Promo Flashcards

Question

What is implementation science?

Answer 1

Methods to promote uptake of research findings into routine practice including community settings

Answer 2

"Lack of evidence is often not the main barrier to change/action, more oftern is lack of political will" | Equity in all policies to change political will ## Footnote Brownson, 2021

Answer 3

Some will say to narrow the research-practice gap (including community settings). Brownson will way that the goal is Equity! Equity in all policies --> to change political will

Answer 4

Health differences often reflect social injustice | "Equity begins with justice" ## Footnote Brownson, 2021

Answer 5

Changes/alters the effect that a variable has on another (ex., gendre, age) | Answer to the questios "for where" and "for whom"

Answer 6

Explains the relationship | Answers the question "why"

Answer 7

## Footnote Lewis

Answer 8

**Cultural and ecological systems** maintain their **full functionality**—not only for the benefit of present generations, but also for **future generations**; not only for the benefit of the human component but for the benefit of **all species**. | Rapport, 2007

Answer 9

Individuals at the centre of promo (instead of social systems) * Minimal government intervention * Individualistic and individual responsibility * Instead of determinants, free people choosing goods/services * Inequality is inevitable | Ayo, 2012

Answer 10

From neoliberal vision (Ayo, 2012) --> Sustainable promo (Spenser, 2019)/Indigenous promo (Ratima, 2019) * Address structural causes (power, colonialism) * Health as a right * Empowerment * Partnerships * Human as interconnected with other species and evironment Sustainable health promotion incorporates rights, partnerships and empowerment (salutogenic) (Spencer G et al. 2018) | Sustainability + promo is a duality (Jelsoe)

Answer 11

* reduced productivity * leaching of soil nutrients * loss of endemic species * increased presence of contaminants | Rapport

Answer 12

Racism as a driver from environmental issues Racism embedded in society as a determinant of health | Low SES, poverty, gender, race particularly affected by climate change ## Footnote Northridge, 1997

Answer 13

Adverse negative experiences --> social, emotional, learning challenges --> risky behaviours --> health and social problems --> early death | Pickett

Answer 14

Biology of adversity * Toxic stress = adverse neg. exp. + absence of support/buffer * Cummulative exposure to toxic stress --> risky behaviours --> ↓ health --> early death * Biological embedding * Inner child * Adversity has intergenerational effects | Shonkoff; Kinner; Sjöblom

Answer 15

Early experiences can influence key biological systems over the long term, producing gradients. Examples of such systems: * the hypothalamic-pituitary-adrenal (HPA) axis and its accompanying secretion of **cortisol** * the autonomic nervous system (ANS) in association with **epinephrine and norepinephrine** * the development of memory, attention, and other executive functions in the **prefrontal cortex** * the systems of social affiliation involving the primitive **amygdala** and locus coeruleus, mediated by serotonin and other hormones | Hertzman, 2010

Answer 16

* Toxic stress = adverse neg. exp. + absence of support/buffer * Normative stress = adverse neg. exp + support/buffer/coping U-shape graph: Reactivity vs exposure to toxic stress, normative stress and no stress | It's not about eliminating stress but promoting nurturing care (Lancet) ## Footnote Shonkoff; Hertzman

Answer 17

a stable environment that promotes children’s health and **nutrition**, **protects** children from threats, and gives them opportunities for early **learning**, through **affectionate** interactions and **relationships** | The Lancet, 2016 ## Footnote Nurturing care could be targeted to the family but also at a more strctural level (e.g. child-friendly cities: play, active transport, safe spaces, greenspace)

Answer 18

Instead of dividing people by age group, the concept of the inner child to explain that human beings’ life journey includes **all the past life experiences impacting human beings lives**. * Each developmental age is not left behind but rather forms a small part of all that we are. * taking care of your inner child at a micro- (yourself as a person), meso- (in the family and near surrounding) and macrolevel (in the society) may promote health through the life-course. | Sjöblom

Answer 19

"co-occurrence of labeling, stereotyping, separation, status loss, and discrimination in a context in which power is exercised" Link and Phelan (2001) "societal-level conditions, cultural norms, and institutional policies that constrain the opportunities, resources, and well-being of the stigmatized” (Hatzenbuehler & Link, 2014) | Stigma as a SDoH

