Chapter 8 - Interventions, the Heat of your health program

Intervention is composed of all factors that are used to coordinate event A turning into event B. Therefore the intervention is what will cause your desired health change. An intervention is most effective when they are aimed at multiple exposures (multiplicity) at multiple levels of influence that effect both individual and population behavior and health status = using a socio-ecological approach. Effectivness is also increased when the number of times an intervention is administered (dose) is increased such as offering many classes, handing out many brochures, playing the PSA many times.

When devising and implementing an intervention you need to:
            1) Assess and examine

Chapter 4

Needs Assessment involves identifying actual and perceived needs, analyzing needs, and prioritizing needs for a population. Not only will you discover the needs you will also discover the capacity of the community aka the resources the community has. One aspect of action is capacity building this is usually done after identifying the subgroups of a population that have the greatest need.

Primary Data: data you collect yourself through written questionnaires via mail, telephone interview, electronic interview, group interview, community forums aka town hall meetings, focus group which is where you have 8 to 12 people from the community who don't know each other and have them discuss a problem to see if it is a problem and possible solutions, or self reporting. Proxy methods where you gather data on an attribute that proves a need exists like taking someones weight instead of asking them if they exercise. The delphi technique is a questionnaire where the next question given is determined by the answer to the previous question. Nominal Group Process involves selecting a group of people, asking them a question, they privately make a decision, than you discus decisions and rank response together as a group. Windshield is a drive through observation method. Photovoice is my favorite means of collecting data where you give target population cameras to take pictures of problems.

Gather primary data from priority populations, significant others, opinion leaders, and key informants. Make questionnaires easy to complete and attach a cover letter describing what respondents are to do and why.

Secondary Data: someone else has already done a needs assessment and thus has data on the issue. Where can you find secondary data? Here:

• Governmental Agencies like the US Bureau of Census, CDC, FDA, EPA, SAMHSA, National Cancer Institute. Agencies provide free data required by law to collect such as census, births, deaths, notifiable diseases. And data other data like safety belt usage. 
• NGO and NGA like the American Cancer Society, American Hearth Society, County Health Rankings, and Henry J. Kaiser Family Foundation.
• Check existing records. Just because an organization is not currently getting data does not mean the data has nor already been gathered.
• From the literature. Get a subscription to PschINFO which has psychological publications since the 1800's, Medline which serves as a life line for medical information, Education Resource Information Center (ERIC) which has educational information, CINAL which has nursing literature, and ETHXWeb which has policy information.

To search secondary sources first pin point the need of the priority population. The need you pinpoint may be a health topic. If you know an author who has published information on this need search for them using last names. Look through search results, look at the thesaurus and find a list of key terms. Use these to conduct your search. Look at abstracts, full documents and find other authors under references.

(note: www. means world wide web and url means uniform resource locator)

The book mentioned GIS Geographic Information Systems, when it said, "1) it makes patterns based on place much easier to identify and analyze, and 2) it makes a visual way of communicating those patterns to a broad audience, quickly, and dramatically." (Krischenbaum and Russ) The GIS process is 1) determine which geographic area the map will cover 2) gather data 3) import to GIS and mesh with locations 4) analyze. (see Riner, Cunningham, and Johsnon 2004 page 57 for more). The book said that "THE USE OF GIS IN THE NEEDS ASSESSMENT PROCESS WILL CONTINUE TO GROW AS THE DEVELOPMENT OF SUCH SOFTWARE BECOMES MORE WIDELY AVAILABLE AND EASY TO USE." (SEE WWW.ESRI.COM/LIBRARY/BROCHURES/PDFS/HEALTH-EDUCATION.PDF AND READ APPROACHES TO GIS PROGRAMS IN HEALTH EDUCATION) Which is interesting because in my GIS class, there was a section about Google, Microsoft, Yahoo, CDC, and other making easier software with GIS capabilities. 

There are 6 steps to conducting a full needs assessment. The tools mentioned thus far can be used during these steps for data collection and analysis.

