Sample MET 414 Applied Epidemiology Assignment

MET414 Applied Epidemiology Assignment Sample

To be submitted via Turnitin by 14.00 on 15 March 2021

Using a public health or healthcare service that is currently being delivered in a population of your choice, prepare a written assignment describing how you would assess whether the service is meeting the health needs of its target population.

The service may be based in any specified patient population, neighborhood, city, or country. Please be very specific about the population. It is recommended that this should be a population and service that you are relatively familiar with.

The assignment should cover the following points:

1. Description of the service, including:

• If you find a strategy with many components, just choose one intervention to evaluate;
• Service aims and objectives;
• Target service users;
• How service is being delivered;
• Underlying evidence-base and guidelines that relate to the service, including evaluation of both clinical and cost-effectiveness.

2. Use a health needs assessment (HNA) approach to assess the:

• Health needs of the target service users;
• What indicators would you include to measure their health status?
• What sources would you use to find data on your chosen indicators?
• The HNA section should include scoping of the epidemiological, corporate and comparative parts.

3. Service evaluation; i.e.:

• Present a logic model to include structural, process and outcome indicators that would allow you to assess the performance of the service;
• Are there any gaps in services?
• Is the service meeting the health needs of the population?
• Are there any associated inequalities?
• Are there any members of the target service users who are not benefiting from the service?
• What would happen if the service was removed?

You are not expected to carry out the HNA itself. However, you are expected to describe your methods and potential sources of data, knowledge and intelligence.

The completed assignment should be type-written with a word limit of 2,000 words, excluding your logic model, tables, figures, and references.

References should be in Harvard style.

This assignment carries 50% of the marks for the MET414 Applied Epidemiology module.

For assignment help you prepare and practice a HNA, you will receive teaching about the principles. As part of your formative assessment, you will be asked to work in small groups to design and present an outline for a HNA. These presentations will offer you the opportunity to work through the design of a HNA and receive feedback.

Please note: whilst the oral presentations are based on group work, your summative assignments writing should be submitted individually, and not be related to the topic of the group oral presentation.
Email the module lead / MPH Office if any questions

Solution

EVALUATING TOBACCO CONTROL ‘STOP SMOKING’ HEALTHCARE SERVICES IN THE UK

SECTION 1: DESCRIPTION OF THE SERVICE

1.1 BACKGROUND TO THE SERVICE:

There have been considerable advances in health with advancements in research and up-gradation in technology. There is a considerable increase in tobacco smoker worldwide which leads to more than more preventable deaths than ever before. This creates a greater need for health care policy on the prevention of smoking leading to a considerable challenge for the NHS. NHS England partners with various organizations for the prevention of smoking amongst people in England. The Tobacco control healthcare delivery plan aims at a Smoke Free Generation (Wee et al., 2020). The Tobacco Control Plan for England was developed by the Government in 2017-22 as a nationwide initiative to provide support towards tobacco control. The aim of this plan was to focus on reducing the rate of smoking amongst 15-year-olds, who are smokers. Reducing the rate of adult smokers in England and reducing gaps existing in inequalities prevalent amongst routine and manual occupations across England. The policy also aims at reducing the prevalence of smoking amongst pregnant mothers. The Government prepared a delivery plan that engaged inter-departmental collaborations also local partnerships such that appropriate governance regarding the delivery of the plan could be easily achieved. The Government in the UK has high ambitious targets for making England smoke free even with the threats of budget cuts being prominent (Beard et al., 2014, p 280). The Government of England offers specialized services to stop smoking. Though there has been a significant reduction in funds available to stop smoking yet the Government continues their undeterred efforts to prevent smoking services in the entire nation. Thus, the service of the Stop Smoking plan aims at prevention or reducing smoking amongst varied age groups and amongst members of the population.

1.2 SERVICE AIMS AND OBJECTIVES:

The government’s plan of Stop Smoking aims at controlling the use of tobacco in England. Some of the specific aims regarding the service include;

o Prevention of smoking at the national level.
o Supporting smokers to quit their habit of smoking
o Reducing the variations in rates of smoking
o Effective application of the policy of smoking control

This service aims to reduce the overall rate of smokers prevalent in the UK (Department of Health & Social Care, 2018). With the present service being built on the foundations of past successes in tobacco control efforts in local areas. With the support and vision of the NHS, there is a long term plan developed for pursing approaches to adopt a sustainable care system that can bring about significant effects of tobacco prevention and control.

