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Planning and Evaluating Clinical Prevention Interventions

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The rigor of science andgraded evidence-based practicesthat address reduction of fall riskfactors (not level of risk) or injuryrisk has gained momentum withinand across health care

However,more needs to be done to addressvariability, duration, and power ofthe research so conclusions aremore generalizable.

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The preventionof chronic disease in populations is a complex challenge. It requires efforts to reduce the biobehavioural risk factors for noncommunicable diseases (NCDs) such as physical inactivity, poor nutrition and smoking, and to consider the social and economic contexts in which health-compromising behaviours occur. NCD prevention programs are ‘complex public health programs’ because of their multiple intervention components, delivery in different settings and prolonged time frames. Evaluation of NCD programs is correspondingly complex. Because of the complexity of NCD risk, and its myriad antecedents and determinants, people working in population-level prevention need to comprehend the complexity of understanding effective programs

This paper describes an organising framework for evaluating comprehensive and complex intervention programs that incorporate a complicated mix of educational, environmental and policy interventions targeting risk factors in a population. The framework includes the measurement and monitoring of each of the intervention components (education, environment and policy), assessment of short-term program impact (such as change in health literacy, implementation of public policy) and assessment of the longer term outcomes (reduced behavioural, social and environmental risk).

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In the health research context, a clinical intervention is described as any intentional action designed to result in an outcome [Schillinger D, 2010]. Thus, clinical interventions establish the magnitude of the effect of an intervention on health related outcomes [Guyatt GH, Oxman AD, 2011]. This effect can be determined through the conduct of individual studies or knowledge syntheses (for example, systematic reviews), and knowledge tools (e.g. guidelines, decision aids, pathways) informed by a synthesis of the best available evidence. Clinical interventions establish effects for specific clinical practices and programs, systems for the delivery of care, and even health related policies or legislation. Therefore, clinical interventions create the research evidence, knowledge [Graham ID, Logan JL, 2011], or, according to Lavis and colleagues the ‘what’ to be implemented. As illustrated in this paper, this can be for example a falls prevention program or stroke rehabilitation guidelines, originating from clinical intervention studies. In clinical research, the aim is generally to evaluate the efficiency or effectiveness of a specific clinical intervention, whereas implementation science considers the effectiveness of strategies to change behaviours, in line with the evidence of clinical effectiveness.

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Usually, an effective evaluation plan is more than a column of indicators added to your program’s work plan. It is a dynamic tool (i.e., a “living document”) that should be updated on an ongoing basis to reflect program changes and priorities over time. An evaluation plan serves as a bridge between evaluation and program planning by highlighting program goals, clarifying measurable program objectives, and linking program activities with intended outcomes.

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Schillinger D. An introduction to effectiveness, dissemination and implementation research. UCSF clinical and translational science institute (CTSI) resource manuals and guides to community-engaged research. San Fransisco: University of California San Francisco; 2010.

Guyatt GH, Oxman AD, Kunz R, Brozek J, Alonso-Coello P, Rind D, et al. GRADE guidelines 6. Rating the quality of evidence--imprecision. J Clin Epidemiol. 2011;

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