CHES Exam 8th Edition Study Guide

Advisory Committee

usually consists of individuals who are in a position to periodically report on their actual experiences related to some common issue. In doing so, members of this committee may offer their advice to a key individual who is bringing them together or to another group of people who will be making programmatic decisions

Capacity assessment

a measure of actual and potential individual, group, and community resources that can be inherent, and/or brought, to bear for health maintenance and enhancement. The process of mapping community assets is included in the capacity assessment

Coalition

a group of diverse organizations and constituencies working together toward a common goal

Needs assessment

the process of identifying, analyzing, and prioritizing the needs of a priority population

Qualitative data

data in narrative form, which is collected to better understand motivation, thoughts, feelings, and behaviors

Quantitative data

data collected in numerical form (e.g., mortality rates or number of cigarettes smoked) or easily translated to numerical form (e.g., patient satisfaction using a 5 point scale from dissatisfied to satisfied)

Planning Committee

advisory committee members, experts, and agency staff. The lifespan of this committee may be episodic (with limited duration) or continuing (on-going)

Primary data

data that a health education specialist collects directly (via a survey, a focus group, in-depth interview, etc.), which are used to answer unique questions related to the specific needs assessment

Secondary data

data that already have been collected by others that may or may not be directly gathered from the individual or population being assessed. Examples include existing research published in peer-reviewed journals and/or datasets, such as the United States Census, Vital Records, and Disease Registries

Stakeholders

individuals or agencies with a vested interest in the health education program

Social determinants of health

conditions in which people are born, live, work, play, as well as age, that affect their health risks, health, daily functioning, and quality of life (Centers for Disease Control and Prevention [CDC], 2018a)

needs assessment

the process of identifying, analyzing, and prioritizing the needs of a priority population

capacity (asset-based) assessment

actual and potential influential resources in the community (e.g., stakeholders) and the support (e.g., individual protective factors, significant others, settings) at an individual level to address needs

Area of Responsibility 1

Assessment of Needs and Capacity

Competency 1.1 Plan Assessment

Sub-competencies:

1.1.1 Define the purpose and scope of the assessment.

1.1.2 Identify priority population(s).

1.1.3 Identify existing and available resources, policies, programs, practices, and interventions.

1.1.4 Examine the factors and determinants that influence the assessment process.

1.1.5 Recruit and/or engage priority population(s), partners, and stakeholders to participate throughout all steps in the assessment, planning, implementation, and evaluation processes.

1.1.1 Planning committee should ask and address at this stage of the assessment process

What is the goal of the needs assessment?

What does the planning committee hope to gain from the needs assessment?

How extensive will the needs assessment be?

What types of resources will be available to conduct the needs assessment?

What type of needs assessment is appropriate? (e.g., comprehensive, focused)

1.1.2 Priority Population

can be identified by the demographic qualities of the population such as age, sex, ethnicity, and income that will impact the information gathered for the needs assessment.

Community perspective

allows health education specialists to use specific criteria including geography (i.e., state, county, zip code), sector (i.e., school, worksite, faith-based), environmental conditions, culture and social aspects, size of population, and shared characteristics within the community to further define the priority population

1.1.3 Existing Five factors

Resources

Policies

Programs

Practices

Interventions

Resources

human resources (e.g., staff, data collectors), supplies, incentives for participation, and travel funds that are available to conduct assessment.

individuals, organizations and institutions, buildings, landscapes, equipment that may be a potential asset for development of the program/intervention.

assessments that have been conducted in the targeted community to avoid duplication of efforts.

Policies

(e.g., laws, regulations, both formal/informal) at the sector/organizational, local, state and/or federal level that may influence the actions or behaviors of the priority population

Programs area 1

available for the priority population to assess usage, effectiveness, accessibility and if priority population needs are being met to avoid duplication

Practices

evidence-based, or best practices, that can have the potential to impact assessment process/findings and program planning efforts in multiple settings and populations

Interventions

designed to change environmental or behavioral factors related to health

6 types of community assets

individual

institutional

organizational

governmental

physical and land

cultural

1.1.4 Framing the Assessment Factors and Determinants

identify both a planning model and implementation model in this stage, which will help to identify the types of data that need to be collected to fully understand the complex influences on health

