Sara Karrar MBBS MPH CIH Intervention Coordinator

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Sara Karrar MBBS MPHCIH Intervention Coordinator
Confronting the Epidemic of Chronic Disease

• Reducing Chronic Disease Through Risk Management
• Innovative Partnerships and Action

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Oxford Health Alliance (OxHA) message

• Three risk factors cause four chronic diseases
  (diabetes, heart disease, many cancers and
  chronic lung disease) that cause well over half
  of deaths worldwide.
• The risk factors are
• Tobacco use Lack of physical
  activity Poor diet

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OxHA mission

• We are about preventing and reducing the global
  impact of chronic disease.
• We stand for innovative action with diverse
  stakeholders around three risk factors smoking,
  physical inactivity and diet.

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OxHA innovations in chronic disease prevention
control

• Industry inclusion as collaborators in the
  conversation
• 3FOUR50 website dedicated online social
  networking site
• Grand Challenges priority setting
• Community Interventions for Health (CIH)
  inclusion of community coalitions and profiles

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Collaboration

• The Oxford Health Alliance (OxHA) is confronting
  this global epidemic of chronic disease.

OxHA enables experts and activists from different
backgrounds to collaborate in order to raise
awareness and change behaviours, policies and
perspectives about the epidemic of chronic
disease at every level of society.
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Online communities using new media

• www.3FOUR50.com - 3 risk factors four chronic
  diseases over 50 of deaths worldwide.
• An opportunity for people from different target
  audiences to connect and collaborate to create
  a healthier future.
• An awareness-raising, action-based online social
  network where people can build online coalitions
  and share their experience, success stories and
  research.

www.oxha.org
www.3FOUR50.com
www.cih.net
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CIH part of the solution

• CIH Community Interventions for Health is the
  action arm of the Oxford Health Alliance.
• CIH addresses both the risk factors for chronic
  disease and the barriers to change.
• It is a multinational collaborative
  study(developing and developed countries) to
  address unhealthy diet, physical inactivity and
  tobacco use.

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CIH objectives

• 1) To examine the effectiveness of comprehensive,
  community-wide interventions that address
  policy, environment, and economic changes, as
  well as population knowledge and skills, to
  support
• a reduction in tobacco use
• an increase in physical activity level
• an increase in healthy food consumption
  behaviours
• a reduction in hip/waist ratio, BP, cholesterol,
  glucose level

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CIH objectives

• 2) To examine the relative effectiveness of these
  comprehensive, community-wide interventions by
  assessing
• cross-cultural differences
• implementation fidelity

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CIH focus

• On the individual level the focus will be changes
  in knowledge, attitude, and behaviour as well as
  changes in physical/biological risk factors.
• On the local level, the focus will be on changes
  in policies and environments.
• Targeting structural (policy, environment,
  economic) changes as part of a comprehensive
  approach in neighbourhoods, schools, workplaces,
  and health centres is a primary strength of the
  CIH study.

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Settings strategies

• Four settings of the comprehensive intervention
  approach
• Neighbourhoods
• School
• Workplaces
• Health centres
• Four strategies for change
• Community coalition-building
• Structural interventions
• policy, environmental, economic
• Health education
• Social marketing

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Comprehensive Approach
Comprehensive approach
CIH is about individual behavioural change
through policy and environmental changes. Making
the healthy choices the easy choices.
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Types of structural interventions

• Neighbourhoods
• Health assessments at community events
• Affordable and accessible fruit and vegetables
• Smoke-free policies
• Healthy food choices at stores, restaurants and
  at events
• Safe routes for walking and bicycling (addressing
  active transport)
• Including addressing the built environment for
  where people shop, eat and play

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Types of Structural Interventions
Types of structural interventions

• Schools
• Affordable healthy food and drink in cafeterias
  and vending machines
• 30 minutes of physical activity a day, three
  times per week
• Advertisement-free schools
• Enhanced health curricula

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Types of structural interventions

