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PUBH 504 > Final > Flashcards

Final Flashcards

1
Q

Implementation Science

A

Study of factors that influence the full and effective use of innovations in practice.

Goal is not to answer factual questions about what is, but to determine what is required.

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2
Q

Dissemination

A

Purposeful distribution of information and intervention materials to a specific public health or clinical practice audience.

Intent is to spread information and the associated evidence-based interventions.

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3
Q

Efficacy vs Effectiveness

A

Efficacy: expected results under ideal circumstances

Effectiveness: degree of beneficial effect in real world clinical settings

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4
Q

Define CBPR

A

Community-Based Participatory Research

Balancing research with community needs

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5
Q

Why CBPR?

A
  • -traditional research fails to solve complex health disparities
  • -community members demand research address their identified needs (no more guinea pigs)
  • -community involvement can lead to scientifically sound research
  • -research findings can be directly applied to community-specific interventions
  • -built greater trust and respect between researchers and communities
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6
Q

CBPR Principles

A
  • -community is unit of identity
  • -builds on strengths/resources of community
  • -facilitate collaborate partnerships
  • -integrate knowledge/action for mutual benefit
  • -promote co-learning and empowering process to attend to social inequalities
  • -cyclical and iterative process
  • -address health from positive and ecological perspectives
  • -disseminate findings to all partners
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7
Q

Organizational Climate

A

Personality of the organization defined as prevailing attitudes and beliefs, type of leadership, communication, role clarity, process for conflict resolution

Perceptions about organization that vary across levels

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8
Q

Organizational Culture

A

Assumptions, values, norms, behaviors, and artifacts (symbols) that define an organization.

Basic assumptions about the organization that transcend across levels of organization.

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9
Q

Organizational Capacity

A

Degree to which the organization is functioning and the resources available to support organizational change

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10
Q

Inter-Organizational Relations Theory

A
  • -collaborative efforts across different organizations
  • -“whole greater than sum of parts”
  • -early work focused on benefits from collaboration (efficiency, innovation, expansion)
  • -partnerships not always effective, can reduce efficiency when overlap resources
  • -similarity in culture/climate may lead to better outcomes, as well as some interdependence
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11
Q

3 Types of Inter-Organizational Models

A
  1. Exchange or obligational network
  2. Action or promotional network
  3. Systematic network
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12
Q

Exchange or Obligational Network

A
  • -type of IOR
  • -loose collaboration
  • -engage in few collaborative activities
  • -coordinated by select representatives across organizations
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13
Q

Action or Promotional Network

A
  • -type of IOR
  • -focus on pooling resources across organizations
  • -target accomplishing an activity that is 2ndary to mission of each organization
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14
Q

Systematic Network

A
  • -type of IOR
  • -more formal partnership across organizations
  • -target accomplishing activities that are primary to organization’s mission
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15
Q

Community Coalition Action Theory

A
  • -formal organization partnerships to focus on addressing specific issue over long-term
  • -extension of community building to organizations
  • -identifying issues comes from organization members and process is sensitive to culture and focused on developing ownership of issue
  • -stage model: forming partnership –> institutionalizing it
  • -guide process outcomes and health outcomes
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16
Q

Functionally illiterate

A

Can only perform very basic tasks (23%)

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17
Q

Marginal literacy skills

A

Unable to read above 8th grade level (28%)

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18
Q

Proficient literacy

A

9th grade and above

13% of adults

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19
Q

Knowledge Gap Hypothesis

A

Differences in knowledge about a PH problem across SES groups

Media-based interventions may increase gap d/t lower access to information

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20
Q

Agenda Setting Theory

A

Media influences public opinion and the issues for which there should be opinions

  • -public agenda setting
  • -policy agenda setting
  • -media agenda setting

Framing

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21
Q

Steps of Intervention Mapping

A
  1. Needs assessment
  2. Outcome matrices and performance objectives
  3. Theory-based intervention methods and practical applications
  4. Program
  5. Adoption and implementation plan
  6. Evaluation plan
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22
Q

RE-AIM Framework

A

R: reach - % and representativeness of population
E: effectiveness - +/- effects
A: adoption - % and representativeness of setting/staff that provide program
I: implementation - consistency/cost of providing program, scope of modifications
M: maintenance - long-term effects for participants, sustainability for setting

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23
Q

Strengths of RE-AIM

A
  • comprehensive framework utilizing studies
  • -assesses impact value
  • -assess fidelity, mediators, moderators
  • -assess barriers to success
  • -website resources and tools
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24
Q

Weaknesses of RE-AIM

A
  • -are all components needed?
  • -time intervals for assessing are arbitrary
  • -adoption/implementation built in even if intervention ineffective
  • -no consensus on adequate reach, adoption, implementation
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25
Q

