Intervention: “theory based strategy or experience to which those in the priority population will be exposed or in which they will take part. “to comeo or coccur between two things, events, or points in time; to come in or between so as to hinder or alter an action.” Pg 206 book
We know that Intervention is “A set of learning activities, delivery plan, and evaluation activities designed to achieve the desired outcomes of the program. Interventions or programs may use single or multiple strategies to accomplish objectives. An intervention is a specific component of a more comprehensive program. Using a combination of several intervtions is good because you are able to the specific parts of an intervention to help aid you. But when you just chose one specific intervention it makes you limited on specific options and different outcomes.
Types of Intervention Strategies Strategy: “A general plan of action for affecting a health problem. A strategy may encompass several activities”
-CDC system of classification for strategies–more common strategies used by planners, categories not independent of each other:
1. Health communication
2. Heal edu.
3. Health policy/environment
4. Environmental change
5. Health-related community service
6. Community mobilization
7. other
Health Communication Strategies Designed to inform and influence individual and community decisions to influence health. Usually a part of most interventions and are useful in reaching many goals and objectives. High penetration rate. More cost effective and less threatening than other strategies. Pg 208 book
Image from pg 209
Communication channel is the route thought which a message is disseminated to the priority population.
Four traditional communication channels include intrapersonal, intrapersonal, orginiization and community and mass media. Social media is a very affect way of reaching many people who are of a younger target age.
Health Strategies
Adult learning principles include
1. adults need to know why they are learning
2. adults are motivated to learn by the need to solve problems
3. adults previous experience must be respected and built upon.
4. adults need learning approaches that match their background and diversity.
5. adults need to be acutely involved in the learning process
pg 220
Health policy enforcement strategies
Include executive orders, laws, ordinances, judicial decisions, policies, regulations, rules and position statements.
Represent a decision made by an authoritative entity that is intended to influence the behaviors of others
Examples:
• Seat belt laws
• Taxes on cigarettes, alcohol and weed
• Regulations on develpers requiring te consturtion of connected, walkable pathways in new build communities.
• A position statement by a school board vowing to provide well balanced meals in the cafeteria
• Smoke free campuses
• Speed bumps near grade schools
• No texting laws
• No cellphone use while driving laws
Environmental change strategies
• Create health-enhancing environments by removing environmental barriers such as:
• Poor environemtnal quality
• Inadequate access to affordable, nutritious food
• Inadequate availability of safe physical activity spaces
• Inadequate access to healthcare or patient education
• Closely related to health policy/enforcement-ther are times when a plicy change is needed for example, seat belt laws, taxes on cigarettes, alcohol, week,
• Seat belt laws
• Taxes on cigarettes, alcohol and weed
• Regulations on develpers requiring te consturtion of connected, walkable pathways in new build communities.
• A position statement by a school board vowing to provide well balanced meals in the cafeteria
• Smoke free campuses
• Speed bumps near grade schools
• No texting laws
• No cellphone use while driving laws
Health Related community sercie strategies:
Include services, tests, treatments or care to improve the health of those in the priority population (those for who the program is inted to serve)
Often offered in settings such as
• Groceery stores, shopping malls and centers
• Health fairs
• Worksites
• Personal residenceis
• Moble units
• Easily accessible health care facilities.
Community mobilization strategies
Involve healthing communities identify and take action on shared concerns, empowering community members
Community groups are health to:
• Idintify common problems and goals
• Mobilize resources
• Develop and implement strataegies for reaching goals
Communication Channel The route through which a message is disseminated to the priority population.
Examples:
1. Video and audio teleconferencing
2. Telephones: individual initiated/outreach
3. Mass media
4. In person
5. Printed materials
6. Computers, internet, tailored e-mail
7. Text messaging
8. Social media
9. Applications
5 Traditional Communication Channels 1. Intrapersonal: health care, health coaches, hotlines
2. Interpersonal: small classes, support groups
3. Organizational: church bulletins, company or agency newsletters
4. Mass media: newspaper, billboards, magazines, PSAs and more
5. Social media: User or consumer generated, organized, and distributed, information can be revised or updated almost immediately, typically low cost in terms of creation and maintenance, FB, blogs, Twitter, texts
POST Assists program planners in creating health promotion interventions that include social media. People, Objectives, Strategy, Technology.
Health Literacy Degree to which individuals have the capacity to obtain, process, and understand basic health info/services to make appropriate health decisions
Health Numeracy Degree to which individuals have the capacity to access, process, interpret, communicate, and act on numerical, quantitative, graphical, biostatistical, and probabilistic health info needed to make effective health decisions
*Important health communication interventions are appropriate fit for their priority population.
Health Education Strategies 10 General Principles of Learning (keep in mind before and during curriculum design):
1. Appeal to multiple senses
2. Get the learner active in the learning process
3. Limit distraction
4. Make sure they are ready to lean
5. Make sure the subject is relevant to the participants
6. Use repetition
7. Make sure learning is recognized and encouraged
8. Move from simple to complex concepts
9. Make concept applicable to several settings, generalize
10. Find an appropriate pace
Health Education Strategies cont. Health education and health communication are not mutually exclusive categories. Health education provides the opportunity to gain in-depth knowledge about a health topic.
-Curriculum (course of study): material priority population will be taught
-Scope: breadth and depth of material covered
-Sequence: order in which material is presented
Units of Study Orderly, self-contained collection of activities educationally designed to meet a set of objectives. AKA: curriculum plans, modules, and strands.
