Evaluation Of Public Health Interventions Research Articles

From Daunting to Doable: Tools for Qualitative Evaluation of a Complex Public Health Intervention.

To address complex problems like health disparities, public health interventions have become increasingly ''complex''-engaging multisector partners and communities at multiple ecological levels. Complex interventions are intentionally flexible, making them challenging to evaluate with predetermined measures. While innovative evaluation methods tailored to complex interventions have been developed, there is a need for practical guidance to enhance capacity within public health. This article describes the qualitative FIND (Frame, Identify, Narrow, Do) evaluation process for a complex, community-engaged health equity intervention. Illustrative examples and take-away tools are provided. The FIND process is sensitive to complexity, involving ongoing data collection that helps guide implementation. The evaluator is embedded within the project team, facilitating frequent, direct interaction between the evaluator and those whose roles position them to hear or see happenings with the on-the-ground implementation in real time. The FIND process includes (a) developing a flexible framework for determining relevant processes and outcomes, (b) identifying important project events, (c) narrowing in on the most impactful events, and (d) making decisions informed by data. Using the FIND process, the project team learned about significant project events that would have been missed without a complexity-sensitive approach. Having the evaluator embedded within the project team, rather than as an independent entity, was crucial for understanding and utilizing on-the-ground developments in an evolving intervention. There is a need for more practical guidance to build capacity for evaluating complex public health interventions, including strategies for communicating with stakeholders about approaches that diverge from traditional scientific norms.

Theoretical perspectives on biostatistics and its multifaceted applications in global health studies

Biostatistics plays a crucial role in global health studies by providing the tools necessary for analyzing complex health data and informing evidence-based public health decisions. This theoretical review explores the foundations of biostatistics and its diverse applications in the context of global health. At its core, biostatistics utilizes mathematical and statistical principles to analyze health data, enabling researchers to identify patterns, determine risk factors, assess interventions, and predict health outcomes across populations. Key theoretical concepts, including probability theory, statistical inference, and regression models, form the backbone of biostatistical analysis and are integral to understanding the dynamic relationships between health determinants and outcomes. The review highlights the various applications of biostatistics in global health, focusing on areas such as disease surveillance, epidemiology, and public health intervention evaluation. Biostatistical techniques are essential for analyzing epidemiological data, monitoring disease trends, and evaluating the effectiveness of health policies and interventions on a global scale. Furthermore, advanced statistical methods, including machine learning and Bayesian approaches, are becoming increasingly important in global health research. These methods allow for the analysis of large-scale data, predictive modeling, and more precise risk assessments, particularly in the context of emerging diseases, genetic research, and environmental health studies. Despite its strengths, biostatistics faces challenges in global health, including issues related to data quality, ethical considerations, and cross-cultural variations in health outcomes. Addressing these challenges is critical for ensuring accurate and equitable health assessments. Looking forward, biostatistics continues to evolve with innovations in data science, big data analytics, and real-time health data collection, making it an indispensable tool for improving global health outcomes and supporting health policies. This review emphasizes the theoretical underpinnings of biostatistics while highlighting its transformative potential in global health research and practice. Keywords: Theoretical Perspectives, Biostatistics, Multifaceted Applications, Global Health Studies.

Creating a learning health system to include environmental determinants of health: The GroundsWell experience.

Policies aiming to prevent ill health and reduce health inequalities need to consider the full complexity of health systems, including environmental determinants. A learning health system that incorporates environmental factors needs healthcare, social care and non-health data linkage at individual and small-area levels. Our objective was to establish privacy-preserving household record linkage for England to ensure person-level data remain secure and private when linked with data from households or the wider environment. A stakeholder workshop with participants from our regional health board, together with the regional data processor, and the national data provider. The workshop discussed the risks and benefits of household linkages. This group then co-designed actionable dataflows between national and local data controllers and processors. A process was defined whereby the Personal Demographics Service, which includes the addresses of all patients of the National Health Service (NHS) in England, was used to match patients to a home identifier, for the time they are recorded as living at that address. Discussions with NHS England resulted in secure and quality-assured data linkages and a plan to flow these pseudonymised data onwards into regional health boards. Methods were established, including the generation of matching algorithms, transfer processes and information governance approvals. Our collaboration accelerated the development of a new data governance application, facilitating future public health intervention evaluations. These activities have established a secure method for protecting the privacy of NHS patients in England, while allowing linkage of wider environmental data. This enables local health systems to learn from their data and improve health by optimizing non-health factors. Proportionate governance of health and linked non-health data is practical in England for incorporating key environmental factors into a learning health system.

