N528 Nursing Theory

What are the intERpersonal models of health behavior?

Social Cognitive Theory Social Network Theory Social Network Analysis Transactional Model of Stress and Coping

Institutional Factors

Social institutions and organization characteristics and formal/informal rules and regulations for operations

Interdisciplinary problem

solving increases the team's ability to identify options and to prioritize actions that optimize care for individuals with complex clinical and social needs.

Received support

the actual provision of support by another person, has a more complicated relationship with health. Sometimes received support has a positive associated with good health, but at other times it has been linked with adverse effects on health. It has been suggested that the effect of received support is dependent on whether the support receiver perceives the support to be responsive to his or her needs.

Perceived support

the expectation that others will provide support if it is needed, has been consistently associated with better health.

Empiricism

theory that states that knowledge comes only or primarily from sensory experience. One of several views of epistemology, the study of human knowledge, along with rationalism and skepticism, empiricism emphasizes the role of experience and evidence, especially sensory experience, in the formation of ideas, over the notion of innate ideas or traditions, empiricists may argue however that traditions (or customs) arise due to relations of previous sense experiences (this theory that all knowledge is derived from sense and/or experience)

IBM

· Adds to constructs from TRA/TPB · Intention is primary determinant of behavior · Four other factors that also affect behavior: o Knowledge and skills are required to act o Relevance of behavior o Environmental constraints o Habit · Interventions using IBM require all constructs working together

HBM

· Assumes perception, beliefs and attitudes influence action as much as knowledge of disease and consequences · Can explain why people engage in risky activities (e.g. exceptionalism); risk and health choices not always rational · Useful for developing campaigns and educational materials that increase awareness and address perceptions

TPB

· Attitude and subjective norms can be measured using scales · Useful for understanding behavior and action to preventative change · Development of targeted communication and information · When behaviors not perceived under individual's control

What is community engaged participation research?

"A partnership approach to research that equitably involves community members, organizational representatives, and researchers in all aspects of the research process" Community identifies the problem or does so with the researcher. Research WITH community (participants = Community-Based) Needs assessment, data collection, implementation, and analysis is everyone's responsibility Sustainability is a priority that begins at research inception

Spectrum of community engagement in research and health promotion

(Spectrum based on: Power & control, responsibility & ownership, participation Influence) Low Community Placed/Based Research Community-Based Participatory Research High Investigator-Driven Research Community-Engaged Research Community-Driven Research

What are the benefits of community engaged research?

-Increases research relevance, quality, and validity. -Strengthens intervention design & implementation. -Joins partners with diverse expertise to address complex problems. -Increases possibility of overcoming distrust -Knowledge attained and interventions benefit the community. -Recognizes Community as a level of identity. -Builds on strengths and resources within the community. -Facilitates collaborative, equitable partnership in all research phases and involves an empowering and power sharing process that attends to social inequities. -Promotes co-learning and capacity building among all partners. -Disseminates findings and knowledge gained to all partners and involves all partners in the dissemination process.

IntRApersonal Models involve:

-developmental history of the individual -past experiences of the individual -and the skills of the individual

Limitations of IntRApersonal Models

-perception not always reality -requires knowledge of individual or population specific motivating and normative factors to promote change -little direct recognition of the larger context of health behaviors -understand the basic concepts from primary intrapersonal models described in our text (HBM, TPB, TRA, IBM, TTM)

SNT 3 Main Components

1) people or actors (organizations, states, collective, etc.) take actions based on their environment. 2) a person's position in a network influences his or her behaviors. 3) networks have structure and these network (or system-level) properties influence system performance. A final component of SNT is that there is a dynamic relationship between the micro and macro levels of network analysis.

Evidence Based Practice Steps

1. Ask a clinical guiding question 2. Search for the best evidence 3. Critically appraise the evidence 4. Integrate the evidence with one's clinical expertise and client's preferences to make the best clinical decision 5. Evaluate the outcome(s) of the EBP practice decision or change based on evidence of the EBP decision or change 6. Disseminate the outcome

five (5) key areas of social determinants of health (SDOH)

1. Economic stability - Poverty - Employment - Food security - Housing stability 2. Education - High school graduation - Language and Literacy - Early childhood education and develop. 3. Social and community context - Social cohesion - Civic participation - Incarceration 4. Health and Health Care - Access to healthcare - Health literacy 5. Neighborhood and Built Environment - Access to healthy foods - Quality of housing - Crime and violence - Environmental conditions

Variable

A construct that is operationalized (made measurable) in a theory. Can be modified or manipulated to affect the outcome

Challenges of applying and evaluating ecological models

A major challenge is to develop more sophisticated models that lead to testable hypotheses and useful guidance for interventions. Research based on ecological models are more demanding than behavioral research at a single level. Increased length of time to implement interventions, more flexible schedule required.

