Community Health Planning
Implementation and evaluation
Read chapter 5, 7 and 8 of the attached PowerPoint presentations. Once done answer the following questions;
Chapter 5
Epidemiology
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
Epidemiology Is …
… the study of the distribution
and determinants of health and
disease in human populations
(Harkness, 1995)
… the principal science of
public health
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
2
Historical Perspective
Investigations of disease pattern in the
community; comparing people who had
disease or who remained healthy
Person-Place-Time Model
➢
➢
➢
Person: “Who” factors, such as demographic
characteristics, health, and disease status
Place: “Where” factors, such as geographic
location, climate and environmental conditions,
political and social environment
Time: “When” factors, such as times of day, week,
or month and secular trends over months and year
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
3
Different Types of Epidemiology
Descriptive Epidemiology
➢
➢
➢
Study of the amount and distribution of disease
Used by public health professionals
Identified patterns frequently indicate possible
causes of disease
Analytic Epidemiology
➢
➢
Examine complex relationships among the many
determinants of disease
Investigation of the causes of disease, or etiology
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
4
Epidemiological Triangle
Figure 5-1
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
5
Agent of Disease
(Etiologic Factors)
Nutritive elements
➢
Chemical agents
➢
Poisons, allergens
Physical agents
➢
Excesses, deficiencies
Ionizing radiation, mechanical
Infectious agents
➢
Metazoa, protozoa, bacteria, fungi, rickettsia,
viruses
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
6
Host Factors–Intrinsic Factors
(Susceptibility, or Response to Agent)
Genetic
Age
Sex
Ethnic group
Physiological state
Prior immunological experience
➢
Active/, passive
Intercurrent or preexisting disease
Human behavior
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
7
Environmental Factors— Extrinsic
Factors…
… influence existence of the agent, exposure,
or susceptibility to agent
Physical environment
Biological environment
➢
Human populations, flora, fauna
Socioeconomic environment
➢
Occupation, urbanization and economic
development, disruption
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
8
Wheel Model of
Human-Environment Interaction
Figure 5-2
Redrawn from Mausner JS,
Kramer S: Mausner and
Bahn epidemiology: an
introductory text, ed 2,
Philadelphia, 1985,
Saunders.
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
9
Web of Causation
Figure 5-3
From Friedman GD:
Primer of epidemiology, ed
4, New York, 1994,
McGraw-Hill.
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
10
Ecosocial Approach
Emphasize the role of evolving macro-level
socioenvironmental factors along with
microbiological process in understanding
health and illness (Smith & Lincoln, 2011)
Challenges the more individually focused risk
factor approach to understanding disease
origins
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
11
Calculation of Rates
Rates are arithmetic expressions that help
practitioners consider a count of an event
relative to the size of the population from
which it is extracted
➢
➢
Number of health events in a specified period
Population in same area in same specified period
• Proportion multiplied by a constant (k)
• For example, the rate can be the number of cases of a
disease occurring for every 1000, 10,000 or 100,000
people in the population
➢
Can make meaningful comparisons
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
12
Morbidity Rates
Incidence rates
➢
➢
New cases or conditions
Attack rate
• Number of new cases of those
exposed to the disease
Prevalence rates
➢
All cases of a specific
disease or condition at
a given time
Figure 5-4
Redrawn from Morton RF, Hebel JR,
McCarter RJ: A study guide to epidemiology
and biostatistics, ed 3, Gaithersburg, MD,
1990, Aspen Publishers.
Prevalence Pot
The relationship between incidence
and prevalence
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
13
Morbidity Rates (Cont.)
Incidence Rate
Number of new cases
_in given time period
× 1000
Population at risk in
same time period
___75___ = 0.02
4000–250
0.02 × 1,000 = 20 per 1000 per time period
Prevalence Rate
Number of existing cases
Total Population
250
_____
= 0.0625
4000
0.0625 × 1000 = 62.5 per 1000
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
14
Mortality Rates
(routinely collected birth and death rates)
Other rates
Crude rates
Age-specific rates
Age-adjusted rates or
standardization of rates
Proportionate mortality
ratio (PMR)
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
15
Number of deaths in year
× 100,000
Total population size
_1720_ = 0.0086
200,000
Number of births in year
× 100,000
Total population size
_2900_ = 0.0145
200,000
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
16
Concept of Risk
Risk—probability of an adverse event
Risk factor
➢
➢
Attributable risk
➢
Refers to the specific exposure factor
Often external to the individual
Estimate of the disease burden in a population
Relative risk ratio
➢
Divide the incidence rate of disease in the
exposed population by the incidence rate of
disease in the nonexposed population.
