Epidemiology Paper Part Three: Implementation and Evaluation
Epidemiology Paper Part Three: Implementation and Evaluation
Implementation of health promotion activities is important in addressing certain health issues affecting at risk populations. This involves the implementation of evidence-based programs to promote health in certain communities (Yarnell & O’Reilly, 2013). A large number of these programs focus on prevention strategies, which play an important role in addressing some of the infectious diseases. Evaluation of prevention and health promotion activities for an at risk population is part of health reform which is important in determining the outcome of the health promotion activities in terms of costs and its effectiveness in addressing at risk populations (Yarnell ; O’Reilly, 2013). This process is also important in determining the efforts of health workers in achieving healthcare goals and what can be done to improve their practices. Policy makers are also interested in analyzing the effectiveness of certain policies and projects in health promotion, which will enable the policy makers to determine certain areas needing improvements (Yarnell & O’Reilly, 2013).

Public Health Theory to Support the Implementation of the Prevention and Health Promotion Activities
Health promotion is important and plays an important role in addressing some of the external factors outside the health system which contribute to the development of certain health issues for an at risk population. These include socioeconomic factors, demographic factors, and sociopolitical factors (Holzemer ; Klainberg, 2013). At risk, populations can be empowered through health promotion activities as a health strategy to promote a sustainable health system. There are several public health theories, which can be implemented to support the implementation of the prevention and health promotion activities (Holzemer ; Klainberg, 2013). These theories are used in the planning of programs and activities to provide a better understanding regarding human behavior, the implementation, and evaluation of health programs. In selection of a public health theory to guide the implementation of prevention and health promotion activities, there are important factors to be considered (Holzemer ; Klainberg, 2013).
These include the health concern to be addressed, the characteristics of the specific population, and other external factors, which may relate to the program being implemented. It is important to understand the human behavior to be able to implement the suitable intervention in public health (Holzemer ; Klainberg, 2013). This is because of the diverse and complex health systems and needs, which require new ways to address some of the challenges experienced. Social practices are important as they influence the daily life and activities of individuals and are generally shared by a given community, which makes them a good platform in determining the best intervention to implement (Holzemer ; Klainberg, 2013). Social practices also enable a community to use the same resources, which a program may focus on. Some of the theories, which can be used for disease prevention and health promotion programs, include social cognitive theory, the health belief theory, ecological theories, and the transtheoretical theory (Blue, Shove, Carmona, ; Kelly, 2016).
Social Ecological Model
The social ecological model is a theory-based framework, which is aimed at understanding the interaction between individuals and other environmental factors, which determine behaviors (Blue et al., 2016). This model is used for health promotion in a community. A social ecological approach focuses on population in general as well as individual levels as determinants of health and in implementation of health interventions. This involves a community-based intervention, which may include community policies and intrapersonal factors (Blue et al., 2016). This model also determines the relationship between individuals and their environment and the contribution of the environment to the overall health status of a certain population (Blue et al., 2016). The social ecological model helps in understanding the social interactions, which helps in developing an effective communication approach. Identifying and incorporating social norms in program planning and implementation is important in the implementation of prevention and health promotion activities (Blue et al., 2016).

