Putting Public Health Evidence in Action
METHODS TABLE TO USE TO INFLUENCE DETERMINANTS*
TABLE 1. BASIC METHODS AT THE INDIVIDUAL LEVEL
Methods
Related Theory
Participation
Diffusion of Innovations
Theory, Models of Community Organization; Empowerment theories
Belief selection
Theory of Planned Behavior/Theory of Reasoned
Action
Persuasive communication
Persuasion-Communication
Matrix, Elaboration Likelihood Method, Social Cognitive Theory, Diffusion of
Innovations Theory
Active learning
Persuasion-Communication
Matrix, Elaboration Likelihood Method, Social Cognitive Theory
Definition
Parameters for Use
Examples
Assuring high level engagement of the participants’ group
in problem solving, decision
making, and change activities;
with highest level being control
by the participants’ group
Using messages designed to
strengthen positive beliefs,
weaken negative beliefs and
introduce new beliefs
Requires willingness by the health
promoter or convener to accept the
participants as having a high level of
influence; requires participants’
group to possess appropriate motivation and skills
Requires investigation of the current
attitudinal, normative and efficacy
beliefs of the individual before
choosing the beliefs on which to
intervene
A health promoter includes representatives of students in the project group that
is developing a new sex education program for schools.
Guiding individuals and environmental agents toward the
adoption of an idea, attitude, or
action by using arguments or
other means
Messages need to be relevant and
not too discrepant from the beliefs of
the individual; can be stimulated by
surprise and repetition. Will include
arguments.
Encouraging learning from goal
driven and activity based experience
Time, information, and skills
In a program for HIV prevention for Hispanic men, the men’s belief that condoms were unclean needed to be
changed; the importance of family values
needed to be reinforced; and the belief
that condoms could prevent HIV infection
needed to be introduced.
Viewing a television broadcast on the
health consequences to children from
environmental tobacco smoke and the
benefits of protecting children from
smoke may influence a mother to declare
her home smoke free.
Getting individuals to search for answers
to questions they pose as a result of
some stimulus leads to better information
processing and learning than passive
learning and to increased, change in determinants and behavior.
1
*From Bartholomew, LK, Parcel GS, Kok G, Gottlieb NH, Fernandez ME; Planning Health Promotion Programs: An Intervention Mapping Approach, 3rd ed.
San Francisco: Jossey-Bass, 2011.
Putting Public Health Evidence in Action
Tailoring
Trans-Theoretical Model,
Precaution Adoption Process Model, Protection
Motivation Theory, Persuasion-Communication Matrix
Individualization
Trans-Theoretical Model
Modeling
Social Cognitive Theory;
Theories of Learning
Feedback
Theories of Learning, Goal
Setting Theory
Reinforcement & punishment
Theories of Learning, Social Cognitive Theory
Matching the intervention or
components to previously
measured characteristics of the
participant
Tailoring variables or factors related
to behavior change (such as stage)
or to relevance (such as culture or
socioeconomic status)
Providing opportunities for
learners to have personal
questions answered or instructions paced according to their
individual progress
Providing an appropriate model
being reinforced for the desired
action
Personal communication that responds to a learner’s needs
Giving information to individuals and environmental agents
regarding the extent to which
they are accomplishing learning or performance, or the extent to which performance is
having an impact.
Providing reinforcement: linking a behavior to any consequence that increases the behavior’s rate, frequency or
probability. Provide punishment: linking a behavior to any
consequence that decreases
the behavior’s rate, frequency
or probability.
Feedback needs to be individual,
follow the behavior in time, and specific
Attention, remembrance, selfefficacy and skills, reinforcement of
model; identification with model,
coping model instead of mastery
model
Reinforcement and punishment
need to be tailored to the individual,
group or organization, to follow the
behavior in time, and to be seen as
a consequence of the behavior.
A patient educator motivates her patients
to engage in vigorous physical activity by
giving different messages based on the
stage of change of each patient, for example providing information that physical
activity will reduce their cardiovascular
risk and increase their stamina to patients who are precontemplators.
An AIDS services organization provides
a phone facility for young gay people to
ask questions about their sexual identity
and coming-out.
The health promoter finds a role model
from the community or at-risk group who
will encourage identification and serve as
a coping model: “I tried to quit smoking
several times and was not successful,
then I tried . . . Now I have been off cigarettes for . . .”
A physical activity counselor informs a
client that her body mass index has decreased by 4% since she has begun her
physical activity program.
An elementary school teacher praises a
student for selecting a healthful dessert.
2
*From Bartholomew, LK, Parcel GS, Kok G, Gottlieb NH, Fernandez ME; Planning Health Promotion Programs: An Intervention Mapping Approach, 3rd ed.
San Francisco: Jossey-Bass, 2011.
Putting Public Health Evidence in Action
Facilitation
Social Cognitive Theory
Creating an environment that
makes the action easier or reduces barriers to action
Requires real changes in the environment instead of perceptions of
the environment. Requires the identification of barriers and facilitators
and the power for making the appropriate changes. Facilitating conditions on one environmental level are
usually dealt with by intervening on a
higher environmental level.
A program that targets improvement in
drug users’ self-efficacy for using clean
needles must also facilitate clean needles being easily accessible
Parameters for Use
Examples
Using stimulus patterns that
may be made up of parts but
that one perceives as a whole
Labels or acronyms are assigned to
material to aid memory.
Presenting an overview of the
material that enables a learner
to activate relevant schemas so
that new material can be associated
Schematic representations of the
content, or guides to what is to be
learned
Using artifacts that have a similar appearance to some subject
Familiar physical or verbal images
as analogies to a less familiar process
Encouraging consideration of a
topic in open informal debate
Listening to the learner to ensure
that the correct schemas are activated
Children in the asthma selfmanagement program learned a rap
song with the words “Watch, discover,
think, and act” for the stages of selfmanagement.