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
17
Use of Epidemiology
Disease prevention
➢
Primary prevention
• Health promotion and specific prevention
➢ Secondary and tertiary prevention
➢ Establishing causality
➢ Screening
➢ Surveillance
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
18
Use of Epidemiology (Cont.)
Health services
➢
➢
➢
Used to describe the distribution of disease
and its determinants in populations
Study population health care delivery
Evaluate use of community health services
Nurses must apply findings in practice
➢
➢
Incorporate results into prevention
programs for communities and at-risk
populations
Extend application into major health policy
decisions
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
19
Community health nurses should exercise
“social responsibility” in applying
epidemiological findings, but this will require the
active involvement of the consumer.
Community health nurses collaborating with
community members can combine
epidemiological knowledge and aggregate-level
strategies to affect change on the broadest
scale.
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
20
Epidemiological Methods
Descriptive epidemiology
➢
Focuses on the amount and distribution of health
and health problems within a population
Analytic epidemiology
➢
Investigates the causes of disease by determining
why a disease rate is lower in one population
group than in another
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
21
Analytic Epidemiology
Observational studies
➢
➢
➢
Descriptive purposes
Etiology of disease
No manipulation by investigator
Cross-sectional studies
➢
➢
➢
Sometimes called prevalence or correlational
studies
Examine relationships between potential causal
factors and disease at a specific time
Impossible to make causal inferences
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
22
Analytic Epidemiology (Cont.)
Retrospective studies
➢
➢
Compare individuals with a particular condition or
disease with those who do not have the disease
Data collection extends back in time
Prospective studies
➢
➢
➢
Monitor a group of disease-free individuals to
determine if and when disease occurs
Cohort shares a common experience within a
defined time period
Monitors cohort for disease development
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
23
Analytic Epidemiology (Cont.)
Experimental design
➢
Also called a Randomized Clinical Trial (RCT)
• Subjects assigned to experimental or control group
• Apply experimental methods to test treatment and
prevention strategies
• Ethical considerations with human subject rights review
➢
Also useful for investigating chronic disease
prevention
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
24
Chapter 6
Community Assessment
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
Defining the Community
Aggregate of people
➢
➢
Location in space and time
➢
➢
The “who”
Share personal characteristics and risks
The “where” and “when”
Physical location frequently delineated by boundaries and
influenced by the passage of time
Social system
➢
➢
The “why” and “how”
Interrelationships of aggregates fulfilling community
functions
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
2
Diagram of Assessment Parameters
Figure 6-1
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
3
Community Assessment Parameters
Geography
Population
Environment
Industry
Education
Recreations
Religion
Communication
Transportation
Public services
Political organization
Community development
or planning
Disaster programs
Health statistics
Social problems
Health manpower
Health professional
organizations
Community services
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
4
Healthy Communities
A movement to help
community members bring
about positive health
changes
Interconnectedness between
people and the public and
private sectors is essential to
make changes.
Each community has its
unique perspective.
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
5
Assessing the Community
Windshield survey
➢
➢
➢
Gain an understanding of environmental layout
Locate possible areas of environmental concern
through “sight, sense, and sound”
Gives nurse an opportunity to observe people and
their role in the community
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
6
Windshield Survey
Community vitality
Indicators of social
and economic
conditions
Health resources
Environmental
conditions related
to health
Social functioning
Attitudes toward
health and health
care
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
7
Assessing the Community (Cont.)
Sources of data:
➢
Census data and other census reports
➢ Vital statistics
➢ NCHS survey data
➢ Local, regional, and state government reports
➢ Locally generated data collection
Analysis of demographic information provides
descriptive information about the population
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
8
Assessing the Community (Cont.)
Needs assessment
Used to understand the community’s perspective
➢ Interview key community informants
➢ Use community forums, focus groups, or surveys
➢ 12 Steps in a Needs Assessment
➢
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
9
Steps in the Needs Assessment
Process
1.
2.
3.
4.
5.
6.
Identify aggregate for assessment
Engage the community in planning the assessment
Identify required information
Select method of data gathering
Develop questionnaires or interview questions
Develop procedures for data collection
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
10
Steps in the Needs Assessment
Process (Cont.)
