1. Making High-Yield Prevention Choices: Intervention Selection Tools Margaret Beaudry Public Health Foundation (PHF) APHA 141 th Annual Meeting and Exposition Boston, Massachusetts November 4, 2013

2. Presenter Disclosures The following personal financial relationships with commercial interests relevant to this presentation existed during the past 12 months: Margaret Beaudry “No relationships to disclose”

3. PHF Mission: We improve the public’s health by strengthening the quality and performance of public health practice www.phf.org Healthy Practices Healthy People Healthy Places

4. Learning Objectives Identify decision factors that impact the success of public health interventions. Develop a strategy for comparing evidence-based interventions for best-fit and greatest yield in local contexts.

5. Background This presentation is based on a hypothetical model developed by Dr. Norma Kanarek entitled Strategic Practice Selection Exercise. Her paper is available on www.phf.orgStrategic Practice Selection Exercisewww.phf.org The idea is to tailor the exercises to your community, weighing decision factors according to local priorities. You can also substitute your own decision factors for those proposed. The result is a weighted ranking of potential interventions based on local applicability and likelihood of success. Organizations can use this approach to inform practical programmatic decisions on how to invest limited prevention resources to achieve the most high-yield results.

6. A Three-Part Planning Process Community/State Health Needs Assessment Identify priorities based on supporting data Strategic Planning Assessing the availability, affordability, accessibility, and utility of interventions to address priority problems Implementation Planning Identify sources of funding, partners, leaders, and a time frame for addressing priority problems

7. Think Global, Act Local #1 Identify Potential Interventions Global... Look far and wide to understand the many good ideas already in play Evidence-based Cost-effective Potentially applicable in diverse settings #2 Rank Interventions Local... Assess applicability and likelihood of yielding results Availability Affordability Acceptability Impact potential

8. #1 Identify Potential Interventions The Guide to Community Preventive Services (Community Guide) The Cochrane Database of Systematic Reviews The Healthy People 2020 Evidence-Based Resources The County Health Roadmaps: What Works for Health The University of Massachusetts Evidence-Based Strategies for Public Health The National Registry of Evidence-Based Programs and Practices (NREPP) PubMed Clinical Queries The Grey Literature Report The Promising Practices Network (PPN) Canadian Best Practices Portal The National Prevention Strategy Appendix 5: Justification for Evidence-Based Recommendations Healthy People 2020 Structured Evidence Queries The Guide to Community Preventive Services (Community Guide) The Cochrane Database of Systematic Reviews The Healthy People 2020 Evidence-Based Resources The County Health Roadmaps: What Works for Health The University of Massachusetts Evidence-Based Strategies for Public Health The National Registry of Evidence-Based Programs and Practices (NREPP) PubMed Clinical Queries The Grey Literature Report The Promising Practices Network (PPN) Canadian Best Practices Portal The National Prevention Strategy Appendix 5: Justification for Evidence-Based Recommendations Healthy People 2020 Structured Evidence Queries

9. #1 Identify Potential Interventions The Community Guide This resource allows you to choose programs and policies to improve health outcomes in 22 topic areas including tobacco, physical activity, motor vehicle injury, adolescent health, and cancer. More than 200 systematic reviews on proven effectiveness, intervention cost, and likely return on investment. The National Registry of Evidence-Based Programs and Practices (NREPP) More than 290 public health interventions for mental health and substance abuse, and information to help determine which will best meet local needs. The National Prevention Strategy Appendix 5: Justification for Evidence-Based Recommendations Evidence-based recommendations validated from five major scientific resources.

10. #2 Will This Work for Us? Decision Factors Strength of Evidence Organizational Control Potential Uptake / Additive Penetration Community Acceptability Potential Number of Deaths Averted

11. #2 Will This Work for Us? An Example The organization selected tobacco use as its public health priority The organization then listed potential evidence-based tobacco interventions in the rows. The decision factors included the strength of the evidence, as well as other variables related to the likelihood of successful health impact.

