Chapter 8: Gathering Evidence For Public Health Practice ✓ Solved

Chapter 8 Gathering Evidence For Public Health Practicecop

Chapter Highlights

Epidemiologic/public health research defined

Observational studies: Descriptive versus analytical research

Strengths and limitations of epidemiologic research methodology

Applying epidemiologic research to public health nursing practice

Question #1 Is the following statement true or false? In descriptive studies, the researcher relies on comparisons between groups to determine the role of various risk factors in causing the problem. Answer to Question #1 False. Rationale: In analytical studies, the researcher relies on comparisons between groups to determine the role of various risk factors in causing the problem. In descriptive studies, the researcher collects information to characterize and summarize the health event or problem.

Epidemiologic Research Epidemiologic/public health research can be descriptive or analytical. Study designs are based on the problem under study and range in strength on a continuum, with the weakest design being the retrospective design and the strongest being the experimental design.

Observational Studies In descriptive studies, the researcher collects information to characterize and summarize the health event or problem. In analytical studies, the researcher relies on comparisons between groups to determine the role of various risk factors in causing the problem.

Descriptive Studies Descriptive studies are most frequently used in public health research. They may be observational or analytical: Case studies, Survey research, Cross-sectional studies: examine the relationship of health-related characteristics and other variables of interest in a defined population at a particular point in time. Analytical Studies Cohort studies, also called longitudinal studies, examine phenomena prospectively to observe presumed effects over time. Case–control studies retrospectively compare subjects (cases) with a condition (disease) and matched subjects/control without the condition/disease.

Advantages: Allow for the examination of multiple exposures for a single outcome, suitable for studying rare diseases and those with long latency periods, require fewer case subjects, generally quicker, less expensive, and well suited for outbreak investigation.

Disadvantages: Not appropriate for rare exposures, subject to bias because of the method used to select controls, do not allow direct measure of incidence.

Question #2 Is the following statement true or false? Cohort studies involve an in-depth analysis of an individual, group, or social institution. Answer to Question #2 False. Rationale: Case studies involve an in-depth analysis of an individual, group, or social institution. Cohort studies, sometimes referred to as prospective studies, are longitudinal studies, which monitor subjects over time to find associations between risk factors and health outcomes.

Question #3 Is the following statement true or false? Case–control studies, also known as prospective studies, work backward from the effect to the suspected cause. Answer to Question #3 False. Rationale: Case–control studies, also known as retrospective studies, work backward from the effect to the suspected cause. Cohort studies, sometimes referred to as prospective studies, are longitudinal studies, which monitor subjects over time to find associations between risk factors and health outcomes.

Intervention (Experimental) Studies Preventive trials, Therapeutic trials.

Question #4 Is the following statement true or false? Intervention study is the epidemiologic investigation designed to test a hypothesized relationship by modifying an identified factor in a population. The study is preventive. Answer to Question #4 False. Rationale: Intervention study is the epidemiologic investigation designed to test a hypothesized relationship by modifying an identified factor in a population. Studies may be therapeutic (clinical) or preventive.

Quasi-experimental and Experimental Design Quasi-experimental and experimental designs are used to examine causality. The “gold standard” for research design is the randomized, control group design.

Question #5 Is the following statement true or false? The “gold standard” for research design is the randomized, experimental group design. Answer to Question #5 False. Rationale: The “gold standard” for research design is the randomized, control group design.

Chapter 9: Planning for Community Change Chapter Highlights #1 Health planning at the state, national, and global levels Social and environmental determinants of health Social ecologic model and multilevel interventions Community coalitions.

Chapter Highlights #2 Health impact pyramid Health equity and social justice Lewin’s change theory, force field analysis, and levers of change Logic models Role of the community health worker.

Chapter Highlights #3 Funding community health interventions Evaluating community health interventions Nurse-managed health centers.

