Using Intervention Mapping for child development and wellbeing programs in early childhood education and care settings

Development of a mobile application based on the salutogenic model for self-management in adolescents with Moyamoya disease

PURPOSE

Moyamoya disease (MMD) is a rare disease which has a high incidence of onset in adolescence. Disease self-management skills are imperative for adolescents with MMD. This study aimed to describe the systematic development, content, and usability of the Moyamoya Healthy Youth application (app), which was developed to enhance self-management skills for adolescents with MMD.

DESIGN AND METHODS

The theoretical grounding for the app was salutogenic model and the development process of the app was guided by the intervention mapping (IM) protocol. Results of each IM step were applied to the next step leading to the design of the app. Additionally, a pilot test was conducted to determine the usability of the app.

RESULTS

Following the salutogenic model, we identified the stressors, behaviors, and resources regarding managing symptoms of MMD by interviewing adolescents with MMD, their parents, and healthcare providers. Based on the findings of the interviews, we determined the program outcomes and performance objectives to improve the self-management of MMD in adolescents. The app was developed by translating the theoretical methods to achieve the performance objectives into practical strategies for delivering the program. A pilot test with eight participants showed satisfaction with the app in terms of its usefulness and ease of use.

CONCLUSION

We delineated the development process of the Moyamoya Healthy Youth. Additionally, we presented the positive outcomes regarding the usability of the app.

PRACTICE IMPLICATIONS

The Moyamoya Healthy Youth app could benefit adolescents with MMD, by improving their self-management skills which are crucial for their health.

Improving Fundamental Movement Skills during Early Childhood: An Intervention Mapping Approach

The earlier in life that a child can begin mastering fundamental movement skills (FMS), the more positive their physical activity (PA) trajectories and health outcomes are. To achieve sufficient development in FMS, children must be guided with tuition and practice opportunities. Schools and educators provide an opportunity for interventions that improve health behaviours and outcomes for children. The aim of this study was to use intervention mapping (IM) to design a programme of school-based intervention to improve FMS for children aged 4-5 years old. Following the six steps of IM, with each step comprising three to five tasks that require the input of a planning group formed by key stakeholders, a programme of intervention was planned. Prior knowledge and primary and secondary evidence was used to support the development of the programme. A logic model of the problem as well as logic models of change, programme design, production, implementation, and evaluation were proposed or completed within the study. The results can be used to begin to implement an FMS-focussed intervention within school settings within England and propose a sustainable and realistic approach for helping children to develop FMS with the support of well-informed educators who are confident to deliver better FMS practice and PA opportunities.

An Evidence-Based Digital Prevention Program to Improve Oral Health Literacy of People With a Migration Background: Intervention Mapping Approach

BACKGROUND

Studies in Germany have shown that susceptible groups, such as people with a migration background, have poorer oral health than the majority of the population. Limited oral health literacy (OHL) appears to be an important factor that affects the oral health of these groups. To increase OHL and to promote prevention-oriented oral health behavior, we developed an evidence-based prevention program in the form of an app for smartphones or tablets, the Förderung der Mundgesundheitskompetenz und Mundgesundheit von Menschen mit Migrationshintergrund (MuMi) app.

OBJECTIVE

This study aims to describe the development process of the MuMi app.

METHODS

For the description and analysis of the systematic development process of the MuMi app, we used the intervention mapping approach. The approach was implemented in 6 steps: needs assessment, formulation of intervention goals, selection of evidence-based methods and practical strategies for behavior change, planning and designing the intervention, planning the implementation and delivery of the intervention, and planning the evaluation.

RESULTS

On the basis of our literature search, expert interviews, and a focus group with the target population, we identified limited knowledge of behavioral risk factors or proper oral hygiene procedures, limited proficiency of the German language, and differing health care socialization as the main barriers to good oral health. Afterward, we selected modifiable determinants of oral health behavior that were in line with behavior change theories. On this basis, performance objectives and change objectives for the relevant population at risk were formalized. Appropriate behavior change techniques to achieve the program objectives, such as the provision of health information, encouragement of self-control and self-monitoring, and sending reminders, were identified. Subsequently, these were translated into practical strategies, such as multiple-choice quizzes or videos. The resulting program, the MuMi app, is available in the Apple app store and Android app store. The effectiveness of the app was evaluated in the MuMi intervention study. The analyses showed that users of the MuMi app had a substantial increase in their OHL and improved oral hygiene (as measured by clinical parameters) after 6 months compared with the control group.

