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					Analysis of the Health
Problem
List the Direct and Indirect
Causes of each subproblem

Direct Cause :
The immediate cause of the health
 problem

Indirect Cause:
Factor that has an effect on a direct
 cause
To prepare the list of causes
answer these questions

   Does the health problem have a biological
    source?
   What behavioral factors add to the problem?
   What environmental factors add to the
    problem?
   What policies or lack of policies add to the
    problem?
   What barriers to health or healthy behavior
    exist?
   What resources are lacking?
Developing an Etiology Chart

   It is a visual representation of the
    relationship between direct and indirect
    causes of the health problem.
   Charting a health problem’s causes can
    help figure out the most appropriate
    subgroup to receive the focus of your
    effort and resources
To better understand the direct and
indirect causes of the health problem ,
you should examine several types of
data
   Mortality and morbidity data
   Behavioral data
   Causal data
   Social marketing, health promotion and
    behavioral theories
   Consensus statements and
    recommendations
Sources of health Status
Indicators

   Vital records
   Hospital records
   Primary care records
   Reportable disease statistics
   Accident reports
   Data registries
   Reports and surveys in the international and
    national literature
   Interviews
   Questionnaires and focus groups
      You can describe the problem
      in more details by answering
      these questions:
   Who is affected?
   In what ways are people affected?
   What general health, environmental
    or social conditions are connected to
    the problem?
   How common is the problem?
   How severe is the problem?
Describing the Problem

   Population affected by the problem
   Ways that the population are affected
   How often the problem occurs
   Severity of the problem
   Type(s) of the problem
   How the problem is viewed by different
    groups
Describing the Problem
(continued)

   Where the problem occurs
   History/origin of the problem
   Collection of the original data using
    various methods (focus group, in-depth
    interviews, small inexpensive surveys)
     Collection of Information that
     Already Exists on the Problem

   Trends
   Policy history
   National surveys
   Reports from studies
   Information from epidemiologists
   Reports from various ministries
   Possible partners who know about the
    problem ( foundations, associations)
   Agencies , institutions and
    organizations who know about the
    problem
Determine Subgroups Affected by
the Problem

   Population that seem to be most
    affected or at high risk for the health
    problem (large ,different enough)
   Health care providers and institute
   Decision makers
Differences in Subgroups Based
on

   Demographics: age, gender, race,
    education income
   Geography: residence , place of work
   Belief systems: attitudes, opinions,
    intentions, beliefs, values, cultural
    characteristics
   Time: the season of the year during
    which most people experience the
    problem
       Describe each subproblem in
       more details by answering
       these questions:
   Who is affected? What makes each
    subgroup different?
   How are members of each subgroup
    affected?
   What general health, environmental
    or social conditions are connected to
    the sub problem?
   How common is the subproblem?
   How severe is the sub problem?
   Where does the sub problem exist
    geographically?
   When and where does the sub problem
    start?
   What trends are related to the sub
    problem?
   Will you address the sub problem for each
    subgroup?
   Are there other groups ? Who are?
      Prioritize and select sub
      problems that need
      intervention
   Identify the most significant sub
    problems that you consider to be
    important health problems needing
    intervention. Consider behaviors,
    biology, and the social and physical
    environment in your review of
    subproblems.
Prioritize and select subproblems
that need intervention (cnt’d)

   Create a short list of the most important sub problems
   Identify a list of criteria for setting priorities
      Size of the health problem
      Seriousness of the health problem
      Effectiveness of related interventions
      Community concern
      Lost output
      Medical costs to treat the health problem
      Preventable aspects of the problem
      Emerging aspects of the problem
      Disability associated with the problem
      Current access to needed service
    Writing goals for each subproblem

   A goal is a general statement of what you
    want to do and is the "grand reason" for
    your intervention. For example, a goal could
    be to raise the awareness of thirty percent of
    the general public to the benefits of vitamin
    A. Goals do not have a deadline and usually
    refer to long-range plans. Objectives have
    specific deadlines.
   In writing your goals, use specific verbs
    such as "improve," "increase," "promote,"
    "protect," "minimize," "prevent," and
    "reduce."
Focus Groups: Face to Face
Focus Groups: Face to Face


   Description
   This tool is a qualitative method of data collection
    wherein a skilled moderator facilitates discussion on
    a selected topic among 6 to 10 respondents,
    allowing them to respond spontaneously to the
    issues raised. Focus groups held in person usually
    last for 60 to 90 minutes per session. For focus
    group research to be most valuable, the moderator
    must go over the research topics, establish an
    environment in which all points of view are
    welcome, and follow up on unexpected but
    potentially valuable topics that are raised.
Focus Groups: Face to Face


