4. Select and implement self-care promotion intervention(s)
Select and implement self-care promotion interventions
4.1. Linking intervention(s) with the hindering/facilitating mechanisms
Once the hindering or facilitating mechanisms have been identified a key next step can be to link interventions to those mechanisms.
4.2. Selecting intervention(s)
This section presents a general overview of possible interventions to promote self-care. The degree of complexity of those interventions are varied, however all are also susceptible to be combined to form an overarching strategy to promote self-care.
- Bartholomew LK, Parcel GS, Kok G, Gottlieb NH & Fernández ME (2011). Planning health promotion programs. An Intervention Mapping approach (3rd ed.). San Francisco: Jossey-Bass. Hoofdstuk 6, en tabellen 6.3-6.13.
- Michie S, Atkins L, West R. The behavior change wheel: a guide to designing interventions. London: Silverback Publishing; 2014. http://www.behaviourchangewheel.com/
- NCI Pink Book – Making Health Communication Programs Work: http://www.cancer.gov/cancertopics/cancerlibrary/pinkbook/page1
- Precede – Proceed
- Plan Do Check Act (PDCA) (Deming cirkel)
- Community Tool Box (a public service of the Work Group for Community Health and Development at the University of Kansas): http://ctb.ku.edu/en/table-contents/overview/chapter-2-other-models-promoting-community-health-and-development/section-2
For this general presentation multiple interventions are presented and not all the readers of this guideline might be able to implement all of the interventions (for example, most healthcare professionals won’t have capacity to decide over financing of the primary care system).It is recommendable to go through the general overview of self-care promotion interventions to have a broad idea on the issue.
- Structural interventions
- Staff-oriented interventions
- Financial interventions
- Financial incentives to patients
- Financial incentives to Primary Care Centers (or elimination of potential barriers such as payment by volume of visits)
- Patient-focused interventions
- Skill development
- Behaviour change
- Family support
- Information provision
- Professional-focused interventions
- Educational interventions
- Educational materials
- Large-scale educational meetings
- Small-scale educational meetings
- Outreach visits
- Use of opinion leaders
- Feedbacks and reminders
- Local consensus processes
- Educational interventions
(We are developing an interactive table to categorise and further detail the interventions)
4.3. Piloting intervention(s)
When preparing the implementation of a complex strategy it often useful to first pilot it. Depending on the position from where you are developing a self-care strategy (policy maker, professional, patient organisation…) and the strategy you select the pilot will be significantly different. However piloting the strategy can be helpful to identify operational difficulties.
In piloting an intervention one should consider:
- Criteria for the selection of the sites for the pilot. Those could vary; usually the selection is based on sites that might be particularly willing to adopt new practices or on site where there issue at hand is most relevant.
- Criteria for a possible limitation of minor conditions. If the selected approach affects more than one specific minor condition one might want to consider limiting the pilot to just one condition.
4.4. Implementing intervention(s)
- Ensemble a working group representative of the stakeholders involved in the strategy.
- Design a strategy based on the different components (interventions). When preparing a strategy that combines multiple interventions, bear in mind that:
- The combination of multiple interventions can be more effective than a single intervention, but even the combination of many different interventions does not guarantee effectiveness of the strategy.
- The effectiveness of the combination will be determined by the effectiveness of the individual interventions and the interaction between them. This interaction can act as an enhancer of the individual interventions’ effectiveness but also might reduce it.
- Considering the different phases of the process of change could facilitate the selection of intervention(s).
- Rogers’s Diffusion of innovation,
- Fleuren’s model (http://www.ncbi.nlm.nih.gov/pubmed/24951511)
- Bandura describes in his Social Cognitive Theory
- Bartholomew LK, Parcel GS, Kok G, Gottlieb NH & Fernández ME (2011). Planning health promotion programs. An Intervention Mapping approach (3rd ed.). San Francisco: Jossey-Bass. Hoofdstukken 2 en 3.
- Michie S, West K, Campbell RJB, Grainforth H. An ABC of behavior change theories. London: Silverback Publishing; 2014. http://www.behaviourchangetheories.com/
- Van Lange et al. (Eds, 2011) Handbook of Theories of Social Psychology. Volumes 1 & 2 http://www.uk.sagepub.com/books/Book233017#tabview=toc
- Fiske et al. (Eds. 2010) Handbook of Social Psychology (2 Volume Set), 2010 http://eu.wiley.com/WileyCDA/WileyTitle/productCd-0470137487.html
- Glanz, K., Rimer, B.K. & Viswanath K.. (2008). Health Behavior and Health Education. Theory, Research and Practice. San Francisco: Wiley & Sons. http://eu.wiley.com/WileyCDA/WileyTitle/productCd-0787996149.html
- Suls et al. (Eds., 2010) Handbook of Health Psychology and Behavioral Medicine: http://www.amazon.com/Handbook-Health-Psychology-Behavioral-medicine/dp/1606238957/ref=pd_sim_b_3?ie=UTF8&refRID=1WWWJPCVW0JPS04M5XJW
- Cohen et al. (Eds. 2003) The Health Psychology Handbook. Practical Issues for the Behavioral Medicine Specialist. SAGE Publications. http://www.sagepub.com/refbooks/Book220792
- GEM (https://www.gem-beta.org/public/ConstructList.aspx?cat=1)
- NCI http://cancercontrol.cancer.gov/brp/constructs/index.html
- NCI behavioral research http://cancercontrol.cancer.gov/brp/research_tools.html
- Alan Reifmans pages ( http://www.webpages.ttu.edu/areifman/qic.htm )
- UT communicatie theorieën http://www.utwente.nl/cw/theorieenoverzicht/Theory%20Clusters/
- Social Psychology Network: http://www.socialpsychology.org/
- Psychwiki http://www.psychwiki.com/wiki/Self-regulation
- Psychology Campus http://www.psychologycampus.com/
|Phases on the process of behaviour change|
Communication will play a key role throughout the process of implementation, and it should be adapted at each stage. For more details see Guidelines for the development of communication tools – WP2
- Define the resources that will be needed to implement the strategy, based on the potential available resources identified in step 1: Identify the problem and evaluate your context. Pay special attention to the available budget and the effort and time required by those involved in relation to the expected effectiveness.
- Identify needs for the implementation. Those might include:
- Professionals’ training needs
- Re-definition of professional roles
- Development of new management tools (e.g: registration forms, medical history, new evaluation form for patients, etc.)
- Develop communication tools to accompany throughout the complete process of implementation
- This element is thoroughly developed in the Guidelines for the development of communication tools – WP2 (We will develop an icon that identifies all the instances that are directly referring to WP2 materials to facilitate the identification throughout the text).
- Define the role of all the involved stakeholders
- Flow diagrams might be useful to identify the role of each stakeholder in the overall process.
- Prepare a protocol or document that reflects the agreed upon flows.
- Develop and agree on an action plan
- Any good action plan should at least answer the questions: When, where, how and by whom?
- As a general guidance the action plan should consider the following 5 change elements, based on the behaviour change theories
- Try to gain the support of managers and other leaders in the main stakeholder groups (those leaders are not necessarily formal management positions).
- Communicate the strategy (for further details see the Guidelines for the development of communication tools – WP2)