The present study is the description of a study conducted to develop a training-intervention program using IMA. Intervention mapping has six steps and some tasks at each step, where the basic processes are used in completing each step to benefit from theories and models.
Step 1: needs assessment
As the first part of intervention mapping, needs assessment is defined as a systematic study to identify the difference between what the status is and what should be in a given group and the intended state [13, 14]. In the current study, the planning group was established to identify the health issue, and examine the life quality of teenage students with the presence of stakeholders in health education, Orthopedic specialist, school principals, health educators, parents, and student, was examined using health needs assessment group, life quality, and behavioral and environmental determinants using PRECEDE model [15]. This assessment was done using a review of the studies conducted, and a qualitative study was conducted. Finally, the results of the needs assessment were determined by identifying the health and life quality outcomes of the evaluation program.
In the review over the studies conducted to select the papers, Pubmed, scoups, Embase, and Google Scholar databases were searched for English papers and Iranmedex, SID, and Google Scholar databases for Persian ones. Given the differences in searching Iranian and foreign scientific databases, various Persian and English keywords were selected. The search was performed based on keywords among the papers of the past 5 years. After extracting the papers from the databases, the ones related to the topic were examined.
After coordination, an invitation letter was sent to all health educators and parents of teenage students (12-14 years) in Ardabil to participate in group discussion sessions to conduct the qualitative study. The samples were selected using purposive and voluntary sampling methods, and the main criterion for the inclusion was the individuals’ willingness to participate in group interviews and their interest in working with project executives. After obtaining informed consent, the data were collected through 6 focus group discussions from 15 school health educators, 23 participating parents, and 20 teenage students (12-14 years). Sampling continued until data saturation (until the end of the fifth session) in all groups. The sessions were conducted by the researcher using a semi-structured index based on how the researcher interacted and discussed. All sessions and interviews were audio-recorded and transcribed by the researcher and analyzed following encoding in a basic thematic method. Finally, the results of the needs assessment were linked to the health planning and quality of life assessment and planning program[16].
Step 2: Matrix
The main tool in IMA is matrix of change objectives [17]. At this step, change objectives determine what to be done to reach performance goals to bring about changes in behavioral and environmental conditions and ultimately improve the life quality of the target group [17, 18]. At this stage, the expected outcomes were performed in two distinct behavioral and environmental levels, focusing on these outcomes, and the next step was the expected outcomes divided by the performance goals [19] where the matrix of change objectives was obtained from the midpoint of the performance goals using determinants. In the present study, this matrix was designed to meet the three expected outcomes according to the results obtained from the first step.
Stage 3: Theoretical methods and practical applications
In the third step, while the planning team predicted the ideas of the plan, the theoretical methods affecting the determinants of change were selected, and practical solutions were selected, and the evaluation program was designed to implement the predicted theoretical methods.
Step 4: Producing components and program materials
At this step of designing the intervention program, while holding a group meeting with the participants and considering their priorities and suggestions, the implementation, scope, and implementation sequence themes of the program were identified along with the constraints. For instance, if one part of the program had been planned for the school program during the school year, the resources needed by the principal and teacher along with the financial constraints of the program and the stages of program implementation were determined. The planning team then decided on the intervention methods to achieve the goals of change, and finally pre-tested the messages and other parts of the program before final production.
Step 5: Program implementation
At this step, the tasks of the individuals and what they must do so that the outcome is fully met and implemented acceptably were determined. Then similar to Step 2, matrix planning was defined to guide the intervention program. In this matrix, the operational goals and determinants were determined for adoption, implementation and maintenance of the program. For instance, determinants responded to the question why do decision makers decide to use the program and why those in charge try to make sure the program continues over time? The answers to these questions determine the adoption, implementation, and maintenance of the program.
Stage 6: Assessment planning
In the final step, the assessment program was defined to determine the effectiveness of the program, and the extent to which the performance goals and objectives were changed. Assessment questions were identified from the defined outcomes and objectives, and a criterion was identified [20].
The results of the first step, needs assessment: The results of a review of studies (15 related papers) showed that Students' information on how to use a backpack and related injuries was low. Moreover, the majority of teenage students does not have a proper definition of backpack and how to use it, how to use a backpack bag, A variety of backpack bags. In this study, mothers and school health educators were the most reliable channel of transmission of information.
The results were categorized into 3 outcomes:1- Increasing student information about backpacks and musculoskeletal injuries 2- Increasing student information about all kinds of backpacks 3- Proper use of backpacks.