Designing and Evaluating Theory-Based Interventions

Facilitated by Charles Abraham, Susan Ayers and Susan Michie.
Theory may initially emerge out of descriptions of observed associations and develop as explanations of how and why certain events are associated. Such explanations can be tested using predictive studies but are most effectively tested using experiments in which particular independent variables are manipulated and theory-specified effects on dependent measures are observed (Abraham, 2004). Unfortunately theory-based interventions in health psychology often fail to fulfill this purpose. Links between explanatory theories and the change techniques in interventions may be only loosely related, confounding variables may not be controlled and it may be unclear which theory-based techniques were responsible for the observed behaviour or health change (Michie & Abraham; Rothman 2004). This dislocation of theory and experimental theory selection impedes theory development and makes it more difficult for health psychologists to develop evidence-based interventions.
For example, the rapid development of interventions designed to promote HIV-preventive behaviour resulted in few theoretically-based programmes and few, if any, of these were found to influence sexual behaviour (Fisher & Fisher, 1992). By contrast, more recent HIV-preventive interventions, based on social cognition models, have proved to be effective in controlled trials (Fisher et al., 1986; Jemmott & Jemmott, 2000; Kalichman, Carey & Johnson, 1996; Kalichman & Hospers, 1997). Thus social cognition models appear to offer a theoretical basis for health promotion activities. Unfortunately, however, there are relatively few experimental tests of the effectiveness of interventions based directly on these theories (e.g., Jones, Jones, & Katz, 1988). For example, Hardeman et al. (2002) identified only 12 studies that used the TPB to develop a behaviour change intervention. Of these, four were found to change behaviour but none investigated whether behaviour change was mediated by the psychological changes proposed by the theory.
The workshop will provide an opportunity to reflect on the relationship between intervention design and theory in health psychology. We will discuss how interventions can be designed and tested in a manner that furthers theory development and selection. We will also consider challenges that arise in designing and implementing interventions as well as factors that are crucial to effective intervention evaluation. In this context we will consider the utility of the intervention mapping framework in intervention design (Bartholomew, Parcel, Kok, & Gottlieb, 2001). This includes theory selection. Michie et al. (2004) map out a series of theoretical domains from which intervention designers may select relevant theories. How useful are these to intervention design.
Day 1: Introduction: Design, Theory and Outcomes
Day 2: Intervention Mapping
Day 3: Practical Problems and Reporting Interventions
Essential Preparatory Reading
  • Kelley, K. & Abraham, C. (2004). RCT of a theory-based intervention promoting healthy eating and physical activity amongst out-patients over 65. Social Science and Medicine, 59, 787-797.
  • Kok, H., Schaalma, H., Ruiter, R. A. C., & van Empelen, P. (2004) .Intervention mapping: A protocol for applying health psychology theory to prevention programmes. Journal of Health Psychology, 9, 85-98.
  • Michie, S. & Abraham, C. (2004). Interventions to change health behaviours: Evidence-based or evidence inspired? Psychology and Health, 19, 29-49.
  • Michie, S., Johnston, M., Abraham, C., Lawton, R., Parker, D., Walker, A. (2004). Making psychological theory useful for implementing evidence based practice: a consensus approach. Quality and Safety in Health Care, 14, 26-33.
  • Rothman, A. J. (2004). Is there nothing more practical than a good theory? Why innovations and advances in health behavior change will arise if interventions are used to test and refine theory. International Journal of Behavioral Nutrition and Physical Activity 2004, 1, 11. 
The workshop took place from 28th - 30th of August, 2005, i.e. on the three days preceding the EHPS conference. The workshop venue was the University of Galway in Galway, Ireland.
Enhancing Individual, Family & Community Health