In a brochure for children with asthma,
graphic organizers were placed on the
top of every page, with the relevant
concepts addressed on that page highlighted in the organizer by means of
thick lines and shadings.
A patient educator helps a learner
memorize a long self-care process by
attaching the steps in the procedure to
landmarks on a familiar daily route.
A classroom teacher has students discuss what they learned in a video about
defusing a bullying situation.
TABLE 2. METHODS TO INCREASE KNOWLEDGE*
Methods
Related Theory
Chunking
Theories of Information
Processing
Advance organizers
Theories of Information
Processing
Using imagery
Theories of Information
Processing
Discussion
Theories of Information
Processing
Definition
3
*From Bartholomew, LK, Parcel GS, Kok G, Gottlieb NH, Fernandez ME; Planning Health Promotion Programs: An Intervention Mapping Approach, 3rd ed.
San Francisco: Jossey-Bass, 2011.
Putting Public Health Evidence in Action
Elaboration
Theories of Information
Processing, Elaboration
Likelihood Model
Providing cues
Stimulating the learner to add
meaning to the information that
is processed
A classroom teacher has students discuss the Safe Sex message: “When you
want to get pregnant, use a condom”;
stimulating adolescents to discover that
Chlamydia can cause infertility: “If you
want to get pregnant later, use a condom now”.
For teens who are learning to negotiate
condom use, the cues present during
learning, such as what the partner says,
should be as similar as possible to what
teens will actually encounter in real life.
*Always consider basic methods at the individual level: Participation, belief selection, persuasive communication, active learning, tailoring,
individualization, modeling, feedback, reinforcement & punishment, and facilitation; see Table 6.3.
Theories of Information
Processing
Assuring that the same cues
are present at the time of learning and the time of retrieval
Individuals with high motivation and
high cognitive ability; messages that
are personally relevant, surprising,
repeated, self-pacing, not distracting, easily understandable, and include direct instructions; messages
that are not too discrepant and
cause anticipation of interaction
Cues work best when people are
allowed to select and provide their
own cues
TABLE 3. METHODS TO CHANGE AWARENESS AND RISK PERCEPTION*
Methods
Related Theory
Consciousness raising
Health Belief Model, Precaution-Adoption Process Model, Trans-Theoretical Model
Personalize risk
Precaution-Adoption Process Model
Scenario-based risk
information
Precaution-Adoption Process Model
Definition
Providing information, feedback,
or confrontation about the causes, consequences and alternatives for a problem or a problem
behavior.
Providing information about personal costs or risks of action or
inaction with respect to target
behavior
Providing information that may
aid the construction of an image
of the ways in which a future
loss or accident might occur.
Parameters for Use
Examples
Can use feedback and confronta- An HIV counselor reminds a person of
tion; however, raising awareness recent episodes of failure to use condoms
must be quickly followed by increasewhen
in problem-solving
having sex andability
the potential
and (collective)
conse- self-efficacy
quences of that behavior on significant
others.
Present messages as individual
Individuals receive personal risk feedback
and undeniable, and compare
on their fat intake, indicating whether it is
them with absolute and normative higher than their self-rated level.
standard
Plausible scenario with a cause
Peer models in an HIV-prevention program
and an outcome; imagery. Most
present a series of scenarios in which they
effective when people generate
describe how they found themselves in
their own scenario or when multi- risky situations, for example, a sexual relaple scenarios are provided
tionship over the summer holidays.
4
*From Bartholomew, LK, Parcel GS, Kok G, Gottlieb NH, Fernandez ME; Planning Health Promotion Programs: An Intervention Mapping Approach, 3rd ed.
San Francisco: Jossey-Bass, 2011.
Putting Public Health Evidence in Action
Using gain-framed messages
Requires high self-efficacy ex“Missing early detection of cancer by not
emphasizing the advantages of
pectations. Gain frames are more getting a Pap test every year can cost you
performing the healthy behavior; readily accepted and prevent
your life (loss frame). Getting a Pap test
or loss-framed messages, emdefensive reactions.
every year may enable you to live to see
phasizing the disadvantages of
your grandchildren grow up (gain frame).”
not performing the healthy behavior
Self-reevaluation
Encouraging combining both
Can use feedback and confronta- A person can compare his or her image as
Trans-Theoretical Model
cognitive and affective assesstion; however, raising
a sedentary person to a possible image as
ments of one’s self-image with
awareness must be quickly folan active person.
and without an unhealthy behav- lowed by increase in problemior
solving ability and self-efficacy
Dramatic relief
Encouraging emotional experiPreferably should be done in
A counselor encourages a client to roleTrans-Theoretical Model
ences, followed by reduced afcounseling context so that emoplay a traumatic experience so that the
fect or anticipated relief if appro- tions can be aroused and subse- emotion can be experienced and then repriate action is taken
quently relieved
lieved.
Environmental reevalua- Encouraging combining the afMay include awareness about
In a smoking cessation class, participants
tion
fective and cognitive assessserving as a role model for others describe how their family members feel
Trans-Theoretical Model
ments of how the presence or
about their smoking.
absence of a personal behavior
affects one’s social environment
Fear arousal
Arousing negative emotional
Requires high self-efficacy exA health promoter shows in an emotionally
Protection Motivation Theory reactions in order to promote
pectations rather than high outmoving way how a child is hurt by fireself-protective motivation and
come expectations alone; is rare- works before demonstrating techniques for
action
ly effective
safer firework handling.