Strengths of Diffusion of Innovation Theory

A
  • -framework to guide eval of efforts to overcome research-practice gap
  • -facilitates broad implementation of effective tx to enhance reach
  • -considers individual, innovation, contextual factors
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26
Q

Weaknesses of Diffusion of Innovation Theory

A
  • -Pro-Innovation Bias: that any innovation should be adopted
  • -Individual blame bias
  • -no research on: relative influence of different variables; authority figures; mediators and moderators
  • -no consistency in defining key measures
  • -feasibility and cost challenging as RCT
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27
Q

define Diffusion of Innovation Theory

A

the degree to which efficacious programs (or interventions or policies) are integrated within a system or community

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28
Q

diffusion vs dissemination

A

diffusion: ways in which policy or program is integrated within a population or system (passive)
dissemination: ways in which a policy is made accessible to greatest number of people (active)

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29
Q

staged process of Diffusion of Innovation

A 
Knowledge
Persuasion
Decision
Implementation
Confirmation
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30
Q

3 Determinants of Diffusion

A

The Innovation
The Individual
The Setting

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31
Q

Determinants of Diffusion: The Innovation

A
  • -relative advantage: improvement vs replacement
  • -compatibility: congruent with values
  • -complexity: easy to adopt
  • -trialability:
  • -observability: benefits and advantages
32
Q

Determinants of Diffusion: The Individual

A

open to innovation

33
Q

Determinants of Diffusion: The Setting

A
  • -socioecological context
  • -innovations not independent of the environment in which they are to be implemented
  • -factors that influence practicality and feasibility of the innovation can matter
34
Q

The Adoption Curve

A 
innovators
early adopters
early majority
late majority
laggards

innovation gap

35
Q

PRECEDE-PROCEED challenges

A
  • -feasibility
  • -vagueness of intervention development
  • -many applications fuse together PRECEDE phases or ignore others
36
Q

PRECEDE-PROCEED strengths

A
  • -procedural structure for constructing intervention
  • -facilitates replication
  • -participatory
  • -encourages theory application
  • -framework for critical analysis
  • -multi-level evaluation
  • -leeway to adapt
  • -consideration of socio-ecological perspective
37
Q

PRECEDE-PROCEED overview

A

framework for guiding implementation of behavior change program to facilitate theory application and evaluation

PRECEDE: develop intervention, recognize importance of education

PROCEED: evaluate intervention, recognize environmental factors as determinants of health behaviors

38
Q

overview of PRECEDE-PROCEED phases

A
  1. social assessment
  2. epidemiological, behavior, environmental assessment
  3. educational and ecological assessment
  4. administrative/policy assessment and intervention alignment
  5. implementation
  6. process evaluation
  7. impact evaluation
  8. outcome evaluation
39
Q

PRECEDE phase 1

A

social assessment: ID overarching PH problem

  • -understand target audience
  • -involve target audience members
  • -involve community organization/building processes
40
Q

PRECEDE phase 2

A

epidemiological/behavioral/environmental assessment

  • -identify aspects of health problem and factors that influence
  • -appropriate measures of health problem
  • -data collection
  • -involvement of individual, interpersonal, and community and organization models
41
Q

PRECEDE phase 3

A

educational/ecological assessment

  • -predisposing factors (individual)
  • -reinforcing factors (interpersonal)
  • -enabling factors (environmental)
42
Q

PRECEDE phase 4

A

administrative/policy assessment & intervention alignment

  • -specific intervention components to ensure sustainability
  • -micro level to address predisposing/reinforcing factors
  • -macro level to address enabling factors

comprehensive program:

  • -matches (congruence btwn enabling factors and macro intervention)
  • -maps (congruence btwn predisposing/reinforcing factors and micro intervention)
  • -pools: existing literature
  • -patches: refines interventions
43
Q

PROCEED 5-8

A
  1. implement: program to right audience
  2. process eval: fidelity?
  3. impact eval: degree of change seen in mediators
  4. outcome eval: degree of effect on health and QoL.
44
Q

Strengths of Community Organizing/Building models

A
  • -address issues critical to pop. of interest
  • -address broad causal factors involved in PH problem
  • -suggest mediators and outcomes
  • -high impact value interventions
45
Q

Weaknesses of Community Organizing/Building Models

A
  • -few rigorous experimental studies testing interventions
  • -time-consuming and complex process to develop/implement intervention
  • -challenging to adapt traditional RCT methods for evaluation
46
Q

4 Dimensions of Organizational Behavioral Change

A
  • -organizational vs subsystem
  • -transformational vs incremental
  • -remedial vs developmental
  • -reactive vs proactive
47
Q

Strengths of Organizational Change models

A
  • -high impact value

- -multiple improvements with far reaching effects (community capacity)

