We all agree that programs should be designed with a theoretical and evidence-based methodology. There are many different methodological approaches used by development organizations. I recently learned about the core processes methodology which combines strategic brainstorming sessions with a literature review to identify theoretical approaches for answering research questions. With my colleagues in Uganda, I applied the core processes methodology to our work exploring why adolescents engage in multiple concurrent sexual relationships. In this post, I briefly explain the six steps of the methodology and then share what we learned and lessons from our published paper. I hope that you will find this methodology interesting and worth trying in your development work.

What is the core processes methodology?

The core processes methodology, as described by Bartholomew-Eldredge et al. (2016), is an intervention planning approach based on using theory and evidence as a foundation for assessing and addressing health problems. The methodology provides a step-by-step process from which we identified six steps:

1. Posing the problem question related to the cause, behavioral determinants, environmental conditions, and program interventions;
2. Brainstorming for possible answers using qualitative sessions to encourage the generation of “wild” ideas from different stakeholder groups;
3. Reviewing empirical literature related to the problem based on the insights from the brainstorming sessions to further learn what is known and not known about the problem;
4. Identifying theoretical support based on the topic, concepts, and general theoretical approaches;
5. Identifying and addressing new needs for research through identifying what is not yet known and remains unclear about the problem from the empirical literature and using the insights to formulate specific research questions for further exploration; and
6. Proposing answers to the problem by drawing insights from the brainstorming sessions, literature review and theoretical support. The frequently listed possible explanations are ranked by order of importance and changeability to inform future prioritization in program design.

How did we apply the core processes methodology in our study?

Data from Demographic and Health Surveys show the percentage of adolescents in Uganda reporting two or more sexual partners (often concurrent) increased from 1.5% to 2.2% in females and 5.4% to 6.6% in males between 2011 and 2016. Little is understood though about why adolescents engage in multiple concurrent sexual partnerships despite the increased risk of HIV and unplanned pregnancies.

Our research team applied the six steps of the core processes methodology to identify determinants of multiple concurrent sexual partnerships so that others can successfully design targeted adolescent health programs. You can read our full process in the paper. Here I focus only on step 4 (Identifying theoretical support based on the topic, concepts and general theoretical approaches) because it describes the complex nature of linking program design to theoretical perspectives and paradigms. More so, I emphasize step 4 because the theoretical application in program design is most of the time invisible. Thus, this makes the visibility of theoretical paradigms in program implementation an elusive reality.

In applying step 4, we started by reviewing and identifying theoretical constructs used in the design of empirical studies found in the literature review (the topic approach). We found six different theories across the literature. We then scrutinized ideas generated during the brainstorming sessions with adolescents, community leaders, policymakers, and program implementers, and grouped similar ideas (the concepts approach). For accuracy, we relabeled related ideas from the brainstorming sessions and empirical literature according to the six identified theories using labels such as attitude, perceived susceptibility beliefs, self-efficacy, and social norms. We then explored the theories that may offer an answer or explanation to our problem – why adolescents engage in multiple concurrent sexual partnerships (the general approach). Additionally, we also explored two alternative theories not assessed by other reviewed studies (i.e., not identified in the topic and concept approach steps) but were deemed relevant to explaining the problem.

We categorized the eight theories (six identified and two alternative) by the individual, community and environmental aspects and narrowed the list down to four theories that highlighted new insight into the problem of multiple concurrent sexual partnerships. We reviewed these four theories and applied them to our study.

Table 2 in our paper describes each of the four theories and its application to our problem of multiple concurrent sexual partnerships among adolescents. For example, the Extended Parallel Process Model (one of our two alternative models) predicts program interventions that elicit fear in adolescents may affect behavior if self-efficacy and threat are both successfully manipulated. However, we found programs designed to stimulate damage control failed because of missing self-efficacy components. In our findings, self-efficacy is an individual determinant that ranks high in importance and changeability in programs designed to reduce adolescent multiple concurrent sexual partnerships.

What do we recommend?

The application of the core processes methodology in our study truly opened our eyes. It showed us that there is much more to learn and discover when you solicit a deeper understanding of your research problem. We learned that there is quite a lot to explore among what is already known before jumping into conducting new research and proposing what we may think are new interventions, which often may not be the case. We also learned that putting what is already known and not known in the perspective of program design – with theoretical paradigms taking the center stage – is imperative in understanding the problem. I, therefore, encourage all program designers reading this post to try applying all six steps of the core processes methodology in their work to get a contextual comparative edge.


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