1. PHSB 612: Interventions Diane M. Dowdy, Ph.D. Spring 2008

3. Public Health Interventions  Are 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

4. Describe the problem Explore context and identify determinants Test interventions Formulate interventions Assess efficacy of intervention Assess effectiveness of intervention Monitor adequacy and impact of large-scale interventions Identify risk factors Select or formulate possible interventions

5. 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

6. 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

7. Theory of Unreasonable Actions All Other Theories Explaining Health Behavior 97% 3% From Dr. Burdine

8. 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

9. 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.

10. 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).

11. 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.

12. 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.

13. Policy Organizational Community Interpersonal Individual Source: McLeroy et al, 1998 Social Ecological Model

14. 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

15. Levels of Behavioral Change Interventions Interventions can be aimed at multiple levels:  Personal or interpersonal level  The organizational or institutional level  The health care level  The environmental level  The policy or legislative level

16. 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

17. RE-AIM: Plan, Evaluate, and Report Studies R…….IncreaseReach E…….IncreaseEffectiveness A……IncreaseAdoption I…….IncreaseImplementation M……IncreaseMaintenance

18. 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