uu.seUppsala University Publications
Change search
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf
A novel approach used outcome distribution curves to estimate the population-level impact of a public health intervention
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health. (Socialpediatrisk forskning/Sarkadi)
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health. (Socialpediatrisk forskning/Sarkadi)
National Institute of Health and Care Excellence, Centre for Public Health, London, UK.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health. (Socialpediatrisk forskning/Sarkadi)
2014 (English)In: Journal of Clinical Epidemiology, ISSN 0895-4356, E-ISSN 1878-5921, Vol. 67, no 7, p. 785-792Article in journal (Refereed) Published
Abstract [en]

Objectives: To provide an analytical framework within which public health interventions can be evaluated, present its mathematical proof, and demonstrate its use using real trial data. Study Design and Setting: This article describes a method to assess population-level effects by describing change using the distribution curve. The area between the two overlapping distribution curves at baseline and follow-up represents the impact of the intervention, that is, the proportion of the target population that benefited from the intervention. Results: Using trial data from a parenting program, empirical proof of the idea is demonstrated on a measure of behavioral problems in 355 preschoolers using the Gaussian distribution curve. The intervention group had a 12% [9%-17%] health gain, whereas the control group had 3% [1%-7%]. In addition, for the subgroup of parents with lower education, the intervention produced a 15% [6%-25%] improvement, whereas for the group of parents with higher education the net health gain was 6% [4%-16%]. Conclusion: It is possible to calculate the impact of public health interventions by using the distribution curve of a variable, which requires knowing the distribution function. The method can be used to assess the differential impact of population interventions and their potential to improve health inequities. 

Place, publisher, year, edition, pages
2014. Vol. 67, no 7, p. 785-792
Keywords [en]
Public health, Intervention studies, Normal distribution, Area under the curve, Primary prevention, Parenting education
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
URN: urn:nbn:se:uu:diva-228973DOI: 10.1016/j.jclinepi.2013.12.012ISI: 000337983600009OAI: oai:DiVA.org:uu-228973DiVA, id: diva2:735304
Available from: 2014-07-25 Created: 2014-07-24 Last updated: 2018-01-08
In thesis
1. Prevention and Treatment of Externalizing Behaviour Problems in Children through Parenting Interventions: An Application of Health Economic Methods
Open this publication in new window or tab >>Prevention and Treatment of Externalizing Behaviour Problems in Children through Parenting Interventions: An Application of Health Economic Methods
2016 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The early onset of externalizing behaviour problems (EBP) is associated with negative outcomes later in life, such as poor mental health, substance use, crime, and unemployment. Some children also develop conduct disorder (CD), entailing a high disease and economic burden for both individuals and society.

Most studies on the effectiveness and cost-effectiveness of parenting interventions targeting EBP among children have evaluated selective or indicated preventive interventions, or treatment strategies. Evidence on the effectiveness of universally delivered parenting programmes is controversial, partly due to methodological difficulties.

The overall aim of this thesis was to 1) address the methodological challenges of evaluating universal parenting programmes, and to 2) employ different health economic methods to evaluate parenting interventions for EBP and CD in children.

Study I indicated that offering low intensity levels of Triple P universally, with limited intervention attendance, does not result in improved outcomes, and may not be a worthwhile use of public resources. Study II showed that using the distribution of an outcome variable makes it possible to estimate the impact of public health interventions at the population level. Study III supports offering bibliotherapy to initially target CP in children, whereas Comet could be offered to achieve greater effects based on decision-makers’ willingness to make larger investments. Cope could be offered when targeting symptom improvement, rather than clinical caseness. The economic decision model in Study IV demonstrated that Triple P for the treatment of CD appears to represent good value for money, when delivered in a Group format, but less likely, when delivered in an Individual format.

To reduce the burden of mental health problems in childhood, cost-effective and evidence-based interventions should be provided on a continuum from prevention through early intervention to treatment. We believe our results can assist decision-makers in resource allocation to this field.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2016. p. 72
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 1203
Keywords
parenting interventions, externalizing behaviour problems, conduct problems, conduct disorder, health economics, cost-effectiveness, prevention, treatment
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Research subject
Child and Youth Psychiatry; Health Care Research; Economics
Identifiers
urn:nbn:se:uu:diva-281349 (URN)978-91-554-9530-5 (ISBN)
Public defence
2016-05-17, Eva Netzeliussalen (BH/10:K102), Kraemers Allé 1, Uppsala, 13:15 (English)
Opponent
Supervisors
Available from: 2016-04-25 Created: 2016-03-22 Last updated: 2016-04-29

Open Access in DiVA

No full text in DiVA

Other links

Publisher's full text

Authority records BETA

Sarkadi, AnnaSampaio, FilipaFeldman, Inna

Search in DiVA

By author/editor
Sarkadi, AnnaSampaio, FilipaFeldman, Inna
By organisation
Department of Women's and Children's Health
In the same journal
Journal of Clinical Epidemiology
Public Health, Global Health, Social Medicine and Epidemiology

Search outside of DiVA

GoogleGoogle Scholar

doi
urn-nbn

Altmetric score

doi
urn-nbn
Total: 406 hits
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf