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Making High-Yield Prevention Choices: Intervention Selection Tools
Margaret Beaudry
Public Health Foundation (PHF)
APHA 141th Annual Meeting and Exposition Boston, Massachusetts
November 4, 2013
Presenter Disclosures
The following personal financial relationships with commercial interests relevant to this presentation
existed during the past 12 months:
Margaret Beaudry
“No relationships to disclose”
PHF Mission:
We improve the public’s health by strengthening the quality and performance of public health practice
www.phf.org
Healthy Practices
Healthy People
Healthy Places
Learning Objectives
Identify decision factors that impact the success of public health interventions.
Develop a strategy for comparing evidence-based interventions for best-fit and greatest yield in local contexts.
Background
This presentation is based on a hypothetical model developed by Dr. Norma Kanarek entitled Strategic Practice Selection Exercise. Her paper is available on www.phf.org
The idea is to tailor the exercises to your community, weighing decision factors according to local priorities. You can also substitute your own decision factors for those proposed.
The result is a weighted ranking of potential interventions based on local applicability and likelihood of success.
Organizations can use this approach to inform practical programmatic decisions on how to invest limited prevention resources to achieve the most high-yield results.
A Three-Part Planning Process
Community/State Health Needs AssessmentIdentify priorities based on supporting data
Strategic PlanningAssessing the availability, affordability, accessibility, and utility of interventions to address priority problems
Implementation PlanningIdentify sources of funding, partners, leaders, and a time frame for addressing priority problems
Think Global, Act Local
#1 Identify Potential Interventions
Global. . . Look far and wide to understand the many good ideas already in
playEvidence-based
Cost-effective
Potentially applicable in diverse settings
#2 Rank Interventions
Local . . . Assess applicability and likelihood of yielding results
Availability
Affordability
Acceptability
Impact potential
#1 Identify Potential InterventionsThe Guide to Community Preventive Services (Community Guide)
The Cochrane Database of Systematic Reviews
The Healthy People 2020 Evidence-Based Resources
The County Health Roadmaps: What Works for Health
The University of Massachusetts Evidence-Based Strategies for Public Health
The National Registry of Evidence-Based Programs and Practices (NREPP)
PubMed Clinical Queries
The Grey Literature Report
The Promising Practices Network (PPN)
Canadian Best Practices Portal
The National Prevention Strategy Appendix 5: Justification for Evidence-Based Recommendations
Healthy People 2020 Structured Evidence Queries
The Guide to Community Preventive Services (Community Guide)
The Cochrane Database of Systematic Reviews
The Healthy People 2020 Evidence-Based Resources
The County Health Roadmaps: What Works for Health
The University of Massachusetts Evidence-Based Strategies for Public Health
The National Registry of Evidence-Based Programs and Practices (NREPP)
PubMed Clinical Queries
The Grey Literature Report
The Promising Practices Network (PPN)
Canadian Best Practices Portal
The National Prevention Strategy Appendix 5: Justification for Evidence-Based Recommendations
Healthy People 2020 Structured Evidence Queries
#1 Identify Potential Interventions
The Community Guide
This resource allows you to choose programs and policies to improve health outcomes in 22 topic areas including tobacco, physical activity, motor vehicle injury, adolescent health, and cancer. More than 200 systematic reviews on proven effectiveness, intervention cost, and likely return on investment.
The National Registry of Evidence-Based Programs and Practices (NREPP)
More than 290 public health interventions for mental health and substance abuse, and information to help determine which will best meet local needs.
The National Prevention Strategy Appendix 5: Justification for Evidence-Based Recommendations
Evidence-based recommendations validated from five major scientific resources.
#2 Will This Work for Us?
Decision FactorsStrength of Evidence
Organizational Control
Potential Uptake / Additive Penetration
Community Acceptability
Potential Number of Deaths Averted
#2 Will This Work for Us?
An Example
The organization selected tobacco use as its public health priority
The organization then listed potential evidence-based tobacco interventions in the rows.
The decision factors included the strength of the evidence, as well as other variables related to the likelihood of successful health impact.