12. #2 Will This Work for Us? Decision Factors [3] Potential Number of Deaths Averted Strength of Evidence Potential Intervention Delivery and Coverage Community Acceptability Organiza- tional ControlTotal Public Health Interventions Increase Price of Tobacco Products 3312110 Limit Youth Access to Tobacco 1133311 Avert Exposures to Second and Third-Hand Smoke 222129 Example: Tobacco Use Intervention Selection Matrix [1],[2] [1][2] Ranking: 3 represents the most impactful idea, 1 represents the least impactful idea [1] [1] Data are shown for illustrative purposes only. [2] [2] This matrix was derived from the Nominal Group Technique, in which group members’ individual ranks are totaled to attain a group score. [3] [3] The relative weight, or importance, of the decision factors will vary depending on the organization’s public health priorities and should be discussed prior to ranking.

13. #2 Will This Work for Us? Limit Youth Access to Tobacco had the highest overall ranking and therefore the greatest likelihood of successful, impactful implementation. Community Acceptability Components Applicability to health departments Utility to local agency Reliability of implementation Ease of monitoring implementation Applicability to broad range of communities Controversy potential Resource or cost requirements Rating Scale 5 = Strongest, 1= Weakest

14. #2 Will This Work for Us? Acceptability Components 54321 Applicability to health departments Consonant with agency mission and traditional roles Similar to other interventions/ populations Consensus it is worthwhile, but community lacks enthusiasm Genuine difference of local opinion about agency role in the intervention Viewed as peculiar or and not helpful to the community or whole population Utility to local health departments Similar target population, personnel required that PHD already uses Target population and necessary personnel is totally new to the PHD Reliability of implementation One implementation protocol fits all Implementation protocols differ for communities, subpopulations, time periods, etc. Ease of monitoring implementation Simple, straightforward intervention Intricate intervention many steps, a hierarchy of implementation, or many contacts Applicable to a broad range of communities Low variability of intervention uptake Moderate variability of intervention uptake High variability of intervention uptake Controversy potential Addresses protection of the entire population Addresses illegal activity, an unfavored subpopulation, or has negative impacts Resource or cost requirement Low cost, intensity of trained personnel, or few FTEs Moderate cost, intensity of trained personnel, or FTEs High cost, intensity of trained personnel, or many FTEs

15. Links to Evidence-based Resources The Guide to Community Preventive Services (The Community Guide) www.thecommunityguide.org/index.html www.thecommunityguide.org/index.html The Cochrane Database of Systematic Reviews www.thecochranelibrary.com/view/0/index.html www.thecochranelibrary.com/view/0/index.html The Healthy People 2020 Evidence-Based Resources www.healthypeople.gov/2020/implement/EBR.aspx www.healthypeople.gov/2020/implement/EBR.aspx The County Health Roadmaps: What Works for Health www.countyhealthrankings.org/roadmaps/what-works-for-health/using- what-works-health www.countyhealthrankings.org/roadmaps/what-works-for-health/using- what-works-health The University of Massachusetts Evidence-Based Strategies for Public Health http://library.umassmed.edu/ebpph/index.cfmhttp://library.umassmed.edu/ebpph/index.cfm PubMed Clinical Queries www.ncbi.nlm.nih.gov/pubmedwww.ncbi.nlm.nih.gov/pubmed The Grey Literature Report www.greylit.org/www.greylit.org/ The Promising Practices Network (PPN) www.promisingpractices.net/programs.asp www.promisingpractices.net/programs.asp

16. Links (continued) Canadian Best Practices Portal http://66.240.150.14/intervention/search-eng.html http://66.240.150.14/intervention/search-eng.html The National Registry of Evidence-Based Programs and Practices (NREPP) www.nrepp.samhsa.gov/Search.aspxwww.nrepp.samhsa.gov/Search.aspx The National Prevention Strategy Appendix 5: Justification for Evidence- Based Recommendations www.surgeongeneral.gov/initiatives/prevention/strategy/appendix5.pdf www.surgeongeneral.gov/initiatives/prevention/strategy/appendix5.pdf Healthy People 2020 Structured Evidence Queries http://phpartners.org/hp2020/index.html http://phpartners.org/hp2020/index.html Also Strategic Practice Selection Exercise (Dr. Norma Kanarek) www.phf.org/resourcestools/Documents/Strategic_Practice_Selection_E xercise.pdf www.phf.org/resourcestools/Documents/Strategic_Practice_Selection_E xercise.pdf

17. Public Health Foundation www.phf.org Margaret Beaudry Director, Performance Management & Quality Improvement mbeaudry@phf.org 202.218.4415 mbeaudry@phf.org