Intervention mapping

Intervention mapping[1] is a protocol for developing theory-based and evidence-based health promotion programs. Intervention Mapping describes the process of health promotion program planning in six steps:

  1. the needs assessment based on the PRECEDE-PROCEED model
  2. the definition of performance and change objectives based upon scientific analyses of health problems and problem causing factors;
  3. the selection of theory-based intervention methods and practical applications to change (determinants of) health-related behavior;
  4. the production of program components, design and production;
  5. the anticipation of program adoption, implementation and sustainability; and
  6. the anticipation of process and effect evaluation.

Intervention mapping is characterized by three perspectives: an ecological approach, participation of all stakeholders, and the use of theories and evidence. Although intervention mapping is presented as a series of steps, the authors see the planning process as iterative rather than linear.[1] Program planners move back and forth between tasks and steps. The process is also cumulative: each step is based on previous steps, and inattention to a particular step may lead to mistakes and inadequate decisions.

Brief history and purpose of the protocol

Intervention mapping was first developed and introduced in 1998 by L. Kay Bartholomew, Guy S. Parcel & Gerjo Kok,[2] with an article in Health Education & Behavior. In 2001 the first edition of the book followed, with Nell H. Gottlieb as 4th author.[3] In 2006, the 2nd edition was published,[4] and in 2011, the 3rd edition, with Maria E. Fernández as 5th author.[5] The 4th edition appeared in 2016, authored by L. Kay Bartholomew Eldridge, Christine M. Markham, Robert A.C. Ruiter, Maria Fernández, Gerjo Kok & Guy S. Parcel.[1] This was the last edition led by L. Kay Bartholomew Eldridge, who passed away in February 2016.

Intervention mapping was developed as a reaction to a lack of comprehensive frameworks for health promotion program development.[2] Intervention mapping aims to help health promoters develop the best possible intervention. The key words in this protocol are planning, research, and theory. Intervention mapping provides a vocabulary for intervention planning, procedures for planning activities, and technical assistance with identifying theory-based determinants and methods for change. Intervention mapping can also help in adapting existing interventions to new populations and settings,[5] and provides a taxonomy of behavior change methods that can be used to code intervention content.[6][7] In the health promotion field, intervention mapping has successfully been applied in various settings, to a wide range of different behaviors and populations.[5] It may help planners develop theory- and evidence-based interventions to promote healthy behavior.

More specifically, intervention mapping ensures that theoretical models and empirical evidence guide planners in two areas: (1) the identification of behavioral and environmental determinants related to a target problem, and (2) the selection of the most appropriate theoretical methods and practical applications to address the identified determinants. Intervention mapping has been described as complex and elaborate.[8][9][10] However, this is crucial to bring the development of interventions to a higher level,[11] indicating that advantages outweighed disadvantages. Intervention mapping is developed in the health promotion field but can easily be applied in other fields, such as promoting energy conservation.[12]

Steps and tasks
  • Step 1: Logic Model of the Problem
    • Establish and work with a planning group
    • Conduct a needs assessment to create a logic model of the problem
    • Describe the context for the intervention including the population, setting, and community
    • State program goals
  • Step 2: Program Outcomes and Objectives – Logic Model of Change
    • State expected outcomes for behavior and environment
    • Specify performance objectives for behavioral and environmental outcomes
    • Select determinants for behavioral and environmental outcomes
    • Construct matrices of change objectives
    • Create a logic model of change
  • Step 3: Program Design
    • Generate program themes, components, scope, and sequence
    • Choose theory- and evidence-based change methods
    • Select or design practical applications to deliver change methods
  • Step 4: Program Production
    • Refine program structure and organization
    • Prepare plans for program materials
    • Draft messages, materials, and protocols
    • Pretest, refine, and produce materials
  • Step 5: Program Implementation Plan
    • Identify potential program users (implementers, adopters, and maintainers)
    • State outcomes and performance objectives for program use
    • Construct matrices of change objectives for program use
    • Design implementation interventions Implementation
  • Step 6: Evaluation Plan
    • Write effect and process evaluation questions
    • Develop indicators and measures for assessment
    • Specify the evaluation design
    • Complete the evaluation plan
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See also
  1. Behavior change (public health)
  2. Behavioural change theories
  3. Health psychology

