DPH 801 Module 6 Theory-Based Intervention Design Example

Designing for Every Level: A Theory-Based Multilevel Intervention for Hypertension Control Among Black Men

Student Name

Doctor of Public Health Program, Aspen University

DPH 801: Health Determinants, Disparities, Behavior and Promotion

Instructor Name

Month Day, Year

Designing for Every Level: A Theory-Based Multilevel Intervention for Hypertension Control Among Black Men

With the determinants traced and a framework chosen, the next task is design. A theory-based intervention names each component, shows which construct it targets and explains why it should work for the population. This paper presents a multilevel intervention, provisionally called Strong Hearts, Strong Families, for Black men in midlife whose blood pressure is not yet under control.

Goal and Objectives

The overarching aim is to narrow the city's blood pressure control gap separating Black men from other adults. Objectives over two years are to enroll 1,200 men with uncontrolled hypertension through 30 barbershops and 20 churches; to bring at least 50% of enrolled men below 140/90; to increase participants' self-efficacy for blood pressure management; and to secure city funding and a state policy change supporting pharmacist-led care.

Design Principles

The design follows the ecological perspective, acting on several levels so that each reinforces the others (McLeroy et al., 1988). Within it, individual and interpersonal components draw on social cognitive theory, especially building self-efficacy through mastery and peer modeling (Bandura, 2004). Expansion across sites follows diffusion principles.

Components by Level

The table maps components to levels and constructs.

The Core Model

At each site, trained barbers or church health ministers check blood pressure, encourage participation and schedule monthly visits with clinical pharmacists who can start or adjust medication under a collaborative agreement with physicians. This core draws directly on the barbershop trial, in which barber-promoted pharmacist care brought pressure down far more than usual advice did (Victor et al., 2018).

Peer Champions and Families

Peer champions, men from the community who have controlled their own blood pressure, share their experience at sites and through short videos. Family sessions invite spouses and adult children to learn about lower-sodium cooking and medication support. These components use observational learning and social support to build confidence and reinforce new routines.

Removing Structural Barriers

To address cost and access, the program provides free home monitors, covers medication copays through a partnership with a community health center and arranges pharmacy delivery. Evening and weekend visits accommodate hourly workers. These changes address the downstream effects of the structural determinants identified in the first module.

Workplace Outreach

At the advisory group's suggestion, the program partners with two large employers to offer on-site screening and enrollment during shifts, reaching men who rarely visit barbershops or churches during business hours. Employers benefit through healthier workers and fewer absences, which helps secure their cooperation.

Diffusion Plan

The program begins at eight early-adopter sites, documents results and uses opinion leaders among barbers and pastors to recruit additional sites in waves, prioritizing neighborhoods with the highest rates of uncontrolled hypertension so that spread narrows rather than widens gaps (Greenhalgh et al., 2004).

Staffing and Budget

Staffing includes a program manager, four clinical pharmacists, two community health workers and stipends for site partners and peer champions. The estimated two-year budget is $1.9 million, about $1,580 per enrolled participant, to be sought from a foundation grant, city funds and health plan contributions.

Equity Safeguards

Safeguards include tracking enrollment and control rates by neighborhood and age, ensuring sites in the highest-need areas join early, using data to adjust outreach and protecting participants' privacy in public settings through private screening spaces. Quarterly equity reports will go to the steering committee, which can redirect resources if gaps appear.

Pharmacist Collaboration

Clinical pharmacists will work under collaborative practice agreements with physicians at a community health center, allowing them to start, adjust and monitor medications. They will send visit summaries to participants' primary care providers when available, ensuring coordination. Where state law limits pharmacist prescribing, pharmacists will recommend changes for physician approval within 48 hours.

Training Site Partners

Barbers and church health ministers will complete four hours of training on blood pressure measurement with validated devices, privacy, referral criteria and encouraging follow-up without giving medical advice. Refresher sessions will occur every six months.

Communication Strategy

Messages will emphasize strength, family and community, reflecting advisory group input. Materials will feature local men and be distributed through shops, churches, radio and social media. Stories from peer champions will be central.

Risks and Mitigation

Risks include site turnover, pharmacist shortages and funding gaps. Mitigation includes recruiting backup sites, contracting with a pharmacy school for clinical faculty and pursuing multiple funding sources, including health plan contracts that pay for improved blood pressure control.

Timeline

Months one to six: hire staff, sign agreements, train partners and launch eight pilot sites. Months seven to twelve: refine based on pilot data and add the first expansion wave. Months thirteen to twenty-four: expand to 50 sites and pursue policy advocacy. Evaluation runs throughout.

Community Governance

The steering committee of barbers, pastors, residents and clinicians will meet monthly to review data, approve adaptations and set expansion priorities. Its members will receive stipends, and residents will hold a majority of seats.

Adapting for Different Sites

Barbershops, churches and workplaces differ in space, schedules and culture. Core elements, trained measurement, pharmacist visits, peer encouragement and follow-up, stay fixed, while scheduling, messaging and privacy arrangements adapt to each setting. A site guide documents allowed adaptations.

Sustainability

Long-term sustainability depends on health plan payments for pharmacist services, city funding for community health workers and embedding stations in site routines. The steering committee will lead advocacy for these commitments from the first year.

Conclusion

The Strong Hearts, Strong Families design acts on every ecological level: individual monitoring and feedback, peer and family support, barbershop and church care with pharmacists, community ownership and spread and policy advocacy for sustainable access. Each component targets a construct from the chosen framework and builds on trial evidence, giving the design a clear rationale that the next module will translate into a logic model and evaluation.

References

Bandura, A. (2004). Health promotion by social cognitive means. Health Education & Behavior, 31(2), 143-164. https://doi.org/10.1177/1090198104263660

Greenhalgh, T., Robert, G., Macfarlane, F., Bate, P., & Kyriakidou, O. (2004). Diffusion of innovations in service organizations: Systematic review and recommendations. The Milbank Quarterly, 82(4), 581-629. https://doi.org/10.1111/j.0887-378X.2004.00325.x

McLeroy, K. R., Bibeau, D., Steckler, A., & Glanz, K. (1988). An ecological perspective on health promotion programs. Health Education Quarterly, 15(4), 351-377. https://doi.org/10.1177/109019818801500401

Victor, R. G., Lynch, K., Li, N., Blyler, C., Muhammad, E., Handler, J., Brettler, J., Rashid, M., Hsu, B., Foxx-Drew, D., Moy, N., Reid, A. E., & Elashoff, R. M. (2018). A cluster-randomized trial of blood-pressure reduction in Black barbershops. New England Journal of Medicine, 378(14), 1291-1301. https://doi.org/10.1056/NEJMoa1717250