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.
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.
3
Q
Efficacy vs Effectiveness
A
Efficacy: expected results under ideal circumstances
Effectiveness: degree of beneficial effect in real world clinical settings
4
Q
Define CBPR
A
Community-Based Participatory Research
Balancing research with community needs
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
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
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
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.
9
Q
Organizational Capacity
A
Degree to which the organization is functioning and the resources available to support organizational change
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
11
Q
3 Types of Inter-Organizational Models
A
- Exchange or obligational network
- Action or promotional network
- Systematic network
12
Q
Exchange or Obligational Network
A
- -type of IOR
- -loose collaboration
- -engage in few collaborative activities
- -coordinated by select representatives across organizations
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
14
Q
Systematic Network
A
- -type of IOR
- -more formal partnership across organizations
- -target accomplishing activities that are primary to organization’s mission
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
16
Q
Functionally illiterate
A
Can only perform very basic tasks (23%)
17
Q
Marginal literacy skills
A
Unable to read above 8th grade level (28%)
18
Q
Proficient literacy
A
9th grade and above
13% of adults
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
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
21
Q
Steps of Intervention Mapping
A
- Needs assessment
- Outcome matrices and performance objectives
- Theory-based intervention methods and practical applications
- Program
- Adoption and implementation plan
- Evaluation plan
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
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
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
25
Strengths of Diffusion of Innovation Theory
- -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
26
Weaknesses of Diffusion of Innovation Theory
- -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
27
define Diffusion of Innovation Theory
the degree to which efficacious programs (or interventions or policies) are integrated within a system or community
28
diffusion vs dissemination
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)
29
staged process of Diffusion of Innovation
```
Knowledge
Persuasion
Decision
Implementation
Confirmation
```
30
3 Determinants of Diffusion
The Innovation
The Individual
The Setting
31
Determinants of Diffusion: The Innovation
- -relative advantage: improvement vs replacement
- -compatibility: congruent with values
- -complexity: easy to adopt
- -trialability:
- -observability: benefits and advantages
32
Determinants of Diffusion: The Individual
open to innovation
33
Determinants of Diffusion: The Setting
- -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
The Adoption Curve
```
innovators
early adopters
early majority
late majority
laggards
```
innovation gap
35
PRECEDE-PROCEED challenges
- -feasibility
- -vagueness of intervention development
- -many applications fuse together PRECEDE phases or ignore others
36
PRECEDE-PROCEED strengths
- -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
PRECEDE-PROCEED overview
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
overview of PRECEDE-PROCEED phases
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
PRECEDE phase 1
social assessment: ID overarching PH problem
- -understand target audience
- -involve target audience members
- -involve community organization/building processes
40
PRECEDE phase 2
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
PRECEDE phase 3
educational/ecological assessment
- -predisposing factors (individual)
- -reinforcing factors (interpersonal)
- -enabling factors (environmental)
42
PRECEDE phase 4
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
PROCEED 5-8
5. implement: program to right audience
6. process eval: fidelity?
7. impact eval: degree of change seen in mediators
8. outcome eval: degree of effect on health and QoL.
44
Strengths of Community Organizing/Building models
- -address issues critical to pop. of interest
- -address broad causal factors involved in PH problem
- -suggest mediators and outcomes
- -high impact value interventions
45
Weaknesses of Community Organizing/Building Models
- -few rigorous experimental studies testing interventions
- -time-consuming and complex process to develop/implement intervention
- -challenging to adapt traditional RCT methods for evaluation
46
4 Dimensions of Organizational Behavioral Change
- -organizational vs subsystem
- -transformational vs incremental
- -remedial vs developmental
- -reactive vs proactive
47
Strengths of Organizational Change models
- -high impact value
| - -multiple improvements with far reaching effects (community capacity)
48
Weaknesses of Organizational Change models
- -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
determinants of health
```
age
income
literacy skills
employment status
education level
race/ethnic group
```
50
health, risk, crisis communication
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
consolidated framework for implementation research
- -intervention characteristics
- -outer setting
- -inner setting
- -characteristics of individuals
- -process of implementation
52
factors affecting learning ability
```
stress
illness
age
cultural barriers
language barriers
```
53
4 P's
Product
Price
Place
Promotion
54
Product
packaging or labeling the message based on physical, economic, social, psychological benefits to enhance appeal
55
Price
financial, social, psychological costs associated with product, relative to potential gains
56
Place
channels used to access the audience and how the audience is expected to access the product being marketed
57
Promotion
overall design of the marketing approach and the matching of the overall campaign to characteristics of the audience
58
Strengths of Social Marketing
- -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
Weaknesses of Social Marketing
- -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
Strengths of Ecological Model
- -broad intervention approach to target multiple determinants of health and behavior
- -increased reach and impact value
61
Weaknesses of Ecological Model
- -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
define Social Marketing
adoption by PH advocates of concepts, principles, and methods from commercial marketing to design health communication and health promotion programs
63
Basic Principles of Social Marketing
- -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
Evaluation of Social Marketing
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
behavioral outcomes of Social Marketing
outcome must be defined as behavioral change - not just as awareness, attitudes, opinions, or intention
66
consumer benefits of Social Marketing
fundamental goal of marketing campaign is to benefit the members of the target audience and society
67
maintaining market perspective in Social Marketing
- -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
3 E's
(of social marketing)
Engineering
Education (downstream)
Enforcement (upstream)
69
audience segmentation in Social Marketing
- -identify specific and narrow audience and personalize the message
- -vary the message
70
product-driven approach in Social Marketing
- -appeal and uniqueness of product
- -branding
- -highlight positive associations
- -ex: stretch your dollar
71
consumer-driven approach in Social Marketing
- -focus on social norms
- -yields more lasting results
- -ex: Jessica Simpson Weight Watchers or FitBit
72
market-driven approach in Social Marketing
broad-scale campaigns to counter the influence of broad societal or cultural influences on behavior
ex: anti texting
73
define Ecological Model
develop interventions to promote health behavior by emphasizing environmental and policy influences, as well as social and psychological influences
74
basic assumption in Ecological Model
behavior and health determined by following factors:
- -intrapersonal (social support)
- -organizational/community (work/home environment)
- -environmental/policy (access to parks, laws)
75
use of Ecological Model
identify determinants of behavior and health
provide framework for intervention development
guide measurement
76
core principles of Ecological Model
- -multiple levels of influence
- -environment influences behavior
- -levels interact
- -models specific to behavior
- -interventions targeted to levels