1. Identify focus and scope of needs assessment. (determine the purpose and scope)
1. categorical funding and stakeholders = the project's topic is often determined by your funding partners where they could say they want to have a cancer prevention program implemented for this population.
2. community assessment = understand the community, become an expert about this community and the chose topic by determining information you need to gather in order to understand the scope of the issue. Collect this data.
3. Participatory assessment = people from the selected population will be used to obtain primary data.
2. Gather data
1. look for secondary data first
2. if data does not exist locally search state, regional and then national
3. then get primary data. Use population involvement to get supporters and momentum for your program idea. You can get a group from the population to carry out data collection to others.
4. Having both primary and secondary data makes a stronger case
3. Data Analysis
1. Compare the data with other populations to identify problem areas.
2. Compare the problem areas with each other to identify priority problems.
3. Analysis tools:
1. MAPPS
1. society contributions to population health assessment
2. health contributing organizations/agencies assessment
3. population health assessment
4. forces changing health of population assessment
2. BPR a rating system made 50 years ago to prioritize needs in a community.
1. size of problem or at risk people
2. seriousness of the problem (what is the consequence of this problem)
3. effectiveness of intervention
4. can this idea even be carried out
4. BPR model 2.0 is an updated BPR system.
4. Identify the risk factors linked to the health problem.
1. What are the determinants of the health problem? Find using epidemiological assessments.
2. Factors can be behavioral, genetic, and environmental. But all of these topics are multidimensional which means they overlap and have subtopics such as the political, economical, psychological/emotional support environments. Look beyond clean water, but to economic incentives and disincentives, barriers to health care, peer pressure, social support, and health policy.
3. Health promotion will later seek to change these behavioral/environmental risk factors. 
4. These risk factors for the most part will already be known, like smoking for lung cancer.
5. What will be the program focus?
1. Say your population has high cases of lung cancer. You identified the risk factors, and prioritized them. Now it is time to focus in. You see that the population lacks the skills to stop smoking, this is a predisposing risk factor. You see that quit smoking programs don't exist, this is an enabling risk factor. You see that people around smokers don't support efforts to manage and quit smoking, this is a reinforcing risk factor. Look into these aspects associated with the risk factor to determine your program's focus.
2. Don't duplicate health promotions, discover them and figure out what they do and if they are failing or successful. Check health departments, local chamber of commerce, coalition, medical/dental societies, community task force, a community health center, and the population to find current and past health promotions and to talk about your program focus.
6. Validating and Prioritizing Needs
1. double check for error induced from bias
2. use a focus group to see how people from the population feel about your problem area, means of making a positive change to it, and the prioritiy risk factors you selected.
3. Ask other health professionals from mainstream health departments to do the same thing.
4. Use a HIA aka health impact assessment to make the program more beneficial and to reduce the negative effects of your project.

Chapter 1

Infant mortality, smallpox, poliomyelitis, measles, tetanus, rubella, diphtheria, program planning, haemophilus influenza type b, these have been controlled and the result is 29.5 years of extra life added to Americans since 1900. And since the 1900 health prevention has changed from addressing environmental factors that require combating nature to changing health behaviors that concentrated on personal responsibility.

America ranks not first but 50th in life expectancy. Also 75% of health spending is on chronic illness. Van Dam in 2008 said all causes of death could be cut by 55% by never smoking, not being over weight, eating a healthy diet, and engaging in physical activity. Only 3 % of Americans, do not smoke, maintain a healthy weight, exercise regularly, and eat 5 fruits and vegetables a day.

Most common causes of death in the U.S are:                      The top causes of the common causes are:
1) Cardiovascular Disease                                                    1) Tobacco
2) Malignant Neoplasms                                                       2) Poor Diet and physical activity
3) Chronic Lower Respiratory Disease                                 3) Alcohol
4) Cerebrovascular Disease                                                  4) Microbal Agents
5) Accidents                                                                         5) Toxic Agents
6) Alzheimer's Disease                                                          6) Motor Vehicles
7) Diabetes Mellitus                                                              7) Fire Arms
8) Influenza and Pneumonia                                                   8) Sexual Behavior ... Illicit Drugs

Health Promotion, which is a broad field encompassing health education, policy, organizational support for actions and conditions to increase the health of an individual, group or community, didn't take off until 1974 where it started with the Canadians publishing "A New Perspective on the Health of Canadians," this concentrated on human biology, the environment, lifestyle, and health care organization. Also in the U.S Congress passed PL 94-317 an act which created which is now know as the Office of Disease Prevention and Health Promotion. ( it might be a good idea to read the "Health People" publication as well as, "Promoting Health/Preventing Disease Objectives: Objectives for the Nation."

Health Education, falls under health communication, and is using a variety of means to provide knowledge, attitudes, or skills that will cause health to improve, be maintained, for individuals, groups or communities.

Health Education Specialists facilitate the development of health policy, procedures, intervention, and systems for individuals, groups and communities. They educate and promote health in primary prevention which involves people who are perfectly healthy, secondary prevention which involves people who have just got sick, and tertiary prevention which involves people who have been through illness and now need to rehabilitate. There was a delineation project used to define the 7 areas aka frameworks the job entailed and the three levels of health education specialists. (read the published document Competency-Based Framework 2010)  These areas involve, assessing health condition, program planning, implementing, evaluating, administrating, acting as a resource person, and communicating health education and health. (if you are thinking into this field, and I think you should give it some thought, check out the NCHEC website, they talk about the content of the tests offered, also look at NCATE and SOPHE and AAHE and SABPAC)

Health promotion moves people toward better health, health prevention keeps people from going towards worse health.

There are many assumptions that have to be accepted by an advocate of Health Education and Promotion. My favorite are that Disease and Health involve biological, psychological, behavioral, and social factor combinations. That the source of disease can be identified and understood. That behavior change is hard. That when talking about behavior we are not pointing a finger at an easy link between fault and a problem, but are instead contemplating the natural course the future is heading and trying to make the river flow in another direction. It is not hard to do, but you believe if it can be done than good things will happen, so you set off to try and do it.

Program Planning is important, it causes you to think through the situation prior. It allows your program to be transparent. It gives you power as once your plan has been accepted you can go on ahead and do it. A plan creates understanding across parties.

First Impressions

This course is HS 390 baby! Health Programming and Implementation. It is made to prepare me to take the CHES exam which is the certified health education specialist exam. The information I am going to write about will give the reader the ability to understand the academic area of health promotion and health program design, implementation, and evaluation. Here we go!