Evidence Based Practice

A problem solving approach for clinical practice that integrates the conscientious use of best evidence (internal and external) in combination with a clinician expertise as well as patient's preference and values to make decisions about the type of care provided · As the conscientious, judicious, and explicit use of current best evidence in making decisions about the care of the individual patients · The role of research is to create scientific knowledge that can be generalized to similar clients, population, and clinical settings

Nurse Practitioner use of EBP

Allows APRN's to separate irrelevant and relevant studies by assessing the studies validity and relevance. EBP is a strategy to keep knowledge up to date, enhance clinical judgment, and lead to cost effective treatment modalities. EBP enables NPs to present accurate evidence to clients, while further involving clients and families in the clinical decision making process.

Phase 2 of PRECEDE-PROCEED Model: Epidemiological assessment--Health problems and related quality of life impact

Behavioral causes of health problems: How at-risk group increases risk of experiencing the health problem, e.g. lack of dietary, physical, medication adherence. Environmental analysis: Conditions in the social (ex. Laws, zoning, political forces allowing low SES housing to be placed in areas of high pollution), physical (ex. Housing quality, absence of trash collection), and biological (ex. Genetic, climate and biome) environments that influence health problem directly or through its behavioral components. Ex. Lead based paint exposure (direct) or lack of workplace smoking restrictions (indirect) Theories useful for this phase: SCT, Self-Regulation Theory, TTM *At this phase, planners begin to describe community problems and their causes with existing data sources.

What are the PRECEDE-PROCEED model and intervention Mapping, and how can we use them to develop health behavior interventions? Understand the phases/stages of these models and how they inform interventions.

Broadly, PRECEDE-PROCEED and Intervention Mapping are tools that help guide the selection of constructs and theories to optimize change in the behavioral and environmental factors that influence health. Both can be used with a wide range of theories for describing health problems and devising models.

Components of a Theory (CC VAP DMM)

Concepts Constructs Variable Antecedent Predictor Dependent or outcome variable Mediator Moderator

Constructs

Concepts that are defined specifically for a given theory

Antecedent

Conditions or factors that provide context or background information Conditions that occur before expected relationship (or are independent from it)

Secondary Prevention

Detecting disease/illness that has already occurred in order to limit its impact. Strategies focus on early diagnosis and limitation of disability.

Phases 6-8 PRECED-PROCEED Model:

Develops data collection plans to conduct: Process evaluation: Is the plan feasible? Also, the extent to which the program was implemented according to protocol (Fidelity=did the intervention follow protocol, was it delivered the same to all participants, can it be reliably reproduced in another setting?) Impact evaluation: assesses change in predisposing, reinforcing, and enabling factors as well as in behavioral and environmental factors Outcome evaluation: determine the effect of the program on health and quality-of-life indicators.

Social Ecological Models

Ecological models as they evolve in behavioral sciences and public health, focus on the nature of people's transactions with their physical and sociocultural environments. The environmental and policy levels of influence distinguish ecological models from widely used behavioral models and theories that emphasize individual characteristics, skills and proximal social influences, but do not explicitly consider the broader community, organizational and policy influences on health behaviors. Ecological models are most effective when they are behavior specific Guide research and intervention when tailored to specific health behaviors

What are intRApersonal models of health behavior?

Health Belief Model (HBM) Theory of Reasoned Action (TRA) Theory of Planned Behavior (TPB) Integrated Behavior Model (IBM) Transtheoretical Model (Stages of Change)

How does epidemiologic data inform health promotion and practice?

Epidemiologic research to address health disparities has also evolved, through the four phases of health disparities research (13). The first phase of health disparities research has been the identification of the nature and extent of disparities (4). The second phase identified underlying factors for racial, ethnic and socioeconomic disparities. The third phase, the development and implementation of interventions (14), increasingly includes transdisciplinary research, community engagement, and knowledge translation. The fourth phase encompasses a mixed methods approach to evaluation of comprehensive, multi level interventions. A primary goal of epidemiologic research is to provide an evidentiary basis for informed policy decisions, and this is no less true for policies that impact health through broad social determinants such as food, housing, schooling and employment.

