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Introduction: Over the last decade, hypertension (HPT) is among the leading causes of death and morbidity in Ghana. In recent past, most health policy research in Ghana and Africa focussed on communicable diseases. In recent times, Ghana and other developing nations have shifted their attention to non-communicable diseases because most of these countries are going through an epidemiologic transition where there is a surge in the prevalence of HPT. This paper was therefore set out to estimate the cost of treating HPT in Ghana from the patients' and health system's perspectives., Method: We used a cost of illness framework to simulate the cost of HPT management in Ghana taking into account 4 of the common target organ complications with the most mortality implication. A decision analytic model (DAM) was developed in Microsoft ® Excel to simulate the progression of HPT patients and the Markov model was employed in simulating the lifetime cost of illness., Results: The results show that by 10 years from diagnosis, the probability of death from any of the 4 complications (ie, stroke, myocardial infarction, heart failure, and chronic kidney disease) is roughly 41.03%. By 20 years (or 243 months) from diagnosis, the probability of death is estimated to be 69.61%. However, by the 30th anniversary, the probability of death among the cohort is 82.3%. Also, the lifetime discounted cost of treating HPT is about GHS 869 106 which could range between GHS 570 239 and GHS 1.202 million if wide uncertainty is taken into account. This is equivalent to USD 119 056 (range: USD 78 115-164 723)., Conclusion: By highlighting the lifetime cost of treating HPT in Ghana, policies can be formulated regarding the cost of treating HPT by the non-communicable disease unit and National Health Insurance Authority (NHIA) of the Ministry of Health., Competing Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2024.)

The process of developing a behavior change intervention can cover a long time period. However, in times of need, this development process has to be more efficient and without losing the scientific rigor. In this article, we describe the just-in-time, planned development of an online intervention in the field of higher education, promoting COVID-19 vaccination among university students, just before they were eligible for being vaccinated. We demonstrate how intervention development can happen fast but with sufficient empirical and theoretical support. In the developmental process, Intervention Mapping (IM) helped with decision-making in every step. We learned that the whole process is primarily depending on the trust of those in charge in the quality of the program developers. Moreover, it is about applying theory, not about theory-testing. As there was no COVID-19-related evidence available, evidence from related fields helped as did theoretical knowledge about change processes, next to having easy access to the target population and important stakeholders for informed qualitative and quantitative research. This project was executed under unavoidable time pressure. IM helped us with systematically developing an intervention, just-in-time to positively affect vaccine acceptance among university students.

Sexual and gender minority (SGM) youth too often live in nonsupportive environments. This study reports the influence of social support from primary and secondary social ties on confidence and self-esteem among participants in Hatch Youth, a drop-in group-level intervention for SGM youth. Each 3-hour Hatch Youth meeting consists of a social, educational, and youth-led support hour. Over 14 weeks, these meetings were randomly observed and individual interviews with participating youth ( n = 12) and staff and volunteers ( n = 12) were conducted; data underwent a content analysis. Participants perceived an increase in confidence and self-esteem through enhanced bonding with family and friends, a sense of belonging, and community empowerment because of their involvement with Hatch Youth, suggesting drop-in centers can strengthen secondary social ties and improve confidence and self-esteem.

Objectives The objective of this project was to determine whether intervention mapping is a suitable strategy for developing an Internet- and text message-based smoking cessation intervention. Method We used the Intervention Mapping framework for planning health promotion programs. After a needs assessment, we identified important changeable determinants of cessation behavior, specified objectives for the intervention, selected theoretical methods for meeting our objectives, and operationalized change methods into practical intervention strategies. Results We found that "social cognitive theory," the "transtheoretical model/stages of change," "self-regulation theory," and "appreciative inquiry" were relevant theories for smoking cessation interventions. From these theories, we selected modeling/behavioral journalism, feedback, planning coping responses/if-then statements, gain frame/positive imaging, consciousness-raising, helping relationships, stimulus control, and goal-setting as suitable methods for an Internet- and text-based adult smoking cessation program. Furthermore, we identified computer tailoring as a useful strategy for adapting the intervention to individual users. Conclusion The Intervention Mapping method, with a clear link between behavioral goals, theoretical methods, and practical strategies and materials, proved useful for systematic development of a digital smoking cessation intervention for adults., (© 2016 Society for Public Health Education.)

