Intervention Mapping: A Process for Developing Theory and Evidence-Based Health Education Programs
Abstract
The practice of health education involves three major program-planning activities: needs assessment, program development, and evaluation. Over the past 20 years, significant enhancements have been made to the conceptual base and practice of health education. Models that outline explicit procedures and detailed conceptualization of community assessment and evaluation have been developed. Other advancements include the application of theory to health education and promotion program development and implementation. However, there remains a need for more explicit specification of the processes by which one uses theory and empirical findings to develop interventions. This article presents the origins, purpose, and description of Intervention Mapping, a framework for health education intervention development. Intervention Mapping is composed of five steps: (1) creating a matrix of proximal program objectives, (2) selecting theory-based intervention methods and practical strategies, (3) designing and organizing a program, (4) specifying adoption and implementation plans, and (5) generating program evaluation plans.
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Two included studies adopted the intervention mapping framework developed by Bartholomew and colleagues in 1998.
“Two studies adopted the intervention mapping framework [41] developed by Bartholomew and colleagues in 1998 [42, 43]”
From Optimisation of complex health interventions prior to a randomised controlled trial: a scoping review of strategies used (2016) · cites this paper as [41]
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“Behavior change methods targeted these determinants, and were translated into videos and classroom activities.”
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Verhagen, E. A. L. M., Voogt, N., Bruinsma, A., & Finch, C. F. (2013) · British Journal of Sports Medicine · doi:10.1136/bjsports-2013-092241 · Cited by 148 · see citing works
Curtis, K., Lahiri, S., & Brown, K. (2015) · JMIR mhealth and uhealth · doi:10.2196/mhealth.3857 · Cited by 144 · see citing works
“…designers on which theoretical constructs to target in an intervention to elicit behavioral change, intervention development frameworks (eg, intervention mapping and/or Medical Research Council framework [37,38]) provide guidance on the development of a "coordinated set of activities" to help”
Changing Behavior Using the Model of Action Phases
Keller, L., Gollwitzer, P. M., & Sheeran, P. (2020) · The Handbook of Behavior Change · doi:10.1017/9781108677318.006 · Cited by 147 · see citing works
Bissett, J. E., Kroshus, E., & Hebard, S. (2020) · BMJ Open Sport & Exercise Medicine · doi:10.1136/bmjsem-2019-000676 · Cited by 147 · see citing works
“23 Thus, there is a critical need to establish consensus about the role of the coach related to mental health promotion.”
BackgroundSustained Benefit of a Community and Professional Intervention to Increase Acute Stroke Therapy
Morgenstern, L. B., Bartholomew, L. K., Grotta, J. C., Savas, L. S., King, M., & Chan, W. (2003) · Archives of Internal Medicine · doi:10.1001/archinte.163.18.2198 · Cited by 143 · see citing works
Self-citationthe Canada PRIme Plus Team, Bussières, A., Patey, A. M., Francis, J., Sales, A. E., & Grimshaw, J. (2012) · Implementation Science · doi:10.1186/1748-5908-7-82 · Cited by 143 · see citing works
“Theories can provide a framework for interpreting and predicting behavior, help tailor interventions to improve the likelihood of successful change, and can help evaluate potential causal mechanisms [49-54].”
Use of theory to plan or evaluate guideline implementation among physicians: a scoping review
Members of the Guidelines International Network Implementation Working Group, Liang, L., Bernhardsson, S., Vernooij, R. W. M., Armstrong, M. J., Bussières, A., Brouwers, M. C., & Gagliardi, A. R. (2017) · Implementation Science · doi:10.1186/s13012-017-0557-0 · Cited by 140 · see citing works
“Intervention mapping, used by only two studies included in this review [53, 58], is an increasingly used process for engaging stakeholders in choosing and designing theory-based interventions [74, 75].”
MethodStetler, C. B., McQueen, L., Demakis, J. G., & Mittman, B. S. (2008) · Implementation Science · doi:10.1186/1748-5908-3-30 · Cited by 144 · see citing works
“highlighted the importance of intervention mapping, theoretical frameworks, strength of evidence issues, formative evaluation, and spread and sustainability issues, as well as the critical role of context [3,15,35,36].”
