Use of Economic Evidence When Prioritising Public Health Interventions in Schools: A Qualitative Study with School Staff

Schools are an ideal setting to deliver public health interventions, yet there are competing obligations that could limit their implementation. This study aimed to examine the decision making process and explore what evidence informs prioritisation of public health interventions in this setting. Semi-structured interviews were conducted with 14 staff in seven UK schools between November 2017 and March 2018. Participants were recruited from schools participating in The Birmingham Daily Mile trial and comprised leadership staff, teachers, and pastoral staff. Analyses used a constant comparison approach to explore the prioritisation process and schools’ use of economic evidence. Teachers felt that they had little decision making influence in regard to public health interventions, with this falling on leadership staff. Participants perceived tension between delivering academic subjects and public health initiatives and thought proven impact was important to justify the opportunity cost. Evidence did not appear to be routinely used, and participants were unaware of cost-effectiveness analyses, but thought it could be a useful tool. This study shows that schools face challenges in balancing the academic, health, and wellbeing needs of children. There is a need for targeted evidence that includes appropriate costs and outcomes and meets school decision makers’ needs.

Download Full-text

Differential impact of non-pharmaceutical public health interventions on COVID-19 epidemics in the United States

10.21203/rs.3.rs-60056/v2 ◽

2020 ◽

Author(s):

Xiaoshuang Liu ◽

Xiao Xu ◽

Guanqiao Li ◽

Xian Xu ◽

Yuyao Sun ◽

...

Keyword(s):

Public Health ◽

United States ◽

Decision Making ◽

The United States ◽

School Closure ◽

Health Interventions ◽

Public Health Interventions ◽

Health Crisis ◽

The Us ◽

Individualized Decision

Abstract Background: The widespread pandemic of novel coronavirus disease 2019 (COVID-19) poses an unprecedented global health crisis. In the United States (US), different state governments have adopted various combinations of non-pharmaceutical public health interventions (NPIs), such as non-essential business closures and gathering bans, to mitigate the epidemic from February to April, 2020. Quantitative assessment on the effectiveness of NPIs is greatly needed to assist in guiding individualized decision making for adjustment of interventions in the US and around the world. However, the impacts of these approaches remain uncertain.Methods: Based on the reported cases, the effective reproduction number (Rt) of COVID-19 epidemic for 50 states in the US was estimated. Measurements on the effectiveness of nine different NPIs were conducted by assessing risk ratios (RRs) between R t and NPIs through a generalized linear model (GLM). Results: Different NPIs were found to have led to different levels of reduction in Rt. Stay-at-home contributed approximately 51% (95% CI 46%-57%), wearing (face) masks 29% (15%-42%), gathering ban (more than 10 people) 19% (14%-24%), non-essential business closure 16% (10%-21%), declaration of emergency 13% (8%-17%), interstate travel restriction 11% (5%-16%), school closure 10% (7%-14%), initial business closure 10% (6%-14%), and gathering ban (more than 50 people) 7% (2%-11%).Conclusions: This retrospective assessment of NPIs on Rt has shown that NPIs played critical roles on epidemic control in the US in the past several months. The quantitative results could guide individualized decision making for future adjustment of NPIs in the US and other countries for COVID-19 and other similar infectious diseases.

Download Full-text

The Impact of Public Health Interventions on The First and Second Waves of COVID-19 in Trinidad And Tobago – A Simple Epidemic Model

Caribbean Medical Journal ◽

10.48107/cmj.2020.12.007 ◽

2020 ◽

Author(s):

Loren De Freitas ◽

Han-I Wang

Keyword(s):

Public Health ◽

Decision Making ◽

Trinidad And Tobago ◽

Specific Treatment ◽

Health Interventions ◽

Public Health Interventions ◽

Support Methods ◽

The Impact ◽

Second Wave ◽

Combined Interventions

Introduction The COVID-19 pandemic has resulted in more than 35 million confirmed cases worldwide. Currently, there is no specific treatment for the disease or available vaccine to reduce the spread of COVID-19. As such, countries rely on a range of public health interventions to assist in halting the spread of transmission. Caribbean countries have also adopted many public health interventions. In this paper, we use mathematical modelling to demonstrate the impact of public health interventions on the progression of COVID-19 in order to provide timely decision support. Methods A cohort Markov model, based on the concept of the SEIR model, was built to reflect the characteristics of the COVID-19 virus. Five possible public health interventions in the first wave and a projection of current second wave were simulated using the constructed model. Results The model results indicate that the strictest combined interventions of complete border closure and lockdown were the most effective with the number of deaths less than ten in the first wave. For the current second wave, it will take around 30 days for the pandemic to pass its peak after implementing the wearing of face masks policy. Conclusions This paper shows the impact of common public health interventions on the COVID-19 pandemic, using Trinidad and Tobago as an example. Such impacts may be useful in reducing delays in decision-making and improving compliance by populations. However, given the limitations associated with mathematical models, decision-making should be guided by economic assessments, infectious disease and public health expertise.

