Points of Intervention

An intervention is any action taken to reduce the impact of a disease, including interventions to prevent disease, cure or reduce the mortality and morbidity of a disease, or influence public behavior that increases the risk of disease. Interventions can be classified as preventive, therapeutic, or other public health interventions. In clinical studies, interventions are tested on subject groups to assess their effects on a disease or condition. The particular implementation of these interventions has considerable influence on the study design that will be ultimately chosen to assess them.

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Editorial responsibility: Stanley Oiseth, Lindsay Jones, Evelin Maza

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Preventive Interventions

Preventive interventions are actions that prevent a disease and reduce the incidence of new cases, including education, vaccines, nutritional interventions, maternal and neonatal interventions, behavioral interventions, and environmental interventions.

Vaccines

  • Non-infectious antigens given to provoke an immune response that conveys protection against infection by a specific pathogen
  • Often the most cost-effective interventions
  • Employed as part of public health programs

Nutritional interventions

  • Provide appropriate nutrition to prevent health problems related to malnutrition Malnutrition Malnutrition is a clinical state caused by an imbalance or deficiency of calories and/or micronutrients and macronutrients. The 2 main manifestations of acute severe malnutrition are marasmus (total caloric insufficiency) and kwashiorkor (protein malnutrition with characteristic edema). Malnutrition in children in resource-limited countries and/or nutrient deficiencies
  • Applicable to all age groups (fetal development to adults)
  • Often ongoing and long term
  • Can target whole populations or specific subgroups 

Maternal and neonatal interventions

  • Tests and care applied before/during pregnancy Pregnancy Pregnancy is the time period between fertilization of an oocyte and delivery of a fetus approximately 9 months later. The 1st sign of pregnancy is typically a missed menstrual period, after which, pregnancy should be confirmed clinically based on a positive β-hCG test (typically a qualitative urine test) and pelvic ultrasound. Pregnancy: Diagnosis, Maternal Physiology, and Routine Care, antepartum, and postpartum to prevent disease in both mother and child
  • Examples:
    • Family planning 
    • Antenatal visits and routine screening tests
    • Antenatal monitoring (e.g., ultrasound)
    • Treatment of gestational infections
    • Nutritional recommendations and supplements
    • Access to adequate care during delivery

Educational and behavioral interventions

  • Attempts to change behaviors linked to disease, often through widespread community education programs (e.g., educational campaigns, public awareness efforts, public service announcements)
  • Efficacy dependent on individual willingness and effort
  • Often must be implemented for years to demonstrate results

Environmental interventions

  • Alterations to the environment of a population to reduce the risk of infection or disease
  • Alterations often widespread, involving large-scale, costly changes to public spaces
  • Success requires significant lifestyle changes and the co-operation of multiple individuals.
  • Examples: 
    • Infrastructure changes (e.g., construction of proper sewage and clean water supplies)
    • Vector control (e.g., reduction of habitats and breeding sites) 
    • Pharmacological prophylaxis (e.g., antimalarial medication in endemic zones)

Therapeutic Interventions

Therapeutic interventions alleviate or prevent mortality (reduce case fatality rate) and morbidity of a disease once established, including the management of infectious disease, surgical and radiation treatment, diagnostics to guide therapy, and control of chronic diseases.

Management of infectious disease

  • Use of pharmacologic agents that seek to kill or inhibit the replication of pathogens to prevent their spread and reduce associated mortality and morbidity
  • Studies of these agents often involve:
    • Case detection: the ability to accurately diagnose and identify new cases 
    • Case holding: the ability to regularly follow and treat cases over a sufficient period of time to eliminate the pathogen

Surgical and radiation management

  • Direct surgical or radiation interventions to reduce morbidity and mortality of disease 
  • Often seen as part of randomized control trials (RCTs)

Diagnostics to guide therapy

  • Application of diagnostic tests Diagnostic tests Diagnostic tests are important aspects in making a diagnosis. Some of the most important epidemiological values of diagnostic tests include sensitivity and specificity, false positives and false negatives, positive and negative predictive values, likelihood ratios, and pre-test and post-test probabilities. Epidemiological Values of Diagnostic Tests to accurately identify new cases and assess the effectiveness of management 
  • Studies are performed to assess specificity and sensitivity of diagnostic tests Diagnostic tests Diagnostic tests are important aspects in making a diagnosis. Some of the most important epidemiological values of diagnostic tests include sensitivity and specificity, false positives and false negatives, positive and negative predictive values, likelihood ratios, and pre-test and post-test probabilities. Epidemiological Values of Diagnostic Tests to increase diagnostic accuracy, leading to a reduction in disease impact.

Control of chronic diseases

  • Clinical care in addition to management:
    • Screening to identify new cases, clinical assessment of each stage of disease
    • Monitoring and management of complications of disease 
  • Studies often require years to decades to evaluate.

Other Interventions

Other interventions also affect disease burdens, including governmental and healthcare system changes.

Governmental changes

  • Widespread changes in policy, legislation, or taxes that seek to change public behavior that leads to or exacerbates disease 
  • Assessment studies are difficult because implementation is often nationwide, and it is difficult to find a control group.

Healthcare system changes

  • Include changes in health sector training, healthcare organization, healthcare education, financing, and decentralization of care 
  • Studies often involve a “step approach,” where phased implementations are evaluated over time to assess efficacy.

References

  1. Smith, P., Morrow, R. & Ross, D. (2015). Field trials of health interventions: a toolbox. Oxford University Press.

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