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The communication for development approach, which is used under the social ecological model, is important in supporting behavior and social change, which will improve the effectiveness of any health program implemented within a community system (Blue et al., 2016). The social ecological model has five levels, which include the individual level, interpersonal level, the community level, organizational, and the policy environment. For an effective outcome in the implementation of this model, it is important that all levels of the social ecological model are used (Blue et al., 2016). The individual level involves an analysis on the knowledge, attitudes, ethnic identity, and behaviors of individuals in the certain population while the interpersonal level involves an analysis on the family aspect and social networks that are present in the population (Blue et al., 2016).
The community level involves determining the relationship between the community and other healthcare organizations while the organizational level involves determining the social institutions in the certain locality and their impact on the population (Blue et al., 2016). The last level is the policy environment, which involves determining the national, state, and local laws and their impact on any health programs or activities, which are to be implemented. This also analyses the lack of important policies, which may have an impact on the health status of the population (Blue et al., 2016). This theory is the best to use since in not only focuses on individual factors rather community-based factors, which provides useful information in the implementation of the prevention program. This program also allows the community to be involved in the program implementation where they help in the decision-making process (Blue et al., 2016).
Involvement of the community in this process will promote the development of policies and programs, which will enhance the quality of life for the whole community without the discrimination of certain members of the society (Michie, 2014). This approach also empowers a population especially at risk populations, which might be marginalized and more vulnerable to developing certain diseases (Michie, 2014). This strengthens communities in developing their own capacity to identify their own development needs and assess the available options taking action based on what will best work for them. Any gaps in their actions are also addressed as the community easily identifies them. Interventions should be able to address determinants at all levels, which is different from the traditional theories, which focused on interventions to address the individual level (Michie, 2014).
Community-based programs have become effective strategies in enhancing health with evidence of health programs being initiated to prevent the development of tuberculosis in certain regions (Michie, 2014). Involving the community also helps in member participation, which helps individual in gaining skills in assessing their needs, prioritizing the interventions, and having control over their environment, which empowers the members (Michie, 2014). These members are also able to provide important resources in the implementation of the preventive programs and other important skills, which may be difficult to access. This support from the local community increases the benefits associated with the prevention and health promotion activities and enables the program to be easily accepted by the community (Michie, 2014).
Evidenced-Based Prevention and Health Promotion Activities That Can Be Implemented To Decrease the Health Risk among a Population with No Health Insurance Coverage
At risk, populations are populations with a high probability of developing certain diseases. However, with the implementation of evidence-based prevention and health promotion activities, the development of the diseases can be prevented or reduced (Maville ; Huerta, 2013). The reasons for the development of the diseases may be based on social, cultural, demographic, or the surrounding environment, which must be considered in the development of prevention programs. The risk factors should be identified and their contribution to the development of the disease and how each factor can be addressed (Maville ; Huerta, 2013). Potential obstacles that may hinder the implementation of the prevention and health promotion activities should also be determined and addressed effectively. Evidenced-based prevention and health promotion activities involve scientific evidence, which helps policy-makers in the decision-making process. These activities consider the effectiveness of different programs on different populations and the aspect of cost in implementing certain health programs (Maville ; Huerta, 2013).
These sources are credible and designed to help in planning of programs and activities in achieving certain objectives. One of the evidence-based prevention and health promotion activities that can be implemented to decrease poor health in a population, which has no health insurance coverage, includes improvement of information communication (Maville ; Huerta, 2013). There should be an open communication channel between the populations and healthcare institutions to report the outbreak of an infectious disease promptly which will allow immediate action to be taken by the local administrative healthcare institutions (Maville ; Huerta, 2013). Healthcare insurance should also be availed to this population as this also contributes to the poor health experienced by this population. There are programs, which include the Medicaid program and policies such as the Affordable Care Act, which have implemented measures to ensure everyone has access to health insurance (Maville ; Huerta, 2013).
Health care insurance subsidies can be provided to these populations and public health insurance providers involved in this process to ensure that every individual has access to health insurance (Stanhope ; Lancaster, 2014). Health insurance is important in improving the health status of a high-risk population by enabling the individuals to have access to important healthcare services, which include preventive healthcare services (Stanhope ; Lancaster, 2014). Healthcare providers can be used to conduct campaigns focused on increasing public awareness on the importance of having health insurance (Stanhope ; Lancaster, 2014). Health insurance also enables individuals to have access to quality healthcare services promoting the health of individuals. This is achieved through regular medical checkups at healthcare facilities to be screened for any developing disease and receive information on better living (Stanhope ; Lancaster, 2014).
Access to healthcare services will also help in identifying risk factors, which may contribute to the development of certain diseases and guidelines on preventive measures. Information helpful in disease prevention may include immunization programs and a close relationship with the healthcare provider, which is important in tracking one’s health status (Stanhope & Lancaster, 2014). Health education and training activities also aimed at improving behavior change are also important in preventing behaviors, which can lead to infectious diseases. Some of the diseases, which can be addressed through behavior change, include cardiovascular diseases and diabetes, which can be addressed by an active lifestyle (Stanhope & Lancaster, 2014). Programs aimed at improving the diet of the high-risk population may also improve the health status of the population. Trained healthcare professionals can educate the population on the benefits of behavior change on their health (Stanhope & Lancaster, 2014).

