In public health, most of the interventions are integrated with primary care for broader reach and promoting optimal outcomes for all groups. This report aims to explore four public health interventions that partner with primary care and explore the effectiveness for anyone of the chose intervention. In addition, a plan will be provided for redesigning any one of the intervention and different methods to evaluate public health intervention.
Part A
Four public health interventions that work in partnership with primary care are immunisation programs, healthy lifestyle programs, obesity prevention campaigns and disease screeningprograms.
Immunisation programs are often implemented in collaboration with primary care so that such services are accessible to all people. The national primary healthcare strategies of all countries focus on designing sustainable immunisation programs for the population (Rechel,2020).
Immunisation is one of the public health programs that have a long history. For centuries, people have looked at ways to protect people from threatening diseases and they have taken various approaches to deal with diseases. The history of vaccination dates to the fifteen century when healthy people were intentionally exposed to smallpox. In 1796, Dr Edward Jenner was successful in creating the world’s first successful vaccine for smallpox. Nowadays, most of these programs are being implemented in primary care. The purpose is to move from isolation to mutual awareness, collaboration, partnership, and cooperation (WHO, 2021). In the context of disease surveillance or screening programs, primary care physicians have played an active role in doing comprehensive checks on the population. Hence, the screening program is a work that cannot be initiated without the participation of public health professionals and volunteers. The criteria for the effective screening are that it should be uniformly applied by all primary care practitioners and standard follow-up is needed for positive cases (Speechley et al, 2017).
Primary care is also involved in implementing interventions such as healthy lifestyle programmes, surveillance programs and obesity prevention programs. Primary care performs public health functions, whereas public health can ensure that the provisions of the program are successful. Both often work in coordination with each other to strengthen disease and address community health problems (). One example of a healthy lifestyle program launched in the UK is the ‘Better Health’ campaign. The campaign encourages the population to make healthier choices by losing weight and being physically active. It offers evidence-based guidance to ensure that people achieve a healthy weight (Talbot & Branley-Bell, 2022).
In addition, programs such as healthy lifestyle programs or obesity prevention initiatives
are types of health promotion campaigns. The health promotion campaign was developed during the Ottawa Charter and the term health promotion was first used in 1945 by Henry Siegrist. The Ottawa Charter mandates that the responsibility of public health is not just a mandate for the health sector, but also for physicians, community groups and individuals. Health promotion is one of the important activities for physicians working in primary care settings. Primary care physicians broaden their impact at community, organisational and government levels. Through these roles, they ensure having an impact on the people as well as the primary care to reduce the risk of diseases (Pati et al, 2017).
In addition, screening programs are public health interventions that aim to identify people at risk of a particular condition. It may include campaigns for breast cancer screening or asthma or malnutrition. Some of the screening programs available in the UK are breast screening, bowel cancer screening and diabetes screening. These screening programs are often delivered from primary care settings such as general practice and community care services (Peckham et al, 2017).
The public health interventions (such as screening, lifestyle intervention or disease surveillance programs) aim to promote the identification of people at risk and address all risk factors contributing to diseases. Some of the theories of practice that inform these interventions are Giddens, Bourdieu, Foucault, Heidegger, Wittgenstein and Marx’s theories. These theories have informed social practices linked to the management of diseases (Blue et al, 2016). In addition, capacity building is one of the major roles of public health practitioners. Capacity building is defined as the development of knowledge, skills, commitment, and leadership to enable effective health promotion. Four theories linked to the capacity building are social learning theories, diffusion of innovation, Transformational learning theory and Behaviour Change Theory. Roger’s diffusion of innovation theory states that active two-way linking is needed for resource groups and user groups. Other theories informed tailored public health intervention for the target population group. Among all the models and theories, the Diffusion of Innovation was one of the approaches to disseminate and promote the uptake of innovations (Bergeron et al, 2017).
Various evidence informs the implementation of public health interventions such as disease surveillance or vaccination programs. For instance, seasonal influenza is a major public health concern. It causes 3-5 million cases of severe illness and 650, 000 respiratory deaths per year globally. The seasonal vaccination programme is implemented in such cases to address the need for antiviral treatment. The data from influenza surveillance programs inform local, national, and global burden of disease. The surveillance data informed the development and arrangement of resources. Different countries also look at cost, benefit, and context-specific evidence to inform decisions on vaccination (WHO, 2020). This evidence base informs decision- making on policy issues surrounding influenza vaccination. Various tools are used to collect data on the burden of disease. Some of the common data collection tools are population-based surveys, facility-based data collection and specialized tools for diseases requiring specific tests such as mammograms or others (Norris et al, 2019).