Self-affirmation task
Increasing people’s self-image
Must be tailored to individual self- A stress management class includes a
Protection Motivation Theory by having them elaborate on
image
writing exercise in which people record as
their relevant values or desirable
many of their desirable characteristics as
characteristics
they can think of.
*Always consider basic methods at the individual level: Participation, belief selection, persuasive communication, active learning, tailoring, individualization, modeling, feedback, reinforcement & punishment, and facilitation; see Table 6.3.
Framing
Protection Motivation Theory
5
*From Bartholomew, LK, Parcel GS, Kok G, Gottlieb NH, Fernandez ME; Planning Health Promotion Programs: An Intervention Mapping Approach, 3rd ed.
San Francisco: Jossey-Bass, 2011.
Putting Public Health Evidence in Action
TABLE 4. METHODS TO CHANGE HABITUAL, AUTOMATIC AND IMPULSIVE BEHAVIORS*
Methods
Related Theory
De-conditioning
Theories of Learning
Counter-conditioning
Trans-Theoretical Model;
Theories of Automatic, Impulsive and Habitual Behavior
Implementation intentions
Theories of Goal Directed
Behavior; Theories of Automatic, Impulsive and Habitual Behavior
Cue altering
Theories of Goal Directed
Behavior; Theories of Automatic, Impulsive and Habitual Behavior
Stimulus control
Theories of Automatic, Impulsive and Habitual Behavior; Trans-Theoretical
Model
Definition
Letting people experience a
lack of reinforcement or even
negative outcomes of the undesired behavior
Encouraging the learning of
healthier behaviors that can
substitute for problem behaviors
Parameters for Use
Slow process, especially when reinforcement schedule was intermittent. It may be necessary to create a
continuous lack of positive reinforcement
Availability of substitute behaviors
Examples
A health educator advises parents to
ignore a child’s requests to buy unhealthy foods as they shop in a store.
When they feel the urge to smoke,
smokers in a cessation program are
instructed to do other behaviors than
smoking, such as taking a short walk,
chewing gum, or making a positive
self-statement.
"You are more likely to go for a cervical
smear if you decide when and where
you will go. Please write in below
when, where, and how you will make
an appointment."
Prompting making if-then plans
that link situational cues with
responses that are effective in
attaining goals or desired outcomes
Existing positive intention
Teaching people to change a
stimulus, that elicits or signals a
behavior
Existing positive intention
Dieters change the places they keep
snack food in order to prevent taking
the snack automatically.
Encouraging removing cues for
unhealthy habits and adding
prompts for healthier alternatives
Needs insight in the behavioral
chain leading to the automatic response
Interventions to break habits should be
directed at people when they are in
new environments. For example,
smokers are encouraged to remove all
smoking paraphanalia (e.g., ashtrays,
matches) from their houses and cars.
6
*From Bartholomew, LK, Parcel GS, Kok G, Gottlieb NH, Fernandez ME; Planning Health Promotion Programs: An Intervention Mapping Approach, 3rd ed.
San Francisco: Jossey-Bass, 2011.
Putting Public Health Evidence in Action
Planning coping responses Attribution Theo-
Getting the person to identify
potential barriers and ways to
overcome these
Identification of high-risk situations
and practice of coping response
The HIV-nurse and the patient define
the causes of non-adherence as
ry and Relapse Prevention
caused by habits. Then the HIV nurse
Theory; Theories of Goal
and the patient formulate solutions to
Directed Behavior
solve or avoid the causes for nonadherence.
Early commitment
Having people choose a (largMaking the choice may be forced
A designated driver who voluntarily
Theories of Learning
er) delayed reward far in adbut the choice for the delayed rerefrains from alcohol (immediate revance
ward needs to be voluntary.
ward) during a party to bring friends
safely home feels good about his role
and will use a friend’s service as designated driver at the next party (delayed reward).
Public commitment
Stimulating pledging, promising Most effective when publicly anA patient trying to get more exercise
Theories of Automatic, Imor engaging oneself to perform nounced; may include contracting
makes a private commitment to self
pulsive and Habitual Bethe healthful behavior, and anand then announces her decision to
havior
nouncing that decision to others
others in the social environment.
*Always consider basic methods at the individual level: Participation, belief selection, persuasive communication, active learning, tailoring,
individualization, modeling, feedback, reinforcement & punishment, and facilitation; see Table 6.3.
TABLE 5. METHODS TO CHANGE ATTITUDES*
Methods
Related Theory
Classical conditioning
Theories of Learning
Definition
Parameters for Use
Examples
Stimulating the learning of an
association between an unconditioned stimulus (UCS) and a conditioned stimulus (CS)
Most effective when the time interval is short and the CS precedes
the UCS
Women with high body concern
completed a conditioning procedure
in which pictures of their bodies
were selectively linked to positive
social feedback: smiling faces.
7
*From Bartholomew, LK, Parcel GS, Kok G, Gottlieb NH, Fernandez ME; Planning Health Promotion Programs: An Intervention Mapping Approach, 3rd ed.
San Francisco: Jossey-Bass, 2011.
Putting Public Health Evidence in Action
Self-reevaluation
Trans-Theoretical Model, Social
Cognitive Theory
Environmental reevaluation
Trans-Theoretical Model, Social
Cognitive Theory
Shifting perspective
Theories of Stigma and Discrimination
Arguments
Persuasion-Communication Matrix, Elaboration Likelihood Model
Direct experience
Theories of Learning
Elaboration
Theories of Information Processing, Elaboration Likelihood
Model
Anticipated regret
Theory of Planned Behavior/Theory of Reasoned Action2
Encouraging combining both
cognitive and affective assessments of one’s self-image with
and without an unhealthy behavior
Encouraging realizing the negative impact of the unhealthy behavior and the positive impact of
the healthful behavior
Encouraging taking the perspective of the other
Using a set of one or more meaningful premises and a conclusion.
