INTERVENTIONS PART 1

AN INTERVENTION SHOULD BE ____ &_____ MULTIPLICITY- DOSE-

An intervention should be effective (leads to desired outcome) & efficient (uses resources in a responsible manner). Multiplicity - # of components that make up the intervention Dose - number of program units delivered;

Community mobilization strategies - The subcategories profiled here are:

Community mobilization strategies involve helping communities identify and take action on shared concerns using participatory decision making, and include such methods as empowerment" The subcategories profiled here are: 1) Community building and Community organizing; and 2) Community advocacy

ENVIRONMENTAL CHANGE STRATEGIES -not limited to...

Have been most useful in providing "opportunities, support, and cues to help people develop healthier behaviors" They help remove barriers to change in the environment. ◦ Removing environmental barriers often helps to make the healthier choice the easier choice. ◦ Environmental change strategies are characterized by changes "around" individuals and are not limited to the physical environment

SOCIO-ECOLOGICAL APPROACH

Interventions that target multiple layers such as: ◦ Individual ◦ Interpersonal ◦ Community ◦ Built/Physical Environment ◦ Social Environment ◦ Organizational (workplaces, places of worship, housing) ◦ Policy at: Local/Municipal Provincial NationaL

ADDITIONAL PRINCIPLES FOR ENGAGING ADULTS

Learning through reflection Apply personal experience Using self-directed learning

Penetration rate:

Number in the priority population exposed or reached

SOCIAL MARKETING

Social marketing is mass media education (p. 282) Mass media is used to sell "health" through particular behaviours or products (p.282) Develop the right product - the message and how it is presented, backed by the right promotion, and put in the right place at the right price - a potent component of a health promotion program

Incentives

"An anticipated positive or desirable reward designed to influence performance of an individual or group" ◦ Matching motivation & incentives ◦ Types — social, material, miscellaneous motivate people to get involved, encourage health service use behavior Incentives can work because they make good health decisions easier and poor ones more difficu

Community building - "an orientation to practice focused on ..

"an orientation to practice focused on a community, ... building on capacities, not fixing problems" Stresses the identification, nurturing, and celebrating of community assets.

Disincentives

(i.e., stick; taking away) ◦ Discourages behavior ◦ "An anticipated negative or undesirable consequence designed to influence performance of an individual or group" ◦ Can range from intrapersonal (e.g., surcharge) to public policy leve

HEALTH EDUCATION Unit plan ◦ Units of study (unit plans) are subdivided into lessons; ◦ Many methods for presenting lessons:

- "An orderly, self-contained collection of activities educationally designed to meet a set of objectives. Other terms for this are curriculum plans, modules, and strands" Thus, a school health curriculum may have units on exercise, nutrition, chronic diseases, communicable diseases, and so forth, while the diabetes education curriculum might include units on self-management, working with a health care professional, and avoiding emergencies. And finally, outlines for the lessons are called lesson plans; lesson plans are composed of introduction, body, & conclusion. -lecture/discussion, group work, using audiovisuals, e

Tailoring -

-information or change strategies intended to reach one specific person based on individual characteristics

7 stategies

1. Health communication strategies 2. Health education strategies 3. Health policy/enforcement strategies 4. Environmental change strategies 5. Health-related community service strategies 6. Community mobilization strategies 7. Other strategies

HEALTH COMMUNICATION STRATEGIES The four traditional channels include:

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 . Probably the most visible communication channel to most people is the mass media channel. Mass media interventions can seek to influence people either directly or indirectly A mass media intervention to counter the advertising of unhealthy foods and drinks in a specific neighborhood would be an example of indirect mass media intervention. The mass media channel includes both print and electronic (e.g., distribution via the Internet) 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 Facebook, blogs, LinkedIn, Twitter, text messaging

10 GENERAL PRINCIPLES OF LEARNING

1. Use repetition. 2. Make sure learning is recognized and encouraged, pleasant, and progress is recognized (climate of mutual respect & dynamic partnership) 3. Move from what is known to unknown - simple to complex concepts. 4. Make concept applicable to several settings, generalize. 5. Find an appropriate pace. 1. Appeal to multiple senses (e.g., seeing, hearing, speaking). 2. Get the learner active in the learning process (participative). 3. Limit distractions. 4. Make sure they are ready to learn. 5. Make the subject relevant to the participants (learn for action).

