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Conducting a Formal Problem Analysis. The Foundation of an Effective Intervention Strategy. Roadmap for this Module. Articulate the rationale for a formal problem analysis Describe the conceptual framework Describe the 6 steps of a formal problem analysis Define terms used. - PowerPoint PPT Presentation
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Conducting a Formal Problem AnalysisThe Foundation of an Effective Intervention Strategy
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Roadmap for this Module Articulate the
rationale for a formal problem analysis
Describe the conceptual framework
Describe the 6 steps of a formal problem analysis
Define terms used
Rationale for a Problem Analysis? In order to identify effective
interventions or strategies, it is necessary to understand the range of underlying factors that can
impact a health outcome, and how they relate to one another
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Why do a Problem Analysis? To assure a rational
allocation of resources To assist in targeting
limited resources to those factors that play the biggest role in causing the problem
To mitigate the risk of allocating resources based on political pressure
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Why do a Problem Analysis, continued Necessary step in developing a problem
statement to use when developing a logic model, and designing and evaluating an intervention
Assists in identification of short, intermediate and longer term objectives
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Steps in a Problem Analysis1. Examine epidemiologic data2. Examine literature and consult
experts3. Determine extent to which these
factors are active in the community4. Determine relative contribution of
each identified factor5. Identify the interrelationships among
factors – causal pathways6. Determine the most effective points
in the causal pathways for intervention
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1. Examining the epidemiologic data How does the rate compare to a
standard? (i.e., reference population) Is the problem increasing or decreasing? Is a particular group more affected than
other groups and why? When does the disease / problem occur? What causes the problem?
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2. Examining the literature and consulting experts To identify causal or risk factors:
Search the Web
Conduct a literature search
Locate a literature search conducted by a reliable source
Invite experts to participate
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3. Determining the extent to which the factors are active in the community Consult with state or local
epidemiologists
Identify studies or results of surveys of the target community
Consult other local agencies or institutions
4. Determining the relative contribution of each identified factor Epidemiologists and other data analysts
use a variety of statistical tests to determine risks associated with particular individual level characteristics or risk factors
Statistical tests answer important questions such as How much more likely to have a low
birthweight infant is a woman who smokes compared to one who doesn’t smoke?
How many low birthweight births are the result of exposure to maternal smoking?
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5. Identifying the interrelationships among factors – causal pathways Determine how identified causal and
risk factors interact to either increase the chances of a negative outcome or to promote a positive outcome
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SECONDARY
TERTIARY
PRIMARY
Mother’s Level of EducationNewcomer statusTransient housing
Barriers to care:LanguageCulturalTransportationFinancialLegal
Families with many childrenParent with alcohol or drug problemDomestic Violence
Chronic Childhood Illness / immunocompromised
Racism / Discrimination PovertyLimited availability of health insurance for the poor
PROBLEM: INADEQUATE IMMUNIZATIONS
Health ProvidersMissed OpportunitiesLack of availability of vaccinesInadequate record keeping
Lack of tracking & reminder / recall systems
Parental non-complianceReligious or philosophical objectionsFear of vaccine side effects
Lack of federal funding for vaccinesManufactures liability fears
Family lack of health Insurance
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SECONDARY
TERTIARY
PRIMARY
Mother’s Level of EducationNewcomer statusTransient housing
Barriers to care:LanguageCulturalTransportationFinancialLegal
Families with many childrenParent with alcohol or drug problemDomestic Violence
Chronic Childhood Illness / immunocompromised
Racism / Discrimination PovertyLimited availability of health insurance for the poor
PROBLEM: INADEQUATE IMMUNIZATIONS
Health ProvidersMissed OpportunitiesLack of availability of vaccinesInadequate record keeping
Lack of tracking & reminder / recall systems
Parental non-complianceReligious or philosophical objectionsFear of vaccine side effects
Lack of federal funding for vaccinesManufactures liability fears
Family lack of health Insurance
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6. Determining the most effective points in the causal pathways for intervention Determine where you would get the
greatest effect Determine whether there have been
well-evaluated interventions Assess the available resources
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Diagramming Critical Pathways to Identify Effective Interventions
Low perceived threat of
communicable diseases
Low Immunizatio
n Rate
INTERVENTION
Parental refusalof vaccine
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Benefits of Using a Problem Analysis Clearly documents the decision-making
process for the group and for others
Can use simplified problem analysis or causal pathway diagram to communicate rationale for intervention strategy to policymakers and the public
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Points to Remember Before selecting an intervention:
Have adequate data relevant to your community;
Identify precursors, protective factors, system barriers and consequences; and
Identify inter-relationships among these factors (causal pathways)
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Using a Problem Analysis in a Group Planning Process
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Process for doing a problem analysis with a planning group Do a brief presentation on the rationale
for the process and what you hope to accomplish
Be clear about how group input will be used or not
Brainstorm precursors Review definition of terms used in a
problem analysis
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Planning Group Process, continued Determine the level at which the
precursors operate Discuss possible linkages between and
among precursors Have quiet time for members to
individually identify one causal pathway Members share and discuss pathways
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Planning Group Process, continued Identify any needs for more information,
e.g., data, data analysis, public health literature, experts
Gather the information and send out Meet again to revise diagram and make
decisions on intervention strategies
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Definition of Terms & Examples
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Definitions: Precursors Factors that have been proven to be
associated with the problem Causal factor Risk factor Systems barriers Protective factors
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Individual Level - Primary Precursors Definition:
Factors that operate on the level of the individual that directly cause the outcome in question (cause/effect should be supported by peer reviewed studies)
OR Factors that increase the risk of an
individual’s likelihood of having the outcome of concern (documented risk)
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Primary Precursors:Examples for Low Immunization Rate Child who is immuno-
compromised
Parental refusal of vaccine due to fear of side effects of vaccination
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Family/Local Community/ Secondary Level Precursors Definition:
Factors that operate at the level of the family or local community or institution(s) that increase an individual’s risk of developing a direct precursor
May include local institutions such as health provider‘s characteristics that are often, but not always, associated with the problem or its determinants
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Secondary Precursor / Risk Factor: Examples of Low Immunization Rate Lack of provider tracking
systems/ reminder calls
Transient housing
Missed opportunities where child has recurrent or chronic heath problems
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Ecological - Tertiary Level Precursors Definition: Factors that are operational at the state
or national level such as cultural, health, social, legal or economic policies
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Ecological - Tertiary Level Precursor: Examples of Low Immunization Rate Poverty National vaccine shortage Lack of available health insurance for
kids
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Consequences Definition: The effects of the problem on
individuals, families and society Can include financial, physical and
psychological effects on the individual, the family or the community
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Consequences:Examples of Low Immunization Rate Parent misses work Loss of herd immunity leading to costly
increase in infections Death or disability for children infected
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Linkages Definition: The association between problem and
precursors Review the literature Consult experts Analyze your data
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Systems Barriers and Protective Factors: Definitions Systems Barriers Attributes of health and other related systems
that are associated with a negative outcome (e.g., lack of health insurance and poor transportation)
Protective Factors Attributes of family, culture, social systems or the
environments associated with a positive outcome (e.g., high rate of literacy and presence of community agencies)
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AcknowledgementsThe slides for this presentation were adapted from work prepared for CityMatCH’s DaTA Institute by:Gerry Oliva, MD, MPHDirector, Family Health Outcomes Project at the University of California at San Franciscohttp://familymedicine.medschool.ucsf.edu/fhop/index.htm
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