NCHES: Area of Responsibility 1: Assessment of Needs and Capacity (8th Ed.)

5 Strategies to select team members (1.1.5)

1. Ask for volunteers by word of mouth, in a newsletter, a needs assessment widely distributed publication) 2. Hold an election (throughout the community or subdivision of the community) 3. Invite/recruit people to serve 4. Have members formally appointed 5. Have an application process & then select specific most desirable characteristics

Coalition Success depends on the use of principles of collective impact conditions (1.1.5)

1. A common agenda 2. Shared measurement 3. Mutually reinforcing activities 4. Continuous communication 5. A backbone organization

Other Considerations for implementation (1.2.8)

(1) Defining roles, responsibilities,&skills needed to collect, enter, & analyze qualitative data (focused groups, interviews, & community forums) & may differ from needs related to quantitative data(survey). (2) Monitor data collection to ensure implementation of the process will assist in maintaining established timeframes & objectives. Identifying a committee or group should provide this insight. (3) Maintain the integrity of data collected & ensure protocols address quality control measures on both collection & data entry. Consider operational resources during data collection in the planning stage E.g, the use of incentives could improve the population/participants' response rate; Software access can improve qualitative analysis; & cost can cover the use of facilities & conducting focus groups. Continue to communicate with partners & stakeholders with information on the data implementation collection process.

Healthy people 2030-5 key areas of social determinants of health (1.3.3)

(1) Economic stability (e.g., poverty, employment, food security, housing stability) (2) Education Access & Quality (e.g., high school graduation, enrollment in higher education, language & literacy, early childhood education & development) (3) Social & community context (e.g., social cohesion, civic participation, perceptions of discrimination & equity, incarceration/institutionalization) (4) health care access & Quality (e.g., access to health care & primary care, health literacy) (5) Neighborhood & Built Environment (e.g., access to healthy foods, quality of housing, crime & violence, environmental conditions)

Advantages & Disadvantages Surveys Mail (1.2.7)

(1) Eliminate interviewers' bias (2) Increase assurance of anonymity (3) Allows respondents to complete at their convenience (4) Increase accessibility to a whole geographic region (5) Increase accuracy because respondents can consult records (6) Encourages identical wording for all respondents (7) Promotes inter-rater reliability. Disadvantages: (1) Lack of flexibility (2) Likelihood of unanswered questions (3) Low response rate (4) Inability to record spontaneous reactions or nonverbal responses (5) Lack of control over the order of responses (6) No guarantees of return by due date (7) Inability to use complex questionnaire format (8) Strong possibility of duplicate mailing (9) Fear of loss of anonymity (20) Expense

Primary collection sources can be at the individual, group-level sources (1.2.1)

(1) Individual: self-assessment, interviews, & surveys. Surveys are used to determine the knowledge, attitude, belief, behavior & skills, and set us off the prayer of the population. It should use well-constructed questionnaires that have been tested for validity and reliability, have a high response rate, & have been administered to a valid sample. A good survey correlates with good planning. (2) Group-level: Delphi technique, community forum, focus groups, nominal group process, & observations.

Advantages and disadvantages of Interviews (1.2.7)

(Advantages: (1) Personalization of the survey to one participant. (2) Flexibility for further probing (3) Higher response rates (4) Control over question order (5) Spontaneity (6) No possibility of help from others (7) Ability to use kore complex questionnaires Disadvantage: (1) Expensive (2) Time-consuming (3) Increased change of interviewers' bias (4) Lack of anonymity (5) Lack of standardization of questions (6) Difficulty in summarizing the findings ​

Types of Interviews (1.2.7)

(1) Key informant interviews: conducted with person with knowledge of, & ability to report on, the needs of a corporation, hospital, or organization. (2) Telephone interviews: is a easy method yo collect data at a moderate cost. They allow interviewers to clarify questions, & don't have the ability of visual cues that face-to- face method offers. (3) Electronic ( or web- based) Interviews: growing as a viable way to collect data from a large number of persons quickly & at a low cost. Disadvantages: access to a limited population [only those with internet access], lack of anonymity, & ignored e-mail, and are difficult to overcome. (4) Self-assessment instrument: allows people to answer questions about their health history, behaviors & screening results, such as blood pressure, cholesterol, height. & weight & are.then compared to others with similar characteristics providing a risk assessment fir a number of diseases, life- expectancy. Disease or disease risk an be detected by performing other Self-assessment techniques. including health assessment or risk appraisals breast & testicular Self-examination, & Self-monitoring for skin cancer.

