Population health Interventions Flashcards
What are population health interventions?
Population health interventions are policies, programs, and resource distribution approaches that impact a number of people by changing the underlying conditions of risk and reducing health inequities. They aim to disturb the “natural” order of things to bring about change.
What are the goals of population health interventions in relation to health inequity?
The goal is to impact a number of people by changing the underlying conditions of risk and reducing health inequities. Ideally, interventions should decrease disparities over time by focusing on minimizing inequities. If an intervention doesn’t address disparities, they may increase.
What is efficacy in the context of interventions?
Efficacy is a test of whether a program does more good than harm when delivered under optimum conditions.
* Study Design (Efficacy): Controlled conditions - often using Randomized Controlled Trials (RCTs).
* Population (Efficacy): Strict inclusion/exclusion criteria leading to a homogenous population.
* Intervention Delivery (Efficacy): Highly standardized procedures conducted by highly trained individuals.
What is effectiveness in the context of interventions?
Effectiveness is a test of whether a program does more good than harm when delivered under real-world conditions.
* Study Design (Effectiveness): More closely resembles real-world conditions - often using “quasi-experimental” designs (pre and post measures without a control group).
* Population (Effectiveness): Heterogeneous population reflecting real-world diversity.
* Intervention Delivery (Effectiveness): Less standardized procedures conducted by real-world people like teachers or healthcare professionals.
What are the different levels of the Social Ecological Framework (SEF)?
The levels of the SEF, from broadest to most individual, are:
* Policy
* Community
* Institutional
* Interpersonal
* Intrapersonal
Give an example of the Policy level of the SEF.
Examples of the Policy level include:
* National/Provincial/Local laws
* Increased cost of SSBs
* Children’s fitness tax
* Provincial law regarding the length of outdoor recess time
* New federal policy that bans advertising unhealthy foods to children
Give an example of the Community level of the SEF.
Examples of the Community level include:
* Neighbourhood features
* Community groups
* Absence of sidewalks in a local area
* PA program – 60 for kids
* Change in the environment in a single neighbourhood
* City or provincial public land allocation for parks
Give an example of the Institutional level of the SEF.
Examples of the Institutional level include:
* Workplaces
* Schools
* Daycares
* Teacher facilitating a tag game outside
* School health / wellness program (PA + Nutrition)
Give an example of the Interpersonal level of the SEF.
Examples of the Interpersonal level include:
* Family influence
* Peers influence
* Teachers influence
* Partner’s influence
* Parents taking the kids for a bike ride
* Family support for a healthy lifestyle
Give an example of the Intrapersonal level of the SEF.
Examples of the Intrapersonal level include:
* Knowledge
* Attitudes
* Skills
* Children’s confidence to play games
Why is it important to evaluate population health interventions?
Evaluation is important to:
* Test a hypothesis for research purposes
* Assess the efficiency or effectiveness of a program
* Identify ways to improve a program
* Determine what works, what doesn’t work, and why
* Compare with another program
* Be accountable to stakeholders (funders, clients, etc.)
What are the five dimensions of the RE-AIM framework for evaluating interventions?
The five dimensions of RE-AIM are:
* Reach
* Efficacy or Effectiveness
* Adoption
* Implementation
* Maintenance
What is the Reach dimension of RE-AIM and at what level is it measured?
Reach refers to the percentage of the target population that participates in the intervention. It is measured at the individual level.
What is the Efficacy/Effectiveness dimension of RE-AIM and at what level is it measured?
Efficacy/Effectiveness assesses the impact of the intervention on the primary outcome(s), including any potential negative consequences. It is measured at the individual level.
What is the Adoption dimension of RE-AIM and at what level is it measured?
Adoption refers to the uptake of the intervention by target staff, settings, or institutions. It is measured at the setting/institutional level.
What is the Implementation dimension of RE-AIM and at what level is it measured?
Implementation refers to the consistency, costs, and adaptations made during the delivery of the intervention. It is measured at the setting/institutional level.
What is the Maintenance dimension of RE-AIM and at what level is it measured?
Maintenance looks at the long-term effects of the intervention after it is over, both at the individual level (continued behavior change) and the setting level (continued delivery of the intervention components). It is measured at both the individual and setting levels.
What is scaling up of health interventions?
Scaling up refers to deliberate efforts to increase the impact of successfully tested health interventions to benefit more people and to foster policy and program development on a lasting basis.
What is vertical scaling up?
Vertical scaling up involves institutionalization through policy, budgetary, or other health systems changes. An example is policies to ban smoking in public spaces moving from local to provincial/federal levels.
What is horizontal scaling up?
Horizontal scaling up involves expansion or replication of the intervention in different sites or extending it to serve larger or different populations.
Are scaled up interventions effective?
The main findings from a review suggest that scaled-up interventions can be effective, with 6 out of 10 eligible studies achieving significant improvements in at least one physical activity measure. Adaptations for scaled-up interventions are common, typically in the mode of delivery.