Answer 20

* biology * lifestyle habits (origins of lifecourse) * environment * health care system

Answer 21

Tiple-A solution: * Advocacy (with evidence) * Analyze (anticipate budget cuts, maintain core functions of surveillance and protection of health) * Alignment (align with other priorities, esp. economic) | Fineberg, 2013

Answer 22

4th industrial revolution AI and virtual space as a health determinant | Kickbusch I, 2019 ## Footnote HiAP is important gatekeeper to responsible use and development of AI – eg. Access to health data, inclusion of users

Answer 23

misinformation unintended consequences widening inequities | Kickbusch I, 2019

Answer 24

1. Well-being principle (must help individuals improve their living conditions) 2. Respect for autonomy (empowerment of citizens and foster literacy and critical thinking) 3. Protection of privacy and intimacy 4. Solidarity principle (among people and generations) 5. Equity (just and equitable society) 6. Democratic participation (democratic scrutiny) 7. Diversity inclusion (maintaining diversity) 8. Sustainable development 9. Prudence (anticipating the adverse consequences) 10. Responsibility (must not contribute to lessening the responsibility of human beings)

Answer 25

## Footnote Kickbusch I, 2019

Answer 26

* none * token * authentic ## Footnote MacDonald M & Mullett, 2009

Answer 27

* ownership and control * time orientations * funding priorities * competition for community resources ## Footnote Potvin L & Mullet J, 2008 ;MacDonald M & Mullett, 2009

Answer 28

Critical realism – looks at the **mechanism and process** for what works and what doesn’t (methods are mixed, case studies to look at **causal explanation** and underlying structure) – points to the **importance of theory** underlying methods Not about whether it is right or wrong, but if it is **useful**, is it enough to create change – to fit with the transformative Health promotion vision of research ## Footnote Poland B et al. 2008

Answer 29

1. acceptability 2. adoption 3. appropriateness 4. cost 5. feasibility 6. fidelity 7. penetration 8. sustainability

Answer 30

Confounding Selection bias – groups not comparable Information bias * measurement reliability and validity * Instrumentation – types of tools, keeping them consistent * Social interaction or desirability – eg. Hawthorne (being studied) Pygmalion (researcher influence) * Recall bias * Regression to the mean – people response tend to the mean * Time or Maturation – outcomes vary with time Attrition bias – drop out

Answer 31

People Places Time

Answer 32

Comparable control group Large sample size, Tools with masked purpose - Randomization Masking – for participants, for researchers, for analysis Matching

Answer 33

related to exposure and outcome, but not part of causal mechanism, eg.smoking as a confounder between alcohol and lung cancer

Answer 34

## Footnote (Rothman KJ et al. 2008

Answer 35

Non-reductive and reflexive, relative conception of health **Contextualism**, (McQueen D et al. 2007) * Bottom-up interventions * **Holism**, Systems – where the sum is greater than its parts * Epistemology – reflexivity, **acceptance of ambiguity** * Challenge of Causal generalizations – which implies reduction * Evaluation - look at process in context, developmental evaluation (**critical realism**) * Medical vs social public Health (causation is less relevant and the focus is on patterns of change and complexity is expected) ## Footnote Hawe, 2015; Tremblay MC & Richard L, 2014; McQueen D et al. 2007;

Answer 36

Health outcomes/disparities are not random, but are influenced by underlying social factors * Social epidemiology studies how disparities are distributed in communities. * The idea is to identify strategies to improve population health.

