Planning Behavior Change Programs

1. Planning Behavior Change Programs An Intervention Mapping Approach Gerjo Kok & Gill A. ten Hoor Sydney, 28-02-2017 http://interventionmapping.com

2. Planning Health Promoting Goal Health Promoting Program

3. 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

4. Intervention Mapping Problem HIV+: therapy adherence Objectives Planning skills Methods Modeling Program Hospital Implem. Nurses Evaluation Self-report; observations

5. Intervention Mapping Problem Medication available (Afr.) Objectives Outcome expectation (Poln) Methods Advocacy Program Community action Implem. Patient community / NGO’s Evaluation Observations

6. Perspectives • Theory and research; multi-theory • Ecological model; environment, system • Participations of all stakeholders

7. Systems Theory BB AA BC BD AC a1 KL Attitude T a2 b3 b2 Testing

8. Intervention Mapping • Defining Program Objectives Who, What, Why? • Selecting Methods and Applications How?

9. Intervention Mapping Problem Assessment Defining Program Objectives Selecting Methods and Applications Designing the Program Planning for Program Implementation Planning for Program Evaluation

10. Behavioral factors Health Problem Quality of Life Environmental factors: Agent

11.      Environmental Factors: Agents Society Community Organization Interpersonal Individual

12. Worksheet 1: Problems Behavior: Person Environmental factors: Behavior Family Health Problem Quality of Life Environmental factors: Behavior Community Environmental factors: Behavior Policy

13. Intervention Mapping Problem Assessment Defining Program Objectives Selecting Methods and Applications Designing the Program Planning for Program Implementation Planning for Program Evaluation

14. Behavioral factors Health Problem Quality of Life Environmental factors: Agent

15. What will the priority population do as a result of the health promotion program? How will an environmental condition change as a result of the health promotion program? Behavioral outcomes Health Problem Quality of Life Environmental outcomes

16. Worksheet 2: Outcomes Behavior: Person Environmental outcomes: Behavior Family Health Outcomes Quality of Life Outcomes Environmental outcomes: Behavior Community Environmental outcomes: Behavior Policy

17. Logic Model Why? What? Who? Change objectives Personal determinants Performance objectives Behavioral outcomes Health Quality of Life Change objectives Personal determinants Performance objectives Environmental outcomes 17

18. Logic Model: Performance Objectives 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? Change objectives Personal determinants Performance objectives Performance objectives Behavioral outcomes Health Quality of Life Change objectives Personal determinants Performance objectives Performance objectives Environmental outcomes 18

19. 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

20.      Performance objectives for the environment Society Community Organization Interpersonal Individual What do the agents in the environment need to do to make the environmental change?

21. HIV-Stigma: Which Behaviors?  • Relatives and friends support person with HIV when disclosing • Managers develop policies against stigmatization • Opinion leaders communicate norms for treating every community member with respect regardless of HIV status • Elected officials support programs that provide education and enforcement for nondiscrimination of people with HIV    Page 261-262

22. 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? - -

23. Intervention Mapping • Defining Program Objectives Who, What, Why? • Selecting Methods and Applications How?

24. Why? - Integrated Behavioral Model / RAA Environmental levels Attitudes Expectations Barriers Intention Behavior Intention Social norm Skills Self- efficacy

25. Determinants: Automaticity Social-cognitive determinants predict ‘reasoned action’ Not all behavior is reasoned action

26. Intervention Mapping • Defining Program Objectives Who, What, Why? • Selecting Methods and Applications How?

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

28. The Matrix of Change Objectives'

29. Change Objectives: Who, What, Why? • Answer to the question: What does the target have to learn (determinant) to do the performance objective?

30. Worksheet 4a: Determinants What are the relevant determinants of the target behaviors/performance objectives? Brainstorm Literature Theories Additional research

31. Worksheet 4b: Change Matrices

32. Intervention Mapping Needs Assessment Defining Program Objectives Selecting Methods and Applications Designing the Program Planning for Program Implementation Planning for Program Evaluation

33. Intervention Mapping • Defining Program Objectives Who, What, Why? • Selecting Methods and Applications How?

34. How? - Logic Model of Change Program Methods & Applications Change objectives Change objectives Personal determinants Performance objectives Performance objectives Behavioral outcomes Health Quality of Life Program Methods & Applications Change objectives Change objectives Personal determinants Performance objectives Performance objectives Environmental outcomes 34

35. The Matrix of Change Objectives'

36. The Matrix of Change Objectives'

37. Definitions A theoretical methodis a general technique or process for influencing changes in the determinants of behaviors and environmental conditions. Practical applicationsare 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.

38. 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 HIV+ 38

39. Individual-Level Methods / BCTs

40. Using Methods Correctly Translating methods into applications demands sufficient knowledge of the theory behind the method, the conditions or parameters

41. Using Methods Correctly Theoretical method Parameter Method Determinant Parameter p. 309

42. Using Methods Correctly Modeling according to Social Cognitive Theory Theoretical method Parameter Method Determinant Coping model (not mastery) Relevant skills are present Parameter Modeling Self-efficacy Identification with model Positive reinforcement p. 309

43. 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

44. All program components must have theoretical methods! Parameters/Conditions Select or Design Practical Applications

45. Methods for Skills and Self-Efficacy

46. Methods to Change Communities

47. Methods to Change Policy

48. Worksheet 5: Methods & Applications

49. Intervention Mapping Needs Assessment Defining Program Objectives Selecting Methods and Applications Designing the Program Planning for Program Implementation Planning for Program Evaluation

50. Program • Consult with participants • Create program sequence, themes, delivery channels, and materials • Review available materials • Develop materials: Collaboration • Pretest materials