Selecting interventions

Question 1

Define “intervention” in the context of public health

Answer 1

“Actions that are done intentionally to have a direct effects on the persons with the health problem“ - Issel

“Actions to improve health.“ - Walley

“Public health interventions are intended to promote or protect health or prevent ill health in communities or population.“ - Rychetnik et al. Criteria for evaluating evidence on public health interventions. JECH. 2002

Question 2

What are the different levels of public health interventions?

Answer 2

Primary - aim is to prevent disease

Secondary - aims to identify and treat disease pre-symptoms/development

Tertiary - aims to limit damage from an established disease (‘damage limitation’)

Question 3

What are the different types of public health interventions? (according to Walley)

Answer 3

• Population based* - e.g. sanitation, information campaigns, smoking bans (remove underlying cause of ill health)
• Personal preventive services* - e.g. screening
• Basic clinical services* - e.g. family health

Question 4

What are the different types of public health interventions? (according to Masters et al)

Answer 4

The various types of interventions are:

• health protection interventions e.g. vaccinations
• health promotion interventions e.g. smoking cessation services
• legislative interventions e.g. ban on smoking in public places, sugar tax
• healthcare public health interventions e.g. management of chronic disease
• wider determinants intervention e.g. reducing speed limits

Question 5

Define “public health programmes” (according to Walley)

Answer 5

Systematic implementation of interventions to control disease

Question 6

What are the criteria for a good public health intervention (according to Issel)?

Answer 6

• evidence based
• tailored to the target population
• conducive to health gains
• manipulable
• technologically and logistically feasible
• reasonable cost
• politically feasible
• addresses social priorities

Question 7

What questions should you ask when assessing “effectiveness” and “feasibility”?

Answer 7

• Effectiveness* - does it work? How well does the intervention control the disease? - considers harms & benefits as well as context
• Feasibility* - can it be done?

(Walley)

Question 8

What are the different types of feasibility?

Answer 8

Organisational - how easy is it to implement the intervention?

Gender-cultural and political - how acceptable is the intervention to the stakeholders?

Resources / cost - affordability, budget flexibility, cost-effectiveness

Question 9

What is a delivery strategy?

Answer 9

Looks at hows the intervention will be delivered.

i. e. how will you achieve coverage of the target group?
e. g. vaccinations are an effective intervention, but how will they be delivered? Through schools/clinics/hospitals?

Question 10

What tools will help support selection of good interventions?

Answer 10

Existing evidence e.g. literature review

National/international guidance

Stakeholder involvement

Question 11

Who are the stakeholders?

Answer 11

Individuals/groups with an interest in the intervention e.g.

• government (national/local)
• NGOs
• target population
• advocacy groups
• patients/public

Question 12

Why is it important to involve the stakeholders?

Answer 12

Alternative perspective

Financial support

Buy-in/support

Highlight problems

Accountablity

Question 13

What is the APEASE criteria?

Answer 13

Affordability - can it be delivered to a budget?

Practicability - can it be delivered as designed?

Effectiveness / cost-effectiveness - does it work (ratio of effect to cost)?

Acceptability - is it judged appropriate by relevant stakeholders (e.g. public, professional, political)?

Side effects - does it have any unwanted side-effects or unintended consequences?

Equality - will it reduce or increase the disparities in health/wellbeing/standard of living?

Michie et al. The behaviour change wheel: a guide to designing interventions. 2014.

Question 14

What are the steps to take when reviewing and choosing an intervention?

Answer 14

1. list the options
2. exclude all that are obviously not practical / appropriate
3. prioritise based on intervention effectiveness and feasiblity
4. review effectiveness feasibility of delivery

Walley

Question 15

What are the components of the “intervention dosage”?

Answer 15

Intensity - how much?

Duration - how long?

Frequency - how often?

Question 16

When should you set the criteria for success?

Answer 16

Set criteria for success at onset

Goal(aim) : broad statement about impact to be achieved e.g. improve birth outcomes.

Objectives : statements about outcomes that are stated in measurable terms

“by when, who will achieve what, by how much”

Issel, chapter 7

Question 17

How do SMART targets apply to interventions?

Answer 17

Specific to the needs of the programme - this involves moving from vague aims to very specific and measurable outcomes

Measurable by simple and objective methods with a baseline level at the beginning and a target level for achievement at the end of the intervention

Achievable - it should be possible to achieve the change during the time scale of the project with the resources available

Relevant - the target is relevant to the programme you are carrying out

Time-specific - time scale for change is specified

Question 18

What are the things that should be included in an action plan?

Answer 18

Which activities are required to implement the intervention? e.g.:

• ordering supplies
• developing materials
• meeting stakeholders
• training course
• piloting
• start intervention (pilot/phased/in full)

Who is responsible?

Timescales?

Resources involved?

See Walley Chapter 4 for how to write an action plan