Week 2 Community

Community planning process

• Assess

• Analyze and design

• Planning an implementation

• Evaluation

Target population

• Group you seek to reach with program

  • Primary TP

    • MAIN GROUP you design project around

  • Secondary TP

    • Not target but happen to benefit from that

Assessment stage

• Issue to explore

• Views of target population

• Data collection

  • Review literature (census data, vital statistics,  health records)

    • Ex) literature on adolescent drunk driving in georgia

  • Informant interviews: formal and informal leaders;

    • Ex) interview church leaders, high schoolers, school nurse

  • Windshield survey

    • Ex) Drive around and observe, maybe there’s a lot of liquor stores

• Limit focus to a number of health factors

Analyzing data

• Engage community members

  • If not involved the might not come up with initiatives

  • Community must be involved in every step

  • Let you know if they tried something before and failed

• Identify priority community problem

• Problem evidenced in literature

• Focus on one problem

Statement of need

• A question to consider when writing a statement of need.

  • What is the need that my group will address?

• The statement should brief

  • Identify the target population to be served

  • Describe the problem(s) to be addressed and identify factors that contribute to the problem(s)

Planning and Implementing

• Develop your plan to achieve your goal and objectives

• Client focus

  • Engage target population

  • Understand target population

  • Advisory groups

  • Problem supported by evidence from literature

• Sufficient resources/Budget

• Evidence guide interventions

• Timeline

• Budgeting and system for acquiring additional funding

• Collaborate with other health care professionals

• Monitoring progress and consider  how you will evaluate your objectives

Two types of evaluation

• Formative/process evaluation:  focus on the project/process during program implementation to make changes

  • What is working or not working

  • Were activities completed?

• Summative/Outcome evaluation

  • Were outcome objectives met

Behavior Change

AKA Changeability

• Knowledge attitudes and beliefs of your target audience

• Input of representatives from the community/target population.

• Non-modifiable: Genetic predisposition, gender, race

Factors that influence Behavior change

• Predisposing factors

• Reinforcing factors

• Enabling factors-

What is considered a VERY important rule when planning a health program?

Should be tailored to target population and specific issue, and they should engage in all processes

three dimensions of a community as a client

• Status

• Structure

• Proceed

Describe the characteristics of a healthy community

• Attend to things that give them good health outcomes

  • Eliminate health disparities

    • Attain healthy thriving lives free of preventable diseases and premature deaths

    • Eliminate health disparities and achieve health equity and health literacy

    • Have social, physical, and economic environments that promote well being

    • Stress the interconnectedness between people and the public and private sectors to make changes

    • Promote healthy development and healthy behavior across all life stages

    • Engage leadership and the public to design policies that improve health and well being for all

Describe the meaning of community as client.

• The community directly influences the health of individuals, families, groups, subpopulations, and populations who are a part of it

• A community-wide group of people as the focus of nursing service

Identify the different types of community assessment

• Windshield surgery (familiarization assessment)

• aka familiarization

• Initial step

• Drive around community and chat with residents

• Problem-oriented assessment

  • Address specific problem

  • Should gauge size of problem, prevelance

• Community subsystem assessment

  • Focus on one dimension or component of community

    • Schools, Safety, churches

• Comprehensive assessment’

  • Look at everything available to community in their community health

  • COMPLETE understanding, compiles as much information as possible

• Community assets assessment

  • Resources available to community

  • Focuses on strengths and resources instead of problems

  • 3 levels

    • Individual businesses

    • Organizations and institutions controlled within community

      • Libraries, police, schools, volunteer agencies, social service agencies

    • Local institutions controlled from outside of community

      • Welfare agencies

  • Non pathology model unlike others

Discuss methods of conducting a community health assessment

• Surveys

  • Series of questions used to collect data for analysis of specific group or area

  • Determine variables that affect wellness

  • Self reports, questionnaires, telephone, in person interviews

• Descriptive epidemiological studies

  • Examines amount & distribution of disease or health condition in population

    • By person, place, and time

• Geographic information system analysis

  • Uses research methods and from both analytic techniques from both medical geography and spatial epidemiology

• Community forums and social media

  • Forums aka town meeting

  • Qualitative assessment method designed to obtain community opinions

  • Occurs in school gymnasium or auditorium

  • Inexpensive and quick result

• Focus groups

  • Guide to collect

  • Hold to obtain grassroots opinion with small group of participants 5-15 people from homogenous groups with respect to demographic variables

    • Ex) Community health nurses assigned female at birth, young people in first pregnancy or retired business people

Formative/process evaluation

• focus on the project/process during program implementation to make changes

  • What is working or not working

  • Were activities completed?