Ducharme, F., Lévesque, L., Lachance, L., Kergoat, M., Legault, A., Beaudet, L., & Zarit, S. H. (2011) · The Gerontologist · doi:10.1093/geront/gnr014 · Cited by 141 · see citing works
Interventions to Reduce Sexual Prejudice: A Study-Space Analysis and Meta-Analytic Review
Bartos, S. E., Berger, I., & Hegarty, P. V. (2014) · The Journal of Sex Research · doi:10.1080/00224499.2013.871625 · Cited by 138 · see citing works
Patient engagement in hospital health service planning and improvement: a scoping review
Liang, L., Cako, A., Urquhart, R., Straus, S. E., Wodchis, W. P., Baker, G. R., & Gagliardi, A. R. (2018) · BMJ Open · doi:10.1136/bmjopen-2017-018263 · Cited by 145 · see citing works
“Matching of barriers and facilitators to relevant interventions could be informed by taxonomies of behaviour change interventions such as the Expert Recommendations for Implementing Change,(33) or the Effective Practice and Organisation of Care taxonomy,(34) and formal processes for developing behavioural intervention…”
Backgroundvan Oostrom, S. H., Anema, J. R., Terluin, B., Venema, A., de Vet, H. C. W., & van Mechelen, W. (2007) · BMC Health Services Research · doi:10.1186/1472-6963-7-127 · Cited by 133 · see citing works
“IM includes both knowledge obtained from the literature and involvement of key stakeholders to develop, implement and evaluate an intervention [19,20].”
Levati, S., Campbell, P., Frost, R., Dougall, N., Wells, M., Donaldson, C., & Hagen, S. (2016) · Pilot and Feasibility Studies · doi:10.1186/s40814-016-0058-y · Cited by 101 · see citing works
Concerns, Barriers, and Recommendations to Improve Transition from Pediatric to Adult IBD Care
Gray, W. N., Resmini, A., Baker, K. D., Holbrook, E., Morgan, P. J., Ryan, J. L., Saeed, S. A., Denson, L. A., & Hommel, K. A. (2015) · Inflammatory Bowel Diseases · doi:10.1097/mib.0000000000000419 · Cited by 119 · see citing works
Ratti, V., Hassiotis, A., Crabtree, J. W., Deb, S. S., Gallagher, P., & Unwin, G. (2016) · Research in Developmental Disabilities · doi:10.1016/j.ridd.2016.06.015 · Cited by 120 · see citing works
Correlates of motivation to prevent weight gain: a cross sectional survey
Wammes, B., Kremers, S., Breedveld, B. C., & Brug, J. (2005) · International Journal of Behavioral Nutrition and Physical Activity · doi:10.1186/1479-5868-2-1 · Cited by 118 · see citing works
A design and evaluation framework for digital health interventions
Kowatsch, T., Otto, L., Harperink, S., Cotti, A., & Schlieter, H. (2019) · it - Information Technology · doi:10.1515/itit-2019-0019 · Cited by 118 · see citing works
“Intervention Mapping [6, 7] (1998) Health education interventions with a focus on theory as justificatory knowledge Increasing condom use among men with HIV [57]”
BackgroundReference Report: An overview of behaviour change models and their uses
Darnton, A. (2008) · Cited by 113 · see citing works
Changing Behavior Using the Health Action Process Approach
Schwarzer, R., & Hamilton, K. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108677318.007 · Cited by 107 · see citing works
James, S., Reddy, P. S., Ruiter, R. A. C., McCauley, A. P., & van den Borne, B. H. P. (2006) · AIDS Education and Prevention · doi:10.1521/aeap.2006.18.4.281 · Cited by 108 · see citing works
Freire, K., Pope, R., Jeffrey, K., Andrews, K., Nott, M. T., & Bowman, T. (2022) · Adolescent Research Review · doi:10.1007/s40894-022-00181-w · Cited by 105 · see citing works
An AIDS Risk Reduction Program for Dutch Drug Users: An Intervention Mapping Approach to Planning
van Empelen, P., Kok, G., Schaalma, H. P., et al. (2003) · Health Promotion Practice · doi:10.1177/1524839903255421 · Cited by 103 · see citing works
Self-citationAbildgaard, J. S., Saksvik, P. Ø., & Nielsen, K. M. (2016) · Frontiers in Psychology · doi:10.3389/fpsyg.2016.01380 · Cited by 105 · see citing works
“…in correspondence with the general literature, which has documented the distinct role of line managers, (Nielsen, 2013), the importance of information (Mattila et al., 2006), the necessity of perceived change (Semmer, 2011; Nielsen and Randall, 2012) and needs assessment (Bartholomew et al., 1998).”
