Discussion Question
- Explain the planning process of community health improvement. Choose one of the models / tools for community health planning discussed in your book and explain it. (Please, mention which model / tool you chose).
- APA style
- 3 paragraphs 3 sentences each
- 2 references
Chapter 9: Planning for Community Change
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Chapter Highlights #1
Health planning at the state, national, and global levels
Social and environmental determinants of health
Social ecologic model and multilevel interventions
Community coalitions
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Chapter Highlights #2
Health impact pyramid
Health equity and social justice
Lewin’s change theory, force field analysis, and levers of change
Logic models
Role of the community health worker
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Chapter Highlights #3
Funding community health interventions
Evaluating community health interventions
Nurse-managed health centers
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Question #1
Is the following statement true or false?
Health planning occurs on both an ongoing and an episodic basis.
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Answer to Question #1
True
Rationale: The timing of health planning depends on the responsibilities of the planning agency, the type of assessment data, and the nature of the health problem.
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Health Planning
Organized and systematic process in which problems are identified, priorities selected, and objectives set for the development of community health programs based on the findings of community health assessments and health surveillance data.
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Common Themes
Common themes of current national and international health plans include providing health promotion and disease prevention at the population level, addressing social determinants of health, and achieving health equity.
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Levels of Health Planning
Global
National and state levels
Healthy People 2020
National Prevention Strategy
State Departments of Public Health
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Community Health Improvement Planning Process
Systematic process that involves all sectors of a community to conduct a comprehensive community health assessment (CHA), identify priorities for action, develop and implement a community health improvement plan (CHIP), and guide future community decisions and resource allocations.
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Community Assessment
Systematic process that may use several approaches including key informant interviews, analysis of data on health status and health behavior indicators, observation, and community surveys.
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Systems Theory
Social systems engage in reciprocal exchange or flows of information, energy, resources, and goods or services. Systems within the community are interdependent and interconnected.
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Working With the Community
Defining the population of interest
Coalitions
Stakeholders and opinion leaders
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Social Ecologic Model
Based on general systems theory and health promotion theory
Multiple determinants of health interact at different levels to affect the health status of individual people, population aggregates, or communities.
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Question #2
Is the following statement true or false?
The purpose of using levers of change is to decrease driving forces and/or to increase restraining forces.
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Answer to Question #2
False
Rationale: The purpose of using levers of change is to increase driving forces and/or to decrease restraining forces.
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Health Impact Pyramid
Useful framework for community health nurses when planning health promotion interventions at multiple levels
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Multilevel Interventions
Multilevel interventions are needed to achieve change in complex community health conditions that have multiple determinants.
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Social Determinants of Health
Obesogenic and salutogenic environments
Health impact assessment
Health disparities, health equity, and social justice
Community empowerment model
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Change Theory
Lewin’s Model of Change
Unfreezing
Changing
Refreezing
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Force Field Analysis
Force field analysis is a tool used to identify the forces driving or restraining change.
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Levers of Change
The purpose of using levers of change is to increase driving forces and/or to decrease restraining forces.
Public policies such as tax increases on tobacco, alcohol, or soft drinks can serve as policy levers to bring about change in community health status.
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Community Readiness for Change
Planning programs or interventions to change community health status include an assessment of the community’s readiness to undertake the change process related to a specific health issue.
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Planning Community-Level Interventions
Guide to community preventive services
Logic model
SMART objectives
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Collaboration and Teamwork
Community health workers can help bridge the gap between the community health nurse and the community, especially when there are cultural and language differences.
Nurses can play an important role in their professional and personal lives as advocates and champions for health improvement, social justice, and health equity at the local, regional, national, and global levels.
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Evaluating Community-Level Interventions
Develop evaluation questions.
Determine indicators or measures you will use to answer your evaluation questions.
Identify where you will find the data you need to measure your indicators and answer your questions.
Decide what method you will use to collect data.
Specify the time frame for when you will collect data.
Plan how you will analyze your data based on the type of data you are using.