Summative/Outcome evaluation

Were outcome objectives met in the end

Predisposing factors

provide the rationale or motivation for the behavior. Intrinsic. Comes from person.

• Attitudes, beliefs, confidence, knowledge that drive health choices

Reinforcing factors

provide the continuing reward or incentive for the persistence or repetition of the behavior. Outside forces encourage change.

• Comes from family, friends, authority figures, community decisions makers

Enabling factors

Promote or facilitate the behavior based on availability. Do or don’t have access to thing

• Precede behavior and allow motivation to be realized

• Ex) resources, laws, gov support for health behavior

Status and people

• physical, social, and emotional aspects

  • Physical determinants

    • Vital statistics, morbidity, mortality rate, birth rate, addiction rates, leading causes of sickness and health,

  •  Social determinants

    • Crime rates, education, income levels

Structure

• availability, quality, and use of health resources and services within the community

  • Buildings such as hospitals, clinics, schools, fire department, libraries, churches, grocery stores

  • Also refers to demographics

    • Race, SES, age, gender, education levels

• Process

communities ability to function.

• Processes inside

  • Education and health subsystems

• Processes outside

  • State and national organization

• Community competency

  • Covers strengths and weaknesses of community as a client

  • Competent community can attain consensus, collab, and agree on methods of implementation

• Interrelationships between people in the community and organizations

  • Collab between health and education systems

  • Do community members know about resources available

Delineate five sources of community data.

• Primary

  • Observe yourself, community members from formal or informal leaders

• Secondary

  • Already collected

  • Healthcare providers, local census data

  • Epidemiological data

• International

WHO, world bank, UN

• National

  • NIH, CDC

• State

  • Georgia department of health, social service organizations

• Local

  • Local health department, hospital data

Distinguish primary and secondary data

• Primary: You get info yourself from observing, windshield, interview

• Secondary: information is already collected for you, census

Community social system variables:

• Family dynamics, the law, religion, education, economy, politics, communication

Partnership

• Agreement between two or more people or agencies

Coalition

• Team of individuals or groups that work towards a specific goal

Community needs assessment

• Course of action is determined through this

• Collecting and analyzing info about a communities health current or future status

Authoritative knowledge

• Knowledge that is respected

• Ex) Local beliefs and values as opposed to scientific facts from outside community

Advisory group

• made up from target population

• Useful tool for gathering info

• Interprets info and propose solution

Successful interventions

• Needs to be limited to health behaviors that rate high in importance and changeability

  • IMPORTANT

    • How often behavior occurs and how closely it links to health problem

  • Changeability

    • How recently behavior was established, how deeply it’s rooted in culture’s patterns and lifestyle, and if it’s responded to change in the past.

      • Three factors

        • Predisposing

        • Reinforcing

        • Enabling

Benchmarking

• CONTINOUS and systematic measuring of initiatives strengths and weaknesses

• Measure quality and improvement using structure, Process and outcome, SMART goals

• Results should be evaluated by disease progression and patient adherence

Grants

• Financial support that one individual or group gives to another

• Provides money for planning, start up, managing, technical support, and management

• Must be secured by nurses and other healthcare professionals

• Begins with letter of inquiry to grant funded

  • Letter of inquiry

    • Describes organization, its purpose, the need to be met, and overview of the  project,

• Request for proposals

  • Formal invitation for full grant application

  • Outlines contents of application, order that it needs or be submitted, and any supplemental information

• Geographic information system data (GIS)

• Mapping size and potential client population after problem has been identified

• NCHS,CDC, environment protection agency