Bartholomew et al. (2006). Planning health promotion programs: An intervention mapping
approach. (2nd ed.) Jossey-Bass Inc. (Read chapter 1 Overview of Intervention Mapping pp.
3 – 21 (until Posing Questions, excluding box pp. 4 - 7)).
The purpose of Intervention Mapping is to provide health promotion program planners with a
framework for effective decision-making at each step in intervention planning,
implementation, and evaluation. Health promotion has been defined as combinations of
educational, political, regulatory, and organizational supports for behavior and environmental
changes that are conducive to health (Green & Kreuter, 2005), and health education is a
subset of health promotion applications that are primarily based on education.
Perspectives
Intervention Mapping is a planning approach based on using theory and evidence as
foundations for taking an ecological approach to assessing and intervening in health
problems and engendering community participation.
Theory and Evidence
In this approach, the main focus is on problem-solving, and the criteria for success are
formulated as outcomes related to the problem.
Ecological Models and Systems Thinking
A system consists of activities, actors, and settings that are affected by or affect a certain
problem situation. Planners should understand that interventions are events in systems and
that other factors within a system can reinforce or dampen the influence of an intervention on
the specific behavior or environmental change being targeted.
Participation in Health Promotion Planning
Community participation is described as particularly important for “wicked problems,”
wherein stakeholders may have conflicting interpretations of the problem and the science
behind it, as well as different values, goals, and life experiences. Accordingly, policymakers,
public health professionals, and other stakeholders grappling with these problems cannot
expect to resolve them effectively by relying solely on expert-driven approaches to problem-
solving.
(p. 441)
Ethical Practice of Health Promotion
A systematic, thoughtful planning process can provide part of the roadmap required to
establish ethical health promotion practice.
, ● Program goals should always be related to the health of the public.
● Interventions should be based on thorough evidence to increase the chance of
effectiveness.
● The development of interventions should include diverse participation.
● Intervention planners should consider the rights of persons and take action to protect
them.
Intervention Mapping Steps
Step 1: Logic Model of the Problem
To develop this model, beginning with a health problem, the planning team addresses the
questions:
● What is the problem and who has it?
● How many people have it or will get it?
,Moving to the right, the model explores:
● What quality-of-life effects occur because of this health problem?
Moving to the left of the health problem, the questions focus on causes:
● What behaviors among the priority population may cause the health problem or
make it worse?
● What environmental factors contribute to the health problem either directly or through
behavior?
Finally, the "why" questions are addressed:
● Why do people in the priority population engage in the behavior (risk behavior)?
● Why do people in the environment create conditions that contribute to the health
problem directly or through the behavior of the priority population?
Step 2: Program Outcomes and Objectives and Logic Model of Change
The questions to ask are:
● What needs to change in the behavior of the priority population (behavioral outcome)
or in the environment (environmental outcome)?
Moving to the right:
● What impact will these changes have on the health problem?
Moving toward the left, the "why" questions become:
● Why would the priority population make these changes?
● Why would agents in the environment make these changes?
Step 3: Program Design
Designing the intervention means first matching theory- and evidence-based methods to the
change objectives they are meant to influence and selecting or devising practical
applications to deliver the methods to the various priority populations.
,Step 4: Program Production
The products in this step are all of the support materials needed for an intervention.
Step 5: Program Implementation Plan
The purpose of this step is to design a plan to promote program implementation, beginning
with adoption and extending through maintenance.
To devise an implementation intervention, the planning team will develop new matrices,
using the process from Step 2, with these matrices addressing performance objectives and
determinants of program adoption, implementation, and maintenance.
In this step, the planning team would ask:
● Where can the intervention reach the relevant populations?
● In the chosen venues, who would be in charge of adoption? Implementation?
Maintenance?
● What specific performance would be necessary at each stage?
● What would motivate performance?
Step 6: Evaluation Plan
To evaluate the effect of an intervention, researchers analyze the change in health and
quality-of-life problems, behavior, environment, and their determinants.
Ruiter, R. A., Crutzen, R., Leeuw, E. D., Kok, G., Hagger, M. S., Cameron, L. D., ... &
Lintunen, T. (2020). Changing behavior using theories at the interpersonal, organizational,
community, and societal levels. In M. S. Hagger et al. (Eds.), The handbook of behavior
change (pp. 251-266).
Various factors in an individual’s environment, as well as “social agents” within this
environment, can influence an individual’s behavior. Examples include family and peers,
professionals, organizations, community members, opinion leaders, and policies. In line with
this, planned behavior change programs target not only individuals but also the social
agents who exert an influence on these environments. Examples of these kinds of behavior
change programs include:
● Formation of patient support groups
● Provision of strategies to cope with work stress
● Creation of safer bicycle lanes
● Advocacy for better child health insurance
Researchers targeting people to behave in a healthier or more energy-efficient way can
draw on theories about environmental influences to design behavioral interventions. In this
chapter, these theories and their use at the interpersonal, organizational, community, and
societal levels are described within the framework of a systematic theory- and evidence-
based approach to behavior change.
, 18.1 Introduction: A Problem-Driven and Socioecological Approach
Various “social agents” in an individual’s environment, such as family members and peers,
professionals in organizations, opinion leaders, and policymakers, can have a pervasive
influence when it comes to behavior change.
Two key assumptions from the socioecological approach can guide the identification of
intervention targets for promoting behavior change:
1. Behavior influences and is influenced by multi-level environmental factors.
2. Individual behavior both shapes and is shaped by the environment.
18.2 Theories at the Environmental Level
The major environmental-level theories that have been applied to behavior change
interventions are summarized in Table 18.1.
A stakeholder is any individual, group, or entity that can influence an organization. The more
salient a stakeholder is to the organization, and the more central the stakeholder is in the
network, the stronger the influence.
Planned Behavior Change at Higher Ecological Levels
Consequently, the understanding of a problem is often incomplete, and attempts to solve the
problem may be based on an incorrect or inappropriate conceptualization of it (known as a
“type III error”).