ResultCorso, E., Hind, D., Beever, D., Fuller, G., Wilson, M. J. A., Wrench, I., & Chambers, D. (2017) · BMC Pregnancy and Childbirth · doi:10.1186/s12884-017-1265-0 · Cited by 94 · see citing works
Thompson, E. L., Vamos, C. A., & Daley, E. M. (2015) · Journal of sport and health science/Journal of Sport and Health Science · doi:10.1016/j.jshs.2015.08.001 · Cited by 98 · see citing works
“Intervention mapping is a potential tool for future research to integrate the findings on the salient theoretical determinants that impact PA during pregnancy in this review to promote PA behavior change during pregnancy through the development of theory-based and evidence-informed interventions.(46) Additionally, dev…”
Geidl, W., Semrau, J., & Pfeifer, K. (2014) · Disability and Rehabilitation · doi:10.3109/09638288.2014.891056 · Cited by 97 · see citing works
“As can be seen in Table 1, following the ideas of intervention mapping [53], we developed a matrix of proximal programme objectives.”
MethodInfluentialMiddelweerd, A., van der Laan, D. M., van Stralen, M. M., Mollee, J. S., Stuij, M., Velde, S. J. T., & Brug, J. (2015) · International Journal of Behavioral Nutrition and Physical Activity · doi:10.1186/s12966-015-0189-1 · Cited by 97 · see citing works
“Developing a theory-based, effective and engaging PA app that is also based on user preferences and opinions is a complex process, as are all thoroughly-developed theory- and evidence-based interventions [19].”
BackgroundEffective methods to change sex-risk among drug users: a review of psychosocial interventions
van Empelen, P., Kok, G., van Kesteren, N. M. C., van den Borne, B. H. P., Bos, A. E. R., & Schaalma, H. P. (2003) · Social Science & Medicine · doi:10.1016/s0277-9536(02)00557-9 · Cited by 97 · see citing works
Self-citationActive Involvement of End Users When Developing Web-Based Mental Health Interventions
de Beurs, D., van Bruinessen, I., Noordman, J., Friele, R., & van Dulmen, S. (2017) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2017.00072 · Cited by 97 · see citing works
“intervention Mapping (iM) A method developed to structure the integration of evidence-based information, theory, and practice in the field of health-promoting programs is the IM Framework (23).”
MethodLifestyle intervention for prevention of diabetes: determinants of success for future implementation
Roumen, C., Blaak, E. E., & Corpeleijn, E. (2009) · Nutrition Reviews · doi:10.1111/j.1753-4887.2009.00181.x · Cited by 95 · see citing works
Wight, D. (2000) · Health Education Research · doi:10.1093/her/15.1.25 · Cited by 93 · see citing works
“This suggests that many traditional framework for intervention development set out school-based programmes should be expanded. by Bartholomew et al. (Bartholomew et al., 1998).”
BackgroundInfluentialOrganizational Interventions for Health and Well-being
Martin, A., & LaMontagne, A. (2018) · Routledge eBooks · doi:10.4324/9781315410494 · Cited by 93 · see citing works
Decoding health education interventions: The times are a-changin’
Schaalma, H. P., & Kok, G. (2008) · Psychology and Health · doi:10.1080/08870440801995802 · Cited by 92 · see citing works
“Intervention Mapping (IM) was developed as a planning framework for the development of theory- and evidence-based health promotion programmes (Bartholomew, Parcel, & Kok, 1998 ).”