7. Train data collectors
8. Arrange for a sample representative of the
aggregate
9. Conduct needs assessment
10. Tabulate and analyze data
11. Identify needs suggested by data
12. Develop an action plan
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
11
Nursing Process
● The nursing process can be applied to the
community as a client.
➢ Needs assessment
➢ Diagnosing health
problems (actual and
potential)
➢ Planning
➢ Intervention
➢ Evaluation
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
12
Format for Community Health
Diagnosis
Figure 6-3 Redrawn from Muecke MA: Community health diagnosis in
nursing, Public Health Nurs 1:23-35, 1984. Used with permission of Blackwell
Scientific Publications.
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
13
Epidemiological Studies Used
Throughout the Nursing Process
Support planning by establishing
effectiveness of certain interventions in
specific aggregates
Construct benchmarks to gauge achievement
of program objectives
Compare data with other rates
Identify objectives of successful programs
Document effectiveness with epidemiological
data
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
14
Chapter 7
Community Health Planning,
Implementation, and Evaluation
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
The Community as Client
Figure 7-1
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
2
Levels of
Community Health Nursing Practice
Client
Example
Characteristics
Health
Assessment
Nursing
Involvement
Individual
Lisa McDonald
Individual with various
needs
Individual strengths,
problems, and needs
Client-nurse interaction
Family
Moniz family
Family system with
individual and group
needs
Individual and family
strengths, problems, and
needs
Interactions with
individuals and the family
group
Group
Boy Scout
troop
Alzheimer’s
support group
Common interests,
problems, and needs
Interdependency
Group dynamics
Fulfillment of goals
Group member and
leader
Population
group
AIDS patients
in a given state
Pregnant
adolescents in
a school
district
Large, unorganized
group with common
interests, problems, and
needs
Assessment of common
problems, needs, and
vital statistics
Application of nursing
process to identified
needs
Organization
A workplace
A school
Organized group in a
common location with
shared governance and
goals
Relationship of goals,
structure,
communication, patterns
of organization to its
strengths, problems and
needs
Consultant and/or
employee application of
nursing process to
identified needs
Community
Italian
neighborhood
Anytown, USA
An aggregate of people
in a common location
with organized social
systems
Analysis of systems,
strengths,
characteristics,
problems, and needs
Community leader,
participant, and health
care provider
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
3
Health Planning Model
Figure 7-2
Hogue (1985)
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
4
Steps in the Health Planning
Model
Assessment
➢
➢
➢
➢
➢
➢
➢
➢
Meet with group leaders of aggregate to clarify mutual
expectations
Determine sociodemographic characteristics
Interview a key informant
Consider both positive and negative factors
Compare the aggregate with the “norm”
Research potential problems
Identify health problems and needs
Prioritize the identified problems and needs to create an
effective plan
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
5
Four Types of Needs to Assess
Expressed needs
➢
Normative needs
➢
Lack, deficit, or inadequacy of services determined by health
professionals
Perceived needs
➢
Demand for services and the market behavior of the targeted
population
Wants and desires expressed by audience
Relative needs
➢
Gap showing health disparities between advantaged and
disadvantaged population
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
6
Factors for Determining Priorities
Aggregates preferences
Number of individuals affected by the health
problem
Severity of the health need or problem
Availability of potential solutions
Practical considerations such as skills, time,
and available resources
May use Maslow’s hierarchy of needs or
levels of prevention to further refine priorities
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
7
Community Involvement Is Essential
“Start where the people are!”
Five spheres of empowerment
➢
➢
➢
➢
➢
Interpersonal (personal empowerment)
Intragroup (small group development)
Intergroup (community)
Interorganizational (coalition building)
Political action
– Labonte (1994)
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
8
Steps in the Health Planning Model
(Cont.)
Planning
➢
➢
➢
Determine the intervention levels
• Subsystem, aggregate system, and/or suprasystem
Plan interventions for each system level
• Primary, secondary, or tertiary levels of prevention
Validate the practicality of the planned
interventions according to available resources
• Personal, aggregate, and suprasystem
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
9
Development of Goals and
Objectives
Goals—where we want to be
Objectives—steps needed to get there
➢
➢
➢
➢
Measurable
Specific measures
Instructions to guide population
Used to measure outcomes
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
10
Steps in the Health Planning Model
(Cont.)