-Subdivided into lessons; outlines for the lessons are called lesson plans; lesson plans are composed of intro, body and conclusion
-Many methods for presenting lessons: lecture/discussion, group work, using
Kinzie’s modification of Gagne’s “Events of Instruction” 1. Gain attention (convey health threats and benefits)
2. Present stimulus material (tailor message to audience knowledge and values, demonstrate observable effectiveness, make behaviors easy to understand and do)
3. Provide guidance (use trustworthy models to demonstrate)
4. Elicit performance and provide feedback (for proficiency and self-efficacy)
5. Enhance retention and transfer (social support and behavioral cues)
Health Policy/Enforcement Strategies Include executive orders, laws, ordinances, policies, position statements, regulations, formal/informal rules
-Mandated or regulated activities
-May be controversial, may be political, can take away freedoms, pride, $, psyche
Six Phases of Policy Making 1. Agenda setting-what is the prob?
2. Policy formulation-development
3. Policy adoption-approval
4. Policy implementation-funding/enforcement
5. Policy assessment-is it working correctly?
6. Policy modification-improve based on results
When creating a policy, keep following in mind… Have top-level support.
Use representative group to form policies/laws.
Get input from priority population.
Get expert advice.
Seek legal opinions.
Review the issues others have faced.
Base policy on sound principles/research.
Seek input and debate/discussion.
Write policies in simple format & include rationale.
Consider phasing in the policy over time.
Provide education & behavior change programs to help people comply.
Once formulated: communicate, apply to all, enforce, & review to revise.
Environmental Change Strategies -Useful in providing “opportunities, support, and cues to help people develop healthier behaviors”
-Help remove barriers to change in the environment, goal is to make healthier choices the easier choices
Other Environments Include -Economic environment: financial costs, affordability
-Service environment: accessibility to health care or patient education
-Social environment: social support, peer pressure
-Cultural environment: traditions of an ethnic group
-Psychological environment: emotional learning environment
-Political environment: support for healthy environments
Health Related Community Service Strategies Ex: HRA, clinical screenings, services, test to improve health, flu shots, check-ups.
-Reduce barriers to the services, be mindful of affordability, accessibility.
-Referrals and follow-ups important; link with priority pop health care providers
Community Mobilization Strategies -Involve helping communities identify and take action on shared concerns using participatory decision making, and include such methods as empowerment.
Community Organizing Proces by which community groups are helped to identify common problems or goals, mobilize resources, and develop/implement strategies for reaching community goals
Community Building An orientation to a community that is strength-based rather than need based and stresses the identification, nurturing and celebrating of
7 Ways of Advocating for Health/Health Education 1. Influencing voting behavior
2. Electioneering
3. Direct lobbying
4. Integrating grassroots lobbying into direct lobbying efforts
5. Use of internet
6. Media advocacy-newspaper letters to the editor and opinion-editorial (op-ed) articles
7. Media advocacy-acting as a resource person
Behavior Modification Activities Often used in intrapersonal-level interventions, include techniques intended to help those in the priority population change behavior, based on SR theory. Process: keep records for a period of time, analyze the records, create plan to modify behavior
Organizational Cultural Activities -Like people, organizations also have a culture
-Consists of norms and traditions that are generated by and linked to the community
-The culture of an organization expresses what is and what is not considered important for the organization
-Should begin with an assessment or cultural audit to determine if the culture hinders or supports health promo
Incentives “An anticipated positive or desirable reward designed to influence performance of an individual or group”. Matching motivation and incentives. Types: Social, material, miscellaneous
Disincentives Discourages behavior. “An anticipated negative or undesirable consequence designed to influence performance of an individual or group”. Can range from intrapersonal (surcharge) to public policy levels (cigarette taxes)
Incentives/Disincentives cont. -Regulated by HIPAA: GINA-treating genetic info as protected health info, remove any financial incentives or penalties if genetic info is collected in HRA
-Employers cannot discriminate against their employees because of a health status related factor with the outcome affecting coverage or cost to the employee under a group or individual health plan
-In other words, cannot deny coverage or charge employees more because of health status related conditions such as high BP or high cholsterol
Social Support Activities -Many people find it much easier to change a behavior if those around them provide support or are willing to be partners in the behavior change process
-Social support can work as an incentive
-Types: support groups, buddy systems, social gatherings, social networks
Creating Health Promo Interventions -Once program planners have completed a needs assessment, written program goals and objectives, and considered diff types of intervention strategies, in position to begin designing an appropriate intervention
-There is no one best way of intervening to accomplish a specific program goal that can be generalized to all priority populations
Criteria and Guidelines for Developing Health Promo Interventions -APHA/CDC guidelines:
1. Address risk factors that are carefully defined, measurable, modifiable, and prevalent among the members of a chose target group
2. Reflect a consideration of the special characteristics, needs, and preferences of its target groups
3. Include interventions that will clearly and effectively reduce a target risk factor and are appropriate for a particular setting
4. Identify and implement interventions that make optimum use of the available resources
5. Be organized, planned, and implemented in such a way that it’s operation and effects can be evaluated
Designing Appropriate Interventions -Planner should use best available evidence to inform intervention
1. Best practices-using interventions that have undergone critical review of multiple research and evaluation studies
2. Best experiences-fall short of best practices but show promise
3. Best processes-original interventions based on theory
-Segmenting: dividing broader pop. into smaller groups
-Tailoring: intervention created for specific needs, interests, circumstances