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Structural Interventions

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Behavioral Interventions for Prevention and Control of Sexually Transmitted Diseases

The term “structural intervention” is a relative newcomer to a longstanding mode of implementing changes beyond the individual in order to change health behaviors and health outcomes. As such, there remain variations in the precise definition of the term. In 1995 there was increasing use of the term applied to HIV/AIDS interventions. Sweat and Denison (1) differentiate structural levels of causation from other macro-levels in that structural interventions influence laws, policies, and standard operational procedures implemented through activism, lobbying, and changes in policy. Interventions that they review pair structural-level intervention with those that are environmental (influencing living conditions, resources and opportunities, and recognition of other levels of causation). O'Reilly and Piot (2) portray structural intervention as synonymous with “enabling approaches” (3). These are defined as interventions that change the social or physical environment to enable changes in determinates of risk. Interestingly, this is categorized as environmental intervention by Sweat and Denison (1). O'Reilly and Piot (2) differentiate structural interventions from other interventions including the community level, described as those pertaining to a fixed geographical area. More recent writers have included community-level interventions as a type of structural intervention (4). Thus, there is clearly disagreement in the limits of what may be considered a structural intervention.

Some of the difficulties in finding a clear definition of structural intervention are reflections of the multi-disciplinary aspects of public health, where different theoretical frameworks and terms refer to similar concepts (5). In addition, structural interventions may be linked to other levels of intervention either directly or indirectly. For example, implementation of a national immunization program might be considered a structural intervention because of the policy and organizational changes. However, this same intervention is dependent on 1) a biomedical intervention preventing infection by increasing host resistance to infection by altering biological factors; 2) community-level intervention using messages to increase vaccination acceptability; and 3) individual level intervention involving patient care by health care providers, and so on. These latter three interventions may have been developed independently through research, indirectly instilling a multi-level approach to the program, or implemented as part of the structural intervention directly, as part of a multilevel intervention program.

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Authors and Affiliations

  1. Division of STD Prevention, National Centers for HIV, STD, and TB Prevention, Centers for Disease Control and Prevention, Georgia, Atlanta, USA

    Frederick R. Bloom (R.N., Ph.D.)

  2. RAND Center for Population Health and Health Disparities, California, Santa Monica, USA

    Deborah A. Cohen (M.D., M.P.H.)

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Editors and Affiliations

  1. Division of STD Prevention, National Centers for HIV, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA

    Sevgi O. Aral Ph.D.  & John M. Douglas Jr M.D.  & 

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Bloom, F.R., Cohen, D.A. (2007). Structural Interventions. In: Aral, S.O., Douglas, J.M. (eds) Behavioral Interventions for Prevention and Control of Sexually Transmitted Diseases. Springer, Boston, MA. https://doi.org/10.1007/978-0-387-48740-3_5

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  • DOI: https://doi.org/10.1007/978-0-387-48740-3_5

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