Priority Population Perspective

Expressed, actual, perceived, and relative needs should all be addressed in the needs assessment, because community concerns may not always reflect empirical evidence

Expressed needs

observed through individuals' use of services

Actual needs

inferred through the discrepancy of services provided to one community group as compared to another

Perceived needs

what individuals in a community state that they want

Relative needs

describe a discrepancy between an individual's or group's current status and that of others, such as smoke free environment in restaurants among different cities

1.1.5 Recruit/Engage

Involving those who will be impacted by the health promotion program/intervention

Partners

either individuals or organizations that bring knowledge, skills, or resources to the table and are willing to share risks, responsibilities, and rewards

8 reasons why partnering is beneficial

Meeting the needs of a priority population, which could not be met by the capacities of an individual partner.

Sharing of financial resources.

Solving a problem or achieving a goal that is a priority to several partners.

Bringing more stakeholders to the "table."

Bringing more credibility to the program.

Seeing and solving a problem from multiple perspectives.

Creating a greater response to a need because there is strength in numbers.

Who should be on the planning committee?

Members of the priority population

Both doers and influencers

Members of the agency

Other important stakeholders

5 strategies to select team members

Asking for volunteers (word of mouth, a newsletter, a needs assessment widely distributed publication),

holding an election (throughout the community or subdivision of community),

inviting/recruiting people to serve,

having members formally appointed, and

having an application process and then selecting specific to most desirable characteristics.

1.2.1 Individual- level primary resources

include surveys, interviews, and self-assessment.

Group- level primary resources

Delphi technique, community forums, focus groups, nominal group process, and observations

Secondary resources

involves gathering epidemiological data, such as health status, risk factors, incidence and/or prevalence rates, death rates, birth rates, and more.

Samples of secondary data sources

Government agencies

State and local agencies

Nongovernment agencies and orgs.

Existing records

Literature

1.2.3 Literature review

method of locating, synthesizing, and interpreting a collection of work by researchers and practitioners in a systematic manner to uncover what is already known about a topic resulting in a summary and synthesis of the review.

basic components of the literature review process include the following

What questions do you want to answer?

What evidence will address the question?

What are the inclusion and exclusion criteria for the evidence?

How will you find the evidence you want? What is the search strategy?

What evidence from the search process meets your criteria?

How will you document answers to your question?

What metric will you use to judge strength of the evidence? How will you summarize the findings and draw conclusions based on the data and the limitations?

Search Strategies

key search terms,

search sources (e.g., online and bibliographic databases such as MEDLINE),

a period of time to conduct the search (e.g., 2010 to 2019),

characteristics of the priority population (e.g., age, race, gender, geographic location) or intervention, and

health conditions (e.g., diabetes, obesity, asthma, teenage pregnancy) of interest.

8 Questions when evaluating research in the literature

Was the purpose of the study stated?

Was the research question or hypothesis stated?

Were the subjects in the study described? Did the literature describe participant recruitment?

Was the design and location of the study described?

Were the data collection instruments described?

Did the presented results reflect the research question or hypothesis?

Were the conclusions reflective of the research design and data analysis?

Were the implications meaningful to the priority population?

1.2.4 Procure Data: Reliability data

Who collected the data? Source of data? Methods used to collect the data?

Accessibility to data

Is the database available? What are costs? Is there a need for informal/formal agreements?

Timeliness of data

Is the information too old to be relevant?

Applicable to priority population

Do results only apply to a broader population?

1.2.5 Validity and Relatability: Validity

they are representative of what is intended to be measured

Reliable

consistent across multiple assessments of a specific measure

1.2.6 Identify gaps

apply explanatory theories and models to identify gaps in data, to help understand why a health problem exists, or to guide the search for modifiable factors

1.2.7 Surveys- individual

determine the knowledge, attitudes, beliefs, behaviors, skills, and health status of a priority population

key informant interviews- individual survey

conducted with individuals who have knowledge of and the ability to report on the needs of a corporation, hospital or organization

telephone interviews- individual survey

allow the interviewer to clarify questions, but they do not have the advantage of visual cues that the face-to-face method offers

electronic (or web-based) interviews- individual survey

growing as a viable means of collecting data from a large number of individuals quickly and at lower cost

self-assessment instruments- individual survey

allow people to answer questions about their health history, behavior, and screening results, such as blood pressure, cholesterol, height, and weight

observations- group

used to gather data through direct surveillance of the population

community forums- group

public meetings.