Practice Level Theory

Explores one particular situation found in nursing. It identifies explicit goals and details how these goals will be achieved. Nursing practice theories have the most limited scope and level of abstraction and are developed for use within a specific range of nursing situations. Nursing practice theories provide frameworks for nursing interventions, and predict outcomes and the impact of nursing practice. . Measurable but not always generalizable · Focused on causal relationships · Can draw from multiple mid range theories

Dependent or outcome variable

Factor or condition of interest in a study Defining relationships among variables

Social Network Theory

Focuses on the structure and system-level properties of the web of social relationships within which individuals live. It stresses the importance of connections or relations for understanding health or other outcomes of individuals

What is healthy People 2020? How and why does HP2020 influence national healthcare priorities?

For the past three decades, the Healthy People initiative has represented an ambitious yet achievable health promotion and disease prevention agenda for the nation. The recently released fourth version—Healthy People 2020—builds on the foundations of prior iterations while newly embracing and elevating a comprehensive "social determinants" perspective. By clearly articulating a new overarching goal to "create social and physical environments that promote good health for all" and a new topic area dedicated to defining the social determinants of health approach, it breaks new ground. Specifically, the 2020 plan emphasizes the need to consider factors such as poverty, education, and numerous aspects of the social structure that not only influence the health of populations but also limit the ability of many to achieve health equity. Improving health is too multifaceted to be left to those working in the health sector alone. Using a social determinants approach can reframe the way the public, policy makers, and the private sector think about achieving and sustaining health. In this time-honored initiative coordinated federally by the U.S. Department of Health and Human Services (DHHS), a network of thousands of governmental and private sector partners set priorities for national public health improvement in an open and transparent process. Healthy People encompasses several mutually reinforcing tasks: setting overarching goals; identifying baseline data and 10-year targets for a wide range of quantifiable health and related health care objectives; monitoring outcomes; and evaluating progress based on the collective effects of national-, state-, and local-level interventions. It increases public awareness of the determinants of health, unifies national dialogue, and motivates action by articulating goals, specific topics to organize health improvements, and measurable objectives. Through all these efforts, HealthyPeople offers a public health roadmap and compass for the country, while encouraging new directions (Koh, 2010).

IntERpersonal

Formal and informal social network and social support systems, including family, work groups and social groups

How does data from Framingham inform health promotion and practice?

Framingham: The Framingham Heart Study has been a trailblazer in the field of cardiovascular epidemiology. The wealth of novel scientific data that it has generated over 5 decades has made a significant contribution to cardiovascular disease (CVD) prevention in the United States and indirectly influenced global CVD prevention strategies. The Framingham Study has provided insights into the prevalence, incidence, prognosis, predisposing factors, and determinants of CVD. The now well-established risk factor concept, fundamental to prevention of CVD, originated from the Framingham study. It generated seminal findings such as the effects of tobacco use, unhealthy diet, physical inactivity, obesity, raised blood cholesterol, raised blood pressure, and diabetes on CVD. When these findings were first published, these were novel cardiovascular risk factors, now they are the major focus for global and national prevention efforts for reducing the burden of CVD and other major noncommunicable diseases. The Framingham Heart Study has also been in the forefront of the development of cardiovascular risk prediction equations for assessment of absolute risk.Further developments in this area including the development of World Health Organization/International Society of Hypertension risk prediction charts have resulted in a paradigm shift in CVD prevention strategies, from a single risk factor focus to a more cost-effective total cardiovascular risk approach, an approach recommended by the World Health Organization for CVD prevention worldwide.

Phase 3 of PRECEDE-PROCEED Model: Ecological and educational assessment

Health professionals explore factors that produce behavioral and environmental conditions from phase 2. What antecedent and reinforcing factors encourage the risk behaviors or environmental conditions that cause or contribute to the health problem? Predisposing factors-knowledge, attitudes, beliefs that facilitate or hinder motivation for change. Reinforcing factors - feedback and rewards learner receives from others following adoption of a behavior. Enabling factors - skills, resources or barriers that help or hinder desired behavioral and environmental changes. Theory is very beneficial for describing the determinants of behavior. This phase could use: HBM, SCT, and Theory of Planned Behavior.

