Page 89 - Preventing pertussis in early infancy - Visser

Methods
Intervention Mapping (IM) uses a six-step protocol describing an iterative process which starts from the health problem and provides an integrated answer to that problem, encompassing targets, methods and a plan for action (see Figure 1) (Bartholomew-Eldredge et al. 2016). All objectives formed in the first 5 steps should be formulated as measurable concepts, which can be evaluated to indicate where the programme requires improvement.
In each step of the IM process, three perspectives are continuously applied. The participation perspective acknowledges that the involvement of stakeholders is essential to the success of a programme and therefore stimulates potential target group and implementer participation in all aspects of decision making. The multiple-theory perspective endorses that the promotion of healthy behaviour is complex and argues that because each theory can be seen as a reduction of reality, the use of various theories, each focusing on another aspect of the behaviour, will be necessary (Davidoff et al. 2015). The application of these two perspectives is also reflected in the IM core processes described below and its outcome will be further evaluated in the results section.
The third perspective is the ecological aspect. In this article, we chose to present a detailed description of the HCW levels, as target individuals for the vaccination programme. However, it is important to remember that IM aims to address all relevant ecological levels in a final intervention. From an ecological perspective, it is recognized that individual people function in a complex environment, where different social and physical environmental conditions are relevant, which should be taken into account during programme development. For example, the HCWs targeted in this article are surrounded by organisational level agents, who are responsible for the organisational policies, such as the hospital board, maternity care organisation management or midwife practice colleagues. They, in turn, operate within the context of national healthcare policies, professional standards, and Health Council recommendations, which are developed by more distant environmental agents. For all environmental agents the same processes can be performed as we will describe for HCWs.
The IM process as a whole is facilitated by using the IM core processes as described by Bartholomew-Eldredge et al. (2016). These core processes are: posing questions, brainstorming with the planning group, reviewing findings from empirical literature, reviewing theories for additional constructs, assessing and addressing needs for new data and developing a working list of answers.
Programme implementation and evaluation should be anticipated throughout the IM process. At the time the current project was running, the Health Council of the Netherlands was discussing pertussis cocooning vaccination among HCWs, but its positive advice was only issued after the end date of the project. As a result there was no real-life situation available to support an implementation and evaluation plan within the time frame of our study; IM steps 5 and 6 have therefore not been described.
Intervention Mapping
Intervention Mapping
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