Health Promotion Test

Outcome evaluation

- evaluation of the short term and long term effects of the educational program - focuses on overall evaluation of program's long term goals evaluation of health outcomes, cost-benefit analysis - feedback on health status, morbidity and mortality

Commoner's Law of Ecology

- everything is connected to everything else - everything must go somewhere - nature knows best - there is not such thing gas a free lunch

Nurse as health educator

- focus on essential info - use clear and concise language - set realistic goals and objectives - space teaching over time - incorporate health education into other activities - seek feedback

Environmental Health

- freedom from illness or injury related to exposure to toxic agents and other environmental conditions that are potentially detrimental to human health

Social Marketing

- manages the environment to help achieve desired behavior - the environment promotes exchange through the development of a choice that provides either: favorable cost/benefit, convenience of time/place, comparative advantage

Key points of using models

- models help guide the development of interventions - models may be individual, socially, or environmentally based - the model chosen should be based on the assessment of the population/individual and the desired outcomes

Teaching plan

Audience - learner characteristics Theoretical Models Environment Objectives Resources - teaching and student materials Methods of evaluation Content outline Timeline

Health Behavior

Actions of individuals, groups, and organizations as well as their determinants, correlates and consequences, including social change, policy development and implementation, imported coping skills and enhances quality of life

Precede: Phase 4

Administrative and policy diagnosis - identify and adjust where necessary the internal administrative issues and internal and external policy issues that can affect the successful conduct of the intervention - these issues may include generating the funding and other resources for the intervention

Impact evaluation

Are knowledge, attitudes or behaviors changing as a result of the program?

Formative evaluation

Are the program methods meaningful to the target population? This type of evaluation occurs throughout the program but before the evaluation of outcomes and can be used to guide decisions about modifications of the process.

Outcome evaluation

Can health status, morbidity, or mortality be attributed to the program?

Drinking water contaminants

Chlorine Methyl Tertiary Butyl Ether Nitrates Pesticides Lead Arsenic Microbial Contamination Radionuclides - radon

Teaching Learning Theory

Developmentally appropriate Meets learning style needs of student Use learner focused goals Encourage student participation Is aligned with group dynamics

When can a logic model be used?

During planning During implementation During evaluation During advocacy

Radon planning and Intervention

Educate - can't taste/see/smell Test (home, schoo, work) Seal cracks Ventilation Mitigate (>4 pCi/L) Re-test every two years and structural changes

The 3 E's of Prevention

Education Enforcement Engineering

HBM, Cues to action

Education Symptoms Media

Lead

in paint up to 1950s neurotoxin that accumulates in the blood, soft tissues and bone No safe level of lead

When do you evaluate?

ideally, when the program evaluation begins with community assessment and continues across the life of the program to ensure proper implementation

Which statement about health lit is incorrect if a patient is literate, he or she is also health lit a lack of health lit can create barriers to achieving desired health outcomes difficulty in understanding a using health info is a common problem in the us

if a patient is lit, he or she is also health lit=WRONG

Precede

Predisposing Reinforcing and Enabling Constricts in Educational and Environmental Development

Evidence-based population strategies

- addresses socio-cultural, political, economic, and physical environmental factors - shifts emphasis from individual to community

Healthy People 2020 goals

- decrease ED visits for asthma by 28% - decrease blood lead levels by 30% - increase focused pest control in schools by 10%

Process Evaluation

- ongoing evaluation of the educational process/professional practice - feedback on program implementation - personnel competency - was the program implemented as designed? - includes responses from the site, participants, and practitioner - formative evaluation

Logic models

- summarize key program elements - explain rationale behind program activities - clarifies the intended outcomes - provide a communication tool

Impact Evaluation

- summative evaluation - feedback on knowledge, attitudes, beliefs, and behavior of participants, programs, and organizational policies - evaluation of the immediate outcomes of the program i.e. changes in specific knowledge, skills, behavioral intentions

