Using Intervention Mapping to Develop a Breast and Cervical Cancer Screening Program for Hispanic Farmworkers: Cultivando La Salud

A Web-Based Patient Empowerment to Medication Adherence Program for Patients With Rheumatoid Arthritis: Feasibility Randomized Controlled Trial

BACKGROUND

Living with a chronic illness such as rheumatoid arthritis (RA) requires medications and therapies, as well as long-term follow-up with multidisciplinary clinical teams. Patient involvement in the shared decision-making process on medication regimens is an important element in promoting medication adherence. Literature review and needs assessment showed the viability of technology-based interventions to equip patients with knowledge about chronic illness and competencies to improve their adherence to medications. Thus, a web-based intervention was developed to empower patients living with RA to adhere to their disease-modifying antirheumatic drugs (DMARDs) medication regimen.

OBJECTIVE

This study aims to discuss the intervention mapping process in the design of a web-based intervention that supports patient empowerment to medication adherence and to evaluate its feasibility among patients living with RA.

METHODS

The theory-based Patient Empowerment to Medication Adherence Programme (PE2MAP) for patients with RA was built upon the Zimmerman Psychological Empowerment framework, a web-based program launched through the Udemy website. PE2MAP was developed using a 6-step intervention mapping process: (1) needs assessment, (2) program objectives, (3) conceptual framework to guide the intervention, (4) program plan, (5) adoption, and (6) evaluation involving multidisciplinary health care professionals (HCPs) and a multimedia team. PE2MAP is designed as a 4-week web-based intervention program with a complementary RA handbook. A feasibility randomized controlled trial was completed on 30 participants from the intervention group who are actively taking DMARD medication for RA to test the acceptability and feasibility of the PE2MAP.

RESULTS

The mean age and disease duration of the 30 participants were 52.63 and 8.50 years, respectively. The feasibility data showed 87% (n=26) completed the 4-week web-based PE2MAP intervention, 57% (n=17) completed all 100% of the contents, and 27% (n=8) completed 96% to 74% of the contents, indicating the overall feasibility of the intervention. As a whole, 96% (n=24) of the participants found the information on managing the side effects of medications, keeping fit, managing flare-ups, and monitoring joint swelling/pain/stiffness as the most useful contents of the intervention. In addition, 88% (n=23) and 92% (n=24) agreed that the intervention improved their adherence to medications and management of their side effects, including confidence in communicating with their health care team, respectively. The dos and do nots of traditional Chinese medicine were found by 96% (n=25) to be useful. Goal setting was rated as the least useful skill by 6 (23.1%) of the participants.

CONCLUSIONS

The web-based PE2MAP intervention was found to be acceptable, feasible, and effective as a web-based tool to empower patients with RA to manage and adhere to their DMARD medications. Further well-designed randomized controlled trials are warranted to explore the effectiveness of this intervention in the management of patients with RA.

An anxiety management intervention for people with substance use disorders (ITASUD): An intervention mapping approach based on Peplau's theory

Background

The comorbidity of anxiety and drug use disorders complicates treatment prognosis, and one of the greatest challenges is to address the environmental and behavioral factors involved. The aim of this study was to describe the uses of intervention mapping in the design of a theory and evidence-based complex intervention to develop skills around the management of anxiety for cocaine users in outpatient addiction treatment.

Methods

The six steps of the intervention mapping approach, which are needs assessment, creation of matrices of performance objectives, selection of methods and practical strategies, program development, adoption and implementation, and evaluation were applied to develop the Interpersonal Theory of nursing to Anxiety management in people with Substance Use Disorders (ITASUD) intervention. The theory used for the conceptual model was interpersonal relations theory. All theory-based methods and practical applications were developed at the individual level, acting in behavioral, interpersonal, organizational and community environments.

Results

The intervention mapping provided a broad overview of the problem and outcome expectations. The ITASUD intervention consists of five consecutive sessions of 110-min targeting individual determinants of anxiety (knowledge, triggers, relief behaviors, self-efficacy and relations), delivered by a trained nurse using Peplau's concepts of interpersonal relations. Intervention Mapping is a multi-step process that incorporates theory, evidence, and stakeholder perspectives to ensure that implementation strategies effectively address key determinants of change.

Conclusions

The intervention mapping approach increases the effectiveness of the intervention since the matrices provide a broad view of all factors that affect the problem and facilitate replication through transparency of the determinants, methods, and applications used. ITASUD addresses all factors that play an important role in substance use disorders based on a theoretical basis, which provides the translation of evidence from research into effective practice, policy, and public health improvements.

Evidence-Based Intervention (EBI) Mapping: a systematic approach to understanding the components and logic of EBIs

BACKGROUND

Despite the development of numerous evidence-based interventions (EBIs), many go unused in practice. Hesitations to use existing EBIs may be due to a lack of understanding about EBI components and what it would take to adapt it or implement it as designed. To improve the use of EBIs, program planners need to understand their goals, core components, and mechanisms of action. This paper presents EBI Mapping, a systematic approach based on Intervention Mapping, that can be used to understand and clearly describe EBIs, and help planners put them into practice.

METHODS

We describe EBI Mapping tasks and provide an example of the process. EBI Mapping uses principles from Intervention Mapping, a systematic framework for planning multilevel health promotion interventions. EBI Mapping applies the Intervention Mapping steps retrospectively to help planners understand an existing EBI (rather than plan a new one). We explain each EBI Mapping task and demonstrate the process using the VERB Summer Scorecard (VSS), a multi-level community-based intervention to improve youth physical activity.

RESULTS

EBI Mapping tasks are: 1) document EBI materials and activities, and their audiences, 2) identify the EBI goals, content, and mechanisms of action, 3) identify the theoretical change methods and practical applications of those methods, 4) describe design features and delivery channels, and 5) describe the implementers and their tasks, implementation strategies, and needed resources. By applying the EBI Mapping tasks, we created a logic model for the VSS intervention. The VSS logic model specifies the links between behavior change methods, practical applications, and determinants for both the at-risk population and environmental change agents. The logic model also links the respective determinants to the desired outcomes including the health behavior and environmental conditions to improve the health outcome in the at-risk population.

CONCLUSIONS

EBI Mapping helps program planners understand the components and logic of an EBI. This information is important for selecting, adapting, and scaling-up EBIs. Accelerating and improving the use of existing EBIs can reduce the research-to-practice gap and improve population health.

An intervention mapping-based support program that empowers patients with endocrine therapy management

BACKGROUND

For women diagnosed with hormone-receptor-positive breast cancer, endocrine therapy (ET) is recommended. Patients experience diverse side effects, and difficulties in managing these side effects have been identified as obstacles for treatment continuation. The aim of this study was to describe the development of a support program for patients prescribed ET.

METHODS

Intervention mapping (IM) a comprehensive theory-based approach was used in the support program development. A participatory design was used and four advisory groups was formed including both patients and healthcare professionals.

RESULTS

This study employed the systematic stages of IM to develop a theory-based support program with the goal to empower patients prescribed ET to manage ETrelated symptoms and problems, and to illuminate the healthcare structure. The needs assessment identified three performance objectives: (1) Patients have knowledge of and understand their symptoms and their management strategies. (2) Patients have the knowledge and confidence to express their care needs and to ask for guidance from healthcare professionals. (3) Patients are active in and lead their healthcare process.

CONCLUSION

This is a systematic developed model, built upon aspects of ET both from a patient´ perspective as well as from healthcare professionals' perspectives.

Rural Latino health and the built environment: a systematic review

Objective: This study systematically reviewed literature examining the influence of the rural built environment on Latinos' health outcomes and behaviour in the United States. A secondary aim of the study was to identify strategies developed to address challenges in the rural built environment affecting Latinos' health.Design: This study followed the reporting guidelines set forth by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Articles included in the final analysis clearly linked Latino health outcomes to characteristics of the rural built environment.Results: Of the nearly 2,500 articles identified in the initial search, the final review included approximately 146 full-text sources. The majority of the articles focused on aspects of Latinos' physical (n = 68), behavioural (n = 43), and mental health (n = 23).Conclusions: Rural Latino neighbourhoods in the United States possess limited access to health care, internet, transportation, and recreation infrastructure, which negatively impacts health outcomes and behaviours. Strategies developed to mitigate these issues include but are not limited to: the use of telecommunications to distribute health information; the use of community health workers and mobile clinics to increase awareness and availability of select health services; the use of worksite trainings and adaptations to the workplace; and the promotion of safety net programmes, such as the Supplemental Nutrition Programme for Women, Infants and Children (WIC). This review supports the need for a more robust research agenda documenting the health experiences of rural Latinos of various nationalities, age groups, and genders.

