Besharati Fereshteh, Karimi-Shahanjarini Akram, Hazavehei Seyed Mohammad Mehdi, Bashirian Saeid, Bagheri Fahimeh, Faradmal Javad
Department of Public Health, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran. Email:
Asian Pac J Cancer Prev. 2017 Aug 27;18(8):2193-2199. doi: 10.22034/APJCP.2017.18.8.2193.
Background: While the incidence rate of the colorectal cancer (CRC) has been increasing over the last three decades in Iran, very limited interventions to increase CRC screening have been developed for Iranian population. The purpose of this study was to describe the use of Intervention Mapping (IM) for applying theory and evidence and considering local contexts to develop a CRC screening program among adults in Iran. Materials and Methods: From April 2014 to July 2016 following the IM process, six steps were formulated and implemented. First a need assessment was conducted involving relevant stakeholders and using focus groups discussions (n=10), individual interviews (n=20), and a household survey (n= 480). Then a matrix of change objectives was developed for each behavioral outcome and theoretical methods and their practical applications were identified to guide intervention development and implementation. A multi-component intervention was developed and piloted. Decision on suitable parts of intervention was made based on feedback of pilot study. Finally, evaluation plan including process and outcome evaluation was generated and conducted to inform future scale up. Results: The needs assessment highlighted factors affecting CRC screening including knowledge, self efficacy, social support and perceived benefit and barriers (financial problems, fear of detection of cancer and etc). Results of needs assessment were used to develop next steps IM. The program utilized methods like information delivery, modeling, and persuasion. Practical applications included video presentation, group discussion, role playing and postcards.This program was assessed through a cluster-randomized controlled trial. Results showed that there were significant differences in CRC screening uptake between intervention groups and control (P<0.001). Conclusions: IM is a useful process in the design of a theory-based intervention addressing CRC screening among Iranian population.
在过去三十年中，伊朗的结直肠癌（CRC）发病率一直在上升，但针对伊朗人群开展的增加CRC筛查的干预措施非常有限。本研究的目的是描述如何运用干预映射（IM）来应用理论和证据，并考虑当地情况，为伊朗成年人制定CRC筛查计划。材料与方法：2014年4月至2016年7月，按照IM流程，制定并实施了六个步骤。首先，进行了需求评估，涉及相关利益攸关方，采用焦点小组讨论（n = 10）、个人访谈（n = 20）和家庭调查（n = 480）。然后，针对每个行为结果制定了变革目标矩阵，并确定了理论方法及其实际应用，以指导干预措施的制定和实施。开发并试点了多成分干预措施。根据试点研究的反馈，决定干预措施的合适部分。最后，制定并实施了包括过程评估和结果评估的评价计划，为未来的扩大规模提供依据。结果：需求评估突出了影响CRC筛查的因素，包括知识、自我效能感、社会支持以及感知到的益处和障碍（经济问题、对癌症检测的恐惧等）。需求评估结果用于制定下一步的IM。该计划采用了信息传递、示范和劝说等方法。实际应用包括视频展示、小组讨论、角色扮演和明信片。该计划通过整群随机对照试验进行评估。结果显示，干预组和对照组在CRC筛查接受率方面存在显著差异（P<0.001）。结论：IM是设计基于理论的干预措施以解决伊朗人群CRC筛查问题的有用过程。