Logic Model

- visual representations of events leading to desirable program outcomes - helps to define program strategies - links resources, activities, and process with short term and long term outcomes - highlights the importance of stake holders - provides specific process and outcome measures of evaluation

Precede/Proceed Model

-A type of logic model -A community-oriented, participatory model for creating successful community health promotion interventions -Focuses initially on outcome rather than intervention (then works backwards) The premise of the model is that a diagnosis should start with the desired end result and work backwards to determine what needs to be done to bring about the desired result.

development of strategies

1. Assess the target population 2. Review the scientific literature (the evidence) 3. Identify a program planning framework 4. Consider existing challenges and strengths of the population 5. Apply health ed/health promotion models to develop methodologies 6. Specify the forms of evaluation 7. Implement the program 8. Assess evaluation date

Precede: 4 Phases

1: Social assessment 2: Epidemiological assessment 3: Educational and organizational assessment 4: Administrative and policy assessment, including intervention alignment

The PRECEDE-PROCEED model is based on some assumptions about the prevention of illness and promotion of health and other community issues as well. These include:

1st assumption: Health-promoting behaviors and activities that individuals engage in are almost always voluntary, so carrying out health promotion has to involve those whose behavior or actions you want to change. PRECEDE-PROCEED should be a participatory process, involving all stakeholders - those affected by the issue or condition in question - from the beginning of the process. Health promotion is more likely to be effective if it's participatory. 2nd assumption: Health is, by its very nature, a community issue. It is influenced by community attitudes, shaped by the community environment (physical, social, political, and economic), and colored by community history. Therefore, health and other issues must be looked at in the context of the community. 3rd assumption: Health is an integral part of quality of life, and it's within that context that health must be considered. It is only one of many factors that make life better or worse for individuals and the community as a whole. Finally, the 4th assumption is that health is more than physical well-being, or than the absence of disease, illness, or injury. It is a constellation of factors - economic, social, political, ecological, and physical - that add up to healthy, high-quality lives for individuals and communities and requires a joint effort.

Precede Phase 3

Behavoral and environmental diagnosis: - identify the predisposing, enabling, and reinforcing factors that act as supports for or barriers to changing the behaviors and environmental factors - identify the behaviors, attitudes, and/or environmental factors thatmustbe changed to affect the health or other issues identified in Phase 2 - determine which of them are most likely to be changeable

Low literacy print materials

Headers used White space Text uses upper and lower cases 12 to 14 point font Underlining and boldface is used Frequent summaries

HBM, Modifying Factors

Demographics

Stages of change model

Precontemplation>Comtemplation>Preparation>Action>Maintenance

The nurse is preparing a smoking class and is amazed at how many people still smoke. She believes her class will convert many smokers to nonsmokers one they get all of the latest info. The nurse is a believer in which of the following health care models? Health Belief Health Promotion Transtheoretical (changes) model of change Logic model

Health Belief Model

Environmental Hazards at Home

Home Environmental Health and Safety Assessment Tool Environmental Working Group National Library of Medicine's ToxTown and ToxMap

Process evaluation

How is the program being implemented? A process evaluation looks at the actual development and implementation of a particular program. It establishes whether you've hit or are hitting quantifiable targets and implemented strategies as planned. It's typically done at the end of the project but may be done during the project implementation and it looks at the program to assess cause-and-effect relationships between the program components and outcomes. This type of evaluation can be very useful in determining whether a program should continue, be expanded upon, refined or eliminated.

Based on the transtheoretical model of change, what is the most appropriate response to the client statement: me, exercise? i haven't done that since junior high and i hated it then

I understand, can you think of one reason why being more active would be helpful for you

Proceed phase 7

Impact evaluation You begin evaluating the initial success of your efforts. Is it actually doing what you expected on the target population?

Proceed Phase 5

Implementation The design and actual conducting of the intervention.

