Program theory evaluation of a lifestyle intervention program for metabolic syndrome

One of the quality requirements for a health intervention program to achieve its intended outcomes is to be established with sound program logic. To evaluate program logic of a lifestyle intervention program for metabolic syndrome, a comprehensive review was performed on program literature, including program plan and reports, health education manual, and health education materials. Matrices suggested by the Intervention Mapping (IM) model were built to evaluate the construction of program objectives, the match between intervention methods and strategies, and the composition of health education materials in terms of health behavior theory constructs. The evaluated program was developed using the IM framework and the constructs of Transtheoretical Model (TTM) and Social Cognitive Theory (SCT). The program showed the TTM pattern of transitioning from cognitive processes to behavioral processes across its intervention areas including diet, physical activity, smoking cessation, moderation of alcohol drinking, and stress management. Consciousness raising, counter-conditioning, stimulus control were main constructs of the TTM applied to the program while SCT constructs such as self-control, self-efficacy, and expectation were also emphasized. However, the program was limited to an individual level, and lacked fostering environmental changes and reinforcing relationships. The health education manual of the program should reflect the theoretical structure of the intervention and highlight specific intervention strategies to be used in health education for theory-based constructs and approaches to be actually implemented. Program theory evaluation serves as an opportunity to examine the logic of the program and to enhance program structure and implementation.