Advancing the Health of Migrant and Seasonal Farmworkers in the United States: Identifying Gaps in the Existing Literature, 2021

There are profound health inequities for agricultural workers. We sought to assess the literature on migrant and seasonal farmworker health with an eye toward health promotion interventions, special populations, use of community health workers (CHWs), and technology. We conducted a systematic mapping review by searching five databases in March 2021. Using quantitative content analysis after establishing interrater reliability, we coded titles and abstracts to assess 13 topics and six characteristics of the research such as its focus on health promotion, use of technology, and inclusion of CHWs. We identified 1,083 records. Just 8.2% of records described or evaluated a health promotion effort to intervene in farmworker well-being and even fewer (4.2%) examined unique populations of farmworkers such as indigenous farmworkers (n = 11) or sexual minority farmworkers (n = 1). A small body of literature focused on the role of CHWs or promotores most frequently described their role in implementing health interventions. The literature on farmworker health has gaps regarding health promotion interventions, special populations, and integration of CHWs into research projects. We offer suggestions to fill in identified gaps in the literature.

Prevention of partner violence: virtual case simulation for religious leaders of Korean American immigrant communities

The project 'Religious Leaders for Healthy Families' aims to prevent intimate partner violence (IPV) and increase access to resources for immigrant victims by enhancing the capacity of religious leaders. Due to cultural and psychosocial barriers, immigrant women prefer to exhaust informal resources, including religious leaders, before seeking help from professional service providers. This study reports the development of a virtual case simulation in which Korean American (KA) religious leaders living in the USA practice how to prevent and address IPV in their congregation. Intervention mapping (IM) guided the development of the simulation. This process was informed by theory, research and expertise in prevention and virtual case simulation. We partnered with victim service organizations and received feedback from religious leaders. The simulation was pilot tested with nine KA religious leaders and three community leaders with IPV expertise in the KA community. The resulting intervention consists of 4 behavioral outcomes and 24 performance objectives. We identified the knowledge, attitudes, outcome expectations and self-efficacy needed to accomplish each objective. The most creative phase was the development of four modules, as interactive virtual case simulations, that address all performance objectives. IM and social cognitive theory provided a useful framework for developing this virtual case simulation. With culturally responsive modifications, the intervention has the potential to be adapted for religious leaders from other immigrant communities.

Applying Community-Engaged Intervention Mapping to Preparing Nurse Scientists

BACKGROUND

Preventing and managing chronic illness necessitates multilevel, theory-based interventions targeting behaviors, environmental factors, and personal determinants that increase risk for illness onset, greater burden, and poorer outcomes.

OBJECTIVES

The purpose of this article is to provide the basis for multilevel interventions, describe community-engaged intervention mapping as an approach to designing theory-based interventions, and discuss potential benefits of applying community-engaged intervention mapping in preparing nurse scientists to build programs of interdisciplinary research in preventing and managing chronic illness.

METHODS

Community-engaged intervention mapping integrates two methodological approaches: intervention mapping and community-engaged research.

RESULTS

The six-step intervention mapping approach provides a logical structure for preparing nurse scientists in designing, adapting, and implementing multilevel, theory-based interventions. Community-engaged research approaches offer principles and direction for engaging patients, clinicians, community members, and other stakeholders throughout the research process. Integrating these methods retains the theoretical integrity of interventions; improves the relevance and timely completion of the research and its products; and enhances intended beneficiaries and the community's understanding, trust, and use of the results.

DISCUSSION

Potential benefits of preparation in community-engaged intervention mapping to nurse scientists and nursing science include explicit consideration of multilevel factors influencing health. Additional benefits include guidance for linking relevant constructs from behavior- and environment-oriented theories with evidence-based methods for affecting desired changes in care and quality of life outcomes. Moreover, enhancement of the theoretical fidelity of the intervention, explication of the mechanisms influencing change in the primary outcome, and improved relevance and feasibility of interventions for intended beneficiaries and potential adopters are other benefits.

A lay health worker intervention to improve breast and cervical cancer screening among Latinas in El Paso, Texas: A randomized control trial

INTRODUCTION

We examined the effectiveness of a lay health worker (promotora)-delivered intervention on increasing breast and cervical cancer screening among low-income, primarily uninsured Latinas living in El Paso, Texas.

METHODS

In 2015, Breast and Cervical Cancer Screening (BCCS) program promotoras recruited Latinas overdue for breast and/or cervical cancer screening in community settings. Promotoras consented eligible women and conducted baseline surveys before individually randomizing women into control (n = 313) or intervention (n = 314) groups. Control participants received printed material providing basic information about breast and cervical cancer screening.Intervention participants received promotora-delivered one-on-one breast and cervical cancer screening education followed by navigation calls, providing assistance to address personal and logistic barriers to accessing clinical services. We assessed breast and cervical cancer screening outcomes using a 6-month follow-up survey. Per protocol (PP) and intent to treat (ITT) analyses are reported.

RESULTS

At follow-up, among women in need of breast cancer screening, those in the intervention group were significantly more likely to complete a mammogram than those in the control group (PP: 53.4% vs. 40.1%, p = .013; ITT: 47.9% vs. 35.2%, p = .011). Among women in need of Pap screening, only intervention group women 50 years and older were more likely to complete a Pap screening compared with control group women (PP: 64.5% vs. 43.5%, p = .019).

CONCLUSIONS

A promotora-delivered behavioral intervention, embedded in a community-based organization, increased mammography uptake in all women and Pap uptake among women 50 years and older in a sample of low-income Latinas. NCT04397744.

Never Screened: Understanding Breast Cancer Nonadherence in Puerto Rico

Breast cancer is the most commonly diagnosed cancer and the leading cause of cancer-related death among women in Puerto Rico (PR). The purpose of this study was to identify factors associated with never screened status among a sample of women nonadherent to the 2013 American Cancer Society guidelines. The inclusion criteria for this study were being a woman (1) aged ≥40 years old and (2) nonadherent to breast cancer screening guidelines. We used baseline data from participants (N = 300; aged ≥40 years old) enrolled in the intervention trial Cultivando la Salud, implemented in Canóvanas, Puerto Rico, from 2012 to 2014. We used multivariate logistic regression models to identify factors associated with never screening status, adjusting by sociodemographical variables and psychosocial constructs about mammography (self-efficacy, beliefs about mammography pros [benefits] and cons [disadvantages], and subjective norms) as well as by health care insurance, usual source of care, and Pap test adherence. Among nonadherent women, 18.0% reported never having a mammography. Never screened women were significantly younger than previously screened women (adjusted prevalence odds ratio [aPOR] = 7.32, 95% confidence interval (CI): [2.38, 22.50]) and almost four times as likely to have the governmental health plan (GHP; aPOR = 3.78, 95% CI: [1.15, 12.46]). In addition, never screened women perceived more cons (disadvantages) to mammography than previously screened women (aPOR = 1.81, 95% CI: [1.18, 2.78]). We found that women who were younger, had GHP insurance, and had higher levels of beliefs against mammography were more likely to have never been screened. Results from this study can be used to target never screened women with health education messages addressing perceived cons of mammography. Additionally, women with GHP insurance may experience disparities in health care access and should be targeted with policies that facilitate access to mammography screening.

Using Intervention Mapping to Develop a Provider Intervention to Increase HPV Vaccination in a Federally Qualified Health Center

Introduction: A healthcare provider's ability to give a strong recommendation for the HPV vaccine is of utmost importance in increasing HPV vaccination. To reduce the burden of HPV-related cancers, there is a critical need to develop and implement theory-based interventions aimed at strengthening healthcare providers' communication about the HPV vaccine. Methods: We used Intervention Mapping (IM) steps 1-5 to develop and implement a provider-level intervention that aligns with the priorities and needs of a large, urban Federally Qualified Health Center (FQHC). Results: In step 1, a diverse planning group identified barriers to HPV vaccination in clinical settings and generated process maps and a logic model of the problem. Step 2 outlined outcomes and provider performance objectives of the intervention and identified knowledge, skills, self-efficacy, outcome expectations, and normative beliefs as modifiable targets that need to change for providers to deliver strong recommendations for the HPV vaccine to parents and patients. In step 3, the planning group mapped the methods of persuasive communication, information, and modeling and skills training to behavioral targets and outlined the program practical applications (strategies) components, scope, and sequence. In steps 4 and 5, the planning group produced the intervention and planned for program implementation. The iterative and participatory process of IM resulted in modifications to the initial intervention that aligned with the needs of the FQHC. Discussion: IM provided a systematic, participatory, and iterative approach for developing a theory-based provider-level intervention aimed at strengthening healthcare providers' ability to provide a strong recommendation for the HPV vaccine to eligible patients and parents served by a large FQHC. IM assisted with the identification of behavioral targets and methods that move beyond HPV knowledge and reminders to create behavior change. IM can help researchers and planners describe the processes and rational behind developing interventions and may help to facilitate implementation in real-world clinical settings by tailoring intervention components to the needs of the population.

