Question

• Discuss what possible relationships exist between the effect theory and the selection of interventions for a health program. Include in the discussion a critique of the contribution of program theory to avoiding the failure of interventions. (250 words)

Answer 1

Program theory is conceptual plan about what the program is and how it is expected to work.The comprehensive review of how the program is to work has various names that includes logic model,causal model,program model and action theory.A new health program is for designing an evaluation for a existing health program,understanding and articulating the program theory is essential.

They are two main components:

• Process theory:This theory deals about resources and action is called process theory.
• Effect theory:This theory deals about intervention and outcomes is called as effect theory.

Effect theory: It consist about how the programmatic interventions will affect the casual factors and mediating factors of the health problem and also describe the relationship between the programmatic intervention and long term outcomes for program participants.

They are 3 sets of relationships:

• Casual theory
• Intervention theory
• Impact theory

Casual theory:This theory deals with the existing factors that is mainly caused for health problem and mediating mechanism to cause health problem.

Impact theory:It deals with health impact and desired health outcome.

Intervention theory:This methods used for analysis for making decision related to health problems of intervention effectively in a situation in order to secure desired outcomes.

Types of Interventions: It is considered to be the level of prevention

• Primary prevention: It includes those activities to prevent disease.For example:Getting adequate exercise,having good nutrition,being immunized and wearing seat belts
• Secondary prevention:It involves screening for undiagnosed problems so that a disease can be treated before the symptoms appear.Example:Cholesterol tests,Blood pressure screening,Fecal occult blood tests.
• Tertiary prevention:It involves to limit the extent of an existing disease.Example:Physical rehabilitation after injury,blood pressure medication,stress management.

Type and level of public health:

Typeof intervention	Direct service level	Enabling service	Population level
Treating	Medical procedure,Medication,Tertiary prevention	Respite care,Exercise	Water treatment,Immunization
Assessing	Secondary prevention,Determination of need	Determination of need for assessment	Epidemiological data to identify rate of illness
Coordinating	Care coordination,Client advocacy	Local provider networks and collaboration	System integration,record and data sharing
Monitoring	Follow up	News reports	Trend analysis
Educating	Skill building	Job training program	Media campaigns

To Avoid the failure of intervention:

Steps in development of intervention of public health:

1. Define the problem and its causes: First step in intervention development is clarifying the problem with stake holder using the existing evidence. Health problems are defined and measured such as prevalence of a diagnosed disease in different groups. For example:Unhealthy housing can be attributed to antisocial behavior,poor construction and overcrowding.
2. Clarify which causal factor are malleable and have a greatest scope for change:The next step is to identify which is the underlying factors to shape a problem and have the greatest scope to be changed.Example:Primary prevention(Is it promising to act on the factors that encourage children to start smoking),Secondary prevention(Target existing smokers through smoking cessation)
3. Identify the change mechanism:Example:Modified factor:Poor attachment and parent bonding.Change mechanism:Explaining infant development and parent child interactions
4. Identify and how to deliver the changed mechanism: This step is to helpful to involve the stake holders with the practical expertise to develop implementation plan.It brought through a very limited range of activities for instance of legal change is achieved through legislation. Example: Intervention to be delivered by health visitors and they are available everywhere and senior mangers can allow time for delivery.
5. Test and improve on small scale: Testing can clarify the fundamental issues such as acceptability to the target group,practitioners and deliver organization ,duration,structure;who should deliver it and where training is required and how to maximize population reach.
6. Collect evidence for effectiveness to justify rigorous implementation:The final step to establish evidence for effectiveness to warrant such investment,Inadequate resources often mean practitioners move to wide scale evaluation or implementation