Causal Pathway Mapping

A causal pathway is the first step in organizing an intervention to address a public health issue. Think of a public health issue you want to address through a behavioral intervention. Throughout this course, we will work to address the public health issue within a specific population. Take a look back at Week 2 and review your discussion feedback as well as the "assignment preparation" module. The public health issue you select will be the same topic you address throughout the assignments this term.

A causal pathway is the outline to identifying the determinants of health of your selected public health issue. Use what you have learned from your studies material to "map" a path FROM the Structural Determinants of Health (SDOH) to a health outcome THROUGH the intermediary determinants of health for the public health issue you have selected.

The SDOH Framework is outlined on page 25 of your textbook. Construct a “flowchart” (an example is provided below) and a narrative describing the pathway of your flowchart. It is highly encouraged to use PowerPoint to construct your map and use the “Notes” portion below to write the narrative describing the pathway. Please be aware that your ‘notes’ will not be visible in the ‘preview’ of the assignment during the submission process. The instructor will download the PPT file and view the notes on the download.

Your pathway should include at least one complete path from a structural determinant to the health outcome (i.e., there should not be any “gaps” in the connections between the mediating constructs in your illustration or narrative) and the points marked on your map for potential interventions.

Mark the “points of potential public health interventions” on your pathway with a star. You should have at least two points of intervention (one will be used as potential interventions to develop on later assignments). Provide a narrative (in the notes section under the slide) identifying and discussing each of the constructs in your model along with potential interventions that could be utilized to change the points you identified.

Points will be deducted for lack of correspondence between the structural determinants, the intermediary determinants and the health behavior and outcome, and for unprofessional presentation of your exercise (i.e., poor organization in your writing, misspelling, etc.). You do not need to cite literature or provide references in this exercise.

It may be helpful to review the Causal Pathway Example [PPTX] before beginning work on your assignment.

Create a pathway from the structural determinants to the selected health outcome.
Make sure the pathway clearly flows through the structural and intermediary determinants. Please note the structural determinants begin with a policy, governance, etc. as outlined in the SDOH Framework in your book on page 25.
Identify two points of intervention on the causal pathway.
Why are the points of intervention you identified relevant?
How do these points of intervention have the potential to have positive impacts?
Describe the connection between the constructs of the causal pathway and the health outcome(s).
Are the connections clear and easy to follow for someone else?
Are the constructs clearly explained?
Convey purpose, in an appropriate tone and style, incorporating supporting evidence and adhering to organizational, professional, and scholarly writing standards.

Full Answer Section

         
[Structural Determinant 2]
**Cultural/Societal Norms: Limited Health Literacy & Mistrust of Formal Healthcare Systems**
  ⬇
[Intermediary Determinant 2a]
**Psychosocial Factors: Stress/Anxiety related to Illness & Financial Burden**
  ⬇
[Intermediary Determinant 2b]
**Behavioral Factors: Reluctance to Engage in Long-Term Preventive Care**
  ⬇
[Health Outcome 2]
**Poor Chronic Disease Management (Complications, Hospitalizations)** ⭐ (Intervention Point 2)
  ⬇
[Health Outcome 3]
**Increased Morbidity & Mortality; Exacerbated Poverty**

[Narrative for Slide Notes Section] Narrative Describing the Causal Pathway for High Out-of-Pocket Expenditure and Poor Chronic Disease Outcomes in Kisumu County This causal pathway illustrates how specific structural determinants of health (SDOH) contribute to the significant public health issue of high out-of-pocket expenditure (OOPE) for healthcare, particularly affecting individuals with chronic diseases, ultimately leading to poor health outcomes and exacerbated poverty in Kisumu County. The pathway also identifies key points for potential public health interventions. Pathway 1: From Health Financing Policy to Catastrophic OOPE and Poor Outcomes
  1. Structural Determinant: County Health Financing Policy (Limited Public Subsidy & Inadequate NHIF Coverage for Informal Sector)
    • Description: This represents the overarching policy environment that dictates how healthcare is funded and accessed in Kisumu County. While there's a National Health Insurance Fund (NHIF) and some county-level subsidies, the current policy framework leads to insufficient public subsidy for comprehensive care, especially for chronic diseases. A significant portion of the population, particularly those in the informal employment sector (e.g., small traders, casual laborers), find NHIF premiums or co-payments unaffordable or are not adequately covered, pushing costs directly onto individuals. This structural determinant creates the fundamental economic vulnerability.
  2. Intermediary Determinant (Material Circumstances): Low Disposable Income for Healthcare
    • Description: As a direct consequence of the inadequate financing policy, individuals, especially those with chronic conditions requiring continuous care, face a situation where their limited disposable income cannot comfortably cover the costs of medications, diagnostics, and frequent clinic visits. This financial strain is immediate and tangible.
  3. Intermediary Determinant (Behavioral Factors): Delayed Healthcare Seeking & Medication Non-Adherence

Sample Answer

         

Slide 1: Causal Pathway for High Out-of-Pocket Healthcare Expenditure & Poor Chronic Disease Outcomes

  Title: Causal Pathway: From Structural Determinants to Catastrophic OOPE and Poor Chronic Disease Outcomes in Kisumu County [Flowchart Diagram on Slide - Please imagine this visually as a flow from left to right, or top to bottom, with arrows connecting each box.]
[Start]
  ⬇
[Structural Determinant 1]
**County Health Financing Policy (Limited Public Subsidy & Inadequate NHIF Coverage for Informal Sector)** ⭐ (Intervention Point 1)
  ⬇
[Intermediary Determinant 1a]
**Material Circumstances: Low Disposable Income for Healthcare**
  ⬇
[Intermediary Determinant 1b]
**Behavioral Factors: Delayed Healthcare Seeking & Medication Non-Adherence**
  ⬇
[Health Outcome 1]
**High Out-of-Pocket Expenditure (Catastrophic)**
  ⬇
[Health Outcome 2]
**Poor Chronic Disease Management (Complications, Hospitalizations)**
  ⬇
[Health Outcome 3]
**Increased Morbidity & Mortality; Exacerbated Poverty**