• Workplace
• Healthy and affordable food in vending machines
  and cafeterias
• Use of healthier oils in food preparation
• Health risk assessments and smoking-cessation
  programmes
• Incentives for participation in on-site and
  off-site physical activity
• Point-of-contact prompts
• Smoke-free workplaces

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Types of Structural Interventions
Types of structural interventions

• Healthcare settings
• Smoke-free hospitals with healthy food options
• Lifestyle-tracking for patients
• Incentives and training for providers to screen
  for and prevent chronic disease
• Social marketing
• Using social marketing to influence demand
• Billboards, signs, posters to encourage healthy
  lifestyles

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CIH Globally
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Evaluation methodology

• Intervention and Comparison Community
• Intervention units selected as similar to
  comparison units on SES, rural/urban status, and
  cultural/ethnic factors
• Pre- and Post Assessments
• Individuals
• Surveys
• Physical and Biological Measurements
• Policy and Environment
• Environmental scans
• Key informant interviews
• GIS mapping
• Process evaluation (on-going)

Ongoing Process Evaluation
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Evaluation Indicators
Evaluation indicators

• Intervention versus control and pre-post
• D Behavioural determinants
• e.g. consumption patterns
• D Biometric measures
• e.g. BMI, blood pressure
• D Behavioural risk factor prevalence
  (self-reported)
• Policy implementation
• e.g. environmental changes within community
  settings
• Economic factors
• e.g. affordability/availability/accessibility of
  healthy options

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Innovation Environmental Scan
Innovation environmental scan
0.25 mile (or 400m) radius
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Evironmental scan
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End products of CIH

• A comprehensive international database of
  intervention processes and outcomes
• A best-practice roadmap of guidance to address
  chronic disease risk factors
• Research articles to further the field in risk
  factor reduction and chronic disease prevention

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Importance of CIH
Importance of CIH

• Comprehensive community interventions are rare
  (particularly in developing countries)
• Structural interventions work
• Need for best practice research
• CIH includes an extensive evaluation component
  including both process and outcome evaluation
• Cross cultural comparisons

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CIH Investigators Pilot Initiative
Investigators Pilot initiative

• OxHA Board Stig Pramming, MD, Executive
  Director of the Oxford Health Alliance
• Christine Hancock, RN, Director, Oxford Health
  Alliance
• Sara Karrar, MBBS MPH, Intervention Coordinator,
  Oxford Health Alliance
• Beatriz Champagne, PhD, Executive Director of the
  InterAmerican Heart Foundation
• KR Thankappan, MD, Professor and Head of Achutha
  Menon Centre for Health Science Studies of Sree
  Chitra Tirunal Institute for Medical Sciences and
  Technology, Trivandrum, India
• Liming Lee , MD, Vice President for Chinese
  Academy of Medical Science Peking Union Medical
  College and Professor at Peking University School
  of Public Health
• Jorge Ramírez Hernández, MD, PhD, Coordinator of
  Social and Economic Studies for Latin America,
  InterAmerican Heart Foundation, Mexico
• Robert Baggott, Ph.D., Professor of Public Policy
  and Director Health Policy Research Unit,
  deMontefort University, Leicester, United Kingdom
• Denise Stevens, PhD, Director of CIH Evaluation,
  President, MATRIX PHS (Evaluation Team)
• Kathleen OConnor, M.Ed, Co-Director of CIH
  Evaluation (PhD candidate) Yale University School
  of Epidemiology Public Health (Evaluation Team)
• Evaluation Team (additional)
• Fiona Wong, MIH, Research Coordinator CIH, MATRIX
  PHS (Evaluation Team)
• Brenda Fenton, Ph.D. Director of Research and
  Evaluation, MATRIX PHS (Evaluation Team)
• Monika Doshi, MPH, Field Researcher, MATRIX PHS
  (Evaluation Team)
• Karen Siegel, MPH, previously Data Manager CIH
  (currently Oxford University Research Fellow)

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CIH Advisory Board and Expert Panel
CIH advisory board and intervention committee
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Thank you