Introduction to Intervention Mapping

1. Introduction to Intervention Mapping Christine Markham, PhD Susan Tortolero, PhD Center for Health Promotion Research & Development, University of Texas-HSC Houston

2. Session Overview • Introduction to Intervention Mapping • Example: It’s Your Game, Keep it Real! • Small Group Activities: • IM Step 1: Conduct a needs assessment • IM Step 2: Develop change objectives for a health promoting program

3. What is Intervention Mapping? • An evidence-based framework to help health promotion program planners make effective decisions at each step in intervention planning, implementation, and evaluation. • Assessing community health needs • Designing/redesigning programs to be more effective • Evaluating new/existing programs

4. Intervention Mapping Process* Step 1: Conduct Needs Assessment Step 2: Specify Change Objectives Step 3: Select Theory-based Methods & Practical Strategies Step 4: Develop Program Components Step 5: Specify Adoption & Implementation Step 6: Generate Evaluation Plan * Bartholomew, Parcel, Kok, Gottlieb, 2001; 2nd Edition. 2006

5. IM Step 1: Needs Assessment • Review epidemiological data, empirical literature & theoretical literature related to problem area • Collect new data from community • Use PRECEDE risk model to map out needs assessment

6. Community Collaboration • Community Advisory Board • Principals, parents, social service providers, school nurse, religious representatives, pediatrician, sexuality experts, school district representatives • Teen Advisory Board • Multi-ethnic, 7th-9th grade • Houston Independent School District

7. PRECEDE* – RISK MODEL Behavioralfactors Qualityof lifeindicators Personal determinants Healthproblems • Environmentalfactors: • Interpersonal • Organizational • Community • Society * Green & Kreuter, 2000, Health Promotion Planning: An Educational and Environmental Approach

8. Sexual Behavior in Middle School Youth - Final Risk Model Personal Determinants Behavior • Early sexual debut • Multiple partners • Low condom use • Low birth control use • Dating older partners • Alcohol & drug use • Low HIV/STI testing • Student: • Low refusal skills • Low communication skills • Low self-efficacy • Knowledge (condoms/bc) • Low self-esteem • Peer norms • Parental values • Parent: • Low behavioral capability • Self-efficacy • Outcome expectations Health and QOL • Health Problems • STIs, HIV • Teen pregnancy • Reproductive health problems • Quality of Life • School drop out • Reduced job options/income • Increased welfaredependence • Disclosure • Medication Environmental Interpersonal: • Parent-child communic. • Low parental monitoring Community: • Lack of pos. role models. • Societal: • Media influence

9. IM Step 2: Do the What needs to change? Flip! Behavioralfactors Qualityof lifeindicators Personal determinants Healthproblems • Environmentalfactors: • Interpersonal • Organizational • Community • Society

10. IM Step 2: Develop Change Objectives Task 1: State expected changes in behavior and environment Prioritize by importance and changeability

11. Middle School Study:Health-PromotingBehavioral Objectives Students will: • Choose not to have sex • Have healthy relationships with their friends, girlfriends and boyfriends • Use condoms consistently and correctly when having sex. • Use an effective method of birth control along with condoms when having sex. • Get tested for HIV, STIs, pregnancy

12. Environmental Conditions – Interpersonal Level Parents will: EC 1. Communicate with their child about dating, intimate/healthy relationships, and sexual behavior EC 2. Monitor their child’s time, friendships, and dating activities

13. CATCH: Environmental Conditions to Support Dietary Change in Elementary School Children • Behavior (child) Child reduces total fat intake to 30% of calories • Interpersonal level Parents provides snack food options with less than 30% of calories from fat • Organizational level School provides cafeteria meals with less than 30% of calories from fat • Community level Commodities available to schools that can be prepared with less than 30% of calories from fat

14. IM Step 2Task 2: Write Performance Objectives A performance objective is an observable substep of the behavior. Students will not have sex PO1. Decide to not have sex PO2. Communicate your personal limits regarding sex and intimate behaviors PO3. Avoid situations where you could have sex PO4. Refuse to have sex

15. Use Condoms Correctly and Consistently When Having Sex Performance Objectives PO1. Buy/obtain condoms PO2. Carry or have condoms easily available PO3. Negotiate the use of a condom with a partner PO4. Correctly apply condoms during use PO5. Maintain use over time

16. CATCH - Organizational Level: School Provides Meals that are <30% of Calories from Fat • Performance Objectives • Food service directors will modify menus to include more low fat foods • Food service directors will modify purchase order specifications to reduce the fat content of vender prepared food • Nutritionists and cooks will modify recipes to reduce the fat content • Cooks will modify cooking practices to reduce the fat content of prepared foods

17. IM Step 2, Tasks 3 & 4 Task 3: Specify determinants for behaviors & environmental conditions Task 4: Develop matrix of change objectives

18. Partial Matrix for Students Will Not Have Sex

19. IM Step 3:Select Methods and Strategies Atheoretical methodis a general process for influencing changes in the determinants of behavior and environmental conditions A strategy is a practical techniques for the application of methods in ways that fit with the intervention group and the context in which the intervention will be conducted

20. IM Step 4:Producing Program Components • Organize strategies into a program plan that considers implementers and sites • Structure, scope and sequence • Delivery vehicles • Themes • Develop design documents and produce materials • Pretest programs and materials with intervention groups and implementers

21. Scope & Sequence 7th Grade 8th Grade

22. Delivery Vehicles The program consists of 2 main components: Classroom curriculum • Interactive CD-Rom Based Tailored Intervention • Information is tailored to the individual’s gender and sexual risk-taking behaviors

23. Theme: It’s Your Game…Keep It Real • Game = Life • Real = Telling it like it is, being respectful, being responsible, doing the right thing, being yourself, being healthy and happy • How do you keep your game real? • Respecting yourself and respecting others • Playing by your rules

24. How do you play by your rules? • Select your personal rules ahead of time • Detect signs or situations that could challenge your rules (risky situations) • Protect your rules • Avoid risky situations ahead of time • Refusal skills and alternative actions

25. Storyboard for animation or video. Jane “Then get lost jerk” [Pours soda in his lap and leaves]. Apollo …Hmm, that went well.

26. Screen Capture of Virtual 3-D World

27. Example Peer Video: Healthy Relationships

28. Parent-Child Components • Parent-child homework activities • Peer modeling activities in CD-ROM • Parent newsletters • Quizzes • Role model stories from parents • Tips on Communication & Monitoring skills • Other resources

29. IM Step 5: Planning for Adoption, Implementation and Sustainability • Develop a linkage system between developers, adopters & implementers • Create matrices of change objectives for adoption, implementation & institutionalization • Select methods and strategies

30. IM Step 6: Evaluation Plan • Develop evaluation or logic model • Specify evaluation questions • Specify indicators and devise or choose measures • Specify evaluation design

31. Middle School Evaluation • Impact Evaluation • Randomized controlled trial • 10 middle schools (n=1300 7th graders) • Surveys at baseline, 4-, 18-, and 24-months • Use of laptop computers to ensure privacy • Major Constructs • Sexual behavior • Psychosocial variables • Process Evaluation to measure fidelity of implementation

32. 7th Grade Outcomes: Behaviorala a All controlled for ethnicity, age, genderb Among students who had not had sex at baseline c Entire sample, adjusted for baseline status

33. 7th Grade Outcomes: Psychosociala a All controlled for ethnicity, age, gender

34. 7th Grade Outcomes: Psychosociala b All controlled for ethnicity, age, gender b Students responding probably or definitely likely

35. Questions?