community analysis, diagonsis, planning, intervention, and evaluation

barriers to behavioral change

1. predisposing factors: provides rational for behavior

   1. ex) lack of knowledge, beliefs/misconceptions, negative attitudes

      1. vaccines cause autism, avoid care with health organizations, avoiding certain areas

2. reinforcing factors: continued motivation to resist in behavior

   1. ex) social group, discourgement in behavior change, norm/culture encouraging behavior

      1. work encouraging workaholic behaviors

3. enabling factors: promote/facilitate behavior based on availability, can hinder/help w/ enviornmental changes

   1. ex) cost of medical treatment, financial barriers, availability/accessibility of resources, accessibility to behavior

      1. cost of gym memberships, availability of nicotine patches, live in food desert

changeability

behaviors that are easiest to change

• usually still developing → easier to quit

• recently adopted

• not deeply rooted in culture/lifestyle → does not enable reinforcing factors

• have attempted to change before with partial success

importance

the frequency of the identified behavior and how strongly linked it is to a health problem

• helps to prioritize intervention

• ex) smoking → more it occurs → higher risks of lung cancer, running → more you engage → reduces risk as a protective factor

community diagnosis characteristics

portrays community focus

• community response and related factors that have potential to change w/ CHN

• consistent, response and factors linked

• narrow enough to guide interventions

community diagnosis types

1. wellness nursing diagnosis (health promotion)

   1. “readiness for enhanced..r/t..”

   2. ex) readiness for enhanced community health management r/t active senior programs

2. deficit community nursing diagnosis (at risk)

   1. “risk for..r/t..”

   2. ex) risk for impaired mental health in community r/t economic stress from job losses

3. socioeconomic community diagnosis (system level influence)

   1. “compromised or ineffective..r/t..”

   2. ex) compromised community safety r/t reduced funding for law enforcement

prioritization with PEARL acronym

PEARL

• propriety → program suitable?

• economics → economically make sense to address problem?

• acceptability → community accept the program?

• resources → resources available?

• legality → we have legal right to intervene?

establishing goals vs. objective

goals: broad statements of desired outcomes

• ex) reduce % of high blood pressure by _ amount and by this time

objectives: specific statements of desired outcomes, in behavioral terms that can be measured

• ex) to reduce blood pressure we will increase awareness of healthy eating behaviors by eating this _ diet by this _ time frame and measure their blood pressure and recording

→ both use SMART acronym to establish (specific, measurable, attainable, relevant, timely)

key social marketing concepts

1. exchange/competition → individuals weigh cost and benefits

2. self-interest → individuals typically act in their best interests

3. behavior change → campaign to implement change/create awareness/facts in place/prep for training/accessible to behavior/positive reinforcement

4. consumer orientation → design program on tailorization of community

5. 4Ps: product, price, place, promotion → intervention itself, inexpensive to recieve, where can recieve intervention, message to deliver importance

6. partners and policy → organizations w/ similar interest implement collaborate together to create bigger policy change

logic model

tool that assists in planning interventions

• resources/inputs: materials needed

  • ex) nurses, materials, monitors, telehealth process

• activities: how we will improve quality of life

  • ex) group education, individual adherence sessions

• output: number of intervention implementation completed

  • ex) results of intervention

• outcome: how program will improve quality of life

  • ex) reduction in health issue, improved awareness, increased adherence

• impact: improved quality of life

  • amount of time needs to pass to see impact

types of evaluations to implement community health plan

formative: focus on the objectives of intervention

• effect → degree to which objective has been met

summative: focus on the goal/outcomes of intervention

• impact → determains how close program is to attaining its goals

evaluation of outcomes

• impact report: communication to the public on the outcomes of the project

• quality indicators: of patient outcomes, uses quantitative measures of patient response to care, determaines goal achievement

• benchmarking: compares performance of an individual practice/department/agency w/ existing standard that can be external or internal