Sustainability Of Public Health Interventions Research Articles

Sustainability of Public Health Interventions to Reduce the Risk of Dioxin Exposure at Severe Dioxin Hot Spots in Vietnam.

Severe dioxin contamination at Bien Hoa and Da Nang airbases, Vietnam is of international concern. Public Health risk reduction programs were implemented in Bien Hoa in 2007-2009 and in Da Nang in 2009-2011. In 2009 and 2011 we reported the encouraging results of these interventions in improving the knowledge, attitude and practices (KAP) of local residents in reducing the dioxin exposure risk through foods. In 2013 we revisited these dioxin hot spots, aimed to evaluate whether the results of the intervention were maintained and to identify factors affecting the sustainability of the programs. To assess this, 16 in-depth interviews, six focus group discussions, and pre and post intervention KAP surveys were undertaken. 800 respondents from six intervention wards and 200 respondents from Buu Long Ward (the control site) were randomly selected to participate in the surveys. The results showed that as of 2013, the programs were rated as "moderately sustained" with a score of 3.3 out of 5.0 (cut off points 2.5 to <3.5) for Bien Hoa, and "well sustained" with a score of 3.8 out of 5.0 (cut off points 3.5 to <4.5) for Da Nang. Most formal intervention program activities had ceased and dioxin risk communication activities were no longer integrated into local routine health education programs. However, the main outcomes were maintained and were better than that in the control ward. Migration, lack of official guidance from City People's Committees and local authorities as well as the politically sensitive nature of dioxin issues were the main challenges for the sustainability of the programs.

Effectiveness of the 2006 Commonwealth Games 10,000 Steps Walking Challenge

There is little evidence supporting sustainability of public health interventions based upon the 10,000 steps concept conducted in "real-world" settings. This study investigated the effectiveness of the 10,000 Steps Walking Challenge, initiated in conjunction with the 2006 Commonwealth Games in Melbourne, Australia, in March 2006. This study analyzed characteristics of registrants (n = 1836), pedometer counts logged onto a Web site between February 2006 and February 2007 (n = 18,032 entries by 914 participants), and two surveys of participants in June 2006 (n = 128) and December 2006 (n = 62). The program reached its target population of females aged 30-49 yr (40.2% of participants), a group known to have low activity levels, which also has potential to influence the behavior of family, friends, and workmates. Compliance was poor; only 49.8% of registrants ever logged steps, and of these, only 45.5% continued beyond the period of the challenge and 16.6% for more than 1 month. Mean (9527 +/- 297, 95% confidence interval) and median (9638) recorded steps per day came close to the target of 10,000 steps; 80.1% of participants reached 10,000 steps at least once and 21.9% did so every time they logged steps. For survey respondents who provided complete data (n = 53), the mean estimated daily steps increased significantly (P < 0.001) from 6401 +/- 884 steps before the program to 9921 +/- 1039 steps at the first survey and then fell back significantly (P = 0.026) to 8727 +/- 1284 steps at the second survey but remained significantly higher than the baseline figure (P < 0.001). The program had immediate effectiveness and was sustainable for a small proportion of participants, but effectiveness was limited by problems with long-term motivation and compliance/adherence.

Sustainability of the Impact of a Public Health Intervention: Lessons Learned From the Laval Walking Clubs Experience

To inform health promotion practice regarding the sustainability of public health interventions, the authors interviewed the directors of 13 new community-based organizations created through a practitioner-initiated public health intervention designed to promote physical activity at the community level. The purpose of the interviews was to uncover the factors that lead organization directors to become involved in the initiative and to maintain their involvement across an extended period of time. Results showed that there were 3 categories of positive outcomes associated with leading a walking club: maintaining and improving health, personal satisfaction, and group motivation. Difficulties associated with directing the club included high participant turnover rates, isolation of club directors, and lack of support from community organizations. Club directors indicated that sustainability would be enhanced through developing individual competencies, becoming more proficient at leading group dynamics, and developing better rootedness in the community. This information is interpreted in light of the six factors associated with sustainability.

The Role of Surveillance in Interventions Directed Against Vector‐Borne Disease

ABSTRACT To analyze the contribution of epidemiological surveillance to the sustainability of public health interventions, programs designed to suppress prevalence of vector‐borne infections are contrasted with those aiming to contain outbreaks of such agents of disease. Suppression programs apply insecticides or drugs according to a predetermined plan, employing surveillance solely for evaluating progress. Containment programs, in contrast, react to epidemiological indicators. Although efforts to suppress prevalence should be time‐limited, reactive programs may be indefinitely sustainable. Alternative epidemiological bases for surveillance are described, including indicators for the basic reproduction number of infections, vectorial capacity, reservoir capacity, entomological inoculation rates (EIR), and transmission indices (TI) based on experience. Although risk of human infection is most reliably estimated as a function of the EIR, interventions are most frequently guided by TI estimates. Because they invest in surveillance rather than application of insecticides or drugs, containment efforts are more sustainable and more conducive to ecosystem health than are programs designed to suppress transmission.