MethodSelf-citationSkinner, H. A., Maley, O., & Norman, C. D. (2006) · Health Promotion Practice · doi:10.1177/1524839905278889 · Cited by 91 · see citing works
“Within health promotion, models range in focus from individual behavior change to community mobilization ( Bartholomew, Parcel, & Kok, 1998; Glanz, Lewis, & Rimer, 1997; Sorensen et al., 2003); however, none accounts for information technology applications.”
BackgroundAntecedents and consequences of monitoring domestic electricity consumption
Webb, T. L., Benn, Y., & Chang, B. P. I. (2014) · Journal of Environmental Psychology · doi:10.1016/j.jenvp.2014.07.001 · Cited by 92 · see citing works
National Standards for Diabetes Self-Management Education
Mensing, C. R., Boucher, J. L., Cypress, M., Weinger, K., Mulcahy, K., Barta, P., Hosey, G. M., Kopher, W., Lasichak, A., Lamb, B., et al. (2006) · Diabetes Care · doi:10.2337/diacare.29.s1.06.s78 · Cited by 89 · see citing works
Tate, D. F., Lytle, L. A., Sherwood, N. E., Haire-Joshu, D. L., Matheson, D., Moore, S. M., Loria, C. M., PRATT, C. A., Ward, D. S., Belle, S. H., et al. (2016) · Translational Behavioral Medicine · doi:10.1007/s13142-015-0369-1 · Cited by 86 · see citing works
Graziose, M. M., Downs, S., OʼBrien, Q., & Fanzo, J. (2017) · Public Health Nutrition · doi:10.1017/s1368980017002786 · Cited by 89 · see citing works
“To our knowledge, multiple design frameworks exist, including the Trials of Improved Practices((49)), the DESIGN system((10)), Behaviour Centred Design((28)) and others((12,13)).”
BackgroundMethodvan Rongen, A., Robroek, S. J., van Ginkel, W., Lindeboom, D., Altink, B., & Burdorf, A. (2014) · BMC Public Health · doi:10.1186/1471-2458-14-573 · Cited by 87 · see citing works
“Indeed, theories and frameworks such as the ‘Intervention mapping’ protocol [44] and participatory and peer-led interventions have been developed to this end, both aimed at developing successful interventions with a high take-up level by incorporating the needs and preferences of potential participants.”
Peters, G.-J., Ruiter, R. A. C., ten Hoor, G. A., Kessels, L. T. E., & Kok, G. (2018) · Health Psychology Review · doi:10.1080/17437199.2018.1454846 · Cited by 87 · see citing works
Self-citationShort, C. E., James, E. L., Stacey, F., & Plotnikoff, R. C. (2013) · Journal of Cancer Survivorship · doi:10.1007/s11764-013-0296-4 · Cited by 78 · see citing works
“To increase the likelihood of success, interventions should be based on empirical research evidence and grounded in strong health behavioural theory [25, 26].”
BackgroundResultDopp, A. R., Narcisse, M.-R., Mundey, P., Silovsky, J. F., Smith, A. B., Mandell, D., Funderburk, B. W., Powell, B. J., Schmidt, S., Edwards, D., et al. (2020) · Implementation Research and Practice · doi:10.1177/2633489520939980 · Cited by 79 · see citing works
“For example, we have started to explore how intervention mapping (Bartholomew et al., 1998)—a multi-step method for developing interventions or implementation strategies based on theory, research evidence, and stakeholder perspectives—can be used to guide stakeholders in their strategic selection…”
Effect of early postnatal breastfeeding support: a cluster randomized community based trial
Kronborg, H., Væth, M., Olsen, J., Iversen, L., & Harder, I. (2007) · Acta Paediatrica · doi:10.1111/j.1651-2227.2007.00341.x · Cited by 106 · see citing works
“The methods used in the programme included modelling, skills training with guided practice and feedback, increasing of practical knowledge by tailoring, identification of high risk situations, planning of coping responses, and mobilizing social support (15).”
MethodAmmendolia, C., Cassidy, D., Steenstra, I. A., Soklaridis, S., Boyle, E., Eng, S., Howard, H., Bhupinder, B., & Côté, P. (2009) · BMC Musculoskeletal Disorders · doi:10.1186/1471-2474-10-65 · Cited by 82 · see citing works
“Although this approach is novel in the occupational setting intervention mapping has been used extensively in the design of complex community health programs for over 20 years [11].”