A Bedside Electronic Whiteboard System for Patient Care in Isolation Rooms: A Scenario-Based Preliminary Study.

To assess a commercially available electronic whiteboard's usability and acceptability in isolation rooms, focusing on improving nurse-patient communication and supporting data input. A cross-sectional study with quantitative and qualitative mixed methods. We evaluated the usability and acceptability of electronic whiteboards among nurses using scenarios in a virtual isolation room environment. Nurses recognised the electronic whiteboard as a valuable tool for communication and error reductions in record-keeping but noted a learning curve for less tech-savvy users. Positive correlations were found between perceived usefulness, ease of use and adoption intent. Despite challenges, electronic whiteboards show promise for enhancing patient care, requiring comprehensive training and management systems. Time allocation in patient wards and nurse-patient interactions are crucial considerations. Electronic whiteboards have usability and acceptability as a tool to improve nurse-patient communication. However, considering technical issues and staff resistance, a management system and user training are necessary. Nurses perceive electronic whiteboards as user-friendly and as facilitating data input. TREND (Nonrandomised evaluations of behavioural and public health interventions). No patient or public contribution.

Navigating process evaluation in co-creation: a Health CASCADE scoping review of used frameworks and assessed components

BackgroundCo-creation is seen as a way to ensure all relevant needs and perspectives are included and to increase its potential for beneficial effects and uptake process evaluation is crucial. However,...

Evaluation of Public Health Interventions in Reducing the Burden of Malaria Infection in Emohua Community, Rivers State, Nigeria.

Evaluation of Public Health Interventions in Reducing the Burden of Malaria Infection in Emohua Community, Rivers State, Nigeria.

Step-by-step towards regular health examination surveys in Portugal

Abstract The 1st National Health Examination Survey was performed in Portugal in 2015 following the EHES procedures. It consisted of a cross-sectional population-based study representative at regional and national level. Individuals aged 25-74 years, residing in Portugal were selected from the national health users’ registry through multi-stage stratified probabilistic sampling. Data was collected in primary care units and included blood pressure, height, weight, hip and waist measurements, blood collection for lipid profile, HbA1c and blood count and a general health questionnaire. A biobank was created which includes serum, plasma, DNA and whole blood of consenting INSEF participants. Nationally representative quality epidemiological data is now available for public health monitoring, planning and research. The data has provided several indicators for the National Health Programs such as tobacco consumption, prevalence of diabetes, obesity, hypertension and dyslipidaemia for the National Program for Tobacco Prevention and control, National Program of Diabetes and National Program for the Promotion of Healthy Eating. In addition, indicators such as excessive salt consumption were used as a starting point for healthy eating campaigns towards reducing its use. The second National Examination Survey is currently being planned and is expected to be held in 2025 in a consortium with the National Food and Nutrition Survey and with the National Serological Survey. The planning and implementation of a single health survey that associates self-reported information on health status and disease, behavioural health determinants, including a detailed dietary and physical activity component, physical examination, and collection of biological products (blood and urine) would constitute an essential source of knowledge for the monitoring, evaluation of public health interventions, and for population-based epidemiological research.

Evaluation of Public Health Mass Campaign: Hesitancy and Event Ratios Method

Several public health interventions administer drugs and vaccines to large number of people for preemptive or reactive intervention. These vaccines and drugs were developed in very narrow conditions in clinical trials and we therefore have to continuously monitor the efficacy in the field. This paper proposes a method to evaluate the efficacy in the field using data collected from the intervention coverage survey and surveillance. The design is closely related to cohort prospective studies except that the sample size is not fixed upfront and the measure of association not affected by the population denominator. It uses two new terms: hesitancy ratio denoted β, which is the ratio of the target that does to receive the intervention to the target that received it; event ratio is denoted by α is the ratio of health event or disease being prevented absolute incidence in the intervention group to that is in control group. It further shows that risk ratio (RR) can be calculated from these two parameters by taking their products. i.e. RR = α β. This method is therefore called Hesitancy and Event Ratios (HER) Method. We can conclude that this method is scientifically sound and can be used in the evaluation of public health intervention in the field. We recommend that this method be included in routine monitoring of programs for efficacy evaluation.