This can involve education on the best diet changes to address any rising diseases related to a poor diet. The high-risk population, which involves poor individuals, may also involve themselves in drug and alcohol related behaviors, which may worsen their health status (Maville & Huerta, 2013). The population can be trained on correct behaviors and how to address any negative behaviors affecting the high-risk population. The program may also include activities aimed at improving the environment, which is a main contributor in the development of certain diseases (Maville & Huerta, 2013). A poor environment can affect the quality of water, air, and food, which is directly related to the environment. Some of the prevention and health promotion activities may involve the restoration and improvement of the environment, which has a direct impact on the health of the high-risk population (Maville & Huerta, 2013).
Evaluation Program to Use in Determining the Efficacy of the Health Promotion Activities and Meeting the Expected Outcomes
The evaluation of the health promotion activities is important in determining the achievement of the expected outcomes. Without evaluation, it is difficult to determine the success of a program in achieving set objectives (Kaur, Prinja, & Kumar, 2014). Evaluation also enables a policy maker to make improvements if the activities are not achieving the desired outcome. Evaluation in disease prevention and health promotion programs are important in providing information on the effectiveness of a program or certain activities aimed at improving the health of a certain population (Kaur, Prinja, & Kumar, 2014). This is done by analyzing the cost, the impact of the activities, and the quality of the program, which determines areas needing improvement by analyzing the implementation of the program according to the desired goals. Evaluation also helps in encouraging community support and provides information to policy-makers as they make policy decisions (Kaur, Prinja, & Kumar, 2014).
Different evaluation programs use different designs and frameworks in assessing the prevention and health promotion programs. One of the evaluation programs to be used in determining the efficacy of the health promotion activities is outcome evaluation (Kaur, Prinja, & Kumar, 2014). Outcome evaluation is important in evaluating the short-term as well as the long-term objectives. This program has measures aimed at demonstrating changes in the health conditions of a particular population, measuring the quality of life, and change in behaviors (Kaur, Prinja, & Kumar, 2014). Outcome evaluation determines the effectiveness of a certain program by analyzing the outcomes against the desired outcomes that the program was meant to achieve. This type of evaluation happens after the program has been implemented in the selected population (Kaur, Prinja, & Kumar, 2014).
The impact that the program is having on the selected target population is analyzed based on specific aspects, which include a change in the environmental factors, which contribute to poor health or the change in the behaviors of the target population (Brown, 2018). If the program is not effective in preventing and reducing the development of certain diseases in this high-risk population, certain adjustments can be done to improve the performance of the programs and promotion activities (Brown, 2018). Outcomes are the changes, which are as a result of the implementation of the promotion activities and may include short-term or long-term outcomes which can be analyzed at different time periods (Brown, 2018). Outcomes are the main drivers of the promotion activities although there are other elements involved, which include the aspect of cost, time, and other resources required in the implementation of the promotional activities (Brown, 2018).
These are the inputs used in the implementation of the promotion activities. Outcome evaluation must also involve the planning stage as well as the implementation stage as they play an important role in setting up realistic evaluation and objectives (Brown, 2018). A new program will have different evaluation objectives compared to an already implemented program. This evaluation program will also determine the relationship between the activities carried out and the outcomes (Brown, 2018). Partnerships can be used to evaluate the health promotion activities, which can include private partners who collaborate and support public programs to improve the population’s health. Having many organizations to support the implementation of programs is essential in providing the necessary resources and support, which will lead to an improved outcome of the program (Brown, 2018).
Blue, S., Shove, E., Carmona, C., ; Kelly, M. (2016) Theories of practice and public health: understanding unhealthy practices, Critical Public Health, 26(1), 36-45.

Brown, H. (2018). The economics of public health: Evaluating public health interventions. Cham: Palgrave Macmillan.

Holzemer, S. P., ;Klainberg, M. B. (2013). Community health nursing: An alliance for health. Burlington: Jones ; Bartlett Learning.

Kaur, M. Prinja, S., ; Kumar, R. (2014). Evaluating the performance of health promotion interventions. Indian journal of medical research. 142(2), 109-112.

Maville, J. A., ; Huerta, C. G. (2013). Health promotion in nursing. Clifton Park, NY: Delmar, Cengage Learning.

Michie, S. (2014). ABC of behavior change theories: (an essential resource for researchers, policy makers, and practitioners: 83 theories). Sutton, Surrey: Silverback publishers.

Stanhope, M., ; Lancaster, J. (2014). Public health nursing: Population-centered health care in the community. Maryland Heights, Missouri: Elsevier Mosby.

Yarnell, J., ; O’Reilly, D. (2013). Epidemiology and prevention: A global approach. United Kingdom: Oxford University Press.


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