Public health is the art and science of disease prevention, promoting health and prolonging life by instituting efforts and informed actions that involve individuals, communities and institutions. It analyses the health in a particular population and the threats that face the community and device methods of mitigating the challenges. In this paper, heart disease and stroke prevention have been used to discuss the basics and foundations of public health. The apparent reason for this choice is that heart disease is among the leading causes of mortality and morbidity and still rapidly increasing in all parts of the globe. It is estimated that 30 percent of all deaths in the world are due to related heart conditions. Cardiovascular disease is, therefore, a significant disease burden worldwide and hence a significant public health concern. On the other hand, stroke has also been a significant public health concern. It is defined as the sudden death of brain cells due to hypoxia in the brain when there is impaired blood flow due to a ruptured artery (hemorrhagic stroke) or blockage (ischaemic stroke). Stroke is largely preventable yet in the developed world, and it causes about 8 percent of all male deaths and about 12 percent of all female deaths. According to statistics, more than a third of patients suffering from stroke die within the first ten days. However, the major burden of disease from morbidity due to stroke is living with disability, epilepsy, dementia and other issues due to disability among them financial constraints and depression. In the UK alone, stroke affects 2-3 percent of the population, and it is believed to be even more on a world scale. There are various models invoked in public health in the prevention of diseases among them the logic model, ecological model among others.
From the Evaluation guide by the CDC Division for Heart Disease and Stroke Prevention, development of the Logic model is evaluated as used in the prevention of heart disease and stroke. It gives an overview of the use and the development of the logical model. The logical model involves the use of specific tools used in the planning, management, communication, description and evaluation of the programs or interventions. Graphically, the logical model gives a picture on the program and the program’s intended purpose elucidating on whether the programs served or are serving their purpose. The state health department also has methods and programs to deal with morbidity and mortality associated with heart disease and stroke. Their mission is to ‘prevent and reduce death and disability due to diabetes, heart disease, and stroke. The programs set apart in the objective include; promotion and implementation of evidence-based management programs for patients with chronic conditions. Secondly, they build a community- clinical link where it makes it easy to get early interventions from healthcare providers with a focus on Health equity zone communities hence the elimination of any disparities. They also provided improvement training programs, health system data, and tools as well as increased funding for health specific to patients with heart disease and stroke. The state health department has also set apart specific programs that seek to improve on the state healthcare systems, supported the health workers in the community in the linkage between clinical and community resources. Specific to heart disease and stroke, programs on the promotion of cardiovascular awareness, education and health have been set up as well as support for activities that are evidence-based in improving the quality of life and care for patients with heart disease and stroke. On nutrition, the state department has sought to improve affordability and access to healthy foods and supplemental nutrients within the state.
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The use of the logical model in the evaluation of programs increases the chances of the program's success due to various reasons that include; it gives the objective of the program and the results expected. It also describes the activities to be carried out and the results that are expected to generate from the activities. The logic model serves as a reference to all those involved in the programs. There is improves expertise in the management, planning, and implementation of the program since it involves well thought out procedures and activities. It also involves results from other demonstration and research — the logic model composed of inputs, activities in the program, outputs, outcomes, and impacts. The outcomes are the short-term outcomes, long term outcomes, and intermediate outcomes. Its development involves various steps. One, developing a purpose for the program and a work plan. The other step is to convene stakeholders and individuals who should participate, epidemiologists, program planners, and managers. A focus is then determined for the logic model. With the project's goal as the anchor, priorities are set and expectations clarified. In conclusion, research, what others have done and knowledge base are reviewed, findings and lessons learned compiled and the construction of link activities and outcomes constructed. Used as an evaluation tool, the logic model helps to determine what to evaluate, gives the appropriate questions for evaluation, indicates what information to collect, determines the type of data to be received and determines sources, instruments, and methods of data collection.
Inputs
The logic model is invoked to evaluate the programs by the state department on the prevention of heart disease and stroke as a public health concern. Input in the logic model involves what was invested. Human resource is one of the investments in the prevention of various public health concerns and heart disease and stroke are no exception. The state department, apart from adding on healthcare staff, has also developed programs to train more health professionals and community health workers on the creation of awareness programs and on techniques of dealing with heart disease and stroke emergencies. There has also been a specific budget allocation set aside for patients with heart disease and stroke designated on the provision of emergency care, subsidy on healthy foods, free screening for the risk factors of the diseases. There are also activities during community awareness programs involving giveaways, educative materials, and photography.
Outputs
The outputs include the participants, activities and direct products. The participants involve every individual member of the state, health care professionals and legislators in the state as well as a stakeholder that fund the programs. The program also targets patients that have heart disease or have a history of stroke as well as those that are at risk of developing diseases such as people with dyslipidemia, diabetes among others. The stakeholders that provide funding such as the CDC DHDSP. Qualified staff is also essential with a fulltime manager for the project and epidemiologist on a part-time basis. In the past, the logic model was not used in the evaluation of programs in the state department, and therefore those supporting the programs depended on the relationships they had with the state department and internal and external factors. The activities developed by the department involved capacity building and assessment of needs. From this, the state public health action plan was formulated for the prevention and management of heart disease and stroke prevention.
Activities included focus groups with cardiovascular disease patients currently attending a clinic and developing a plan to recruit practice teams in clinics. A contract was then established with FHCQ with the aim to develop a score grading system for scholarships to clinics. Learning sessions were then organized as well as visits to potential cardiovascular teams of clinicians.
Outcomes
The short-term outcomes included widespread adoption of the planned care model with a measure of the outcome being the total number of clinical teams using the planned care model prepared. The intermediate outcomes expected were an improved quality of care for patients with heart disease and those with a recent episode of stroke with the outcome measure being a survey by healthcare providers on the prevalence of the implementation of the planned care model. The other intermediate expected outcome would be on better management of chronic conditions that predispose to heart disease or stroke. The outcome measure for this is also a provider survey on the implementation of the guidelines. Better management of the disease by the affected patients is also an outcome expected with the evaluation being knowledge of disease and medications as well as disease symptoms by the patients. Thirdly, the control of risk factors predisposing to heart disease including high cholesterol, diabetes, and hypertension with the measure of the outcome being a brief questionnaire for the population on the risk factors. Lastly, an improved lifestyle is an expected outcome measured by nutritional and lifestyle change questions.
The long-term outcomes include reducing the disparities that may be present between the priority population and the general population as well as the reduction in mortality and disability caused by heart disease and stroke. The measures for outcome include vital statistics data for both the long-term outcomes. In conclusion, the development of the logic model in state departments helps describe the events and processes expected as well as the outcomes aimed at the programs.
References
CDC. (2019). CDC Division for Heart Disease and Stroke Prevention: State Heart Disease and Stroke Prevention Program. Retrieved from https://www.cdc.gov/dhdsp/docs/logic_model.pdf