Meta Theory

Identifies specific phenomena through abstract concepts. Addresses philosophical questions and ways of knowing.

Postmodernism

Includes skeptical interpretations of culture, literature, art, philosophy, history, economics, architecture, fiction, and literary criticism. A rejection of the sovereign autonomous individual with an emphasis upon anarchic collective, anonymous experience. (a reaction to the assumed certainty of scientific, or objective, efforts to explain reality. Defines nursing as a scientific, philosophical discipline)

How does community engaged health promotion enhance acceptability and sustainability of interventions?

Integrates and achieves a balance between research and action for the mutual benefit of all partners. Emphasizes public health problems of local relevance and also ecological perspectives that recognize and attend to the multiple determinants of health and disease.

How are the (intERpersonal) different from other models?

Interpersonal models emphasize elements in the interpersonal environment that affect individuals' health behavior whereas others (health behavior at individual level) focus on individual health behavior and focus on variables within individuals that influence their health behavior and response to health promotion and education interventions, and other models (health behavior at group level) focus on the community or aggregate level of change including community engagement, implementation, dissemination, and diffusion of innovations, and media communications. Understand basic concepts from primary interpersonal models described in our text (SCT, SNT, Social Network Analysis, Transactional model of Stress and Coping). What are the central concepts of these models? What concepts are similar across these models? (Refer to each model description)

How do they differ from other models of health behavior?

Intrapersonal = "within individuals" Intrapersonal Models focus on individual perception, behaviors and actions personal beliefs perceived risk/barriers perceived gains self-efficacy

Transactional model of Stress and Coping

Is a classic framework for evaluating processes of coping with stressful events. Stressful experiences are construed as person-environment transactions in which the impact of an external stressor is mediated by the person's appraisal of the stressor and the psychological, social, and material resources at his or her disposal. When faced with a stressor, a person evaluates potential threats or harms (primary appraisal), as well as his or her capacity to alter the situation and manage negative emotional reactions (secondary appraisal). Actual coping efforts, aimed at problem management and emotional regulation, affect outcomes of the coping process.

A Nursing Theory

Is a set of concepts, definitions, relationships, and assumptions or propositions derived from nursing models or from other disciplines and project a purposive, systematic view of phenomena by designing specific inter-relationships among concepts for the purposes of describing, explaining, predicting, and /or prescribing. An internally consistent group of relational statements that presents a systematic view about a phenomenon and that is useful for description, explanation, prediction, and prescription or control · Provides structure/direction for abstract thinking · Varying levels of abstraction - Ultimately measurable · Helps identify new questions and answers

Social Cognitive Theory

Is used to inform, enable, guide, and motivate people to adopt habits that promote health and to reduce habits that impair health. SCT is one of the most widely applied models of health behavior, and it has been applied to initiation and achievement of personal and group-level changes, maintenance of behavior changes, and relapse prevention.

IntRApersonal

Knowledge, attitudes, behavior, self-concept, skill, developmental history

What challenges can occur with intERprofessional approaches?

Lack of expertise: Communication and teamwork are essential for interdisciplinary approaches and are skills that have to be learned but are often lacking. Cultural silos: Values, perspectives: "Health professionals are traditionally educated in isolation of one another, without much understanding of the disciplinary perspectives and expertise of their colleagues in other professions." Existing infrastructure: Schedules, rewards, levels: "Physical, social, and structural barriers impede widespread collaboration. The most oft-cited barrier to interprofessional education is the differing schedule structures across health profession curricula, as well as issues of matching appropriate levels of students in optimal clinical situations." "Traditional financial models in academia (at the department level) may not support interprofessional education, particularly when budgets are tight and delivery of interprofessional education requires additional time for planning, faculty development, and teaching." Reimbursement: Physician-based, episodic: "Current reimbursement for health care services favors episodic care delivered by hospitals and physicians in ambulatory clinics and may discourage innovation by teams. There are no reimbursement codes for many team services, and the higher costs of interdisciplinary teamwork associated with communication and coordination are not reimbursed."

Public Policy

Local, state and national laws and policies

When developing an intervention using a planning model (PRECEDE-PROCEED or IM), what steps/phases help to ensure high-quality, reproducible, behavior-changing interventions?

Making sure it is rooted in theory and is based on research/evidence. Fidelity is also key - making sure intervention follows protocol and is delivered the same way to all participants.

