Application of Intervention Mapping to develop a community-based health promotion pre-pregnancy intervention for adolescent girls in rural South Africa: Project Ntshembo (Hope)

Abstract

BackgroundSouth Africa (SA) is undergoing multiple transitions with an increasing burden of non-communicable diseases and high levels of overweight and obesity in adolescent girls and women. Adolescence is key to addressing trans-generational risk and a window of opportunity to intervene and positively impact on individuals’ health trajectories into adulthood. Using Intervention Mapping (IM), this paper describes the development of the Ntshembo intervention, which is intended to improve the health and well-being of adolescent girls in order to limit the inter-generational transfer of risk of metabolic disease, in particular diabetes risk.MethodsThis paper describes the application of the first four steps of IM. Evidence is provided to support the selection of four key behavioural objectives: viz. to eat a healthy, balanced diet, increase physical activity, reduce sedentary behaviour, and promote reproductive health. Appropriate behaviour change techniques are suggested and a theoretical framework outlining components of relevant behaviour change theories is presented. It is proposed that the Ntshembo intervention will be community-based, including specialist adolescent community health workers who will deliver a complex intervention comprising of individual, peer, family and community mobilisation components.ConclusionsThe Ntshembo intervention is novel, both in SA and globally, as it is: (1) based on strong evidence, extensive formative work and best practice from evaluated interventions; (2) combines theory with evidence to inform intervention components; (3) includes multiple domains of influence (community through to the individual); (4) focuses on an at-risk target group; and (5) embeds within existing and planned health service priorities in SA.

Adolescence and the next generation

“…The rapid rise in obesity in middle-income countries, even where undernutrition and food insecurity persist, will require multicomponent approaches with elements addressing healthy diets, physical activity and sedentary behaviour, as well as creating the opportunities for adolescents and their families to make healthy choices 136 . Similarly, high rates of mental disorders are likely to require not only early clinical intervention, but also the targeting of risk factors and the acquisition of protective social and emotional skills.…”

Using an intervention mapping approach for planning, implementing and assessing a community-led project towards malaria elimination in the Eastern Province of Rwanda

“…IM also guided the ecological perspective adopted by MEPR—encompassing both personal and environmental determinants of malaria during project interventions [9]. This has enabled the project to design and implement interventions in a way that increases the likelihood of acceptance and maximizes the benefit to the community [53].…”

“…IM is grounded on a systematic approach in the development of health promotion programmes and the use of theories guiding strategies for change that are linked to behavioural and environmental factors related to health outcomes [7–9]. The approach is comprehensive, comprising six steps (1) a needs assessment, (2) design of a matrix of proximal programme objectives, (3) selection of theory-based intervention methods and practical applications (4) design of the programme, (5) adoption and implementation plans, and (6) programme evaluation plans [10, 11].…”

“…The approach is comprehensive, comprising six steps (1) a needs assessment, (2) design of a matrix of proximal programme objectives, (3) selection of theory-based intervention methods and practical applications (4) design of the programme, (5) adoption and implementation plans, and (6) programme evaluation plans [10, 11]. A number of public health programmes using an IM approach have been previously documented [7, 9, 12–18], however, less is known in regards to the use of IM in community-tailored interventions for malaria control and/or elimination. This paper documents the development, implementation and evaluation of a community-based malaria elimination project using an IM approach.…”

Developmental Origins of Health and Disease: A Lifecourse Approach to the Prevention of Non-Communicable Diseases

“…In South Africa, for example, rates of obesity are high among adolescent girls leading to high rates of gestational diabetes and low birth weight. An intervention to reduce obesity among adolescent girls is being developed, that will use community health workers trained in behavior change techniques, to empower adolescent girls to improve their health behaviors [59]. …”