Using Implementation Mapping to Develop Implementation Strategies for the Delivery of a Cancer Prevention and Control Phone Navigation Program: A Collaboration With 2-1-1

Cancer prevention and control (CPC) behaviors, such as cancer screening, human papillomavirus vaccination, and smoking cessation, are critical public health issues. Evidence-based interventions have been identified to improve the uptake of CPC behaviors; however, they are often inconsistently implemented, affecting their reach and effectiveness. Patient navigation is an evidence-based approach to increasing CPC behaviors. Nevertheless, there are few navigation programs that use systematically developed implementation strategies to facilitate adoption, implementation, and maintenance, which affects uptake and outcomes. This article describes the development of a multifaceted implementation strategy designed to facilitate delivery of a CPC phone navigation program to increase breast, cervical, and colorectal cancer screening; human papillomavirus vaccination; and smoking cessation among 2-1-1 Texas helpline callers. Using implementation mapping, a systematic approach for developing implementation strategies, we designed a strategy that involved training 2-1-1 information specialists to deliver the program, developed online tracking and quality-monitoring (audit and feedback) systems, and developed and distributed protocols and other materials to support training and implementation. Through this iterative process and our collaboration with 2-1-1 Texas call centers, our project resulted in a comprehensive training program with a robust curriculum of pertinent program content, for which we identified core components and appropriate delivery modes that are culturally relevant to the population. The results of this study can be applied to the development of more systematic, transparent, and replicable processes for designing implementation strategies. The study also demonstrates a process that can be applied to other contexts and other CPC program implementation efforts.

Comparing a standard and tailored approach to scaling up an evidence-based intervention for antiretroviral therapy for people who inject drugs in Vietnam: study protocol for a cluster randomized hybrid type III trial

Background

People who inject drugs (PWID) bear a disproportionate burden of HIV infection and experience poor outcomes. A randomized trial demonstrated the efficacy of an integrated System Navigation and Psychosocial Counseling (SNaP) intervention in improving HIV outcomes, including antiretroviral therapy (ART) and medications for opioid use disorder (MOUD) uptake, viral suppression, and mortality. There is limited evidence about how to effectively scale such intervention. This protocol presents a hybrid type III effectiveness-implementation trial comparing two approaches for scaling-up SNaP. We will evaluate the effectiveness of SNaP implementation approaches as well as cost and the characteristics of HIV testing sites achieving successful or unsuccessful implementation of SNaP in Vietnam.

Methods

Design: In this cluster randomized controlled trial, two approaches to scaling-up SNaP for PWID in Vietnam will be compared. HIV testing sites (n = 42) were randomized 1:1 to the standard approach or the tailored approach. Intervention mapping was used to develop implementation strategies for both arms. The standard arm will receive a uniform package of these strategies, while implementation strategies for the tailored arm will be designed to address site-specific needs.

Participants: HIV-positive PWID participants (n = 6200) will be recruited for medical record assessment at baseline; of those, 1500 will be enrolled for detailed assessments at baseline, 12, and 24 months. Site directors and staff at each of the 42 HIV testing sites will complete surveys at baseline, 12, and 24 months.

Outcomes: Implementation outcomes (fidelity, penetration, acceptability) and effectiveness outcomes (ART, MOUD uptake, viral suppression) will be compared between the arms. To measure incremental costs, we will conduct an empirical costing study of each arm and the actual process of implementation from a societal perspective. Qualitative and quantitative site-level data will be used to explore key characteristics of HIV testing sites that successfully or unsuccessfully implement the intervention for each arm.

Discussion

Scaling up evidence-based interventions poses substantial challenges. The proposed trial contributes to the field of implementation science by applying a systematic approach to designing and tailoring implementation strategies, conducting a rigorous comparison of two promising implementation approaches, and assessing their incremental costs. Our study will provide critical guidance to Ministries of Health worldwide regarding the most effective, cost-efficient approach to SNaP implementation.

Trial registration

NCT03952520 on Clinialtrials.gov. Registered 16 May 2019.

Using Intervention Mapping to Develop Health Education and Health Policy Components to Increase Breast Cancer Screening and Chemotherapy Adherence Among Syrian and Iraqi Refugee Women in Beirut, Lebanon

Introduction: Despite the continuous increase in the incidence of metastatic breast cancer among Syrian and Iraqi refugee women residing in camp settings in Lebanon, mammography and chemotherapy adherence rates remain low due to multiple social, economic, and environmental interfering factors. This in turn led to an alarming increase in breast cancer morbidity and mortality rates among the disadvantaged population. Methods: Intervention mapping, a systematic approach which guides researchers and public health experts in the development of comprehensive evidence-based interventions (EBIs) was used to plan a health education and health policy intervention to increase breast cancer screening and chemotherapy adherence among Iraqi and Syrian refugee women aged 30 and older who are residing in refugee camps within the Beirut district of Lebanon. Results: The generation of the logic model during the needs assessment phase was guided by an extensive review of the literature and reports published in peer-reviewed journals or by international/local organizations in the country to determine breast cancer incidence and mortality rates among refugee women of Syrian and Iraqi nationalities. The underlying behavioral and environmental determinants of the disease were identified from qualitative and quantitative studies carried out among the target population and also aided in assessing the sub-behaviors related to the determinants of breast cancer screening and chemotherapy completion as well as factors affecting policy execution to formulate performance objectives. We then developed matrices of change objectives and their respective methods and practical applications for behavior change at the intrapersonal, interpersonal, organizational, and societal levels. Both educational components (brochures, flyers) and technological methods (videos disseminated via Whats app and Facebook) will be adopted to apply the different methods selected (modeling, self-reevaluation, consciousness raising, persuasion, and tailoring). We also described the development of the educational and technological tools, in addition to providing future implementers with methods for pre-testing and pilot-testing of individual and environmental prototype components. Conclusion: The use of intervention mapping in the planning and implementation of holistic health promotion interventions based on information collected from published literature, case reports, and theory can integrate the multiple disciplines of public health to attain the desired behavioral change.

A systematic review of the effectiveness of health education interventions to increase cervical cancer screening uptake

Background

Cervical cancer screening reduced cancer morbidity and mortality in developed countries. Health education interventions are expected to enhance screening and early detection. Thus, this review is aimed to see the effectiveness of the interventions in cervical cancer screening uptake.

Methods

Online databases (PubMed/MEDLINE/PubMed Central, EMBASE, Cochrane Central Register of Controlled Trials, Web of Science and Google Scholar) were searched for all published eligible research articles in the past 12 years (as of January 2005-2017). A total of 17 research articles were included. The interventions were classified as 'individual level', 'community level' and 'cultural sensitive educations' which contains various interventions in their content as compared with usual care. A quality coding system was assessed using Cochrane checklists and rated by each researcher independently and the average score was given accordingly. This study was registered in PROSPERO 2017: CRD42017060405.

Results

The review dovetailed 17 studies. Ten studies (58.82%) were conducted in the United States, three in Iran (17.65%) and one each in Malaysia, China, Cameroon and Nigeria (23.53%). Almost all levels of the interventions boosted the screening uptake and the Pap test. However, the individual level health education interventions were prioritized in many of the studies.

Conclusion

The review indicated that health education interventions have immense contributions in boosting the screening uptake. However, the effectiveness varies with study setting, populations and the way of delivery. Therefore, the limited quality of the studies indicated that further research is required to develop a simple and effective intervention to boost cervical cancer screening uptake.

Use of the consolidated framework for implementation research to guide dissemination and implementation of new technologies in surgery

Background

Improving surgical outcomes is important to patients, providers, and healthcare systems. Understanding best methods to ensure evidence based practices are successfully implemented and sustained in clinical practices leads to improved care. Dissemination and implementation (D&I) science facilitates the successful pathway from clinical trials to sustained implementation.

