Step
1.2: |
List and map the causes of the health problem. |
In this step you will:
- list the direct and indirect causes of the health problem, including the risk and protective factors associated with the problem and the factors that support solutions
- identify the factors that a program can change
This is called analytical epidemiology.
You will also draw a flow chart showing the problem and its causal influences. This chart will not include your program; it will help guide your program development. It can also help you explain your decisions to stakeholders.
How To Do It
Specify causes
Using logic and existing information, list the causes of the health/safety problem. Include:
- genetic or biological factors
- psychological factors
- behaviors
- factors in the physical environment (e.g., a lack of transportation)
- factors in the social environment (e.g., social support, or policy)
There are many sources of information on causal factors. Look beyond the “case count” level of epidemiology.
Example:
…in the WIC-Breastfeeding case, several types of causal factors were identified. They included psychological factors like embarrassment, social environmental factors like hospital policy barriers and a lack of social support from husbands, and physical factors like a lack of private space at work to express milk.
Just like pollution upstream lowers water quality for miles downstream, general risk factors such as a lack of educational opportunity often predict higher rates of subsequent or “downstream” health problems.
The upstream causal factors are referred to as social determinants of health (See “Social Determinants of Health Information Sheet”). A social determinant may seem too big to tackle, or out of bounds because it is not specifically health-related, but there are many health problems that you really can’t understand without acknowledging such predisposing causal factors.
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Weigh and map causes
Categorize the causes as direct and indirect, and as risk and protective factors. Organize them in a logical sequence by completing a Health Problem Analysis Worksheet. A sample flowchart showing causes of obesity among rural adult workers may be helpful. (SOC_health_problem_analysis_worksheet2.pdf)
Weigh the factors and indicate the primary ones on your chart. How often does a given factor play a role? Which factors are most likely to:
- affect the health problem
(e.g., among elementary-aged school children, safe places to play outside may account for more variation in exercise patterns than attitudes towards exercise- change as a result of programmatic action
(e.g., a social marketing program can’t eliminate genetic risk factors)
Do some of the causal arrows go both ways? Adjust your Problem Analysis chart to reflect any reciprocal influences.
Knowledge Check
Test Your Knowledge
Use My Plan
When you finish this step, you should have a preliminary list of the causes of the health problem. Enter them into Step 1.2 of My Plan.
There is also a worksheet in My Plan that will enable you to map your Problem Analysis onto a flow chart.
There will be gaps or assumptions in your understanding of the health problem at this point. Don’t be concerned about that. You will refine your health problem analysis when you get additional information from your market research in Phase 2.