Companies, seen as social communities, are major health promotion contexts. However, health promotion in the work setting is often less successful than intended. An optimal adjustment to the organisational context is required. Knowledge of which organisation-specific factors are relevant to health promotion is scarce. A Delphi procedure is used to identify these factors. The aim is to contribute to more effective workplace health promotion. The identified factors are described and embedded into a practical methodology (Intervention Mapping). A systematic use of these factors (called 'Organisational Mapping') is likely to contribute to more effective health promotion in the work setting., (© The Author(s) 2014.)

Stakeholder theory may help health promoters to make changes at the organizational and policy level to promote health. A stakeholder is any individual, group, or organization that can influence an organization. The organization that is the focus for influence attempts is called the focal organization. The more salient a stakeholder is and the more central in the network, the stronger the influence. As stakeholders, health promoters may use communicative, compromise, deinstitutionalization, or coercive methods through an ally or a coalition. A hypothetical case study, involving adolescent use of harmful legal products, illustrates the process of applying stakeholder theory to strategic decision making., (© 2015 Society for Public Health Education.)

This article describes the development of ROsafe, an intervention to promote sexually transmitted infection (STI) testing at vocational schools in the Netherlands. Using the planning model of intervention mapping (IM), an educational intervention was designed that consisted of two lessons, an Internet site, and sexual health services at the school sites. IM is a stepwise approach for theory- and evidence-based development and implementation of interventions. It includes six steps: needs assessment, specification of the objectives in matrices, selection of theoretical methods and practical strategies, program design, implementation planning, and evaluation. The processes and outcomes that are performed during Steps 1 to 4 of IM are presented, that is, literature review and qualitative and quantitative research in needs assessment, leading to the definition of the desired behavioral outcomes and objectives. The matrix of change objectives for STI-testing behavior is presented, and then the development of theory into program is described, using examples from the program. Finally, the planning for implementation and evaluation is discussed. The educational intervention used methods that were derived from the social cognitive theory, the elaboration likelihood model, the persuasive communication matrix, and theories about risk communication. Strategies included short movies, discussion, knowledge quiz, and an interactive behavioral self-test through the Internet.

This study investigated the hypothesis that adults are faster than adolescents in responding to risks. Twenty-six adolescents (M(age) = 15 years) and 26 adults (M(age) = 47 years) responded to risky situations (e.g. 'Is it a good idea to drive a car while having drunk alcohol?') and non-risky situations (e.g. '… wear a helmet while riding a moped?') in a choice reaction time task. Adults responded 110 ms faster to both risky and non-risky questions than adolescents. Both adolescents and adults responded on average 100 ms faster to risky questions than to non-risky questions. The results of this study suggest a possible explanation for the increased accident involvement of adolescents in traffic.

Background: There is a lack of effective smoking cessation interventions which have a high reach among adolescent smokers., Method: We conducted a randomised controlled trial of an adolescent smoking cessation intervention for students aged 15-21 at 22 continuation schools in Denmark. The intervention was a minimal intervention based on events with short counselling and a range of self-help materials. Our 1-month follow up consisted of 514 baseline daily smokers and the 14-month follow up of 369 daily smokers., Results: We found positive short-term effects regarding smoking cessation (adjusted OR 4.50, 95% CI 1.20-16.86), self-efficacy (p=0.01), and intentions to quit (p=0.004). However, none of these effects were maintained at 1-year follow up. The intervention was successful in reaching more than half of all daily smokers in the target group with more than 30% receiving counselling at least once in the intervention period., Conclusions: This trial shows that a "minimal" intervention can produce short-term effects but that this approach is insufficient in producing long-term effects.

