching many goals and objectives
• High penetration rate
• More cost effective and less
threatening than other strategies

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 Health Communication Strategies – 2

• Tools of health communication include:

• Video and audio teleconferencing
• Telephones
• Individual initiated – e.g., helplines
• Outreach – called by health educator/counselor/coach
• Mass media
• In person
• Printed materials
• Computers, Internet, tailored emails
• A communication channel is the route through which a
message is disseminated to the priority population.

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 Multidirectional Communication Model

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 Health Communication Strategies – 3

• The five communication channels include:

1. Intrapersonal
• Health care, health coaches, hotlines
2. Interpersonal
• Small classes, support groups
3. Organizational
• Church bulletins, company or agency newsletters
4. Mass media
• Newspaper, billboards, magazines, PSAs, and more
5. Social media
• User or consumer generated, organized, and distributed
• Information can be revised or updated almost immediately
• Typically low cost in terms of creation and maintenance
• Facebook, blogs, LinkedIn, Twitter, text messaging

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 Health Communication Strategies – 4

• Motivational Interviewing
• “a collaborative, person-centered form of guiding to
elicit and strengthen motivation for change” (Miller &
Rollnick, 2009, p. 137)
• A process in which the trained professional helps guide
an individual to identify internal motivation for change.
• Four principles of Motivational Interviewing:
1. Express empathy
2. Develop discrepancy
3. Roll with resistance
4. Support self-efficacy

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 Health Communication Strategies – 5

• POST
• Assists program planners in creating health
promotion interventions that include social
media (Thackeray & Bennion, 2009)

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 Health Communication Strategies – 6

• Health Literacy
• the degree to which individuals have the capacity to
obtain, process, and understand basic health information
and services to make appropriate health decisions
(USDHHS, 2000)
• Health Numeracy
• “the degree to which individuals have the capacity to
access, process, interpret, communicate, and act on
numerical, quantitative, graphical, biostatistical, and
probabilistic health information needed to make effective
health decisions” (Golbeck et al., 2005, p. 375)
• Health education specialists need to work to ensure that the
health communication interventions are appropriate for their
priority population.

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 Health Education Strategies – 1

• Ten general principles of learning

(keep in mind before and during curriculum design)
1. Appeal to multiple senses (e.g., seeing, hearing,
speaking).
2. Get the learner active in the learning process.
3. Limit distractions.
4. Make sure they are ready to learn.
5. Make the subject relevant to the participants.
6. Use repetition.
7. Make sure learning is recognized and encouraged.
8. Move from simple to complex concepts.
9. Make concept applicable to several settings, generalize.
10. Find an appropriate pace.

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 Health Education Strategies – 2

• Health education and health

communication are not mutually exclusive
categories.
• Health education provides the opportunity
to gain in-depth knowledge about a particular
health topic.
• Curriculum (course of study) – what those
in the priority population will be taught
• Scope – refers to breadth and depth of
material covered
• Sequence – defines the order in which the
material is presented
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 Health Education Strategies – 3

• Unit plan – “An orderly, self-contained collection

of activities educationally designed to meet a set
of objectives. Other terms for this are curriculum
plans, modules, and strands” (Gilbert et al., 2011,
p. 188).
• Units of study are subdivided into lessons;
outlines for the lessons are called lesson
plans; lesson plans are composed of
introduction, body, and conclusion.
• Many methods for presenting lessons:
lecture/discussion, group work, using
audiovisuals, etc.

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 Health Education Strategies – 4

• Kinzie’s (2005) modification of Gagne’s “Events of

Instruction”
1. Gain attention (convey health threats and benefits).
2. Present stimulus material (tailor message to
audience knowledge and values, demonstrate
observable effectiveness, make behaviors easy to
understand and do).
3. Provide guidance (use trustworthy models to
demonstrate).
4. Elicit performance and provide feedback (for
proficiency and self-efficacy).
5. Enhance retention and transfer (social support and
behavioral cues).
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 Example Lesson Plan Format

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 Health Policy / Enforcement Strategies – 1

• Include executive orders, laws, ordinances,

policies, position statements, regulations, and
formal/informal rules
• Mandated or regulated activities; e.g., state
laws to raise cigarette taxes
• May be controversial; may be political, can
take away freedoms, pride, $, psyche
• Based on common good; protect the
public's health