Public mental health and wellbeing interventions delivered by allied health professionals (AHPs): mapping the evidence and identification of gaps. A systematic review

PurposeMental well-being is associated with positive outcomes throughout the life course. This study aims to examine interventions delivered by allied health professionals (AHPs) to alleviate community stressors adversely impacting public mental health and well-being.Design/methodology/approachReview inclusion criteria comprised experimental and qualitative process evaluations of public mental health interventions delivered by AHPs. Electronic searches in Cinahl, Embase, Medline, PsycINFO and the Cochrane Library, were combined with grey literature searches of National Institute for Health and Care Excellence public health guidance. A narrative synthesis and the Effective Public Health Practice Project appraisal tool were used to evaluate the evidence.FindingsA total of 45-articles were included in the review describing AHP-delivered interventions addressing social disadvantage, trauma, bullying, loneliness, work-related stress, transitional stress, intersectionality, pain and bereavement. No articles were identified evaluating interventions delivered by operating department practitioners or orthoptists. A conceptual map was developed summarising the stressors, and a typology of public mental health interventions defined including: place-based interventions, discrete/one-off interventions, multi-component lifestyle and social connector interventions and interventions targeting groups at risk of mental health conditions.Research limitations/implicationsMany mental health conditions begin in childhood, and a strength of the review is the life course perspective. A further strength is compiling a compendium of public mental health outcome measures used by AHPs to inform future research. The authors excluded many articles focussed on clinical interventions/populations, which did not meet review inclusion criteria. While playing a key role in delivering public mental health interventions, clinical psychologists are not defined as AHPs and were excluded from the review, and this may be construed a limitation. Given heterogeneity of study designs and interventions evaluated numerical analyses of pooled findings was not appropriate.Practical implicationsThe review highlights the breadth of community stressors on which AHPs can intervene and contribute in public mental health contexts, stressors which correspond to those identified in UK Government guidance as currently important and relevant to address. The findings can inform developing community public mental health pathways that align with the UK National Health Service (NHS) Long Term Plan, on prevention and early intervention to protect community mental health and well-being. Further can inform the NHS strategic direction for AHPs including informing ways of increasing utilisation of core AHP skills to optimise contributions in public mental health agendas.Social implicationsIt is surprising there were not more AHP delivered evaluations of interventions for other stressors important to address in public mental health settings, for example gambling, domestic violence or that used digital technology, and these are areas for future research. Future research should identify the most active/effective dimensions of multi-component interventions which could be informed by frameworks to guide complex intervention development. The relative paucity of research identified, highlights the predominant focus of research to date on interventions for clinical mental health conditions and populations. The lack of preventative approaches is evident, and an important area for future research to align with UK health and social care priorities.Originality/valueThe review highlights AHP-delivered interventions impacting diverse community stressors across the life course. The findings can inform developing public mental health pathways aligned with government health service priorities to protect mental health and well-being, prioritise prevention and early intervention and increase utilisation of AHP skills across public mental health settings.

Extending an Antiracism Lens to the Implementation of Precision Public Health Interventions.

Precision public health holds promise to improve disease prevention and health promotion strategies, allowing the right intervention to be delivered to the right population at the right time. Growing concerns underscore the potential for precision-based approaches to exacerbate health disparities by relying on biased data inputs and recapitulating existing access inequities. To achieve its full potential, precision public health must focus on addressing social and structural drivers of health and prominently incorporate equity-related concerns, particularly with respect to race and ethnicity. In this article, we discuss how an antiracism lens could be applied to reduce health disparities and health inequities through equity-informed research, implementation, and evaluation of precision public health interventions. (Am J Public Health. 2023;113(11):1210-1218. https://doi.org/10.2105/AJPH.2023.307386).