Pests/Pest Management

Insecticides (neurotoxins) Health effects pests and pesticides Pest elimination - avoid favorable home; safe alternatives Rodents are asthma triggers HP 2020 goal - increase the use of focused pest control

Teaching methods

Instructor centered Interactive Individualized Experiential

Health Belief Model

Janz and Becker, 1984

Environmental Hazards at HOme

LEad Radon Carbon monoxide Drinking water contaminants Mold Personal hygiene/beauty products Cleaning products Pests/Pest Management

Logic Model Conclusions

Make assumptions explicit Graphic data about the goals, activities, and outcomes of programs Ideally should have some built in flexibility for dealing with unexpected factors

Proceed Phase 8

Outcome evaluation Is your intervention really working to bring about the outcome the community identified in Phase 1?

HBM, Individual Perceptions

Perceived Severity Perceived Suscepitibility

HBM, Likelihood of action

Perceived benefits Perceived barriers

Precede: Phases 1 and 2

Phase 1: Social diagnosis (ask the community what it wants and needs to improve its quality of life) Phase 2: Epidemiological diagnosis (identify the health or other issues that most clearly influence the outcome the community seeks Phase 1 and 2 - create the objectives for your intervention; identify and set priorities In these phases you are creating the objectives for the intervention, and identifying and setting priorities. Phases 1 and 2 are where you develop the long-term goals for your intervention. They tell you what your ultimate desired outcome should be, and what the issue(s) or associated factors may be that influence it. Those are the things you're ultimately aiming to change. Most of the factors influencing the issues or outcomes can be classified as behavioral, lifestyle, or environmental.

Proceed: 4 phases

Phase 5: Implementation 6: Process evaluation 7: Impact evaluation 8: Outcome evaluation PROCEED picks up with the intervention itself (described here as a health program), and works back through the first four phases, evaluating the success of the intervention and addressing each one. When we discussed the logic model, we talked about the process, impact and outcome evaluations. Here, the process evaluation in Phase 6 looks at whether the intervention addressed the concerns of Phase 3 as planned. The impact evaluation of Phase 7 examines the impact of the intervention on the behaviors or environmental factors identified in Phase 2. Remember, however, that the evaluation of impact can take time to truly assess the impact. And the Outcome evaluation of Phase 9 explores whether the intervention has had the desired quality of life outcome identified in Phases 1 and 2.

Proceed

Policy Regulatory Organizational Constructs in Educational and Environmental Development How to proceed with the intervention itself

Program planning frameworks

Precede/Proceed Model Logic Model

Proceed phase 6

Process evaluation This phase isn't about results but about procedure. The evaluation here is of whether you're actually doing what you planned? Evaluate the process of the intervention

Transtheoretical Model of Change Theory

Prochaska and DeClemente, 1982

Marketers use the 4 P's

Product Price Place Promotion

Carbon Monoxide

Products of combustion Flu like symptoms Prevention: ventilation

Benefits of P/P Model

Provides a procedural structure for constructing an intervention Provides a framework for critical analysis Assures community involvement from the beginning Community involvement leads to community buy-in incorporates a multi-level evaluation (opportunity to continuously monitor and adjust your evaluation can adapt the content and methods of the intervention to particular needs and circumstances

Florence Nightingale

Pure air Pure water Efficient drainage/sewage Cleanliness Light Her interventions improved the health of British soldiers in the Crimean War and reduced the high infant mortality rate in London

Radon

Radioactive gas Gets in at ground level Heavy gas Cause of lung cancer Cigarettes and radon Worldwide Problem (WHO) colorless, odorless gas enters building at ground level heavy gas so test basements

A health ed program to adults in workplace that promotes healthy food chooses for lunch and teaching how preparing lunches can be affordable, accessible, etc

Self Efficacy

SMART objectives

Specific Measurable Achievable Realistic Time-bound

Lender's Model of Health Promotion

Teaching/learning process Theoretical foundations Development of a teaching plan Development of SMART objectives Teaching methods

Logic model program planning links

Theoretical assumptions and principles Program activities and processes Outcomes (both short-term and long-term)