CONCLUSIONS

The intervention mapping approach provided a transparent, structured, and evidence-based process for the development of our prevention program. It allowed us to identify the most appropriate and effective techniques to initiate behavior change in the target population. The MuMi app takes into account the cultural and specific determinants of people with a migration background in Germany. To our knowledge, it is the first evidence-based app that addresses OHL among people with a migration background.

The STress-And-Coping suppoRT Intervention (START) for Chinese Women Undergoing Abortion: A Randomized Controlled Trial Protocol

Background: Although undergoing an abortion is stressful for most women, little attention has been given to their psychological wellbeing. This protocol aims to assess the feasibility, acceptability, and primary effects of a complex intervention to promote positive coping behaviors and alleviate depression symptoms among Chinese women who have undergone an abortion. Methods: A two-arm randomized controlled trial design will be used. Participants will be recruited at their first appointment with the abortion clinic and randomly allocated to receive either the Stress-And-Coping suppoRT (START) intervention (in addition to standard abortion care) or standard care only. All participants will be followed-up at two- and six-weeks post-abortion. Approval has been granted by local and university ethics committees. This research was supported by an Australian Government Research Training Program Scholarship. Discussion: The results will assist refinement and further evaluations of the START intervention, contribute to improved abortion care practices in China, and enrich the evidence on improving women’s psychological well-being following abortion in China. Trial registration: Registered at the Chinese Clinical Trials.gov: ChiCTR2100046101. Date of registration: 4 May 2021.

Understanding and supporting peer relationships in adolescents with acquired brain injury: A stakeholder engagement study

Peer relationship difficulties in adolescents with acquired brain injury (ABI) are under-recognized and targets for intervention are unclear. From a social constructionist position, this study aimed to engage with stakeholders to develop a collaborative understanding of peer relationship difficulties in adolescents with ABI and seek consultation on what might be required to improve them. Focus groups and semi-structured interviews were conducted with four stakeholder groups: adolescents with ABI (n = 4); parents of adolescents with ABI (n = 7); adults who sustained an ABI in adolescence (n = 2); and specialist practitioners (n = 3). Qualitative data were analysed using thematic analysis. The analysis yielded 11 themes, grouped into two domains. The first, understanding peer relationship difficulties, included themes from "exclusion and a need to belong", to "loss of past self". The second, supporting peer relationships, comprised themes of "building understanding" and "meaningful social connection", amongst others. A logic model of stakeholder experiences of peer relationship difficulties was constructed. Difficulties with peers can increase vulnerability to feelings of loneliness, shame, and hopelessness for adolescents post-ABI. Stakeholders described that a meaningful intervention would be multi-layered, targeting change within the adolescent's environment and within the adolescent themselves. The presented logic model provides a framework for future intervention development.

Job Demands and Resources Experienced by the Early Childhood Education Workforce Serving High-Need Populations

The early childhood education (ECE) workforce plays a key role in promoting early childhood development by their interactions with young children during formative years. However, the inherent demands of the profession and the work conditions within ECE settings affect job satisfaction and overall health and well-being. This study applied the Job Demands-Resources Model (JD-R) and administered a cross-sectional survey (n = 137) to examine disparities in personal and external demands and resources that may impact job satisfaction and turnover rates among ECE staff who provide care for preschool children (3-5 years of age). ECE staff reported higher levels of personal demands, including depression and perceived stress, and external demands, including workload and staffing concerns, compared to the national workforce (all p < .01). The data also illustrated disparities related to resource access; ECE staff reported lower levels of personal resources, including mindfulness, and less access to external resources including safety climate, resource adequacy, role clarity, respect, and management relationships (all p < .01). Only 34% of ECE staff reported being very satisfied with their work compared to 49% of the national workforce (p < .01). External resources were significantly and positively associated with job satisfaction (B = .09, p < .01). These findings suggest that ECE staff experience significantly higher demands and have access to significantly fewer resources in the workplace, and that bolstering job-related resources may translate to increased job satisfaction.

