The Oxford Health Alliance The Oxford Health Alliance Community Interventions for Health:...

The Oxford Health AllianceThe Oxford Health Alliance www.oxha.orgThe Oxford Health AllianceThe Oxford Health Alliance www.oxha.org

Community Interventions for Health: Methodology

Confronting the Epidemic of Chronic Disease

The Oxford Health AllianceThe Oxford Health Alliance www.oxha.org

Community Interventions for Health (CIH)

• CIH is the largest and most comprehensive multinational collaborative study for community interventions ever undertaken

• The long-term goal of the CIH study is to create sustainable interventions that prevent and control the leading chronic diseases by addressing the three main risk factors

• CIH aims to develop, evaluate and showcase sustainable interventions in addressing tobacco use, unhealthy diet and physical inactivity in communities


Study design

• CIH took place in 3 communities in Hangzhou City in China, Kerala in India and Mexico City

• Non-randomised, controlled study using population approach

• Two panel, cross-sectional study with assessment at baseline and after 18-24 months of intervention

• Intervention and comparison sites selected with similar population size, socio-demographic profile and with geographical separation


Methods

• Each country identified an intervention and control area with similar socio-economic status

• Baseline data about tobacco use, diet and physical activity were collected from a sub-sample in each area using lifestyle questionnaires

• Biometric data were collected from a stratified sub-sample• Environmental scans were conducted to assess the effect of

the local environment on health• Interventions were delivered in four main settings: schools,

workplaces, neighbourhoods and health centres• Interventions lasted 2 years, and follow-up data were

collected post-intervention


Organisation of CIH

CIH management board

International

National

Local

China India Mexico UK

NeighborhoodsHealth Centers

Workplaces Schools


Workplaces Schools


Workplaces Schools


Workplaces Schools


Process system for CIH

Knowledge, attitudes and behaviors for healthy eating, physical activity and tobacco use

Inputs for change

Locus of change

Assessment of change

Health education

Social marketing

Community mobilization

Structural change

Strategiesfor change

Individual Family Community Society

QuestionnairesEnvironmental scan Policy reviews


Evaluation

• Surveys of adult community sample, workplaces and schools

• Biometric data• Process evaluation• Environmental scan


Evaluation: Survey type

• Adult community• Adult workplace• Health care workers• School survey (ages 12-16)


Evaluation: Survey process

• Translation and back-translation• Cultural adaptation• Piloting and feedback based on samples of 200• Adult community sample - randomized selection of

households and then KISH method within households to select participant

• Adult community surveys administered by trained paraprofessionals/professionals

• All other surveys were self-administered on-site at schools and workplaces


Evaluation: research study sample

Survey sample per country site

Neighbourhood Schoolchildren

Workplaces (including industry, health centres, and schools)

Health care providers(doctors and nurses)

TOTAL

Intervention site 1,000 2,000 2,700(1,000, 1000, 700)

400 6,100

Control site 1,000 2,000 2,700(1,000, 1000, 700)

400 6,100

SAMPLE AGGREGATE

2,000 4,000 5,400 800 12,200


Biometric measurements

Collected from all participants:• Height • Weight • Waist circumference • Hip circumference• Heart rate• Skin-fold thickness• Blood pressure

Collected from a sub-sample:• Fasting glucose • Random glucose • Total cholesterol • HDL • LDL• Triglycerides


Process evaluation

Process evaluation examines the internal workings of the program and includes questions such as:• What is delivered in reality?• Where are the gaps between design and delivery?• Examining factors such as:

Who: the program recipients and staff What: activities, behaviours materials When: frequency and length of intervention Where: community context and physical setting How: strategies for operating the intervention


Process measures used in CIHStructu

ral Interventions

The number and types of structural change implemented in environment and policies

Health Educat

ion

The number of and level of attendance at health education programs across workplaces, schools and neighborhoods

The number of and level of attendance at health professional training for adopting standardization of risk factor assessment and advice

Community

Coalition

Building

Strength of community coalition Community readiness to change Key stakeholder engagement including number of collaborative meetings and

calls, involvement of specific types of partners, and tasks needed to achieve buy-in, ensure follow-through and maintain partnership for successful data collection and intervention delivery

Media The types, distribution coverage, and placement of social marketing media


Environmental scanning

400m (0.25m)

Information

Streets Stores and kiosks

Cigarette vending

Street vending

Restaurants and food services

Parks and gardens

Recreationalfacilities

School


Community Health Environment Scan (CHESS) using GIS

Wong et al, Glob Health Action 2011;7:5276-88


GIS mapping – an example

Mapping of supermarkets in a town in the UK

Evaluation Analyses - Summary

1. Comparing intervention vs control communities2. Pre and post assessment of individual behaviour change: – Surveys for prevalence of risk factors– Site-specific surveys allowing integration of relevant

issues in each site– Physical and biological measurement

3. Community changes in environment and policy – Document review– Environmental scans– Key informant interviews– GIS mapping and environmental scans

The Oxford Health Alliance The Oxford Health Alliance Community Interventions for Health:...

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