Issues in Epidemiology and Evaluation: Prevention Interventions and Evaluation Research

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Issues in Epidemiology and Evaluation Prevention
Interventions and Evaluation Research

• PH 2610
• November 11, 2002
• Lowell Sever, Ph.D.

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Overview

• Protecting the publics health Epidemiology and
  the core public health functions
• Prevention The corner stone of public health
• Levels of prevention
• Primary prevention strategies

3
Overview

• 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

4
Overview

• Program evaluation
• Why would you do it?
• What does it involve?
• How do you do it?

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Developing Effective Public Policy A Three
Component Model
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Evidence, Social Strategies, Political Will
Evidence
Political Will
Social Strategies
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Developing Public Health Policy
Moral Considerations
Scientific Strategies
Political Support
Economic Support
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The 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
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Future of Public Health Model for Approaching
Public Health Problems

• Assessment
• Policy development
• Assurance

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Core 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.

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Core 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.

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Core Public Health Functions The Institute of
Medicines Format
Policy Development
Assessment
Assurance
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Core Public Health Functions and Public Health
Activities
Assessment
Policy Development
Levels of Service
Priorities (Needs Assessment)
Outcomes
Risk Factors
Process
Capacity


Assurance
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Framework Core Public Health Functions

• Assessment
• Assurance
• Policy Development

• Scientific Strategies
• Political Support
• Economic Support
• Ethical Considerations

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Answering Prevention Questions

• Are we doing the right things?
• Etiologic studies
• Studies of prevention interventions
• Are we doing things right?
• Program evaluation

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Levels of Prevention

• Primary Prevention
• Prevention of the occurrence of disease through
• General health promotion
• Specific preventive measures
• (Mausner and Bahn)

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Levels of Prevention

• Secondary Prevention Involves
• Curing disease at the earliest stage possible
• Slowing disease progression
• Preventing complication
• Limiting disability
• (Mausner and Bahn)

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Levels of Prevention

• Tertiary Prevention
• Consists of limitation of disability and
  rehabilitation where disease has already occurred
  and left residual damage
• (Mausner and Bahn)

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Evaluation

• The process of determining the
• Relevance
• Effectiveness
• Efficiency
• Impact
• of activities

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Efficacy, 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?

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Evaluation 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

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Why 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

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The Evaluation Process

• Define the problem
• Build an evaluation plan
• Do the research
• Analyze evidence and generate findings
• Present results and derive recommendations

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The Components of Program Evaluation

• Posing evaluation questions
• Setting standards of effectiveness
• Designing the evaluation and selecting
  participants
• Collecting data
• Analyzing data
• Reporting the results

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Evaluation Process

• Baseline data
• Interim data or formative evaluation
• Process evaluation
• Outcome Evaluation

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Process Evaluation

• Has the program been conducted consistently with
  the plan?
• What is the relationship between various program
  activities and the effectiveness of the program?

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Impact 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?

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Planning 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?

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Planning 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.

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A 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

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A 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

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A Summary of Evaluation Principles and Tools

• Tool
• Logic Models

• Principle
• Evaluation of community programs should include
  an assessment of program theory

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A Summary of Evaluation Principles andTools

• Principle
• Evaluation should be informed by social ecology
  and social system concepts

• Tool
• Ecology and system designs

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A Summary of Evaluation Principles and Tools

• Principle
• Community evaluation should involve local
  stakeholders in meaningful ways

• Tool
• Participatory planning