Inconsistency in how professionals can best support the breastfeeding mother after discharge call on further investigation. The authors describe how intervention mapping was used to develop a postnatal breastfeeding support intervention for mothers in community settings. Breastfeeding cessation most often occurred in the first weeks among mothers with low self-efficacy, low confidence, or limited previous breastfeeding experience. Besides learning effective breastfeeding techniques, mothers needed to learn how to recognize their baby's cues, let the baby regulate meals, gain confidence in producing enough milk, and handle breastfeeding problems. Theory-based methods-such as individualization, skills training with guided practice, reattribution, planning coping responses, and mobilizing social support-were built into a health visitor-delivered program. An 18-hour training course addressed determinants for implementation. Finally, process and effect evaluations were planned. Support of the breastfeeding mother in community settings should address the psychosocial and practical aspects of breastfeeding to prevent premature cessation.

This community process evaluation highlights key enabling factors that facilitated the implementation of a community peer education program for youth HIV prevention in four poor and vulnerable areas of Aden, Yemen. It also explains the implementation process and provides a deeper understanding of the impact evaluation outcomes, which revealed improved HIV knowledge and risk perception and decreased stigma and risky behavior. This process evaluation was based on qualitative methodologies, where five focus group discussions and 15 in-depth interviews were conducted among 52 participants: community peer educators, community focal points, targeted young people, and local councils. The results revealed that contributing factors to implementing the peer education program had been community participation, mobilization of targeted communities, and capacity building of all those included in the intervention. Existing community-based organizations like the Social Service Centre played a key role in building trust with the targeted communities and linking HIV peer education intervention to other existing community services. This process evaluation could provide lessons learned for replicating similar youth peer education programs in conservative communities.

The number of assessments on HIV knowledge and stigmatization among adolescents in Yemen is still very limited. This cross-sectional study aimed to have a better understanding on the level of knowledge on HIV transmission and prevention. Also, this study explored the level of stigma and discrimination among students toward people living with HIV (PLWH). The study sample consisted of 2,274 male and female students (mean age 16.6 years) randomly selected from 27 high schools in Aden, Yemen. The results revealed low levels of knowledge on major prevention measures, such as condoms, where only 49.4% knew that condoms could protect from HIV infection; and high levels of misconceptions on the modes of transmission. In addition, the study revealed a high level of stigma and discrimination toward people living with HIV. The results would serve as a baseline for implementing a school-based educational program on HIV/AIDS.

This study examined the effect of graphic organizers on the comprehension of a health education brochure text and compared subjective with objective comprehension measures. Graphic organizers are graphical depictions of relations among concepts in a text. Participants read a brochure text about asthma with and without these organizers, and subjective and objective text comprehension was measured. It was found that graphic organizers had effects on four levels of objective comprehension as indicated by open comprehension questions. However, on the subjective comprehension measure using Likert-type scales, the groups with and without graphic organizers did not differ from each other. It is concluded that health education texts could benefit from relatively simple techniques to increase comprehension. Furthermore, in developing health education materials, comprehension should be measured objectively.

The purpose of this study was to examine the psychological processes pertaining to sexuality and sexual risk behavior among HIV-positive men who have sex with men (MSM). The authors analyzed transcripts of 30 semistructured interviews. Findings suggest that sexual problems in HIV-positive MSM might be primarily caused by the perceived risk of transmitting HIV to others. Furthermore, safer sexual behavior seems to be related to feelings of personal responsibility for safer sex. This study illustrates that although some men might have a clear notion of personal responsibility for safer sex, contextual factors can influence whether behavior is consistent with their norms of personal responsibility. The implications of the study are discussed for the practice of HIV prevention for HIV-positive MSM.

