Title: Issues in Epidemiology and Evaluation: Prevention Interventions and Evaluation Research
1Issues in Epidemiology and Evaluation Prevention
Interventions and Evaluation Research
- PH 2610
- November 11, 2002
- Lowell Sever, Ph.D.
2Overview
- Protecting the publics health Epidemiology and
the core public health functions - Prevention The corner stone of public health
- Levels of prevention
- Primary prevention strategies
3Overview
- Health Objectives for the Nation
- Healthy People 2010
- Establishing objectives
- Examples from the Healthy People 2000 Objectives
in Maternal and Child Health - Achieving the Objectives Interventions and
programs
4Overview
- Program evaluation
- Why would you do it?
- What does it involve?
- How do you do it?
5Developing Effective Public Policy A Three
Component Model
6Evidence, Social Strategies, Political Will
Evidence
Political Will
Social Strategies
7Developing Public Health Policy
Moral Considerations
Scientific Strategies
Political Support
Economic Support
8The Rational Model of Decision Making
Define the Problem
Develop Relevant Alternative Solutions
Evaluate Alternatives
Select a Solution
Longest, 1994, Health Policymaking in the United
States
9Future of Public Health Model for Approaching
Public Health Problems
- Assessment
- Policy development
- Assurance
10Core Public Health Functions
- Assessment
- Figuring out what the important health problems
are. - Policy development
- Deciding what to do.
- Assurance
- Doing it well or making sure someone else does
it well.
11Core Public Health Functions
- These functions are linked in an ongoing
process part of assessment is determining
whether prior policy development and assurance
activities had the desired effects.
12Core Public Health Functions The Institute of
Medicines Format
Policy Development
Assessment
Assurance
13Core Public Health Functions and Public Health
Activities
Assessment
Policy Development
Levels of Service
Priorities (Needs Assessment)
Outcomes
Risk Factors
Process
Capacity
Assurance
14Framework Core Public Health Functions
- Assessment
- Assurance
- Policy Development
- Scientific Strategies
- Political Support
- Economic Support
- Ethical Considerations
15Answering Prevention Questions
- Are we doing the right things?
- Etiologic studies
- Studies of prevention interventions
- Are we doing things right?
- Program evaluation
16Levels of Prevention
- Primary Prevention
- Prevention of the occurrence of disease through
- General health promotion
- Specific preventive measures
- (Mausner and Bahn)
17Levels of Prevention
- Secondary Prevention Involves
- Curing disease at the earliest stage possible
- Slowing disease progression
- Preventing complication
- Limiting disability
- (Mausner and Bahn)
18Levels of Prevention
- Tertiary Prevention
- Consists of limitation of disability and
rehabilitation where disease has already occurred
and left residual damage - (Mausner and Bahn)
19Evaluation
- The process of determining the
- Relevance
- Effectiveness
- Efficiency
- Impact
- of activities
-
20Efficacy, Effectiveness, and Efficiency
- Efficacy How well does the intervention work
under ideal conditions? - Effectiveness How well does the intervention
work when it is applied in the community? - Efficiency Are the results achieved in keeping
with the effort spent?
21Evaluation Research(Freeman and Rossi 1993)
- Systematic application of social research
procedures for assessing the conceptualization,
design, implementation, and utility of social
intervention programs. - Necessary to
- Distinguish useful current programs from
ineffective and inefficient ones - Plan, design, and implement new efforts that
effectively and efficiently have the desired
impact on community members and their environments
22Why Evaluate Your Program?
- Evaluation results can
- Demonstrate the impact of your program
- Be used to improve a program
- Provide evidence of a need for additional
funding, resources or activities - Encourage others to initiate and maintain public
health prevention efforts
23The Evaluation Process
- Define the problem
- Build an evaluation plan
- Do the research
- Analyze evidence and generate findings
- Present results and derive recommendations
24The Components of Program Evaluation
- Posing evaluation questions
- Setting standards of effectiveness
- Designing the evaluation and selecting
participants - Collecting data
- Analyzing data
- Reporting the results
25Evaluation Process
- Baseline data
- Interim data or formative evaluation
- Process evaluation
- Outcome Evaluation
26Process Evaluation
- Has the program been conducted consistently with
the plan? - What is the relationship between various program
activities and the effectiveness of the program?
27Impact or Outcome Evaluation
- To what extent has the program achieved its
objectives? - To what extent can objectives that are achieved
by attributed to the program?
28Planning and Implementingan Evaluation
- Step 1 Define the program goals and objectives
- Step 2 Why and for whom is the evaluation being
done? - Step 3 What is the question and how is the
answer found?
29Planning and Implementingan Evaluation
- Step 4 What method? Quantitative vs.
Qualitative? - Quantitative methods - Program data describing
the clients and the services received, cost
information, surveys, behavioral surveys and
observations are all quantitative methods. - Qualitative methods - Key informant interviews,
focus groups, case studies, and observations are
examples of qualitative data. - Step 5 Analysis, reporting and timelines.
30A Summary of Evaluation Principles and Tools
- Principle
- Evaluation approaches used should be guided by
the questions asked and often require both a
qualitative and quantitative orientation
- Tools
- Qualitative designs
- Experimental and quasiexperimental evaluation
designs
31A Summary of Evaluation Principles and Tools
- Tools
- Questionnaires and surveys
- Social indicators
- Principle
- Evaluation instruments that are used to measure
community programs must be contoured to each
individual community
32A Summary of Evaluation Principles and Tools
- Principle
- Evaluation of community programs should include
an assessment of program theory
33A Summary of Evaluation Principles andTools
- Principle
- Evaluation should be informed by social ecology
and social system concepts
- Tool
- Ecology and system designs
34A Summary of Evaluation Principles and Tools
- Principle
- Community evaluation should involve local
stakeholders in meaningful ways
- Tool
- Participatory planning