Preparing for a literature review (1.2.3)

(1) Literature review helps HESp. to understand the existing body of knowledge on the topic and populations. (2) Identify information gaps to be included in the needs assessment. (3) Topic must be related to the key questions from the planning team.

Five categories for social determinants (1.3.1)

(1) Neighborhood & built environment (2) Health care access & quality (3) Social & community context (4) Education access & quality (5) Economic stability

Group surveys (1.2.7)

(1) Observations: used to gather data through direct surveillance of the population. Data is collected by watching & recording specific behaviors the population being studied.qat time becoming a part of daily activities. E.g., watching factory workers for their use of safety equipment &/or precautions, observing the smoking behaviors of employees on break, & checking food service workers adherence to workplace health code regulations. (2) Community Forums: public meetings, such as people in a particular population brought together ro discuss their perception of the community's health problems. ( Important: the silent majority may not speak, allowing more vocal individual's views to be wrongly seen as the group's views).

Primary collection needs (1.2.7)

(1) Primary data collection can be very costly and require a great deal of time. (2) The planning team identified to the primary data to be collected to support the proper purpose and scope of the assessment. (3) Prioritization is needed in the collection of primary data based on gaps identify through secondary sources and literature review.

Procure secondary data Questions to considered: (1.2.4)

(1) Reliable data- Who collect the data? Source of data? Method used to collect data? (2) Excess ability- Is data is the data available? what are costs? Is there a need for informal/formal agreement? (3) Timeliness of data- is information to all to be relevant? (4) Applicable to priority population- Do results only apply to the broader population?

Individual data collection (1.2.7)

(1) Surveys: used to determine the knowledge, attitude, beliefs, behaviors, skills, & health status of a priority population. Should be well-constructed & tested for validity & reliability, have high response rate & administered to a valid sample. (2) Interviews: similar to pencil & paper survey, they can be conducted in a variety of ways ( by telephone,face-to-face, electronically, or in groups. Interviewers must be trained to ensure consistency & accuracy in an unbiased manner.

Procedures (1.2.7)

(1) The evaluation or research design is the scheme, used to delineate when & from whom data is collected. (2) Method indicates how data is collected as a part of the evaluation & typically consists of strategies to collect data. (3) When conducting a needs assessment be mindful of sampling techniques, basic research designs used in data, collection & comparison, data collection methods, data type needed to answer research questions, ethical considerations, & the need for valid & reliable instruments to measure health status, behaviors, attitudes, beliefs, etc. A proper study design with appropriate methods & instruments is a key part of the assessment planning.

Accuracy of Published Information Questions (1.2.3)

(1) Was the purpose of this study stated? (2) Was the research question or hypothesis stated? (3) Were the subjects in this study described? Did the literature describe participant recruitment? (4) Was the design and location of the described? (5) Was the data collection instrument described? (6) Did the presented result reflect the research question or hypothesis? (7) Were the conclusions reflective of the research design and data analysis? (8) Were implication meaningful to the priority population?

Steps in designing & completing a survey: Verification; Data entry; Tabulation; Analysis; Recording & reporting (1.2.7)

(11) Verification: Test data entry for accuracy & errors in coding (12) Data entry: Method varies by resources; using a user-friendly software program is the key, advantageous for analysis, that can be watched for errors. (13) Tabulation: Frequently count to ascertain the number of answers in each category for every question. (14) Analysis: Varies according to the study's purpose, but generally includes calculating percentages, averages, relational indices, & performing tests of significance. (15) Reports should reflect all previous steps outlined including the objectives, hypotheses, reliability of results, & recommendations for action. Reports include an executive summary of the methods & major findings of the study.