Concepts

Mental representations or ideas in theory

How does data from the Nurses' Study inform health promotion and practice?

Nurses' Health Study: long-term epidemiological studies conducted on women's health. The study followed 121,700 female registered nurses since 1976 and 116,000 female nurses since 1989 to assess risk factors for cancer and cardiovascular disease. Largest study ever done. Researchers have examined the effect of exposures like smoking, oral contraceptive use, alcohol consumption, and diet on disease risk. Identify risk factors were used to inform health promotion and practice to stay away from those risk factors.

IMPORTANCE OF NURSING THEORIES

Nursing theory aims to describe, predict and explain the phenomenon of nursing (Chinn and Jacobs1978). · It should provide the foundations of nursing practice, help to generate further knowledge and indicate in which direction nursing should develop in the future (Brown 1964). · Theory is important because it helps us to decide what we know and what we need to know (Parsons1949). · It helps to distinguish what should form the basis of practice by explicitly describing nursing. · This can be seen as an attempt by the nursing profession to maintain its professional boundaries.

What concepts are similar across these (intRApersonal) models?

Perceived barriers inhibit behavior change in the HBM and TRA/TPB/IBM Perceived risk is important in the HBM and, depending on the results of pilot work for a given study, may be important in the TPB In the TTM, analyses of processes of change can help in identifying strategies to overcome particular types of barriers Self-efficacy is embodied in the TTM and IBM and included in updated versions of the HBM and TPB Although not identical, the TTM's decisional balance construct, which reflects the tension between the pros and cons of behavior change, has some similarity to the concepts of barriers and benefits in the HBM TTM and HBM recognize that if the negatives, or barriers, associated with behavior change are greater than perceived benefits, the likelihood of change decreases. Intentions are explicit in the TRA/TBM and the IBM, but similar motivational constructs appear in the conceptualization of HBM (orientation toward health as a goal) and stages of TTM, increasing readiness to make and maintain behavior changes

Three Phases of the PRECEDE-PROCEED Model

Phases: 1-3 of PRECEDE help planners develop theory of the problem Engage community members to understand opinions and experiences. Identify problem with community member input. Assess causes/contributing factors and environment of health behaviors. Develop a model of the problem.

Phase 1 of PRECEDE-PROCEED Model: Social assessment, participatory planning, situation analysis

Planners try to understand community in which they are working. May or may not be geographically bound, defined by shared characteristics Use qualitative methods to collect info and opinions from community members What is happening, why does community believe it's happening Ensure project addresses important issues to community, project findings are locally relevant *Theories useful at this stage include systems theories, theories regarding social networks, and constructs of social capital and community capacity.

Phase 5 of PRECED-PROCEED Model:

Prepare for implementation by developing necessary training, materials (protocols, handouts, advertisements) and resources to support program delivery.

Primary Prevention

Preventing disease or injury before it begins.

Understand/define principles of ecological models

Principle 1: There are multiple levels of influence on Health Behaviors o Factors at multiple levels (intrapersonal, interpersonal, organizational, community and public policy) can influence health behaviors. o Sociocultural factors and physical environments may apply to more than one levels (ie: organizational and community). Principle 2: Environmental contexts are significant determinants of health belief o Inclusion of social and physical environment variables is a defining feature of ecological model. o Behavior settings are the social and physical situations in which behaviors take place and ecological models open the possibility of intervening on these environments (ie. Promoting, discouraging or restricting behaviors). Principle 3: Influences on behaviors interact across levels o Variables work together. Cross-level influences or interplay can be studied through statistical interactions or moderator effects. o Likely to be multiple variables at each level, but it may be difficult to discern which of the possible interactions are most important. Principle 4: Ecological models should be behavior specific o Most useful for guiding research and intervention when they are tailored to specific health behaviors. Principle 5: Multilevel interventions should be most effective in changing behaviors o Examples of interventions that targeted only individuals; showed small and short-term effects. o Educational interventions designed to change beliefs and behavioral skills are likely to work better when policies and environments support the targeted behavior changes. o Organizational, environmental, and policy changes can be sustained over the long term and affect many more people. Understand the general structure of ecological models and how concepts relate and interact · Multiple levels of factors influence health behavior o Intrapersonal, interpersonal, organizational, community and public policy can influence health behaviors