BOHEMIA a cluster randomized trial to assess the impact of an endectocide-based one health approach to malaria in Mozambique: baseline demographics and key malaria indicators

BackgroundMany geographical areas of sub-Saharan Africa, especially in rural settings, lack complete and up-to-date demographic data, posing a challenge for implementation and evaluation of public health interventions and carrying out large-scale health research. A demographic survey was completed in Mopeia district, located in the Zambezia province in Mozambique, to inform the Broad One Health Endectocide-based Malaria Intervention in Africa (BOHEMIA) cluster randomized clinical trial, which tested ivermectin mass drug administration to humans and/or livestock as a potential novel strategy to decrease malaria transmission.MethodsThe demographic survey was a prospective descriptive study, which collected data of all the households in the district that accepted to participate. Households were mapped through geolocation and identified with a unique identification number. Basic demographic data of the household members was collected and each person received a permanent identification number for the study.Results25,550 households were mapped and underwent the demographic survey, and 131,818 individuals were registered in the district. The average household size was 5 members and 76.9% of households identified a male household head. Housing conditions are often substandard with low access to improved water systems and electricity. The reported coverage of malaria interventions was 71.1% for indoor residual spraying and 54.1% for universal coverage of long-lasting insecticidal nets. The median age of the population was 15 years old. There were 910 deaths in the previous 12 months reported, and 43.9% were of children less than 5 years of age.ConclusionsThe study showed that the district had good coverage of vector control tools against malaria but sub-optimal living conditions and poor access to basic services. The majority of households are led by males and Mopeia Sede/Cuacua is the most populated locality in the district. The population of Mopeia is young (< 15 years) and there is a high childhood mortality. The results of this survey were crucial as they provided the household and population profiles and allowed the design and implementation of the cluster randomized clinical trial.Trial registration NCT04966702.

Persistence of the Omicron variant of SARS-CoV-2 in Australia: The impact of fluctuating social distancing.

We modelled emergence and spread of the Omicron variant of SARS-CoV-2 in Australia between December 2021 and June 2022. This pandemic stage exhibited a diverse epidemiological profile with emergence of co-circulating sub-lineages of Omicron, further complicated by differences in social distancing behaviour which varied over time. Our study delineated distinct phases of the Omicron-associated pandemic stage, and retrospectively quantified the adoption of social distancing measures, fluctuating over different time periods in response to the observable incidence dynamics. We also modelled the corresponding disease burden, in terms of hospitalisations, intensive care unit occupancy, and mortality. Supported by good agreement between simulated and actual health data, our study revealed that the nonlinear dynamics observed in the daily incidence and disease burden were determined not only by introduction of sub-lineages of Omicron, but also by the fluctuating adoption of social distancing measures. Our high-resolution model can be used in design and evaluation of public health interventions during future crises.

Health economic evaluation of preventive digital public health interventions using decision-analytic modelling: a systematized review

BackgroundDigital public health (DiPH) provides novel approaches for prevention, potentially leading to long-term health benefits in resource-limited health systems. However, cost-effectiveness of DiPH interventions is unclear. This systematized review investigates the use of decision-analytic modelling in health economic evaluations of DiPH primary prevention and health promotion interventions, focusing on intervention’s design, methods used, results, and reporting quality.MethodsPubMed, CINAHL, and Web of Science were searched for studies of decision-analytic economic evaluations of digital interventions in primary prevention or health promotion, published up to June 2022. Intervention characteristics and selected items were extracted based on the Consolidated Health Economic Evaluation Reporting Standards (CHEERS). Incremental cost-effectiveness ratios (ICERs) were then extracted and price-adjusted to compare the economic evaluation results. Finally, the included studies’ reporting quality was assessed by building a score using CHEERS.ResultsThe database search (including search update) produced 2,273 hits. After removing duplicates, 1,434 titles and abstracts were screened. Of the 89 studies meeting the full-text search criteria, 14 were ultimately reviewed. The most common targets were physical activity (five studies) and weight loss (four). Digital applications include text messages, web-based inventions, app-based interventions, e-learning devices, and the promotion of smartphone apps. The mean ICER of the 12 studies using quality-adjusted life years (QALYs) is €20,955 per QALY (min. − €3,949; max. €114,211). The mean of reported CHEERS items per study is 81% (min. 59%; max. 91%).ConclusionsThis review only includes primary prevention and health promotion, and thus excludes other DiPH fields (e.g. secondary prevention). It also focuses on decision-analytic models, excluding study-based economic evaluations. Standard methods of economic evaluation could be adapted more to the specifics of DiPH by measuring the effectiveness of more current technologies through alternative methods, incorporating a societal perspective, and more clearly defining comparators. Nevertheless, the review demonstrates using common thresholds that the new field of DiPH shows potential for cost-effective preventive interventions.

