A Framework for Designing Community-Based Interventions
OVERVIEW
The purpose of this chapter is to expose students to the different types of theoretical
frameworks that program planners can use to design and implement community
interventions.
THEORETICAL GUIDANCE FOR HEALTH INTERVENTIONS
Community health interventions must do more than educate or provide knowledge to
a target population about a desirable behavior. Excellent evidence is available to dem-
onstrate that knowledge alone will not change an individual’s behavior. For example.
how many readers have good knowledge about eating low-fat and low-calorie foods.
exercising daily, using sunscreen, and practicing safe sex, yet do not regularly practice
these behaviors‘? Therefore, an intervention must incorporate components or activities
in addition to educational activities to change behavior. By providing a construct made
up of various components, a theory provides guidance as to what program activities
could be included to reach your goal.
Theoretical Models
Successful community interventions do not just spring up from the desks of practitioners.
Most will use a theoretical model to develop the activities of an intervention to change
a targeted health behavior. Most of the theories used in health promotion interventions
are from the behavioral sciences and require knowledge of health sciences, epidemiol-
ogy, and cultural competence to be applied to interventions to address a community
health problem. A theoretical model or framework-the terms are used interchange-
ably here-provides an organized way to think about behavior change and view the
set of relationships between a health problem, a target population, program compo-
nents, and program results. Because the application ofa theoretical framework requires
practitioners to specify their goals, activities, and outcomes and think through how
each ofthese affects the other, interventions that are based on a theory are more likely
to be successful.
Any discussion of theory necessitates an understanding of three particular terms:
a concept, a construct, and a variable. A concept is the building block of a theory.
Each concept corresponds to a specific construct, and a variable that operationalizes
(measures) the construct. For example, one of the main concepts of social cognitive
theory is that a person must feel confident that she can implement the desired behavior-
that is, exercise self-efficacy about her ability. Self-efficacy is, therefore, the theoreti-
cal construct that defines the concept. An intervention that aims to increase physical
activity can apply a theory in which self-efficacy is a construct to measure partici-
pants’ sense of confidence in the likelihood of starting to exercise. To operationalize
the construct, questions will be developed such as, “How sure are you that you will be
able to walk for twenty minutes each day?” and “How certain are you that you will
attend an aerobic dance class once a week over the next six months?”