In public health resources and time are often limited. By identifying a health concern, something that affects a person’s quality of life, and identifying the factors which affect it public health specialists can better focus resources. The decision matrix is a tool public health specialists use in order to sort the factors that affect a health condition by importance and changeability to better focus their efforts.
This Instructable will lay out the steps to create a basic decision matrix as well as going through an example scenario. The information in this Instructable can be applied to scenarios with one person, groups of people, or even institutions.
Estimated time: Research should take approximately 20 minutes, and 5-10 minutes to create the decision matrix.
Materials: Pencil, paper, and a computer.
For this example we will be focusing on an adult Caucasian male in his mid-forties. This adult lives in an unsafe neighborhood and is situated in a food desert. A food desert is an area defined by the United States Department of Agriculture (USDA) as where “at least 500 people and/or at least 33 percent of the census tract's population must reside more than one mile from a supermarket or large grocery store.” This person is also obese and lives alone. His father had type 2 adult onset Diabetes Mellitus and died of complications related to it. He is also a smoker.
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Step 1: Determine the Health Concern
A health concern is any condition which affects a person’s quality of life. The aim of the decision matrix is to change or prevent a health concern in a way that increases a person’s quality of life.
For the example the health concern is going to be preventing diabetes. While other health concerns could be selected for the scenario this is the one I have chosen to use for the example decision matrix.
Step 2: Research Factors That Affect the Health Concern
In this step, you will gather information on factors which affect the health concern. A variety of factors can affect any given health concern and different factors will affect different concerns. Some factors may only be relevant while discussing groups or institutions, rather than individuals. These factors may be environmental, behavioral, or genetic. In order to address these factors you must first know what they are. In order to do this research must be conducted. Depending on the health concern and the level of expertise you have regarding it, this step can take time. While Wikipedia is a source that can be edited by anyone, it can provide a starting point for research and begin to identify health factors. In addition, the Center for Disease Control and Development (CDC) contains extensive and accessible information.
For this example I began by using Wikipedia to familiarize myself with the topic. After that I used the CDC's websites to begin to compile the factors.
Step 3: Compile a List of Factors That Affect the Health Concern
Once you have completed your research, you need to compile a list of factors. These factors will be sorted in the following steps based on their importance and changeability.
For the example I have composed a list of factors that affect the chances a person will develop type 2 adult onset diabetes. Two of the factors, high blood pressure and high cholesterol, could be health concerns as well. So I conducted a quick search of the factors that affect those and marked those with an asterisk in the picture below. In addition, I have included factors which may not be the most relevant to this scenario. However these are factors which would be more relevant when working with groups or institutions.
Step 4: Create the Decision Matrix Diagram
The decision matrix is used to sort the factors on two axis.
A factor will either be classified as “more” or “less” on each axis, this gives four possible areas that a factor can fall in. These two axis are “Importance” and “Changeability”. These will be discussed further in the following steps.
Step 5: Determine Whether Each Factor on Your List Is "More" or "Less" Important
A factor that is classified as more important is one that has a greater effect on the likelihood (incidence) or effect (severity) of the health concern. In other words if you change a more important factor then you will have more of a result. A factor that is classified as less important does not have a large effect on the incidence or severity of the health concern. In other words changing one of these health factors is not going to have as much of a result. A factor may also be classified as less important if it is not relevant, for example men are not affected by gestational diabetes because it only affects pregnant mothers.
· Being overweight or obese is a more important factor since the subject is obese and obesity has a great effect on the incidence of diabetes. It also affects the incidence of other conditions that increase the risk of diabetes.
· Prior history of gestational diabetes is a less important factor since he cannot have gestational diabetes.
· Family history of diabetes is a less important factor because even though the subject’s father had diabetes it is not as important as many of the other factors on this list.
· Race is a less important factor since the subject is not of a race that has an increased incidence of diabetes.
· High blood pressure is a more important factor since it has a high effect on the incidence of diabetes.
· Low HDL is a more important factor since it has a high effect on the incidence of diabetes.
· The patient’s age is a less important factor. Currently the subject’s age has a low effect on the incidence of diabetes.
· Being physically inactive is a more important factor since it has a high effect on the incidence of diabetes.
· Diet is a more important factor because it not only effects the incidence of diabetes it also effects the incidence of high blood pressure and low HDL cholesterol.
Step 6: Determine Whether Each Factor on Your List Is “More” or “Less” Changeable
A factor’s changeability is related to how much effort and time must be applied by you and/or the client in order to cause a change. Factors that are more changeable require less effort and time to change. So a factor which requires little effort and time to change is more changeable. On the other hand, a factor with less changeability will require more effort and time to change. In addition some factors may be impossible to change, they would also be classified as less changeable. So if it requires a great deal of effort and time to change, then the factor is considered less changeable.
· Being overweight or obese is less changeable, it requires a large amount of effort and time to maintain a lower rate.
· Prior history of gestational diabetes is less changeable because it cannot be changed.
· Family history is less changeable because neither you nor the subject can change the past.
· Race is less changeable because it cannot be changed.
· High blood pressure is less changeable because neither you nor the subject can affect the blood pressure directly.
· Having abnormally low HDL is less changeable because neither you nor the subject can directly affect their cholesterol levels.
· Age is less changeable because neither you nor the subject can change his age.
· Being physically inactive is more changeable because it does not require much effort to provide the subject with means of becoming more physically active.
· Diet is more changeable, while the subject lives in an area with low accessibility to fresh foods diet is something that you and the subject can change.
· Smoking is a less changeable factor because it is often an addiction and can require a large amount of time and effort to change.
Step 7: Place Each of Your Factors in the Appropriate Boxes on the Decision Matrix Diagram
Each factor should be placed in a box that matches where you decided it goes on the importance and changeability axis. If you have more factors, repeat steps four through seven again for each factor. Factors that are both more important and more changeable is where specialists will focus for short term changes. Factors which are more important but less changeable can be used by some programs to stir public support since these tend to be more visible factors. Factors that are less changeable and more important are important for long term success.