26 Mar Intervention ModelsIn 1 to 2 pages, briefly describe the health intervention model(s) to be utilized for your proposed program a
Chapter 8: Interventions
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Chapter 8 Lecture
1
Intervention
An intervention (or treatment) is an activity or set of activities that help to achieve the outcomes stated in the goals and objectives.
A theory-based strategy or experience to which those in the priority population will be exposed or in which they will take part
Occurs between two points in time
An intervention should be effective (leads to desired outcome) and efficient (uses resources in a responsible manner).
Multiplicity – number of components or activities
Dose – number of program units delivered; how many times offered
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Types of Intervention Strategies
Strategy – “A general plan of action for affecting a health problem. A strategy may encompass several activities” (CDC, 2003).
CDC system of classification for strategies
More common strategies used by planners
Categories not independent of each other
Categories include:
health communication
health education
health policy/enforcement
environmental change
health-related community service
community mobilization
other
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Health Communication Strategies – 1
Health communication strategies are designed to inform and influence individual and community decisions to influence health.
Usually a part of most interventions and are useful in reaching many goals and objectives
High penetration rate
More cost effective and less threatening than other strategies
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Health Communication Strategies – 2
Tools of health communication include:
Video and audio teleconferencing
Telephones
Individual initiated – e.g., helplines
Outreach – called by health educator/counselor/coach
Mass media
In person
Printed materials
Computers, Internet, tailored emails
A communication channel is the route through which a message is disseminated to the priority population.
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Multidirectional Communication Model
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Health Communication Strategies – 3
The five communication channels include:
Intrapersonal
Health care, health coaches, hotlines
Interpersonal
Small classes, support groups
Organizational
Church bulletins, company or agency newsletters
Mass media
Newspaper, billboards, magazines, PSAs, and more
Social media
User or consumer generated, organized, and distributed
Information can be revised or updated almost immediately
Typically low cost in terms of creation and maintenance
Facebook, blogs, LinkedIn, Twitter, text messaging
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Health Communication Strategies – 4
Motivational Interviewing
“a collaborative, person-centered form of guiding to elicit and strengthen motivation for change” (Miller & Rollnick, 2009, p. 137)
A process in which the trained professional helps guide an individual to identify internal motivation for change.
Four principles of Motivational Interviewing:
Express empathy
Develop discrepancy
Roll with resistance
Support self-efficacy
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Health Communication Strategies – 5
POST
Assists program planners in creating health promotion interventions that include social media (Thackeray & Bennion, 2009)
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Health Communication Strategies – 6
Health Literacy
the degree to which individuals have the capacity to obtain, process, and understand basic health information and services to make appropriate health decisions (USDHHS, 2000)
Health Numeracy
“the degree to which individuals have the capacity to access, process, interpret, communicate, and act on numerical, quantitative, graphical, biostatistical, and probabilistic health information needed to make effective health decisions” (Golbeck et al., 2005, p. 375)
Health education specialists need to work to ensure that the health communication interventions are appropriate for their priority population.
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Health Education Strategies – 1
Ten general principles of learning (keep in mind before and during curriculum design)
Appeal to multiple senses (e.g., seeing, hearing, speaking).
Get the learner active in the learning process.
Limit distractions.
Make sure they are ready to learn.
Make the subject relevant to the participants.
Use repetition.
Make sure learning is recognized and encouraged.
Move from simple to complex concepts.
Make concept applicable to several settings, generalize.
Find an appropriate pace.
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Health Education Strategies – 2
Health education and health communication are not mutually exclusive categories.
Health education provides the opportunity to gain in-depth knowledge about a particular health topic.
Curriculum (course of study) – what those in the priority population will be taught
Scope – refers to breadth and depth of material covered
Sequence – defines the order in which the material is presented
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Health Education Strategies – 3
Unit plan – “An orderly, self-contained collection of activities educationally designed to meet a set of objectives. Other terms for this are curriculum plans, modules, and strands” (Gilbert et al., 2011, p. 188).
Units of study are subdivided into lessons; outlines for the lessons are called lesson plans; lesson plans are composed of introduction, body, and conclusion.
Many methods for presenting lessons: lecture/discussion, group work, using audiovisuals, etc.