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 Health Policy / Enforcement Strategies – 2

• Six phases of policy making (Block, 2008)

1. Agenda setting
2. Policy formulation
3. Policy adoption
4. Policy implementation
5. Policy assessment
6. Policy modification

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 Environmental Change Strategies – 1

• Have been most useful in providing

“opportunities, support, and cues to help people
develop healthier behaviors” (Brownson, Haire-Joshu, &
Luke, 2006, p. 342)
• They help remove barriers to change in the
environment.
• Removing environmental barriers often helps
to make the healthier choice the easier
choice.
• Environmental change strategies are
characterized by changes “around” individuals
and are not limited to the physical environment.
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 Environmental Change Strategies – 2

• Other environments include:

• Economic environment
• financial costs, affordability
• Service environment
• accessibility to health care or patient education
• Social environment
• social support, peer pressure
• Cultural environment
• traditions of an ethnic group
• Psychological environment
• emotional learning environment
• Political environment
• support for healthy environments

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 Environmental Change Strategies – 3

• One “environment” that has received increased attention

in recent years is the built environment.
• “an interdisciplinary area of focus that describes the
design, construction, management, and land use of
human-made surroundings as an interrelated whole,
as well as their relationship to human activities over
time” (Coupland, Rikhy, Hill, & McNeil, 2011, p. 6)
• The built environment can be structured to give people
more or fewer opportunities to behave in health
enhancing ways.
• Environmental change strategies often are more
effective when combined with intervention strategies
from the other categories.

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 Health-Related Community Service
Strategies
• Examples include:
• HRAs/HHAs
• Clinical (biometric) screenings – BP,
cholesterol, glucose
• Services, tests, or treatments to improve
health – flu shots and other immunizations
• Check-ups, exams
• Reduce barriers to the services – be mindful of
affordability, accessibility.
• Referrals and follow-ups are important; link with
priority population’s health care providers.
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 Community Mobilization Strategies – 1

• “Community mobilization strategies involve

helping communities identify and take action on
shared concerns using participatory decision
making, and include such methods as
empowerment” (Barnes, Neiger, & Thackeray, 2003, p. 60).
• Community organizing – “the process by which
community groups are helped to identify
common problems or goals, mobilize resources,
and in other ways develop and implement
strategies for reaching the goals they have
collectively set” (Minlkler & Wallerstein, 2005, p. 26)

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 Community Mobilization Strategies – 2

• Community building – “an orientation to a

community that is strength-based rather than
need based and stresses the identification,
nurturing, and celebrating of community assets”
(Minkler, 2005a, p. 4)
• Community advocacy – process in which those
in the community become involved in the
institutions and decisions that impact their lives

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 Community Mobilization Strategies – 3

• There are seven different ways of advocating for health

and health education:
• Influencing voting behavior
• Electioneering
• Direct lobbying
• Integrating grassroots lobbying into direct lobbying
efforts
• Use of Internet
• Media advocacy — newspaper letters to the editor
and opinion-editorial (op-ed) articles
• Media advocacy — acting as a resource person

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 Other Strategies – 1

• Behavior Modification Activities

• Often used in intrapersonal-level
interventions, include techniques
intended to help those in the
priority population experience a
change in behavior
• Based on SR theory
• Process
• Keep records (logs, diaries,
journals) for a period of time
• Analyze the records
• Create a plan to modify
the behavior

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 Other Strategies – 2

• Organizational Cultural Activities

• Like people, organizations also have a
“culture.”
• Consists of norms and traditions that are
generated by and linked to the community
• The culture of an organization expresses what
is and what is not considered important for the
organization.
• Should begin with an assessment or cultural
audit to determine if the culture hinders or
supports health promotion

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 Other Strategies – 3

• Incentives (i.e., carrot; receiving)

• “An anticipated positive or desirable reward designed
to influence performance of an individual or group”
(Chapman, 2005a, p. 6)
• Matching motivation and incentives
• Types — social, material, miscellaneous
• Disincentives (i.e., stick; taking away)
• Discourages behavior
• “An anticipated negative or undesirable consequence
designed to influence performance of an individual or
group” (Chapman, 2005, p. 6)
• Can range from intrapersonal (e.g., surcharge) to
public policy levels (e.g., cigarette taxes)
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 Other Strategies – 4

