Health Psychology 2022 | AM_470730
Assignment 1: mHealth Intervention Plan
MANAGE AD WITH ME
A self-management mHealth intervention for young adults to cope
with Atopic Dermatitis and increase quality of life
Date: 21/10/20222
University: Vrije Universiteit Amsterdam
Word count: 4427
,Table of contents
1. Step 1 – Logic Model of the Problem 3
1.1. Needs assessment 3
1.1.1. Health and quality of life problems 3
1.1.2. Behavioral and environmental causes 4
1.1.3. Determinants of behavior 4
1.2. Intervention context 5
1.3. Logic Model of the Problem 5
1.4. Program goals 6
2. Step 2 – Logic Model of Change 7
2.1. Behavioral outcomes and performance objectives 7
2.2. Environmental outcomes and performance objectives 8
2.3. Selection of determinants 8
2.4. Matrices of change objectives 9
2.5. Logic Model of Change 12
3. Step 3 – Program production 13
3.1. Program theme 13
3.2. Change methods 14
3.3. Practical applications 15
4. Step 4 – Program design 24
4.1. Program materials (mHealth application prototype) 24
References 30
Rebuttal to the received peer-feedback 35
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,1. Step 1 – Logic Model of the Problem
In step 1 of Intervention Mapping (IM) the needs assessment will be conducted, the description of
the intervention context and a Logic Model of the Problem will be constructed and program goals will
be formulated.
1.1. Needs assessment
1.1.1. Health and quality of life problems
Skin diseases are one of the most common illnesses that cause human health burdens (Hay et al.,
2014). The World Health Organization (WHO) stated that Atopic Dermatitis (AD) is one of many
neglected skin diseases, despite its visible characteristics (Hay et al., 2014; WHO, 2018).
AD is also called atopic or constitutional eczema and is a non-contagious chronic
inflammatory disease on the skin (UMC Utrecht, 2022). The most common symptoms for adults with
AD are suffering from itchiness and pain problems (Amer et al., 2017). AD affects up to 20% of
children and up to 3% of adults worldwide (Nutten, 2015). In the Netherlands -in 2020- there were
estimated 375.500 people who received care for AD. The annual prevalence was estimated at
2.283.100 people, this concerns all people known to the general practitioner (GP), regardless of
whether they received care for this disease. Besides, more women than men have AD, 209.900
women and 165.600 men. Due to demographic developments such as; population growth, age and
income, the absolute number of persons with AD is expected to increase with 12% in a period of
2018-2040 (VZinfo, 2022-a).
Although AD is often described as a childhood disease, population-based outcomes from cross-
sectional research suggest that adult disease prevalence may be similar and even equally common in
adults and children. Self-management skills to cope with AD can be very difficult during early
adulthood and adolescence. The difficulty is related to the insufficient transition process that young
adults have to face. Before the age of eighteen their family was responsible and supportive to cope
with AD (Greenwell et al., 2021). This progress towards taking a more active role leads to
uncertainties in the treatment and management of their own disease (Greenwell et al., 2021; Lundin
et al., 2021).
The burden of AD on young adults is extensive and the effects are multi-dimensional with
implications for mental health, work productivity and Quality of Life (QoL). The symptoms of AD as
well as the demands of treatments often contribute to a significant impact on patients' QoL (Ali et al.,
2020).
The symptom ‘itching’ causes a higher negative impact on QoL. Itching depends on the irritation of
receptors in the skin and thereby the processing of sensory information by the central nervous
system
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, (CNS); brain and spinal cord. Severe itching disrupts the stress response, resulting in disorders of skin
repair, and micro changes in the areas in the CNS responsible for the perception of itching
(Chernyshov, 2016). According to Capec et al. (2022) psychological stress may be an essential factor
that leads to increased itching and scratching and thereby exacerbating skin damage.
Furthermore AD showed positive associations with a lifetime prevalence of self-reported
chronic fatigue syndrome, burnout, depression, sleeping disorder and suicide (Capec et al., 2022;
Zhang et al., 2022). Individuals dealing with AD need more than just physical treatment of their
symptoms. Support for patients on educational and psychological levels in addition to medical
treatment may improve their long-term outcomes and therefore QoL (Mozaffari et al., 2007).
1.1.2. Behavioral and environmental causes
Causes of AD are a complex interplay between different behavioral and environmental factors
(Kantor & Silverberg, 2017). Behavioral causes that enhance symptoms of AD are: smoking habits of
more than 15 packages per year, alcohol consumption of more than 2 glasses per day and both
shorter (7 or less hours a day) and longer (more than 9 hours a day) sleep duration (Zhang et al.,
2022). Other causes are ineffective stress-management, decision-making and individual use of
skincare products (Van de Ven et al., 2006; Greenwell et al., 2021). On the other hand, the non-
behavioral causes are several social demographics such as gender, age and ethnicity (Van de Ven et
al., 2006).
Environmental causes include residential areas (urban and industry), food and other
exogenous factors and a lack of social support (Kantor & Silverberg, 2017). Unsupportive social
factors, such as conflicts in the family, partnership, or workplace may trigger stress which can
exacerbate AD symptoms. However, a supportive social environment can be beneficial for people
with AD (Luschkova et al., 2021). Since social support in this case is related to the behavior of the
patients, seeking social support, from now on will be treated as a behavioral outcome.
1.1.3. Determinants of behavior
There are several personal determinants of behavior that can influence AD self-management. A lack
of self-monitoring, motivation, emotional burden, perceived control, knowledge, skills, self-efficacy,
and attitude are mentioned as influencing factors (Cline et al., 2022; Evers et al., 2009; Greenwell et
al., 2021; Greenwell et al., 2022; Lundin et al., 2021; Vazquez-Ortiz et al., 2020).
Firstly, young adults have a lack of self-monitoring of their own itch and scratching behavior
(Evers et al., 2009). Most of them report the emotional burden of accepting their condition and
continuous care. They are embarrassed by their condition and this often leads to denial of symptoms,
intentional non-adherence, and a negative association with healthcare providers. There is also a lack
of motivation to take responsibility of their AD management (Vazquez-Ortiz et al., 2020). Besides
that,
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