Intervention
➢
Often the most enjoyable stage for the nurse and
the clients
➢ Implementation should follow the initial plan
➢ Should include a variety of strategies
➢ Prepare for unexpected problems
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
11
Interventions by
Type of Aggregate and System Level
Project
Type of Aggregate
System Level for Intervention
Rehabilitation group
Group
Subsystem and aggregate system
Textile industry
Organization
Aggregate system and suprasystem
Crime watch
Group, organization,
and population group
Aggregate system and suprasystem
Bilingual students
(case study)
Community
Aggregate system and suprasystem
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
12
Steps in the Health Planning Model
(Cont.)
Evaluation
➢
➢
➢
➢
Include the participant’s verbal or written feedback and the
nurse’s detailed analysis
Reflect on each previous stage to determine the plan’s
strengths and weaknesses
Evaluate both formative (process) and summative
(product/outcome) aspects
Communicate follow-up recommendations
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
13
Importance of Each Step in the
Nursing Process
Aggregate assessments must be thorough.
➢
➢
The nurse must complete careful planning and set
goals that the nurse and the aggregate accept.
➢
Should elicit answers to key questions about the aggregate’s
health and demographic profile
Should compare this information with similar aggregates
presented in the literature
Mutual planning is very important.
Interventions must include aggregate participation
and must meet the mutual goals.
Evaluation must include process and product
evaluation and aggregate input.
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
14
PRECEDE-PROCEED Model
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
15
Federal Legislation Affecting Health
Planning
Hill-Burton Act
Regional Medical Programs (RMP)
Partnership for Health Program (PHP)
Certificate of Need (CON)
National Health Planning and Resources
Development Act
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
16
Comprehensive Health Reform
Patient Protection and Affordable Care Act
(2010)
➢
Preventive services based on evidence-based
recommendations
➢ National strategy to improve the nation’s health
➢ CMMS innovation center
➢ National quality improvement strategy for services
and population health
➢ Improved access to care
➢ Reduction in the growth of Medicare spending
➢ National workforce strategy
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
17
Nurses’ Role
Work collaboratively with health planners to
improve aggregate health
Fuse technology with knowledge of health
care needs and skills
Become directly involved in the planning
process
Engage in aggregate-level projects
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
18
Chapter 8
Community Health Education
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
Health Education …
… is any combination of learning experiences
designed to predispose, enable, and reinforce
voluntary behavior conducive to health in
individuals, groups or communities.
– Green and Kreuter, 2004
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
2
Health Education’s Goals
To understand health behavior and to
translate knowledge into relevant
interventions and strategies for health
enhancement, disease prevention, and
chronic illness management
To enhance wellness and decrease disability
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
3
Health Education’s Goals (Cont.)
Attempts to actualize the health potential of
individuals, families, communities, and
society
Includes a broad and varied set of strategies
aimed at influencing individuals within their
social environment for improved health and
well-being
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
4
Learning Theories
Humanistic theory helps individuals develop their
potential in a self-directing and holistic manner.
Cognitive theory recognizes the brain’s ability to
think, feel, learn, and solve problems; theorists in this
area train the brain to maximize these functions.
Social learning is based on behavior that explains
and enhances learning through the concepts of
efficacy, outcome expectation, and incentives.
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
5
Adult Learners
Need to know
Concept of self
Experience
Readiness to learn
Orientation to learning
Motivation
– Knowles (1980, 1989)
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
6
Health Education Models
Health Belief Model (HBM)
Perceived susceptibility
Perceived severity
Perceived benefits
Perceived barriers
Self-efficacy
Demographics
Cues to action
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
7
Health Education Models (Cont.)
Health Promotion Model (HPM)
Individual characteristics and behaviors
➢
Behavior—specific cognitions and affect
➢
Prior behaviors, personal factors
Activity-related affect, interpersonal influences, situational
factors, commitment to plan of action, perceived self-efficacy,
immediate competing demands and preferences, perceived
benefits of health-promoting behaviors, perceived barriers to
health-promoting behaviors
Behavioral outcome
➢
Health-promoting behavior
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
8
Model of Health Education
Empowerment
… nurses cannot assign power and control to
the individual within the community but rather
… the “power” must be taken on by the
individual and community with the nurse guiding
this dynamic process.
– Van Wyk, 1999
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
9
Model of Health Education
Empowerment (Cont.)
