disease causation frameworks Flashcards
Dahlgren and whitehead policy rainbow (where to intervene)
SLSLS
- Socioeconomic cultural environmental - policies, values, politics
- Living and working conditions - education, unemployment, work environment, housing, healthcare services, sanitation, education, food
- Social and community networks - family, friends, social capital, social support
- Lifestyle - diet, smoking, exercise, alcohol
- Sex age and hereditary factors
pros: holistic and visually intuitive
Highlights the role of social equity and policy in shaping health outcomes.
Stresses interconnectivity between layers.
cons: Does not show relationships between the layers or relative importance
May oversimplify complex relationships between determinants
Davidsons wheel of participation
inform - provide information
consult
participate - advisory board, partnership, joint decision making
empower - delegated control, full control - co-production
health field concept model - Lalonde (where to intervene)
health influenced by:
healthcare system
lifestyle
biological and genetics factors
physical and social environment
Pros:
Pioneered the shift from a purely medical view of health to a broader, multi-factorial perspective.
Emphasized the role of lifestyle and prevention in health.
Cons:
Overemphasis on individual responsibility (e.g., lifestyle choices) while underestimating structural determinants of health.
Categorization is somewhat simplistic and overlooks the interactions between these factors
models of behaviour change how to bring about change - COM B
for behaviour change you need:
Capability: knowledge, skills, and abilities to engage in a behaviour. physical and psychological.
Opportunity: external factors that make the execution of a behaviour possible - physical (resources, money green spaces, availability of food) and social (social norms, peer support)
Motivation: the internal processes that influence decision-making and behaviour. reflective motivation (the reflective process involved in making plans) and automatic motivation (automatic processes such as impulses and inhibition).
Pros:
evidence based
systematic and comprehensive
widely used
Links to policy wheel
Cons:
oversimplifies behaviour
limited inclusion of interaction between components
models of behaviour change how to bring about change - Beattie model of health promotion
Four approaches to health promotion on a matrix of focus of the intervention - individual –> collective and mode of intervention - negotiated –> authoritative
Health persuasion, personal counselling for health, legislative action, community development.
Pros:
Considers not just the activities involved in health promotion but also how they are delivered (i.e. top-down or bottom-up). It is a useful tool for evaluating health promotion programmes.
transtheoretical behaviour change model
individuals go through stages of change - can enter and exit at any point
pre-contemplation - unaware
contemplation - no commitment to act but aware
preparation - intent on taking action
action
maintenance - sustained change
relapse
pros:
useful for long term, complex behaviour change e.g. smoking
flexible
useful for ordering interventions sequentially
cons:
focus on individuals - less useful for communities or population approaches
blurry stage boundaries
neglects wider context
Health promotion programme implementation
DASP ROME
● Disease summary
● Assess needs - dalhgren and whitehead or lalonde
● Stakeholders – do not forget the public, including community development. State MDT, primary/secondary care
● Policy dilemmas (depends on attitudes, collectivism vs. individualism, SES circumstances, tackle health or policy areas outside of health, targeted or universal approach) Beattie model
● Resources – settings for health promotion (schools, universities, workplaces, prisons, community hubs, healthcare settings)
● Outcomes – SMART
● Methods – use a model (Beattie’s useful in this context to acknowledge the political priorities, national/local standards), Primary/ secondary/ tertiary prevention, Targeted/population approach (inc Rose’s hypothesis and prevention paradox)
Evaluation
Monroe’s motivational sequence
get attention
establish the need
satisfy the need
visualise the future
action
Mirco/meso/macro approaches
At micro/indviudal level – changing individual knowledge, attidutes, beliefs, behaviorus. the invidual can be a patient, consumer (informed choice, empower individual (active participant)
Community level – changing community norms, awareness, attitudes, behaviours
Macro/system = polices, laws, power structures
life course model
Life Course: Combines elements of programming and adult risk factor paradigms. Considers how various biological and social factors throughout gestation and life affect health and disease independently, cumulatively and interactively.
pre-natal, birth and infancy, early and later childhood and adolescence, youth and adulthood, older age
Ewels and simmett five approaches to health promotion
Medical approach approach involves medical interventions to prevent or ameliorate ill health. This approach values preventive medical procedures and the medical profession’s responsibility to ensure that patients comply with recommended procedures e.g. immunisations, screening
Behaviour change approach The behavioral change approach is based upon changing people’s individual attitudes and behaviors so that they adopt a “healthy lifestyle”. Skills training, smoking cessation
Educational approach The aim of the education approach is to provide individuals with information, ensure knowledge and understanding of health issues, and to enable well-informed decisions to be made. Health education and health literacy
Client centred/ empowerment Within the client centered approach the health professional works with clients to help them identify what they want to know about and take action on, and make their own decisions and choices according to their own interests and values.