Encouraging a process whereby
knowledge is created through the
interpretation of experience
Stimulating the learner to add
meaning to the information that is
processed.
Stimulating people to focus on
their feelings after unintended
risky behavior, before any losses
actually materialize
Stimulation of both cognitive and
affective appraisal of self-image
A person can compare his or her
image as a sedentary person to a
possible image of themselves as an
active person.
Stimulation of both cognitive and
affective appraisal to improve appraisal and empathy skills
Empathy training, viewing of documentaries or testimonials, or family
interventions.
Initiation from the perspective of
the learner; needs imaginary competence
For central processing of arguments they need to be new to the
message receiver.
Parents instructing small children to
cross the street kneel down to see
traffic from the child’s height.
Hearing for the first time about the
benefits of protecting children from
smoke may influence a mother to
declare her home smoke free.
Rewarding outcomes from the indi- Rehabilitation counselors in training
vidual’s experience with the behav- try taking a trip while in a wheelior or assurance that the individual chair. This may change their attican cope with and
reframe negative
tudes
outcomes
about what it is like to use a
wheelchair.
Individuals with high motivation
Sex, Games, and Videotapes, an
and high cognitive ability; messag- HIV-prevention program for homees that are personally relevant,
less mentally ill men in a New York
surprising, repeated, self-pacing,
shelter, made messages personally
not distracting, easily understandrelevant, surprising, and repeated
able, and include direct instrucby embedding them in playing comtions; messages that are not too
petitive games, storytelling, and
discrepant and cause anticipation
watching videos, activities that were
of interaction
salient pastimes in the shelter.
Stimulation of imagery; assumes a A sex educator asks people to imagpositive intention to avoid the risky ine how they would feel after risky
behavior
behavior such as having had unsafe
sex.
8
*From Bartholomew, LK, Parcel GS, Kok G, Gottlieb NH, Fernandez ME; Planning Health Promotion Programs: An Intervention Mapping Approach, 3rd ed.
San Francisco: Jossey-Bass, 2011.
Putting Public Health Evidence in Action
Repeated exposure
Theories of Learning
Cultural similarity Persuasion-
Making a stimulus repeatedly
accessible to the individual’s sensory receptors
Using characteristics of the target
group in source, message and
channel
Neutrality of original attitude
Adolescents may be shown condoms repeatedly in classroom HIVprevention education.
Trained members of the Latino
community give culturally relevant
messages for cancer prevention and
screening trials.
Using surface characteristics of the
target group enhances receptivity.
Using social-cultural characteristics
leads to a more positive reception
of the message.
*Always consider basic methods at the individual level: Participation, belief selection, persuasive communication, active learning, tailoring, individualization, modeling, feedback, reinforcement & punishment, and facilitation; see Table 6.3.
Communication Matrix
TABLE 6. METHODS TO CHANGE SOCIAL INFLUENCE*
Methods
Related Theory
Information about others’
approval
Theory of Planned Behavior/Theory of Reasoned Action2
Resistance to social pressure
Definition
Parameters for Use
Examples
Providing information about
what others think about the person’s behavior and whether others will approve or disapprove of
any proposed behavior change
Stimulating building skills for
resistance to social pressure
Positive expectations are available in the environment.
University students are given data showing the percentage of students who drink
on campus, which usually is less than
the students predict.
Commitment to earlier intention;
relating intended behavior to
values; psychological inoculation against pressure
Preferably shift focus to a new
reason for performing the behavior
Combines caring, trust, openness, and acceptance with support for behavioral change; positive support is available in the
environment.
Young women learn effective refusal
skills to use when a partner does not
want to use a condom.
Theory of Planned Behavior/Theory of Reasoned Action2
Shifting focus
Theory of Planned Behavior/Theory of Reasoned Action2
Stimulate communication to
mobilize social support
Theory of Planned Behavior/Theory of Reasoned Action2,
Diffusion of Innovations Theory,
Theories of Social Networks and
Social Support
Prompting hiding of the unpopular behavior or shifting attention
away from the behavior
Prompting communication about
behavior change in order to provide instrumental and emotional
social support
Young women tell a partner that they
want to use a condom to prevent pregnancy (instead of preventing STD/HIV).
An exercise in a sex education program
has students talk about safe sex and
using condoms to make the positive expectations for using condoms more visible.
9
*From Bartholomew, LK, Parcel GS, Kok G, Gottlieb NH, Fernandez ME; Planning Health Promotion Programs: An Intervention Mapping Approach, 3rd ed.
San Francisco: Jossey-Bass, 2011.
Putting Public Health Evidence in Action
Provide opportunities for
social comparison
Facilitating observation of nonUpward comparison may help
A breast cancer patient may have had a
expert others in order to evalusetting better goals; downward
lumpectomy, but sees herself as better
Social Comparison Theory
ate one’s own opinions and per- comparison may help feeling
off than another patient who lost her
formance abilities
more self-efficacious.
breast (downward comparison)
*Always consider basic methods at the individual level: Participation, belief selection, persuasive communication, active learning, tailoring, individualization, modeling, feedback, reinforcement & punishment, and facilitation; see Table 6.3.
TABLE 7. METHODS TO CHANGE SKILLS, CAPABILITY, AND SELF-EFFICACY AND TO OVERCOME BARRIERS*
Methods
Related Theory
Guided practice
Social Cognitive Theory, Theories
of Self Regulation
Enactive mastery experiences
Social Cognitive Theory, Theories
of goal directed behavior, Theories of Self Regulation
Verbal persuasion/ exortation
Social Cognitive Theory, Theories
of Self Regulation
Definition
Prompting individuals to rehearse and repeat the behavior
various times, discuss the experience and provide feedback.