References and bibliography
  1. Bartholomew Eldridge, L. K., Markham, C. M., Ruiter, R. A. C., Fernàndez, M. E., Kok, G., & Parcel, G. S., 2016. Planning health promotion programs; an Intervention Mapping approach, 4th Ed. San Francisco, CA: Jossey-Bass. ISBN 978-1119035497
  2. Bartholomew, L.K., Parcel, G.S. & Kok, G., 1998. Intervention Mapping: a process for designing theory- and evidence-based health education programs. Health Education & Behavior, 25, 545-563.
  3. Bartholomew, L.K., Parcel, G.S., Kok, G. & Gottlieb, N.H., 2001. Intervention mapping; designing theory- and evidence-based health promotion programs. Mountain View, CA: Mayfield.
  4. Bartholomew, L. K., Parcel, G. S., Kok, G., & Gottlieb, N. H. (2006). Planning health promotion programs: an Intervention Mapping approach (2nd ed.). San Francisco, CA: Jossey-Bass.
  5. Bartholomew, L. K., Parcel, G. S., Kok, G., Gottlieb, N. H., & Fernández, M.E., 2011. Planning health promotion programs; an Intervention Mapping approach, 3rd Ed. San Francisco, CA: Jossey-Bass.
  6. Schaalma, H. & Kok, G. (2009). Decoding health education interventions: The times are a-changin'. Psychology & Health, 24, 5-9. DOI: 10.1080/08870440801995802
  7. Kok, G., Gottlieb, N. H., Peters, G.-J. Y., Mullen, P. D., Parcel, G. S., Ruiter, R. A. C., Fernández, M. E., Markham, C., & Bartholomew, L. K. (2015). A Taxonomy of behavior change methods; an Intervention Mapping approach. Health Psychology Review, accepted author version posted online. DOI:10.1080/17437199.2015.1077155
  8. Côté J. C., Godin G., Garcia P. L., Gagnon M., Rouleau G. (2008). Program development for enhancing adherence to antiretroviral therapy among persons living with HIV. AIDS Patient Care STDs, 22, 965–75. DOI: 10.1089/apc.2008.0124
  9. Heinen M. M., Bartholomew L. K., Wensing, M., van de Kerkhof, P., van Achterberg, T. (2006). Supporting adherence and healthy lifestyles in leg ulcer patients: systematic development of the lively legs program for dermatology outpatient clinics. Patient Education & Counseling, 61, 279–91. DOI 10.1016/j.pec.2005.04.007
  10. van Kesteren, N. M., Kok, G., Hospers, H. J., Schippers, J., de Wildt, W. (2006). 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 STDs, 20, 858–75.
  11. Godin G., Gagnon H., Alary M., Levy J. J., Otis J. (2007). The degree of planning: an indicator of the potential success of health education programs. Promotion & Educaction, 14, 138–42.
  12. Kok, G., Lo, S.H., Peters, G-J.Y. & Ruiter, R.A.C., 2011. Changing energy-related behavior: An Intervention Mapping approach. Energy Policy, 39, 5280-5286. DOI: 10.1016/j.enpol.2011.05.036

Further reading
  1. Koutoukidis, D.A., Lopes, S., Atkins, H., Croker, H., Knobf, M.T., Lanceley, A. & Beeken, R.J., (2018). Use of intervention mapping to adapt a health behavior change intervention for endometrial cancer survivors: the shape-up following cancer treatment program. BMC Public Health, 18:415. doi:10.1186/s12889-018-5329-5
  2. Schaalma, H. & Kok, G. (2011). Case study 3: A school HIV-prevention program in the Netherlands. Case study on the companion site for Bartholomew et al. (2011). http://bcs.wiley.com/he-bcs/Books?action=resource&bcsId=6279&itemId=0470528516&resourceId=23357
  3. Bartholomew, L. K., & Mullen, P. D. (2011). Five roles for using theory and evidence in the design and testing of behavior change interventions. Journal of Public Health Dentistry, 71, S20–S33. doi:10.1111/j.1752-7325.2011.00223.x
  4. Abraham, C., Kok, G., Schaalma, H.P. & Luszczynska, A. (2011). Health promotion. In: P.R. Martin, F.M. Cheung, M.C. Knowles, M. Kyrios, L. Littlefield, J.B. Overmier & J.M. Pieto (Eds.), IAAP handbook of applied psychology (pp. 81–111.). Oxford, UK: Wiley Blackwell.
  5. Leerlooijer, J.N., Ruiter, R.A.C., Reinders, J., Darwisyah, W., Kok, G. & Bartholomew, L.K. (2011). The World Starts With Me: using Intervention Mapping for the systematic adaptation and transfer of school-based sexuality education from Uganda to Indonesia. Translational Behavioral Medicine, 1, 331–340. doi:10.1007/s13142-011-0041-3
  6. Vereecken, C., Huybrechts, I., van Houte, H., Martens, V., Wittebroodt, I. & Maes, L. (2009). Results from a dietary intervention study in preschools "Beastly Healthy at School". International Journal of Public Health, 54, 142–149. doi:10.1007/s00038-009-8028-2
  7. Kok, G., Gottlieb, N.H., Commers. M. & Smerecnik, C. (2008). The ecological approach in health promotion programs; A decade later. American Journal of Health Promotion, 22, 437-442.
  8. Godin, G., Gagnon, H., Alary, M., Levy, J.J. & Otis, J. (2007). The degree of planning: an indicator of the potential success of health education programs. Promotion & Education, XIV (3), 138-142.
  9. Tortolero, S. R., Markham, C. M., Parcel, G. S., Peters, R. J., Jr., Escobar-Chaves, S. L., Basen-Engquist, K., et al. (2005). Using Intervention Mapping to adapt an effective HIV, sexually transmitted disease, and pregnancy prevention program for high-risk minority youth. Health Promotion Practice, 6, 286–298. doi:10.1177/1524839904266472
  10. Fernández, M. E., Gonzales, A., Tortolero-Luna, G., Partida, S., & Bartholomew, L. K. (2005). Using Intervention Mapping to develop a breast and cervical cancer screening program for Hispanic farmworkers: Cultivando La Salud. Health Promotion Practice, 6, 394–404. doi:10.1177/1524839905278810
  11. Kok, G., van Essen, G.A., Wicker, S., Llupià, A., Mena, G., Correia, R. & Ruiter, R.A.C., (2011). Planning for influenza vaccination in health care workers: an Intervention Mapping approach. Vaccine, 29, 8512–8519. doi:10.1016/j.vaccine.2011.09.008
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