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Health Education Strategies – 4
Kinzie’s (2005) modification of Gagne’s “Events of Instruction”
Gain attention (convey health threats and benefits).
Present stimulus material (tailor message to audience knowledge and values, demonstrate observable effectiveness, make behaviors easy to understand and do).
Provide guidance (use trustworthy models to demonstrate).
Elicit performance and provide feedback (for proficiency and self-efficacy).
Enhance retention and transfer (social support and behavioral cues).
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Example Lesson Plan Format
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Health Policy / Enforcement Strategies – 1
Include executive orders, laws, ordinances, policies, position statements, regulations, and formal/informal rules
Mandated or regulated activities; e.g., state laws to raise cigarette taxes
May be controversial; may be political, can take away freedoms, pride, $, psyche
Based on common good; protect the public's health
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Health Policy / Enforcement Strategies – 2
Six phases of policy making (Block, 2008)
Agenda setting
Policy formulation
Policy adoption
Policy implementation
Policy assessment
Policy modification
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Environmental Change Strategies – 1
Have been most useful in providing “opportunities, support, and cues to help people develop healthier behaviors” (Brownson, Haire-Joshu, & Luke, 2006, p. 342)
They help remove barriers to change in the environment.
Removing environmental barriers often helps to make the healthier choice the easier choice.
Environmental change strategies are characterized by changes “around” individuals and are not limited to the physical environment.
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Environmental Change Strategies – 2
Other environments include:
Economic environment
financial costs, affordability
Service environment
accessibility to health care or patient education
Social environment
social support, peer pressure
Cultural environment
traditions of an ethnic group
Psychological environment
emotional learning environment
Political environment
support for healthy environments
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Environmental Change Strategies – 3
One “environment” that has received increased attention in recent years is the built environment.
“an interdisciplinary area of focus that describes the design, construction, management, and land use of human-made surroundings as an interrelated whole, as well as their relationship to human activities over time” (Coupland, Rikhy, Hill, & McNeil, 2011, p. 6)
The built environment can be structured to give people more or fewer opportunities to behave in health enhancing ways.
Environmental change strategies often are more effective when combined with intervention strategies from the other categories.
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Health-Related Community Service Strategies
Examples include:
HRAs/HHAs
Clinical (biometric) screenings – BP, cholesterol, glucose
Services, tests, or treatments to improve health – flu shots and other immunizations
Check-ups, exams
Reduce barriers to the services – be mindful of affordability, accessibility.
Referrals and follow-ups are important; link with priority population’s health care providers.
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Community Mobilization Strategies – 1
“Community mobilization strategies involve helping communities identify and take action on shared concerns using participatory decision making, and include such methods as empowerment” (Barnes, Neiger, & Thackeray, 2003, p. 60).
Community organizing – “the process by which community groups are helped to identify common problems or goals, mobilize resources, and in other ways develop and implement strategies for reaching the goals they have collectively set” (Minlkler & Wallerstein, 2005, p. 26)
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Community Mobilization Strategies – 2
Community building – “an orientation to a community that is strength-based rather than need based and stresses the identification, nurturing, and celebrating of community assets” (Minkler, 2005a, p. 4)
Community advocacy – process in which those in the community become involved in the institutions and decisions that impact their lives
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Community Mobilization Strategies – 3
There are seven different ways of advocating for health and health education:
Influencing voting behavior
Electioneering
Direct lobbying
Integrating grassroots lobbying into direct lobbying efforts
Use of Internet
Media advocacy — newspaper letters to the editor and opinion-editorial (op-ed) articles
Media advocacy — acting as a resource person
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Other Strategies – 1
Behavior Modification Activities
Often used in intrapersonal-level interventions, include techniques intended to help those in the priority population experience a change in behavior
Based on SR theory
Process
Keep records (logs, diaries, journals) for a period of time
Analyze the records
Create a plan to modify the behavior
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Other Strategies – 2
Organizational Cultural Activities
Like people, organizations also have a “culture.”
Consists of norms and traditions that are generated by and linked to the community
The culture of an organization expresses what is and what is not considered important for the organization.