BackgroundMethodInfluentialTeam-Based Care with Pharmacists to Improve Blood Pressure: a Review of Recent Literature
Kennelty, K. A., Polgreen, L. A., & Carter, B. L. (2018) · Current Hypertension Reports · doi:10.1007/s11906-018-0803-0 · Cited by 84 · see citing works
den Akker, I. L., van Delden, J. J. M., Verheij, T. J. M., et al. (2009) · Vaccine · doi:10.1016/j.vaccine.2009.05.013 · Cited by 83 · see citing works
“The intervention mapping method will be applied and importance and changeability of the determinants will be derived from this model [ 47 ].”
MethodDiep, C. S., Chen, T. A., Davies, V. F., Baranowski, J. C., & Baranowski, T. (2014) · Journal of Nutrition Education and Behavior · doi:10.1016/j.jneb.2014.05.012 · Cited by 82 · see citing works
van Weert, E., Hoekstra‐Weebers, J. E. H. M., May, A. M., Korstjens, I., Ros, W. J. G., & van der Schans, C. P. (2008) · Patient Education and Counseling · doi:10.1016/j.pec.2007.11.027 · Cited by 82 · see citing works
“For the actual programme we applied principles of intervention mapping [43], which is a process for developing theory and evidence-based health education programmes, including (1) creating a matrix of proximal programme objectives, (2) selecting theory-based intervention methods and practical strategies, and (3) desig…”
MethodEvidence-Based Prevention: Characteristics, Impact, and Future Direction
Pentz, M. A. (2003) · Journal of Psychoactive Drugs · doi:10.1080/02791072.2003.10400509 · Cited by 83 · see citing works
Atherton, H., Brant, H., Ziébland, S., Bikker, A., Campbell, J., Gibson, A., McKinstry, B., Porqueddu, T., & Salisbury, C. (2018) · Health Services and Delivery Research · doi:10.3310/hsdr06200 · Cited by 83 · see citing works
Jenkins, H. J., Moloney, N. A., French, S. D., Maher, C. G., Dear, B. F., MAGNUSSEN, J. S., & Hancock, M. J. (2018) · BMC Health Services Research · doi:10.1186/s12913-018-3526-7 · Cited by 83 · see citing works
Tortolero, S. R., Markham, C. M., Parcel, G. S., Peters, R. J., Escobar‐Chaves, S. L., Basen-Engquist, K. M., & Lewis, H. L. (2005) · Health Promotion Practice · doi:10.1177/1524839904266472 · Cited by 81 · see citing works
Self-citationde Cuevas, R. A., Saini, P., Roberts, D., Beaver, K., Chandrashekar, M., Jain, A., Kotas, E., Tahir, N., Ahmed, S., & Brown, S. L. (2018) · BMJ Open · doi:10.1136/bmjopen-2017-020892 · Cited by 80 · see citing works
“Such estimates would provide information pertaining to the relative importance of facilitators and inhibitors, and how changing them may influence screening attendance.(30) Failure to incorporate inductive findings into the design of deductive studies means that many inductive findings are untested in a population con…”
Fernández, M. E., Gonzales, A., Tortolero‐Luna, G., Partida, S., & Bartholomew, L. K. (2005) · Health Promotion Practice · doi:10.1177/1524839905278810 · Cited by 80 · see citing works
Self-citationBrady, S. S., Brubaker, L. T., Fok, C. S., Gahagan, S., Lewis, C. E., Lewis, J. B., Lowder, J. L., Nodora, J., Stapleton, A. E., Palmer, M. H., et al. (2020) · Health Promotion Practice · doi:10.1177/1524839919890869 · Cited by 82 · see citing works
Process evaluation of a school-based HIV/AIDS intervention in South Africa
Mukoma, W., Flisher, A. J., Ahmed, N., Jansen, S., Mathews, C., Klepp, K., & Schaalma, H. P. (2009) · Scandinavian Journal of Public Health · doi:10.1177/1403494808090631 · Cited by 79 · see citing works
“The intervention delivered in Cape Town was developed following the guidelines of Intervention Mapping, a framework for programme design on the basis of (1) needs assessments and capacity analysis, (2) theory about behaviour and behaviour change, (3) collaborative planning [ 8 ,9].”
