1. Health Promotion Interventions

2. Objectives Recap from last week material Types of interventions Evidence based interventions In-class activity - Reviewing an evidence based intervention research article

3. Generalized Program Planning Model Assessing Needs Setting Goals & Objectives Developing Interventions Implementing Interventions Evaluating Results

4. Let’s Recap from last lecture Types of Objectives: 1. Process Objectives 2. Impact Objectives 3. Outcome objectives Remember, these will later be tied to the process, impact, and outcome evaluation

5. Process Objectives Are focused on assessing: Program resources (materials, funds, space) Appropriateness of intervention activities Priority population exposure, attendance, participation, and feedback Stakeholder reactions

6. Impact Objectives Describe the immediate observable effects of a program such as changes in: 1. awareness 2. knowledge 3. attitudes 4. skills 5. behaviors 6. environment Impact objectives form the groundwork for impact evaluation

7. Outcome objectives Ultimate objectives of the program that are aimed at changes in : 1. Reduction of risk 2. Physiologic indicators 3. Signs and symptoms 4. Morbidity 5. Disability 6. Mortality 7. Quality of life

8. Interventions Once program goals and objectives have been developed, planners need to decide on the most appropriate means of reaching and attaining those goals and objectives. Planners must design set of activities (interventions) that would permit most effective (leads to desired outcome) and efficient (uses resources in responsible manner) achievement of outcomes stated in the goals and objectives.

9. Interventions: Multiplicity Interventions that include several activities are more likely to have effect on priority population than those consisting of single activity Interventions that are aimed at multiple levels of influence that affect individuals’ and populations’ behaviors and health status are more likely to be effective (Socio-Ecological model) The right combination of activities depend on the needs of priority population The greater the dose of intervention the higher the chance for change (key question to decide is how many times will activities of intervention happen?)

10. The Socio-Ecological Model of Health and Wellness 10

11. Ecological Perspective: Levels of Influence/Prevention Intrapersonal/Individual Factors: (Knowledge about health, our values of health, our beliefs about health, skills to obtain health, our lifestyle choices) Interpersonal Factors: (the influence of family, coworker, friends) Institutional and Community Factors Public policy

12. Smoking Reduction Success in United States as Example of Application of Social -Ecological Approach Intrapersonal/individual level: large majority of smokers know that smoking is bad and many have tried to quit (some successfully, some not) Interpersonal level: many smokers are encouraged by their family, friends, physician to quit or join smoking cessation groups Community and Institutional level: many worksites, cities, towns have develop policies that prohibit smoking in buildings and public places Public Policy level: many states passed clean indoor air acts that limit smoking, and passed laws increasing tax on cigarettes. US government spent large funding on media advertising the dangers of tobacco use

13. Types of Interventions 1. Health Communication Interventions 2. Health Education Interventions 3. Environmental Change Interventions 4. Health Policy/Enforcement Interventions 5. Community Mobilizing Interventions

14. Health Communication Interventions Have the highest exposure or reach to the priority population. Mass Media (Media Communication Campaigns) Media Advocacy Risk Communication Entertainment Education Print Material Electronic Communication

15. What Makes Communication Campaigns Work? Dividing audiences into homogeneous clusters in order to design messages and select channels to reach (audience segmentation)

16. What Makes Communication Campaigns Work? Tailoring—Crafting messages to reflect audience characteristics

17. Criteria for Audience Segmentation Definable Mutually exclusive Measurable Accessible Pertinent to organization’s mission Reachable with affordable communication Large enough to be economical

18. Demographic Segmentation Variables Age Sex Family size and life cycle Income Occupation Education Religion Race and nationality

19. Demographic Segmentation Examples CDC HIV campaigns http://www.youtube.com/watch?v=dkd_nH-HeVE http://www.youtube.com/watch?v=AxYRYzQMiek http://www.youtube.com/watch?v=R5Uh3Vp55rA

20. Behavioral Segmentation Variables Degree of health risk Benefits of behavior Readiness to change Medical conditions and disorders Health history of family

21. Psychographic Segmentation Variables Attitudes, values, beliefs, & opinions Self-appraisal & other personality characteristics Media exposure Membership in organizations Health-related activities or actions Other lifestyle characteristics

