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Transcript of The Oxford Health Alliance The Oxford Health Alliance Community Interventions for Health:...
The Oxford Health AllianceThe Oxford Health Alliance www.oxha.orgThe Oxford Health AllianceThe Oxford Health Alliance www.oxha.org
Community Interventions for Health: Methodology
Confronting the Epidemic of Chronic Disease
The Oxford Health AllianceThe Oxford Health Alliance www.oxha.org
Community Interventions for Health (CIH)
• CIH is the largest and most comprehensive multinational collaborative study for community interventions ever undertaken
• The long-term goal of the CIH study is to create sustainable interventions that prevent and control the leading chronic diseases by addressing the three main risk factors
• CIH aims to develop, evaluate and showcase sustainable interventions in addressing tobacco use, unhealthy diet and physical inactivity in communities
The Oxford Health AllianceThe Oxford Health Alliance www.oxha.org
Study design
• CIH took place in 3 communities in Hangzhou City in China, Kerala in India and Mexico City
• Non-randomised, controlled study using population approach
• Two panel, cross-sectional study with assessment at baseline and after 18-24 months of intervention
• Intervention and comparison sites selected with similar population size, socio-demographic profile and with geographical separation
The Oxford Health AllianceThe Oxford Health Alliance www.oxha.org
Methods
• Each country identified an intervention and control area with similar socio-economic status
• Baseline data about tobacco use, diet and physical activity were collected from a sub-sample in each area using lifestyle questionnaires
• Biometric data were collected from a stratified sub-sample• Environmental scans were conducted to assess the effect of
the local environment on health• Interventions were delivered in four main settings: schools,
workplaces, neighbourhoods and health centres• Interventions lasted 2 years, and follow-up data were
collected post-intervention
The Oxford Health AllianceThe Oxford Health Alliance www.oxha.org
Organisation of CIH
CIH management board
International
National
Local
China India Mexico UK
NeighborhoodsHealth Centers
Workplaces Schools
NeighborhoodsHealth Centers
Workplaces Schools
NeighborhoodsHealth Centers
Workplaces Schools
NeighborhoodsHealth Centers
Workplaces Schools
The Oxford Health AllianceThe Oxford Health Alliance www.oxha.org
Process system for CIH
Knowledge, attitudes and behaviors for healthy eating, physical activity and tobacco use
Inputs for change
Locus of change
Assessment of change
Health education
Social marketing
Community mobilization
Structural change
Strategiesfor change
Individual Family Community Society
QuestionnairesEnvironmental scan Policy reviews
The Oxford Health AllianceThe Oxford Health Alliance www.oxha.org
Evaluation
• Surveys of adult community sample, workplaces and schools
• Biometric data• Process evaluation• Environmental scan
The Oxford Health AllianceThe Oxford Health Alliance www.oxha.org
Evaluation: Survey type
• Adult community• Adult workplace• Health care workers• School survey (ages 12-16)
The Oxford Health AllianceThe Oxford Health Alliance www.oxha.org
Evaluation: Survey process
• Translation and back-translation• Cultural adaptation• Piloting and feedback based on samples of 200• Adult community sample - randomized selection of
households and then KISH method within households to select participant
• Adult community surveys administered by trained paraprofessionals/professionals
• All other surveys were self-administered on-site at schools and workplaces
The Oxford Health AllianceThe Oxford Health Alliance www.oxha.org
Evaluation: research study sample
Survey sample per country site
Neighbourhood Schoolchildren
Workplaces (including industry, health centres, and schools)
Health care providers(doctors and nurses)
TOTAL
Intervention site 1,000 2,000 2,700(1,000, 1000, 700)
400 6,100
Control site 1,000 2,000 2,700(1,000, 1000, 700)
400 6,100
SAMPLE AGGREGATE
2,000 4,000 5,400 800 12,200
The Oxford Health AllianceThe Oxford Health Alliance www.oxha.org
Biometric measurements
Collected from all participants:• Height • Weight • Waist circumference • Hip circumference• Heart rate• Skin-fold thickness• Blood pressure
Collected from a sub-sample:• Fasting glucose • Random glucose • Total cholesterol • HDL • LDL• Triglycerides
The Oxford Health AllianceThe Oxford Health Alliance www.oxha.org
Process evaluation
Process evaluation examines the internal workings of the program and includes questions such as:• What is delivered in reality?• Where are the gaps between design and delivery?• Examining factors such as:
Who: the program recipients and staff What: activities, behaviours materials When: frequency and length of intervention Where: community context and physical setting How: strategies for operating the intervention
The Oxford Health AllianceThe Oxford Health Alliance www.oxha.org
Process measures used in CIHStructu
ral Interventions
The number and types of structural change implemented in environment and policies
Health Educat
ion
The number of and level of attendance at health education programs across workplaces, schools and neighborhoods
The number of and level of attendance at health professional training for adopting standardization of risk factor assessment and advice
Community
Coalition
Building
Strength of community coalition Community readiness to change Key stakeholder engagement including number of collaborative meetings and
calls, involvement of specific types of partners, and tasks needed to achieve buy-in, ensure follow-through and maintain partnership for successful data collection and intervention delivery
Media The types, distribution coverage, and placement of social marketing media
The Oxford Health AllianceThe Oxford Health Alliance www.oxha.org
Environmental scanning
400m (0.25m)
Information
Streets Stores and kiosks
Cigarette vending
Street vending
Restaurants and food services
Parks and gardens
Recreationalfacilities
School
The Oxford Health AllianceThe Oxford Health Alliance www.oxha.org
Community Health Environment Scan (CHESS) using GIS
Wong et al, Glob Health Action 2011;7:5276-88
The Oxford Health AllianceThe Oxford Health Alliance www.oxha.org
GIS mapping – an example
Mapping of supermarkets in a town in the UK
Evaluation Analyses - Summary
1. Comparing intervention vs control communities2. Pre and post assessment of individual behaviour change: – Surveys for prevalence of risk factors– Site-specific surveys allowing integration of relevant
issues in each site– Physical and biological measurement
3. Community changes in environment and policy – Document review– Environmental scans– Key informant interviews– GIS mapping and environmental scans