Psychology of prevention and health promotion: Planning, Implementation,
Dissemination (lesson3)
+ Zie artikels van Atkins & Michie (apart document)
AIMS
Explain different approaches (verschillende benaderingen) to using evidence in preventive interventions;
Gain understanding (inzicht krijgen) in the different steps of planning a preventative intervention, using the
“intervention mapping” approach;
Understanding elements of implementation (and dissemination).
THE IMPORTANCE OF PLANNED WORK AND ITS STEPS
Working in a planned manner is important – need to apply existing planning models
Necessary steps:
- Analysis of the problem
- Development of the intervention
- Evalution
CAUTIONS: WHY WE SHOULD CAREFULLY PLAN AND IMPLEMENT AN INTERVENTION
POTENTIAL PITFALLS TO AVOID
Problem level:
- Preventing a problem that is not important/widespread.
Intervention level:
- Changing the “wrong” behavior
- Target the wrong group
- Target the wrong determinants
- Intervention/determinants do not fit
Implementation level:
- Incorrect uptake
- Uninformative evaluation (evaluate wrong outcomes): evaluation should be
appropriate for the goals
EXAMPLE: The healthy marriage initiative: A cautionary tale
Shows the need for empiricism in policy implementation, why we first need evidence
- Idea behind:
• About 20 year ago, there was an increasing interest in the role of marital status
and relationship quality in poor socio-economic and health outcomes
• Evidence: ethnicity is associated to marital and family status - in family at poverty levels, 51% not married
• Marriage has advantages on health and socio-economic status (therefore divorce should be prevented)
• Economic and health impact of divorce
• Then: evidence-based programs implemented to improve relationship satisfaction
- The implementation
• Broad implementation across the US (across administrations, starting with Clinton as a way to prevent
poverty) => President of US was big supporter of this
• $100 M/Year 2007-2012 ➔ spent a lot of money
o Discretionary service grants (79%), demonstration (10%), research/evaluation (2%), training/
technical assistance (6%), program support (3%)
- Evaluation of the healthy marriage initiative (Results were disappointing (no difference: experimental –
controlgroups)
• Limited use of evidence-based approaches
• Sampling bias: they did not reach the intended audience (other concerns, no focus on marital problems…)
• Implementation on a target group on which no knowledge was available => mostly white, middle class ppt
(cannot be generalized)
, EVIDENCE BASED PRATICE
It’s about balances science, values and clinics
- Clinical expertise: without, practice risks becoming tyrannized by evidence, for even
excellent external evidence may be inapplicable to/ inappropriate for an individual ptn
- Best scientific evidence: without, practice risks becoming rapidly out of date, to the
determent of patients
How to produce synthesis:
• Methodologically solid research: PICO [Method to formulate/evaluate a research
question, often used in systematic reviews]
o Patients: who were they?
o Intervention: What intervention was applied, based on which theory?
o Comparison: Which condition was the group compared (placebo, other intervention..)?
o Outcome: How defined and operationalized?
• Systematic: search strategy should be complete and transparent
o Need for precise criteria in the search for articles you want to include
• Transparent
• Correct: systematic/ transparent evaluation of evidence
• Informative: information about magnitude of the effect & quality of evidence
- Patient values, characteristics, obstacles…:
• Even excellent evidence might still be inappropriate for certain (group of) patients
• Evidence cannot be interpreted separately from the target group: need for a fit
FROM THE SYNTHESIS TO THE RECOMMENDATION
SYNTHESIS OF EVIDENCE
- 1) Select outcomes: PICO & rate importance of several outcomes
- 2) Investigate all the outcomes withing panel group (academics, funders, stakeholders…)
- 3) Rate quality of each outcome: high, moderate, low, very low (see Tabel 5.1)
- 4) Use GRADE system to grade the overall quality of evidence
RECOMMENDATION based on evidence that is out there
- Grade recommendations: evidence recommendations – for/against & strong/
weak – quality evidence
Dissemination (lesson3)
+ Zie artikels van Atkins & Michie (apart document)
AIMS
Explain different approaches (verschillende benaderingen) to using evidence in preventive interventions;
Gain understanding (inzicht krijgen) in the different steps of planning a preventative intervention, using the
“intervention mapping” approach;
Understanding elements of implementation (and dissemination).