INTERVENTION PLANNING- ADAPTION

Adapting an existing intervention that is supported by evidence used elsewhere but he setting in which it was used - different than proposed setting Five step process Access target population and capacity to implement in the agency Select: adopt, adapt or select another intervention Prepare - pre-test adapted materials, increase agency capacity, collaborative partnerships Pilot - pilot test the adapted intervention Implement conduct entire intervention

CRITERIA FOR CREATING HEALTH PROMOTION INTERVENTIONS

Address risk factors among the members of a priority population; Theory driven; Based on best possible evidence; Culturally appropriate; Consistent with professional criteria, guidelines, codes of practice; Efficient use of resources: Identify and implement interventions that make optimum use of the available resources; Evaluation: Be organized, planned, and implemented in such a way that its operation and effects can be evaluated.

INTERVENTION PLANNING- ADOPTION In order for program planners to adopt an intervention for use in their program there are several questions they must be able to respond to with a "Yes" answer.

Adopting an existing intervention supported by evidence - was effective when used elsewhere in: Dealing with problem in question? Population with ssimilar characteristics More than one setting? Similar resources in new setting to ensure fidelity Similar environment in new setting If NO to any of these Q's consider adapting or a new intervention

AN INTERVENTION IS..

An intervention (or treatment) is an activity or set of activities that help to achieve the outcomes stated in the goals & objectives. ◦ A theory-based strategy or experience to which those in the priority population will be exposed or in which they will take part ◦ Occurs between two points in time

Built/physical environment Social environment

Bath grab bars and universal access in bathrooms Walkable places that are pleasing and safe near seniors housing

Interpersonal

Buddy systems in apt buildings

Community

Coalitions or other organized collectives taking action on preventing falls by raising awareness & addressing policy change, skilled volunteers assist to make home modifications -handrails, promoting safe exercise classes, role of CBOs to promote physical activity in older adults

CULTURE ◦ 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 su

For example, if organizational decision makers believe exercise is important, they may provide employees with an extra 20 minutes at lunchtime for exercise. Other examples of organizational culture activities that support health might include changing the types of foods found in vending machines, closing the "junk food" machines during lunch periods at school, offering discounts on the health foods found in the company cafeteria, and getting retailers to change the way they have done things in the past, such as moving their tobacco products from in front of a counter to behind a counter, so that an employee has to get them for the customer.

HEALTH COMMUNICATION STRATEGIES Health communication strategies are designed to

Health communication strategies are designed to to inform & influence individual & community decisions to influence health. ◦ Are useful in reaching many goals & objectives ◦ High penetration rate ◦ More cost effective and less threatening than other strategies limit- health communication alone is rarely sufficient to change behavior and reduce the risk of disease.

HEALTH EDUCATION Health education & health communication are not mutually exclusive categories. HEALTH EDUCATION PROVIDES THE OPPORTUNITY.. CURRUCULUM SCOPE SEQUENCE

Health education provides the opportunity to gain in-depth knowledge about a particular health topic ◦ Curriculum (course of study) - what those in the priority population will be taught. Examples include the health education curriculum of a school district or the curriculum for a hospital's diabetes education program ◦ Scope - refers to breadth & depth of material covered ◦ Sequence - defines the order in which the material is presented

HEALTHY POLICY/ enforcement strategy

Health policies/enforcement strategies include executive orders, laws, ordinances, judicial decisions, policies, regulations, rules, and position statements. Though each of the different types of policy/enforcement strategies has its own definition, common to all of them is a decision made by an authoritative person, agency/organization, or body

HEALTH REATED COMMUNITY SERVICE STRATEGY Health-related community service strategies include services, tests, treatments, or care to improve the health of those in the priority population (CDC, 2003). Examples of this type of intervention strategy include, but are not limited to, completing