A Nutrition Intervention to Promote the Consumption of Pulse-Based Foods in Childcare Centers: Protocol for a Multimethod Study

Background

Plant-based foods, including pulses (dry beans, lentils, chickpeas, and peas), have gained worldwide attention owing to their health and environmental benefits. Despite high production, the consumption of pulses is low in Canada. Behavior change interventions systematically designed to promote the consumption of pulse-based foods are scarce.

Objective

We describe the utilization of intervention mapping (IM) in the development of a multicomponent nutrition intervention aimed at promoting consumption of pulse-based foods among preschool children in childcare centers in Saskatchewan, Canada.

Methods

The Pulse Discovery Toolkit intervention was developed following the six steps of the IM protocol. Decisions at each step were either based upon literature review, expert consultation, pretesting, or a combination of these. Following the initial phase of the study, which focused on intervention development, phases II and III of the study were concerned with pilot testing and roll-out of the intervention, respectively. In total, one, two, and four childcare centers participated in phases I, II, and III, respectively. A multimethod approach was designed to evaluate the intervention during pilot testing and roll-out.

Results

The application of IM steps 1 to 3 in phase I resulted in the creation of performance objectives at different levels, including at the individual level (preschool children), and the social and environmental levels (parents, early childhood educators, and cooks). These objectives were then used to create a matrix of objectives matching the constructs of the social cognitive theory while taking Piaget cognitive development into consideration. This step was followed by defining program components, implementation, adoption, and evaluation strategies, which were utilized in phases II and III. Data have been collected from 2015 to 2018 and analyzed. The results will be reported elsewhere.

Conclusions

The IM protocol provided a rigorous framework for the development of a multicomponent evidence-based intervention to promote pulse-based foods in childcare centers.

International Registered Report Identifier (IRRID)

RR1-10.2196/22775

Safety and Health Innovation in Preschools: A Total Worker Health Pilot Project

OBJECTIVE

The primary objective of this study was to evaluate quality of work life in early childhood education (ECE) centers and implement a total worker health (TWH) pilot project with a small sample of ECE teachers.

METHODS

An evidence-based strategic planning process to make policy, system, and environmental (PSE) changes related to TWH was implemented with six ECE centers. A pre-post design with mixed-methods was used to evaluate the impact.

RESULTS

Baseline findings suggest that there are significant disparities related to quality of work life among ECE teachers compared with the national population. After implementation of the pilot project, ECE centers averaged 4.7 PSE changes. Qualitative data informed facilitators and barriers to implementation of TWH-related changes.

CONCLUSIONS

This pilot project reflects an evidence-based participatory approach to assessing and improving the well-being of ECE teachers.

Integrating Health and Educational Perspectives to Promote Preschoolers' Social and Emotional Learning: Development of a Multi-Faceted Program Using an Intervention Mapping Approach

High-quality early childhood education and care (ECEC) can strengthen the social and emotional skills that are crucial for children’s ongoing development. With research highlighting an increasing prevalence of emotional and behavioural challenges in young children, there is emphasis on embedding teaching practices and pedagogies to support social and emotional skills within early learning programs. A growing body of research has examined the impact of social and emotional learning programs in ECEC; however, few studies describe the intervention development process, or how educators and other professionals were engaged to increase the relevance and feasibility of the program. The current paper describes the development of the Cheshire Social-Emotional Engagement and Development (SEED) Educational Program, an online learning tool to support early childhood educators to foster children’s positive mental health. Cheshire SEED was designed using five steps of the Intervention Mapping methodology: (i) comprehensive needs assessment to create a logic model of the problem; (ii) creation of program outcomes and change objectives mapped against determinants of educator behaviour; (iii) co-design of theory-based methods and practical strategies; (iv) program development; and (v) adoption and implementation planning. The process and decisions at each step of the IM protocol are presented, and the strengths and limitations of the approach to develop a mental health intervention for ECEC settings are discussed.