Should begin with an assessment or cultural audit to determine if the culture hinders or supports health promotion
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Other Strategies – 3
Incentives (i.e., carrot; receiving)
“An anticipated positive or desirable reward designed to influence performance of an individual or group” (Chapman, 2005a, p. 6)
Matching motivation and incentives
Types — social, material, miscellaneous
Disincentives (i.e., stick; taking away)
Discourages behavior
“An anticipated negative or undesirable consequence designed to influence performance of an individual or group” (Chapman, 2005, p. 6)
Can range from intrapersonal (e.g., surcharge) to public policy levels (e.g., cigarette taxes)
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Other Strategies – 4
Incentives/Disincentives (cont’d)
Behavioral economics is a method of analysis that applies psychological insights into decision making.
Behavioral economics insights state that individuals:
Are more concerned about avoiding losses than acquiring gains
Are comfortable with status quo and do not want to change
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Other Strategies – 4 (cont’d)
Are aware of social norms and want to conform
Experience decision fatigue (i.e., choice overload) and put off difficult choices
Use heuristics (i.e., shortcuts or quick answers) because of decision fatigue
Have trouble evaluating probabilities associated with health decisions
Overvalue the present outcomes of decision and discount the future outcomes (i.e., present bias; Arhraf, 2013; Riedel & Calao, 2014)
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Other Strategies – 5
Incentives/Disincentives (cont’d)
Regulated by HIPAA
GINA—treating genetic information as protected health information (PHI)
Remove any financial incentives or penalties if genetic information is collected in the HRA
Employers cannot discriminate against their employees because of a “health status related factor” with the outcome affecting coverage or cost to the employee under a group or individual health plan (Chapman, 2005a).
In other words, employers cannot deny coverage or charge employees more because of health status related conditions such as high blood pressure or high blood cholesterol.
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Other Strategies – 6
Incentives/Disincentives (cont’d)
ACA further refined rules associated with how incentives could be used in programs that are a part of group health insurance plans.
Makes a distinction between participatory wellness programs and health-contingent wellness programs
A participatory wellness program is one that does not provide an incentive or does not tie an incentive to a health factor.
A health-contingent wellness program is one that requires individuals to meet a specific health-related standard to obtain an incentive.
Because health-contingent wellness programs have the potential to discriminate based on health status, the ACA also includes extra rules for these programs.
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Other Strategies – 7
Social Support Activities
Many people find it much easier to change a behavior if those around them provide support or are willing to be partners in the behavior change process.
Social support can work as an incentive.
Types of social support include:
Support groups (e.g., Weight Watchers, Overeaters Anonymous)
“Buddy” systems; can be used with contests and contracts
Social gatherings
Social networks – a web of social relationships
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Creating Health Promotion Interventions
Once program planners have completed a needs assessment, written program goals and objectives, and considered different types of intervention strategies, they are in a position to begin designing an appropriate intervention.
There is no one best way of intervening to accomplish a specific program goal that can be generalized to all priority populations.
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Guidelines for Successful Health Promotion Programs
Well-planned and successful health promotion programs have common characteristics such as:
Addressing one or more risk factors of the priority population;
Being theory-driven;
Being based on the best possible evidence (see the discussion of scientific evidence later in the chapter);
Adhering to professional ethical standards;
Being culturally appropriate;
Being consistent with professional criteria, guidelines, or codes of practice (e.g., America College of Sports Medicine’s guidelines for exercise programs (ACSM, 2014))
Using resources efficiently; and
Including an evaluation component.
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Items to Consider When Creating a Health Promotion Intervention
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Designing Appropriate Interventions
Key Terms
Best practices – using interventions that have undergone critical review of multiple research and evaluation studies (Green & Kreuter, 2005)
Best experiences – fall short of best practices but show promise
Best processes – original interventions based on theory
Segmenting – dividing a broader population into smaller groups
Culturally sensitive – interventions “that are relevant and acceptable within the cultural framework of the population to be reached” (Frankish, Lovato, and Shannon, 1998)
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Adapting a Health Promotion Intervention
Planners should use the best available evidence to help create an intervention.
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Limitations of Interventions
Even well-planned interventions are not always successful in achieving the expected outcomes.
Most interventions come with some limitations.
Sleet (2015) noted in order for engineering and technology innovations to be successful in preventing injuries they must be:
effective and reliable
acceptable to those for whom they were intended
easy to use
used properly
The same or similar limitations could be applied to the other categories of intervention strategies.
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