Key concepts of HEP Intervention Development using Intervention Mapping
Step 1 – logic What is the health problem? For whom (target group)? Why? What is the severity / Prevalence / Incidence?
model of the Be specific: e.g. high sugar intake among Dutch high scholars (12-18 years).
problem
Planning group:
- Programme developers: health promoters / health educators / behavioural scientists / epidemiologists
- Programme implementers: …… (think off ‘who will implement your intervention?’) (e.g. teachers, nurses, members of local public health service, health
marketeers etc.) ® this can be adapted when completing step 5 (identification of implementers)
- At-risk population: members of the target group (e.g. Dutch high scholars (12-18 years))
- Decision makers: ….. (think off ‘who will decide about your intervention (adoption)?’) (e.g. school principals, director of the company, managers etc.)
- Stakeholders: ….. (think off ‘who else will be involved?’ (e.g., parents, friends, family members, colleagues etc.)
Needs assessment:
Step in at either the problem behaviour (= behavioural factor) (e.g. smoking) or the health problem (e.g. lung cancer, skin cancer, obesity or high sugar intake)
• What is the health problem? For whom (target group)? Be specific
e.g. high sugar intake among Dutch high scholars (12-18 years).
• What quality of life issues are associated with the health problem? (both individual and societal)
e.g. for the example of the high sugar intake among Dutch scholars ® increased health care costs (societal), increased risk of obesity (individual), increased
risk of diabetes (individual), reduced school performance (individual), reduced labour participation (societal) etc.
• Behavioural factor (or problem behaviour): what does the target group do to increase the risk of the health problem?
e.g. consumption of sugar rich products / smoking at least one cigarette per day / reduced physical activity / increased consumption of unhealthy food
o Determinant: what is causing the target group to perform the behaviour? (knowledge/ skills/ attitude/ beliefs/ perceptions/ outcome
expectations/ norms etc.) e.g. lack of awareness on the health effects of the consumption of sugar rich products, lack of self-efficacy towards eating
low sugar products and lack of knowledge of the amount of sugar in products.
• Environmental factor: what conditions in the environment contribute to the health problem (direct) or impact behaviour (indirect)? [identify agent
and level: interpersonal – organizational – community – society]. There must be a direct and indirect effect of the environmental factor on the health problem
e.g. lack of parent monitoring of child’s sugar intake (agent = parents, level = interpersonal), promotion of sugar rich meals (agent = supermarkets, level =
organizational), lack of policies on that limit the sugar intake at school (agent = schoolboard, level = organizational) (agent should be able to be appointed)
o Determinant: what is causing the environmental conditions to influence the health problem? (knowledge/ skills/ attitude/ beliefs/ perceptions/
outcome expectations/ norms etc.) e.g. supermarkets lack of awareness of the effect of price on buying behaviour of scholars, lack of self-efficacy
towards promoting low sugar products, lack of awareness of the amount of sugar in products and attitude towards promoting sugar rich products.
Context and setting: think off ‘’where will the intervention take place?’’ (e.g. at school)
Programme goal: What will change? | How much? | What period of time? e.g., at the end of 3 months of intervention, the amount of sugar consumed by Dutch
high scholars (12-18 years) will be reduced by 20%.
Pay attention! Sometimes it take some time to see a decrease (e.g. skin cancer among children). In that case, it is better to focus on the related behaviour.
e.g. at the end of 2 months of intervention, the percentage of children that use well-tested sun protection has been increased by 25%.
, Step 2 – logical • Behavioural outcome: what behaviour does the target group have to engage in as result of the intervention? [SMART] e.g., Dutch high scholars eat
model of at least 20% less sugar in their daily meals / Dutch scholars quit smoking within 6 months.
change o Performance objectives: what does the target group need to do to perform the behaviour? [clear sub-behaviours that do not include sub-sub
behaviour] e.g., visit a supermarket (PO1), look for alternative low sugar products (PO2), read the food labels on the products (PO3), calculate the
amount of sugar in products (PO4), select the low sugar products (PO5), buy the low sugar products (PO6)
§ Determinants: what is causing the target-group to perform the behaviour? (knowledge/ skills/ attitude/ beliefs/ perceptions/ outcome
expectations/ norms etc.) e.g. knowledge on reading information on food products, attitude towards reading the information on food
products, outcome expectations regarding the essence of reading food products to make a healthy choice (PO3) | knowledge on food
calculations, skills towards calculating the correct amount of sugar in the product, attitude towards calculating the sugar intake (PO4)
• Select determinants based on importance (how strong is the determinant associated with the behaviour?) and the
changeability (how likely is it that the intervention will change the determinant?)
