• Theory-informed

interventions

UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH

 • Culture-based
• Accessible
• Values-based
• Acceptable
• Literacy-based
• Consumer-centric
• Adaptive
• Data-centric
• Engaging

UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH

Culture-based

• Heterogeneity
• Regionalization
• Country of origin
• Generation of immigration
• Language
• Ethnic identity
• Trust
• Religiosity
• Gender roles

UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH

Accessibility
• Television
• Radio
• Phone
• IVR
• IPOD
• Web
• Print
• DVD and Video
• e-Mail
• Billboard
• Parents
• Teachers
• Peers

UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH

Values-based
Responsibility, to family, co-workers, friends 
Purpose, to have meaning and direction in my life
Helpfulness, to reach out to others 
Inner peace, to find a sense of quiet/calmness 
Justice, to promote fair and equal treatment for all 
Hope, to see what happens in life in a positive way 
Independence, to be able to meet my own needs 
God’s will, to follow God’s plan for me 
Loving, to give and receive love  
Family, to have a happy, loving family 
Spirituality, to grow and mature spiritually 
Strength, to be physically fit and capable 
Mental strength, to be mentally alert  
Humor, to see the funny side of life 
Friendship, to have close, supportive friends 
Growth, to keep changing and growing 
Health, to be physically well  

UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH

Acceptable

• Politically?
• Local branding (who takes credit?)
• Turn-key from promotion to evaluation
• ROI metrics & dashboard reports
• Evidence-based

UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH

Literacy-based

• Keep reading level low but:

•Teach new terms
•Don’t talk down
•Keep it interesting, relevant
•Give options to investigate

UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH

Consumer-centric

• Their garden versus your seed

• Tone (choice)
• “Might want to consider” vs. “You should”
• How to be referred to
• Transparency

UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH

Adaptive

• Learning style
• User expertise
• Longitudinal
• Ipsitive

UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH

Data-centric

• Store baseline and all follow-up data

• Use data
• Links to other records
• Valid behavioral and outcome measures

UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH

Engaging

• Narrative stories
• Interactive
• Normative
• Connect with community
• Relevant!

UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH

 Average time of clinical opportunities (U.S.):

Home 132 days Mass media

Waiting room 20 min. 1957 Highlights magazines

Vital signs 5 min. Vital sign feedback

Exam room (pre-encounter) 15 min. Norman Rockwell picture

Exam room (encounter) 12 min. Physician-patient interaction

Home 132 days Mass media

UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH

 Mammography screening conceptual framework

attitudes outcome
Cultural -Fear of pain
norms -Fear of finding cancer
-Radiation
-Physical exposure
-Negative experience
Intention to Mammography
get screened screening
Perceived
Susceptibility
Severity
-Availability
-early detection Social norms -childcare
-neg result -partner -jobs
-physician -school
-children -cultural divide
-friends -transportation
-media -cost
-church -DP rel
-hair dresser -med anx

UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH

 Mammography screening conceptual framework

Intervention Intervention

attitudes outcome
Cultural -Fear of pain
norms -Fear of finding cancer
-Radiation
-Physical exposure
-Negative experience
Intention to Mammography
get screened screening
Perceived
Susceptibility *
Severity
-Availability
-early detection Social norms -childcare
-neg result -partner -jobs
-physician -school
-children -cultural divide
-friends -transportation
-media -cost Intervention
Intervention
-church -DP rel
-hair dresser -med anx

UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH

The goal:

Cost

High High
efficacy reach

UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH

Estimated status of typical interventions strategies for behavior change:
Reach Efficacy Cost

Group counseling  x  x  = 

Untailored print  x  x  = 

Proactive telephonic  x  x  = 

Reactive telephonic  x  x  = 

Untailored video  x  x  = 

Television  x  x  = 

Radio  x  x  = 

Tailored print  x  x  = 

IVR  x  x  = 

Web  x  x  = 
Lay health advisors  x  x  = 
Peer educators  x  x  = 

Theater  x  x  = 

Clinician counseling  x  x  = 

Tailored web  x  x  = 
UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH