EPIDEMIOLOGY & POPULATION HEALTH
MEASURES AND MEASUREMENT ERROR IN POPULATION RESEARCH
INTRODUCTION
Effective population health promotion and program planning efforts depend upon several factors. These include how often, where, under what conditions, and among whom disease occurs. These are all quantitative measures. When conducting your own research or interpreting the results of another study, you should be familiar with the appropriate use of various epidemiologic measures and sources of measurement error.
What’s Happening This Module?
Module 3: Measures and Measurement Error in Population Research is a 2-week module comprising Weeks 5 and 6 of the course. In Week 5, you’ll be introduced to epidemiologic measures such as odds ratio and risk ratio, mortality and morbidity, and incidence and prevalence, and how these measures can be used to support nursing practice. In Week 6, you will examine sources of error in population research and their implications for nursing practice.
EPIDEMIOLOGIC MEASURES USED IN POPULATION HEALTH
In an effort to reduce costs, the city of Flint, Michigan switched sources for its water supply, in 2014, from the Detroit Water and Sewerage Department to the Flint River (Kennedy, 2016). Less than a month after the switch, residents began complaining about the color, taste, and smell of the water; 10 months later, the first case of elevated lead levels in drinking water were found in a resident’s home. The city had not tested the Flint River water prior to the switch to see if it had a corrosive effect on the system’s aging lead pipes, resulting in a disastrous public health crisis and state of emergency for Flint. The incidence of elevated blood lead levels in children under the age of 5 increased from 2.4% before the supply switch to 4.9% after, with some neighborhoods experiencing much higher increases (Hanna-Attisha et al., 2016). As demonstrated by this example, researchers can determine the level of exposure by comparing rates of incidence before and after the change. This can inform later research on risk and effects and lead to development of interventions for the affected population.
This week, you will continue to examine the association between risk factors and the etiology of disease by investigating measures of morbidity and mortality and measures of effect (incidence, prevalence, risk ratio/relative risk, and odds ratio). You will also consider how nurses use epidemiologic measures to make informed healthcare practice decisions.
References:
Hanna-Attisha, M., LaChance, J., Sadler, R. C., & Schnepp, A. C. (2016). Elevated blood lead levels in children associated with the Flint drinking water crisis: A spatial analysis of risk and public health response. American Journal of Public Health, 106(2), 283–290. https://doi.org/10.2105/AJPH.2015.303003
Kennedy, M. (2016, April 20). Lead-laced water in Flint: A step-by-step look at the makings of a crisis. The Two-Way. https://www.npr.org/sections/thetwo-way/2016/04/20/465545378/lead-laced-water-in-flint-a-step-by-step-look-at-the-makings-of-a-crisis
LEARNING OBJECTIVES
Students will:
Analyze how measures of effect strengthen and support nursing practice
Assess practice limitations of not applying measures of effect to support nursing practice
MEASURES USED IN EPIDEMIOLOGY
One important application of epidemiology is to identify factors that could increase the likelihood of a certain health problem occurring within a specific population. Epidemiologists use measures of effect to examine the association or linkage in the relationship between risk factors and the emergence of disease or ill health. For instance, they may use measures of effect to better understand the relationships between poverty and lead poisoning in children, smoking and heart disease, or low birth weight and future motor skills. The following are some common measures used in epidemiology:
EPIDEMIOLOGIC MEASURES USED IN POPULATION HEALTH
Odds ratio: The odds ratio quantifies the association between an independent variable (exposure) and a dependent variable (outcome). It is calculated as the odds that an effect will occur given the presence or exposure to a studied variable, compared to the odds when there is no exposure (e.g., lung cancer and smoking)
Risk ratio (also called relative risk): Also quantifies the association between an independent variable and a dependent variable. The risk of an effect occurring in one population versus another population (e.g., preeclampsia in women <35 versus >35). Risks greater than one suggest that exposure to a given variable is associated with an increase in the risk of the outcome, and a risk ratio of less than one indicates that the exposure is associated with a decrease in the risk of the outcome.
Mortality: Measure of deaths in a particular population during a specified time interval. If this is attributed to a specific cause, it is referred to as cause-specific mortality.