Methods

We describe D&I science, introduce the consolidated framework for implementation research (CFIR), a D&I framework, and provide an example of how CFIR was utilized to facilitate the translational process from design adaptations to implementation, broad utilization by clinicians, and sustainability of the SUrgical Risk Preoperative Assessment System (SURPAS) tool into regular clinical practice. SURPAS creates data-driven individualized risk assessments of common adverse postoperative outcomes to enhance the informed consent process, shared decision making, and consequently improved surgical outcomes. The CFIR provided a structured systematic way to identify constructs influencing the D&I of SURPAS, including adaptations for the process and tool.

Results

We identified three domains, each with specific constructs, that participants believed would strongly influence effectiveness of SURPAS implementation efforts: the importance of patients' perspectives (outer setting); the quality of SURPAS (intervention characteristic); and integration of SURPAS into the electronic health record (inner setting). Additionally, providers' positive attitudes toward and support of SURPAS (characteristics of individuals); and the ease of integration of SURPAS into the workflow (process), were also identified. Tension emerged between patients' preference of the provision of risk information and providers' concern about additional clinic time required for formal risk discussion with low-risk patients.

Conclusions

Systematically identifying constructs from the beginning of the design through the implementation process can guide design of a multi-component strategy for future large-scale implementation by assessing the relative impact of factors on implementation using the CFIR framework. In the example studied, this allows key stakeholders to ensure success of D&I of SURPAS at multiple levels and times, continuously optimizing the process.

Choosing implementation strategies to address contextual barriers: diversity in recommendations and future directions

BACKGROUND

A fundamental challenge of implementation is identifying contextual determinants (i.e., barriers and facilitators) and determining which implementation strategies will address them. Numerous conceptual frameworks (e.g., the Consolidated Framework for Implementation Research; CFIR) have been developed to guide the identification of contextual determinants, and compilations of implementation strategies (e.g., the Expert Recommendations for Implementing Change compilation; ERIC) have been developed which can support selection and reporting of implementation strategies. The aim of this study was to identify which ERIC implementation strategies would best address specific CFIR-based contextual barriers.

METHODS

Implementation researchers and practitioners were recruited to participate in an online series of tasks involving matching specific ERIC implementation strategies to specific implementation barriers. Participants were presented with brief descriptions of barriers based on CFIR construct definitions. They were asked to rank up to seven implementation strategies that would best address each barrier. Barriers were presented in a random order, and participants had the option to respond to the barrier or skip to another barrier. Participants were also asked about considerations that most influenced their choices.

RESULTS

Four hundred thirty-five invitations were emailed and 169 (39%) individuals participated. Respondents had considerable heterogeneity in opinions regarding which ERIC strategies best addressed each CFIR barrier. Across the 39 CFIR barriers, an average of 47 different ERIC strategies (SD = 4.8, range 35 to 55) was endorsed at least once for each, as being one of seven strategies that would best address the barrier. A tool was developed that allows users to specify high-priority CFIR-based barriers and receive a prioritized list of strategies based on endorsements provided by participants.

CONCLUSIONS

The wide heterogeneity of endorsements obtained in this study's task suggests that there are relatively few consistent relationships between CFIR-based barriers and ERIC implementation strategies. Despite this heterogeneity, a tool aggregating endorsements across multiple barriers can support taking a structured approach to consider a broad range of strategies given those barriers. This study's results point to the need for a more detailed evaluation of the underlying determinants of barriers and how these determinants are addressed by strategies as part of the implementation planning process.

Choosing implementation strategies to address contextual barriers: diversity in recommendations and future directions

BACKGROUND

A fundamental challenge of implementation is identifying contextual determinants (i.e., barriers and facilitators) and determining which implementation strategies will address them. Numerous conceptual frameworks (e.g., the Consolidated Framework for Implementation Research; CFIR) have been developed to guide the identification of contextual determinants, and compilations of implementation strategies (e.g., the Expert Recommendations for Implementing Change compilation; ERIC) have been developed which can support selection and reporting of implementation strategies. The aim of this study was to identify which ERIC implementation strategies would best address specific CFIR-based contextual barriers.

METHODS

Implementation researchers and practitioners were recruited to participate in an online series of tasks involving matching specific ERIC implementation strategies to specific implementation barriers. Participants were presented with brief descriptions of barriers based on CFIR construct definitions. They were asked to rank up to seven implementation strategies that would best address each barrier. Barriers were presented in a random order, and participants had the option to respond to the barrier or skip to another barrier. Participants were also asked about considerations that most influenced their choices.

RESULTS

Four hundred thirty-five invitations were emailed and 169 (39%) individuals participated. Respondents had considerable heterogeneity in opinions regarding which ERIC strategies best addressed each CFIR barrier. Across the 39 CFIR barriers, an average of 47 different ERIC strategies (SD = 4.8, range 35 to 55) was endorsed at least once for each, as being one of seven strategies that would best address the barrier. A tool was developed that allows users to specify high-priority CFIR-based barriers and receive a prioritized list of strategies based on endorsements provided by participants.

CONCLUSIONS

The wide heterogeneity of endorsements obtained in this study's task suggests that there are relatively few consistent relationships between CFIR-based barriers and ERIC implementation strategies. Despite this heterogeneity, a tool aggregating endorsements across multiple barriers can support taking a structured approach to consider a broad range of strategies given those barriers. This study's results point to the need for a more detailed evaluation of the underlying determinants of barriers and how these determinants are addressed by strategies as part of the implementation planning process.

Interventions Developed with the Intervention Mapping Protocol in Work Disability Prevention: A Systematic Review of the Literature

Purposes Intervention mapping (IM) is a protocol for developing effective behavior change interventions. It has been used for 10 years to develop work disability prevention (WDP) interventions, but it is not known to what extent and with what success. The main objective of this study was to review the effectiveness of these interventions. Secondary objectives were to review their fidelity to the IM protocol, their theoretical frameworks and their content. Methods A search strategy was conducted in MEDLINE, Web of Science, PsycINFO, Pascal, Francis, and BDSP. All titles and abstracts were reviewed. A standardized extraction form was developed. All included studies were reviewed by two reviewers blinded to each other. Results Eight WDP interventions were identified aimed at return to work (RTW; n = 6) and self-management at work (n = 2). RTW interventions targeted workers with stress-related mental disorders (n = 1), low back pain (n = 1), musculoskeletal disorders (n = 1), cancer (n = 2) and gynecological surgery (n = 1). The fidelity to the IM protocol was weaker for the participatory planning group. Matrices of change, change methods, and applications were systematically reported. The main theoretical frameworks used were the attitude-social influence-self efficacy model (n = 4) and the theory of planned behavior (n = 2). Half of the interventions included a workplace component (n = 4). Two interventions were reported as effective, and one partially effective. Conclusion The IM protocol is used in WDP since 2007. The participative dimension appears underused. Few theoretical frameworks were used. Implications are to better consider the stakeholders involvement, and mobilize theoretical frameworks with greater attempts to intervene on the work environment.

Development of a culturally relevant physical activity intervention for Navajo cancer survivors

Despite well-documented benefits of physical activity for cancer survivors, few interventions have been developed for Native American cancer survivors, the population with the poorest survival rates of any group. This paper describes the development and cultural adaptation of a physical activity intervention for Navajo cancer survivors using Intervention Mapping (IM). IM procedures were guided by the PEN-3 (Perceptions-Enablers-Nurturers) and Health Belief Models and informed by a qualitative study with 40 Navajo cancer survivors and family members. For each theoretical construct (perceived benefits, barriers, enablers of healthy behaviors, etc.), a measurable objective was identified. These objectives were then matched with intervention strategies. The IM process indicated the need for a highly culturally sensitive environment (site and providers), culturally acceptable measurements and materials, and integrating cultural and environmental activity preferences. Program objectives aligned directly with these areas. Intervention strategies included: (a) collaboration with providers sensitive to historical/cultural context and environmental barriers; (b) cultural adaptation of surveys, non-invasive physical measurements, no biospecimen storage; (c) materials, terminology and symbols embracing cultural values of return to harmony; (d) physical activities that are flexible and aligned with cultural preferences and environment/travel issues (e.g., outdoor walking; community and home-based options; portable, inexpensive resistance equipment; local resources; family/friends participation and more community cancer education); (e) clinical adaptations by site and symptoms. This study is the first to document the process of adaptation of a physical activity program for Navajo cancer survivors. Objectives and strategies incorporated via IM are expected to foster sustainability and enhance uptake, satisfaction, and adherence.