Determinant Importance Changeability
Knowledge ++ ++
Skills ++ ++
Attitude + +
Outcome expectations + 0
• Change objective: what does the target group need to learn with regard to …. (determinant) to accomplish the
performance objective? head = action verb (determinant specific) and tail = repetition of the performance objective
® use identifier codes
Behavioural outcome: Dutch high scholars eat at least 20% less sugar in their daily meals.
Determinants Knowledge Skills Attitude
PO3. Read the food K.1. List ways to read S.1. Demonstrate the ability to A.1. Express positive feelings towards
labels on products food labels on products read food labels on products reading food labels on products
PO4. Calculate the K.2. Describe ways to S.2. Demonstrate the ability to A.2. Express positive feelings towards
amount of sugar in calculate the amount of calculate the amount of sugar calculating the amount of sugar in
products sugar in products in products products
• Environmental outcome: what behaviour does the agent have to engage in as result of the intervention? [SMART] e.g. supermarkets promote low
sugar products within one year.
o Performance objectives: what does the agent need to do to perform the behaviour? [clear sub-behaviours that do not include sub-sub
behaviour] e.g. re-store high sugar products above or below eye height (PO1), store low sugar products at eye height (PO2), place pictures of low
sugar products on banners and billboards within the supermarket (PO3), discount low sugar products (PO4), brand low sugar products (PO5)
§ Determinants: what is causing the agent to perform the behaviour? (knowledge/ skills/ attitude/ beliefs/ perceptions/ outcome
expectations/ norms etc.) e.g., supermarkets’ knowledge on ways to store low sugar products at eye height, supermarkets’ self-efficacy
towards storing low sugar products at eye height and supermarket’s attitude towards storing low sugar products in the direct sight of
customers (PO2) | supermarkets’ knowledge on ways to brand a low sugar product, supermarket’s self-efficacy towards branding low sugar
products and supermarkets’ outcome expectations of the need of branding a low sugar product to make a healthy choice
• Select determinants based on importance (how strong is the determinant associated with the behaviour?) and the
changeability (how likely is it that the intervention will change the determinant?)
Step 1 – logic What is the health problem? For whom (target group)? Why? What is the severity / Prevalence / Incidence?
model of the Be specific: e.g. high sugar intake among Dutch high scholars (12-18 years).
problem
Planning group:
- Programme developers: health promoters / health educators / behavioural scientists / epidemiologists
- Programme implementers: …… (think off ‘who will implement your intervention?’) (e.g. teachers, nurses, members of local public health service, health
marketeers etc.) ® this can be adapted when completing step 5 (identification of implementers)
- At-risk population: members of the target group (e.g. Dutch high scholars (12-18 years))
- Decision makers: ….. (think off ‘who will decide about your intervention (adoption)?’) (e.g. school principals, director of the company, managers etc.)
- Stakeholders: ….. (think off ‘who else will be involved?’ (e.g., parents, friends, family members, colleagues etc.)
Needs assessment:
Step in at either the problem behaviour (= behavioural factor) (e.g. smoking) or the health problem (e.g. lung cancer, skin cancer, obesity or high sugar intake)
• What is the health problem? For whom (target group)? Be specific
e.g. high sugar intake among Dutch high scholars (12-18 years).
• What quality of life issues are associated with the health problem? (both individual and societal)
e.g. for the example of the high sugar intake among Dutch scholars ® increased health care costs (societal), increased risk of obesity (individual), increased
risk of diabetes (individual), reduced school performance (individual), reduced labour participation (societal) etc.
• Behavioural factor (or problem behaviour): what does the target group do to increase the risk of the health problem?
e.g. consumption of sugar rich products / smoking at least one cigarette per day / reduced physical activity / increased consumption of unhealthy food
o Determinant: what is causing the target group to perform the behaviour? (knowledge/ skills/ attitude/ beliefs/ perceptions/ outcome
expectations/ norms etc.) e.g. lack of awareness on the health effects of the consumption of sugar rich products, lack of self-efficacy towards eating
low sugar products and lack of knowledge of the amount of sugar in products.
