Planning theory- and evidence-based behavior change interventions: a conceptual review of the intervention mapping protocol

Kok, Gerjo; Peters, Louk W. H.; Ruiter, Robert A. C.

doi:10.1186/s41155-017-0072-x

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Health Psychology, REVIEW • Psicol. Reflex. Crit. 30 • 2017 • https://doi.org/10.1186/s41155-017-0072-x copy

Planning theory- and evidence-based behavior change interventions: a conceptual review of the intervention mapping protocol

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Abstract

This paper discusses the Intervention Mapping (IM) protocol for planning theory- and evidence-based behavior change interventions. IM has been developed in the field of health promotion in 1998 and has mostly been applied in that field, but applications in other fields are emerging. IM can be used for any intervention that involves changing behavior. The paper discusses the protocol and its basic issues and presents in-depth examples of its use in- and outside the health promotion field: Empowerment, return to work, safety interventions, implementation, energy conservation, and academic performance. IM is characterized by three perspectives: a social ecological approach, participation of all stakeholders, and the use of theories and evidence. Through a series of six iterative steps - from needs assessment to implementation and evaluation - which are each broken down into specific tasks, correct application of the protocol is meant to produce behavior change interventions that fit into the local context and that have the best chances of effectiveness. IM helps intervention planners develop the best possible interventions targeting health behaviors, but also targeting behaviors related to other societal issues, such as environmental concerns, safety and discrimination.

Keywords:
Intervention Mapping; Behavior change; Health promotion; Intervention; Theory; Participation; Ecological

Performance objectives	Determinants
Performance objectives	Awareness	Attitude	Self-efficacy
1. Older adults monitor their recreational physical activity level	Older adults describe the purpose of monitoring and reporting their own recreational physical activity		Older adults express confidence about being able to monitor and report their own recreational physical activity
2. Older adults indicate reasons to be physically active as recreation	Older adults list the personally relevant benefits of being sufficiently physically active	Older adults express a positive attitude about being sufficiently physically active
3. Older adults identify solutions to take away the barriers to being physically active for recreation	Older adults describe the situations and barriers that prevent them from being sufficiently physically active		Older adults express confidence about being able to take away and to cope with their barriers

Methods, theory & definitions	Parameters for use	Examples of applications
Example of basic method at the individual level
Modeling: Providing an appropriate model; being reinforced for the desired action (Social Cognitive Theory, theories of learning; Kazdin, 2012Kazdin, A. E. (2012). Behavior modification in applied settings. (7th ed.). Long Grove, IL: Waveland Press.; Kelder et al. 2015Kelder, S., Hoelscher, D., & Perry, C. L. (2015). How individuals, environments and health behaviors interact: Social cognitive theory. In K. Glanz, B. K. Rimer, & K. Viswanath (Eds.), Health behavior: Theory, research, and practice (5th ed., pp. 159–182). San Francisco, CA: John Wiley & Sons.)	Attention, remembrance, self-efficacy and skills; reinforcement of the model; identification with model; coping model instead of mastery model.	The health promoter finds a role model from the community or at-risk group who will encourage identification and serve as a coping model: “I tried to quit smoking several times and failed; then I tried… Now I have been off cigarettes for…”
Example of method to change habitual, automatic, and impulsive behavior
Cue altering: Teaching people to change a stimulus that elicits or signals a behavior (Theories of goal directed behavior, theories of automatic, impulsive and habitual behavior; Verplanken & Aarts, 1999Verplanken, B., & Aarts, H. (1999). Habit, attitude, and planned behaviour: Is habit an empty construct or an interesting case of goal-directed automaticity? European Review of Social Psychology, 10, 101–134. doi:10.1080/14792779943000035 https://doi.org/10.1080/1479277994300003... ; Wood & Neal, 2007Wood, W. & Neal, D. T. (2007). A new look at habits and the habit-goal interface. Psychological Review, 114, 843–863. doi:10.1037/0033-295X.114.4.843 https://doi.org/10.1037/0033-295X.114.4.... )	Existing positive intention.	Dieters change the places they keep snack food in order to prevent taking the snack automatically.
Example of basic method for change of environmental conditions
Coercion: Attempting to control others against their will (Freudenberg & Tsui, 2014Freudenberg, N. & Tsui, E. (2014). Evidence, power, and policy change in community-based participatory research. American Journal of Public Health, 104,11–14. doi:10.2105/AJPH.2013.301471 https://doi.org/10.2105/AJPH.2013.301471... ; Turner, 2005Turner, J. C. (2005). Explaining the nature of power: A three-process theory. European Journal of Social Psychology, 35, 1–22. doi:10.1002/ejsp.244 https://doi.org/10.1002/ejsp.244... )	Requires or creates a power difference.	Health promotion activists organize a consumer boycott of a company that sells formula in developing countries.
Example of method to change social support and social networks
Developing new social network linkages: Linking members to new networks by mentor programs, buddy systems, and self-help groups (Theories of social networks and social support; Holt-Lundstad & Uchino, 2015Holt-Lunstad, J., & Uchino, B. (2015). Social support and health. In K. Glanz, B. K. Rimer, & K. Viswanath (Eds.), Health behavior: Theory, research and practice (pp. 183–204). San Francisco, CA: Jossey-Bass.; Valente, 2015Valente, T. (2015). Social networks and health behavior. In K. Glanz, B. K. Rimer, & K. Viswanath (Eds.), Health behavior: Theory, research and practice (5th ed.a, pp. 204–222). San Francisco, CA: John Wiley & Sons.)	Willingness of networks to reach out; availability of networks that can provide appropriate support and linkage agents.	Volunteers who are breast cancer survivors are linked to newly diagnosed patients to provide emotional and informational support.

Lessons and Goals	Practical Applications
Lesson 1: To Increase knowledge and to change risk perceptions	Inquiry teaching Classroom discussion Exercises to apply the information that is provided (e.g., making an information brochure, completing a quiz, interviewing peers) Teachers lecture and experts give information in print
Lesson 2: To change attitudes about condom use and safer sex in general	Classroom discussion on the basis of a homework assignment addressing facts about AIDS and sexually transmitted infection (STI) prevention Role-model stories in print material covering attitudes about safe sex and problems with practicing safe sex Classroom discussion on the basis of statements about practicing safe sex (students respond to statements orally or in writing) “Paper-and-pencil”-subgroup discussion
Lesson 3: To strengthen values, social influences, and communication skills regarding the prevention of AIDS and STIs	Homework assignment requires students to respond to situations addressing social pressures (“What would you do when ….”) Classroom discussion subsequent to homework Teacher-delivered information about the process of social influence (didactic approach or inquiry teaching) Peer models discussing safe sex and telling about their attitudes, values, and experiences by means of dramatized videotape and subsequent classroom discussion about videotape modeling
Lesson 4: To enhance students’ self-efficacy regarding negotiating and condom use skills	Homework assignment on buying condoms Subsequent classroom discussion about buying experiences Demonstration and practice of condom use on fingers Video-animation of adequate condom use Interactive videotape showing peer models negotiating real-life troublesome situations and subsequent classroom discussion

Curso de Pós-Graduação em Psicologia da Universidade Federal do Rio Grande do Sul Rua Ramiro Barcelos, 2600 - sala 110, 90035-003 Porto Alegre RS - Brazil, Tel.: +55 51 3308-5691 - Porto Alegre - RS - Brazil
E-mail: prc@springeropen.com

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[1] * Correspondence: g.kok@maastrichtuniversity.nl