1. Overview of intervention
mapping p. 3-32
CHAPTER 1 AND 2, OLD VERSION p.3-81
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 behaviour and environmental changes that are conducive to health, and health education is a subset of
health promotion applications that are primarily based on education.
Intervention Mapping is a planning approach that is based on the importance of developing theory- and
evidence-informed programs, taking an ecological approach to assessing and intervening in health problems,
and community participation.
The use of theory is necessary in evidence-informed health promotion to ensure that we can describe and
address the factors to achieve change. In general, the use of theory can help us protect against type III error,
that is, failing to find intervention effectiveness because the program is poorly designed or implemented.
In Intervention Mapping we work from a problem-driven perspective. Choices have to be made in the process
of developing an intervention, and theories are one tool to enable us to make better choices. By the term
evidence, we mean not only data from research studies as represented in the scientific literature but also
opinion and experience of community members and planners. In this way theoretical and empirical evidence
are brought to bear on meeting a health or social need.
The socioecologic model, which has been used extensively in health promotion and is consonant with and
encompassed by systems thinking, continues to be an underpinning for Intervention Mapping. The social
ecological paradigm focuses on the interrelationships among individuals with their biological, psychological,
and behavioural characteristics and their environments.
Planners can look at the relationship between individuals and their environments in two ways. First,
mechanistically, the individual and the environment can be viewed as mechanisms in a general system in
which small changes in the social environment can lead to large changes in individual behaviour. This view
tends toward an emphasis on higher-order intervention leverage points, such as policy or social norms, as
determinants of the individual’s behaviour, health, and quality of life. Second, the various levels are viewed as
embedded systems. higher-order systems set constraints and provide inputs to lower-order systems, and the
lower-order systems provide inputs to systems at a higher level. New properties emerge at each system level,
but each level incorporates the lower levels of embedded systems.
Multiple levels may be influenced by an
intervention at one level.
A program may be aimed at any ecological
level and have effects on that level and all
the levels nested within it.
This figure indicates that the individual
exists within groups, which, in turn, are
embedded within organizations and higher-
order systems. The individual is influenced
by these systems and can, in turn, influence
, them directly or through groups and organizations.
Agency in the environment
We draw the approach to change at the various ecological levels from three traditions. The first is focused on
the gatekeepers within channels. The second is social exchange theory, which focuses on the positions or
roles of persons within the social system, and the third is the MATCH model that has been used to plan
multilevel interventions for health education. In each of these views, the key to understanding social reality at
each of the ecological levels and how to change conditions at each level is tied to understanding the positions
that comprise the level and exert influence on its conditions.
Equitable community participation helps to ensure that program focus reflects concerns for the local
community; can bring a greater breadth of skills, knowledge, and expertise to the project; can make sure that
the research topic comes from, or reflects, a major concern of the local community; and will improve external
validity of interventions and evaluation by recognition of the local knowledge of community members.
A number of principles for facilitating community action and partnerships have been suggested and used by
others to evaluate community-based participatory program efforts:
1. Recognize a partner community as a unit of identity
2. Build upon community strengths and resources
3. Facilitate collaborative, equitable decisionmaking in which partners negotiate
desired roles in all project phases and attend to social inequalities
4. Foster co-learning among partners
5. Balance knowledge generation with community benefit
6. Focus on ecological perspectives, local problems, and multiple determinants
of health
7. Develop systems using an iterative process
8. Disseminate information, results, and benefits to all partners
9. Develop a commitment and long-term process
A systematic planning process can also address the need for ethical practice of health promotion. Kass (2001)
has presented a framework for the evaluation of public health interventions in terms of their ethical integrity.
She suggests the following evaluation scheme for ethical public health interventions:
1. Include goals related to the health of the public
2. Present a reasonable chance of effectiveness (including a basis in solid evidence)
3. Address the known and potential burdens of the program including risks to
privacy and confidentiality, liberty, self-determination and justice
4. Minimize burdens by adopting alternate approaches
5. Ensure fair allocation of the program and its benefits
6. Balance program benefits and burdens
Intervention mapping steps:
The completion of all of the steps serves as a blueprint for designing, implementing, and evaluating an
intervention based on a foundation of theoretical, empirical, and practical information. Even though we
present Intervention Mapping as a series of steps, the process is iterative rather than completely linear.
Program developers move back and forth between tasks and steps as they gain information and perspective
from various activities.
, Step 1: Needs Assessment
In Step 1) before beginning to actually plan an intervention, the planner assesses the health problem,
behavioural and environmental causes of the problem, and determinants of the behavioural and
environmental causes. This assessment encompasses two components: (1) an epidemiologic, behavioural, and
social analysis of an at-risk group or community and its problems and (2) an effort to get to know and begin to
understand the character of the community, its members, its strengths, and its knowledge of the health
problem and potential solutions. The product of this first step is a description of a health problem, its impact on
quality of life, behavioural and environmental causes, and determinants of behaviour and environmental
causes.
mapping p. 3-32
CHAPTER 1 AND 2, OLD VERSION p.3-81
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 behaviour and environmental changes that are conducive to health, and health education is a subset of
health promotion applications that are primarily based on education.