Engaging stakeholders in the co-development of programs or interventions using Intervention Mapping: A scoping review

BACKGROUND

Health care innovations tailored to stakeholder context are more readily adopted. This study aimed to describe how Intervention Mapping (IM) was used to design health care innovations and how stakeholders were involved.

METHODS

A scoping review was conducted. MEDLINE, EMBASE, Cochrane Library, Scopus and Science Citation Index were searched from 2008 to November 2017. English language studies that used or cited Intervention Mapping were eligible. Screening and data extraction were done in triplicate. Summary statistics were used to describe study characteristics, IM steps employed, and stakeholder involvement.

RESULTS

A total of 852 studies were identified, 449 were unique, and 333 were excluded based on title and abstracts, 116 full-text articles were considered and 61 articles representing 60 studies from 13 countries for a variety of clinical issues were included. The number of studies published per year increased since 2008 and doubled in 2016 and 2017. The majority of studies employed multiple research methods (76.7%) and all 6 IM steps (73.3%). Resulting programs/interventions were single (55.4%) or multifaceted (46.4%), and 60.7% were pilot-tested. Programs or interventions were largely educational material or meetings, and were targeted to patients (70.2%), clinicians (14.0%) or both (15.8%). Studies provided few details about current or planned evaluation. Of the 4 (9.3%) studies that reported impact or outcomes, 3 achieved positive improvements in patient or professional behaviour or patient outcomes. Many studies (28.3%) did not involve stakeholders. Those that did (71.7%) often involved a combination of patients, clinicians, and community organizations. However, less than half (48.8%) described how they were engaged. Most often stakeholders were committee members and provide feedback on program or intervention content or format.

CONCLUSIONS

It is unclear if use of IM or stakeholder engagement in IM consistently results in effective programs or interventions. Those employing IM should report how stakeholders were involved in each IM step and how involvement influenced program or intervention design. They should also report the details or absence of planned evaluation. Future research should investigate how to optimize stakeholder engagement in IM, and whether use of IM itself or stakeholder engagement in IM are positively associated with effective programs or interventions.

Using Intervention Mapping to Develop and Adapt Two Educational Interventions for Parents to Increase HPV Vaccination Among Hispanic Adolescents

Introduction: Effective interventions to increase HPV vaccination are needed to reach national vaccination goals and to reduce later HPV-related cancer disparities. We used Intervention Mapping (IM) to develop and adapt a theory- and evidence-based educational intervention targeting parents of Hispanic adolescents to increase HPV vaccination.

Methods: We followed IM steps 1–6 to: (1) develop a logic model and identify modifiable factors associated with vaccination among Hispanic adolescents by conducting literature reviews, focus groups, and in-depth interviews with Hispanic parents; (2) develop outcomes, write performance objectives, and develop a matrix of change objectives; (3) develop and identify a program theme, program components, theoretical methods, and practical applications; (4) develop an intervention design plan; (5) develop implementation strategies; and (6) develop an evaluation plan. We completed Steps 1–6 for to develop an intervention targeting parents of females, and we followed the steps again to adapt the program once HPV vaccine recommendations included males.

Results: The program Por Nuestras Hijas (For Our Daughters) included two components: a print fotonovela and a tailored interactive multimedia intervention (TIMI). The program utilized the methods tailoring, targeting, framing, anticipated regret, modeling, skill building, and education and counseling to target the following determinants: parental knowledge, attitudes, self-efficacy, skills, perceived benefits/barriers, perceived susceptibility, perceived norms, and outcome expectations as modifiable factors influencing HPV vaccination. Lay health workers implemented the program in community clinics. A logic model of change guided evaluation planning. We later adapted the outcome and intervention content for parents of Hispanic adolescent males and changed the theme to Por Nuestros Hijos (For Our Children). Throughout the development and adaptation processes, we relied on theory, empirical evidence, and new data to make decisions.

Discussion: IM provided a systematic methodology for program development and adaptation. Tasks in each step built upon one another integrating findings from the literature, previous research, qualitative findings, and theory to develop two educational programs for parents to increase HPV vaccination. The systematic process allowed us to develop messages and materials targeting factors beyond HPV knowledge or awareness to create behavior change.

Participatory Research to Advance Colon Cancer Prevention (PROMPT): Study protocol for a pragmatic trial

BACKGROUND

Colon cancer is the second leading cause of cancer deaths in the United States. The Participatory Research to Advance Colon Cancer Prevention (PROMPT) study is a collaboration between two research institutions and a federally qualified health center (FQHC). The study seeks to raise colon cancer screening rates using a direct-mail fecal immunochemical testing (FIT) and reminder program in an FQHC serving a predominantly Latino population in California.

METHODS

PROMPT is a pragmatic trial enrolling 16 clinics. The study will test automated and live prompts (i.e., alerts, reminders) to a direct-mail FIT program in two phases. In Phase I, we tailored and defined intervention components for the pilot using a community-based participatory research approach called boot camp translation. We then plan to conduct a three-arm patient-randomized comparative effectiveness trial in two pilot clinics to compare 1) automated prompts, 2) live prompts, and 3) a combination of automated plus live prompts to alert and remind patients to complete screening. In Phase II, the adapted best practice intervention will be spread to additional clinics within the FQHC (estimated population 27,000) and assessed for effectiveness. Patient and staff interviews will be conducted to explore receptivity to the program and identify barriers to implementation.

DISCUSSION

This pragmatic trial applies innovative approaches to engage diverse stakeholders and will test the effectiveness and spread of a direct-mail plus reminder program. If successful, the program will provide a model for a cost-effective method to raise colon cancer screening rates among Latino patients receiving care in FQHCs.

TRIAL REGISTRATION

National Clinical Trial (NCT) Identifier NCT03167125.

Methods to Improve the Selection and Tailoring of Implementation Strategies

Implementing behavioral health interventions is a complicated process. It has been suggested that implementation strategies should be selected and tailored to address the contextual needs of a given change effort; however, there is limited guidance as to how to do this. This article proposes four methods (concept mapping, group model building, conjoint analysis, and intervention mapping) that could be used to match implementation strategies to identified barriers and facilitators for a particular evidence-based practice or process change being implemented in a given setting. Each method is reviewed, examples of their use are provided, and their strengths and weaknesses are discussed. The discussion includes suggestions for future research pertaining to implementation strategies and highlights these methods' relevance to behavioral health services and research.

Interventions developed with the Intervention Mapping protocol in the field of cancer: A systematic review

OBJECTIVES

The Intervention Mapping (IM) protocol provides a structured framework to develop, implement, and evaluate complex interventions. The main objective of this review was to identify and describe the content of the interventions developed in the field of cancer with the IM protocol. Secondary objectives were to assess their fidelity to the IM protocol and to review their theoretical frameworks.

METHODS

Medline, Web of Science, PsycINFO, PASCAL, FRANCIS, and BDSP databases were searched. All titles and abstracts were reviewed. A standardized extraction form was developed. All included studies were reviewed by 2 reviewers blinded to each other.

RESULTS

Sixteen studies were identified, and these reported 15 interventions. The objectives were to increase cancer screening participation (n = 7), early consultation (n = 1), and aftercare/quality of life among cancer survivors (n = 7). Six reported a complete participatory planning group, and 7 described a complete logic model of the problem. Ten studies described a complete logic model of change. The main theoretical frameworks used were the theory of planned behaviour (n = 8), the transtheoretical model (n = 6), the health belief model (n = 6), and the social cognitive theory (n = 6). The environment was rarely integrated in the interventions (n = 4). Five interventions were reported as effective.

CONCLUSIONS

Culturally relevant interventions were developed with the IM protocol that were effective to increase cancer screening and reduce social disparities, particularly when they were developed through a participative approach and integrated the environment. Stakeholders' involvement and the role of the environment were heterogeneously integrated in the interventions.

Using Intervention Mapping to Develop Health Education Components to Increase Colorectal Cancer Screening in Puerto Rico

Introduction

Colorectal cancer (CRC) is a leading cause of cancer-related mortality in Puerto Rico (PR). Although largely preventable through screening and treatment of precancerous polyps, CRC screening rates in PR remain low while CRC incidence and mortality continue to increase.

Methods

We used intervention mapping (IM), a systematic framework using theory and evidence to plan a health promotion intervention to increase colorectal cancer screening (CRCS) among Puerto Rican adults 50 years and older who are patients of Federally Qualified Health Centers (FQHCs) in PR.