Steps in designing & completing a survey: Questionnaire construction; Pretest questionnaire; Questionnaire revision; Administering the survey; Code preparation (1.2.7)

(6) Questions formulated for the survey are of the utmost importance & require detailed attention. Use existing validated questions when possible. All questions must match objectives. (7)retest questionnaire: Pretest survey with a sample comparable to the population of interest. (8) Questionnaire revision: Revise pretest findings. Perform a second pretest if there were extensive changes. (9) Administering the survey: Chosen methods should fit the nature of data gathered & objectives of the survey(e.g., mail, e-mail, telephone). (10) Code preparation: Data preparation includes coding questions & responses for tabulation & designing contingent valuesto imit data error( as necessary).

Typically search strategies helps HESp. to Identify (1.2.3):

(a) Key s search terms (b) Search source (e.g., online bibliographic databases such as MEDLINE) (c) A period to conduct the search (e.g., 2010 to 2019) (d) Characteristics of the priority population (e.g., age, race, gender, geographic location) or intervention. (e) Health condition (e.g., diabetes, obesity, asthma, teenage pregnancy) of interest. In many cases, topics have already been evaluated or researched with a plethora of published results in the literature.

Basic components of a literature review Process (1.2.3)

(a) What questions do you want to answer? (b) What evidence will address the question? (c) what are the inclusion and exclusion criteria for the evidence? (d) how will you find the evidence you want what is the search strategy? (e) what evidence from the search process needs your criteria? (f) how will you document answers to your question? (g) what metrics will you use to judge strength of the evidence? how will you summarize the findings and join conclusions based on the data and limitation?

Secondary data sources Government Agencies (1.2.1):

1). CDC, Morbidity/mortality weekly report (MMWR), CDC Wonder, Behavior Risk Factor Surveillance System (BRFSS): Youth (YBRFSS), National Center for health statistics(NCHS), vital records, (a) Census Bureau- Provides a statistical abstract of the U.S., A summary of the population by Metropolitan area, state, & county. Information on health expenditure and coverage (Medicaid & Medicare), injury, disability, status nutrition intake, & food consumption. -Population, -employment, -income, -family size, -education, -housing, -other social indicators. existing records, public scientific studies, reports, and peer-reviewed literature. These sources must be valid and reliable.

The 5 major factors that determine the health of a population (1.3.3)

1). Education 2). Economic stability 3). Neighborhood & built environment 4). Health & Healthcare 5). Social & Community context

Theories (1.1.4)

1. Can Provide a framework for a needs assessment. 2. Useful during the various stages of planning, implementing, & evaluating interventions. 3. Used to shape answers to questions of why what, & how. Why people are not following public health and medical advice or not providing healthy self-care. 4. Helps to pinpoint areas of knowledge needed before developing and organizing an intervention. 5. Provides insight on shaping program strategies to reach people and the organization, impacting them. 6. Identify what should be monitored, measured, & compared in a program evaluation. 7. HESp. can better understand behavioral change at a community, interpersonal, or individual level when considering the role of theory based on the application in practice.

5 Models for Needs Assessment (1.1.4) .

1. Epidemiological Model: Focuses on epidemiological data, death rates, prevalence rate, birth rates, etc. 2. Public Health Model: Attempts to quantify health problems using epidemiological data. Can be focused on a specific population & can be mindful of the limitations of resources. 3. Social Model: investigate social or political issues that influence health. 4. The Asset Model: Focuses on community strengths, organization, or population & finds ways to use existing assets to improve health. 5. The Rapid Model: Used when time and money are lacking in the needs assessment. It offers some basic information but lacks detail.

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

1. Getting a priority population involved at the beginning of the planning process is critical. Ensures that the goals & objectives of the assessment, planning, implementation, & evaluation phase will be completed effectively.