Ethical decision-making in public health involves using a systematic process to identify,
prioritise and justify public health actions based on the ethical principles, values, and beliefs of different stakeholders. For instance, policies such as mandatory immunisation of health workers and school children lead to many ethical concerns. In such a situation, the use of ethical concepts such as informed consent, confidentiality, respect for human rights and scientific integrity is essential. Public health ethics works on the following three main functions: identifying the ethical dilemma, evaluating an alternative course of action and consequences, and resolving the dilemma by balancing principles and values. Based on the application of the above concepts, various issues are resolved. The protection of a patient’s right to privacy and the liberty to use medical procedures may clash with the right to protect against harmful health issues (Klinger et al, 2017). It is recommended that ethics should be incorporated into all steps in public health.
Part B
Here you could have subheadings such as :
From the four public interventions, this section will discuss in more detail about influenza vaccination program in the UK.
The national flu immunisation program is one of the initiatives that have been implemented in England. The primary objective of the program is to provide the best protection against the serious effects of illness. The incidence of flu contributes to great pressure on the NHS in winter. The goal of the programme is to protect those people who are more vulnerable to risks such as children and the elderly.
Approach of delivery: In 2018/2919 the flu immunisation programme was recommended to people above 65 years, pregnant women, carers, children aged 2 and 3 years, those combing under clinical risk groups and health and social care workers.
To improve the success of the program, the public health staff was involved in evaluating vaccine coverage rates. These reports were published weekly and monthly. Some of the steps that were taken to increase vaccination rates included moving vaccination of children from GP to schools, ensuring the availability of flu vaccination for adults through community pharmacies and commissioning maternal care providers to enhance access for pregnant women.
The evaluation of these interventions was done by collecting data on vaccination coverage (Department of Health and Social Care, 2019). The government is revising the plans every year and they are committed to ensuring that the government supports investment in new medical products and vaccines.
Various studies have reported the effectiveness of the influenza vaccine in reducing severe outcomes in patients during the influenza season. The main rationale for prioritizing influenza vaccination is to prevent primary healthcare visits and hospital admission for patients. The author conducted a hospital-based observational study by including patients with reported cases of influenza virus infection. For each reported case of influenza, data on demographic, virological and clinical characteristics were included. Out of 1727 hospitalized patients, influenza vaccination uptake was found to be lower in patients requiring ICU admission. The overall conclusion from the study was that influenza vaccination was effective in decreasing the severity of diseases. Such improvement can lead to positive implications on healthcare costs (Godoy et al, 2018). The study by (Schumacher et al,2021) used the review method to explore different campaign strategies to increase influenza vaccination coverage. The study reported different campaign strategies such as making influenza vaccination mandatory for health care workers, setting deadlines for vaccination, use of declination forms and multifaceted interventions such as education, promotion, or incentives to promote vaccination. Although many of the policies are confronted with opposition, the effectiveness of such policies has been found. It has increased. overall vaccination coverage for the population. Thus, the above evidence justified the effectiveness of implementing an annual influenza vaccination program in the community.
The above discussion gave an idea of the effectiveness of national flu vaccination programs in reducing the burden of influenza. The above intervention can be implemented successfully in our local area too if the local government and the public staff come together to prioritise activities for the success of the vaccination campaigns. Arranging vaccination campaigns will not be enough to ensure full vaccination coverage. This will require a multi-component strategy. such as education of healthcare workers regarding the need for vaccination, use of social media to promote the vaccination campaign and ensuring easy accessibility to influenza vaccination. Educational intervention can effectively increase the uptake of vaccines. Thus, it is recommended to implement an educational program to increase awareness of the benefits of vaccination. Such educational sessions can address hesitancy related to vaccines and increase participation in vaccination campaigns (Opadeyi et al, 2019). In addition, there is a need to promote vaccination through social media campaigns. Such a campaign can further promote adherence to vaccination. Vaccine misinformation is the primary reason behind the poor uptake of vaccines. Social media platforms such as Facebook, Twitter and YouTube can be targeted to promote the vaccination process. Such tools can ensure that the message about vaccination goes to a large audience and the negative impact of vaccination is reduced (Argyris et al, 2022). Thus, using the above strategy, it is possible to achieve the core objective of vaccination campaigns in the local area.
One of the interventions chosen in the report was lifestyle modification programs linked to adult obesity prevention. Thepurpose behind any lifestyle modification program is to reduce the risk factors of obesity and other chronic diseases. Most of the lifestyle modification programs have mostly targeted the eating pattern and physical activity of clients. It involves exposing the individuals to specialised physical activity interventions of a specific duration.