Providing increasingly challenging tasks with feedback to
serve as indicators of capability
Using messages that suggest
the participant possesses certain capabilities
Parameters for Use
Sub-skill demonstration, instruction, and enactment with individual feedback; requires supervision by an experienced person;
some environmental changes
cannot be rehearsed
Requires willingness to accept
feedback
Credible source
Examples
The trainer first models the target behavior a number of times and then asks
the trainees to do the same a number of
times. The trainer gives brief comments
on the trainees’ performances, emphasizing aspects done well.
After the students are taught the necessary know-how of intervening in bullying
situations, they perform the new skills in
a simulated setting in order to experience their mastery at handling bullying
class mates.
Teachers were shown a videotape on
which teachers like them discussed
their successful experiences in the regular classroom using the intervention
with difficult-to-teach children.
10
*From Bartholomew, LK, Parcel GS, Kok G, Gottlieb NH, Fernandez ME; Planning Health Promotion Programs: An Intervention Mapping Approach, 3rd ed.
San Francisco: Jossey-Bass, 2011.
Putting Public Health Evidence in Action
Improving physical and
emotional states
Social Cognitive Theory
Reattribution training
Attribution Theory and Relapse
Prevention Theory, Theories of
Self Regulation
Self-monitoring of behavior
Theories of Self Regulation
Provide contingent rewards
Theories of Learning, Theories of
Self Regulation
Cue altering
Theories of Goal Directed Behavior, Theories of Automatic, Impulsive and Habitual Behavior, Theories of Self Regulation
Public commitment
Theories of Automatic, Impulsive
and Habitual Behavior
Prompting interpretation of enhancement or reduction of
physiological and affective
states, to judge own capabilities
Must carefully interpret and manage emotional states.
Helping people reinterpret previous failures in terms of unstable attributions and previous
successes in terms of stable
attributions
Prompting the person to keep a
record of specified behavior(s)
Requires counseling or bibliotherapy to make unstable and
external attributions for failure
Praising, encouraging, or
providing material rewards that
are explicitly linked to the
achievement of specified behaviors
Teaching changing a stimulus,
either consciously or unconsciously perceived, that elicits
or signals a behavior
Stimulating pledging, promising
or engaging oneself to perform
the healthful behavior and announcing that decision to others
Students in a public speaking class are
taught to breathe deeply and relax prior
to their presentation. They label the
anxiety they feel as excitement. Reduce
stress and depression while building
positive emotions – as when fear is
labeled as excitement.
The counselor suggests that a smoker’s
relapse was due to a temporary condition and that she can learn from this
experience to stay off cigarettes.
The monitoring must be of the
specific behavior (i.e., not of a
physiological state or health outcome). The data must be interpreted and used. The reward
must be reinforcing to the individual.
Rewards need to be tailored to
the individual, group or organization, to follow the behavior in
time, and to be seen as a consequence of the behavior.
Existing positive intention
Patients keep a diary on their therapy
adherence in order to find out when and
why medication is missed.
Needs to be a public announcement; may include contracting
High school students sign individual
contracts not to smoke, which are then
placed on the classroom wall for all to
see.
Smokers who are trying quit smoking
receive monetary vouchers for breath
samples with carbon monoxide (CO)
levels of 8 ppm or less.
Dieters change the route they take
walking to work in order to avoid easy
access to snack shops
11
*From Bartholomew, LK, Parcel GS, Kok G, Gottlieb NH, Fernandez ME; Planning Health Promotion Programs: An Intervention Mapping Approach, 3rd ed.
San Francisco: Jossey-Bass, 2011.
Putting Public Health Evidence in Action
Goal setting
Goal Setting Theory, Theories of
Self Regulation
Set tasks on a gradient of
difficulty (set graded tasks)
Prompting planning what the
person will do, including a definition of goal-directed behaviors that result in the target behavior
Setting easy tasks and increase difficulty until target behavior is performed
Commitment to the goal; goals
that are difficult but available
within the individual’s skill level
Dietician and patient discuss the goal
for the next meeting, deciding on a goal
that is acceptable to the patient and to
the dietician
The final behavior can be reduced to more easy but increasingly difficult sub-behaviors
Physiotherapist and patient discuss
increasingly intensive exercises for the
Social Cognitive Theory, Theories
patient in order to gradually build up the
of Self Regulation
patient’s condition
Planning coping responses
Prompting participants to list
Identification of high-risk situaThe HIV-nurse and the patient define
Attribution Theory and Relapse
potential barriers and ways to
tions and practice of coping rethe causes of non-adherence (lack of
Prevention Theory, Theories of
overcome these
sponse
understanding, lack of motivation, insufGoal Directed Behavior, Theories
ficient action plan, barriers). Then the
of Self Regulation
HIV nurse and the patient formulate
solutions to solve or avoid the causes
for non-adherence.
*Always consider basic methods at the individual level: Participation, belief selection, persuasive communication, active learning, tailoring, individualization, modeling, feedback, reinforcement & punishment, and facilitation; see Table 6.3.
TABLE 8. METHODS TO REDUCE PUBLIC STIGMA*
Methods
Related Theory
Stereotype-inconsistent information
Theories of Stigma and Discrimination
Interpersonal contact
Theories of Stigma and Discrimination
Definition
Providing positive examples
from the stigmatized group
Bringing people in contact with
members of the stigmatized
group
Parameters for Use
Examples
Only effective when there are
many different examples.
Examples are not too discrepant
from original stereotype.
Requires positive experiences.