Process includes examining
➢
Education
➢ Health literacy
➢ Gender
➢ Racism
➢ Class
Recognizes the structural and foundational
changes that are needed to elicit change for
socially and politically disenfranchised groups
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
10
Problem-Solving Education …
…centers on empowerment (Freire, 2005)
➢
Allows active participation and ongoing dialogue
➢ Encourages learners to be critical and reflective
about health issues
➢ Involves individuals as subjects, not objects
➢ Increases health knowledge through a
participatory group process
Involves activism on the part of the educator
➢
➢
Facilitator-educator is a resource person and is an
equal partner with the other group members
Leads to sustainable lateral relationships
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
11
Participatory Action Research (PAR)
Goal of PAR is social change
Embraces the use of community-based
participatory methods
➢
Participation and action from stakeholders and
knowledge about conditions and issues helps to
facilitate strategies reached collectively
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
12
Community Empowerment
Community members take on greater power
to create change
Based on community cultural strengths and
assets
Attention must be given to collective rather
than individual efforts to ensure that
outcomes reflect voices of the community and
truly make a difference in people’s lives
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
13
The Nurse’s Role in Health
Education
Become a partner with individuals and
communities
Serve as catalyst for change
Activate ideas
Offer appropriate interventions
Identify resources
Facilitate group empowerment
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
14
Framework for Developing
Health Communications
Figure 8-1
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
15
Health Education Model
Stage I: Planning and strategy selection
Questions to Ask
➢
Who is the intended audience?
➢ What is known about the audience and from what
sources?
➢ What are the communication and education
objectives and goals?
➢ What evaluation strategies will the nurse use?
➢ What are the issues of most concern?
➢ What is the health issue of interest?
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
16
Health Education Model
Stage I: Planning and strategy selection (Cont.)
Collaborative Actions to Take
➢
Review the available data.
➢ Get community partners involved.
➢ Obtain new data.
➢ Determine perceptions of health problems.
➢ Determine the community’s assets and strengths.
➢ Identify underlying issues and knowledge gaps.
➢ Establish goals and objectives.
➢ Assess resources.
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
17
Health Education Model
Stage II: Developing and pretesting concepts, messages, and
materials
Questions to Ask
➢
What channels are best?
➢ What formats should be used?
➢ Are there existing resources?
➢ How can the nurse present the message?
➢ How will the intended audience react to the
message?
➢ Will the audience understand, accept, and use the
message?
➢ What changes may improve the message?
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
18
Health Education Model
Stage II: Developing and pretesting concepts, messages, and
materials (Cont.)
Collaborative Actions to Take
➢
Identify the messages and materials.
➢ Decide whether to use existing materials or
produce new ones.
➢ Select channels and formats.
➢ Develop relevant materials with the target
audience.
➢ Pretest the message and materials and obtain
audience feedback.
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
19
Health Education Model
Stage III: Implementing the program
Questions to Ask
➢
➢
➢
➢
➢
➢
➢
➢
How should we launch the health education program?
How do we maintain interest and sustainability?
How can we use process evaluation?
What are the strengths of the health program?
How can we keep on track within timeline and budget?
How do we know if we have reached our intended audience?
How well did each step work (process evaluation)?
Are we maintaining good relationships with partners?
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
20
Health Education Model
Stage III: Implementing the program (Cont.)
Collaborative Actions to Take
➢
Work with community organizations to enhance
effectiveness.
➢ Monitor and track progress.
➢ Establish process evaluation measures.
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
21
Health Education Model
Stage IV: Assessing effectiveness and making refinements
Questions to Ask
➢
What was learned?
➢ How can outcome evaluation be used to assess
effectiveness?
➢ What worked well, and what did not work well?
➢ Has anything changed about the intended
audience?
➢ How can we refine methods, channels, and
formats?
➢ What lessons were learned? What modifications
could strengthen the health education activity?
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
22
Health Education Model
Stage IV: Assessing effectiveness and making refinements
(Cont.)
Collaborative Actions to Take
➢
Conduct outcome evaluations.
➢ Reassess and revise goals and objectives.
➢ Modify unsuccessful strategies or activities.
➢ Generate continual support from community
groups.
➢ Provide justification for continuing/ending the
program.
➢ Summarize in an evaluation report.
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
23
Health Literacy Definitions Evolved
Over Time
National Literacy Act (1991)
➢
Literacy is operationally defined as the ability to
read and write at the fifth-grade reading level in
any language and can be measured according to
a continuum.
IOM Report (2004)
➢
The capacity to obtain, interpret, and understand
basic health information and services and the
competence to use such information and services
to enhance health
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
24
Health Literacy
In 1999, the AMA’s Report of the Council on
Scientific Affairs reported that patients with the
most health care needs are often the least able
to read and understand information that would
enable them to function successfully within
the health care system.