According to McKinlay’s model, what are downstream approaches to health promotion?
Downstream approaches are individual-level interventions focused on those who already possess the unhealthy behavior or have a disease. They operate at the intrapersonal and interpersonal levels of the SEF. Examples include patient health education and family counseling.
According to McKinlay’s model, what are midstream approaches to health promotion?
Midstream approaches are population-level interventions aimed at defined populations to support healthy behaviors. They operate at the institutional and community levels of the SEF. Examples include worksite wellness programs and APPLE Schools.
According to McKinlay’s model, what are upstream approaches to health promotion?
Upstream approaches are population-level interventions involving public policy and large widespread environmental changes to support health behaviors in the entire population. They operate at the policy and community levels of the SEF. Examples include new taxes on cigarettes and policies mandating green space in new developments.
What are the key questions of the Population Health Promotion Model?
The key questions are:
* WHO: With whom can we act? (Socio-Ecological Framework)
* WHAT: On what can we take action? (Social Determinants of Health)
* HOW: How can we take action to improve health? (Ottawa Charter: Action Areas)
How does the Population Health Promotion Model relate to the Ottawa Charter Action Areas?
The “HOW” question of the Population Health Promotion Model is answered by the Ottawa Charter’s Action Areas, which provide strategies for action. Examples include:
* Strengthen Community Action: Developing after-school PA programs
* Develop Personal Skills: Media literacy initiatives
* Build Healthy Public Policy: Taxing sugar-sweetened beverages
* Create Supportive Environments: Building bike lanes
* Reorient Health Services: Investing in city-wide health promotion
What is a comprehensive intervention plan within the Population Health Promotion Model, and why is it considered the “ideal” approach?
A comprehensive intervention plan targets the full range of social determinants of health (WHAT), uses a comprehensive set of action strategies (HOW), with action taken at various levels within society (WHO). This is the “ideal” approach because it has the biggest potential impact on health.
What is a focused intervention plan within the Population Health Promotion Model?
A focused intervention plan concentrates on a specific health concern and might target a midstream level. An example is a practicum where Kinesiology students lead after-school PA programs in lower socioeconomic status neighborhoods.
For the following intervention: “As part of a practicum, Kinesiology students from the University of Alberta will lead after school physical activity programs at elementary schools in lower socioeconomic status neighbourhoods in Edmonton,” identify the WHO, WHAT, and HOW according to the Population Health Promotion Model.
- WHO (With whom can we act?): Schools (Sector/system), Kinesiology students
- WHAT (On what can we take action?): Healthy child development, personal health, and Income and social status (addressing inequities)
- HOW (How can we take action?): Strengthen community action (university students leading programs)
How does the International Obesity Task Force Causal Web visually illustrate the many factors that contribute to overweight and obesity.
These factors are essentially the determinants of health related to weight [see previous turn].
Examples from the sources include:
* Individual factors like genetics potentially predisposing someone to obesity.
* The obeseogenic environment, encompassing access to ultra-processed foods and availability of healthy foods.
* Physical activity levels influenced by occupational changes towards more sedentary work.
* Socioeconomic factors affecting access to healthy foods.
* Weight bias and discrimination, leading to negative health behaviors.
The causal web would show how these interconnected determinants contribute to the complex issue of obesity.
How does the International Obesity Task Force Causal Web encompass population health interventions specifially the SEF?
- A causal web can depict how population health interventions, viewed through the lens of the Social-Ecological Framework (SEF), can target different determinants of health to impact obesity.
- The SEF outlines multiple levels of influence: intrapersonal, interpersonal, institutional, community, and policy.
- The causal web could show:
1. Intrapersonal interventions (e.g., health education) addressing individual knowledge and skills related to diet and activity.
2. Interpersonal interventions (e.g., family counseling for childhood obesity) targeting social influences on behavior.
3. Institutional interventions (e.g., school wellness programs) modifying environments in settings like schools and workplaces.
4. Community interventions (e.g., increasing access to parks) changing neighborhood features and community resources.
5. Policy interventions (e.g., taxes on unhealthy foods) impacting the broader environment through laws and regulations.
How does the International Obesity Task Force Causal Web relate to dietary aspects?
- Dietary factors are central to the concept of energy balance, a key element in understanding obesity.
- The International Obesity Task Force Causal Web would undoubtedly include various dietary aspects as significant contributors to weight gain.
Examples from the sources that would likely be featured include:
1. Increased availability and consumption of ultra-processed foods (UPF).
2. Decreased intake of whole foods and fruits.
3. Larger portion sizes.
4. Increased overall availability of food and energy in the food supply.
5. The influence of income and culture on accessibility to healthy foods.
6. The impact of food marketing on consumption patterns.
The causal web would illustrate how these dietary factors, often influenced by the broader environment and policies, contribute to energy imbalance and ultimately to overweight and obesity.