Most effective when there are no
status differences, it is externally
sanctioned, there is intensive contact, and there are common goals
Positive portrayals of stigmatized individuals in mass
media or leaflets
Presentations by stigmatized
persons in educational interventions
12
*From Bartholomew, LK, Parcel GS, Kok G, Gottlieb NH, Fernandez ME; Planning Health Promotion Programs: An Intervention Mapping Approach, 3rd ed.
San Francisco: Jossey-Bass, 2011.
Putting Public Health Evidence in Action
Empathy training
Theories of Stigma and Discrimination
Cooperative learning
Theories of Stigma and Discrimination
Conscious regulation of impulsive
stereotyping and prejudice
Theories of Stigma and Discrimination
Reducing inequalities of class, race,
gender and sexuality
Stimulating people to empathize
with another person. imagine
themselves in the situation of
the stigmatized person
Engineering lessons in a way
that students must learn from
one another
Forcing oneself to control impulsive negative reactions related
to stigma
Requires being able and willing to
identify with the stigmatized person. Imagine how the other person would feel (this leads to empathy). Do not imagine how you
would feel (this leads to both empathy and distress).
Requires careful organization of
lesson information distribution
Mere suppression almost always
leads to counterproductive effects.
Not advisable.
Conscious self-regulation of automatic stereotyping can be used
effectively.
Personal stories of experiences of stigmatized individuals
Teachers give each student
one piece of the lesson plan,
so that good comprehension
requires students to collaborate.
Participants practice saying
“Stop thinking this way” to
themselves as they watch
videos of stigmatizing people.
See methods for changes at
higher environmental levels (see
Tables 6.11-6.16).
Mobilizing social support,
community organizing, emTheories of Stigma and Discrimination
powerment of stigmatized
persons, agenda setting,
creating and enforcing laws
and regulations, and threatening with coercion
*Always consider basic methods at the individual level: Participation, belief selection, persuasive communication, active learning, tailoring, individualization, modeling, feedback, reinforcement & punishment, and facilitation; see Table 6.3.
13
*From Bartholomew, LK, Parcel GS, Kok G, Gottlieb NH, Fernandez ME; Planning Health Promotion Programs: An Intervention Mapping Approach, 3rd ed.
San Francisco: Jossey-Bass, 2011.
Putting Public Health Evidence in Action
TABLE 9. BASIC METHODS AT ENVIRONMENTAL LEVELS*
Methods
Related Theory
Systems change
Definition
Parameters for Use
Interacting with the environment
to change the elements and relationship among elements of a
system at any level, especially
through dialogue with stakeholders, action, and learning
through feedback
Methods and actors depend on the
level of the system
Diagnosing the problem, generating potential solutions, developing priorities, making an action plan, and obtaining feedback after implementing the plan
Requires willingness by the health
promoter or convener to accept the
participants as equals and as having
a high level of influence; requires
target group to possess appropriate
motivation and skills
Coercion
Attempting to control others
against their will
Requires/creates a power differential.
Advocacy and lobbying
Arguing and mobilizing resources on behalf of a particular
change; giving aid to a cause;
active support for a cause or
position
Form of advocacy must match style
and tactics of the people, communities or organizations represented,
and the nature of the issue; includes
policy advocacy; often tailored to a
specific environmental agent
Systems Theory
Participatory problem
solving
Organizational Theories, Coalition Theory, Social Capital
Theory, Models of Community
Organization
Stage Theory of Organizational
Change, Models of Community Organization , AgendaBuilding Theory, Multiple
Streams Theory
Examples
A city’s transportation department
created bicycle lanes on streets to
encourage people to ride bicycles to
work as a result of a stakeholder advisory committee’s recommendations. The committee monitored the
use of the bicycle lanes and held a
focus group of bicyclists about their
experiences.
A health promotion consultant assists
employees of a small company to
identify the level of perceived work
stress and sources of work stress, to
develop a plan with management
support to address sources of stress
and provide coping strategies, to implement the plan and monitor perceived work stress.
Health promotion activists organize a
consumer boycott of a company that
sells formula in developing countries.
Members of the American Public
Health Association use the organization’s action alert system to contact
their legislators to urge them to vote
for pending health care reform legislation.
14
*From Bartholomew, LK, Parcel GS, Kok G, Gottlieb NH, Fernandez ME; Planning Health Promotion Programs: An Intervention Mapping Approach, 3rd ed.
San Francisco: Jossey-Bass, 2011.
Putting Public Health Evidence in Action
Modeling
Social Cognitive Theory, Organizational Theories, Diffusion of Innovations Theory,
Empowerment Theory
Technical assistance
Organizational Theories, Diffusion of Innovations Theory,
Coalition Theory, Social Capital Theory, Models of Community Organization
Providing an appropriate model
being reinforced for the desired
action
Appropriate models will vary by level,
including group members and organizational, community and policy
change agents
Providing technical means to
achieve desired behavior
Nature of technical assistance will
vary by environmental level
An article in the state medical journal
highlights the experience of a city
hospital emergency department that
has instituted routine HIV testing,
found new cases of HIV that would
have gone undetected, and received
recognition from the state’s HIV
Community Planning Group.
A health department liaison helps a
community health center design recruitment procedures, training, and
supervisory guidelines as they establish a new lay health worker program.
*Consider basic methods and all appropriate methods at individual level, see Tables 6.3-6.10.