• Incentives/Disincentives (cont’d)
• Behavioral economics is a method of analysis
that applies psychological insights into decision
making.
• Behavioral economics insights state that
individuals:
1. Are more concerned about avoiding losses than
acquiring gains
2. Are comfortable with status quo and do not want to
change

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 Other Strategies – 4 (cont’d)

3. Are aware of social norms and want to conform

4. Experience decision fatigue (i.e., choice overload)
and put off difficult choices
5. Use heuristics (i.e., shortcuts or quick answers)
because of decision fatigue
6. Have trouble evaluating probabilities associated
with health decisions
7. Overvalue the present outcomes of decision and
discount the future outcomes (i.e., present bias;
Arhraf, 2013; Riedel & Calao, 2014)

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 Other Strategies – 5

• Incentives/Disincentives (cont’d)
• Regulated by HIPAA
• GINA—treating genetic information as protected health
information (PHI)
• Remove any financial incentives or penalties if genetic
information is collected in the HRA
• Employers cannot discriminate against their employees
because of a “health status related factor” with the
outcome affecting coverage or cost to the employee under
a group or individual health plan (Chapman, 2005a).
• In other words, employers cannot deny coverage or
charge employees more because of health status related
conditions such as high blood pressure or high blood
cholesterol.

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 Other Strategies – 6

• Incentives/Disincentives (cont’d)
• ACA further refined rules associated with how incentives
could be used in programs that are a part of group health
insurance plans.
• Makes a distinction between participatory wellness
programs and health-contingent wellness programs
• A participatory wellness program is one that does
not provide an incentive or does not tie an incentive to
a health factor.
• A health-contingent wellness program is one that
requires individuals to meet a specific health-related
standard to obtain an incentive.
• Because health-contingent wellness programs have the
potential to discriminate based on health status, the
ACA also includes extra rules for these programs.
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 Other Strategies – 7

• Social Support Activities

• Many people find it much easier to change a
behavior if those around them provide
support or are willing to be partners in the
behavior change process.
• Social support can work as an incentive.
• Types of social support include:
• Support groups (e.g., Weight Watchers,
Overeaters Anonymous)
• “Buddy” systems; can be used with contests
and contracts
• Social gatherings
• Social networks – a web of social relationships
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 Creating Health Promotion Interventions

• Once program planners have completed a

needs assessment, written program goals and
objectives, and considered different types of
intervention strategies, they are in a position to
begin designing an appropriate intervention.
• There is no one best way of intervening to
accomplish a specific program goal that can be
generalized to all priority populations.

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 Guidelines for Successful Health Promotion
Programs
• Well-planned and successful health promotion programs have
common characteristics such as:
1. Addressing one or more risk factors of the priority
population;
2. Being theory-driven;
3. Being based on the best possible evidence (see the
discussion of scientific evidence later in the chapter);
4. Adhering to professional ethical standards;
5. Being culturally appropriate;
6. Being consistent with professional criteria, guidelines, or
codes of practice (e.g., America College of Sports
Medicine’s guidelines for exercise programs (ACSM, 2014))
7. Using resources efficiently; and
8. Including an evaluation component.
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 Items to Consider When Creating a Health
Promotion Intervention

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 Designing Appropriate Interventions

• Key Terms
• Best practices – using interventions that have
undergone critical review of multiple research and
evaluation studies (Green & Kreuter, 2005)
• Best experiences – fall short of best practices but
show promise
• Best processes – original interventions based on theory
• Segmenting – dividing a broader population into
smaller groups
• Culturally sensitive – interventions “that are relevant
and acceptable within the cultural framework of the
population to be reached” (Frankish, Lovato, and
Shannon, 1998)
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 Adapting a Health Promotion Intervention

• Planners should use the best available evidence

to help create an intervention.

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 Limitations of Interventions

• Even well-planned interventions are not always

successful in achieving the expected outcomes.
• Most interventions come with some limitations.
• Sleet (2015) noted in order for engineering and
technology innovations to be successful in preventing
injuries they must be:
• effective and reliable
• acceptable to those for whom they were intended
• easy to use
• used properly
• The same or similar limitations could be applied to the
other categories of intervention strategies.

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