Morbidity: Measure of instances of illness or disability in a population from a given cause (e.g., heart disease) during a specified time interval
Incidence: The occurrence of new cases of an effect or disease in a population over a defined time period relative to the size of the population at risk (e.g., new cases of COVID-19 in a population over a 7-day period/1000 people)
Prevalence: The number of all cases of an effect or disease, not just new ones, in a population at a given time relative to the size of the population (e.g., number of people with autism/1000)
What is the significance of these measures of effect for nursing practice? In this Discussion, you will consider this pivotal question.
RESOURCES
Be sure to review the Learning Resources before completing this activity.
Click the weekly resources link to access the resources.
WEEKLY RESOURCES
LEARNING RESOURCES
Required Readings
Curley, A. L. C. (Ed.). (2020). Population-based nursing: Concepts and competencies for advanced practice(3rd ed.). Springer.
Chapter 3, “Epidemiological Methods and Measurements in Population-Based Nursing Practice: Part I”
Friis, R. H., & Sellers, T. A. (2021). Epidemiology for public health practice(6th ed.). Jones & Bartlett.
Chapter 3, “Measures of Morbidity and Mortality Used in Epidemiology”
Chapter 9, “Measures of Effect”
TO PREPARE:
Select item 1, 2, or 3 to use for this Discussion. Consider the definitions, differences, and utility of the two terms listed under your item selection. Your response will need to include both terms in the item selected.
Odds ratio and risk ratio
Mortality and morbidity
Incidence and prevalence
Consider how these epidemiologic measures strengthen and support nursing practice.
Assess practice limitations of not using these measures in nursing practice.
Conduct additional research in the Walden Library and other credible resources, and then locate two examples in the scholarly literature that support your insights.
Post a cohesive scholarly response that addresses the following:
Explain how your selected measures of effect strengthen and support nursing practice. Provide at least two specific examples from the literature to substantiate your insights.
Assess limitations of notusing measures of effect in nursing practice.
Assignment Rubric DetailsClose
Rubric
NURS_8310_Week5_Discussion_Rubric
NURS_8310_Week5_Discussion_Rubric
Criteria
Ratings
Pts
This criterion is linked to a Learning OutcomeRESPONSIVENESS TO DISCUSSION QUESTION (20 possible points) Discussion post minimum requirements: The original posting must be completed by Day 3 at 10:59 pm CT. Two response postings to two different peer original posts, on two different days, are required by Day 6 at 10:59 pm CT. Faculty member inquiries require responses, which are not included in the peer posts. Your Discussion Board postings should be written in Standard Academic English and follow APA 7 style for format and grammar as closely as possible given the constraints of the online platform. Be sure to support the postings with specific citations from this week’s learning resources as well as resources available through the Walden University library and other credible online resources (guidelines, expert opinions etc.)
20 to >19.0 pts
Excellent
• Discussion postings and responses are responsive to and exceed the requirements of the Discussion instructions. • The student responds to the question/s being asked or the prompt/s provided. Goes beyond what is required in some meaningful way (e.g., the post contributes a new dimension, unearths something unanticipated) • Demonstrates that the student has read, viewed, and considered a variety of learning resources, as well as resources available through the Walden University library and other credible online resources (guidelines, expert opinions etc.) • Exceeds the minimum requirements for discussion posts.
19 to >15.0 pts
Good
• Discussion postings and responses are responsive to and meet the requirements of the Discussion instructions. • The student responds to the question/s being asked or the prompt/s provided. • Demonstrates that the student has read, viewed, and considered a variety of learning resources, as well as resources available through the Walden University library and other credible online resources (guidelines, expert opinions etc.) • Meets the minimum requirements for discussion posts.
15 to >12.0 pts
Fair
• Discussion postings and responses are somewhat responsive to the requirements of the Discussion instructions. • The student may not clearly address the objectives of the discussion or the question/s or prompt/s. • Minimally demonstrates that the student has read, viewed, and considered a variety of learning resources, as well as resources available through the Walden University library and other credible online resources (guidelines, expert opinions etc.) • Does not meet the minimum requirements for discussion posts; has not posted by the due date at least in part.
