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

mbeaudry@phf.org202.218.4415