Food manufacturers pay for placement of their product in the bull's eye zone

True Kids cereal on bottom shelf

Social Marketing Theory

Use of commercial marketing techniques to help a target population develop desired health behaviors, Weinrich, 1999 - Customer driven

Social Marketing Theory

Used in business world

SMART objectives

What Why Who When How

Logic model answers the questions:

What problem is the intervention trying to solve? What resources are needed to achieve success? What outcomes (evaluation criteria) represent success)? a logic model keeps everyone moving in the same direction, providing a common language and a common point of reference

The school nurse is part of a team that has implemented a smoking cessation program in the high school. An example of an impact measure would be: a. A decrease in the number of students with respiratory illnesses over the next 3 years A decrease in the number of students smoking Increased participation in the number of students participating in the smoking cessation classes a decrease in the lung cancer rate in the community

a decrease in the number of students smoking it is an immediate effect of the program

Using the Logic Model, your team has identified poor dental hygiene among cognitively impaired young adults. Examples of inputs for this program are (select all that apply): a) Dental hygiene students from the local college b) Local funding partners c) A "Teethbrushing Campaign" program d) Toothbrush donations by a local pharmacy e) Return demonstration of oral hygiene by participants

a) Dental hygiene students from the local college b) Local funding partners d) Toothbrush donations by a local pharmacy

information literate

abel to obtain and apply relevant info

numerically or computationally literate

able to calculate or reason numerically

computer literate

able to operate a computer

visually literate

able to understand graphs or other visual info

3 A's of health communication Is it

accurate accessible actionable

Health Promotion

any combination of health education and related organizational, economic, and environmental supports for behavior of individuals, groups, or communities conducive to health

Health Education

any combination of learning experiences designed to facilitate *voluntary* adaptations of behavior conducive to health

Understand the subjective culture

assess the beliefs, attitudes, roles, social norms, expectancies, stereotypes, cognition's, and values of the population segment

Lung cancer rates are increasing in a local community. Phase 2 of PRECEDE-PROCEED, identifies environmental determinants that may be influencing the outcome. Identify this factor. a. Increased smoking rates among teens b. Elevated radon levels c. Genetic risk factors d. The lack of open space in the community

b. Elevated radon levels

Logic model presents how you believe that your program will work Uses words or pictures to describe: impact:

behavior, knowledge, skill changes resulting from the program

Mold

biological hazard mold needs oxygen and moisture to grow allergy infection (immune comp) irritation toxicity can trigger asthma attach

An example of an outcome measure for this identified problem of Poor Dental Hygiene among Cognitively Impaired adults would be a. 100 % score on the posttest following the educational session b. Improved dental hygiene practices for the attendees of the program c. A decrease in rate of dental caries and gum disease in this population d. 75 % attendance at the Education Program on Dental Hygiene

c. A decrease in rate of dental caries and gum disease in this population

Logic model presents how you believe that your program will work Uses words or pictures to describe: outputs:

direct services provided by the program

Logic model presents how you believe that your program will work Uses words or pictures to describe: program activities:

interventions designed to achieve change

logic model

is a group/community level model

Ecological Systems model

microsystem: the person/family and their immediate environment Macrosystem: the larger context in which the micro system is imbedded (culture, school/work, physical environment)

Role of the NUrse

personalize health messages incorporate real life examples use demonstrations summarize often use appropriate resources encourage questions validate learning

Logic model presents how you believe that your program will work Uses words or pictures to describe: inputs:

resources necessary to plan and implement the plan

water polution

safe drinking water act EPA and State Gov

Dairy in back of market

so customers have to walk farther

Logic model presents how you believe that your program will work Uses words or pictures to describe: outcomes:

the changes in health outcomes that result in the community over 7-10 years

health literacy

the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions

evidence-based nursing

the integration of the best evidence available, nursing expertise, and the values and preferences of the individuals, families, and communities who are served

The underlying purpose of a logic model is

to assess the causal relationships between the elements of the programs they also help to highlight the role and importance of key stakeholders in the process