1.3 TARGET SERVICE USERS:

Priority in tobacco control has been given in England due to the high rates of prevalence along with increasing rates of smokers in the nation. A survey conducted by the NHS found a considerable rise in the number of smokers since 2013. There has been given considerable importance on controlling the use of tobacco not only from the national levels but also from local authorities. There remain high rates of prevalence of smokers in England (Bauld et al., 2016, p 1165).

A survey conducted by the Government depicts reveals that the targeted population of smokers in England constitutes young people age 15 years and above, the adult population also pregnant women. There has been a significant rise in the number of smokers at the school level. The ease of availability of tobacco makes them susceptible to becoming smokers early in their lives. 87% were seen to be pregnant women who were using tobacco. Pregnant women seemed unaware of the effects of smoking during their pregnancy period hence there was seen extensive use of tobacco amongst them. 70% had some kind of mental health conditions associated, 67% people were in some routine and manual occupations with low levels of incomes and 60% of smokers were seen to be with acute long-term conditions (Office for National Statistics, 2021). People with mental conditions or with low levels of incomes were seen to be using tobacco greater than people with middle to high levels of income. These high prevalence groups have been the key target population for the Government of England.

The targeted service aims at bringing about considerable effectiveness in either reducing or preventing smokers from their smoking-related habits. Through effective intervention from the NHS along with local authorities, the specialized services will be provided for long-term efforts (Pirie et al., 2013, p 140). Most of the targeted users and participants for the services include those who are taking up services such that they can avoid smoking also it includes those who are yet to adopt but intends to adopt services aimed at preventing or reduction in the incidence of smoking.

1.4 SERVICE BEING DELIVERED:

Prevention and reducing tobacco smoking services in England is adopted by the NHS along with local authorities. The targeted population for the purpose of this service delivery has been adequately identified, also the Government has adopted tremendous efforts with suitable budgetary allocations by setting different levels of priorities for the delivery of tobacco smoking control services (Smith et al., 2020, p 42). Methodology for service delivery aimed at prevention or reduction in tobacco smoking includes the NHS coordinating with local authorities to delivery intervention programs aimed at desired outcomes.

Services targeted at prevention or reduction in tobacco control practices has mainly been delivered through local healthcare authorities rendering healthcare services. They set-up training centers also programs frequently for different targeted groups of the population at different locations to bring about effectiveness in the services (Beard et al., 2016, p 354). Community settings were primarily selected for the purpose of service delivery aimed at tobacco control and prevention methods.

There are varied services that are adopted as a part of this service. There are programs aimed at prevention and reduction which includes interacting with patients, providing them strategies that might be adopted for preventing smoking and so on. Training is provided by healthcare professionals for smoking cessation. Recording outcomes for smoking prevention also assists in accurately measuring smoking beyond self-reporting (Hollingworth et al., 2012, p 165). Through Carbon Monoxide resting, there are programs developed for the prevention of smoking amongst pregnant women. The services also aim at promoting self-care and prevention amongst individuals.

The targeted users are actively invited and referred to this service such that they can accommodate them and prevent or reduce their smoking-related habits. Targeted users are required to attend programs also training sessions such that they are able to take up the course and prevent smoking altogether (Richardson et al., 2014, p 45). Targeted users are contacted by the community such that they can take part in sessions, programs, training and activities aimed at promoting cessation of smoking.

1.5 UNDERLYING EVIDENCE-BASE AND GUIDELINES THAT RELATE TO THE SERVICE, INCLUDING EVALUATION OF BOTH CLINICAL AND COST-EFFECTIVENESS:

The Government publishes reports that include data and statistics of adult smoking in the UK. In the year 2019, it was found that 14.1% of individuals in the age group above 18 years smoked tobacco, accounting for 6.9 million people, as reflected in the Annual Population Survey (APS). Though there has been a considerable decline in the proportion of smokers from 2018 amounting to 14.7% to 14.1% in the year 2019. The highest proportion of current smokers were in the age bracket of 25 to 34 years accounting for almost 19.0% of the population (Office for National Statistics, 2021). There was also 23.4% people in routine and manual occupations who smoked amounting to 2.5 times greater than people who were engaged in managerial and professional occupations, amounting to 9.3%. the NHS aims to adopt tobacco control services as per the WHO Framework Convention for Tobacco Control to be followed at all levels of the nation.