HESp. must consider the following to assist & identify potential factors related to the assessment's scope & purpose. Resources (1.1.3)

1. Human resources e.g., staff, data collectors, Incentives for participation, & travel funds available for the needs assessment. 2. Individuals, organizations, & institutions, buildings, landscapes, and equipment, potential assets for the development of the program/intervention. 3. Assessment that has been conducted in the target community to avoid duplication of efforts.

5 levels of influence for health behavior(1.3.2)

1. Individual: knowledge, attitude, and beliefs that influence behavior. 2. Interpersonal: association with families, friends, and peers that defines social identity, support, and role. 3. Institutional: rules, regulations, and policies which may constrain or promote recommended behaviors. 4. Community: social work and norms. 5. Public policy: local, state, and federal policies & laws that regulate or support actions/practices. Data gathered from needs assessment, the literature indicating risk factors determinants of health, & surveys (e,g., YRBSS & BRFSS) can be used to identify factors most important & changeable to determine the goal & objectives o the health program.

Benefits of Partnerships (1.1.5)

1. Meet the needs of the priority population better than an individual partner. 2. Shared financial resources 3. Solve problems or achieve goals that is a priority to several partners. 4. Bring more stakeholder to the table 5.Bring more credibility tp the program 6. Seeing & solving a problem from multiple perspectives 7. Creating a greater response to a need because thee is strength in numbers

Constituents in a planning committee (1.1.5)

1. Members of the priority population 2. Doers & influencers 3. Members of the agency 4. Other important stakeholders 5. Good leaders

Plan Assessment (1.1)

1. Needs assessment 1st step program planning. Identify, analyze, & prioritize the needs of priority population. It provides essential foundation used to guide the direction, development, & support of the intervention. 2. Capacity (asset-based) assessment directed toward actual & potential influential resources in the community (e.g., Stakeholder) & the supporter (Individual protective factors, significant others, settings) t the individual level to address needs.

The planning models (1.1.4)

1. Not independent & HESp. can use several at once. 2. Some program planning models include one or more steps in collecting data for a needs assessment. 3. Some include PRECEDE-PROCEDE, Mobilization for Action through Planning & Partnership (MAPP) & Interventions Mapping Approach 4. Necessary to review the behavior change model to understand the diverse influences on health & behaviors to be considered in the needs assessment process. 5. important to collect data not only on "Why is happening but Why it is happening" because health & health behaviors are influenced by many factors. 6. HESp. must consider health equity & socio-ecological influence in the assessment process to fully understand the needs of the community. 7. HESP. must identify both a planning model & implementation model in the assessment stage to identify data type & complex influence on health.

Elements of facilitating participatory action and partnership to ensure effective community based participatory efforts (1.1.5)

1. Recognize a partner community as a unit of identity 2. Build on community strengths 3. Facilitate collaborative, equitable decision making 4. Foster co-learning among partners 5. Balance knowledge generation within community benefit 6. Focus on ecological perspectives, local problems, & multiple determinants of health 7. Develop systems using an iterative process. 8. Disseminate information, results, & benefits to all partners 9. Develop a commitment & long-term process

Theories & Models (1.1.4)

1. Theories and models can provide a framework for needs assessment and are useful during various stages of planning, implementation, and evaluation of interventions. 2. Theories can be used to shape answers to questions of "why what, and how." in other words series guide the search for why people are not following public health and medical advice or not caring for themselves in a healthy way. 3. Theories can pinpoint what health education specialists need to know before developing an organizing and Intervention Program. 4. Provides insights into how to shape program strategies to reach people and organizations and make an impact on them. 5. Identify what should be monitored, measured, and compared in a program evaluation. 6. Behavior change needs to be understood at the community, interpersonal, or individual level.

The assessment Plan (1.1)

1. Used to direct the s.appropriate use of limited resources 2. Provides a focus on priority population (equity and social justice) 3. Informs planners of the capacity of the community to address needs 4. Ensures the priority population needs are the focal point in developing the intervention & can be a baseline for future assessment &/or evaluations.