Important to remember is that the silent majority may not speak out, allowing more vocal individuals' iews wrongly to be seen as the group's view

focus group- group

communication among participants who are selected based on specific criteria

Nominal group process- group

process in which a few representatives from the priority population are asked to respond to specific questions, which are based on what the health education specialist needs to know

Delphi panel- group

a group process that generates consensus by using a series of mailed or e-mailed questionnaires based of answers from each previous questionnaire. involves individuals from three groups: decision-makers, staff, and program participants

Community Asset Mapping

"map" local resources, abilities, and other building blocks for community growth and change.

visual representation of the physical assets of a community that may constitute important physical and social support structures for achieving community goals

PhotoVoice- community

specific photographic technique to enable people to record and reflect on personal and community strengths and concerns. promotes critical dialogue and knowledge about personal and community issues through group discussion of photographs

Methods: Mail survey

Advantages: Eliminates interviewer bias, increases assurance of anonymity, allows respondents to complete at their convenience, increases accessibility to a wide geographic region, increases accuracy because respondent can consult records, encourages identical wording for all respondents, and promotes inter-rater reliability

Disadvantages: Lack of flexibility, likelihood of unanswered questions, low response rate, inability to record spontaneous reactions or nonverbal responses, lack of control over the order of responses, no guarantee of return by due date, inability to use complex questionnaire format, strong possibility of duplicate mailing, fear of loss of anonymity, and expense

Methods -Telephone survey

Advantages: Cost savings compared with face-to-face survey, faster than mailsurvey or personal interview, accessibility to a wide geographic region, and increased monitoring and quality control

Disadvantages: Call may be seen as a hoax or disruption, loss of visual component of reading the survey, interviewer has little control and respondent can hang up at any time, and low response rates due to unlisted numbers, caller ID, reduced use of land lines, "do not call" lists

Methods- Interview survey

Advantages: Personalization of the survey to one participant, flexibility for further probing, higher response rates, control over question order, spontaneity, no possibility of help from others, and ability to use more complex questionnaires

Disadvantages: Expensive, time-consuming, increased change of interviewer bias, lack of anonymity, lack of standardization of questions, and difficulty in summarizing the findings

Methods- web survey

Advantages: Quick response, low cost to administer, automated data gathering process, administered to a large number of participants, and a forced-choice format

Disadvantages: Limited ability to monitor returned surveys, limited time frame within which respondent can access survey, forced-explicit choice responses, costly hardware and software

Methods- Interviews or focus group

Advantages: Help people learn more about group or community opinions and needs have more depth, nuance and variety, nonverbal communications and group interactions also can be observed, and focus groups can, therefore, get closer to what people are really thinking and feeling

Disadvantages: Responses may be harder to score on a scale

Methods- Observations

Advantages: A place or event, as well as situations or interactions, can be directly viewed, allowing the observer to experience the life of the community or a population

Disadvantages: Documenting observations may be harder to analyze

Procedures- Data Collection Process

(a) data collection and instrument development, (b) data analysis plan, (c) findings or results of assessment, and (d) written reporting of data.

1.2.8 Adhere to data collection procedures

To ensure quality, it will be important to find reliable, trustworthy, and skilled people to collect, enter, analyze, and manage the data

1.3.1 priority population social determents of health

behavioral, environmental, and social risk factors that are associated with health. the conditions in which people are born, live, work, play, and age that affect their health risks, health, daily functioning, and quality of life.