The Impact of a Workplace Wellness Program on Provider Health in Early Childhood Education Settings

Background: Early childhood education (ECE) working environments often contribute to poor health outcomes. The purpose of this study was to describe healthy eating–related and physical activity–related awareness and adoption of behavior change of ECE providers after participating in a workplace wellness (WW) program and to explore facilitators and barriers to ECE provider participation in WW program. Methods: The WW program offered healthy eating and physical activity challenges to promote ECE provider health and well-being. Approximately 1,000 ECE providers in Colorado from 35 ECE settings were invited to participate. After the intervention, ECE providers completed two surveys: (a) a provider postsurvey and (b) a WW challenge survey. Multivariable logistic regression modeling was used to examine factors associated with percent agreement that participation in the WW program increased awareness and adoption of health behaviors. Findings: A total of 250 (25%) ECE providers participated in WW program from 2015 to 2017. After participation, approximately 84% of respondents agreed they were more aware of the importance of eating fruits and vegetables and of being physically active, while 81% reported eating more fruits and vegetables, and 80% reported being more physically active in the workplace. Logistic regression models found that the length of time teaching in ECE settings was positively and significantly associated (odds ratio [OR] = 1.10, 95% confidence interval [CI] = [1.00, 1.21]) with the odds of providers agreeing that participation in the WW program increased their awareness of health behaviors. Conclusion/Application to Practice: The design and implementation of WW programs that emphasize facilitators, such as intrinsic and extrinsic motivation, as well as reduce barriers, such as time constraints and unachievable goal setting, may increase the awareness and adoptions of healthy eating–related and physical activity–related behaviors among ECE work settings.

Design of an educational strategy based on Intervention Mapping for nutritional health promotion in Child Care Centers

Early childhood is a critical period for instilling healthy habits to prevent overweight and obesity. This paper describes the development of an educational intervention for the promotion of healthy eating and physical activity among two-to-four-year-old children in public child care centers (CCCs) in Mexico City. Following the Intervention Mapping (IM) protocol, we developed the Bright Futures multidisciplinary intervention. First, a formative research process to identify the personal and environmental determinants of childhood overweight and obesity, behavioral outcomes and performance objectives was conducted. Then, a matrix of change objectives by intersecting the performance objectives with the determinants was integrated. Bright Futures lasted six months and included 24 weekly sessions, each composed of five phases: warm-up, theory, active movements, relaxation, and hydration. Ad hoc interactive teaching materials focused on recreational activities, and formulated plans for the adoption, implementation and process/impact evaluation of the intervention was developed. IM successfully guided the design of a theory-driven and evidence-based intervention for children in CCCs within a socio-ecological and participatory planning framework. This is one of the first studies in Mexico to use IM in the context of CCCs.

Comprehensive Cost Analysis of First Step Next for Preschoolers with Disruptive Behavior Disorder: Using Real-World Intervention Data to Estimate Costs at Scale

While the long-term societal costs for youth with disruptive behavior disorders are well documented, there is a dearth of information about the comprehensive costs of implementing even the most well-regarded early intervention programs, and the costs of scaling effective interventions are even less well understood. This study estimated the costs of delivering and disseminating First Step Next (FSN), an established tier two school-based early intervention, in preschool and kindergarten settings, including the training and ongoing technical assistance that support sustained, high-quality implementation. Using the Ingredients Method, we estimated (a) the per student costs of implementation, (b) the incremental cost of offering FSN to an additional student, and (c) the cost to disseminate FSN to 40 preschool and kindergarten students, including a sensitivity analysis to examine potential areas of cost savings. The per child cost to implement the FSN intervention with 29 triads in two cohorts was $4330. The incremental cost per additional student was only $2970, highlighting efficiencies gained once intervention infrastructure had been established. The cost of disseminating the intervention to a single cohort of 40 students was $170,106, or $4253 per student. The range in sensitivity analysis was $3141-$7829 per student, with variability in personnel wages having the greatest impact on cost estimates. This research expands on existing literature by providing a more comprehensive understanding of the cost of effective disruptive behavior interventions based on real-world implementation data, using these data to estimate dissemination costs, and showing how dissemination costs are particularly sensitive to personnel wages.