Develop a data analysis plan (1.2.9)

A roadmap for organizing & analyzing needs & capacity assessment data before collection of data. Data Analysis Plan includes: (1) Scope & purpose of assessment (2) Key needs assessment questions (3) description of data collection instrument(qualitative & quantitative ) selected & why being used. Supporting documents on database use(e.g., methodology) can provide credibility to assessment findings. (4) Description of inclusion/exclusion criteria (5) Description of variables to be used in the analysis (6) Statistical methods & software to be used .

Community: Photo voice (1.2.7)

A specific photographic technique to enable people to record & refect on personal & community strengths & concerns. It promotes critical dialog & knowledge about personal & community issues through group discussion of photographs. It's an excellent way to reach policy makers, through these discussions. ​

Specific Rates

A specific rate is a statistic referring to a particular of the population. ■ Age specific rates: the number of cases per age group of population during a specific time period. (describes both morbidity(cases) & Mortality (death). Helps to make comparison regarding a cause of mortality or morbidity across age groups. Age-specific Rate: R= # of deaths among those that age (15-24/# of persons who are the same age (15-24) x 100,000 ■Sex-specific rate: the frequency of a disease in a gender group divided by the total number of person within that gender group during a time period times a multiplier. Sex-specific death rate= # of death in a sex group/ Total # of persons in the sex group x 100,000. E.g., In 2013, Number of deaths among men =1,306,034- Male population = 55,651,602 In 2013, Number of deaths among females = 1, 290,959- Female population 160,477,237 ■ Sex-specific crude death rate for females in 2013 per 100,000 was = 1,290,959/160,477, 237 x 100,000 = 804.4 per 100,000.

Conduct a Literature Review (1.2.3)

A systemic method of locating, synthesizing, and interpret a collection or work by researchers and practitioners. An effective literature conducted in a systemic manner to uncover what is already known about a topic resulting in a summary and synthesis of the review.

Critical components in the data planning & preparation process: (1.2.7)

Adequate planning & preparation are vital to successful data collection activities. (a) Data collection & instrument development (b) data analysis plan (c) Findings or results of assessment (d) Written reporting of data

Advantages and Disadvantages of Observations (1.2.7)

Advantages: (1) A place or event (2) Situation or interactions (3) can be directly viewed (Allows the observer to experience the life of the community or a population. Disadvantages: (1) Documenting observations may be harder to analyze.

Advantages & Disadvantages of Telephone Surveys (1.2.7)

Advantages: (1) Cost saving compared with face to face survey (2) Faster than mail survey or personal interview (3) Accessibility to a wide geographic region (4) Increased monitoring * quality control. Disadvantages: (1) Call may be seen as a hoax or disruption (2) Loss of visual component of reading the survey (3) Interviewer has little control (4) Respondent can hang up at any time (5) Low response rates due to unlisted numbers (6) Caller ID (7) Reduced use of land lines (8) "do no call" lists

Advantages and disadvantages of Interviews or Focus Group (1.2.7)

Advantages: (1) Help people learn more about the group or community opinions & needs have more depth (2) Nuances & variety (3) Nonverbal communications & group interaction also can be observed (4) Focus groups can therefore get closer to what people are really thinking & feeling. Disadvantages: (1) Responses may be harder to score on a scale

Advantages and disadvantages of Web Surveys (1.2.7)

Advantages: (1) Quick response (2) Low cost to administer (3) Automated data gathering process (4) Administered to a large number of participants (5) A forced-choice format Disadvantages: (1) Limited ability to monitor returned surveys (2) Limited time frame within which respondents can access the survey (3) Forced- explicit choice responses (4) Costly hardware and software

Obtain Primary & Secondary data, & other evidence-informed sources. (1.2)

An assessment allows HESp. to 1. Determine the health problems that exist in a particular setting, group of people, & the level of community capacity to address the result of the assessment. 2. Multiple methods that HESp. should use to obtain health data. (a) Primary Data: HESp. Firsthand answers to unique questions about the specific purpose of the project. (b) Secondary Data: collected previously for another purpose by others and made available depending on the practice settings. (3) In the assessment process, engaging the community members is essential in establishing relationships that aid in findings interpretation & supports implementation.