48
Q

Weaknesses of Organizational Change models

A
  • -challenging to adapt traditional RCT methods for eval
  • -difficult to operationally define many constructs
  • -few rigorous experimental studies
  • -time-consuming and complex processes to develop/implement intervention
49
Q

determinants of health

A 
age
income
literacy skills
employment status
education level
race/ethnic group
50
Q

health, risk, crisis communication

A

health: influence individual/community decisions that enhance health
risk: inform, motivate, minimize - reach intended audience
crisis: reach as many people as fast as possible

51
Q

consolidated framework for implementation research

A
  • -intervention characteristics
  • -outer setting
  • -inner setting
  • -characteristics of individuals
  • -process of implementation
52
Q

factors affecting learning ability

A 
stress
illness
age
cultural barriers
language barriers
53
Q

4 P’s

A

Product
Price
Place
Promotion

54
Q

Product

A

packaging or labeling the message based on physical, economic, social, psychological benefits to enhance appeal

55
Q

Price

A

financial, social, psychological costs associated with product, relative to potential gains

56
Q

Place

A

channels used to access the audience and how the audience is expected to access the product being marketed

57
Q

Promotion

A

overall design of the marketing approach and the matching of the overall campaign to characteristics of the audience

58
Q

Strengths of Social Marketing

A
  • -it works
  • -broad intervention approach to increase reach and impact value
  • -cost effective
  • -focus on individual and socioecological factors that influence health
  • -utilize theory in developing intervention
  • -assess fidelity and outcome
  • -encourages audience participation in design/implementation
59
Q

Weaknesses of Social Marketing

A
  • -challenging to test using rigorous study designs
  • -extensive time, effort, personnel, technical abilities to design/implement
  • -health behaviors not as amenable to change as targets of commercial marketing
60
Q

Strengths of Ecological Model

A
  • -broad intervention approach to target multiple determinants of health and behavior
  • -increased reach and impact value
61
Q

Weaknesses of Ecological Model

A
  • -challenging to test, open to confounding
  • -extensive time/effort/personnel etc.
  • -difficult to isolate effects of variables across different levels
  • -conceptual model, not a theory
62
Q

define Social Marketing

A

adoption by PH advocates of concepts, principles, and methods from commercial marketing to design health communication and health promotion programs

63
Q

Basic Principles of Social Marketing

A
  • -focus on behavioral outcomes
  • -consumer benefit is priority
  • -maintain market perspective
  • -determine market mix with 4 P’s
  • -audience segmentation
  • -product-driven approach
  • -consumer-driven approach
  • -market-driven approach
64
Q

Evaluation of Social Marketing

A

Phase 1: Design
who, how, what, with whom, pretesting

Phase 2: Implementation
fidelity and impact assessments
adjust to enhance reach

Phase 3: evaluation
primary outcome and effectiveness assessment
mediator and moderator analysis
cost-effectiveness analysis

65
Q

behavioral outcomes of Social Marketing

A

outcome must be defined as behavioral change - not just as awareness, attitudes, opinions, or intention

66
Q

consumer benefits of Social Marketing

A

fundamental goal of marketing campaign is to benefit the members of the target audience and society

67
Q

maintaining market perspective in Social Marketing

A
  • -markets produce to match needs, benefits, values, desires
  • -markets to multiple levels (downstream to individual; upstream to social factors and policies)
  • -3 E’s
68
Q

3 E’s

A

(of social marketing)
Engineering
Education (downstream)
Enforcement (upstream)

69
Q

audience segmentation in Social Marketing

A
  • -identify specific and narrow audience and personalize the message
  • -vary the message
70
Q

product-driven approach in Social Marketing

A
  • -appeal and uniqueness of product
  • -branding
  • -highlight positive associations
  • -ex: stretch your dollar
71
Q

consumer-driven approach in Social Marketing

A
  • -focus on social norms
  • -yields more lasting results
  • -ex: Jessica Simpson Weight Watchers or FitBit
72
Q

market-driven approach in Social Marketing

A

broad-scale campaigns to counter the influence of broad societal or cultural influences on behavior
ex: anti texting

73
Q

define Ecological Model

A

develop interventions to promote health behavior by emphasizing environmental and policy influences, as well as social and psychological influences

74
Q

basic assumption in Ecological Model

A

behavior and health determined by following factors:

  • -intrapersonal (social support)
  • -organizational/community (work/home environment)
  • -environmental/policy (access to parks, laws)
75
Q

use of Ecological Model

A

identify determinants of behavior and health

provide framework for intervention development

guide measurement

76
Q

core principles of Ecological Model

A
  • -multiple levels of influence
  • -environment influences behavior
  • -levels interact
  • -models specific to behavior
  • -interventions targeted to levels

PUBH 504 (1 decks)

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