Question #1 Is the following statement true or false? Health planning occurs on both an ongoing and an episodic basis. Answer to Question #1 True. Rationale: The timing of health planning depends on the responsibilities of the planning agency, the type of assessment data, and the nature of the health problem.

Health Planning Organized and systematic process in which problems are identified, priorities selected, and objectives set for the development of community health programs based on the findings of community health assessments and health surveillance data.

Common Themes Common themes of current national and international health plans include providing health promotion and disease prevention at the population level, addressing social determinants of health, and achieving health equity.

Levels of Health Planning Global National and state levels Healthy People 2020 National Prevention Strategy State Departments of Public Health Community Health Improvement Planning Process Systematic process that involves all sectors of a community to conduct a comprehensive community health assessment (CHA), identify priorities for action, develop and implement a community health improvement plan (CHIP), and guide future community decisions and resource allocations.

Community Assessment Systematic process that may use several approaches including key informant interviews, analysis of data on health status and health behavior indicators, observation, and community surveys.

Systems Theory Social systems engage in reciprocal exchange or flows of information, energy, resources, and goods or services. Systems within the community are interdependent and interconnected.

Working With the Community Defining the population of interest Coalitions Stakeholders and opinion leaders.

Social Ecologic Model Based on general systems theory and health promotion theory Multiple determinants of health interact at different levels to affect the health status of individual people, population aggregates, or communities.

Question #2 Is the following statement true or false? The purpose of using levers of change is to decrease driving forces and/or to increase restraining forces. Answer to Question #2 False. Rationale: The purpose of using levers of change is to increase driving forces and/or to decrease restraining forces.

Health Impact Pyramid Useful framework for community health nurses when planning health promotion interventions at multiple levels.

Multilevel Interventions Multilevel interventions are needed to achieve change in complex community health conditions that have multiple determinants.

Social Determinants of Health Obesogenic and salutogenic environments Health impact assessment Health disparities, health equity, and social justice Community empowerment model Change Theory Lewin’s Model of Change Unfreezing Changing Refreezing Force Field Analysis Force field analysis is a tool used to identify the forces driving or restraining change.

Levers of Change The purpose of using levers of change is to increase driving forces and/or to decrease restraining forces.

Public policies such as tax increases on tobacco, alcohol, or soft drinks can serve as policy levers to bring about change in community health status.

Community Readiness for Change Planning programs or interventions to change community health status include an assessment of the community’s readiness to undertake the change process related to a specific health issue.

Planning Community-Level Interventions Guide to community preventive services Logic model SMART objectives Collaboration and Teamwork Community health workers can help bridge the gap between the community health nurse and the community, especially when there are cultural and language differences.

Nurses can play an important role in their professional and personal lives as advocates and champions for health improvement, social justice, and health equity at the local, regional, national, and global levels.

Evaluating Community-Level Interventions Develop evaluation questions. Determine indicators or measures you will use to answer your evaluation questions. Identify where you will find the data you need to measure your indicators and answer your questions. Decide what method you will use to collect data. Specify the time frame for when you will collect data.

Plan how you will analyze your data based on the type of data you are using. Decide how you will communicate your results.

Funding Community-Level Intervention Programs Accountability Sustainability Program replication.

Project funding Government Private Local Community Benefit Programs Community benefit programs of local or regional hospitals and HMOs may be valuable partners to the public health department or community health nurse in planning, implementing, and funding programs to improve population health.

Social Marketing Use of marketing principles and practices to change health behaviors or beliefs, social or cultural norms, or community standards to improve health or benefit society.

Nurse-Managed Health Centers Nurse-managed health centers provide health promotion and primary care services to vulnerable and underserved population aggregates.

Paper For Above Instructions

In the field of public health, gathering evidence is paramount to implementing effective interventions and improving community health. Epidemiologic research serves as a cornerstone for understanding health outcomes and risk factors. This paper will explore various study designs used in public health research, focusing on their strengths, limitations, and applications in practice.