Intervention Mapping is a planning approach that is based on the importance of developing theory- and
evidence-informed programs, taking an ecological approach to assessing and intervening in health problems,
and community participation.
The use of theory is necessary in evidence-informed health promotion to ensure that we can describe and
address the factors to achieve change. In general, the use of theory can help us protect against type III error,
that is, failing to find intervention effectiveness because the program is poorly designed or implemented.
In Intervention Mapping we work from a problem-driven perspective. Choices have to be made in the process
of developing an intervention, and theories are one tool to enable us to make better choices. By the term
evidence, we mean not only data from research studies as represented in the scientific literature but also
opinion and experience of community members and planners. In this way theoretical and empirical evidence
are brought to bear on meeting a health or social need.
The socioecologic model, which has been used extensively in health promotion and is consonant with and
encompassed by systems thinking, continues to be an underpinning for Intervention Mapping. The social
ecological paradigm focuses on the interrelationships among individuals with their biological, psychological,
and behavioural characteristics and their environments.
Planners can look at the relationship between individuals and their environments in two ways. First,
mechanistically, the individual and the environment can be viewed as mechanisms in a general system in
which small changes in the social environment can lead to large changes in individual behaviour. This view
tends toward an emphasis on higher-order intervention leverage points, such as policy or social norms, as
determinants of the individual’s behaviour, health, and quality of life. Second, the various levels are viewed as
embedded systems. higher-order systems set constraints and provide inputs to lower-order systems, and the
lower-order systems provide inputs to systems at a higher level. New properties emerge at each system level,
but each level incorporates the lower levels of embedded systems.
Multiple levels may be influenced by an
intervention at one level.
A program may be aimed at any ecological
level and have effects on that level and all
the levels nested within it.
This figure indicates that the individual
exists within groups, which, in turn, are
embedded within organizations and higher-
order systems. The individual is influenced
by these systems and can, in turn, influence
, them directly or through groups and organizations.
Agency in the environment
We draw the approach to change at the various ecological levels from three traditions. The first is focused on
the gatekeepers within channels. The second is social exchange theory, which focuses on the positions or
roles of persons within the social system, and the third is the MATCH model that has been used to plan
multilevel interventions for health education. In each of these views, the key to understanding social reality at
each of the ecological levels and how to change conditions at each level is tied to understanding the positions
that comprise the level and exert influence on its conditions.
Equitable community participation helps to ensure that program focus reflects concerns for the local
community; can bring a greater breadth of skills, knowledge, and expertise to the project; can make sure that
the research topic comes from, or reflects, a major concern of the local community; and will improve external
validity of interventions and evaluation by recognition of the local knowledge of community members.
A number of principles for facilitating community action and partnerships have been suggested and used by
others to evaluate community-based participatory program efforts:
1. Recognize a partner community as a unit of identity
2. Build upon community strengths and resources
3. Facilitate collaborative, equitable decisionmaking in which partners negotiate
desired roles in all project phases and attend to social inequalities
4. Foster co-learning among partners
5. Balance knowledge generation with community benefit
6. Focus on ecological perspectives, local problems, and multiple determinants
of health
7. Develop systems using an iterative process
8. Disseminate information, results, and benefits to all partners
9. Develop a commitment and long-term process
A systematic planning process can also address the need for ethical practice of health promotion. Kass (2001)
has presented a framework for the evaluation of public health interventions in terms of their ethical integrity.
She suggests the following evaluation scheme for ethical public health interventions:
1. Include goals related to the health of the public
2. Present a reasonable chance of effectiveness (including a basis in solid evidence)
3. Address the known and potential burdens of the program including risks to
privacy and confidentiality, liberty, self-determination and justice
4. Minimize burdens by adopting alternate approaches
5. Ensure fair allocation of the program and its benefits
6. Balance program benefits and burdens
Intervention mapping steps:
The completion of all of the steps serves as a blueprint for designing, implementing, and evaluating an
intervention based on a foundation of theoretical, empirical, and practical information. Even though we
present Intervention Mapping as a series of steps, the process is iterative rather than completely linear.
Program developers move back and forth between tasks and steps as they gain information and perspective
from various activities.
, Step 1: Needs Assessment
In Step 1) before beginning to actually plan an intervention, the planner assesses the health problem,
behavioural and environmental causes of the problem, and determinants of the behavioural and
environmental causes. This assessment encompasses two components: (1) an epidemiologic, behavioural, and
social analysis of an at-risk group or community and its problems and (2) an effort to get to know and begin to
understand the character of the community, its members, its strengths, and its knowledge of the health
problem and potential solutions. The product of this first step is a description of a health problem, its impact on
quality of life, behavioural and environmental causes, and determinants of behaviour and environmental
causes.