Outcome harvesting as a methodology for the retrospective evaluation of small-scale community development interventions

PurposeUndertaking evaluations of public health interventions can be problematic, particularly where there are multiple stakeholders and high degrees of complexity. This is especially true with regards to the evaluation of community interventions that can include multiple actors with differing priorities, budgets and resources. Using the example of a place-based community wellbeing project, this paper discusses the practical application of ‘Outcome Harvesting’ as a methodology for retrospective, responsive and collaborative evaluation in public health research. ResultsOur example shows that Outcome Harvesting can be effectively applied to the evaluation of community development initiatives and is likely to have potential in evaluating public health interventions more generally. Our case study also found it was well suited to retrospective evaluation, although the earlier the work can begin the more beneficial it is in understanding the project and in gathering sufficient data. ConclusionOutcome Harvesting shows promise for evaluating community development initiatives, allowing evaluators to work closely with key stakeholders to arrive at a mutually agreed and verifiable set of outcomes. However, challenges remain with regards to engaging a broad range of participants and with ensuring adequate time and resources are available to evaluate initiatives effectively.

Testing and refining middle-range theory in evaluations of public-health interventions: evidence from recent systematic reviews and trials

Evaluations of public-health interventions might potentially be used to test and refine middle-range theory (ie, theory about the mechanisms, which generate outcomes that is analytically generalisable enough to span a...

The contribution of peer research in evaluating complex public health interventions: examples from two UK community empowerment projects

BackgroundPeer-research is steered and conducted by people with lived experience of the issues being researched. This paper explores the value of peer-research in two complex public health intervention evaluations in the UK.MethodsReports from 18 peer research projects, completed by residents from 12 communities in the UK taking part in two community empowerment interventions, were analysed using cross-case analysis.ResultsUndertaking peer research helped to build the evaluation and research skills within individual projects as well as providing data on other outcomes related to the programmes Theory of Change. Some peer researchers, however, felt unprepared for the activity despite support from the academic team and were unsatisfied with project outcomes. While peer research projects provided more opportunities for local residents to engage with the overall evaluations, there was an overreliance on people closely connected to the programmes to be peer researchers. The peer research projects explored topics that were broader than the aims and objectives of the overall programme evaluations. All provided insight into the context in which projects occurred, while some also informed understanding of programme change mechanisms.ConclusionsIncluding peer research as part of complex public health intervention evaluations can help uncover important contextual and ecological details beyond the reach of more traditional evaluation data collection. Peer research can also empower and build research/evaluation capacity within communities, which is particularly pertinent for community empowerment interventions.

Presenting a Social Value Database and Simulator for Public Health

Abstract Background There is increasing recognition that Public Health Institutes need to build on the traditional value for money approach, to find ways to capture, measure and show the full range of their outcomes, impacts and related value. As part of a drive to measure value and impact in public health and demonstrate how investment in health can contribute to an Economy of Well-being, Public Health Wales has developed an interactive database to capture and illustrate the social value of public health services and interventions. Methods Scoping reviews of both academic and grey literature were undertaken to populate a database of health economics evaluations of public health interventions, focusing on Social Return on Investment (SROI). In addition, a simulated methodology was developed which allows the evidence to be manipulated and made relevant to individual contexts to help inform investment decisions at a local level. Results To date, the database has accumulated an excess of 50 SROI evaluations of various public health interventions, across areas including mental health, behaviour change, physical activity, nutrition, employment and primary care. The evaluations are based on European and International contexts, are published in both grey and academic sources, and are of varying quality. Conclusions SROI is a credible method for measuring the value of wider social, economic and environment outcomes achieved from public health interventions. The Social Value Database and Simulator presents a collation of studies and analysis utilising innovative health economics methods. Key messages • Public Health Wales’ Social Value Database and Simulator collates economic evaluations of public health interventions, to be used by policy makers to enable improved investment in health and well-being. • Social Return on Investment is a credible method for measuring the wider impact created by public health interventions.