Decide how you will communicate your results.
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Funding Community-Level Intervention Programs
Accountability
Sustainability
Program replication
Project funding
Government
Private
Local
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Community Benefit Programs
Community benefit programs of local or regional hospitals and HMOs may be valuable partners to the public health department or community health nurse in planning, implementing, and funding programs to improve population health.
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Social Marketing
Use of marketing principles and practices to change health behaviors or beliefs, social or cultural norms, or community standards to improve health or benefit society
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Nurse-Managed Health Centers
Nurse-managed health centers provide health promotion and primary care services to vulnerable and underserved population aggregates.
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Chapter 8: Gathering Evidence for Public Health Practice
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Chapter Highlights
Epidemiologic/public health research defined
Observational studies: Descriptive versus analytical research
Strengths and limitations of epidemiologic research methodology
Applying epidemiologic research to public health nursing practice
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Question #1
Is the following statement true or false?
In descriptive studies, the researcher relies on comparisons between groups to determine the role of various risk factors in causing the problem.
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Answer to Question #1
False
Rationale: In analytical studies, the researcher relies on comparisons between groups to determine the role of various risk factors in causing the problem. In descriptive studies, the researcher collects information to characterize and summarize the health event or problem.
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Epidemiologic Research
Epidemiologic/public health research can be descriptive or analytical. Study designs are based on the problem under study and range in strength on a continuum, with the weakest design being the retrospective design and the strongest being the experimental design.
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Observational Studies
In descriptive studies, the researcher collects information to characterize and summarize the health event or problem.
In analytical studies, the researcher relies on comparisons between groups to determine the role of various risk factors in causing the problem.
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Descriptive Studies
Descriptive studies are most frequently used in public health research. They may be observational or analytical
Case studies
Survey research
Cross-sectional studies: examine the relationship of health-related characteristics and other variables of interest in a defined population at a particular point in time
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Analytical Studies
Cohort studies, also called longitudinal studies, examine phenomena prospectively to observe presumed effects over time.
Case‒control studies retrospectively compare subjects (cases) with a condition (disease) and matched subjects/control without the condition/disease.
Advantages: Allow for the examination of multiple exposures for a single outcome, suitable for studying rare diseases and those with long latency periods, require fewer case subjects, generally quicker, less expensive, and well suited for outbreak investigation
Disadvantages: Not appropriate for rare exposures, subject to bias because of the method used to select controls, do not allow direct measure of incidence
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Question #2
Is the following statement true or false?
Cohort studies involve an in-depth analysis of an individual, group, or social institution.
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Answer to Question #2
False
Rationale: Case studies involve an in-depth analysis of an individual, group, or social institution. Cohort studies, sometimes referred to as prospective studies, are longitudinal studies, which monitor subjects over time to find associations between risk factors and health outcomes.
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Question #3
Is the following statement true or false?
Case–control studies, also known as prospective studies, work backward from the effect to the suspected cause.
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Answer to Question #3
False
Rationale: Case–control studies, also known as retrospective studies, work backward from the effect to the suspected cause. Cohort studies, sometimes referred to as prospective studies, are longitudinal studies, which monitor subjects over time to find associations between risk factors and health outcomes.
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Intervention (Experimental) Studies
Preventive trials
Therapeutic trials
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Question #4
Is the following statement true or false?
Intervention study is the epidemiologic investigation designed to test a hypothesized relationship by modifying an identified factor in a population. The study is preventive.
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Answer to Question #4
False
Rationale: Intervention study is the epidemiologic investigation designed to test a hypothesized relationship by modifying an identified factor in a population. Studies may be therapeutic (clinical) or preventive.
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Quasi-experimental and Experimental Design
Quasi-experimental and experimental designs are used to examine causality.
The “gold standard” for research design is the randomized, control group design.
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Question #5
Is the following statement true or false?
The “gold standard” for research design is the randomized, experimental group design.
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Answer to Question #5
False
Rationale: The “gold standard” for research design is the randomized, control group design.
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