A variety of primary prevention strategies are used in HIV prevention programs in Africa. However, these are often developed through intuition and the theoretical basis for many interventions is limited to the knowledge /attitude model. This Article illustrates how research findings from a base-line survey are combined with Paulo Freire's social change theory and the Ecological Model for Health Promotion to develop a participatory intervention for HIV/AIDS prevention in farm workers in Zimbabwe. The article addresses the need to focus attention on the process of change at the interpersonal level, organizational and policy levels of the community. Dialogue is central to the range of strategies proposed for the intervention. The effect will be measured through process and outcome evaluation.

The aim of this study was to gain insight into the extent to which health education text writers apply writing principles derived from cognitive psychological theory. Seventeen professional text writers of health education materials participated in a qualitative study, consisting of a rewriting task combined with a think-aloud procedure and a semistructured interview. The verbal data were explored carefully in light of seven text coherence principles that have proven effective in cognitive psychological research to increase text comprehension. Findings indicate text writers vary in their ideas and use of coherence principles to make a text comprehensible. It is argued that the health education profession can benefit greatly from knowledge about cognitive text processing and cognitive coherence principles for realizing effective comprehension of written health education messages.

Evidence-based health promotion programmes are based on empirical data and theory. While a broad range of social and behavioural science theories are available, the actual application of these theories in programme design remains a real challenge for health promotion planners. Intervention Mapping describes a protocol for the development of theory- and evidence-based health promotion programmes. It provides guidelines and tools for the selection of theoretical foundations and underpinnings of health promotion programmes, for the application of theory, and for the translation of theory in actual programme materials and activities. This article presents the protocol and elaborates on the application of theory, using examples from successful intervention programmes.

This article presents the development of a theory- and evidence-based AIDS prevention program targeting Dutch drug users and aimed at promoting condom use. The emphasis is on the development of the program using a five-step intervention development protocol called intervention mapping (IM). Preceding Step 1 of the IM process, an assessment of the HIV problem among drug users was conducted. The product of IM Step 1 was a series of program objectives specifying what drug users should learn in order to use condoms consistently. In Step 2, theoretical methods for influencing the most important determinants were chosen and translated into practical strategies that fit the program objectives. The main strategy chosen was behavioral journalism. In Step 3, leaflets with role-model stories based on authentic interviews with drug users were developed and pilot tested. Finally, the need for cooperation with program users is discussed in IM Steps 4 and 5.

Fear appeal theory postulates a multiplicative relationship between threat information and coping appraisal on fear control (e.g., avoid thinking about breast cancer to reduce feelings of fear) and danger control (e.g. motivation to perform monthly breast self-examination to detect breast cancer). That is, the effects of threat information on measures of both coping modes are moderated by beliefs about one's ability to cope with the presented threat. However, in the present study no support for an interaction between threat information and coping appraisal was found on both coping modes. Instead threat information seems to contribute positively to fear control and not to danger control, whereas coping appraisal contributed positively to danger control and negatively to fear control. The results thus suggest that we might do without threatening information in persuading people to adopt health-promoting behaviours.

The practice of health education involves three major program-planning activities: needs assessment, program development, and evaluation. Over the past 20 years, significant enhancements have been made to the conceptual base and practice of health education. Models that outline explicit procedures and detailed conceptualization of community assessment and evaluation have been developed. Other advancements include the application of theory to health education and promotion program development and implementation. However, there remains a need for more explicit specification of the processes by which one uses theory and empirical findings to develop interventions. This article presents the origins, purpose, and description of Intervention Mapping, a framework for health education intervention development. Intervention Mapping is composed of five steps: (1) creating a matrix of proximal program objectives, (2) selecting theory-based intervention methods and practical strategies, (3) designing and organizing a program, (4) specifying adoption and implementation plans, and (5) generating program evaluation plans.

