What is a 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.
What is a key informant?
Person knowledgeable about specific aspects of a problem and the community current and past attempts to address it.
What is the logic model?
Visual representation of how a program is organized, including activities, resources, short-term and intermediate outcomes, and program goals.
What is a population aggregate?
A defined subset of the population such as people with or at risk for a specific health problem or having specific social/demographic characteristics.
What is a stakeholder?
An individual, organization, or group that has an interest in a specific community health issue or the outcome of a community-level intervention.
What is health planning?
An organized and systematic process in which problems are 1) identified 2) priorities selected 3) objectives set for the development of community health programs.
Does health planning occur at the global, national, regional, state, county, and local levels?
Yes
Three recommendations of the CSDH? Commission on social determinants of health
1. Improve the conditions under which all people are born, grow, live, work, and age to minimum standards.
2. Ensure more equitable distribution of power, money, and resources
3. Expand knowledge the social determinants of health and establish a system to
What is HealthyPeople 2020?
National objectives for improved health outcomes that guide the health promotion and disease prevention efforts in the United States.
What are the goals of HealthyPeople 2020?
Attain high-quality, longer lives free of preventable disease, disability, injury, and premature death
Achieve health equity , eliminate health disparities, and improve health of all groups
Create social/physical environments that promote good health for
What does the HealthyPeople 2020 do for us?
Provides a framework for assessing the health status of a community
Serve as a benchmark against which to compare the health status of a population aggregate when conducing a community health assessment.
Serve as the long-term goals of a community health
What is the goal of the national prevention strategy which was created by the PPACA?
Focus on the nation's healthcare system on population health through initiatives and funding to prevent disease and support health promotion and wellness across the life span.
What is community health improvement planning?
systematic process that involves all sectors of a community to conduct a comprehensive CHA, identify priorities for action, develop and implement a CHIP, and guide future community decisions and resource allocations.
What is a community assessment?
Systematic process that may use several approaches, including key informants, interviews, analysis of data on health status health behavior indicators, observation, and community surveys.
What is the goal of a community assessment?
Identify the community health problems that are priorities for interventions, as well as community resources available to address each health problem/need.
What does the community assessment involve?
Identifies assets and strengths of community, specific health problems/needs.
Community readiness and community capacity to address these problems that are identified.
What is the systems theory?
One system affects another.
For example, changes in school or workplace may have an impact on family or broader community.
The strategy of using coalitions to bring about change recognizes that?
1. Population health results from the interaction of social, cultural, economic, and political determinants in the overall community.
2. Both the problems and the solutions are embedded int eh community system
What is the population of interest?
How ill be affected, benefit from, or participate in the change.
Can be the entire nation, state, county, or city.
What are reasons that a coalition fails?
Lack of a clear mission, goals, objectives, and expectations
Lack of leadership
Lack of accountability for meeting expectations
Poor management of meeting/lack of consideration for the time and expertise of members
What should leaders do in coalitions?
Make use of the expertise of individual members by asking for their help and input when it directly relates to their field.
Seek out people with a range of opinions/roles in the community.
Consider how each member of a coalition and organization or group
What is the social ecologic 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.
Embed public health values in the social eco
Levels of the Health impact pyramid?
Socioeconomic factors (poverty, clean water)
Changing the context to make default decisions healthy (taking out trans fat in foods people consume)
Long-lasting protective interventions - immunizations, screenings (colonoscopy)
Clinical interventions - Tre
Interventions can be directed at different system levels, what are they?
Upstream: societal, environmental, policy level
mainstream: community/population
Downstream: individual level.
What is a health impact assessment?
Helps communities make informed choices about improving public health through community design.
Helps evaluate the potential health effects of a plan, project, or policy before it is built or implemented.
What does the health impact assessment help with?
provides recommendations to increase positive health outcomes and minimize adverse outcomes.
Potential public health impacts an d considerations the the decision-makeing process for plans, projects, and policies that fall outside the traditional public he
Health disparities become health inequities when what occurs?
When they are unnecessary, unfair, and preventable resulting from social injustices that become engrained in the fabric of society through its social, economic, and political structures, laws, policies, and culture so as to become largely invisible.
Social and economic conditions and their effect on people's lives determine what?
People's risk of illness
What is social justice?
Refers to an equitable sharing of both the common burdens and the common benefits or advantages in society.
What are the three phases of Lewin's Model of change?
Unfreezing, change, refreezing.
What is unfreezing?
Moves a community from the stage of denial/lack of awareness to the need of change (September 11th terrorist attack)
When does change occur?
When the community has become aware of the need for change.
Dissatisfied with current conditions.
What is refreezing?
Process of stabilizing once change or has been made.
Making the new behaviors the community norm.
What is sustainability?
Maintaining the change.
Community members and stakeholders must be involved to keep change sustainable.
What is force field analysis?
Identifying factors within a community/organization that are driving or reinforcing chance in the desired direction, as well as those that are restraining or resisting change.
Why is force field analysis important?
It can determine where to reduce restraining forces or strengthen driving forces to create unfreezing, change, and refreezing.
What are levers of change?
Tools or techniques that achieve the largest change with the least investment of resources.
