Steps to Intervention Mapping to develop and select strategies

Intervention Mapping can help you develop, select, or tailor implementation strategies to increase adoption, implementation, and sustainability.
Intervention Mapping involves six steps:
1. Conduct an implementation needs assessment by identifying what needs to be changed and for whom;
2. Establish implementation outcomes and change objectives, identify factors that affect implementation;
3. Choose a theory or framework and select or design implementation strategies based on it;
4. Integrate these strategies into an organized program;
5. Plan for adoption, implementation, and sustainability of the program in your setting; and
6. Evaluate the implementation.
Intervention Mapping guides change teams through a systematic process that engages stakeholders in the development of a practice change or intervention.
Depending on what the intervention is that will be implemented, you may choose to use all six steps of Intervention Mapping starting with Step 1, or simply Step 5.
You can start with Step 1 if, for instance, the task is to develop an intervention to implement clinical practice guidelines at multiple levels of an organization (e.g., changing patient and provider behavior) and/or there are no specific products (activities, training, materials) to be implemented yet,
Conversely, if there is an existing practice or intervention that has been developed and tested, you can focus on how to get this practice or intervention adopted, implemented, and maintained by beginning with Step 5.

Step 1: Conduct needs assessment

Identify what needs to be changed and for whom the change is beneficial.
Identify stakeholders - i.e., those who are indirectly or directly affected by the change.
Explore the possible obstacles and the support that is needed when applying the practice change or intervention in your setting.

Tip: Sit down with stakeholders and understand how the change may impact them from their perspective. During your meeting with these stakeholders, it’s never too early to ask them about how to remove any barriers that may prevent the practice or intervention from being implemented and sustained.

Step 2: Establish implementation outcomes and change objectives

Define concrete objectives for the change. The objectives for the change are based on the needs assessment you conducted
You can also identify the barriers and plan for strategies that will address them.

Step 3: Select theory-based methods and practical strategies

You may need to refer to the literature on the theories that would match your change objective.
For example, you may wish to use the Social Cognitive Theory (Bandura, 1997) to apply role modeling and verbal persuasion to change the providers’ attitude and self-efficacy for a practice change or intervention. In Social Cognitive Theory, role modeling and verbal persuasion help providers believe that they have the skills and competencies to apply the practice or intervention effectively and correctly.

Step 4: Integrate these strategies into an organized program

This step requires you and your team to design documents, draft content, pretest and refine content, and produce final materials for integration into an organized program.
This program contains what messages, methods, materials, and people are needed for each implementation strategy that you identified in Step 3.
You may also want to include the purpose of the material, intended audience, targeted barrier and change objectives, theory-based literature that you used to develop the strategies.
Even when selecting existing strategies (e.g., from the Expert Recommendations for Implementing Change (ERIC) list (Powell et al., 2017), the content within these strategies must be defined.

Step 5: Plan for adoption, implementation, and sustainability

Identify users and supporters of the practice or intervention, determine what their needs are and how these should be fulfilled
Host a brainstorming session that includes stakeholders. Who are the adopters? Who are the resisters?
Think about how you can engage resisters so that they become supporters of the change.
What are the contextual factors that influence the implementation?
What factors might help your practice or intervention be sustained in your setting?
Will the strategies you chose be sustained? Will they need to be consistently applied for a change to occur?

Step 6: Evaluate the implementation

Implementation outcomes are essential preconditions for achieving the desired change (Fernandez et al., 2019)
Implementation evaluation and process evaluation are terms that are often used interchangeably and essentially assess the extent to which implementation strategies fit well within the context, are delivered with fidelity and are addressing identified needs (Fernandez et al., 2019)
Process and implementation evaluation can answer questions such as who the program reached, to what extent was it delivered as planned (to whom, what level of fidelity, whether theory, and evidence-based change methods were applied correctly). Because implementation is highly dependent on context, process evaluation questions can also include those that assess the organizational factors that influenced intervention adoption, use, and/or maintenance including understanding what were the barriers and facilitators to implementation.

SOURCE: Bartholomew-Eldredge et al., 2016.