12 to >0 pts
Poor
• Discussion postings and responses are unresponsive to the requirements of the Discussion instructions. • Does not clearly address the objectives of the discussion or the question/s or prompt/s. • Does not demonstrate that the student has read, viewed, and considered a variety of learning resources, as well as resources available through the Walden University library and other credible online resources (guidelines, expert opinions etc.) • Does not meet the requirements for discussion posts; has not posted by the due date and did not discuss late post timing with faculty.
20 pts
This criterion is linked to a Learning OutcomeCONTENT REFLECTION and MASTERY: Initial Post (30 possible points)
30 to >29.0 pts
Excellent
Initial Discussion posting: • Post demonstrates mastery and thoughtful/accurate application of content and/or strategies presented in the course. • Posts are substantive and reflective, with critical analysis and synthesis representative of knowledge gained from the course readings and current credible evidence. • Initial post is supported by 3 or more relevant examples and research/evidence from a variety of scholarly sources including course and outside readings.
29 to >23.0 pts
Good
Initial Discussion posting: • Posts demonstrate some mastery and application of content, applicable skills, or strategies presented in the course. • Posts are substantive and reflective, with analysis and synthesis representative of knowledge gained from the course readings and current credible evidence. • Initial post is supported by 3 or more relevant examples and research/evidence from a variety of scholarly sources including course and outside readings.
23 to >18.0 pts
Fair
Initial Discussion posting: • Post may lack in depth, reflection, analysis, or synthesis but rely more on anecdotal than scholarly evidence. • Posts demonstrate minimal understanding of concepts and issues presented in the course, and, although generally accurate, display some omissions and/or errors. • There is a lack of support from relevant scholarly research/evidence.
18 to >0 pts
Poor
Initial Discussion posting: • Post lacks in substance, reflection, analysis, or synthesis. • Posts do not generalize, extend thinking or evaluate concepts and issues within the topic or context of the discussion. • Relevant examples and scholarly resources are not provided.
30 pts
This criterion is linked to a Learning OutcomeCONTRIBUTION TO THE DISCUSSION: First Response (20 possible points)
20 to >19.0 pts
Excellent
Discussion response: • Significantly contributes to the quality of the discussion/interaction and thinking and learning. • Provides rich and relevant examples and thought-provoking ideas that demonstrates new perspectives, and synthesis of ideas supported by the literature. • Scholarly sources are correctly cited and formatted. • First response is supported by 2 or more relevant examples and research/evidence from a variety of scholarly sources including course and outside readings. • Responds to questions posed by faculty.
19 to >15.0 pts
Good
Discussion response: • Contributes to the quality of the interaction/discussion and learning. • Provides relevant examples and/or thought-provoking ideas • Scholarly sources are correctly cited and formatted. • First response is supported by 2 or more relevant examples and research/evidence from a variety of scholarly sources including course and outside readings. • Responds to questions posed by faculty.
15 to >12.0 pts
Fair
Discussion response: • Minimally contributes to the quality of the interaction/discussion and learning. • Provides few examples to support thoughts. • Information provided lacks evidence of critical thinking or synthesis of ideas. • There is a lack of support from relevant scholarly research/evidence. • No response to questions posed by faculty.
12 to >0 pts
Poor
Discussion response: • Does not contribute to the quality of the interaction/discussion and learning. • Lacks relevant examples or ideas. • There is a lack of support from relevant scholarly research/evidence. • No response to questions posed by faculty.
20 pts
This criterion is linked to a Learning OutcomeCONTRIBUTION TO THE DISCUSSION: Second Response (20 possible points)
20 to >19.0 pts
Excellent
Discussion response: • Significantly contributes to the quality of the discussion/interaction and thinking and learning. • Provides relevant examples and thought-provoking ideas that demonstrates new perspectives, and extensive synthesis of ideas supported by the literature. • Second response is supported by 2 or more relevant examples and research/evidence from a variety of scholarly sources including course and outside readings. • Scholarly sources are correctly cited and formatted. • Responds to questions posed by faculty.
19 to >15.0 pts
Good
Discussion response: • Contributes to the quality of the interaction/discussion and learning. • Provides relevant examples and/or thought-provoking ideas • Second response is supported by 2 or more relevant examples and research/evidence from a variety of scholarly sources including course and outside readings. • Scholarly sources are correctly cited and formatted. • Responds to questions posed by faculty.