TABLE 10. METHODS TO CHANGE SOCIAL NORMS*
Methods
Related Theory
Mass media role-modeling
Diffusion of Innovations Theory,
Social Cognitive Theory
Entertainment-education,
edutainment
Diffusion of Innovations Theory
Behavioral journalism
Diffusion of Innovations Theory,
Social Cognitive Theory
Definition
Parameters for Use
Providing appropriate models
being reinforced for the desired
action through the mass media
Conditions for modeling;
conditions for persuasive
communication (see table
6.3)
Providing a form of entertainment designed to educate
(about health behavior) as well
as to entertain
Using by the mass and local
media of appropriate role-model
stories of behavior change
based on authentic interviews
with the target group
Consideration of source and
channel; balance of media
professional’s and health
promoter’s needs
Adequate role models from
the community and elicitation interviews to describe
the behavior and the positive
outcome
Examples
A feature story about mammography
screening on the news includes a woman
who caught the cancer early by having routine mammogram. The cancer was removed by lumpectomy.
A soap opera has a story line about a lead
character’s being arrested for drinking and
driving.
Baseball sized cards with a picture and a
short story concerning how a woman got
her boyfriend to willingly use a condom are
part of a sex education program for runaway teens.
15
*From Bartholomew, LK, Parcel GS, Kok G, Gottlieb NH, Fernandez ME; Planning Health Promotion Programs: An Intervention Mapping Approach, 3rd ed.
San Francisco: Jossey-Bass, 2011.
Putting Public Health Evidence in Action
Mobilizing social networks
Encouraging social networks to
Availability of social network Parents are coached on how to make their
provide informational, emotional, and potential support givers
negative views about smoking clear to their
appraisal and instrumental supchildren as part of a tobacco prevention
port
program.
*Consider basic methods and all appropriate methods at individual level, see Tables 6.3-6.10. Consider basic methods at environmental levels, i.e. systems change, participatory problem solving, advocacy and lobbying, modeling, and technical assistance. See Table 6.11.
Theories of Social Networks
and Social Support
TABLE 11. METHODS TO CHANGE SOCIAL SUPPORT AND SOCIAL NETWORKS*
Methods
Related Theory
Enhancing network linkages
Definition
Examples
A patient educator helps a patient
who has had a stroke and her family members to make plans for the
patient to return home. The plans
include linking to a patient support
group and community daycare.
Developing new social netLinking members to new netWillingness of networks to reach Volunteers who are breast cancer
work linkages
works by mentor programs, budout; availability of networks that
survivors are linked to newly diagTheories of Social Networks and
dy systems, and self-help groups can provide appropriate support
nosed patients to provide emotional
Social Support
and linkage agents
and informational support.
Use of lay health workers
Mobilizing members of the target Natural helpers in community
Promotoras from a local clinic proTheories of Social Networks and
population to serve as boundary
with opinion leader status and
vide information and outreach to
Social Support, Models of Comspanners, credible sources of
availability to volunteer for traincommunity members at risk for diamunity Organization
information, and role models
ing
betes.
*Consider basic methods and all appropriate methods at individual level, see Tables 6.3-6.10. Consider basic methods at environmental levels, i.e. systems change, participatory problem solving, advocacy and lobbying, modeling, and technical assistance. See Table 6.11.
Theories of Social Networks and
Social Support
Training network members to
provide support and members of
the target group to mobilize and
maintain their networks
Parameters for Use
Available network
16
*From Bartholomew, LK, Parcel GS, Kok G, Gottlieb NH, Fernandez ME; Planning Health Promotion Programs: An Intervention Mapping Approach, 3rd ed.
San Francisco: Jossey-Bass, 2011.
Putting Public Health Evidence in Action
TABLE 12. METHODS TO CHANGE ORGANIZATIONS*
Methods
Related Theory
Sense-making
Organization Change Theory
Organizational diagnosis and
feedback
Organizational Development Theory
Team building and human relations training
Organizational Development Theory
Structural redesign
Definition
Parameters for Use
Leaders reinterpret and relabel
processes in organization, create
meaning through dialogue, and
model and redirect change
Used for continuous change,
including culture change.
Assessing of organizational structures and employees’ beliefs and
attitudes, desired outcomes and
readiness to take action, using
surveys and other methods
Methods appropriate to organizational characteristics, e.g.,
size and information technology
Grouping development activities
based on the values of human
potential, participation and development
Change organizational elements
such as formal statements of organizational philosophy, communication flow, reward systems, job
descriptions, and lines of authority
Increase stakeholder power, legitimacy and urgency, often by forming coalitions and using community development and social action
to change an organization’s policies
Compatible with the culture
Examples
A supervisor in a hospital talks to
his staff about the positive aspects
of finding and correcting mistakes
in documentation of medication
administration.
An organizational consultant conducts a survey of employees’
health behaviors and determinants
and holds focus groups of employees to review the results and
plan for health promotion programs.
Participants in a retreat work interdependently to solve a puzzle.
A health promotion consultant
works with an organization to renew the organizational vision
statement to include the health of
employees.
Increasing stakeholder influThe focal organization perA community group uses media
ence
ceives the external organizaadvocacy to highlight the ground
Stakeholder Theory
tion or group is to be one of its
water pollution by gas storage
stakeholders
tanks located in the community
and to demand that the tanks be
moved by the gas company that
owns them.
*Consider basic methods and all appropriate methods at individual level, see Tables 6.3-6.10. Consider basic methods at environmental levels, i.e. systems change, participatory problem solving, advocacy and lobbying, modeling, and technical assistance. See Table 6.11.
Organizational Development Theory
Management authority and
agreement
17
*From Bartholomew, LK, Parcel GS, Kok G, Gottlieb NH, Fernandez ME; Planning Health Promotion Programs: An Intervention Mapping Approach, 3rd ed.
San Francisco: Jossey-Bass, 2011.
