Define the Problem
As any intervention is designed to alter, modify, improve, or reduce a “problem” of public health importance, the first essential thinking and action process that needs to be accomplished is to clearly identify and define the specific problem area or focal point for an intervention. Problem areas can be identified from four primary sources and/or their combination: personal experience, clinical work, published research evidence including both qualitative and quantitative sources (e.g., needs assessments, focus groups, population-based studies), and/or existing or projected societal trends. In this period of discovery, a problem area must be clearly articulated and delineated; for example, parents of children with disability have more depression than those without a disabled child and this affects care provision; or, in an aging population, dementia is expected to increase exponentially and prevention strategies to reduce the risk of cognitive impairment must be identified and tested in middle-aged adults without cognitive impairment.
In the example shown in Table 3.1, clinical observations of older frail adults combined with evidence from epidemiological studies indicated that functional limitations were common, resulting in significant difficulties performing everyday activities (e.g., self-care and instrumental activities) at home. This in turn places older adults at risk for relocation to more restricted living environments, hospitalizations, social isolation, depression, poor quality of life, comorbidities, and mortality. Thus, a combination of observational and empirical data initially led to problem identification and substantiation of the need for an intervention to address functional concerns at home, subsequently referred to as the ABLE Program (Advancing Better Living for Elders; Gitlin et al., 2006).