HESp. must consider the following to assist & identify potential factors related to the assessment's scope & purpose. Program (1.1.3)

Available for priority population to assess usage, effectiveness, accessibility & if priority population needs are being net avoiding duplication.

System change (1.3.3)

Can take a long period of time, and the impact may be years away. Important-!!!!! consider interim milestones ■ Evaluation of systems change can have the same methods & Impacts as those policies, including process, context, and short-term & long-term outcomes. ● This is more complex & involves data collection at multiple stakeholders levels (e.g., leadership, staff, partners consumers/ clients). ■ Evaluation method- could include ● Organizational interviews with leaders & staff. ● Observations of events or structure. ● Surveys of key informants, patients/population-oriented outcomes for more process-oriented questions. ■ System thinking allows the planning team to look at the components of a system not as separate pieces, but in terms of how they interact. ● System thinking involves looking at system parts, including shifts in systems interdependent, communications or interactions, and system choice (e.g., attitudes about change, change fit alignment with a mission).

Focus Group Techniques (1.2.7)

Capitalize on communicating among participants selected based on specific criteria. A skilled facilitator lead the individual invited to participate, encouraging them to talk with each other, to ask questions, give examples, providing comments on the topic. Designed for participation to share opinions . Number of people depend on the intended outcome, can be 2 or more persons, as much as the facilitator can manage. Analysis of results may be challenging. inferring concensus may be difficult, & results may not be Generalizable.

Priority Population Perspective (1.1.4) Expressed, actual, perceived, & relative needs must be addressed in Needs Assessment.

Community concern may not reflect empirical evidence. 1. Expressed Needs: Observed through use of services, Such as exercise classes taken by adults at a senior center. 2. Actual Needs: May be inferred through the discrepancy of services provided to one community group as compared to another, such as bicycling & walking lanes. 3. Perceived Needs: what individuals in the community state that they want, such as more healthy food choices in a school vending machine. 4. Relative Needs: Describes a discrepancy between an individual's or group's current status & that of the others, such as a smoke-free environment in restaurants in different cities.

One way to Include multiple levels of interventions (1.3.3)

Consider including system change strategies to enhance the likelihood of successful maintenance of change. ■ System Strategies are changes that impact all elements of an organization, institution, or system. ■ A system is an organized collection of integrated elements that work as a whole to accomplish a goal. ■ Simple system e.g, a clinical reminder system ■ Complex system e.g., more coordination between elements, engagement of actors, & organization. ■ A system change is modification in how a collective unit decides upon policies, program services, decision-making, & the allocation of resources. ■ System thinking & change requires actions multiple levels & have been identified to address public health issues. These provide areas of leverage point for system change.

Identify Priority Population(s)- (1.1.2)

Consist of the entire population if an intervention is being implemented for the total community. Can be identified by: 1. Demographic qualities such as Age, sex ethnicity, & income that will impact information gathered. 2. Geography such as state, county, zip-code, the community perspective allows HESp. to use this specific criteria. 3. Sector such as school, worksite, faith-base. 4. Environment conditions 5. Culture & social aspect 6. Size of population 7. Shared characteristics within the community to further & more comprehensively define the population for need assessment. The priority population mat change as needs assessment data are processed.

