Health Intervention Evaluation Using Semantic Explainability and Causal Reasoning
Open accessAbstract
As serious public health problems require complex responses, health interventions often involve multiple components implemented by groups including policy experts, social workers, and health practitioners. The success or failure of an intervention depends on many different factors, ranging from available resources to characteristics of the targeted public health issue and community to the complex mechanics relating cause and effects of the actions performed. In this paper, we present a novel formal methodology to evaluate public health interventions, policies, and programs. Our method uses the theory of change (TOC) approach along with logic models that define the intervention under consideration to generate a causal diagram and an ontology-based inference model for causal description. The resulting causal diagram will then be compared to existing knowledge and data to determine whether the intervention is coherent, internally consistent and its goals are achievable in the allotted time with the resources provided. The contextual knowledge and semantics provided by the ontology will generate a more explainable, understandable, and trustworthy approach to compare and assess different interventions based on their shared goals. Depending upon the quality and quantity of data available we perform a mix of qualitative and quantitative evaluation of the interventions. This study uses smoking cessation interventions to showcase the proposed methodology in action.
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Pairing implementation outcomes with theory-informed, causally grounded evaluation approaches can help assess not only acceptability, but whether proposed mechanisms (eg, improved coordination leading to fewer delays) are supported by observed data rather than usability proxies alone.
“Pairing implementation outcomes with theory-informed, causally grounded evaluation approaches can help assess not only acceptability, but whether proposed mechanisms (eg, improved coordination leading to fewer delays) are supported by observed data rather than usability proxies alone [58].”
From User-Centered Design for Digital Patient-Navigation Tools in Oncology: Scoping Review (2026) · cites this paper as [58]
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The seven tools of causal inference, with reflections on machine learning
Pearl, J. (2019) · Communications of the ACM · doi:10.1145/3241036 · Cited by 659 · cited 1× · see citing works
“Our method provides a semantic backbone to explain and explore questions throughout all three levels (association, intervention, and counterfactuals) of causal hierarchy [32].”
MethodUsing theory of change to design and evaluate public health interventions: a systematic review
Breuer, E., Lee, L., De Silva, M., & Lund, C. (2015) · Implementation Science · doi:10.1186/s13012-016-0422-6 · Cited by 425 · see citing works
Causal discovery and inference: concepts and recent methodological advances
Spirtes, P., & Zhang, K. (2016) · Applied Informatics · doi:10.1186/s40535-016-0018-x · Cited by 304 · see citing works
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Shaban-Nejad, A., Michalowski, M., Brownstein, J., & Buckeridge, D. (2021) · IEEE Journal of Biomedical and Health Informatics · doi:10.1109/jbhi.2021.3088832 · Cited by 71 · see citing works
Self-citationZink, J. A., Rashid, R., Chinthala, L., Kheirinejad, S., White, B. M., Kheirkhah Rahimabad, P., Hashtarkhani, S., Kumsa, F. A., Brett, C. L., Davis, R. L., et al. (2026) · ESMO Real World Data and Digital Oncology · doi:10.1016/j.esmorw.2026.100771 · Cited by 1 · see citing works
Self-citationUser-Centered Design for Digital Patient-Navigation Tools in Oncology: Scoping Review
Kheirinejad, S., White, B. M., Kheirkhah Rahimabad, P., Zink, J. A., Hashtarkhani, S., Kumsa, F. A., Rashid, R., Chinthala, L., Brett, C. L., Davis, R. L., et al. (2026) · JMIR Human Factors · doi:10.2196/87686
Self-citation
- Authors
- Brenas, J. H., & Shaban-Nejad, A.
- Venue
- IEEE Access
- Published
- 2020
- Volume
- 8
- Pages
- 9942-9952
- ISSN
- 2169-3536 (ISSN-L)
- OpenAlex
- W3000079853
- Cited by
- 24
- References
- 3
- Citations by year
- 2026: 4 · 2025: 1 · 2024: 6 · 2023: 1 · 2022: 6 · 2021: 5 · 2020: 1
- FWCI
- 2.07
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- IEEE Access (publishedVersion, cc-by)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- Health Science Center, University of Tennessee
- Topics
- Social Sciences › Decision Sciences › Management Science and Operations Research › Evaluation and Performance Assessment
- Health Sciences › Health Professions › General Health Professions › Public Health Policies and Education
- Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
- Keywords
- health intervention evaluation, public health interventions, theory of change, logic model, causal graphs, ontology reasoning, causal reasoning, intervention coherence, smoking cessation interventions, public health policy
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