Download Full-text

Differential impact of non-pharmaceutical public health interventions on COVID-19 epidemics in the United States

10.21203/rs.3.rs-60056/v1 ◽

2020 ◽

Author(s):

Xiaoshuang Liu ◽

Xiao Xu ◽

Guanqiao Li ◽

Xian Xu ◽

Yuyao Sun ◽

...

Keyword(s):

Public Health ◽

United States ◽

Decision Making ◽

The United States ◽

School Closure ◽

Health Interventions ◽

Public Health Interventions ◽

The Us ◽

The Impact ◽

Individualized Decision

Abstract The widespread pandemic of novel coronavirus disease 2019 (COVID-19) poses an unprecedented global health crisis. In the United States (US), different state governments have adopted various combinations of non-pharmaceutical public health interventions (NPIs) to mitigate the epidemic from February to April, 2020. Quantitative assessment on the effectiveness of NPIs is in great need to assist in guiding the individualized decision making for adjustment of interventions in the US and around the world. However, the impact of these approaches remain uncertain. Based on the reported cases, the effective reproduction number of COVID-19 epidemic for 50 states in the US was estimated. The measurement on the effectiveness of eight different NPIs was conducted by assessing risk ratios (RRs) between and NPIs through a generalized linear model (GLM). Different NPIs were found to have led to different levels of reduction in. Stay-at-home contributed approximately 51% (95% CI 46%-57%), gathering ban (more than 10 people) 19% (14%-24%), non-essential business closure 16% (10%-21%), declaration of emergency 13% (8%-17%), interstate travel restriction 11% (5%-16%), school closure 10% (7%-13%), initial business closure 10% (6%-14%), and gathering ban (more than 50 people) 6% (2%-11%). This retrospective assessment of NPIs on has shown that NPIs played critical roles on epidemic control in the US in the past several months. The quantitative results could guide individualized decision making for future adjustment of NPIs in the US and other countries for COVID-19 and other similar infectious diseases.

Download Full-text

Media advocacy for policy influence

Oxford Handbook of Public Health Practice ◽

10.1093/med/9780198800125.003.0031 ◽

2020 ◽

pp. 340-347

Author(s):

Simon Chapman ◽

Becky Freeman

Keyword(s):

Public Health ◽

Health Interventions ◽

Public Health Issue ◽

Health Issues ◽

Public Health Interventions ◽

Media Advocacy ◽

Effective Media ◽

Health Initiatives ◽

The Media ◽

Public Health Initiatives

Many public health interventions are controversial or potentially controversial. The way the media handle such issues can strongly influence public and policy-maker attitudes towards them, and effective media advocacy can be a powerful way of taking forward public health initiatives. After reading this chapter, you should have a better understanding of: how the media deal with public health issues; how the framing of an issue influences whether and how it leads to changes in policy; what you can do when a public health issue is framed in an adverse or harmful way.

Download Full-text

More harm than good? Building a framework to identify adverse effects of public health interventions

European Journal of Public Health ◽

10.1093/eurpub/ckaa166.1258 ◽

2020 ◽

Vol 30 (Supplement_5) ◽

Author(s):

J Stratil ◽

K Oliver ◽

P von Philipsborn ◽

A Movsisyan ◽

E A Rehfuess

Keyword(s):