4.G. Workshop: Economic evaluations of public health interventions: from case studies to next methodological steps

Abstract For establishing evidence-based or evidence-informed decision making in health systems, it is essential to determine which public health interventions and health policies are worth investing in, considering that public budgets are always limited. For that purpose, we can use well-established economic evaluation methods based on marginal analysis as cost-benefit and cost-effectiveness analyses. While the use of economic evaluations is a common practice in health technology assessment of drug and medical device in many high-income countries, the systematic assessment of public health interventions is marginal and non-compulsory. In fact, if conducted at all, many economic evaluations of public health interventions are performed internally without dissemination outside organisations. In general, there is already some guidance on how to perform and report economic evaluations that can also be used for public health interventions, as the recent update version of Consolidated Health Economic Evaluation Reporting Standards (CHEERS) check list. However, some methodological and implementation difficulties still persist, including insufficient or low-quality data on costs and outcomes (e.g. absence of experimental studies), complexities related to the need of measuring outcomes in the very long term an on aspects beyond the healthcare sector, or high relevance of contextual factors that are difficult to measure. This workshop will take on some examples of economic evaluations of public health interventions and explore how analyses, methods and implementation can be improved in order to allow a more evidence-based or evidence-informed decision making process. Key messages • Economic evaluations of public health interventions could be performed more frequently when it comes to the decision making. Planning and implementation difficulties are highlighted in this workshop. • Methods used in current economic evaluations of public health interventions can still be improved with a correct estimation of costs and outcomes, based on good quality data.

Economic evaluation of legislation-based public health interventions – the case of tobacco control

Abstract Economic evaluation of public health interventions have mostly been performed for interventions whose cost and effectiveness can be well identified, such as protective interventions (vaccination or screening), clinical interventions (prevention drugs) or counselling and education programs. Yet, following the Thomas Frieden's health impact pyramid, these public health interventions are less effective than those “changing the context to make individuals’ default decision healthy”. The economic evaluation of population-based interventions that modify the context is rather challenging. First, such interventions include various components, e.g., taxes and subsidies, media campaigns or bans. Second, since they correspond to political decisions applied at a wide scale, their effectiveness can hardly be measured using experimental designs. Third, the cost of such interventions is difficult to assess, since they are not represented by a specific product or service, but rather by political decisions and their implementation, whose costing is not straightforward. Using the case of tobacco control policies, we show how alternative methods can be used to assess their economic value. We show that quasi-experimental methods with country comparisons allow identify the effectiveness of specific policies, and that qualitative approaches are needed to quantify their costs. Results indicate that tobacco-control policies have low costs and are highly effective, so that their cost-effectiveness is quite favorable in light of commonly referred thresholds, and in comparison with widely financed clinical interventions. Population-based interventions that focus contextual factors must also be carefully evaluated from an economic viewpoint. Although economic evaluations are challenging, alternative approaches help obtain results that are valuable for decision making.

Challenges in economic evaluation of public health interventions: the example of surveillance of high risk pancreatic tumour patients

Abstract Evaluation of public health interventions raises a number of potential challenges in applying and performing economic analyses. The impact of interventions may extend beyond the health sector, and even within the health sector, the value may be difficult to estimate and extended beyond the health improvement of individuals. Screening and surveillance cancer programmes give the possibility to detect patients in a curable and treatable stage. Increasing number of expert recommendations and guidelines of cancer screening and surveillance have been recorded in the last decades. This scenario has increased the uncertainty on the most valuable and affordable approach to adopt. A case study can be provided by the premalignant pancreatic primarily cystic tumours surveillance. American, European and International guidelines for surveillance of asymptomatic cysts are available with significant differences in patients stratification, surveillance intensity (frequency of visits-exams), and duration. Further, real-world data suggest a significant variability in the surveillance approach even within Europe. However, no comparative data on different programmes efficacy are available, neither reliable medium-long term data on cancer risk. The lack of evidence must be considered with methodological issue associated to the inclusion of method to estimate inequalities created by the different programs and the indirect effect of healthcare resources consumption (e.g. CT and MRI) to access and allocation of these resources to other subjects (cancer and no cancer patients). Economic evaluations of surveillance or screening cancer program raise significant challenges, as data availability and methodological approach to apply. This scenario highlight the need of specific recommendation on data quality and type required to assess the programmes value and on methodological approach required (e.g. type of decision analytical models) to provide useful information for public health decision makers.