The goal of public health interventions is to improve the health and well-being of populations. Creating effective interventions is a science and an integral part of the public health field. Interventions usually target a specific population in order to reduce the incidence of a particular disease or condition affecting the population. Such interventions can be divided into two categories: community-defined interventions and evidence-based interventions.
Evidence-based interventions are practices that have been tried and tested through several research studies and shown to be effective at improving health outcomes. The main weakness of evidence-based interventions are that they typically aren’t tailored to specific populations and take on a “one-size fits all” approach. In the studies that determine the effectiveness of evidence-based interventions, minority communities are largely underrepresented, limiting our knowledge on the different populations to which evidence-based interventions can be applied to.
Community-defined interventions are practices that are tailored to particular populations. They are made through a complex and resource-intensive process that involves listening to members of the intended group and finding the specific root cause of the problem. Community-defined interventions take the historical and cultural contexts of the population into consideration, especially how systemic discrimination and social determinants of health (SDoH) have played a role. SDoH are the non-medical factors that can influence an individual’s health; SDoH can differ from population to population and even person to person. Community-defined interventions acknowledge that there are more than biological factors at play in health. For this reason, community-defined interventions are usually more effective on marginalized and minority groups, especially since these groups are often left out of studies concerning evidence-based interventions. However, community-defined interventions are implemented less often because of the amount of resources they require.
One example of an evidence-based intervention is the use of directly observed therapy (DOT), which was first used on a large scale for tuberculosis patients in the 1990s in the United States. Treatment for tuberculosis, an infectious disease, requires patients to take antibiotics for a course of 6-9 months. Many TB patients stop antibiotics before the time period is over, leading to an ongoing spread of TB and the possible risk of the emergence of antibiotic-resistant TB strains. Directly observed therapy (DOT), or the direct observation of patients taking TB antibiotics by primary care providers, greatly improved treatment completion rates and reduced the incidence of TB relapses. The World Health Organization (WHO) has since conducted several studies demonstrating the effectiveness of DOT as an intervention for infectious diseases worldwide.
Promotoras de Salud, a program implemented in Hispanic immigrant communities throughout the United States, is an example of a community-defined intervention. Promotoras de Salud was implemented due to high type-2 diabetes rates in these communities, due to limited English proficiency, and long distances to primary care providers. The intervention involved training trusted individuals from the diabetes-affected communities to organize group education sessions, cooking demonstrations, and other projects with the goal of improving diabetes outcomes. Communities where Promotoras de Salud were implemented showed better blood sugar control and an upward trend in overall health.
Both evidence-based and community-defined interventions are essential in improving public health, but each has its own strengths and limitations. For the greatest impact, evidence-based interventions should be combined with cultural competence to produce more equitable health outcomes.
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