Grand Theory

Provides a conceptual framework under which the key concepts and principles of the discipline can be identified. Shape nursing practice core competencies.refer to the form of highly abstract theorizing in which the formal organization and arrangement of concepts takes priority over understanding nursing. Grand nursing theories have the broadest scope and present general concepts and propositions. Theories at this level may both reflect and provide insights useful for practice but are not designed for empirical testing. This limits the use of grand nursing theories for directing, explaining, and predicting nursing in particular situations. Theories at this level are intended to be pertinent to all instances of nursing. Grand theories consist of conceptual frameworks defining broad perspectives for practice and ways of looking at nursing phenomena based on the perspectives Summary points: Provides shape/space for nursing practice · Differentiates nursing practice from other practices/disciplines-defines concepts like health, healing, and caring · Generally cannot be tested- leads to middle range theory

Social Network Analysis

Provides tools for understanding how social context influences decision-making processes and actions. SNA quantifies the extent to which members of one's social network endorse certain attitudes or engage in specific behaviors. Research suggests that on the one hand, when people are considering how often an unhealthy or risky behavior (ex/ smoking) is being performed by their peers, they tend to overestimate the prevalence. On the other hand, people tend to underestimate the extent to which healthy behaviors are being performed. SNA provides information necessary for an accurate descriptive norm among network members, thus providing the data needed to influence people's behaviors to become more in line with the accurate and ideally, healthy behavior norm.

Intervention Mapping

RECEDE-PROCEED is the foundation for IM Builds on the logic model of the problem developed in PRECEDE and expands on PROCEED to add detail to the process of intervention development. Focuses on defining determinants of behavioral and environmental change and matching theory-based change methods to the determinants.

Tertiary Prevention

Rehabilitation or return to highest level of function possible given the presence of disease, condition, or illness.

Community Factors

Relationships among organization, institutions and informal networks with defined boundaries

What are the challenges of community engaged research?

Requires long term process and commitment to sustainability Engaging and maintaining community involvement. Community partners and researchers may be unfamiliar with and unprepared for the demands and requirements of each other's research or practice Community partners and research teams may require additional training, staffing, or administrative resources to carry out study activities Overcoming differences between and among academics and the community. Working with nontraditional communities. Initiating a project with a community and developing a community advisory board. Overcoming competing priorities and institutional differences.

What concepts are similar across these models (IntERpersonal)?

SNT & SNA: social networks influence behavior and outcomes. An example: more likely to gain weight when exposed to overweight peers. SCT: explains that behavior, personal cognitive factors, and socioenvironmental factors all interact to influence human behavior. This is similar to both SNT & SNA as the individual's environment such as their social networks and peers, influence their behavior. TMOSC: evaluates the process of coping with stressful events. Stressful experiences are construed as person-environment transactions in which the impact of an external stressor is mediated by the person's appraisal of the stressor. This is similar to the SCT as with this theory there are cognitive influences that lead to behaviors.

General focus of evaluation questions for each IM step: (sums up the point of each step)

Step 1: Did the program have an effect on health or quality-of-life factors? Step 2: Did the program have an effect on behavioral and environmental changes as specified in the program plan? Did the program affect the determinants of behavior or environmental conditions? Step 3: were the theory-based change methods included in the program appropriate to influence change? Were the theory-based change methods and practical applications implemented as intended in the program design and according to the theoretical guidance for their use? Step 4: Were the program components acceptable to the target population? Step 5: Was the program delivered as intended (with fidelity)? What was the extent of the program's reach to the intended populations?

Strengths of Eco Model

Supports that all levels of influence are important. Multilevel studies should be more effective that single level. Provide a framework for integrating other theories and models to create a comprehensive approach to study design and interventions. Promotes enhanced initiation as well as maintenance of behavioral change.

PRECEDE-PROCEED model:

Systematic application of theory and previous research to assessment of local needs, priorities, circumstances, and resources. Guides the process of designing, implementing and evaluating behavior change programs. PRECEDE-PROCEDE is the entire roadmap. Theory provides the specific directions within the map. Population-based planning framework, ecological in perspective. Promotes in-depth understanding of the community or other population or target audience and its needs, as well as both the proximal determinants of health and quality-of-life problems and the more distant contextual causes. Its use leads to planning interventions that are specifically targeted to these desired outcomes and causes and provides a structure for systematically applying theories and concepts.

