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Plan BasedEvidence Informed

Prevention

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Prevention

A set of activities aimed at keeping unhealthy situations / behaviour from taking place

An intervention mix addressing different determinants of unhealthy behaviour / environment

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Prevention

Primary prevention: Keeping problems from taking place

Secondary prevention: Identifying problems at an early stage

Tertiary prevention: Limiting the consequences of a problem

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A logic model adapted from PRECEDE

BehavioralFactors

EnvironmentalFactors

HealthProblems

Qualityof Life

Personal and External Determinants (Predisposing, enabling and reinforcing factors)

Personal and External Determinants (Predisposing, enabling and reinforcing factors)

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A logic model adapted from PRECEDE

BehavioralFactors:

compliance, consumption,

coping, preventive actions, risk

behavior, utilization, self-

care

EnvironmentalFactors:

medical care, social support, access to service, rules or

laws, availability of resources, attitudes

and behavior of health care

providers, peers, parents, employers

HealthProblems:

disability, discomfort,

fertility, fitness,

morbidity, mortality,

physiological risk factors

Qualityof Life

Indicators:

alienation, comfort,

happiness, hostility,

self esteem, unemployment,

welfare

Personal and External Determinants (Predisposing, enabling and reinforcing factors)

Personal and External Determinants (Predisposing, enabling and reinforcing factors)

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Some more on Precede Model …

• Important to describe: what is the problem exactly? Who has it? Where can the group’s at-risk individuals be reached with a program? What are the characteristics of the population at-risk?

• Environmental determinants/factors can be identified at different levels: interpersonal, organizational, community, societal. Examples: solidarity, social norms, reputation, availability

• Examples of personal determinants are: knowledge, attitude, beliefs, norms, values, perceptions, skills, self efficacy, outcome expectation, risk awareness, resources

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Fishbein ModelEXTERNAL VARIABLES  DEMOGRAPHICS   

 PERSONAL CHARACTERISTICS  INDIVIDUAL DIFFERENCES 

 ATTITUDE

 NORM

SELF- EFFICACY

ENVIRONMENTALCONSTRAINTS

 INTENTION

 BEHAVIOUR

BELIEFS ABOUTEFFICACY

NORMATIVE BELIEFS

BEHAVIOURALBELIEFS

 SKILLS

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EXTERNAL VARIABLES

DEMOGRAPHICS

PERSONAL

CHARACTERISTICS

INDIVIDUAL DIFFERENCES

GENERAL KNOWLEDGE

- general knowledge about hepatitis B

- general knowledge about the consequences of hepatitis B

- knowledge about the campaign

BELIEFS ABOUT BEHAVIOUR

- the shots are painful

BEHA-VIOUR

- doesn’t get vaccinated

SELF-EFFICACY

- cannot deal with the test results

- openness about gay lifestyle (self-esteem)

- no adherence to vaccination schedule

NORM

- you only get vaccinated if you have run a risk

BELIEFS ABOUT EFFICACY

- “I don’t want to know the results”

NORMATIVE BELIEFS

- only gays get vaccinated

- you have obviously run a risk if you get vaccinated

- negative characterisation by others (“slut”)

ENVIRONMENTAL CONSTRAINTS

- costs related to this

- not familiar with campaign

- negative social influence (getting vaccinated is not the norm)

- inflexible scheduling at policlinic

SKILLS

- making an appointment is time-consuming and complicated.

ATTITUDE-low risk assessment for hepatitis B and its infectiousness- low risk assessment, because “I always have safe sex”- negative attitude due to fear of shots- fear of vaccine / side effects- fear of test results- health motivation (“I’m going to get it anyway”)

INTENTION

- low level of intention to get vaccinated

Schorer example: Hepatitis B

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Fishbein terms…

• Behaviour: You do something or you refrain from doing it

• Skills: Do you know how to do it?

• Intention: Do you want to behave in a certain way?

• Environmental constraints: Does your environment make it harder or easier for you to behave in a certain way?

• Attitude: Do you have a positive or negative feeling about the behaviour?

• Norm: The social pressure you feel to behave or not behave in a certain way

• Self-Efficacy: Do you think you are able to do it?

• Beliefs: What are your views about (the results of) … ?

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Need for Action!

Often the situation screems for action, although the health problem is not completely clear (nor what is causing it) people jump to action.

Often people skip the researching, thinking through and careful planning and preparing for implementation process. No time for this.

Plan-based evidence informed prevention supports youin doing this right (making it relevant, effective and efficient)

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Intervention Mapping

Intervention Mapping is a collection of theories and methods from which you can take whatever is useful for you.

We are not doing 100% intervention mapping.But are using the main principles and thoughts.

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Some important IM Principles

• Think first, then act• Step by step, so there is room for looking back and

adapting: an iterative process• Analyse the target group AND the environment• Focus by looking at the relevance and changeability

of determinants • Experts, target groups AND mainstream partners are

involved• Evidence-informed: a combination of theory,

(scientific) data and (personal) experiences (How do you know what you know)

• Wait with the choice of activity/product• Determining your goals and implementation strategy

from the very beginning• Implementation strategy and constant evaluation

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Plan-Based Prevention Steps

Step 1: Needs Assessment• Carefully define the intervention population• Talk about the dimensions of the relevant problem and

realted quality of life issues• Define the risk behaviours• Define the environmental factors that are related to the

problem of that influence behavioural risk

Step 2: Determinant selection (weighing and thinking)• Relevance: the strength of the evidence relating a

determinant and the behavior or environmental factor we want to change

• Changeability: strength of the evidence that the proposed change can be realized by an intervention.

• Behaviors and environmental conditions that are both more relevant and more changeable will be a high priority for program focus – Not so relevant, not so changeable: X– Not so relevant, but easily changeable: easy gains– Quite relevant, but difficult to change: think well before investing

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Plan-based intervention Steps

Step 3: Select (theory based) intervention (change) methods and strategies to address those determinants

(also your ideas about how change works)

Step 4: Compile, pretest and produce a program

Step 5: Plan adoption and implementation

Step 6: Plan evaluation (link: evaluation studies)

Step by step, so there is room for looking back andadapting: an iterative process