Individual choices, developing insights into own health and behaviour, access to information
Community engagement and development
Societal change approach Rather than changing the behavior of individuals, the societal change approach modifies the physical and social environment in order to make it more conducive to good health. Lobbying, increasing representation, procedural justice, influencing and negotiating
evaluation frameworks
logic model - inputs, activities, outputs, outcomes, impact + risks and assumptions
RE-AIM = Reach the target population
Effectiveness or efficacy
Adoption by target staff, settings, systems and communities
Implementation consistency, costs and adaptions made during delivery
Maintenance/sustainment of intervention effects in individuals and settings over time
donabedian - input process output
maxwell’s = accessibility, appropriateness, acceptability, efficiency, effectiveness, equity
Levels of prevention
Primary = pre disease onset - avoid development of disease, remove risk factors, address SDH e.g. vaccination, smoking bans
secondary = early detection of disease - screening
tertiary = managing disease in sick people - reduce disability, and improve outcomes
high risk vs. population approach
high risk = risk stratification of the population - focus on those most likely to get sick with targeted interventions
pros: can be more cost effective
high risk more likely to engage
can be more feasible - especially in healthcare settings
often preferable in society
tailored to individual
cons:
challenges in identifying the high risk
does not address wider determinants
ignores prevention paradox
victim blaming or stigma
population approach = for risk factors or conditions normally distributed - seeks to shift the whole population distribution and reduce everyone’s risk
can change social norms
can improve healthy equity by improving living conditions of the worse off
pros:
prevention paradox - most cases of disease are from the low-moderate risk majority
address determinants of health
lack of motivation of individual - due to small benefit
can widen health inequalities if there is inequity in uptake
less effective where there is no dose response relationship
Vaccine hesitancy
complacency - perceived risk of disease
convenience - accessibility, costs, language/ability to understand
confidence - in the system, in the vaccine
culture - social norms, religious beliefs
incident response - environmental hazards
ECCM + L
E - hazard identification, dose response assessment, exposure assessment, comparison to safe standards
C - communication - sandman: risk = hazard + outrage
C - control: source pathway receptor
M - monitoring
L - lessons
risk assessment / hazard identification
physical / mechanical
infrastructure
biological
chemical
psycho-social
populations at risk?
ASSEOLF
- Age
- Sex
- Socioeconomic status
- Ethnicity
- Occupation
- Lifestyle
- Familial/Genetic
Outbreak response?
Disease Outbreak (CCDCs Do Help To Control Cholera Deaths)
o Confirm outbreak exists – collect information (inc NOIDs), compare to that expected, definitions of outbreak. Establish OCT / IMT
o Confirm Diagnosis – specimens
o Case Definition – time/person/place, symptoms, possible/probable/confirmed
o Collect data – determine background rate of disease, find cases, microbiological data, genetics, environmental samples
o Describe data – time/person/place – plot the epi curve, population at risk, risk factors
o Generate Hypothesis – pathogen, source, transmission
o Test Hypothesis – cohort/case-control,
o Control – control source, transmission mode, host defences, protect at risk.
o Communication/– Must agree comms strategy – accuracy and timeliness, proactive/reactive. Internal (shared situational awareness): OCT members. External: healthcare professionals, social care, public health teams (regional/national if appropriate), epidemiologists, virologists/microbiologists, environmental health, industry, the public
o Declare outbreak is over –once returned to background rate. Outbreak report + Evaluation and learning to prevent future incidents.
socio ecological model for designing a programme
individual - e.g. skills, resources, attitudes
interpersonal - family, friends
institutional - schools, workplaces
community - norms, cities, neighbourhood
policy - legislation, regulation, enabling environment
