Return on investment (ROI)
measures cost of the program verses financial return of the program *if ROI is 0, the program pays for itself, if higher than 0, the program will produce savings that exceed the cost of the program
The community guide
summarizes the findings from systematic reviews of public health interventions covering a variety of topics. The Community Guide is an essential planning tool for several reasons:
uses a science based approach
helps identify appropriate interventions for behaviour change, DP, and environmental change
identifies suffiencent evidence
complements science and rationale associated with healthy people
social math
“the practice of translating statistics and other data so they become interesting to the journalist and meaningful to the audience”
eg. breaking the numbers down by time
what does the amount look like over a year? hour? minute?
Planning parameters
There are several questions to which committee members should have answers before they become too deeply involved in the planning process.
capacity
the individual, organizational, and community resources, such as leadership, relationships, operations, structures, infrastructure, politics, and systems, to name a few, that can enable a community to take action
community capacity = characteristics of a community
Capacity building = activities that enhance the resources of individuals, organizations and communities to improve their effectiveness to act
single step or cross sectional surveys
point in time eg. online surveys, mail surveys, face-to-face interviews or telephone interviews
the information provided will be self report data
limitations = bias
Opinion leaders
individuals who are well-respected in a community and who can accurately represent the views of the priority population. These leaders are:
Discriminating users of media, data, and activity that are community-related
Demographically similar to the priority group
Knowledgeable about community issues and concerns
Early adopters of innovative behaviour
Active in persuading others to become involved in innovative behaviour
key informants
individuals with unique knowledge about a particular topic. eg.
a person who has had a specific problem like losing weight and being able to talk about the barriers of such an experience
*can be subject to bias
multistep survey
those collecting the data contact respondents who will provide the data on more than one occasion.
send out broad survey
taking into account the 1st survey, a second more specific survey is sent out
nominal group process
highly structured process in which a few
knowledgeable representatives of the priority population (5 to 7 people) are asked to qualify and quantify specific needs.
those invited to participate are asked to record their responses to a question without discussing it among themselves.
steps for conducting a literature search
health impact assessment
an approach that can help to identify and consider the potential or actual health impacts of a proposal on a population. *can affect needs assessment
Health Impact assessment: 6 steps
screening
scoping
assessment
recommendations
reporting
monitoring and evaluation
needs assesment: 6 steps
determining the process and scope
gathering data
Analyze data
Identify risk factors
Identify program focus
validating prioritized needs
Determining the process and scope
what is the goal? how extensive will the needs assessment be? what will the planning committee gain? time? resources? planning? funding? participatory action research
*this step must not be minimized
Gathering Data
relevant data
secondary data is recommended since easiest and cheapest to obtain (must be quantitative)
then fill in the gaps with primary data (must be qualitative)
figure out best methods for gathering primary data
Analyze the data
may be most difficult step to complete
use the first stages of PRECEDE-PROCEED
set priorities - Basic Priority Rating model
Identify risk factors linked to the health problem
parallel to second phase of PRECEDE-PROCEED
genetic, behavioural, environmental risk factors?
once risk factors are identified, they must be prioritized
Identifying Program focus
Similar to third phase of PRECEDE-PROCEED
identify the factors that have a direct impact on the risk factors
networking
Validating Prioritized needs
double checking
focus groups with priority population to determine their reaction to the proposed need
Interventions
the planned actions that are designed to prevent disease or injury or promote health in the priority population.
eg. provide an incentive by stating that all employees seen wearing their safety belts would receive a $10 bonus in their next pay check.
logic model
a logic model is a road map (Goldman & Schmalz, 2006) showing the connections among the key components of a program.
also called: a theory of change
5 steps of Design thinking and intervention planning
Empathize
get to know community, develop understanding of the issue
Define
articulate the priority health issues
Ideate
brainstorm and review literature for potential strategies
Prototype
select a potential solution and develop the intervention
pilot test
test
work with community to design and improve the best intervention
6 groups of intervention strategies
Health communication
highest penetration rate lol
health promotion programs
Motivational interviewing
Health education
theory and evidence based information
no clear line between health communication and education
Health policy/enforcement
orders, laws, policies
made by authoritative person or organization
Environmental change
providing opportunities, support to develop healthier behaviours
removing environmental barriers
Health-related community service
tests, treatments, care
offered in variety of settings (clinics, pharmacies, stores)
Health advocacy and community mobilization
community advocacy
lobbying
where do we spend most of our healthcare dollars?
treatment and 'never ending ever-elusive' search for cures
T/F? our medical system falls under the population strategy
false, 95% of our medical system falls under the clinical strategy
5% is population
the prevention paradox
unless we focus on people who are low or moderate risk, we will fail to reach the majority of people that will eventually develop a disease like cancer, obesity, heart disease
high risk strategies (Micro)
individuals deemed at high risk to develop a certain disease are targeted to receive the health intervention
High risk strategies have the ability to prevent disease in a small number of highly susceptible individuals, but no ability to prevent disease in large numbers of low risk people
eg. screening for gum cancer in individuals who chew tobacco
advantages of high risk strategies
motivation of both practitioners and patients/ clients
financial sensibility (using limited resources on those who need it)
benefits are favourable
disadvantages of high risk strategies
medicalization of prevention (sense of feeling like a patient requiring treatment instead of they healthy individual they though they were
challenges and costs of interventions
ideal is very hard to achieve
temporary results
limited potential for individuals and population
Behavioural insufficiencies
*large numbers of people with low risk produce higher incidence rates than a smaller group with low risk
A _____ number of people at a small risk may give rise to more cases of disease than the _____number who are at high risk
large small
Population-based strategies (macro)
targets entire population
purpose = decrease disease incidents and reduce overall level of risk
factors intended to change behaviours & practices of the population
eg. COVID-19 mask mandates
advantages of population based strategies
radical = attempts to find the ROOT cause of disease and eradicate it
powerful - changes the exposure risk for the entire population = powerful potential for health gains
behaviourally appropriate = working with social norms eg. smoking indoors
limitations of population based strategies
individual benefits are minimal
lack of motivation for population
minimal benefits experienced by each individual may not outweigh the small risk
eg. fake fat -> olestra in potato chips
circumstances for adopting population-based strategies
when the health risk has permeated the entire population
when, on a population-scale, benefits are outstanding but on an individual level, benefits are minimal
when the only way to deliver intervention is through population strategies eg. vitamin rich foods
whenever the need is to impact as many people as possible eg. smoking bylaws
MI: If at the end.... happened....
1st tool of effective behaviour change - find out what they want allows for:
client to consider their goal
client buy in
expectation management
engages client
cultivates 'partner' relationship
MI lecture definition
"a client centered counselling style that helps people to resolve and restore their ambivalence regarding behaviour change" (can be seen as scary to clients)
better definition:
"arranging conversations so people talk to themselves into change based on their own values and interests"
ENGAGING - Critical importance of relationship with you in manifesting positive change
the importance of: What is important?...
taps into clients values
why WE want them to change is irrelevant
finding their desire to change
responsibility shifts from practitioner to client
more effective for client
eg. what is important to you about having a healthy heart?
the advice challenge
*AVOID UNSOLICITED ADVICE
ask permission before giving advice
4 qualities of empathy
perspective taking
staying out of judgement
recognizing emotion
communicating that emotion
The Michelangelo belief
Michelangelo carved his statue from an uggo mountain
the capacity and potential for change is within every person
masterpiece is within us