• Environmental factor: what conditions in the environment contribute to the health problem (direct) or impact behaviour (indirect)? [identify agent
and level: interpersonal – organizational – community – society]. There must be a direct and indirect effect of the environmental factor on the health problem
e.g. lack of parent monitoring of child’s sugar intake (agent = parents, level = interpersonal), promotion of sugar rich meals (agent = supermarkets, level =
organizational), lack of policies on that limit the sugar intake at school (agent = schoolboard, level = organizational) (agent should be able to be appointed)
o Determinant: what is causing the environmental conditions to influence the health problem? (knowledge/ skills/ attitude/ beliefs/ perceptions/
outcome expectations/ norms etc.) e.g. supermarkets lack of awareness of the effect of price on buying behaviour of scholars, lack of self-efficacy
towards promoting low sugar products, lack of awareness of the amount of sugar in products and attitude towards promoting sugar rich products.
Context and setting: think off ‘’where will the intervention take place?’’ (e.g. at school)
Programme goal: What will change? | How much? | What period of time? e.g., at the end of 3 months of intervention, the amount of sugar consumed by Dutch
high scholars (12-18 years) will be reduced by 20%.
Pay attention! Sometimes it take some time to see a decrease (e.g. skin cancer among children). In that case, it is better to focus on the related behaviour.
e.g. at the end of 2 months of intervention, the percentage of children that use well-tested sun protection has been increased by 25%.
, Step 2 – logical • Behavioural outcome: what behaviour does the target group have to engage in as result of the intervention? [SMART] e.g., Dutch high scholars eat
model of at least 20% less sugar in their daily meals / Dutch scholars quit smoking within 6 months.
change o Performance objectives: what does the target group need to do to perform the behaviour? [clear sub-behaviours that do not include sub-sub
behaviour] e.g., visit a supermarket (PO1), look for alternative low sugar products (PO2), read the food labels on the products (PO3), calculate the
amount of sugar in products (PO4), select the low sugar products (PO5), buy the low sugar products (PO6)
§ Determinants: what is causing the target-group to perform the behaviour? (knowledge/ skills/ attitude/ beliefs/ perceptions/ outcome
expectations/ norms etc.) e.g. knowledge on reading information on food products, attitude towards reading the information on food
products, outcome expectations regarding the essence of reading food products to make a healthy choice (PO3) | knowledge on food
calculations, skills towards calculating the correct amount of sugar in the product, attitude towards calculating the sugar intake (PO4)
• Select determinants based on importance (how strong is the determinant associated with the behaviour?) and the
changeability (how likely is it that the intervention will change the determinant?)
Determinant Importance Changeability
Knowledge ++ ++
Skills ++ ++
Attitude + +
Outcome expectations + 0
• Change objective: what does the target group need to learn with regard to …. (determinant) to accomplish the
performance objective? head = action verb (determinant specific) and tail = repetition of the performance objective
® use identifier codes
Behavioural outcome: Dutch high scholars eat at least 20% less sugar in their daily meals.
Determinants Knowledge Skills Attitude
PO3. Read the food K.1. List ways to read S.1. Demonstrate the ability to A.1. Express positive feelings towards
labels on products food labels on products read food labels on products reading food labels on products
PO4. Calculate the K.2. Describe ways to S.2. Demonstrate the ability to A.2. Express positive feelings towards
amount of sugar in calculate the amount of calculate the amount of sugar calculating the amount of sugar in
products sugar in products in products products
• Environmental outcome: what behaviour does the agent have to engage in as result of the intervention? [SMART] e.g. supermarkets promote low
sugar products within one year.
o Performance objectives: what does the agent need to do to perform the behaviour? [clear sub-behaviours that do not include sub-sub
behaviour] e.g. re-store high sugar products above or below eye height (PO1), store low sugar products at eye height (PO2), place pictures of low
sugar products on banners and billboards within the supermarket (PO3), discount low sugar products (PO4), brand low sugar products (PO5)
§ Determinants: what is causing the agent to perform the behaviour? (knowledge/ skills/ attitude/ beliefs/ perceptions/ outcome
expectations/ norms etc.) e.g., supermarkets’ knowledge on ways to store low sugar products at eye height, supermarkets’ self-efficacy
towards storing low sugar products at eye height and supermarket’s attitude towards storing low sugar products in the direct sight of
customers (PO2) | supermarkets’ knowledge on ways to brand a low sugar product, supermarket’s self-efficacy towards branding low sugar
products and supermarkets’ outcome expectations of the need of branding a low sugar product to make a healthy choice
• Select determinants based on importance (how strong is the determinant associated with the behaviour?) and the
changeability (how likely is it that the intervention will change the determinant?)