Development of an intervention program to prevent childhood obesity targeted to Mexican mothers of school-aged children using intervention mapping and social cognitive theory

In Mexico, data from the last National Health and Nutrition Survey (2016) described the increase in the prevalence of overweight and obesity in school-aged children (33.2%). Obesity prevention strategies have not been effective, and currently, Mexico has one of the highest prevalence of childhood obesity. Thus, there is an urgent need to develop strategies that can prevent childhood obesity and also to avoid these children to remain overweight/obese through adulthood. The objective of this study was to provide a step-by-step description of the design, implementation and evaluation of an intervention plan for Mexican mothers of school aged children to promote healthy eating and to prevent childhood obesity. The program Niño Sano Adulto Sano was developed using the Intervention Mapping Approach and the Social Cognitive Theory frameworks to provide Mexican mothers with knowledge and skills to positively modify their children's food behavior, thus preventing future weight gain. The program was developed, piloted and delivered to the target population with positive results on the mothers' nutrition knowledge and children's BMI. Intervention Mapping and Social Cognitive Theory are useful models to design and deliver an intervention that provides a holistic approach to promote healthy eating.

Enhancing the social capital in industrial workplaces: Developing workplace interventions using intervention mapping

Social capital in the workplace has been found to be associated with employee wellbeing and work engagement. Yet, evidence of effects of interventions to enhance the social capital are lacking. The intervention mapping method has been described as a useful tool for developing workplace interventions but it is very resource consuming. We aimed to develop an adapted version of the intervention mapping method which is more practically feasible to apply. To get insight into strengths and weaknesses of the adapted method, we applied it and conducted interviews with staff at six companies. The interviews revealed that the action plans developed using the adapted intervention mapping method were generally perceived as relevant and that the action plans had a positive effect on the social capital. However, the implementation of the action plans had been a challenge. In conclusion, the adapted intervention mapping method appears to be suitable for developing interventions to enhance the social capital in the workplace. However, more attention to the implementation of the action plans needs to be incorporated into the method. Suggestions to enhance the implementation included the involvement of the management in the implementation and monitoring of the implementation of the action plans as well as integrating the action plans into existing procedures in the workplace.

A Mobile App (WhiteTeeth) to Promote Good Oral Health Behavior Among Dutch Adolescents with Fixed Orthodontic Appliances: Intervention Mapping Approach

Background

The insertion of fixed orthodontic appliances increases the risk of dental caries, particularly in adolescents. Caries can be prevented through good oral health behavior. To support adolescents with fixed orthodontic appliances and for promoting oral health behavior, we developed a theory- and evidence-based mHealth program, the WhiteTeeth app.

Objective

The objective of our paper was to describe the systematic development and content of the WhiteTeeth app.

Methods

For systematic development of the program, we used the intervention mapping (IM) approach. In this paper, we present the results of applying the first 5 steps of IM to the design of an mHealth program: (1) identifying target behaviors and determinants through problem analysis, including a literature search, a survey study, and semistructured interviews, to explore adolescent oral health behavior during orthodontic therapy; (2) defining program outcomes and objectives; (3) selecting theoretical methods and translating them into practical strategies for the program design; (4) producing the program, including a pilot test with 28 adolescents testing the acceptability and usability of the WhiteTeeth app; and (5) planning implementation and adoption.

Results

On the basis of our literature search, we identified fluoride use and control of dental plaque levels (eg, tooth brushing and proxy brush usage) as target behaviors for preventing caries. Next, we identified important and changeable determinants of oral health behavior that fitted the theoretical concepts of the Health Action Process Approach (HAPA) theory. The HAPA theory, the self-regulation theory, and the results of the semistructured interviews were used to define the program objectives, that is, the performance and change objectives. After defining the objectives, we identified multiple behavior change techniques that could be used to achieve these objectives, such as providing oral health information and feedback, prompting self-monitoring, coaching of set actions and coping plans, and sending reminders. We translated these methods into practical strategies, such as videos and a brushing timer. Next, we combined these strategies into a single program resulting in the WhiteTeeth app (which is available on both iTunes and Google Play stores as “Witgebit”). Adolescents with fixed orthodontic appliances and dental professionals were included in the development process to increase the success of implementation. The pilot test revealed that the app users appreciated and liked the app. The WhiteTeeth app can be integrated into current orthodontic care.

Conclusions

IM allowed us to identify multiple techniques that have been shown to be the most effective in initiating behavior change, but have not yet been incorporated into existing orthodontic apps. The WhiteTeeth app contains all these techniques, which makes it a unique and promising home-based app for promoting oral health in adolescents with fixed orthodontic appliances.