Intervention Design: Needs, Theories, and Logic Models

• Module 7 focuses on Interventions I
• Key concepts in intervention design and development are discussed

Major Takeaways:

• The importance of a needs assessment to find the gap between the current situation and a target population's needs in relation to a specific behavior
• Evaluating different behavior change theories helps determine the most relevant components for interventions
• Program logic models are useful to organize and assess health interventions

Introduction to Intervention Planning

• Sound interventions involve an iterative, not linear, process
• For example, experts will often loop back, refine and adjust during program development
• Documenting decisions made during the development sequence is critical
• For example, early-stage considerations, time, resources, external demands, and alternative options
• Interventions need to include stakeholders, as well as end users such as the target group plus practitioners, policymakers and funders

Intervention Mapping

• Bartholomew and colleagues’ (1998) Intervention Mapping approach can help with intervention design, development, implementation, and evaluation
• Intervention Mapping is a widely used framework
• It frames this complex process as tasks and is intuitive
• The Behaviour Change Wheel (Michie et al., 2014) is another approach

Behavior Change Intervention: Ten Tasks

• Define the problem
• Clarify resolution of problem through behavior change
• Identify the target by people, behavior, and levels
• Understand the mechanisms
• Design, pilot, and refine the intervention
• Implement the intervention
• Evaluate the efficacy and effectiveness of the intervention

Understand the Behavior and Identify Change Targets

• Understand and define the problem while assessing the needs of target groups
• Clarify how a behavior change can improve or resolve the problem
• Identifying the people/groups who need to change a behavior and at which level (individual, organizational, governmental, multiple)
• A needs assessment can accomplish tasks 1–3

Needs Assessment

• This assessment determines the discrepancy between current and desired conditions through a systematic process
• This assessment is completed at the start of a project so that time & funds aren't wasted on an unnecessary intervention
• The assessment defines those needing intervention plus the extent of need and ways to address such needs
• Using the assessment to understand the lifestyle, culture, and behavior that is being changed
• Consider responses to help carefully consider the behavior pattern that is to be changed
• Data from multiple sources should be included in a robust needs assessment
• Input from experts, the target audience, stakeholders, and empirical evidence are useful
• Needs assessments are often delivered at multiple time points

Needs Assessment Questions

• Examples include:
• What behavior is targeted for change?
• What behaviors do people currently practice?
• What behaviors are desired?
• Who is the target group?
• When/where does the unwanted behavior occur?
• Does the target group know why target behavior matters?
• Will the target group understand how to successfully practice the target behavior?
• What are the key motivational and emotional drivers?
• What could support and resource target population with successful practice?
• How might those in their social environment affect target behavior?
• What structural and environmental components affect target behavior?
• Consider knowledge, resources, awareness, social influences, motivation, and structural and environmental factors

How to Ask

• How can questions be posed?
• Choices include:
• Binary choice
• Multiple choice
• Likert scales
• Open-ended questions
• Interviews

Action Planning - Needs Assessment Next Steps

• Gather information/bring change that is beneficial to a population's health
• A needs assessment is rendered futile if it doesn't clarify objectives or bring about change
• Understanding how it relates to the rest of your intervention planning and procedures
• Frame the results in key 'lessons learned' which generate action steps focused on implementation

Action Planning Tool

• An action planning tool might have columns titled: NEED, CAUSES, CONSEQUENCES, DIFFICULTY TO CORRECT, CRITICALITY, and ACTION
• Column 1: Summarizes the needs that were found during the assessment
• Column 2: Lists possible controllable causes for each stated need.
• Column 3: States consequences that would result if cause isn't addressed
• Column 4: A rating of difficulty for correcting each problem
• Column 5: A criticality rating, rating the degree if need isn't met
• Column 6: The need is framed as an action

Mechanisms and Techniques for Change

• Understand behavioral antecedents, contexts, cues, and mechanisms that maintain behavior patterns of a group being targeted
• Create components that will alter these behavior antecedents, as well as regulatory mechanisms
• Consider mechanisms on the behaviour-by-behaviour basis and also the target group-to-target group basis
• Evidence should be analyzed (e.g., published articles) to recognize specific mechanisms of behavior regulation
• Interventionalists have to utilize this data when selecting applicable behavior change theories

Design Interventions

• Interventionists have to convert theories into change techniques
• Doing this should also involve implementers and end users with the goal of adoption, fidelity, and sustainability

Modifiable Factors

• Active ingredients which bring about change
• Some factors are notably more modifiable
• Tools capture most (if not all) the key factors effectively targeted in programs
• Tools include Mitchie et al. (2015)'s Behaviour Change Technique Taxonomy v1
• Include The Theory and Techniques Tools by the Human Behaviour Change Project

Behaviour Change Techniques

• Goal Setting, Common Sense Model of Self-Regulation, Health Belief Model, Protection Motivation Theory, Self-Determination Theory, Social Cognitive Theory, and Theory of Planned Behavior.
• Consider using key target behavior techniques

Program Logic Models

• A precise map that displays how an intervention will/won't work
• Should focus on main ideas and should be depicted only on one page
• The models are a series of "if-then" statements arranged in temporal sequence
• Creating the model: often includes inputs, activities, short/long-term outcomes
• It can also include an audience, situation, assumptions, and external factors.

Program Logic Model components

• Inputs - resources used in program/initiative
• Activities - interventions which are carried out
• Outputs - products by program activities/interventions and can quantify activities by attributing percentages/values
• Outcomes - anticipated changes that result from the program. They can range from behavioral skills to knowledge to awareness.

Additional Program Logic Model Components

• Audience: Focus of the program
• Situation: What led to creation
• Assumptions: beliefs/theories of program and effects on implementation while making transparent, explicit
• External Factors: aspects which impact but are out of program planner control e.g. positive/negative factors impacting the project's success.