22. Health Education Interventions There is no clear dividing line between health communication and health education interventions. Health education interventions can be viewed as those associated with settings such as classes, seminars, workshops, and courses (both face-to- face and online). Examples: 1.Prenatal classes for expectant mothers 2. Workshop for parents on how to better communicate with their teenagers 3. CPR and first aid course for babysitters

23. General Principles of Learning Learning is facilitated if: 1. Several of the senses are used (seeing, hearing, speaking) 2. Learner is actively involved in the process, rather than a passive participant 3. Learner is not distracted by discomfort or extraneous events 4. Learner is ready to learn 5. Material is relevant to learner and that relevance is perceived by learner

24. General Principles of Learning Learning is facilitated if: 6. Repetition is used 7. Progress occurs that is recognizable by learner, and learning is recognized and encouraged 8. Material to be learned starts with what is known and proceeds to unknown, while moving from simple to complex concepts 9. Material is paced for the learner

25. Environmental Change Interventions Characterized by changes “around” individuals and are not limited to the physical environment. Other environments include Economic environment (financial costs, affordability) Service environment (accessibility to health care or education) Social environment (social support, peer pressure)

26. Environment & Physical Activity Proximity of recreational facilities Street design Housing density Safety accommodations Sidewalks Bike lanes Wheel chair accessibility Schools Environment determines a child’s ability to walk or drive to school http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1448000/pdf/0931500.pdf http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1448000/pdf/0931500.pdf. 26

27. Health Policy Interventions Health Policy Interventions include: Executive orders Laws Ordinances Policies, regulations, rules Position statements Common to all of these is that a decision is made by an authority that is presented in guidelines intended to direct or influence actions/behaviors of others.

28. Health Policy Interventions Revolve around incentives, disincentives, or requirements to encourage/discourage actions by groups of individuals or society as a whole May be controversial Takes away individual freedom, sometimes plays on person’s pride, “pocketbook”, psyche Does not allow for voluntary behavior conductive for health At the same time, policies can get people to change their behavior when other strategies have failed.

29. How to Choose Interventions Should you make your own intervention or use one that has been proven to work? How to choose most effective interventions? How to make sure it will work for your priority population? Selection of health promotion program should be based on sound rationale backed by the best available evidence Intervention should not be selected just because the planners think “it sounds good” or because they have a “feeling” that it will work.

30. How to Choose Interventions Major questions that planners need to consider are: 1. What needs to change? And, where is the change needed? 2. At what level of prevention will the program be aimed? 3. At what level of influence will the intervention be focused? 4. What types of intervention strategies are known to be effective (i., e., have been successfully used in previous programs) in dealing with the program focus? 5. Is the intervention appropriate fit for the priority population? 6. Are necessary resources available to implement the selected intervention? 7. Would it be better to use intervention that consists of a single strategy or one that is made up of multiple strategies?

31. Evidence-Based Interventions Evidence-based interventions are those that are most likely to:  Be based on theory  Have been shown through empirical study (usually randomized controlled clinical trial) to be effective

32. Evidence-Based Interventions When finding and using an evidence based intervention, you DO need to take into account:  Variations of populations (age, gender, race, culture, SES, etc.)  Variations in settings (place where the intervention took place: geographic location, community, clinic, university, etc.)

33. Approach for Adapting Evidence-Based Behavioral Interventions First, you need to Assess: 1. Target population 2. Intervention being considered for implementation 3. Your agency’s capacity to implement intervention Second, you need to determine whether to adopt the intervention: 1. Without adaptation 2. With adaptation 3. Choose another intervention

34. Approach for Adapting Evidence-Based Behavioral Interventions Third, you need to actually : 1. Adapt the intervention materials 2. Pre-test adapted materials with target population 3. Increase your agency’s capacity and develop collaborative partnerships to implement intervention Fourth, you need to pilot-test the adopted intervention Fifth, implement the entire adopted intervention for the total target population (with minor revisions if needed)

35. CDC’s Tips from Former Smokers: Best Buy for Public Health http://www.cdc.gov/m edia/pdf/releases/2014 /cdc_tipsinfographic- 12-09-14.pdf http://www.cdc.gov/m edia/pdf/releases/2014 /cdc_tipsinfographic- 12-09-14.pdf

36. In-Class Activity Make groups of 3-4 people, take a piece of paper, put your names on it. 1. Critique an Evidence based Intervention article 2. Analyze if you can use that article for an intervention in SELU students