Use of program planning models and theories Brian Oldenburg

Overview of Intervention Mapping Steps of the Intervention Mapping process are Conduct a needs assessment Create matrices of change objectives based on the determinants of behavior and environmental conditions Select theory-based intervention methods and practical strategies Translate methods and strategies into an organized program Plan for adoption, implementation and sustainability of the program Generate an evaluation plan

© 2005 University of Texas Health Science Center at Houston School of Public Health Permission for Classroom Use Granted by Kay Bartholomew

Step 1 Needs Assessment Establish a planning group that includes potential program participants and plan the needs assessment Conduct the needs assessment by analyzing health and quality of life problems and behavioral and environmental causes Balance a needs assessment with an assessment of community capacity Link the needs assessment to evaluation planning by establishing desired program outcomes. © 2005 University of Texas Health Science Center at Houston School of Public Health Permission for Classroom Use Granted by Kay Bartholomew

Step 2 Matrices of Change Objectives State expected change or program outcomes for health-related behavior and environmental conditions Subdivide behavior and environmental conditions into performance objectives Select important and changeable personal and external determinants of at-risk group behavior and environmental conditions Create matrices of change objectives by crossing performance objectives with determinants © 2005 University of Texas Health Science Center at Houston School of Public Health Permission for Classroom Use Granted by Kay Bartholomew

Step 3 Methods and Strategies Review program ideas with the intended participants and use their perspectives when choosing methods and strategies Use core processes to identify theoretical methods to influence changes in determinants and identify conditions under which a method is most likely to be effective Choose program theoretical methods Select or design practical strategies for delivering the methods to intervention groups Assure that the final strategies [still] match the change objectives from the matrices. © 2005 University of Texas Health Science Center at Houston School of Public Health Permission for Classroom Use Granted by Kay Bartholomew

Methods and Strategies

A Method is a general process for influencing changes in the determinants of behavior and environmental conditions

A strategy is a practical technique for the application of methods in ways that fit with the intervention group and the context in which the intervention will be conducted

© 2005 University of Texas Health Science Center at Houston School of Public Health Permission for Classroom Use Granted by Kay Bartholomew

Step 4 Producing Program Components Consult with the intended participants for a health education and promotion program and bring their preferences to program design Create program scope and sequence, themes and list of needed program materials Prepare design documents to aid in producing materials that meet program objectives and adhere to parameters for particular methods and strategies Review available program materials for possible match with change objectives, methods, and strategies Develop program materials Pretest program materials and oversee final production © 2005 University of Texas Health Science Center at Houston School of Public Health Permission for Classroom Use Granted by Kay Bartholomew

Step 5 Planning for Adoption, Implementation and Sustainability Identify potential users of the health promotion program (revisit the planning group and linkage system to assure representation) Specify performance objectives for program adoption, implementation, and sustainability Specify determinants of adoption, implementation, and sustainability and create change objective matrices for program use Select methods and strategies Design interventions and organize programs to affect change objectives related to program use © 2005 University of Texas Health Science Center at Houston School of Public Health Permission for Classroom Use Granted by Kay Bartholomew

Step 6 Planning for Evaluation Describe the program and complete the logic model Describe program outcomes for quality of life, health, behavior and environment and write objectives and evaluation questions Write evaluation questions based on the matrix, i.e. concerning performance objectives and determinants as expressed in the change objectives Write process evaluation questions based on the descriptions of methods, conditions, strategies, program and implementation Develop indicators and measures Specify evaluation design © 2005 University of Texas Health Science Center at Houston School of Public Health Permission for Classroom Use Granted by Kay Bartholomew

Lifestyle Interventions for Primary Care Patients with Multiple Chronic Conditions

A Model for Improving Care* Community Resources and Policies

Health System Organization of Health Care

SelfDecision Management Support Support

Informed, Activated Patient

Productive Interactions

Delivery System Design

Clinical Information Systems

Prepared, Proactive Practice Team

Functional and Clinical Outcomes *Wagner, MD, W.A.MacColl Institute, Group Health Cooperative of Puget Sound

Key Resources and Supports for Selfmanagement (Fisher et al 2005) 1. Individualized assessment: take into account perspectives of individual and cultural issues

2. 3. 4. 5. 6.