Results

To inform the development of a logic model of the problem during the needs assessment phase, we determined the CRC incidence and mortality rates in PR using recent data from the PR Cancer Registry, conducted a literature review to better understand behavioral and environmental factors influencing CRC among Hispanics in general and in Puerto Ricans, and collected new data. We conducted seven focus groups to identify community needs and resources, specific sub-behaviors related to CRCS (performance objectives) and the determinants of CRCS. We then developed matrices of change objectives that would guide the content, behavioral change method selection, and the practical applications that would be included in the program. We selected two overarching methods: entertainment education and behavioral journalism and developed practical applications, materials, and messages containing several other methods including modeling, persuasion, information, and tailoring. We developed and pretested a Tailored Interactive Multimedia Intervention, newsletter, an action plan, and supplemental print materials for patients. We also developed a patient mediated provider prompt to increase provider recommendation and improve patient provider communication.

Conclusion

The use of IM for systematic planning produced a detailed coherent plan for the CRCS educational intervention. Guided by IM processes, steps, and tasks, we used community level information, existing literature, theory, and new data to develop health education materials that were well received by the priority population and will likely increase CRCS among FQHC patients in PR.

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

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.

Developing implementation strategies for firearm safety promotion in paediatric primary care for suicide prevention in two large US health systems: a study protocol for a mixed-methods implementation study

INTRODUCTION

The promotion of safe firearm practices, or firearms means restriction, is a promising but infrequently used suicide prevention strategy in the USA. Safety Check is an evidence-based practice for improving parental firearm safety behaviour in paediatric primary care. However, providers rarely discuss firearm safety during visits, suggesting the need to better understand barriers and facilitators to promoting this approach. This study, Adolescent Suicide Prevention In Routine clinical Encounters, aims to engender a better understanding of how to implement the three firearm components of Safety Check as a suicide prevention strategy in paediatric primary care.

METHODS AND ANALYSIS

The National Institute of Mental Health-funded Mental Health Research Network (MHRN), a consortium of 13 healthcare systems across the USA, affords a unique opportunity to better understand how to implement a firearm safety intervention in paediatric primary care from a system-level perspective. We will collaboratively develop implementation strategies in partnership with MHRN stakeholders. First, we will survey leadership of 82 primary care practices (ie, practices serving children, adolescents and young adults) within two MHRN systems to understand acceptability and use of the three firearm components of Safety Check (ie, screening, brief counselling around firearm safety and provision of firearm locks). Then, in collaboration with MHRN stakeholders, we will use intervention mapping and the Consolidated Framework for Implementation Research to systematically develop and evaluate a multilevel menu of implementation strategies for promoting firearm safety as a suicide prevention strategy in paediatric primary care.

ETHICS AND DISSEMINATION

Study procedures have been approved by the University of Pennsylvania. Henry Ford Health System and Baylor Scott & White institutional review boards (IRBs) have ceded IRB review to the University of Pennsylvania IRB. Results will be submitted for publication in peer-reviewed journals.

Use of Intervention Mapping to Enhance Health Care Professional Practice: A Systematic Review

Background. Intervention Mapping is a planning protocol for developing behavior change interventions, the first three steps of which are intended to establish the foundations and rationales of such interventions. Aim. This systematic review aimed to identify programs that used Intervention Mapping to plan changes in health care professional practice. Specifically, it provides an analysis of the information provided by the programs in the first three steps of the protocol to determine their foundations and rationales of change. Method. A literature search was undertaken in PubMed, Scopus, SciELO, and DOAJ using “Intervention Mapping” as keyword. Key information was gathered, including theories used, determinants of practice, research methodologies, theory-based methods, and practical applications. Results. Seventeen programs aimed at changing a range of health care practices were included. The social cognitive theory and the theory of planned behavior were the most frequently used frameworks in driving change within health care practices. Programs used a large variety of research methodologies to identify determinants of practice. Specific theory-based methods (e.g., modelling and active learning) and practical applications (e.g., health care professional training and facilitation) were reported to inform the development of practice change interventions and programs. Discussion. In practice, Intervention Mapping delineates a three-step systematic, theory- and evidence-driven process for establishing the theoretical foundations and rationales underpinning change in health care professional practice. Conclusion. The use of Intervention Mapping can provide health care planners with useful guidelines for the theoretical development of practice change interventions and programs.

The role of intervention mapping in designing disease prevention interventions: A systematic review of the literature

Objective

To assess the role of Intervention Mapping (IM) in designing disease prevention interventions worldwide.

Methods

Systematic search and review of the relevant literature—peer-reviewed and grey—was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines.

Findings

Only five of the twenty two included studies reviewed were RCTs that compared intervention using IM protocol with placebo intervention, and provided the outcomes in terms of percentage increase in the uptake of disease-prevention programmes, and only one of the five studies provided an effect measure in the form of relative risk (RR = 1.59, 95% CI = 1.08–2.34, p = 0.02). Of the five RCTs, three were rated as strong evidences, one as a medium evidence and one as a weak evidence, and they all reported statistically significant difference between the two study groups, with disease prevention interventions that have used the intervention mapping approach generally reported significant increases in the uptake of disease-prevention interventions, ranging from 9% to 28.5% (0.0001 ≤ p ≤ 0.02), On the other hand, all the 22 studies have successfully identified the determinants of the uptake of disease prevention interventions that is essential to the success of disease prevention programmes.

Conclusion

Intervention Mapping has been successfully used to plan, implement and evaluate interventions that showed significant increase in uptake of disease prevention programmes. This study has provided a good understanding of the role of intervention mapping in designing disease prevention interventions, and a good foundation upon which subsequent reviews can be guided.

Use of theory to plan or evaluate guideline implementation among physicians: a scoping review

BACKGROUND

Guidelines support health care decision-making and high quality care and outcomes. However, their implementation is sub-optimal. Theory-informed, tailored implementation is associated with guideline use. Few guideline implementation studies published up to 1998 employed theory. This study aimed to describe if and how theory is now used to plan or evaluate guideline implementation among physicians.

METHODS

A scoping review was conducted. MEDLINE, EMBASE, and The Cochrane Library were searched from 2006 to April 2016. English language studies that planned or evaluated guideline implementation targeted to physicians based on explicitly named theory were eligible. Screening and data extraction were done in duplicate. Study characteristics and details about theory use were analyzed.

RESULTS

A total of 1244 published reports were identified, 891 were unique, and 716 were excluded based on title and abstract. Among 175 full-text articles, 89 planned or evaluated guideline implementation targeted to physicians; 42 (47.2%) were based on theory and included. The number of studies using theory increased yearly and represented a wide array of countries, guideline topics and types of physicians. The Theory of Planned Behavior (38.1%) and the Theoretical Domains Framework (23.8%) were used most frequently. Many studies rationalized choice of theory (83.3%), most often by stating that the theory described implementation or its determinants, but most failed to explicitly link barriers with theoretical constructs. The majority of studies used theory to inform surveys or interviews that identified barriers of guideline use as a preliminary step in implementation planning (76.2%). All studies that evaluated interventions reported positive impact on reported physician or patient outcomes.

CONCLUSIONS

While the use of theory to design or evaluate interventions appears to be increasing over time, this review found that one half of guideline implementation studies were based on theory and many of those provided scant details about how theory was used. This limits interpretation and replication of those interventions, and seems to result in multifaceted interventions, which may not be feasible outside of scientific investigation. Further research is needed to better understand how to employ theory in guideline implementation planning or evaluation.

Intervention Mapping to Develop a Print Resource for Dog-Walking Promotion in Canada

Promoting dog walking among dog owners is consistent with One Health, which focuses on the mutual health benefits of the human-animal relationship for people and animals. In this study, we used intervention mapping (a framework to develop programs and resources for health promotion) to develop a clearer understanding of the determinants of dog walking to develop curricular and educational resources for promoting regular dog walking among dog owners. Twenty-six adult dog owners in Ontario participated in a semi-structured interview about dog walking in 2014. Thematic analysis entailing open, axial, and selective coding was conducted. Among the reasons why the participating dog owners walk their dog were the obligation to the dog, the motivation from the dog, self-efficacy, the dog's health, the owner's health, socialization, a well-behaved dog, and having a routine. The main barriers to dog walking were weather, lack of time, the dog's behavior while walking, and feeling unsafe. We compared interview results to findings in previous studies of dog walking to create a list of determinants of dog walking that we used to create a matrix of change objectives. Based on these results, we developed a print resource to promote regular dog walking among dog owners. The findings can be used by veterinary educators to inform course content that specifically educates veterinary students on the promotion of dog walking among dog owners and the benefits to both humans and animals. The study also offers veterinarians a further understanding upon which to initiate a conversation and develop educational resources for promoting regular dog walking among dog-owning clients.