MethodDésiron, H. A. M., Crutzen, R., Godderis, L., Hoof, E. V., & de Rijk, A. E. (2016) · Journal of Occupational Rehabilitation · doi:10.1007/s10926-015-9620-3 · Cited by 77 · see citing works
“The protocol provided by IM describes 6 steps, the first 4 of which we followed as described below [34–36].”
BackgroundMethodZwikker, H. E., van den Ende, C. H. M., van Lankveld, W. G., den Broeder, A. A., van den Hoogen, F. H. J., van de Mosselaar, B., van Dulmen, S., & van den Bemt, B. J. F. (2013) · Patient Education and Counseling · doi:10.1016/j.pec.2013.12.002 · Cited by 77 · see citing works
“The systematic development of the intervention (based on the Intervention Mapping framework)[26] and its content is published by Zwikker et al.”
Methodvan de Gaar, V. M., Jansen, W., van Grieken, A., Borsboom, G. J., Kremers, S., & Raat, H. (2014) · International Journal of Behavioral Nutrition and Physical Activity · doi:10.1186/s12966-014-0098-8 · Cited by 77 · see citing works
“The intervention was developed by the local government using health promotion tools – intervention mapping [55] – in combination with social marketing.”
MethodShort, C. E., James, E. L., Plotnikoff, R. C., & Girgis, A. (2011) · International Journal of Behavioral Nutrition and Physical Activity · doi:10.1186/1479-5868-8-113 · Cited by 77 · see citing works
“mapping protocol [65], explicitly outlined the theoretical methods and practical strategies that were linked to the tailoring variables used to create each message.”
BackgroundKjær, P., Kongsted, A., Ris, I., Abbott, A. D., Rasmussen, C. D. N., Roos, E. M., Skou, S. T., Andersen, T. E., & Hartvigsen, J. (2018) · BMC Musculoskeletal Disorders · doi:10.1186/s12891-018-2334-x · Cited by 76 · see citing works
Bode, C., de Ridder, D. T. D., & Bensing, J. M. (2005) · Patient Education and Counseling · doi:10.1016/j.pec.2005.04.006 · Cited by 74 · see citing works
“There has been some critique that intervention researchers are not explicit enough over how theories have been applied in the development of the intervention [21,22].”
Gaspard, J., & Yang, C.-M. (2016) · BMC Medical Education · doi:10.1186/s12909-016-0638-9 · Cited by 73 · see citing works
- Authors
- Bartholomew, L. K., Parcel, G. S., & Kok, G.
- Affiliations
- The University of Texas Health Science Center at Houston (US)
- Maastricht University (NL)
- Corresponding author
- Bartholomew, L. Kay
- Venue
- Health Education & Behavior
- Publisher
- SAGE Publications
- Published
- 1998-10
- Volume
- 25
- Issue
- 5
- Pages
- 545-563
- ISSN
- 1090-1981 (ISSN-L)
- 1552-6127
- OpenAlex
- W1986321933
- Cited by
- 1,102
- References
- 59
- Citations by year
- 2026: 52 · 2025: 87 · 2024: 67 · 2023: 59 · 2022: 67 · 2021: 78 · 2020: 113 · 2019: 57 · 2018: 69 · 2017: 55 · 2016: 48 · 2015: 46 · 2014: 45 · 2013: 41 · 2012: 25
- FWCI
- 25.57
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Health Education & Behavior (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Health Professions › General Health Professions › Public Health Policies and Education
- Social Sciences › Psychology › Applied Psychology › Behavioral Health and Interventions
- Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
- Keywords
- intervention mapping, health education program development, theory-based intervention design, program planning, needs assessment, program evaluation planning, health promotion
- MeSH terms
- Decision Support Techniques, Forecasting, Health Education, Health Plan Implementation, Health Planning Guidelines, Humans
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