15 to >12.0 pts
Fair
Discussion response: • Minimally contributes to the quality of the interaction/discussion and learning. • Provides few examples to support thoughts. • Information provided lacks evidence of critical thinking or synthesis of ideas. • Minimal scholarly sources provided to support post. • Does not respond to questions posed by faculty.
12 to >0 pts
Poor
Discussion response: • Does not contribute to the quality of the interaction/discussion and learning. • Lacks relevant examples or ideas. • No sources provided. • Does not respond to questions posed by faculty.
20 pts
This criterion is linked to a Learning OutcomeQUALITY OF WRITING (10 possible points)
10 to >9.0 pts
Excellent
Discussion postings and responses exceed doctoral level writing expectations: • Use Standard Academic English that is clear, concise, and appropriate to doctoral level writing. • Make few if any errors in spelling, grammar, that does not affect clear communication. • Uses correct APA 7 format as closely as possible given the constraints of the online platform. • Are positive, courteous, and respectful when offering suggestions, constructive feedback, or opposing viewpoints.
9 to >8.0 pts
Good
Discussion postings and responses meet doctoral level writing expectations: • Use Standard Academic English that is clear and appropriate to doctoral level writing • Makes a few errors in spelling, grammar, that does not affect clear communication. • Uses correct APA 7 format as closely as possible given the constraints of the online platform. • Are courteous and respectful when offering suggestions, constructive feedback, or opposing viewpoints.
8 to >6.0 pts
Fair
Discussion postings and responses are somewhat below doctoral level writing expectations: • Posts contains multiple spelling, grammar, and/or punctuation deviations from Standard Academic English that affect clear communication. • Numerous errors in APA 7 format • May be less than courteous and respectful when offering suggestions, feedback, or opposing viewpoints.
6 to >0 pts
Poor
Discussion postings and responses are well below doctoral level writing expectations: • Posts contains multiple spelling, grammar, and/or punctuation deviations from Standard Academic English that affect clear communication. • Uses incorrect APA 7 format • Are discourteous and disrespectful when offering suggestions, feedback, or opposing viewpoints.
10 pts
Total Points: 100
EPIDEMIOLOGIC MEASURES USED IN POPULATION HEALTH
In response to the learning objectives of Module 3: Measures and Measurement Error in Population Research, it’s crucial to understand the significance of epidemiologic measures in population health. Let’s provide further insights into the provided scenario and learning objectives.
**Analyzing Measures of Effect in Nursing Practice:**
The scenario of the Flint water crisis illustrates the importance of epidemiologic measures, such as incidence and prevalence, in identifying public health issues and informing interventions. By comparing the incidence of elevated blood lead levels before and after the water supply switch, researchers were able to assess the impact of the change and identify affected populations. This analysis strengthened nursing practice by providing valuable data to guide interventions aimed at mitigating the health consequences of lead exposure. Nurses play a critical role in population health by utilizing such measures to advocate for policy changes, educate communities, and implement preventive measures to address identified risks effectively.
**Assessing Practice Limitations without Measures of Effect:**
Failure to apply measures of effect in nursing practice can lead to significant limitations in addressing population health issues. Without proper epidemiologic measures, nurses may overlook trends or disparities in health outcomes, resulting in delayed or inadequate responses to emerging health threats. In the case of the Flint water crisis, if researchers had not assessed the incidence of elevated blood lead levels, the severity of the problem might have been underestimated, leading to delayed interventions and prolonged exposure to lead-contaminated water. Therefore, understanding and applying measures of effect are essential for nurses to effectively identify, prioritize, and address population health concerns in a timely and evidence-based manner.
In conclusion, mastering epidemiologic measures and understanding their application in nursing practice are critical for promoting population health and addressing public health challenges effectively. Nurses must be equipped with the knowledge and skills to analyze, interpret, and apply these measures to support evidence-based practice and improve health outcomes in communities they serve.
References:
– Hanna-Attisha, M., LaChance, J., Sadler, R. C., & Schnepp, A. C. (2016). Elevated blood lead levels in children associated with the Flint drinking water crisis: A spatial analysis of risk and public health response. American Journal of Public Health, 106(2), 283–290.
– Kennedy, M. (2016, April 20). Lead-laced water in Flint: A step-by-step look at the makings of a crisis. The Two-Way.
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