Family/friend recommendations and mammography intentions: the roles of perceived mammography norms and support

Identifying factors that increase mammography use among Latinas is an important public health priority. Latinas are more likely to report mammography intentions and use, if a family member or friend recommends that they get a mammogram. Little is known about the mechanisms underlying the relationship between social interactions and mammography intentions. Theory suggests that family/friend recommendations increase perceived mammography norms (others believe a woman should obtain a mammogram) and support (others will help her obtain a mammogram), which in turn increase mammography intentions and use. We tested these hypotheses with data from the ¡Fortaleza Latina! study, a randomized controlled trial including 539 Latinas in Washington State. Women whose family/friend recommended they get a mammogram within the last year were more likely to report mammography intentions, norms and support. Perceived mammography norms mediated the relationship between family/friend recommendations and intentions, Mediated Effect = 0.38, 95%CI [0.20, 0.61], but not support, Mediated Effect = 0.002, 95%CI [-0.07, 0.07]. Our findings suggest perceived mammography norms are a potential mechanism underlying the effect of family/friend recommendations on mammography use among Latinas. Our findings make an important contribution to theory about the associations of social interactions, perceptions and health behaviors.

Methods to Improve the Selection and Tailoring of Implementation Strategies

Implementing behavioral health interventions is a complicated process. It has been suggested that implementation strategies should be selected and tailored to address the contextual needs of a given change effort; however, there is limited guidance as to how to do this. This article proposes four methods (concept mapping, group model building, conjoint analysis, and intervention mapping) that could be used to match implementation strategies to identified barriers and facilitators for a particular evidence-based practice or process change being implemented in a given setting. Each method is reviewed, examples of their use are provided, and their strengths and weaknesses are discussed. The discussion includes suggestions for future research pertaining to implementation strategies and highlights these methods' relevance to behavioral health services and research.

Increasing Cervical Cancer Screening Among US Hispanics/Latinas: A Qualitative Systematic Review

Hispanic/Latina women experience the highest cervical cancer incidence rates of any racial/ethnic group in the USA and tend to present with more severe cases and experience higher mortality compared to most other populations. The goals of this qualitative systematic review were to explore existing interventions to increase cervical cancer screening among US Hispanics/Latinas and to identify characteristics of effective interventions and research gaps. Six online databases were searched from their inception through June 30, 2013, using designated search terms and keywords. Peer-reviewed articles that documented an intervention designed to improve screening for cervical cancer among Hispanics/Latinas ages 18 years and older living in the USA were reviewed. Data were abstracted using a standardized form to document intervention characteristics and results. Forty-five articles, describing 32 unique interventions, met inclusion criteria. Identified interventions consisted primarily of educational programs and/or provision of screening. Interventions used lay health advisors (LHAs), clinic-based outreach/delivery strategies, partnerships with churches, and mass media campaigns. Twelve interventions resulted in significant increases in cervical cancer screening rates. Interventions developed utilizing theory, applying community-based participatory research approaches, and using LHAs were identified as having the greatest potential for improving cervical cancer screening among Hispanics/Latinas. There continues to be a need for the development of interventions in geographic areas with new and emerging Hispanic/Latino populations and that are comprehensive, follow participants for longer periods of time, and broaden the roles and build the capacities of LHAs.

Using the collaborative intervention planning framework to adapt a health-care manager intervention to a new population and provider group to improve the health of people with serious mental illness

Background

Health-care manager interventions improve the physical health of people with serious mental illness (SMI) and could be widely implemented in public mental health clinics. Local adaptations and customization may be needed to increase the reach of these interventions in the public mental health system and across different racial and ethnic communities. In this study, we describe how we used the collaborative intervention planning framework to customize an existing health-care manager intervention to a new patient population (Hispanics with SMI) and provider group (social workers) to increase its fit with our local community.

Methods

The study was conducted in partnership with a public mental health clinic that serves predominantly Hispanic clients. A community advisory board (CAB) composed of researchers and potential implementers (e.g., social workers, primary care physicians) used the collaborative intervention planning framework, an approach that combines community-based participatory research principles and intervention mapping (IM) procedures, to inform intervention adaptations.

Results

The adaptation process included four steps: fostering collaborations between CAB members; understanding the needs of the local population through a mixed-methods needs assessment, literature reviews, and group discussions; reviewing intervention objectives to identify targets for adaptation; and developing the adapted intervention. The application of this approach enabled the CAB to identify a series of cultural and provider level-adaptations without compromising the core elements of the original health-care manager intervention.

Conclusions

Reducing health disparities in people with SMI requires community engagement, particularly when preparing existing interventions to be used with new communities, provider groups, and practice settings. Our study illustrates one approach that can be used to involve community stakeholders in the intervention adaptation process from the very beginning to enhance the transportability of a health-care manager intervention in order to improve the health of people with SMI.

Electronic supplementary material

The online version of this article (doi:10.1186/s13012-014-0178-9) contains supplementary material, which is available to authorized users.

Developing theoretically based and culturally appropriate interventions to promote hepatitis B testing in 4 Asian American populations, 2006-2011

Introduction

Hepatitis B infection is 5 to 12 times more common among Asian Americans than in the general US population and is the leading cause of liver disease and liver cancer among Asians. The purpose of this article is to describe the step-by-step approach that we followed in community-based participatory research projects in 4 Asian American groups, conducted from 2006 through 2011 in California and Washington state to develop theoretically based and culturally appropriate interventions to promote hepatitis B testing. We provide examples to illustrate how intervention messages addressing identical theoretical constructs of the Health Behavior Framework were modified to be culturally appropriate for each community.

Methods

Intervention approaches included mass media in the Vietnamese community, small-group educational sessions at churches in the Korean community, and home visits by lay health workers in the Hmong and Cambodian communities.

Results

Use of the Health Behavior Framework allowed a systematic approach to intervention development across populations, resulting in 4 different culturally appropriate interventions that addressed the same set of theoretical constructs.

Conclusions

The development of theory-based health promotion interventions for different populations will advance our understanding of which constructs are critical to modify specific health behaviors.

Refinement of an educational toolkit to promote cervical cancer screening among Hispanic immigrant women in rural southern Georgia

Cervical cancer incidence and mortality continue to affect Hispanic women in the U.S. disproportionately. Our project sought to refine a cervical cancer intervention designed for use by community health workers, or promotoras, in rural southern Georgia. We collaborated with Hispanic promotoras to refine a Spanish language educational flipchart featuring cervical cancer topic areas for use in screening promotion.

Cervical cancer control for Hispanic women in Texas: strategies from research and practice

OBJECTIVE

Hispanic women in Texas have among the highest rates of cervical cancer incidence and mortality in the country. Increasing regular Papanicolaou test screening and HPV vaccination are crucial to reduce the burden of cervical cancer among Hispanics. This paper presents lessons learned from community-based cervical cancer control programs for Hispanics and highlights effective intervention programs, methods and strategies.

METHODS

We reviewed and summarized cervical cancer control efforts targeting Hispanic women, focusing on interventions developed by researchers at the University of Texas, School of Public Health. We identified commonalities across programs, highlighted effective methods, and summarized lessons learned to help guide future intervention efforts.

RESULTS

Community-academic partnerships were fundamental in all steps of program development and implementation. Programs reviewed addressed psychosocial, cultural, and access barriers to cervical cancer control among low-income Hispanic women. Intervention approaches included lay health worker (LHW) and navigation models and used print media, interactive tailored media, photonovellas, client reminders, one-on-one and group education sessions.

CONCLUSIONS

Small media materials combined with LHW and navigation approaches were effective in delivering Pap test screening and HPV vaccination messages and in linking women to services. Common theoretical methods included in these approaches were modeling, verbal persuasion, and facilitating access. Adaptation of programs to an urban environment revealed that intensive navigation was needed to link women with multiple access barriers to health services. Collectively, this review reveals 1) the importance of using a systematic approach for planning and adapting cervical cancer control programs; 2) advantages of collaborative academic-community partnerships to develop feasible interventions with broad reach; 3) the use of small media and LHW approaches and the need for tailored phone navigation in urban settings; and 4) coordination and technical assistance of community-based efforts as a way to maximize resources.