   When focus groups are conducted in
    person, participants and the moderator
    gather, usually around a table.
    Observers (members of the research
    team) sit behind a one-way mirror or
    unobtrusively back from the table and
    take notes. Groups may also be
    recorded by audio or videotape.
Focus Groups: Face to Face
   Pros
   Interaction in the group can help elicit in-depth
    thought and discussion
   Considerable opportunity to probe answers
   Can yield richer data than surveys about the
    complexities of thoughts and behavior
   In-person groups give moderator more opportunity
    to read nonverbal cues and use nonverbal cues to
    control the flow of discussion than in telephone
    focus groups
   Rapport can be fostered more easily among in-
    person groups than telephone groups
Focus Groups: Face to Face

   Cons
   Findings not generalizable
   Respondents may be concerned about
    lack of anonymity
   Can be labor intensive and expensive,
    especially if groups are conducted in
    multiple locations
Focus Groups: Face to Face
   Common Uses
   Explore complex topics with target audience
    prior to program (e.g., what helps/hinders
    healthy eating)
   Learn about feelings, motivators, past
    experiences related to a health topic
   Test concepts, messages, materials, and
    artwork
   Can generate and test hypothesis
Expert Review
Expert Review


   Description
   An analysis of program material or
    approaches is performed by individuals who
    are particularly knowledgeable in a content
    area. Reviews may check such issues as
    scientific and technical accuracy or cultural
    appropriateness. Reviews may be
    individuals such as medical research
    scientists, social workers, law enforcement
    officials, teachers, or community leaders.
Expert Review


   Pros
   Inexpensive
   Can help obtain support or "buy in" for
    your program
Expert Review


   Cons
   Risk of experts seeking to take over or
    radically change program plans.
   Can be challenging to reconcile
    differing viewpoints
Expert Review

   Common Uses
   Input prior to program design form experts
    in a health field or who have experience
    working with your target audience.
   Ensure that your messages are scientifically
    accurate
   Test program materials (e.g., ensure
    materials are culturally appropriate)
In-depth Personal Interviews
In-depth Personal Interviews


   Description
   A qualitative data collection method
    involving less rigid question structure
    and interviewing style than quantitative
    methods.
In-depth Personal Interviews

   Pros
   Can explore long or complex draft material
   Can be effective with those of lower literacy
   Allows considerable opportunity to probe
    answers
   Allows for intensive investigation of
    individual thought, opinions, and attitudes
In-depth Personal Interviews
   Cons
   Time consuming
   Requires level of trust between interviewer and
    respondent, especially when dealing with sensitive
    or threatening material
   Interviewer must be highly skilled in active listening,
    probing, and other interviewing skills
   Interviewer must be knowledgeable about and
    sensitive to a respondent's culture or frame of
    reference
    CDC Director’s Challenge
    Interview Guide

   1. From what you observed as a(n)
    (Administrator/Center Director/Division
    Director/Branch Chief) what are some effects do
    you think the Challenge had? (e.g., was it
    unifying, did it instill team spirit, was it
    disruptive?)
   2. What do you see as the benefits for CDC and
    CDC personnel of conducting the Challenge?
   3. What do you see as the drawbacks for CDC
    and CDC personnel of conducting the
    Challenge?
CDC Director’s Challenge
Interview Guide
   4. What changes, if any, did you notice among
    those you supervise that you think were related
    to the Challenge? (include both positive and
    negative changes)
   --What effects did you observe the Challenge to
    have on people’s physical activity levels?
   --Would you say the productivity and
    performance of those you supervise were
    affected by the Challenge? In what way?
   5. Thinking specifically of people who were
    team leaders and center coordinators...what
    impact, if any, did you observe their Challenge-
    related responsibilities to have on them and
    their daily work performance?
In-depth Personal Interviews

   Common Uses
   Develop concepts or messages
   Test long or complex draft materials
   Conduct a needs assessment
Survey By Interviewer
    Survey By Interviewer: Face
    To Face

   Description
   A trained interviewer asks survey questions
    of respondents. Allows respondent to ask for
    clarification and allows interviewer to control
    question sequence. One-on-one, in-person
    interview is used to collect information on
    knowledge, attitudes, and/or behaviors.
Survey By Interviewer: Face To
Face

   Pros
   Generalizable results (if sufficiently large,
    probability sample with high response rate)
   Appropriate for those of lower literacy
   Useful with difficult-to-reach populations (e.g.
    homeless, low literacy) or when target audience
    cannot be sampled by using other data collection
    methods
   Interview available to clarify questions for
    respondent and probe answers
   Decreased likelihood of incomplete questionnaires
Survey By Interviewer: Face To
Face

   Cons
   Can be more labor intensive than self-
    administered or telephone data
    collection
   Less appropriate for sensitive or
    threatening questions (respondents
    may not answer truthfully in person)
Survey By Interviewer: Face To
Face

   Common Uses
   Obtain baseline data
   Determine message's reach, attention-
    getting ability
   Acquire self-reported information on
    behaviors, behavioral intentions,
    attitudes
   Test knowledge, comprehension

				
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