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
25
Health Literacy (Cont.)
Health literacy is about empowerment …
➢
➢
➢
Having access to information, knowledge, and
innovations
Increasingly important for social, economic, and
health development
A key public health issue in the delivery of safe,
effective care
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
26
Low Literacy
Increases the use of health care services
Decreases self-esteem; increases shame and
stigma
Adversely affects outcomes and treatment of
some medical conditions
Poses barriers to obtaining informed consent
Impacts participation in research
Leads to health care and linguistic isolation
Impedes patient-provider communication
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
27
Literacy Concerns
Serious mismatch exists between the reading
levels of materials and patient’s reading skills.
Materials often fail to incorporate the intended
audience’s cultural beliefs, values, languages,
and attitudes.
Low literacy prevents many from gaining the
full benefits of health care.
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
28
Literacy Concerns (Cont.)
Inability to read and understand instructions
influences self-care abilities and health and
wellness.
Individuals with very low literacy skills are at
an increased risk for poor health, which
contributes to health disparities.
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
29
Levels for Interventions
Functional/basic literacy
➢
Communicative/interactive literacy
➢
Increasing basic reading/writing skills
Understanding and using information with
providers
Critical literacy*
➢
Analyzing and using information in life situations
*Most important because it increases empowerment and success
in everyday situations
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
30
Helpful Tips for Effective Teaching
Assess reading skills
Determine what client
needs to know
Identify motivating
factors
Stick with essentials
Set realistic goals and
objectives
Use clear and concise
language
Develop a glossary of
common words
Space teaching over
time
Personalize health
messages
Incorporate methods of
illustration,
demonstration, and
real-life examples
Give and get
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
31
Helpful Tips for Effective Teaching
(Cont.)
Summarize often
Be creative
Use appropriate
resources and materials
Put patients at ease
Praise patients
Be encouraging
Allow time for questions
Employ teach-back
methods
Remember that
comprehension and
understanding take time
and practice
Conduct learner
verification
Evaluate the teaching
plan
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
32
Assess Materials
Become a Wise Consumer and User
➢
Evaluate health materials, including websites,
before disseminating them
➢ Materials should strengthen previous teaching
➢ Materials should be used as an adjunct to health
instruction
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
33
Assessing the Relevancy of
Health Materials
Do materials match the intended audience?
Are materials appealing and culturally and
linguistically relevant?
Do they convey accurate and up-to-date information?
Are messages clear and understandable?
Do messages promote self-efficacy and motivation?
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
34
Assessment of Reading Level
Assess reading levels of intended audience
➢
Rapid estimate of adult literacy in medicine
(REALM)
➢ Single Item Literacy Screener (SILS)
➢ Short Assessment of Health Literacy for SpanishSpeaking Adults (SAHLSA)
Assess readability of educational resources
➢
➢
SMOG readability formula
Flesch-Kincaid formula (on most computers)
Verify understanding of learner
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
35
Role of Social Media
Numerous platforms now available
May reach diverse community constituents
with important public health messages
Potential to…
➢
➢
➢
Facilitate interactive communication
Increase sharing of health information
Personalize and reinforce health messages
Can empower community members to make
informed health decisions
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
36
Essay Writing Service Features
Our Experience
No matter how complex your assignment is, we can find the right professional for your specific task. Achiever Papers is an essay writing company that hires only the smartest minds to help you with your projects. Our expertise allows us to provide students with high-quality academic writing, editing & proofreading services.
Free Features
Free revision policy
$10Free bibliography & reference
$8Free title page
$8Free formatting
$8How Our Dissertation Writing Service Works
First, you will need to complete an order form. It's not difficult but, if anything is unclear, you may always chat with us so that we can guide you through it. On the order form, you will need to include some basic information concerning your order: subject, topic, number of pages, etc. We also encourage our clients to upload any relevant information or sources that will help.
Complete the order form
Once we have all the information and instructions that we need, we select the most suitable writer for your assignment. While everything seems to be clear, the writer, who has complete knowledge of the subject, may need clarification from you. It is at that point that you would receive a call or email from us.
Writer’s assignment
As soon as the writer has finished, it will be delivered both to the website and to your email address so that you will not miss it. If your deadline is close at hand, we will place a call to you to make sure that you receive the paper on time.
Completing the order and download