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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

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

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


Study design

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


Methods

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


Organisation of cih

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


Process system for cih

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


Evaluation

Evaluation

  • Surveys of adult community sample, workplaces and schools

  • Biometric data

  • Process evaluation

  • Environmental scan


Evaluation survey type

Evaluation: Survey type

  • Adult community

  • Adult workplace

  • Health care workers

  • School survey (ages 12-16)


Evaluation survey process

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


Evaluation research study sample

Evaluation: research study sample


Biometric measurements

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


Process evaluation

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


Process measures used in cih

Process measures used in CIH


Environmental scanning

Environmental scanning

Streets

Stores and kiosks

Information

Cigarette vending

School

400m (0.25m)

Street vending

Recreationalfacilities

Restaurants and food services

Parks and gardens


Community health environment scan chess using gis

Community Health Environment Scan (CHESS) using GIS

Wong et al, Glob Health Action 2011;7:5276-88


Gis mapping an example

GIS mapping – an example

Mapping of supermarkets in a town in the UK


Evaluation analyses summary

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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