Epidemiology

The branch of medicine that deals with the incidence, distribution, and possible control of diseases and other factors relating to health.

What is population health?

The health outcomes of a group of individuals, including the distribution of such outcomes within the group. Population health includes health outcomes, patterns of health determinants, and policies and interventions that link these two.

Social Determinants of Health

The social determinants of health (SDOH) are the economic and social conditions and their distribution among the population that influence individual and group differences in health status. They are health promoting factors found in one's living and working conditions (such as the distribution of income, wealth, influence, and power), rather than individual risk factors (such as behavioral risk factors or genetics) that influence the risk for a disease, or vulnerability to disease or injury.

Limitations of Eco Model

They do not necessarily specify the variable or processes at each level expected to be most influential on behavior, they do not specify how such influence may vary for different behaviors, and it may not be feasible to intervene at all levels. Intervening on multiple levels simultaneously may be constrained by budgetary and practical limitations (policy and environments not being under the control of the investigator).

IntERpersonal models of health behavior

They emphasize elements in the interpersonal environment that affects individuals' health behaviors. The fundamental assumption driving these theories and models is that the cognitions, affect, and behaviors of individuals are generally shaped by the people who they interact with. The mechanisms that link individuals' social contexts with health effects revolve around two important social processes: the provision of social support and the exercise of social influence.

What benefits are there to intERprofessional health behavior interventions?

They focus on subgroups that share complexity and risk. Professions: Shared competencies optimize expertise. Business: provides more efficient and effective care improves outcomes and avoids adverse events/patient harm helps in workforce shortages-"New delivery models are required to meet the growing demand for care of older adults, particularly in community settings where workforce shortages and lower preparation are prevalent." Policy: ACA/Health care reform-"To achieve the goals of this legislation, new models of care are required, and interdisciplinary approaches are likely to yield the desired results.3 The current context provides new opportunities for developing innovative approaches that cross settings, address chronic conditions and family care, and incorporate enabling technology. To achieve better outcomes in health and from systems of care, there is a call for "transdisciplinary health care reaching into the spaces between disciplines to create positive health outcomes through collaboration." Creates cost savings Accountability on team members

Middle Range Theory

This theory: is more precise and only analyses a particular situation with a limited number of variables. Middle-range nursing theories are narrower in scope than grand nursing theories and offer an effective bridge between grand nursing theories and nursing practice. They present concepts and propositions at a lower level of abstraction and hold great promise for increasing theory-based research and nursing practice strategy . Testable but generalizable · Testable based on meta-theory · Concepts defined in grand theory · Not specific to a given population

Predictor

Variable that influences or effects an outcome variable

Mediator

Variable/factor that accounts for the relationship between two variables

Moderator

Variable/factor that influences the strength of a relationship between two variable

Phase 4 of PRECEDE-PROCEED Model: Administrative and Policy Assessment and Intervention Alignment

What program components and interventions are needed to effect the changes specified in the previous phases? Does this program have the organizational, policy and administrative capability and resources to develop and implement the program? What theoretical model supports/explains rationale for proposed change? Building a comprehensive program requires: Matching ecological levels to broad program components. Mapping specific interventions based on theory and prior research and practice to specific predisposing, enabling, and reinforcing factors. Pooling prior interventions and community-preferred interventions that might have less evidence to support them, Patching, if necessary, those interventions to fill gaps in the evidence-based best practices The challenge at this phase is to continue to use theory to choose powerful methods to promote desired change within organizational/political context - ex. Theories of organizational change.

Examples of Social Determinants of Health

· Availability of resources to meet daily needs (safe housing and local food markets) · Access to educational, economic, and job opportunities · Access to health care services · Quality of education and job training · Availability of community-based resources in support of community living and opportunities for recreational and leisure -time activities · Transportation options · Public safety · Social support · Social norms and attitudes (discrimination, racism, and distrust of government) · Exposure to crime, violence, and social disorder · Residential segregation · Language/Literacy · Access to mass media and emerging technologies

TTM

· Change is a process that occurs over time; often not linear · "Transtheoretical": integrates major theories of psychotherapy to describe how people change · Utilizes stages of change to integrate multiple processes of change

TRA

· Intention is more important determinant of behavior · Human behavior is under the control of the individual · People think about consequences and implication of action in deciding how to behave · Behaviors are based on beliefs and social desirability · When behaviors are under individual's control