5 Characterizing and Defining the Health Problem الجزء الثاني.pdf

Haddon’s Typology for Analyzing an Event, Using Highway Safety as an Example Agent factors Human factors Physical environment Sociocultural environment Health system environment Pre-event Latency Genetic makeup, motivation, knowledge Proximity, transportation, availability of agent (i.e., al...

Haddon’s Typology for Analyzing an Event, Using Highway Safety as an Example Agent factors Human factors Physical environment Sociocultural environment Health system environment Pre-event Latency Genetic makeup, motivation, knowledge Proximity, transportation, availability of agent (i.e., alcohol or drugs) Norms, policy and laws, cultural beliefs about causes, family dynamics Accessibility, availability, acceptability Event (behavior) Virulence, addictiveness, difficulty of behavior Susceptibility, vulnerability, hardiness, reaction Force Peer pressure Iatrogenic factors, treatments Post-event Resistance to treatment Motivation, resilience, time for recovery Proximity, availability of agent Meaning of event, attribution of causality, sick role Resources and services, treatment options, emergency response Source: Adapted from Haddon, W., Jr. (1972). A logical framework for categorizing highway safety phenomena and activity. Journal of Trauma, 12, 193–207. Cited in D. C. Grossman (2000), The history of injury control andthe epidemiology of child and adolescent injuries. Future of Children, 10(1), 23–52. Quality-of-Life Acronyms and Definitions Acronym Spelled-out form Definition QALYs Quality-adjusted life years # years of life expected at a given level of health and well-being DALYs Disability-adjusted life years # years of life lost from living with a given level of morbidity or disability YLL Years of life lost # years a person is estimated to have remained alive if the disease hadn’t occurred YPLL Years of potential life lost # years of life lost before a specific age (often 65 or 75); assigns additional value to deaths at earlier ages HYE Healthy years equivalent # years in perfect health considered equivalent to a particular health state YHL Years of healthy life # healthy years of life lived, adjusted for health status Descriptive Statistics • Frequency • Mean • Standard deviation, variance • Odds ratio • • • • Relative risk Confidence interval Synthetic estimate Mapping Example Elements for Two Health Problems Required antecedent factors Moderating factors Key causal factors Mediating factors Health problem Health impact Age, existing health conditions, pathogens in environment Adult immunization knowledge, media attention, medical care quality Motivation to be vaccinated, fear of the communicable disease, perceived susceptibility Vaccine supply and distribution, cost Vaccination Preventable hospitalizations Developmental stage, local history of violence, local lack of jobs, state gun laws Parental supervision, school antiviolence program, community action Lack of conflict resolution skills, school dropout rate, local gang activity, gun availability Individual resilience, inadequate policing, quality of emergency care Admissions for gunshot wounds Adolescent death rate due to gunshot wound Relationship of Problem Definition to Program Design and Evaluation Diagnosis Problem Program Evaluation Risk of: Health problem or condition Program goal Outcome variables Among: At-risk population or group, target audience Recipients Intervention group As demonstrated in: Health indicators Program objectives Outcome and impact variables Resulting from causal factors: Specific processes, conditions, and factors Interventions or treatments for the target population Outcome evaluation Relationship of Problem Definition to Program Design and Evaluation, Continued Diagnosis Problem Program Evaluation But is mediated by: Factors that must be present for the health problem to occur Possible intervention Possible control variables Given moderation of the causes by: Factors that increase or decrease the potency of the causative factors Possible intervention Possible control variables And required existing factors of: Sociodemographic characteristics and social ecological factors Program eligibility criteria Control variables or comparison groups BPRS Criteria A B C BPRS factor Size Urgency Severity Economic consequences Willingness or involvement of others Intervention effectiveness Rating scale 1 (small) – 10 (endemic) 1 (not at all) – 10 (extremely urgent) 1 (low) – 10 (high) 1 (low) – 10 (high) 1 (low) – 5 (high) 1 (low) – 5 (high) Factors to consider Stability of incidence or prevalence over time Extent to which QALYs and DALYs are affected; virulence of the problem Healthcare costs; extent to which YLL and YPLL are affected Political support for addressing the problem; popular awareness Resistance to change; entrenchment of contributing factors Prioritization Based on Importance and Changeability Highly important health Less important health problem problem Highly changeable health problem, more effective intervention High priority for developing a program Low priority, unless resources are available for developing a program Less changeable health problem, less effective intervention High priority, if an innovative program can be developed No program development is warranted