Health risk assessment ◦ Clinical (biometric) screenings- BP, cholesterol, glucose ◦ Services, tests, or treatments to improve health- flu shots & other immunizations ◦ Check-ups, exams Reduce barriers to the services - be mindful of affordability, accessibility. Referrals and follow-ups are important; link with priority population's h Free Flu shots for Seniors

SOCIAL SUPPORT Types of social support include:

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. ◦ Support groups (e.g., Weight Watchers, Overeaters Anonymous) ◦ "Buddy" systems; can be used with contests & contracts ◦ Social gatherings ◦ Social networks - a web of social relationships

Bridging Economic and Cultural Environments to Exploit a Healthy Change

Lucky Fish - A population Level Intervention appeals to the traditions of an ethnic group Population Example Iron-deficiency affects over 3.5 billion people. Cambodia has the highest rates of iron deficiency in the world, affecting 44 per cent of the population (more than 15 million people) and resulting in an estimated $70 billion of lost gross domestic product (GDP).

Municipal Policy Provincial Policy National Policy

Monitoring wear and tear of walkable spaces Provincial building codes - private & public housing Recommendations for building codes

Individual

Patterns & type of exercise, perceptions of barriers to activity, & risk of falling

Organizational policy (workplace, housing, etc.)

Policies in LTC influencing physical activity

Motivational Interviewing -

collaborative , person -centered form of guiding to elicit and strengthen motivation for change

Community advocacy - process in which those in the community become involved in the Potential for:

process in which those in the community become involved in the institutions & decisions that impact their lives Potential for: ◦ More support, keeps more people informed, influences decisions, activates non participants, improves service; ◦ People, plans, and programs to be more responsive

Community organizing - the process by which community groups are helped to identify common

the process by which community groups are helped to identify common problems or goals, mobilize resources, and in other ways develop and implement strategies for reaching the goals they have collectively set"

A communication channel is

the route through which a message is disseminated to the priority population.

Health Numeracy

◦ "the degree to which individuals have the capacity to access, process, interpret, communicate, and act on numerical, quantitative, graphical, biostatistical, and probabilistic health information needed to make effective health decisions" This definition recognizes that there are degrees of health numeracy that fall along a continuum, and "that health numeracy is not simply about understanding (processing and interpreting), but also functioning (communicating and acting) on numeric concepts in terms of health" four skills: basic (e.g., counting the number of pills), computational (e.g., determining the number of calories consumed using a nutritional label), analytical (e.g., determining if test results are in the normal range), and statistical (e.g., determine risk with probability).

DESIGNING HEALTH PROMOTION INTERVENTIONS ◦ Best practices - ◦ Best experiences -

◦ Best practices - using interventions that have undergone critical review of multiple research & evaluation studies ◦ Best experiences - have not gone through critical research, fall short of best practices but show promise ◦ Can be found by networking with other professionals and consulting literature

◦ Best processes -planners create ◦ Segmenting - Segmenting - dividing a broader population into

◦ Best processes - planners create original interventions based on knowledge and skills of good planning, involving priority population and appropriate theories and models see Table 8.5 If neither best practices nor best experiences are available to planners, then the third source of guidance for selecting an intervention strategy is using best processes ◦ Segmenting - dividing a broader population into smaller groups with similar characteristics (depending on intervention - approp. reading level, culturally sensitive, consideration of unintended effects - threaten physical safety or undue anxiety)

Behavior Modification Activities uses.... includes techniques Process

◦ Often used in intrapersonal-level interventions, include techniques intended to help those in the priority population experience a change in behavior (such as exercise or stress management techniques) or to decrease (such as smoking or consumption of fats) ◦ Based on SR theory ◦ Keep records (logs, diaries, journals) for a period of time ◦ Analyze the records ◦ Create a plan to modify behav

Tools of health communication include:

◦ Video and audio teleconferencing ◦ Telephones ◦ Mass media ◦ In person ◦ Printed materials ◦ Computers, Internet, tailored emails

Health Literacy

◦ the degree to which individuals have "the capacity to obtain, process, and understand basic health information and services to make appropriate health decisions