Evidence of the cost-effectiveness of the service can be ascertained by the limited budget and spending undertaken by the government in curbing smoking (Shahab et al., 2017, p 85). All the intervention mechanisms are handled at the local community levels for adopting cost-effective efforts. Though there is a considerable cost component attached to the training and programs which are advertised for tobacco prevention and control mechanism.

2 SECTION 2: ASSESSING THE HEALTH NEEDS OF THE TARGET SERVICE USERS

2.1 INDICATORS TO MEASURE HEALTH STATUS

The services on stop smoking of tobacco have been built and developed on the basis of past efforts for the prevention of smoking. Initiatives in the domain include working in a joint manner with individuals in the local authority services, partnering with the NHS and also pursuing approaches for the population for the development of a sustainable and integrated system of care. The Government in England has very ambitious targets for attaining smoke free ambition in England by 2030 in spite of threat pertaining to budget cuts remaining (Cancer Research UK, 2021). Ascertaining the health need assessment of the targeted population, the aims of the service has been ascertained. The health needs of the targeted population are being ascertained especially for pregnant women, school-going children and adults such that the impacts of smoking on their health can be reduced. Tobacco control can be seen to be of considerable importance when reducing the impact of adverse effects on the health of individuals also reduce the incidence of cancers amongst the population. Survey data reveals a considerable impact on the health of the targeted population also a rise in the incidence of cancers associated with tobacco smoking (Hunt et al., 2018, p 314).

2.2 SOURCES OF DATA ON INDICATORS

Cancer research organization in the UK publishes relevant data which reveals that tobacco smoking has been seen associated with cancers of 15 different types affecting the nasopharynx, oral, lung, oesophagus, larynx, ovarian, stomach, pancreas, bladder, pharynx, liver, kidney, bowel, leukaemia, and bowel and also many more. The organization reveals that tobacco remains one of the biggest forms of preventable cancers and death in the UK. Smoking was seen to be associated with 125,000 deaths in the UK. 15% of cancers were seen to be caused by smoking. There was also seen considerable deprivation associated with cigarette smoking in 2019 (Ash, 2017).

2.3 SCOPING OF THE EPIDEMIOLOGICAL, CORPORATE AND COMPARATIVE APPROACHES:

Cancer research organization in the UK also ASH organization revealed that in every 2 people born after 1960 in the UK is diagnosed with some forms of cancer during their life and approximately 1 in every 4 will die from tobacco smoking disease. Tobacco smoking is estimated to be causing one-fifth of cancers every year and causing 27% of deaths related to cancers in the UK (Raupach et al., 2015, p 374). A recent survey conducted by Ash organization reveals that 19% of cancers are connected to some form of tobacco smoking. These bodies are the leading research organizations in cancers in the UK. Data search conducted in these organizations reveals the health needs of the population to prevent cancers.

2.4 EVALUATION OF SERVICE

Logic model to adopt structural, process and outcome indicators which will allow assessing the performance of the service (Brain et al., 2017, p 914). There will be adopted prevention-related indicators for assessing the intervention of the service for understanding the effectiveness of the service performance.

Figure 1: Service Evaluation Model
Source: Author

Using an epidemiological approach, the HNA has been conducted and then an evaluation approach is undertaken for ensuring effective intervention. This approach will enable the meeting needs of the target population (Jones, and Hamilton, 2013, p 565). The health service is evaluated using the above methodological approach. Limitation on the service includes budgetary constraints remaining with the need of the target population. Though budgetary constraints cannot be addressed by the services.

2.5 GAPS IN THE SERVICES

The services in the UK is made available to all possible types of users such that inequalities can be removed with the best possibilities. Targeted users in the service have been benefitting tremendously from this service. There does not remain any significant gaps that remain in attending to the services for the targeted users. Intended targeted users such as adults often restrain from the services provided. A possible explanation for this includes their unawareness regarding the impacts associated with the consequences of tobacco smoking.

2.6 IN CASE THE SERVICE WAS REMOVED

In case the service was removed or withdrawn then there might arise significant consequences reflected in the direct rise of cases of tobacco smokers. The relevance of this service is regarding its sustainability aspect, which otherwise in case not implemented then will lead to considerable impacts on the health of the targeted population. School going children and pregnant women will be the most impacted group in case the service was removed. As the service focuses on considerable behavioral change to have a positive impact on the targeted population.

