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Table 1 Intervention mapping step 1, needs assessment logic model

From: Development and preliminary evaluation of a rehabilitation consult for survivors of head and neck cancer: an intervention mapping protocol

  Phase 4: determinants Phase 3: behavioural and environmental factors Phase 2: body structures and functions Phase 1: function, participation, and health
Modifiable Knowledge about condition Goal setting and action planning Swallowing Decreased functional status,
Fatigue
Knowledge about symptom management and resources Health care professionals knowledge about rehab and HNC treatment Muscle strength, joint mobility Decreased health status, Decreased participation and engagement in personally-meaningful life areas
Cardiovascular capacity
Knowledge about metacognitive strategy use Expectations Dental issues
Energy budgeting Mouth opening
Neck and arm range of motion Decreased psychosocial function
Knowledge about association among needs/issues? Coping habits Speech
Exercise habits Anxiety Decreased role function
Dietary habits Dry mouth
Substance use, particularly smoking Neuropathies/sensory issues Decreased employment
Local processes Fibrosis
Physician referral processes Action planning Pain
Problem solving Cardiovascular capacity
Developing strategies
Self efficacy
Communication style Self regulation/self evaluation Digestive system functioning
Coping style Rehab resources Weight loss
Pre-existing mood/behaviour Community resources Cognitive impairments
Access to resources Personality changes
Emotional issues
Intimacy
Body image/body satisfaction
Lymphedema
Late effects
Non-modifiable Disease site Hospital type (eg cancer centre vs tertiary care centre) Aesthetic outcomes  
Treatment received
Age
Sex
Education level
Socioeconomic status/finances
Personality
  1. Items in italics are targeted for change.