5 categories of social determinants of health

1) neighborhood and built environment, 2) health care access and quality, 3) social and community context, 4) education access and quality, and 5) economic stability

1.3.2 5 levels of influence

-Individual: knowledge, attitudes, and beliefs that influence behavior

-Interpersonal: association with family, friends, and peers that define social identity, support, and role

-Institutional: rules, regulations, and policies, which may constrain or promote recommended behaviors

-Community: social networks and norms

-Public policy: local, state, and federal policies and laws that regulate or support actions / practices

1.3.3 social and economic conditions

created by societal norms and policies in both health and non-health sectors determine opportunities to make healthy choices

5 key ares of social determents of health according to Healthy People 2030

Economic Stability (e.g., poverty, employment, food security, housing stability)

Education Access and Quality (e.g., high school graduation, enrollment in higher education, language and literacy, early childhood education and development)

Social and Community Context (e.g., social cohesion, civic participation, perceptions of discrimination and equity, incarceration/institutionalization)

Health Care Access and Quality (e.g., access to health care and primary care, health literacy)

Neighborhood and Built Environments (e.g., access to healthy foods, quality of housing, crime and violence, environmental conditions.)

Systems strategies

changes that impact all elements of an organization, institution, or system. modification in how a collective unit decides upon policies, program services, decision-making, and the allocation of resources

System

an organized collection of integrated elements that work as a whole to accomplish an overall goal

Levels for Systems Change

paradigm

goals

system structure

feedback and delays

system elements

paradigm

the mindset or beliefs of how the systems work and refer to goals, policies, and structure

Change: shift or reinforcement of the paradigm

Goals- level of system change

Aims of the system

Change: focus or change the aims of the system

Feedback and delays

Providing information about the results of different actions by system elements to the source/administration of the actions.

Change: create or change feedback loop, adding feedback loops or changing feedback delays

System elements

Actors and physical elements of the system connection through activities and information flow (communication)

1.3.4 Assess existing and available resources, policies, programs, practices, and interventions

identify gaps or overlaps in existing programs by communicating with stakeholders in the community, looking at service use by clients, and observing levels and patterns of the provided services

1.3.5 community-building processes

focused on the identification, nurturing, and celebration of community assets

capacity assessment

What is the health problem, and what are its consequences for the state or community?

What is the size of the problem overall and in various segments of the population?

What are the determinants of the health problem?

Who are priority populations?

What changes or trends are occurring?

A review of actual and potential availability of resources

is essential for establishing realistic program/intervention starting points and determining how the programs/interventions can be sustained

1.3.6 List needs of priority population

final step in the needs assessment is validating the needs identified in the assessment.

validation process- "double checking" methods

a) rechecking the steps followed in the needs assessment to eliminate any bias, b) conducting a focus group with some individuals from the priority population to determine their reaction to the identified need (if a focus group was not used to gather the data), and c) getting a second opinion from other health professionals

1.4 Synthesize findings to inform planning process

synthesized information should be used to determine priorities for planned interventions

Factors that should be identified during this synthesis

Predisposing factors

Enabling factors

Reinforcing factors

Predisposing factors

individual knowledge and affective traits

Enabling factors

factors that make possible a change in behavior

Reinforcing factors

feedback and encouragement resulting from a changed behavior, perhaps from significant others.

1.4.2 prioritize health education and promotion needs

Health education specialists must confirm that health education needs match the program needs.

Criteria for prioritizing health needs

-percentage of the population directly affected

-effectiveness of possible interventions

-appropriateness, economics, acceptability, resources, and legality of the possible intervention

percentage of the population directly affected

How serious is the problem?

How urgent/critical is the nature of the problem?

How severe is the problem?

What is the morbidity/mortality severity, duration, and/or disability associated with the problem?

What medical costs are associated with the problem?

How many people are affected by the problem?

System structure

Parts of the systems, actors (e.g., leadership, staff, partners), and interconnections between the parts

Change: modifying linkages within the system, system elements, or incorporating new elements

effectiveness of possible interventions

How effective are health education interventions in addressing the problem? Are they meeting stated goals and objectives?

Are the potential interventions accessible to the affected population?

How were the needs for the potential programs determined? Are the needs of the population being met? If not, why?

appropriateness, economics, acceptability, resources, and legality of the possible intervention

What health education programs are presently available to the population(s) affected?

Are the programs being utilized? If not, why?

Given the population, is the intervention appropriate and in accordance with societal/group norms?

Are there sufficient resources for implementation?

Is the intervention legal?