2I Prevention

Question 1

Why is evaluation of public health interventions challenging?

Answer 1

• Not always appropriate/feasible to perform an RCT
• Lack of a control group
• Long lead time between intervention and its effects

Question 2

Discuss key areas for early intervention for children and families and why these areas are important

Answer 2

Education
- Pre school education can improve children’s social and intellectual development and long term outcomes
- Parenting skills education for parents is also important
- Ensuring access to adult education for young parents

Health and Nutrition
- Preventing low birthweight (associated with higher infant mortality and higher risk of chronic disease in adult life) e.g. through –> Improved maternal nutrition
–> Smoking cessation in pregnancy
- Breastfeeding to:
–> Improve immunity
–> Reduce childhood obesity
–> Reduce atopy
–> Better mother-baby bonding
–> Reduce breast and ovarian Ca for mothers
- Possible interventions
–> Education to improve diet/cooking skills
–> Subsidies e.g. free school meals, Healthy Start vouchers
–> Supplements e.g. water fluoridation
–> Preventing injuries through education campaigns, playground renovation, seatbelts and cycle helmets

Socioeconomic benefits
- Accessible and affordable childcare
- Increasing benefits/ensuring their uptake

Emotional/social support
- Family support programmes to
–> Improve parental wellbeing
–> Improve child’s physical, emotional and cognitive development
–> Prevent abuse

Programmes may combine elements of the above e.g. Children’s Centres

Question 3

What are pre-determinants of health?

Answer 3

Determinants of determinants
E.g. income may be a determinant of housing which is a determinant of health
Not clear cut though, sometimes income may also be a direct determinant of health

Question 4

How does social cohesion affect health?

Answer 4

Lack of social cohesion –> isolation and insecurity –> physical and mental health impacts

Greater social cohesion may improve life expectancy

Question 5

What is motivational interviewing?

Answer 5

• An approach to individual level counselling based on the stages of change model
• Explores why someone may be ambivalent to behaviour change

Key features
- Empathetic
- Highlights discrepancies between patient’s values and behaviours (provide opportunity for reflection)
- Respond to resistance with understanding
- Build self-efficacy

Question 6

How can you incentivise behaviour change?

Answer 6

• Vouchers/discounts
• Financial rewards

Question 7

What is social marketing?

Answer 7

The use of techniques of commercial marketing to sell a health message

Question 8

What is the social marketing process

Answer 8

1. Identify target group
   - Not a traditional cohort e.g. people with diabetes or a demographic group
   - Rather it goes deeper, uses segmentation tactics such as consumption patterns, or psychographic classification to identify target groups
2. Research target group
   - Surveys or FGDs
3. Competition analysis
   - Understand competition
   - In this context may be tendency to continue an unhealthy behaviour or a commercial actor such as alcohol industry
4. Set clear objectives e.g. is campaign raising awareness or changing behaviour
5. Develop the message
   - Pretest the message with target group
6. Sell the message
7. Evaluate

Question 9

What are the 4Ps of marketing?

Answer 9

These relate the the ‘sell the message’ part of social marketing

Product
- Be clear on what is being sold - e.g. with vaccine it could be the procedure, the service or prevention of disease

Price
- Consider opportunity cost for target audience

Place
- What channel will be used (as this affects who is exposed to the message)

Promotion
- Advertising, marketing campaigns (e.g. ribbons)

Question 10

What are the strengths and weaknesses of social marketing?

Answer 10

Strengths:
- Based on a deep/objective understand of target group (not clinicians’ perceptions of the group)
- Clear objectives
- Uses approaches that have been commercially successful

Weaknesses:
- Assumes behaviour change is simply an individual choice
- Danger of only providing partial info through overly simplified messaging
- Danger of reinforcing stereotypes of commercial products e.g. health is equivalent to beauty, youth etc

Question 11

Why involve the public in health programmes?

Answer 11

• Improve outcomes (greater buy in from patients in their treatment)
• Empowerment
• Democracy - community participation in decision-making as a human right
• More integrated/holistic approaches may result
• More effective services
• Greater acceptability of services
• Greater community ownership and sustainability

Question 12

What is the health ladder of community involvement?

Answer 12

These is more than one ladder model

Brager & Sprecht’s model broad goes: community having absolute control –> joint decision making –> community offers input into statutory plans –> community informed of statutory plans –> community not involved

Criticism of ladders is the implication that the top of the ladder should be the goal for every situation. May not always be appropriate.

Question 13

Which factors reinforce the effects of deprivation on health?

Answer 13

• Social exclusion (as a result of poverty)
• Discrimination (reinforces poverty through dissemination in hiring etc)
• Unemployment
• Stress
• Antenatal effects e.g. malnutrition can affect the health of the child as an adult e.g. CHD risk

Question 14

What are the strengths and weaknesses of using targets?

Answer 14

Strengths:
- Provide focus
- Clear priorities
- Level playing field for comparing different orgs
- Can reflect org’s priorities
- Opportunity for sharing good practice and learning
- Can stimulate managerial interest in key areas

Weaknesses:
- May not have info to measure relevant outcomes for the targets
- Gaming/distortions to meet targets
- Neglect key areas that do not have targets
- Clinicians disengage when targets are top down

Question 15

What are different ways of setting targets?

Answer 15

• Use SMART targets
• Use Donabedian (think about structure, processes and outcomes)