PHSB 612: Interventions

Diane M. Dowdy, Ph.D.

Spring 2008

Public Health InterventionsAre created to generate specific outcomes

or effects+ Well-defined group+ Specific period of time+ Concentrated set of activities

Includes evaluation+ Measures impact of intervention+ Prompts the establishment of goals and

objectives+ Understand why or how the intervention

worked+ Future planning

Describe the

problem

Explore context and

identify determinants

Test intervention

s

Formulate intervention

s

Assess efficacy of

intervention

Assess effectiveness

of intervention

Monitor adequacy and impact of large-scale

interventions

Identify risk factors

Select or formulate possible

interventions

Definitions

Theory“A set of interrelated concepts, definitions, and

propositions that presents a systematic view of events or situations by specifying relations among variables in order to explain and predict the events or situations.”

Glanz, Lewis, & Rimer, 1997

Importance of Theory in Interventions

Guide the search for why people are not following public health and medical advice or not caring for themselves in healthy ways

Pinpoint what one needs to know before developing and organizing an intervention program

Provide insight in how to shape program strategies to reach people and organizations and make an impact on them.

Identify what should be monitored, measured, or compared in a program evaluation

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Theory of Unreasonable Actions All Other Theories

Explaining Health Behavior

97%

3%

From Dr. Burdine

How Does a Model Differ from a Theory?

“Health behavior and the guiding concepts for influencing it are far too complex to be explained by a single unified theory.

“Models draw on a number of theories to help people understand a specific problem in a particular setting or context.”

“Unlike theories, models do not attempt to explain the processes underlying learning, but only to represent them”

From: Glanz, Lewis, and Rimer, 1997

IOM Report: Promoting Health.Intervention Strategies from Social and

Behavioral Research

Recommendation 1: Social and behavioral factors have a broad and profound impact on health across a wide range of conditions and disabilities. A better balance is needed between the clinical approach to disease, presently the dominant public health model for most risk factors, and research and intervention efforts that address generic social and behavioral determinants of disease, injury, and disability.

Recommendation 2: Rather than focusing interventions on a single or limited number of health determinants, interventions on social and behavioral factors should link multiple levels of influence (i.e., individual, interpersonal, institutional, community and policy levels).

IOM Report

Research and intervention efforts should be

based on an ecological model.

Assumes that health and well-being are affected by a dynamic interaction…

Among biology, behavior, and the environment … that

Unfolds over the life course of individuals, families, and communities.

Also assumes that age, gender, race, ethnicity, and socio-

economic differences shape the context in which individuals function…therefore influencing (both directly and indirectly) health risks and resources.

these critical demographics should receive careful consideration in the design and implementation of interventions.

PolicyOrganizationa

lCommunity

Interpersonal

Individual

Source: McLeroy et al, 1998

Social Ecological Model

This ecological model is best operationalized by a social environmental approach to health and

health interventions. It places emphasis on how health is influenced by:

Biological/genetic functioning and pre-

disposition Social and familial relationships Environmental contingencies Broader social and economic trends

Levels of Behavioral Change Interventions

Interventions can be aimed at multiple levels:

Personal or interpersonal levelThe organizational or institutional levelThe health care levelThe environmental levelThe policy or legislative level

Program Outcomes – Goals and Objectives

Theories/ models

Available resources

Appropriate fit

Past experiences

Levels of Influence: Intrapersonal Interpersonal Institution/Org Community Public Policy

Planned intervention

Intervention activities

McKenzie and Smeltzer

RE-AIM: Plan, Evaluate, and Report

Studies

R……. Increase Reach

E……. Increase Effectiveness

A…… Increase Adoption

I……. Increase Implementation

M…… Increase Maintenance

Purposes of RE-AIM

Individual level:Reach to target population

Efficacy/Effectiveness demonstrated

Setting level:Adoption by organization

Implementation as intended

Both:Maintenance on both individual/organizational level