I would redesign the intervention to ensure that it is suitable for people living in low-resource settings. I will design the intervention using the life-course approach. This will enable designing interventions by considering the sociocultural factors of the population. The life course approach ensures maintaining the well- being of people of all ages by ensuring access to health services and safeguarding human rights (Aagaard-Hansen et al, 2019). I have chosen this approach to reduce all barriers that people face while adapting lifestyle interventions. The lif-course approach can ensure meeting the needs of all people at different stages of life. The life-course perspective acknowledges that the needs of individuals evolve over time, and it ensures tailoring the intervention to suit the needs of the population. It can ensure decreasing the gap found in health disparities for the population and tailoring interventions specific to the developmental stage (Jones et al, 2019)
Informed by the life-course approach, it is planned to redesign the intervention and change it from the usual intervention. To make lifestyle intervention more sustainable for the community, it is planned to add personalisation in lifestyle modification programs for the community. This would mean designing physical activity sessions as per the age and context of individuals. For instance, the level of physical activity for a 60-year-old man would be different compared to that of a 30-year-old man. Hence, it is planned to engage in designing different physical activity sessions for different population groups.
One population group that is of interest is preconception or postpartum women. Lack of management of weight in this stage increases the risk of gestational diabetes. The study by (Ku et al, 2022) reported various perceived barriers such as time constraints, lack of knowledge about the impact of obesity, lack of relevant data sources and family culture of individuals. Family culture is a major barrier to taking part in exercise for most of the participants. Their beliefs about health and a healthy lifestyle are influenced by their parent’s mindset about food and exercise. To address these barriers, it is planned to work with families to promote the success of lifestyle programs. It is planned to use different strategies to promote engagement with the group by integrating the feedback process into the intervention.
There are specific purposes for adding personalised feedback sessions in the lifestyle intervention program and promoting goal setting. In the initial stage after the implementation of the lifestyle modification program, mobile health platforms will be used to implement personalised feedback. The participants can be asked to give feedback on the suitability of lifestyle intervention according to their needs. Based on the feedback, health promotion staff can engage in goal setting and modify interventions accordingly. By remodifying the program design, it would be possible to cultivate sustained lifestyle habits in the individual. To achieve success in redesigning the above intervention, collaboration with different expert groups will be required such as health promotion staff, physiotherapists, dieticians, GP, social workers, and policymakers. The study by (Jennings et al, 2021) revealed the success of such programs in a real-world setting. The study implemented the lifestyle program in the UK, and it included feedback sessions. Online feedback was taken from participants. The study revealed the success of the such a program in improving real-work uptake, effectiveness, and program acceptability in the target population group.
The sections discussed about different public health interventions to address the burden of diseases such as immunization, disease surveillance and lifestyle modification programs.
Two methods that can help evaluate influenza immunisation campaigns are impact evaluation and outcome evaluation.
Impact evaluation involves the use of systematic and empirical investigation to evaluate the effect of an intervention. This approach can evaluate the extent to which the outcome experienced by the population was due to the intervention and not any other factors such as environment, political and socioeconomic trends. The impact evaluation can be done using the observation method or by collecting data on the intended outcome. In the context of the vaccination program, impact evaluation will involve measuring the uptake of vaccination and changes in attitude towards vaccination. Some of the health care system data can be useful in conducting such evaluation. For instance, routine data on vaccination uptake in a particular community can give a rich source of information on a large group of patients. Health records are other important tools to evaluate outcomes. The perception or change in attitude can be evaluated by conducting the survey with participants. Based on these surveys, the participant’s perspectives regarding the benefits of vaccination, the experience of side effects and other challenges can be explored (Clarke et al, 2019). This feedback can be useful in understanding the effect of the immunisation program and implementing new changes to make the process effective. Impact evaluation is an appropriate intervention to test improvement in knowledge and behaviour (Gertler et al, 2016). The research shows that online survey or computer assisted interviews with relevant stakeholders can support documenting how the program was delivered, what were the strengths of the program, what were the gaps in the program and what can be done to promote successful outcome in the future. Data from health database, national surveillance data and immunisation register can facilitate implementing above actions.
The second method that can be used to evaluate public health intervention is outcome evaluation. Outcome evaluation can promote evaluating short and long-term outcomes such. as reducing the incidence of diseases. In the context of the influenza vaccination program, outcome evaluation can help determine the impact of vaccines on reducing the rate. and severity of influenza. Such data can be taken to understand the effectiveness of the program, evaluate factors implementing performance and identify new activities that could address the gap in outcomes. The outcome evaluation can be done by obtaining data from immunisation health records, hospital data and data from primary care clinics.
The report gave a summary on the history and characteristics of four public interventions that are implemented in partnership with primary care. The four interventions discussed were disease surveillance program, vaccination program, lifestyle intervention and obesity prevention program. The plan for redesigning vaccination intervention was provided along with a brief description on rationale for redesigning it. The use of life-course approach was suggested to tailor intervention according to the developmental stages of each individual. Lastly, different evaluation methods were suggested to evaluate the outcomes of these interventions.
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