Example of a public policy lever to help reduce the rates of smoking?
Laws requiring workplaces, restaurants, to be smoke-free.
What is an example of lever of change to social norms about smoking?
Social marketing concerning the detrimental effects of secondhand smoke on children and the value of smoke-free homes.
What is the community readiness model?
Tool used to measure a communities readiness to change in six dimensions through key-informant interviews.
Selecting the most appropriate interventions requires what?
Consideration of resources available, including people, money, facilities, and time.
What is the task force on community preventive services?
Conducts systematic reviews of research for evidence of the effectiveness of community-based prevention and health promotion programs and practices.
What are SMART objectives?
Specific, measurable, achievable, relevant, and time-bound.
What are specific program objectives?
What behaviors, knowledge, skill, change in health status indicators or outcomes will result from the program?
What are measurable program objectives?
How will the outcome be measured and how will one know if the objective is achieved? Are the data available?
How are objectives achievable?
Is it realistic to reach the desired outcome with the resources and time?
How are objectives deemed relevant?
Is the objective related the the program's goals and activities?
How are objectives time-bound?
When will the objective be achieved?
Public health nurses may also work with who collaboratively?
Elected officials, social workers, policy-makers, public health professionals, school officials, senior center directors, educations, community health workers, and researchers.
What do Community Health workers do?
Provide cultural and language bridge to members of target populations, work with community health nurses and other members of the program team in both urban and rural areas to provide health education, outreach, and assistance in a accessing services, tra
When does evaluation begin?
When a program is being planned.
Steps to an evaluation plan?
Develop questions
Determine indicators or measures that will be used to answer evaluation questions.
Identify where you will find data
Decide what method you will use to collect
Use a time frame
Plan how you will analyze data
Decide how you will communica
What is accountability when in regards to funding a plan?
Ensuring that there is communication about how funds were used,details of program activities, and progress toward achieving goals.
What is sustainability when in regards to funding?
Need a clear plan outlining how efforts will be done to receive a grant.
How will a program continue after initial funding ends.
What are some ways funding may be provided?
Government agencies- state/federal (RFP request for proposal process) NIH, CDC, HRSA
Private foundations- (program interests, proposal guidelines, range of grant amounts, an eligible trinities)
Local resources- banks/businesses/churches
Ans: A, C, E
Feedback: The three overall recommendations of the CSDH are to: (1) improve the conditions under which all people are born, grow, live, work, and age to minimum standards; (2) ensure more equitable distribution of power, money, and resources;
1. Which are recommendations made by the World Health Organization's Commission on Social Determinants of Health (CSDH)? (Select all that apply.)
A) Improve conditions under which all people are born, grow, live, work, and age
B) Provide increased funding
Ans: A, B, C, E
Feedback: 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
2. The nurse is in charge of a local community program that uses a logic model as a planning and communication tool. Which key components are included in this model? (Select all that apply.)
A) Milestones for completing a community health clinic
B) Plan t
Ans: B, C, D
Feedback: According to Falk-Rafael and Betker (2012), "Health disparities become health inequities when they are unnecessary, unfair, and preventable resulting from social injustices that become engrained in the fabric of society through its
3. Which characterize health inequities? (Select all that apply.)
A) Necessary
B) Unfair
C) Resulting from social injustices
D) Avoidable
E) Natural
Ans: A, B, D
Feedback: At the second level from the bottom of the health impact pyramid are interventions that change the environment or options available so that making the choice for a healthy behavior is the "default" or easy choice whereas choosing a
4. Which changes in the environment (second level from the bottom of the health impact pyramid) make the choice for a healthy behavior the default or easy choice? (Select all that apply.)
A) Iodization of salt
B) Restrictions on smoking in public places
C
Ans: A, E
Feedback: At the level just above the middle of the pyramid are clinical interventions such as treatment of hypertension, hyperlipidemia, and diabetes. At the second level from the bottom of the health impact pyramid are interventions that chang
5. Which exemplify clinical interventions (the level just above the middle of the health impact pyramid)? (Select all that apply.)
A) Administration of insulin injections for diabetes
B) Restrictions on smoking in public places
C) Community immunization p
Ans: C
Feedback: Blood pressure for children aged 12 to 18 years in Marks School will be reduced by 5% after petting the dog for 1 day in March 2019 is an example of a measurable objective. The other objectives listed are not SMART objectives because the
6. The nurse prepares community program objectives that are specific, measurable, achievable, relevant, and time bound (SMART) to help in planning interventions and establishing measurement systems to evaluate programs and outcomes. Which is a measurable
Ans: A, B, D
Feedback: In Lewin's model of change, the change process can be visualized as three steps: unfreezing the status quo, changing or moving to a new state, and refreezing to sustain the change or changes made. Force field analysis is a tool used
7. Which aspects of Lewin's change theory will help people visualize and create needed change? (Select all that apply.)
A) Unfreezing the status quo
B) Changing or moving to a new state
C) Enforcing the status quo
D) Refreezing to sustain the change or ch
Ans: C
Feedback: 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. The change process in Lewin's
8. Which most accurately describes the purpose of force field analysis?
A) Unfreezing the status quo
B) Changing or moving to a new state
C) Identifying the forces driving the change and those resisting it
D) Refreezing to sustain the change or changes ma
Ans: D
Feedback: Mainstream interventions effect change at the population or community level, as in this scenario. Upstream interventions effect change at the societal, environmental, or policy level. Downstream interventions effect change at the individu
9. The nurse researches whether the community would benefit from monthly blood pressure clinics. Which system level would such an intervention address?
