Frameworks Flashcards
What is a health needs assessment?
The systematic method of reviewing the health issues facing a population, leading to agreed priorities and resource allocation that will improve health and reduce inequalities
What do you need before you begin a health needs assessment? (8)
- Established need for the project (a recent assessment hasn’t already been done)
2, Senior management and policy-maker sign up to the project - Lead coordinator with project management skills
- Committed and skilled project team
- Key stakeholders can be identified (including someone who knows about the issue, someone who cares about the issue, someone who can make change happen)
- Access to the target population and their willingness to engage with the peojct
- Resources: time, space, equipment, funding
8 Clear aims and objectives for the project
What are the steps in a health needs assessment?
- Planning/problem identification
- Identifying health priorities
- Assessing a health priority for action
- Planning for change
- Review and evaluation
- Report and disseminate the findings
How does a health needs assessment compare with a health impact assessment? (2)
HNA starts with a population, HIA starts with a proposal or plan
HNA informs decisions about priorities or strategies whereas HIA makes recommendations to minimise adverse or maximise beneficial effects of a health project or proposal
What are some of the challenges of a Health Needs Assessment?
- working across professional boundaries
- obtaining commitment from the top
- accessing relevant data
- accessing the target population
- maintaining commitment
- translating findings into effective action
What are the steps of a Health Impact Assessment?
- Screening assess whether HIA is required
- Scoping: set the parameters of the HIA
- Identification: develop community/population profile and collect information to identify potential health impacts
- Assessment: synthesise and critically assess the information
- Decision making and recommendations
- Evaluation and follow-up
What are the WHO (modified Wilson and Jungner) criteria for a screening program?
- the condition should be an important health
- there should be a recognisable latent or early symptomatic stage
- the natural history of the disease should be understood
- there should be suitable test available
- the test should be acceptable to the population
- there should be agreement on who to treat
- facilities for diagnosis and treatment should be available
- screening should be cost effective
- benefits of screening should outweigh any harms (e.g. false positives)
- screening should be an ongoing process
What are some forms of bias in a screening program?
Lead-time bias: the apparent improval in survival through early detection of a disease
Length-time bias: the tendency of screening to detect slow growing cancers rather than aggressive cancers
+/- referral/volunteer bias (selection bias) through more healthy people participating in a screening program (e.g. higher SES)
What considerations should be made in setting up or evaluating a screening program? (aside from WHO criteria)
- In response to a recognised need
- evidence of effectiveness
- defined target population
- integrate education, testing, clinical services and program management
- Quality assurance with mechanisms in place to minimise potential risks (e.g training and monitoring)
- Informed choice
- Promote equity
- evaluation should be planned from the outset
- Benefits > harm (to both the individuals and to the health system) e.g. overdiagnosis, overtreatment
What are the elements of the Wagner Chronic Care Model?
What other some other considerations in chronic disease care?
Health System (organisation culture promotes safe, high quality care - continuous improvement)
Delivery System Design (proactive system focused on keeping people healthy, defined roles and responsibilites, regular follow up)
Decision Support (embed guidelines, evidence-based training, access to specialists)
Clinical Information Systems (reminders/recalls, monitor performance/audits, facilitate preventive health/treatment/planning)
Self-management support (use effective strategies for goal setting, action planning, problem solving)
The community (partnerships, advocacy)
Other considerations: multidisciplinary, patient centred, culturally appropriate, adequate resources
What are the principles to consider when working with Aboriginal or Torres Strait Islander people?
- Cultural Respect Framework
- Holistic approach: attention to physical, spiritual, cultural, emotional and social wellbeing
- Working in partnership: combine efforts of gov, non-gov and private sectors within and outside health sector (shared learning)
- Community control of primary health care services (demonstrated effectiveness, comprehensive primary care, supports community decision-making, participation, and control)
- Localised decision-making
- Health sector responsibility: make all services responsive to the needs of ATSI people
- Accountability for outcomes
- Capacity-building and sustainability
What are the steps in policy development?
- Stakeholder engagement
- Problem identification
- Policy analysis
- Strategy and policy development
- Policy enactment
- Implementation
- Evaluation
What are the considerations in policy implementation? (7)
Stakeholder engagement (plan to manage competing stakeholder interests)
Planning: (scope, aims, objectives, develop program logic, timeframe)
Governance (roles and responsibilities defined, process for escalating issues)
Policy management (does our agency have the project management capacity to deliver the initiative? can support be provided by other agencies?)
Resource management (how will funding be allocated?, staff, facilities, other infrastructure/resources needed)
Risks (has risk assessment been done, strategies to minimise risks)
Monitoring and evaluation
What is a general public health or program development framework?
- Define the problem
- Assess need
- Develop strategy
- Implementation
- Communication
- Monitoring and evaluation (process, impact, outcome)
- Report and disseminate
What are the key elements of the Ottawa charter for health promotion?
- Build healthy public policy
- Create supportive environments
- Strengthen community action
- Reorient health services
- Develop personal skills