Public Health ◽

Decision Making ◽

Adverse Effects ◽

Adverse Events ◽

Informed Decision ◽

Health Interventions ◽

Decision Makers ◽

Informed Decision Making ◽

Public Health Interventions ◽

Integrate Framework

Abstract Background While the importance of adverse events of medical interventions is widely recognized, adverse effects of public health interventions remain a neglected topic. This project aims to develop a framework to guide researchers and decision-makers to systematically reflect on and identify potential adverse effects of public health interventions. Methods We conducted a mixed-method systematic review of theoretical and conceptual publications on adverse events of public health interventions to develop a preliminary framework employing best-fit framework synthesis. We used the WHO-INTEGRATE framework as a starting point for the synthesis, a multidimensional evidence-to-decision framework developed for complex interventions in complex systems. Results The framework includes two interlinked parts: The first maps domains in which potential adverse events might arise. Drawing on the WHO-INTEGRATE framework, these domains include aspects related to health, but also domains related to societal, economic, and environmental implications. The second part maps general mechanisms through which public health interventions can lead to adverse effects (e.g. reactive behaviour change, increase of labelling and stigmatization, and exposure to environmental risk-factors). Conclusions The framework will be advanced in the second phase of the project through empirical studies of harmful effects in public health interventions, which we will identify through an overview of systematic reviews. Adverse effects of public health interventions are currently not sufficiently considered in research and practice. Taking them into account is essential for informed decision-making and establishing appropriate countermeasures. Our framework could be a valuable asset for researchers and policy makers in developing, implementing and evaluating public health interventions. Key messages Awareness of the adverse effects of public health interventions is essential for informed decision-making and establishing countermeasures. This framework supports researchers and decision-makers in systematically reflecting on and identifying adverse events when developing, piloting, implementing or evaluating public health interventions.

Download Full-text

Some mathematical tools for modelling malaria: a subjective survey

BIOMATH ◽

10.11145/j.biomath.2021.10.029 ◽

2021 ◽

Vol 10 (2) ◽

pp. 2110029

Author(s):

Jacek Banasiak ◽

Rachid Ouifki ◽

Woldegebriel Assefa Woldegerima

Keyword(s):

Public Health ◽

Decision Making ◽

Confidence Interval ◽

Mathematical Modelling ◽

South African ◽

Health Interventions ◽

Design Strategies ◽

Public Health Interventions ◽

The Past ◽

Challenges And Opportunities

In this paper, we provide a brief survey of mathematical modelling of malaria and how it is used to understand the transmission and progression of the disease and design strategies for its control to support public health interventions and decision-making. We discuss some of the past and present contributions of mathematical modelling of malaria, including the recent development of modelling the transmission-blocking drugs. We also comment on the complexity of the malaria dynamics and, in particular, on its multiscale character with its challenges and opportunities. We illustrate the discussion by presenting a curve fitting using a 95% confidence interval for the South African data for malaria from the years 2001-2018$ and provide projections for the number of malaria cases and deaths up to the year 2025.

Download Full-text

Differential impact of non-pharmaceutical public health interventions on COVID-19 epidemics in the United States

BMC Public Health ◽

10.1186/s12889-021-10950-2 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Xiaoshuang Liu ◽

Xiao Xu ◽

Guanqiao Li ◽

Xian Xu ◽

Yuyao Sun ◽

...

Keyword(s):

Public Health ◽

United States ◽

Decision Making ◽

The United States ◽

School Closure ◽

Health Interventions ◽

Public Health Interventions ◽

Health Crisis ◽

The Us ◽

Individualized Decision

Abstract Background The widespread pandemic of novel coronavirus disease 2019 (COVID-19) poses an unprecedented global health crisis. In the United States (US), different state governments have adopted various combinations of non-pharmaceutical public health interventions (NPIs), such as non-essential business closures and gathering bans, to mitigate the epidemic from February to April, 2020. Quantitative assessment on the effectiveness of NPIs is greatly needed to assist in guiding individualized decision making for adjustment of interventions in the US and around the world. However, the impacts of these approaches remain uncertain. Methods Based on the reported cases, the effective reproduction number (Rt) of COVID-19 epidemic for 50 states in the US was estimated. Measurements on the effectiveness of nine different NPIs were conducted by assessing risk ratios (RRs) between Rt and NPIs through a generalized linear model (GLM). Results Different NPIs were found to have led to different levels of reduction in Rt. Stay-at-home contributed approximately 51% (95% CI 46–57%), wearing (face) masks 29% (15–42%), gathering ban (more than 10 people) 19% (14–24%), non-essential business closure 16% (10–21%), declaration of emergency 13% (8–17%), interstate travel restriction 11% (5–16%), school closure 10% (7–14%), initial business closure 10% (6–14%), and gathering ban (more than 50 people) 7% (2–11%). Conclusions This retrospective assessment of NPIs on Rt has shown that NPIs played critical roles on epidemic control in the US in the past several months. The quantitative results could guide individualized decision making for future adjustment of NPIs in the US and other countries for COVID-19 and other similar infectious diseases.