Using intervention mapping to develop a culturally appropriate intervention to prevent childhood obesity: the HAPPY (Healthy and Active Parenting Programme for Early Years) study

Introduction

Interventions that make extensive use of theory tend to have larger effects on behaviour. The Intervention Mapping (IM) framework incorporates theory into intervention design, implementation and evaluation, and was applied to the development of a community-based childhood obesity prevention intervention for a multi-ethnic population.

Methods

IM was applied as follows: 1) Needs assessment of the community and culture; consideration of evidence-base, policy and practice; 2) Identification of desired outcomes and change objectives following identification of barriers to behaviour change mapped alongside psychological determinants (e.g. knowledge, self-efficacy, intention); 3) Selection of theory-based methods and practical applications to address barriers to behaviour change (e.g., strategies for responsive feeding); 4) Design of the intervention by developing evidence-based interactive activities and resources (e.g., visual aids to show babies stomach size). The activities were integrated into an existing parenting programme; 5) Adoption and implementation: parenting practitioners were trained by healthcare professionals to deliver the programme within Children Centres.

Results

HAPPY (Healthy and Active Parenting Programme for Early Years) is aimed at overweight and obese pregnant women (BMI > 25); consists of 12 × 2.5 hr. sessions (6 ante-natal from 24 weeks; 6 postnatal up to 9 months); it addresses mother’s diet and physical activity, breast or bottle feeding, infant diet and parental feeding practices, and infant physical activity.

Conclusion

We have demonstrated that IM is a feasible and helpful method for providing an evidence based and theoretical structure to a complex health behaviour change intervention. The next stage will be to assess the impact of the intervention on behaviour change and clinical factors associated with childhood obesity. The HAPPY programme is currently being tested as part of a randomised controlled feasibility trial.

Plans to obtain a mammogram among Chilean women: the roles of recommendations and self-efficacy

Social factors may heavily influence cancer screening decisions and practices among Latinas, given the importance their culture places on close, interpersonal relationships. Recommendations by healthcare providers, family and friends have been associated with early detection strategies among US-based Latina populations, but little is known about other Latin American populations. Furthermore, less is known about mechanisms underlying this relationship. In this study, we sought to (i) understand if different types of recommendations were associated with subsequent plans to obtain a mammogram and (ii) assess the potential mediating roles of perceived importance of these recommendations and self-efficacy. Our sample included 250 women residing in a low-income, urban area of Santiago, Chile, and who had participated in a 6-month intervention to increase mammography screening, but remained non-compliant. Women who received family recommendations were more likely to indicate they planned to receive a mammogram in the next 6 months. Perceived self-efficacy mediated this relationship, such that women who received a family recommendation appeared to be more likely to plan to get a mammogram because of increased perceived capabilities to do so. Future research should consider the cultural context of family and self-efficacy in the development of screening interventions for Latinas.

The development of a web-based brief alcohol intervention in reducing heavy drinking among college students: an Intervention Mapping approach

In the Netherlands, young adults' drinking practices have become an issue of public concern since their drinking levels are high. Heavy drinking can place young adults at an increased risk for developing short- and long-term health-related problems. Current national alcohol prevention programmes focus mainly on adolescents and their parents and paying less systematic attention to young adults. The present study describes the theory and evidence-based development of a web-based brief alcohol intervention entitled What Do You Drink (WDYD). We applied the Intervention Mapping (IM) protocol to combine theory and evidence in the development and implementation of WDYD. The WDYD intervention aims to detect and reduce heavy drinking of young adults who are willing to decrease their alcohol consumption, preferably below the Dutch guidelines of low-risk drinking. According to the IM protocol, the development of WDYD resulted in a structured intervention. Reducing heavy drinking to low-risk drinking was proposed as the behavioural outcome. Motivational interviewing principles and parts of the I-Change Model were used as methods in the development of WDYD, whereas computer tailoring was selected as main strategy. An effect and a process evaluation of the intervention will be conducted. IM was found to be a practical instrument for developing the WDYD intervention tailored to a specific target population in the area of alcohol prevention.

Evaluating the training of Filipino American community health advisors to disseminate colorectal cancer screening

Community health advisor-led interventions are associated with improved health promotion behaviors, such as cancer screening, but the process of training community health advisors is rarely described and evaluated. We trained 91 Filipino Americans from 19 organizations to conduct small-group sessions with members of their organizations to promote colorectal cancer screening. Community health advisors completed brief pre- and post-training surveys that included knowledge of colorectal cancer screening guidelines (four items), perceived self-efficacy of performing specific tasks (15-item scale, Cronbach's alpha > 0.90) and satisfaction with the training itself (five items). Community health advisors had high levels of knowledge and self-efficacy at pre-training, but levels increased significantly immediately after the 6-h training (percent of knowledge items answered correctly: 63-94 %; self-efficacy: 8.2-8.9 on a 10 point scale, both p < 0.001). Correlates of self-efficacy at pre- and post-test were high educational attainment, health care background, high level of participation in the organization, being perceived by others as a leader, and frequent participation in research activities in the past. Consistent evaluation measuring similar constructs across studies may help to standardize the quality of the training, and may improve the implementation of community health advisor-led programs.

Cervical cancer screening interventions for U.S. Latinas: a systematic review

The high cervical cancer mortality rate among Latinas compared with other ethnic groups in the United States is of major concern. Latina women are almost twice as likely to die from cervical cancer as non-Hispanic white women. To improve Latina cervical cancer screening rates, interventions have been developed and tested. This systematic review was undertaken to determine the effectiveness of such studies. Studies involving both experimental and quasi-experimental designs were located (N = 6), and odds ratios were calculated for screening behavior. The pooled effect of these programs was negligible, and implications are derived from this finding.

Racial differences and disparities in cancer care and outcomes: where's the rub?

Despite a profusion of studies over the past several years documenting racial differences in cancer outcomes, there is a paucity of data as to the root causes underlying these observations. This article reviews work to date focusing on black-white differences in cancer outcomes, explores potential mechanisms underlying these differences, and identifies patient, physician, and health care system factors that may account for persistent racial disparities in cancer care. Research strategies to elucidate the relative influence of these various factors and policy recommendations to reduce persistent disparities are also discussed.

Development of a theory-based (PEN-3 and Health Belief Model), culturally relevant intervention on cervical cancer prevention among Latina immigrants using intervention mapping

The development of efficacious theory-based, culturally relevant interventions to promote cervical cancer prevention among underserved populations is crucial to the elimination of cancer disparities. The purpose of this article is to describe the development of a theory-based, culturally relevant intervention focusing on primary (sexual risk reduction) and secondary (Pap smear) prevention of cervical cancer among Latina immigrants using intervention mapping (IM). The PEN-3 and Health Belief Model provided theoretical guidance for the intervention development and implementation. IM provides a logical five-step framework in intervention development: delineating proximal program objectives, selecting theory-based intervention methods and strategies, developing a program plan, planning for adoption in implementation, and creating evaluation plans and instruments. We first conducted an extensive literature review and qualitatively examined the sociocultural factors associated with primary and secondary prevention of cervical cancer. We then proceeded to quantitatively validate the qualitative findings, which led to development matrices linking the theoretical constructs with intervention objectives and strategies as well as evaluation. IM was a helpful tool in the development of a theory-based, culturally relevant intervention addressing primary and secondary prevention among Latina immigrants.

When promotoras and technology meet: a qualitative analysis of promotoras' use of small media to increase cancer screening among South Texas Latinos

Computer-based multimedia technologies can be used to tailor health messages, but promotoras (Spanish-speaking community health workers) rarely use these tools. Promotoras delivered health messages about colorectal cancer screening to medically underserved Latinos in South Texas using two small media formats: a "low-tech" format (flipchart and video) and a "high-tech" format consisting of a tailored, interactive computer program delivered on a tablet computer. Using qualitative methods, the authors observed promotora training and intervention delivery and conducted interviews with five promotoras to compare and contrast program implementation of both formats. The authors discuss the ways each format aided or challenged promotoras' intervention delivery. Findings reveal that some aspects of both formats enhanced intervention delivery by tapping into Latino health communication preferences and facilitating interpersonal communication, whereas other aspects hindered intervention delivery. This study contributes to our understanding of how community health workers use low- and high-tech small media formats when delivering health messages to Latinos.