A) Upstream
B) Mainstream
C) Sidestream
D) Downstream
Ans: A
Feedback: Upstream interventions effect change at the societal, environmental, or policy level; such is the case in this scenario. Mainstream interventions effect change at the population or community level. Downstream interventions effect change a
10. As an advocate for leukemia research, the nurse along with many others succeeded in urging the U.S. Congress to debate and vote on a bill that significantly increases federal funding for this research. Which system level would such an intervention add
Ans: B, D, E
Feedback: Social marketing is the use of marketing principles and practices to change health behaviors or beliefs, social or cultural norms, or community standards to improve health or benefit society. Examples include the use of social marke
11. Select the examples of social marketing. (Select all that apply.)
A) Ad campaign for a new brand of toothpaste
B) Brochure placed in obstetricians' offices promoting the benefits of breastfeeding
C) Infomercial on television presenting the advantages
Ans: A, B, C
Feedback: Local banks and other businesses, faith communities, civic groups such as Rotary International or the Junior League, and other local resources may provide seed money, matching funds, or in-kind support for community health programs.
12. The nurse decided to approach local organizations for financial and in-kind support for a new community health initiative. On which local resources can the nurse draw? (Select all that apply.)
A) Catholic church
B) Branch of Bank of America
C) Car dea
Ans: A, C, D, E
Feedback: Nurse-managed health centers (NMHCs) are a unique model of community health services led by advanced-practice nurses and providing a wide range of services and programs to vulnerable and underserved populations. The communities s
13. The nurse researches the role of nurse-managed health centers in the city. Which are common characteristics of these centers? (Select all that apply.)
A) Led by advanced-practice nurses
B) Serve upper-income mothers and children
C) Emphasize health pr
Ans: A
Feedback: Sustainability is an important consideration in program planning and a key factor in grant making. Most funding agencies expect programs to give a clear and convincing plan outlining how efforts started with grant funding will be continue
14. The nurse is reviewing the sources of funding for the local community health intervention program on smoking cessation. In the federal grant proposal, the nurse elaborates on all the various local organizations and private foundations that have pledge
Ans: B
Feedback: The ability to replicate or reproduce a successful program within a different community or with a new population aggregate is a test of the strength of the design of an intervention. Sustainability is an important consideration in program
15. After successfully implementing and managing a smoking cessation program in an inner-city neighborhood for 5 years, the group expands the efforts to include a nearby rural community. After a challenging first year, the nurse finds that with a few modi
Ans: A, C, D
Feedback: Community health workers provide a cultural and language bridge to the members of the target population. They work with community health nurses and other members of the program team in both urban and rural areas to provide health ed
16. The nurse reviews the job descriptions of the community health workers who work with community health nurses and other members of the program team. These workers are responsible for: (Select all that apply.)
A) Serving as a cultural and language bridg
Ans: A, B, C
Feedback: Accountability includes regular communication about how funds were used, details of program activities, and progress toward achieving program goals. Proof that the program can be reproduced effectively in other settings would establ
17. The nurse reviews the logic model and formal evaluation plan of a grant proposal on a community rabies program. Which requirements should be included in the plan to support accountability? (Select all that apply.)
A) Regular communication about funds
Ans: B
Feedback: The ability to replicate or reproduce a successful program within a different community or with a new population aggregate is a test of the strength of the design of an intervention and is called program replication.
18. Which best defines program replication?
A) Ability to replicate a successful program in the same community a second time
B) Ability to reproduce a successful program within a different community
C) Ability to replicate a successful program with a new
Ans: C, D, E
Feedback: Organizers of a coalition should do the following: (1) Make use of the expertise of individual members by asking for their help and input on matters directly related to their field. (2) Seek out people with a range of opinions and r
19. The nurse is in the process of forming a coalition to support a community flu shot program. Which step should the nurse take as part of this process? (Select all that apply.)
A) Assign members of the coalition to tasks in a random manner.
B) Seek out
Ans: B
Feedback: A community is a complex system of human activity conducted within the context of the social and ecological environment. Every family, neighborhood, workplace, school, and recreational facility is itself a system with its own boundaries,
20. Which best illustrates systems theory?
A) School systems in two different counties each setting up their own independent afterschool exercise programs
B) Father being challenged to stop smoking because his daughter learned of the hazards of smoking fr
Ans: C
Feedback: Steps in developing a plan for evaluating a community-level intervention include the following: (1) Develop evaluation questions "focused on what happened, how well it happened, why it happened the way it did, and what the results were";
21. Which is the first step in developing a plan for evaluating a community-level intervention?
A) Determine indicators or measures to answer evaluation questions
B) Decide what method you will use to collect data
C) Develop evaluation questions
D) Decide