Download Full-text

How heuristics and cognitive biases affect vaccination decisions

Cadernos de Saúde Pública ◽

10.1590/0102-311x00136620 ◽

2020 ◽

Vol 36 (suppl 2) ◽

Author(s):

Paula Mendes Luz ◽

Paulo Nadanovsky ◽

Julie Leask

Keyword(s):

Public Health ◽

Decision Making ◽

Cognitive Biases ◽

Public Health Intervention ◽

Social Processes ◽

Judgment And Decision Making ◽

Health Interventions ◽

Public Health Interventions ◽

Parental Compliance ◽

Vaccination Decision

Abstract: Immunization, the most successful public health intervention to date, can only be effective if eligible individuals or their legal representatives have access to vaccines and subsequently comply with their use. Under-vaccination stems from multiple causes: access, affordability, awareness, acceptance and activation. In this paper, we focus on acceptance and, specifically, on factors pertaining to individual or parental compliance, specifically the psychology of judgment and decision making. We describe how heuristics and cognitive biases - a facet of thoughts and feelings - affect vaccination decision making. Additionally, we address when and how social processes play a role and how attitudes towards vaccines might reflect a more general underlying attitude or ideology. The understanding of how decision making, with regards to vaccines occurs, and the role played by heuristics and cognitive biases can help inform more appropriate public health interventions.

Download Full-text

A review of the quantitative effectiveness evidence synthesis methods used in public health intervention guidelines

BMC Public Health ◽

10.1186/s12889-021-10162-8 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Ellesha A. Smith ◽

Nicola J. Cooper ◽

Alex J. Sutton ◽

Keith R. Abrams ◽

Stephanie J. Hubbard

Keyword(s):

Public Health ◽

Decision Making ◽

Evidence Synthesis ◽

Meta Analysis ◽

Public Health Intervention ◽

Health Intervention ◽

Health Interventions ◽

Synthesis Methods ◽

Public Health Interventions ◽

Guidance Documents

Abstract Background The complexity of public health interventions create challenges in evaluating their effectiveness. There have been huge advancements in quantitative evidence synthesis methods development (including meta-analysis) for dealing with heterogeneity of intervention effects, inappropriate ‘lumping’ of interventions, adjusting for different populations and outcomes and the inclusion of various study types. Growing awareness of the importance of using all available evidence has led to the publication of guidance documents for implementing methods to improve decision making by answering policy relevant questions. Methods The first part of this paper reviews the methods used to synthesise quantitative effectiveness evidence in public health guidelines by the National Institute for Health and Care Excellence (NICE) that had been published or updated since the previous review in 2012 until the 19th August 2019.The second part of this paper provides an update of the statistical methods and explains how they address issues related to evaluating effectiveness evidence of public health interventions. Results The proportion of NICE public health guidelines that used a meta-analysis as part of the synthesis of effectiveness evidence has increased since the previous review in 2012 from 23% (9 out of 39) to 31% (14 out of 45). The proportion of NICE guidelines that synthesised the evidence using only a narrative review decreased from 74% (29 out of 39) to 60% (27 out of 45).An application in the prevention of accidents in children at home illustrated how the choice of synthesis methods can enable more informed decision making by defining and estimating the effectiveness of more distinct interventions, including combinations of intervention components, and identifying subgroups in which interventions are most effective. Conclusions Despite methodology development and the publication of guidance documents to address issues in public health intervention evaluation since the original review, NICE public health guidelines are not making full use of meta-analysis and other tools that would provide decision makers with fuller information with which to develop policy. There is an evident need to facilitate the translation of the synthesis methods into a public health context and encourage the use of methods to improve decision making.

Download Full-text

Selecting Review Outcomes for Systematic Reviews of Public Health Interventions

American Journal of Public Health ◽

10.2105/ajph.2020.306061 ◽

2021 ◽

Vol 111 (3) ◽

pp. 465-470

Author(s):

Luke Wolfenden ◽

Ani Movsisyan ◽

Sam McCrabb ◽

Jan M Stratil ◽

Sze Lin Yoong

Keyword(s):

Public Health ◽

Decision Making ◽

Systematic Reviews ◽

End Users ◽

Health Interventions ◽

Public Health Interventions ◽

Core Outcome Sets ◽

Public Health Decision ◽

Health Decision Making ◽

Health Decision

For systematic reviews to have an impact on public health, they must report outcomes that are important for decision-making. Systematic reviews of public health interventions, however, have a range of potential end users, and identifying and prioritizing the most important and relevant outcomes represents a considerable challenge. In this commentary, we describe potentially useful approaches that systematic review teams can use to identify review outcomes to best inform public health decision-making. Specifically, we discuss the importance of stakeholder engagement, the use of logic models, consideration of core outcome sets, reviews of the literature on end users’ needs and preferences, and the use of decision-making frameworks in the selection and prioritization of outcomes included in reviews. The selection of review outcomes is a critical step in the production of public health reviews that are relevant to those who use them. Utilizing the suggested strategies may help the review teams better achieve this.

Download Full-text