Answer 37

* income – impacts education – influences job * discrimination and stigma * Working conditions – physical hazards, psychosocial stressors, shift work and long working hours * Toxic environment * Behaviours * Psychosocial stress * Embedding, lifecourse perspective However, having a systemic vision implies more than just social determinants. Consider also: * Political determinats (Mackenbach JP, 2014) - windows of opportunity * Commercial determinants (Kickbusch I, 2014) | Reverse causality – poor health predicts poor SES ## Footnote Social policy: improve social conditions (housing, education, employment, interdisciplinary approach) rather than individual problems

Answer 38

* social networks: the ties that people have with each other * social capital: the confidence that gives communities a common purpose * social hierarchies: which influence people's ability to relate to others * social narratives: shared meanings that play into the construction of a collective identity, cultural repertoires | Berkman LF et al. 2014; Lamont and Hall, 2009

Answer 39

Instead of quantitative terms of internal and external validity * Credibility: The “truth” of the findings, as viewed through the eyes of those being observed or interviewed and within the context in which the research is carried out * Transferability: The extent to which findings can be transferred to other settings (similar contexts) * Dependability: The extent to which the research would produce similar or consistent results if carried out as described * Confirmability: Researchers need to provide evidence that corroborates the “findings” | Instead of quantitative terms of internal and external validity ## Footnote Lincoln & Guba, 1985

Answer 40

* **the causes of the causes of the causes**: Policies shape opportunities for a healthy life and the importance of social determinants (Bambra et al., 2019) * Public policy – a major determinant of health (Clavier D et al. 2013) * Public health practitioners have little experience with the policy process, i**t is not just a document** or a law (it's institutions, organizations, actors, ideas) * Multiple streams theory (Kingdon, 1984) -windows of opportunity, need for policy entrepreneurs * Objective: Make the healthy choice the easy one (Puska P, 2014) * Helsinki statement (WHO, 2014)– whole of government approach ## Footnote Examples: major reduction in mortality and morbidity in 19th century England was 2e to improved living conditions, rather than biomedical treatments (McKeown); HiAP in South Australia

Answer 41

Policy/institutions/organizations is social resource creation, they have the power to influence people's capacities and social mobilization, to have a buffer for stressful events for "wear and tear of everydaylife" . ## Footnote Hall P and Lamont M, 2009

Answer 42

but budgets do not reflect this, with many spending just 2-3.5% on prevention and public health, Canada spending around 6% ## Footnote (Clavier D and de Leeuw E, 2013)

Answer 43

* major reduction in mortality and morbidity in 19th century England was 2e to improved living conditions, rather than biomedical treatments (McKeown) * Social spending more positively associated with population health measures than health spending in terms of life expectancy, infant mortality, obesity, heart disease, mental health (Dutton, 2018)

Answer 44

* provides a buffer against adverse health (Shahidi et al. 2006) * redistributive, provides a buffer against risks of loss of income- Jacques & Alain, 2021

Answer 45

Forgetting values of Health Promotion * Context * Complexity * History * Power relations * Equity

Answer 46

Wicked promles! * We address wicked problems upstream – develop policies that foster an environment which addresses problems at the root before they start * Wicked problems do not lend themselves to technical solutions; **they require political attention** from governments * The need of media advocacy – blends communications, science, politics - To move policy entrepreneurs | Dorfman L and Krasnow I, 2014 ## Footnote "Lack of evidence is often not the main barrier to change/action, more oftern is lack of political will" (Brownson, 2021)

Answer 47

50% of the world lives in cities, this will rise to 60% by 2030 Intervene within neighborhoods and postal code Complexity thinking: 3 components * **Local** experimentation – sensitive to circumstance and resources – city government with a range of stakeholders (eg. Urban planning, community representation) * **Assessment** – based on dialogue, deliberation and discussion, understand policy overlaps * **Forums** – for consultation and debate of ethical dimensions of different approaches with a full range of community representatives ## Footnote Rydin, 2012

Answer 48

* Objective(s): desired change in health outcome * Input: Ressources needed (staff, funding, time, equipment) * Activities: Actions of the program * Target poopulation * Output: Indicators of program implementation/realization * Results: indicators of program effects * Other: context, hypotheses, extenal fx

Answer 49

## Footnote Nuffield Council on Bioethics

Answer 50

## Footnote Limitation: Works better for actions that hapen at one point in time (e.g., vaccination)

Answer 51

## Footnote Bandura

Answer 52

## Footnote Michie et al. 2011

Answer 53

* Lived * Interiorization * Anticipated * Secondary lived by family