Chapter 2 Flashcards
P.E.R.I.E Approach
5 basic questions that we need to ask that together make up what we will call the evidence-based public health approach
P.E.R.I.E stands for
Problem
Etiology
Recommendations
Implementation
Evaluation
Problem
What is the health problem?
What is the burden of a disease or other health problem? What is the course of a disease or other health problem? Does the distribution of the health problem help generate hypotheses?
Etiology
What are the contributory causes?
Has an association been established at the individual level? Does the “cause” precede the “effect”? Has altering the “cause” been shown to alter the “effect”? (If not, use ancillary criteria.)
Recommendations
What works to reduce the health impacts?
What is the quality of the evidence for the intervention? What is the impact of the intervention in terms of benefits and harms? What grade should be given to indicate the strength of the recommendation?
Implementations
How can we get the job done?
When should the implementation occur? At whom should the implementation be directed? How should the intervention(s) be implemented?
Evaluation
How well does the intervention work in practice?
How well does the intervention work in practice on the intended or target population? How well does the intervention work in practice as actually used? How well is the intervention accepted in practice?
Burden of Disease
the occurrence of disability and death due to a disease
In public health, disability is often called
morbidity
In public health, death is often called
mortality
Course of a Disease
how often the disease occurs, how likely it is to be present currently, and what happens once it occurs.
Distribution of Disease
Who gets the disease? Where are they located? When does the disease occur?
Incidence Rates
measure the chances of developing a disease over a period of time—usually one year
(# of new cases of a disease in a year) /(# of people in the at-risk population)
Mortality Rates
a special type of incidence rate that measure the incidence of death due to a disease during a particular year; often used to measure the burden of disease
Case-Fatality
the chances of dying from the disease once it is diagnosed
Prevalence
the number of individuals who have a disease at a particular time divided by the number of individuals who could potentially have the disease.
(# of living with a particular disease) / (#of people in the at-risk population)
3 basic reasons that changes in rates may be artifactual rather than real:
■ Differences or changes in the interest in identifying the disease
■ Differences or changes in the ability to identify the disease
■ Differences or changes in the definition of the disease
1st definitive requirement to establish a contributory cause
1The “cause” is associated with the “effect” at the individual level. That is, the potential “cause” and the potential “effect” occur more frequently in the same individual than would be expected by chance.
2nd definitive requirement to establish a contributory cause
The “cause” precedes the “effect” in time. That is, the potential “cause” is present at an earlier time than the potential “effect.”
3rd definitive requirement to establish a contributory cause
Altering the “cause” alters the “effect.” That is, when the potential “cause” is reduced or eliminated, the potential “effect” is also reduced or eliminated.
The 3 basic types of investigations
Case-control studies
Cohort studies
Randomized controlled trials
Case-control studies
most useful for establishing requirement number one; that is, the “cause” is associated with the “effect” at the individual level.
Cohort studies
most useful for establishing requirement number 2—the “cause” precedes the “effect.”
Randomized controlled trials
most useful for establishing requirement number 3—altering the “cause” alters the “effect.”
Using a chance process known as randomization or random assignment, individuals are assigned to be exposed or not exposed to the potential “cause”. Individuals with and without the potential “cause” are then followed over time to determine who develops the “effect.”
Efficacy
implies that an intervention works; that is, it increases positive outcomes or benefits in the population being investigated.
4 main Ancillary Criteria
■ Strength of the relationship
■ Dose-response relationship
■ Consistency of the relationship
■ Biological plausibility
Strength of the relationship
The risk for those with the risk factor is greatly increased compared to those without the risk factor.
Relative Risk
Measures the strength of the relationship; the probability of developing the disease if the risk factor is present compared to the probability of developing the disease if the risk factor isn’t present.
Dose-response relationship
Higher levels of exposure and/or longer duration of exposure to the “cause” are associated with increased probability of the “effect.”
Consistency of the relationship
Studies at the individual level produce similar results in multiple locations among populations of varying socioeconomic and cultural backgrounds.
Biological plausibility
Known biological mechanisms can convincingly explain a cause- and-effect relationship.
Classification of the strength of the recommendation
A, B, C, D, and I
A
Must—A strong recommendation.
B
Should—In general, the intervention should be used unless there are good reasons or contraindications for not doing so.
C
May—The use of judgment is often needed on an individual-by-individual basis. Individual recommendations depend on the specifics of an individual’s situation, risk-taking attitudes, and values.
D
Don’t—There is enough evidence to recommend against using the intervention.
I
Indeterminant, insufficient, or “I don’t know”— The evidence is inadequate to make a recommendation for or against the use of the intervention at the present time.
Primary interventions
take place before the onset of the disease; they aim to prevent the disease from occurring.
Secondary interventions
occur after the development of a disease or risk factor, but before symptoms appear. They are aimed at early detection of disease or reducing risk factors while the individual is asymptomatic.
Tertiary interventions
occur after the initial occurrence of symptoms, but before irreversible disability. They aim to prevent irreversible consequences of the disease.
3 basic types of interventions when addressing the need for behavioral change
information (education)
motivation (incentives)
obligation (requirements)
RE-AIM
reach, effectiveness, adoption, implementation, and maintenance.
Reach
Asks: Who is the intervention being applied to in practice? May be groups or populations that are different than those on which it was investigated or intended for (i.e., the target population).
Effectiveness
Asks: What is the impact in practice on the intended or target population, including beneficial outcomes as well as harm?
Adoption
Asks: How well is the intervention accepted by individuals and providers of services?
Implementation
Asks: How should the intervention be modified to reach target population and providers of services, but not those for whom the benefits do not exceed the harms?
Maintenance
Asks: How can we ensure long-term continuation of use and success of intervention among individuals and providers of services?