3 REFERENCES

Ash, 2017. Smoking and Cancer. ASH Fact Sheet on Smoking and Cancer. Accessed from [https://ash.org.uk/wp-content/uploads/2019/10/Smoking-Cancer.pdf]

Bauld, L., Hiscock, R., Dobbie, F., Aveyard, P., Coleman, T., Leonardi-Bee, J., McRobbie, H. and McEwen, A., 2016. English stop-smoking services: one-year outcomes. International journal of environmental research and public health, 13(12), p.1175.

Beard, E., Brose, L.S., Brown, J., West, R. and McEwen, A., 2014. How are the English Stop Smoking Services responding to growth in the use of electronic cigarettes? Patient education and counseling, 94(2), pp.276-281.

Beard, E., West, R., Michie, S. and Brown, J., 2016. Association between electronic cigarette use and changes in quit attempts, success of quit attempts, use of smoking cessation pharmacotherapy, and use of stop smoking services in England: time series analysis of population trends. bmj, 354.

Brain, K., Carter, B., Lifford, K.J., Burke, O., Devaraj, A., Baldwin, D.R., Duffy, S. and Field, J.K., 2017. Impact of low-dose CT screening on smoking cessation among high-risk participants in the UK Lung Cancer Screening Trial. Thorax, 72(10), pp.912-918.

Cancer Research UK, 2021. Tobacco statistics. Together we will beat cancer. Accessed from [https://www.cancerresearchuk.org/health-professional/cancer-statistics/risk/tobacco#heading-Zero]

Department of Health & Social Care, 2018. Tobacco Control Plan Delivery Plan 2017 – 2022. National Archives of the Government of the UK. Accessed from [https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/714365/tobacco-control-delivery-plan-2017-to-2022.pdf]

Hollingworth, W., Cohen, D., Hawkins, J., Hughes, R.A., Moore, L.A., Holliday, J.C., Audrey, S., Starkey, F. and Campbell, R., 2012. Reducing smoking in adolescents: cost-effectiveness results from the cluster randomized ASSIST (A Stop Smoking in Schools Trial). Nicotine & Tobacco Research, 14(2), pp.161-168.

Hunt, D., Knuchel-Takano, A., Jaccard, A., Bhimjiyani, A., Retat, L., Selvarajah, C., Brown, K., Webber, L.L. and Brown, M., 2018. Modelling the implications of reducing smoking prevalence: the public health and economic benefits of achieving a ‘tobacco-free’UK. Tobacco control, 27(2), pp.129-135.

Jones, S.E. and Hamilton, S., 2013. Introducing a new stop smoking service in an acute UK hospital: a qualitative study to evaluate service user experience. European Journal of Oncology Nursing, 17(5), pp.563-569.

Office for National Statistics, 2021. Adult smoking habits in the UK: 2019. Office for National Statistics. Accessed from [https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/healthandlifeexpectancies/bulletins/adultsmokinghabitsingreatbritain/2019]
Pirie, K., Peto, R., Reeves, G.K., Green, J., Beral, V. and Million Women Study Collaborators, 2013. The 21st century hazards of smoking and benefits of stopping: a prospective study of one million women in the UK. The Lancet, 381(9861), pp.133-141.

Raupach, T., Al-Herbie, G., McNeill, A., Bobak, A. and McEwen, A., 2015. Smoking cessation education and training in UK medical schools: a national survey. Nicotine & Tobacco Research, 17(3), pp.372-375.

Richardson, S., Langley, T., Szatkowski, L., Sims, M., Gilmore, A., McNeill, A. and Lewis, S., 2014. How does the emotive content of televised anti-smoking mass media campaigns influence monthly calls to the NHS Stop Smoking helpline in England? Preventive medicine, 69, pp.43-48.

Shahab, L., Dobbie, F., Hiscock, R., McNeill, A. and Bauld, L., 2017. Prevalence and impact of long-term use of nicotine replacement therapy in UK Stop-Smoking Services: findings from the ELONS study. Nicotine and Tobacco Research, 20(1), pp.81-88.

Smith, C.E., Hill, S.E. and Amos, A., 2020. Impact of specialist and primary care stop smoking support on socio?economic inequalities in cessation in the United Kingdom: a systematic review and national equity analysis. Addiction, 115(1), pp.34-46.

Wee, L.H., West, R., Hiong, T.G., Yeap, L., Chan, C.M.H., Kiau, H.B., Perialathan, K., Mohamed, M.H.N., Michie, S. and Jackson, S.E., 2020. Effectiveness of training stop?smoking advisers to deliver cessation support to the UK national proposed standard versus usual care in Malaysia: a two?arm cluster randomized controlled trial Addiction.