Chapter 08 ppt

Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Chapter 8: Planning for Community Change


Chapter Highlights

• Health planning at the state, national, and global levels

• Social and environmental determinants of health and disease

• Social ecological model and multilevel interventions

• Community as partner

• Health equity and social justice


Chapter Highlights (cont.)

• Lewin’s change theory, force field analysis, and levers of change

• Planning tools, including logic models and Gantt chart

• Role of the community health worker

• Funding community health interventions

• Social marketing

• Community nursing centers


Question

Is the following statement True or False?

Health planning occurs on both an ongoing and an episodic bases.


Answer

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.


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.

• 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.


Levels of Health Planning

• The impetus for health planning and program development may come from the decision at the local or state level to address a health problem (bottom-up approach); or from a regional, national, or global initiative to improve health status (top-down approach).


Timing of Health Planning

• Health planning occurs on both an ongoing and an episodic bases.

• 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.


Health Planning Approaches

• Healthy People series

– Healthy People 2020 Priorities

– Action Model for Achieving Healthy People 2020 Goals

• World Health Organization

• State departments of public health


Question


The people and organizations that are coalitions are commonly called stakeholders.


Answer

False

Rationale: The people and organizations that are stakeholders are commonly included in coalitions.


Models, Frameworks, and Tools for Use in Health Planning

• Planning health promotion or prevention interventions at the community level can be a complex process.

• Several models and frameworks help organize some or all of the steps in the planning process.


Community Assessment

• Identify the community health problems that are the priorities for intervention as well as community resources available to address each health problem or need

• Key informant—person knowledgeable about specific aspects of a problem and the community’s current and past attempts to address it


Community as Partner

• Defining the community of interest

• Coalition—group of consumers, health professionals, policy makers, and others working together to improve community health status or to solve a specific community health problem

• Stakeholder—an individual, organization, or group that has an interest (stake) in a specific community health issue or the outcome of a community-level intervention


Social Ecological 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.


Multilevel Interventions

• Upstream—at the societal, environmental, or policy level

• Mainstream—at the population or community level

• Downstream—at the individual level

• The technique of mapping the web of causation can help the community health or public health nurse identify multiple determinants of a community health problem.


Health Disparities

• Systematic disadvantages in access to basic needs or health care services

• Systemic deficiencies in the organization and delivery of health care services due to financing problems or lack of cultural or linguistic competence


Health Equity and Social Justice

• Health equity is based on the principles of fairness and social justice, as well as the belief that all people have an equal value.

• Social justice refers to an equitable sharing of both the common burdens and the common benefits or advantages in society.


Question


The purpose of using levers of change is to decrease driving forces and/or to increase restraining forces.


Answer

False

Rationale: The purpose of using levers of change is to increase driving forces and/or to decrease restraining forces.


Change Theory

• Lewin’s Model of Change

– Unfreezing

– Changing

– Refreezing

• Sustainability must always be a concern when planning changes in health beliefs, knowledge, behavior, or social conditions.


Force Field Analysis

• Involves identifying factors within a community or organization that are driving or reinforcing change in the desired direction as well as those that are restraining or resisting change


Levers of Change

• The purpose of using levers of change is to increase driving forces and/or to decrease restraining forces


Community Involvement in Change

• Health behavior change, whether at the individual or community level, requires sustained effort and results that may not be evident in the short term.

• Community participation in all steps of the change process helps to increase the potential for program success and sustained change in community health status.

• Community readiness to change needs to be considered in selecting the most appropriate types and levels of interventions.


Logic Model

• A logic model for a community health program is a visual representation of the logic behind the operation of the program

– who will receive services (target population)

– what will be done (activities)

– when it will happen (timeline)

– Where

– why (program theory)


SMART Objectives

• Specific

• Measurable

• Achievable

• Relevant

• Time bound


Gantt Chart or Project Timeline

• Identifying the major milestones or critical points of a project that must be completed before the next phase or activity may begin

• Marking the deadlines for the critical points on the Gantt chart first. It is necessary to work backward from the critical points to identify all of the steps required to reach them, the time needed for each step or task, and the sequence of related steps

• Developing subsidiary charts for each major program activity


Gantt Chart or Project Timeline (cont.)

• Using color coding to indicate the person, committee, or group with primary responsibility for completion of each step

• Taking into account the time required in each step for organizational review and approval or involvement of coalition or team members so that outside deadlines may be met

• Planning for time to hire and train new employees, if needed, and to order supplies and equipment


Funding Community-level Intervention Programs

• Lead agency

• Accountability

• Sustainability

• Program replication


Documenting Community Support

• Name of the program

• Name of the funding source

• Statement of the problem to be addressed, including data from the community assessment

• Goals or purpose of the program


Documenting Community Support (cont.)

• Target population to be served

• Expected outcomes or results

• Ways the organization or person writing the support letter is or may become involved in the program

• Track record of successful collaboration between the organization writing the letter of support and the one requesting it


Project Funding

• Government agencies

• Private foundations

• Local resources


Community Benefit Programs

• Emphasis on communities with disproportionate unmet health-related needs

• Emphasis on primary prevention

• Building a seamless continuum of care between the hospital and the community

• Building community capacity

• Collaboration with community stakeholders as full partners


Writing Proposals

• Try to present the problem statement, background information, proposed program goals and measurable objectives, expected outcomes, and timeline in two pages.

• Attach a budget clearly indicating all program expenses and sources of income in addition to the funds being requested.


Writing Proposals (cont.)

• Provide a written budget justification to give detail behind each line item.

• Use attachments such as the logic model, list of coalition members, organizational chart, or support letters appropriate to the program and the specific funding source to supplement the proposal narrative.


Community Nursing Centers

• Community health workers can help bridge the gap between the community health or public health nurse and the community, especially when there are cultural and language differences.

• Community nursing centers (CNCs) are organized and managed by nurses in partnership with the communities they serve to provide community health services and primary care to vulnerable and underserved population aggregates.

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Chapter 08 ppt