Putting Public Health Evidence in Action
TABLE 13. METHODS TO CHANGE COMMUNITIES*
Methods
Related Theory
Problem posing education
ConscientizationTheory; Empowerment Theory
Community assessment
Models of Community Organization
Community development
Models of Community Organization;
Theories of Power
Definition
Parameters for Use
Participatory analysis using critical reflection, self-disclosure,
and dialogue regarding the social forces underlying a problem
and a commitment to change
self and community
A safe environment for participation and disclosure; a
critical stance
Assessing a community’s assets
and needs, with feedback of
results to the community
Requires expert assistance
and possibilities for feedback
A form of community organization, based on consensus, in
which power is shared equally
and members engage together
in participatory problem solving
Starting where the community is; may be grass-roots or
professional driven
Examples
In facilitated small group discussion,
adolescents share the effects of their
own and others’ alcohol abuse on their
lives. They reflect on what this means
both personally and to their community.
They ask “what can we do about this?”
and take action.
Community members, with technical
assistance from the health department,
used surveys, door-to-door interviewing,
and community asset mapping, to conduct a community assessment. The
findings were presented and discussed
at a community-wide meeting.
A community organizer convenes a task
force of representatives of the school
board, the mayor’s office, the disenfranchised community and the city council
member representing the community to
discuss the findings of a report documenting inequities in the schools and to
make plans to address them.
18
*From Bartholomew, LK, Parcel GS, Kok G, Gottlieb NH, Fernandez ME; Planning Health Promotion Programs: An Intervention Mapping Approach, 3rd ed.
San Francisco: Jossey-Bass, 2011.
Putting Public Health Evidence in Action
Social action
Models of Community Organization;
Theories of Power
Forming coalitions
Models of Community Organization;
Social Capital Theory
Reporting, social planning
Models of Community Organization
Framing to shift perspectives
A form of community organization, based in conflict, in which
disenfranchised people wrest
power from the official power
Starting where the community is; may be grass-roots or
professional driven
Forming an alliance among individuals or organizations, during
which they cooperate in joint
action to reach a goal in their
own self-interest
Requires collaboration
across various agendas;
requires attention to stages
of partnership development
Using information based on research to address issues.
Requires credible source of
the information
A community organizer works with a low
income community that has identified a
need to improve educational resources
available to their children. They document the inequities in the schools and
extracurricular programs across the city,
present their findings and challenge the
school board to act on them in a press
conference. They organize community
members to attend the next school
board meeting to demand that this inequality be redressed.
A grant application requires that a
community develop a tobacco prevention coalition with representatives from
public health, education, voluntary
health associations, law enforcement,
businesses, the health care sector, and
other community groups to address the
issue of youth smoking.
The health department planner presented epidemiological data on
HIV/Aids prevalence and trends to the
Prevention Planning Group as they selected priority populations for programs.
Community organizers in tobacco prevention frame youth smoking as the
result of heavy targeted advertising by
the tobacco industry rather than an individual decision.
Assigning meaning and interpre- Match with culture
tation to relevant events and
conditions in order to mobilize
potential constituents, gain bystander support, and demobilize
antagonists
*Consider basic methods and all appropriate methods at individual level, see Tables 6.3-6.10. Consider basic methods at environmental levels, i.e. systems change, participatory problem solving, advocacy and lobbying, modeling, and technical assistance. See Table 6.11.
Models of Community Organization
19
*From Bartholomew, LK, Parcel GS, Kok G, Gottlieb NH, Fernandez ME; Planning Health Promotion Programs: An Intervention Mapping Approach, 3rd ed.
San Francisco: Jossey-Bass, 2011.
Putting Public Health Evidence in Action
TABLE 14. METHODS AT THE SOCIETAL LEVEL*
Methods
Related Theory
Media advocacy
Models of Community Organization
Agenda setting
Agenda-Building Theory, Multiple
Streams Theory, Theories of Power
Timing to coincide with policy
windows
Multiple Streams Theory
Creating and enforcing laws
and regulations
Definition
Parameters for Use
Expose environmental agents’
behaviors in the mass media to
order to get them to improve
health-related conditions. A type
of advocacy
Requires the media to approve the news value of the
message and accept the
message without changing
its essential content
Process of moving an issue to
the political agenda for action;
may make use of advocacy and
media when initiated from outside
government
Requires appropriate timing
(see policy window) and collaboration of media gatekeepers
Advocating policy when politics,
problems and policy solutions are
aligned to be receptive to a policy
issue
Astute policy advocate
Examples
A public interest group holds a press
conference to focus attention on the
serving sizes, fat and calories in foods
served in fast food restaurants, how
that contributes to the obesity epidemic, and what the restaurants, as responsible community businesses,
should do.
A state child health advocacy group
developed a position paper on the expansion of the child health insurance
program. They released the report to
the media and held meetings with key
state legislators on the recommendations.
Health care reform advocates in the
US began to develop coalitions and
position papers with the election of a
president known to be supportive of
that issue.
Based on a citizen group’s request the
police department began to enforce the
loitering ordinance to reduce drugrelated activity in the community.
Forcing compliance or dictating
Requires unequal power and
or precluding choices. Someavailability of control and
Theories of Public Policy, Theories
times implementing existing laws sanctions.
of Power
to accomplish change. Laws and
regulations may also provide incentives.
*Consider basic methods and all appropriate methods at individual level, see Tables 6.3-6.10. Consider basic methods at environmental levels, i.e. systems change, participatory problem solving, advocacy and lobbying, modeling, and technical assistance. See Table 6.11.
20
*From Bartholomew, LK, Parcel GS, Kok G, Gottlieb NH, Fernandez ME; Planning Health Promotion Programs: An Intervention Mapping Approach, 3rd ed.
San Francisco: Jossey-Bass, 2011.