A randomized trial was conducted to study the impact of individualized computer-generated nutrition information and additional effects of iterative feedback on changes in intake of fat, fruits, and vegetables. Respondents in the experimental group received computer-generated feedback letters tailored to their dietary intake, intentions, attitudes, self-efficacy expectations, and self-rated behavior. After the first feedback letter, half of the experimental group received additional iterative feedback tailored to changes in behavior and intentions. The control group received a single general nutrition information letter in a format similar to the tailored letters. Computer-tailored feedback had a significantly greater impact on fat reduction and fruit and vegetable intake than did general information. Iterative computer-tailored feedback had an additional impact on fat intake. The results confirm that computer-generated individualized feedback can be effective in inducing recommended dietary changes and that iterative feedback can increase the longer term impact of computer-tailored nutrition education on fat reduction.

End-point evaluations are still the most commonly used method of assessing the success or failure of interventions. This article describes how a process evaluation was used to measure "what happened" during an HIV/AIDS prevention program for farm workers in Zimbabwe. The intervention was developed according to the Paulo Freirian theory of Social Change and the Ecological Model for health promotion. The stages of the intervention were cyclical; in the first stage innovative methods were used to encourage appraisal of vulnerability to HIV/AIDS through activities which raised critical thinking and dialogue. In the next phase, emphasis was placed on developing cognitive and attitude change in the target group. Self-protective behavior was encouraged through condom use and an increase in self-efficacy with respect to negotiating safe sex, especially among women. In the last stage of the intervention, efforts were made to create a climate for maintenance of behavior and socially responsible action within the community. The process evaluation provided valuable insight into factors which, when aggregated, provided an overview of a program whose successes and failures may well have been determined by issues outside the scope of the intervention. The effect of seasonal fluctuations of labor, income, and farming activity on program activity, patterns of STD, and condom demand were marked. This leads back to the researchers' initial question: "Was the intervention implemented as planned?" and the answer-only partially.

A variety of primary prevention strategies are used in HIV prevention programs in Africa. However, these are often developed through intuition and the theoretical basis for many interventions is limited to the knowledge/attitude model. This article illustrates how research findings from a base-line survey are combined with Paulo Freire's social change theory and the Ecological Model for Health Promotion to develop a participatory intervention for HIV/AIDS prevention in farm workers in Zimbabwe. The article addresses the need to focus attention on the process of change at the interpersonal level, organizational and policy levels of the community. Dialogue is central to the range of strategies proposed for the intervention. The effect will be measured through process and outcome evaluation.

This article reports on the design and results of the process evaluation of the Dutch community project "Healthy Bergeyk." The major goal of this project was a reduction in cancer-related risk behavior prevalence, especially smoking and high fat consumption. The project was designed to integrate health education theory and methods with community organization principles. An intersectoral local project group was formed for project implementation. The main objectives of the process evaluation were to assess what was done and how this was evaluated by participants and leaders of activities, project group members and the community in general. Data were gathered throughout the implementation period using minutes of meetings, registration forms, pre-structured telephone interviews, written questionnaires, and semi-structured interviews. Community members were involved in the data collection. The results indicate that the project group organized many health activities in their community in a short time period. Positive elements of the project concern the intersectoral co-operation and the workbook supplied to the project group. Time pressure and limited possibilities for community initiatives were the main negative aspects of the project. The implications of the findings for both the community health project and the process evaluation are discussed.

The planning of health education aimed at preventing sports injuries is often incomplete and not stated explicitly. In most instances, the evaluation is incomplete or nonexistent. We present a theoretical framework for planning and evaluating health education, illustrating the main points by using as an example the health education for downhill skiers. Systematic planning consists of analyzing the magnitude of the problem and the behavioral risk factors, studying behavior determinants, designing an optimal intervention, and implementing the intervention. The evaluation phase deals with the effects on these five levels (implementation, intervention, determinants, behavior, and incidence of injury). Some common pitfalls are mentioned and special attention is given to the study of determinants of behavior and to the design of the intervention. The importance of pretesting health education material and the community approach in educating sports participants is underlined. Health education, together with regulations and facilities, constitutes the health promotion strategy in the prevention of sports injuries. For most sports, there seems to be a strong need for further research on the etiology and determinants of behavior before effective prevention can be realized.