#2 Will This Work for Us?
Decision Factors [3]
Potential Number of
Deaths Averted
Strength of Evidence
Potential Intervention Delivery and
CoverageCommunity
Acceptability
Organiza-tional
Control Total
Public
Health Interventions
Increase Price of Tobacco Products 3 3 1 2 1 10Limit Youth Access to Tobacco 1 1 3 3 3 11
Avert Exposures to Second and Third-Hand Smoke
2 2 2 1 2 9
Example: Tobacco Use Intervention Selection Matrix [1],[2]
Ranking: 3 represents the most impactful idea, 1 represents the least impactful idea
[1] Data are shown for illustrative purposes only.[2] This matrix was derived from the Nominal Group Technique, in which group members’ individual ranks are totaled to attain a group score. [3] The relative weight, or importance, of the decision factors will vary depending on the organization’s public health priorities and should be discussed prior to ranking.
#2 Will This Work for Us?
Limit Youth Access to Tobacco had the highest overall ranking and therefore the greatest likelihood of successful, impactful implementation.
Community Acceptability ComponentsApplicability to health departments
Utility to local agency
Reliability of implementation
Ease of monitoring implementation
Applicability to broad range of communities
Controversy potential
Resource or cost requirements
Rating Scale5 = Strongest, 1= Weakest
#2 Will This Work for Us?
Acceptability Components 5 4 3 2 1
Applicability to health departments
Consonant with agency mission and traditional
roles
Similar to other interventions/ populations
Consensus it is worthwhile, but
community lacks enthusiasm
Genuine difference of local opinion about agency role in the
intervention
Viewed as peculiar or and not helpful to the
community or whole population
Utility to local health departments
Similar target population, personnel required that
PHD already uses
Target population and necessary personnel is totally new to the PHD
Reliability of implementation
One implementation protocol fits all
Implementation protocols differ for communities, subpopulations, time
periods, etc.
Ease of monitoring implementation
Simple, straightforward intervention
Intricate intervention many steps, a hierarchy of
implementation, or many contacts
Applicable to a broad range of communities
Low variability of intervention uptake
Moderate variability of intervention uptake
High variability of intervention uptake
Controversy potential
Addresses protection of the entire population
Addresses illegal activity, an unfavored
subpopulation, or has negative impacts
Resource or cost requirement
Low cost, intensity of trained personnel, or few
FTEs
Moderate cost, intensity of trained personnel,
or FTEs
High cost, intensity of trained personnel, or many
FTEs
Links to Evidence-based Resources
The Guide to Community Preventive Services (The Community Guide) www.thecommunityguide.org/index.html
The Cochrane Database of Systematic Reviews www.thecochranelibrary.com/view/0/index.html
The Healthy People 2020 Evidence-Based Resources www.healthypeople.gov/2020/implement/EBR.aspx
The County Health Roadmaps: What Works for Health www.countyhealthrankings.org/roadmaps/what-works-for-health/using-what-works-health
The University of Massachusetts Evidence-Based Strategies for Public Health http://library.umassmed.edu/ebpph/index.cfm
PubMed Clinical Queries www.ncbi.nlm.nih.gov/pubmed
The Grey Literature Report www.greylit.org/
The Promising Practices Network (PPN) www.promisingpractices.net/programs.asp
Links (continued)
Canadian Best Practices Portal http://66.240.150.14/intervention/search-eng.html
The National Registry of Evidence-Based Programs and Practices (NREPP) www.nrepp.samhsa.gov/Search.aspx
The National Prevention Strategy Appendix 5: Justification for Evidence-Based Recommendations www.surgeongeneral.gov/initiatives/prevention/strategy/appendix5.pdf
Healthy People 2020 Structured Evidence Queries http://phpartners.org/hp2020/index.html
Also
Strategic Practice Selection Exercise (Dr. Norma Kanarek) www.phf.org/resourcestools/Documents/Strategic_Practice_Selection_Exercise.pdf
Public Health Foundationwww.phf.org
Margaret BeaudryDirector, Performance Management & Quality Improvement