Structural Intervention

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Structural intervention is defined in public health as the intervention that attempts to engage the complex social, economic and political determinants of health.
The evaluation of structural interventions can be a difficult task because they need to be observed, sometimes for extended periods of time. In addition, the delivery of these programs is of various levels such as communities, institutions, or certain populations. Furthermore, random assignment can also be challenging because of issues such as ethics, logistics, and /or political feasibility. However, evaluation of structural interventions is important so that there is a positive link between science, health policies and public confidence. Moreover, the global experiences in this
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Structural interventions act indirectly therefore sometimes it takes longer to see measurable effects on health outcomes. However, policy makers and donors are time conscious and are looking for immediate results even when the true evaluation of structural interventions can be long term.
The sampling of structural interventions is primarily delivered at the institution or community level. These interventions must have sufficient numbers in the sampling groups, with adequate exposure and time to evaluate the effects.
Randomization of structural interventions is difficult. However, non –random assignments have demonstrated selection bias.
The secular change includes the mixture of local and national policies and programs. Secular change affects the population as a whole, intervention diffusion affects individuals. Moreover, diffusion occurs when persons in in a comparison or reference group are exposed to specific intervention due to “spillover”. Spillover is the externalities or spillover effects of the intervention services between
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Impact assessments answers the whether the goal of the project was met and whether the effects were caused by intervention. There are three major designs for evaluating structural interventions: adequacy, plausibility and probability
Adequacy is to be sure the intervention meets the objectives. Plausibility observes changes against a non- random group.
Probability does involve randomization. Randomization in structural intervention can be difficult for several reasons; funding, very large groups, time, not necessary and complex. There are two alternate approaches to randomization they are stepped –wedge design and regression

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