THE IMPORTANCE OF PLANNED WORK AND ITS STEPS
Working in a planned manner is important – need to apply existing planning models
Necessary steps:
- Analysis of the problem
- Development of the intervention
- Evalution
CAUTIONS: WHY WE SHOULD CAREFULLY PLAN AND IMPLEMENT AN INTERVENTION
POTENTIAL PITFALLS TO AVOID
Problem level:
- Preventing a problem that is not important/widespread.
Intervention level:
- Changing the “wrong” behavior
- Target the wrong group
- Target the wrong determinants
- Intervention/determinants do not fit
Implementation level:
- Incorrect uptake
- Uninformative evaluation (evaluate wrong outcomes): evaluation should be
appropriate for the goals
EXAMPLE: The healthy marriage initiative: A cautionary tale
Shows the need for empiricism in policy implementation, why we first need evidence
- Idea behind:
• About 20 year ago, there was an increasing interest in the role of marital status
and relationship quality in poor socio-economic and health outcomes
• Evidence: ethnicity is associated to marital and family status - in family at poverty levels, 51% not married
• Marriage has advantages on health and socio-economic status (therefore divorce should be prevented)
• Economic and health impact of divorce
• Then: evidence-based programs implemented to improve relationship satisfaction
- The implementation
• Broad implementation across the US (across administrations, starting with Clinton as a way to prevent
poverty) => President of US was big supporter of this
• $100 M/Year 2007-2012 ➔ spent a lot of money
o Discretionary service grants (79%), demonstration (10%), research/evaluation (2%), training/
technical assistance (6%), program support (3%)
- Evaluation of the healthy marriage initiative (Results were disappointing (no difference: experimental –
controlgroups)
• Limited use of evidence-based approaches
• Sampling bias: they did not reach the intended audience (other concerns, no focus on marital problems…)
• Implementation on a target group on which no knowledge was available => mostly white, middle class ppt
(cannot be generalized)
, EVIDENCE BASED PRATICE
It’s about balances science, values and clinics
- Clinical expertise: without, practice risks becoming tyrannized by evidence, for even
excellent external evidence may be inapplicable to/ inappropriate for an individual ptn
- Best scientific evidence: without, practice risks becoming rapidly out of date, to the
determent of patients
How to produce synthesis:
• Methodologically solid research: PICO [Method to formulate/evaluate a research
question, often used in systematic reviews]
o Patients: who were they?
o Intervention: What intervention was applied, based on which theory?
o Comparison: Which condition was the group compared (placebo, other intervention..)?
o Outcome: How defined and operationalized?
• Systematic: search strategy should be complete and transparent
o Need for precise criteria in the search for articles you want to include
• Transparent
• Correct: systematic/ transparent evaluation of evidence
• Informative: information about magnitude of the effect & quality of evidence
- Patient values, characteristics, obstacles…:
• Even excellent evidence might still be inappropriate for certain (group of) patients
• Evidence cannot be interpreted separately from the target group: need for a fit
FROM THE SYNTHESIS TO THE RECOMMENDATION
SYNTHESIS OF EVIDENCE
- 1) Select outcomes: PICO & rate importance of several outcomes
- 2) Investigate all the outcomes withing panel group (academics, funders, stakeholders…)
- 3) Rate quality of each outcome: high, moderate, low, very low (see Tabel 5.1)
- 4) Use GRADE system to grade the overall quality of evidence
RECOMMENDATION based on evidence that is out there
- Grade recommendations: evidence recommendations – for/against & strong/
weak – quality evidence
