Health improvement / health promotion Flashcards
Outline a strategy to …. e.g. improve health? (what steps)
- Assess need and identify stakeholders (context and cultural relevance)
- Identify targets and best practice
- Conduct gap analysis
- Review evidence to fill gaps
- Prioritise interventions (political, professional, public, price, published evidence)
- Implementation
- Evaluation and monitoring
What are the steps in the audit cycle?
- Score audit and identify data sources and outcomes
- Identify best practice (e.g. NICE guidance)
- Assess current performance against best practice (data source? e.g. notes)
- Findings - share with stakeholders
- Make and share recommendations?
- Monitoring, evaluation and re-audit
Ensure legal and governance principles followed
What are the steps in an evaluation?
Should be planned prior to implementation!
- Scope and agree public health input and timelines (identify and involve stakeholders) - Donebedian (structure, process, output, outcome)
- Agree targets / criteria for evaluation (clinical, financial, performance) - should be SMART
- Measure performance against standards (data sources?)
- Make recommendations and share
- Ongoing monitoring and evaluation
Not legal and governance principles
What steps are required in responding to a disease or environmental outbreak?
Risk assessment:
1. Establish the facts (is it really an outbreak, what is the source)
2. If confirmed, convene outbreak control group (including all relevant stakeholders)
3. -Descriptive epidemiology - number of cases - people, person time - epidemic curve
-Microbiology / sampling, interviews, etc.
-Environment (source, pathway, recptor)
4. Establish case definition and clinical diagnosis
5. Establish hypothesis and test using study
Risk management
6. Communications
7. Source removal / management (chemoprophylaxis, hand washing etc., contact tracing, environmental)
8. Stand down outbreak control (x2 incubation cycles)
9. Ongoing surveillance and monitoring
What are the components of a health needs assessment?
- Scope and agree public health input (population, aims, stakeholders, resources, risks)
- Assess the needs of the population concerned (prevalence, fingertips)
- Assess current service provision
- Gap analysis (national guidance, benchmarking(
- Findings
- Recommendations (evidence based, what works elsewhere) and priorities - interventions should be prioritised that have a high health burden, with effective and evidence based interventions
- Change (change management process)
- Ongoing monitor and review
Consider inequalities
Describe different levels of intervention for health promotion? (Nuffield ladder)
- Do nothing
- Provide information
- Enable choice
- Guide choice (though changing default)
- Guide choice (through incentives)
- Guide choice (through disincentives)
- Restrict choice
- Eliminate choice
What are the key principles of health promotion and what factors can contribute to its success?
-Increase uptake of beneficial (evidence based) interventions
-Harm reduction of risky lifestyle behaviours
Key to success:
-Clear national strategy
-Local coordination
-Accountability / ley lead agency
-Clear commitment and funding
-Partnership working
-Monitoring and evaluation systems
What are the key steps for a health impact assessment?
- Ascertain the facts (where is the potential hazard?, who is concerned? who is the responsible authority? results of impacts assessments to date?)
- Decide if public health input needed and in what regard (personal/professional? conflicts of interest? Independent advice? scope? (can only advise on public health))
- Obtain and interpret relevant and available data and information to inform findings
- Make recommendations
- Facilitate implementation
- Monitor and review
Wider considerations: wider impacts political considerations, legislation, conflicts of interest, communication, team stressors
Describe a framework for tobacco control
MPOWER
Monitor use
Protect people (smoke free venues)
Offer support
Warn about dangers
Enforce bands
Raise taxes
What are the key steps in outbreak communications?
- Acknowledge
- Reassure
- General public health message (e.g. hand washing)
Outline the risk management process?
Hazard identification
1. Dose response assessment (based on research)
2. Exposure assessment (field measurements)
Risk management
1. Evaluation of risk (compared to standards)
2. Communication (of risk) so neither frightened or apathetic
3. Control / prevention (including legislation) - source, secondary prevention, person
4. Monitoring (of risk)
Practical steps:
Find out more about incident
Form interdepartmental team (key members?)
-Designate spokesperson
-Consider demographics e.g. elderly, young
-Think about legislative changes
Describe the steps to response to a disease outbreak?
- confirm outbreak exists (comparison with expected)
- Confirm diagnosis (specimins)
- case definition (time, person, place, symptoms)
- Count cases
- Describe data
- Generate hypothesis
- Test hypothesis
- Control / prevention measures
- Communication / report
Name some barriers to screening uptake?
-Cultural / religious beliefs
-Role of women in society
-Social class
-Access
-Service barriers (language difficulties)
-Mis/disinformation
-Educational levels and understanding
Describe a health promotion framework?
Tannahill (venn diagram):
- Health education
-importing knowledge
-changing attitudes
-altering behaviour - Disease prevention
-primary prevention (preventing the disease in the first place e.g. vaccination, lifestyle)
-secondary prevention (early detection of disease e.g. screening, drugs)
-tertiary prevention (minimise disability if cannot be cured) - Health protection
-National / government: legislation (seat belts) or fiscal (taxes)
-Local/community - environmental control (work environment, speed ramps near school, hygiene regulations in restaurants)
-Individual - cycle helmets for children
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What are the steps of the life course approach?
Prenatal, preschool, school age, working age, retirement age