Epidemiologic research can be categorized into two main types: descriptive and analytical. Descriptive epidemiologic studies provide initial insights into health phenomena by summarizing health events and their characteristics without making direct comparisons between groups (Berkman et al., 2015). In contrast, analytical studies are instrumental in identifying relationships between risk factors and health outcomes, relying on comparisons across different populations (Gordis, 2014). Understanding these distinctions is vital for public health practitioners who aim to base their interventions on robust evidence.

Among descriptive studies, case studies and cross-sectional studies are prevalent. Case studies offer in-depth insights into unique health events or phenomena, while cross-sectional studies allow researchers to examine health-related characteristics across diverse populations at a single point in time (Last, 2012). For analytical studies, cohort and case-control designs are widely used. Cohort studies track individuals over time to identify potential risk factors influencing health, thus facilitating a prospective understanding of disease dynamics (Hernán et al., 2017). Conversely, case-control studies provide retrospective insights by comparing individuals with a specific health outcome to those without it (Schmidt & Kohlmann, 2008). Each design has implications for the validity and reliability of findings, which public health practitioners must critically assess in their work.

Experimental designs, including randomized control trials (RCTs), represent the gold standard in epidemiologic research. RCTs assess the effectiveness of interventions by randomly assigning participants to experimental and control groups (Friedman et al., 2010). These studies are particularly valuable in evaluating public health interventions, as they minimize bias and enhance the generalizability of findings (Sibbald & Roland, 1998). However, the complexity and ethical considerations surrounding RCTs can pose challenges in certain public health contexts.

Utilizing these various methodologies requires an understanding of their respective advantages and limitations. For example, descriptive studies are essential for hypothesis generation and initial exploration but may lack depth in causal inference (Berkman et al., 2015). Analytical designs, while offering more rigorous insights, can be confounded by biases in data collection and interpretation (Hernán & Robins, 2006). The ability to discern these nuances equips public health professionals to select appropriate methodologies tailored to their specific research questions and intervention needs.

Furthermore, the application of these research findings in public health nursing practice is crucial for implementing evidence-based interventions. For instance, the integration of epidemiologic research into community health assessments informs the development of targeted health programs that address identified needs and priorities. By leveraging the strengths of various study designs, practitioners can systematically investigate and respond to pressing public health issues in their communities (Murray et al., 2013).

Health planning represents another critical aspect of public health practice, focusing on strategies to improve community health outcomes. Effective health planning requires a systematic process to identify health problems, set priorities, and allocate resources accordingly (Institute of Medicine, 2012). Community assessments play a foundational role in this process by collecting data and involving stakeholders to ensure comprehensive consideration of the population's needs.

Another essential consideration in health planning is understanding the interplay between social determinants of health and health equity. The social ecologic model emphasizes multiple levels of influence on health, highlighting the importance of addressing systemic factors that contribute to health disparities (McGowan et al., 2018). Public health interventions must therefore be designed to operate across various societal levels, promoting health equity and reducing disparities.

Throughout the planning process, collaboration with community stakeholders is vital. Engaging coalitions and leaders amplifies the voices of those affected by health issues, fostering a more inclusive approach to public health interventions (Wallerstein, 2006). This engagement not only enhances the relevance of interventions but also increases community readiness for change, ensuring that proposed solutions align with community priorities and capacities (Snyder et al., 2019).

In conclusion, gathering evidence through epidemiologic research and applying it in health planning are integral components of public health practice. By understanding the strengths and limitations of various study designs, practitioners can make informed decisions that ultimately enhance population health. The interplay between research, community engagement, and health equity underscores the necessity for a comprehensive approach to public health interventions.

References

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• Gordis, L. (2014). Epidemiology. Elsevier Health Sciences.
• Hernán, M. A., & Robins, J. M. (2006). Estimating causal effects from epidemiological data. Journal of Epidemiology & Community Health, 60(7), 578-584.
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• Institute of Medicine. (2012). For the public's health: The role of metrics in the CDC's priorities. National Academies Press.
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