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138 Cultural Competence in Health Education and Health Promotion

are more appropriate? At what level will the interventions work? What types of materials
and resources are most suitable? These are the main questions that planners need to
take into consideration while planning the interventions of their health promotion
programs.
According to the CDC - Cynergy model, planners should develop goals, outcomes,

and specific and measurable objectives for each selected health problem and then
explore the most promising interventions for achieving such objectives (McKenzie
et al., 2005). For the PRECEDE - PROCEED model the determinants of health and

social conditions identified in the educational and ecological assessment process
should become the objectives of the health program, and later those objectives must be
linked to tested interventions (Green & Kreuter, 2005). Although these models recom-
mend searching for interventions that have been tested and used effectively in other
programs, it is important to remember that given the cultural diversity of the U.S. pop-
ulation, it is often impossible to fi nd well - evaluated interventions that meet the needs
of your specifi c community; therefore the best approach is to adapt interventions that
have already been tested. One resource to use for this purpose is the Guide to Commu-
nity Preventive Services (CDC, 2007), which includes a list of sixteen major health
concern areas — such as alcohol, diabetes, cancer, and physical activity — and provides
descriptions of population - based interventions focused on each area. It also rates

the interventions (recommended, insufficient evidence, and not recommended) and
describes the major findings about the utilization of the interventions. All the lists of

interventions are revised periodically by the U.S. Task Force on Community Preven-
tive Services (Bartholomew et al., 2001).
The MATCH and intervention mapping models offer guidance on how to develop
interventions. The fi rst model recommends selecting as the target for the intervention
the actors that have control over the personal or environmental conditions related
to the selected goals. Interventions can be designed to target individuals, groups, orga-
nizations, societies, or even governments. Depending on intervention levels and the targets
selected, different types of actions — including training, teaching, counseling, policy
advocacy, organizing and social action, among others — can be conducted to effect the
desired changes (McKenzie et al., 2005). The intervention mapping model offers a
more complex approach; it proposes the development of matrixes that specify who
and what will change at each level of intervention. For each expected change, planners
identify the health behavior and the environmental conditions associated with it and
then write a performance objective stating how the change will take place. These
objectives are then translated into theory - based methods and practical strategies that
are pilot - tested with intended recipients (Bartholomew et al., 2001).
Another key element to consider during the development of the interventions is
the selection of the materials, messages, and delivery channels. The consumer - focused
models in particular — SMART and CDC - Cynergy — recommend that the stakeholders
be involved as much as possible or, at least, that pilot tests be conducted before imple-
menting the program to determine the most adequate materials and strategies. When
making this selection, it is important to have in mind once more the characteristics of

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