Public Health Interventions and Program Planning: Key Concepts and Theories

Active protection

Requires individuals to take action to protect their health (for example wearing seatbelts).

Passive protection

Protects people without requiring individual action (for example water fluoridation).

Criteria for good interventions

Evidence-based, culturally appropriate, feasible, cost-effective, politically acceptable, and capable of producing measurable health improvements.

Intervention theory

Explains how program strategies influence determinants such as antecedent, mediating, or moderating factors to change behaviors and improve health outcomes.

Effect theory

Includes causal theory, intervention theory, and impact theory. It explains how interventions lead to short-term, intermediate, and long-term outcomes.

Types of evidence

Evidence-based interventions are supported by systematic reviews and strong research. Effective interventions are supported by peer-reviewed studies. Promising interventions show positive results in evaluations but may lack extensive research.

Assessing EBI fit

Evidence-based interventions should be compared to community needs and program goals to determine whether they are appropriate for the target population.

Adaptation

Involves modifying an intervention to fit a local context.

Fidelity

Refers to maintaining the core components that make the intervention effective.

Process theory

Describes how a program operates and includes the organizational plan (resources needed) and service utilization plan (how services reach the target population).

Program theory

Combines process theory and effect theory to explain how a program is expected to work.

Logic model

Visually represents program theory by showing relationships between inputs, activities, outputs, and outcomes.

Outputs vs outcomes

Outputs are the direct products of program activities (such as number of participants trained). Outcomes are the changes that occur as a result of the program (such as improved health behaviors).

Goals vs objectives

Goals are broad long-term statements describing the desired health impact. Objectives are specific, measurable steps that help achieve the goal.

SMART

Specific, Measurable, Achievable, Relevant, and Time-bound.

Health

A state of complete physical, mental, and social well-being, not merely the absence of disease or infirmity.

Importance of planning & evaluating health programs

Planning helps create programs intentionally to meet health goals, increase the likelihood programs will be effective, make programs transparent and organized.

Evaluation

Helps determine if the program made a difference, whether outcomes were caused by the program, if the program should continue or expand, if it can work in other communities.

Planning & Evaluation Cycle

Includes Trigger Event, Community Health Assessment (CHA), Program theory development, Program Implementation, and Evaluation.

Types of evaluations

Process: check if the program was implemented correctly. Effect: measure program impact. Economic: analyze costs. Comprehensive: combination of evaluations. Meta-evaluation: evaluate multiple program evaluations.

Public Health Pyramid

Includes Direct services, Enabling services, Population-based services, and Infrastructure services.

Diversity

Refers to the ways individuals and groups differ in identity, beliefs, experiences, opportunities, and behaviors.

Health disparities

Avoidable differences in health outcomes or access to care that negatively affect certain groups (such as racial, ethnic, gender, or socioeconomic groups).

Importance of considering diversity among providers

Helps ensure that health programs are culturally appropriate, accessible, and acceptable to different populations.

Measurement implications of not considering diversity

If data are not separated by demographic groups, important health disparities may be hidden.

Community Health Assessments (CHA)

A systematic process used to identify and understand the health needs and strengths of a community.

Types of needs

Expressed needs, Normative needs, Perceived (felt) needs, Relative needs.

Information needed for a CHA

Includes magnitude of the health problem, population characteristics, behavioral risk factors, environmental influences, trends over time, and social determinants of health.

Incidence vs prevalence

Incidence measures the number of new cases of a disease occurring in a population over a specific time period. Prevalence measures the total number of existing cases of a disease in a population at a given time.

Sensitivity vs specificity

Sensitivity is the ability of a test to correctly identify individuals who have a disease (true positives). Specificity is the ability of a test to correctly identify individuals who do not have the disease (true negatives).

Odds ratio vs relative risk

Relative risk compares the probability of an outcome occurring in an exposed group versus an unexposed group. Odds ratio compares the odds of an outcome between exposed and unexposed groups and is commonly used in case-control studies.

Types of data sources

Public data sources include census data, national surveys, and public health databases. Primary data sources include surveys, interviews, focus groups, community forums, and direct observation.

Causal theory

Explains why health problems occur, including health problem itself, causal factors, antecedent factors, moderating factors, and mediating factors.

Prioritizing health problems

Health problems are prioritized based on importance and changeability.

Different ways to classify interventions

Educational, behavioral, policy-based, environmental, or system-level.

Components of intervention dosage

Refers to the amount of intervention delivered, including frequency, duration, strength or intensity, route of administration, and credibility of the provider.

Program components or intervention packages

Sometimes multiple interventions are combined to address different causes of a health problem.