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The Oxford Health Alliance

www.oxha.org. Confronting the Epidemic of Chronic Disease. Community Interventions for Health: Methodology. The Oxford Health Alliance. The Oxford Health Alliance. Community Interventions for Health (CIH).

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The Oxford Health Alliance

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  1. www.oxha.org Confronting the Epidemic of Chronic Disease Community Interventions for Health: Methodology The Oxford Health Alliance The Oxford Health Alliance

  2. 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

  3. 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

  4. 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

  5. Organisation of CIH International CIH management board China India Mexico UK National Local Workplaces Workplaces Workplaces Workplaces Schools Schools Schools Schools Health Centers Health Centers Health Centers Health Centers Neighborhoods Neighborhoods Neighborhoods Neighborhoods

  6. Process system for CIH Inputs for change Knowledge, attitudes and behaviors for healthy eating, physical activity and tobacco use Strategies for change Social marketing Community mobilization Structural change Health education Locus of change Individual Family Community Society Assessment of change Questionnaires Policy reviews Environmental scan

  7. Evaluation • Surveys of adult community sample, workplaces and schools • Biometric data • Process evaluation • Environmental scan

  8. Evaluation: Survey type • Adult community • Adult workplace • Health care workers • School survey (ages 12-16)

  9. 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

  10. Evaluation: research study sample

  11. Biometric measurements • Collected from a sub-sample: • Fasting glucose • Random glucose • Total cholesterol • HDL • LDL • Triglycerides Collected from all participants: • Height • Weight • Waist circumference • Hip circumference • Heart rate • Skin-fold thickness • Blood pressure

  12. 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

  13. Process measures used in CIH

  14. Environmental scanning Streets Stores and kiosks Information Cigarette vending School 400m (0.25m) Street vending Recreationalfacilities Restaurants and food services Parks and gardens

  15. Community Health Environment Scan (CHESS) using GIS Wong et al, Glob Health Action 2011;7:5276-88

  16. GIS mapping – an example Mapping of supermarkets in a town in the UK

  17. Evaluation Analyses - Summary • Comparing intervention vs control communities 2. 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

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