Collaborative goal setting Enhancing skills Follow-up and support Access to resources in daily life Continuity of quality clinical care Fisher et al, Ecological approaches to selfmanagement: the case of diabetes. 2005 Am J Public Health 95:1523-1535

CONTEMPORARY HEALTH DELIVERY SYSTEMS FOR MANAGEMENT OF DIABETES

TLC (Telephone Linked Care): Educates, monitors, supports and produces alerts and reports

Case Manager: monitors and triages reports and alerts

Health Provider: Collaborative goal setting Self-Monitoring: e.g. Blood Glucose testing, symptoms monitoring

Electronic Health Record

Aim • To assess the effectiveness of a telephone and print delivered intervention to improve diet and physical activity in patients with cancer, type 2 diabetes and hypertension

Advisory Group Queensland Cancer Fund • Elizabeth Eakin • Marina Reeves • Kirsty Pickering Qld University of Technology • Brian Oldenburg • Nick Graves • Diana Battistutta • Andrew Hills • Gavin Turrell Bond University • Chris Del Mar Heart Foundation • Anna Hawkes Diabetes Australia • Joe Tooma

Logan Area Division of General Practice • Marguerite Mobbs • Peter Bradley • Ken Wilkie Logan/Beaudesert Health Service District • Brett Bricknell Logan City Council • Paula Seal • Beata Zimkowska Brisbane Southside Public Health • Rene Du Plessis Logan Women’s Health • Lynda Pullen Arthritis Queensland • Bob Unger Nutrition Australia • Aloysa Hourigan

Rationale

Nutrition

CVD (Hypertension)

Physical Activity

Diabetes

Alcohol

Cancer

Smoking

Overweight and Obesity

Rationale • Individuals of lower SES bear a disproportionate burden of disease • Low SES are less likely to use preventive health services (eg clinic based)

• GPs often lack the time, training and incentive to deliver recommended lifestyle behaviour interventions

Rationale • QLD geographical area – need for broader reaching interventions • The telephone has been frequently used to provide follow-up support in the context of behaviour change interventions. • From a public health perspective, there is increasing interest in evaluating the telephone as a primary health behaviour intervention tool.

Queensland Population moderately accessible 9% very remote 30 years • Type 2 diabetes (not requiring insulin) • Hypertension • Previous diagnosis of cancer (>50% 5 year survival) – not on active treatment • No contraindications for participants (screened by GPs and at recruitment)

Extended Intervention Practices

Intervention Groups

Mailed Feedback (Patient and GP) and Program Kit

Brief Intervention Practices Mailed feedback (Patient and GP), LHLP Newsletter and standard off-shelf brochures

Telephone Counselling Three weekly calls followed by fortnightly telephone calls

4 Month Follow-up Assessment (CATI)

4 Month Follow-up Assessment (CATI)

Mailed feedback (Patient and GP)

Mailed feedback (Patient and GP), LHLP Newsletter and standard off-shelf brochures

Telephone Counselling Monthly telephone calls Mailed LHLP Newsletter (8 months)

12-Month Final Assessment (CATI)

12 Month Final Assessment (CATI)

Mailed feedback (Patient and GP) and LHLP Newsletters

Mailed feedback (Patient and GP), LHLP Newsletter and standard off-shelf brochures

24-Month Final Assessment (CATI)

24-Month Final Assessment (CATI)

RE-AIM Evaluation Model • Reach - What % of target population participates? • Efficacy - What is the intervention effect? • Adoption - What % of settings adopt the intervention? • Implementation - Is the intervention implemented as intended? • Maintenance - Is the intervention sustained over time? Glasgow RE et al. Am J Pub Health, 1999;89:1322-1327

Data Collection • CATI: Baseline, 4-, 12- and 24months • Physical activity – Active Australia, CHAMPS

• Diet – ACCV FFQ, Dietary Behaviour Questionnaire

• QoL (SF-36); health care service utilisation; resource support use

Significance • Lifestyle intervention in cancer survivors & inclusion of different chronic diseases • Partnership with general practice in a disadvantaged area • Telephone will be used to deliver the intervention (no face-to-face) • Working with community partners to link participants with community resources

Participant Feedback “Unless someone gives you suggestions and points you in the right direction, you think you’re doing alright…and I was doing alright…but I’m doing even better now.”