State and Local Agencies (1.2.1):

County, City, & State health Departments or related agencies. Vital records, disease registries, police records, morality/morbidity records, epidemiological studies, incident reports, safety surveys. Service, social, & religious organizations (e.g., Rotary Club, United Way)

Epidemiological Measures 2

Crude rates: A type of unmodified rate taking account of any factors, such as demographic make-up of the population., that may affect the observed rate; including a measure of time during which the event occurred. ■ Crude Rate: Frequency of a disease over a specific period or time/A unit size of the population (per 100,000;10,000; 1,000) ■Crude death Rate (Mortality Rate): # if death in a given year/ Reference Population (during the time period of the year) e.g. Total C.O.V.I.D-19 deaths In Passaic County 1,456/ Total Population in Passaic County 501,826 x 100.000 = 290 C.O.V.I.D related deaths per 100,000 people.

Epidemiological Model: Focuses on epidemiological data, death rates, prevalence rate, birth rates, etc.(1.1.4)

Definition: Epidemiology is concerned with the distribution & determinants of health & diseases, morbidity, injuries, disability, and mortality in the population. ■ Epidemic: The occurrence of cases of illness, specific health-related behavior, or other health-related events in excess of normal expectancy ■ Pandemic: An epidemic occurring worldwide or across a wide area, crossing international boundaries&affecting a large group of people. ■ Incidence Rate: The number of new cases that occur during a time period divided by the average number of individuals in the population at risk during the same time period, multiplied by 100,000. ■ Prevalence: The length/duration of disease in the population.

Fourfold table for classification of screening test result

Definitions: ■ True positives-are individuals who have both been screened positive & TRULY HAVE the condition. ■ False positives- are individuals who have been screened positive but DO NOT have the condition. ■ False negatives- individuals who have been screened negative but TRULY HAVE the condition. ■ True negative- are individuals who have both been screened negative & DO NOT HAVE the condition. ■ Test Result: Present <-----------------> Absent ■ Positive --> a = true positives b = false positives = a+b Predictive Value (+) a/a+b ----> (Positive) ■ Negative--> c = false negatives d = true negatives = c+d Predictive Value (-) d/c+d ---> (Negative) Total---> a+c ----------------------b+d = grand total a+b+c+d Sensitivity a/a+c ---------------- Specificity d/b+d

Evidence-informed Resources (1.2.1)

Evidence used by HESp. to make decisions rages from : Objective: Systematic Reviews Subjective: Personal experience & Observation 2). Must be valid & reliable data about a specific population & have the characteristics of the priority population. 3). Must review current literature available in libraries (specific computer bases) & the internet

HESp. must consider the following to assist & identify potential factors related to the assessment's scope & purpose. Practice & Interventions (1.1.3)

Evidence-based or best practices can impact assessment process/ findings & program planning efforts in multiple settings & populations. Interventions are designed to change the environmental or behavioral factors related to health.

Steps in designing & completing a survey: Planning a survey; Overall design; Method of collection; Planning data analysis; Drawing the sample (1.2.7)

Examples of planning required for primary data surveys: (1) Planning a survey; Determining: (a) survey objectives (b) Monetary, Personnel,& Time resources (2) Overall design; Should be designed to accomplish the objectives & reflect data needs, data collection techniques, & resources. (3) Method of collection: Should be chosen to match the survey objectives & fit resource constraints. (4) Planning data analysis: An appropriate method of data analysis, consistent with the type of data being collected & goals of needs assessment, should be chosen. (5) Drawing the sample; From survey objectives & design come: (a) The population of interest (b) The sample size & selection (c) Appropriate interviews if to be conducted

Establish collaborative relationships & agreements that facilitate access to data. (1.2.2)

HESp. Facilitated access to data through collaborative relationships, and formal/informal agreements, with stakeholders and agencies. (a) Collaborative relationships identify goals and work together to meet them with organizations and groups. (b) Collaborative relationship levels include networking, cooperating, coordinating, or collaborating. (c) Establishing a relationship with the organization or group outlining the intended outcome, audience, the purpose for which data will be used, the ownership of data, confidentiality aspects, & conditions of the release of data is an effective method to obtain or exchange needed data & practice data ethics. (d) HESp. can integrate data-sharing agreement guides & templates accessible online into their needs assessment process.

Conducting thorough assessment (1.1)

HESp. Must carefully plan for the process including: 1. Assessing current resources 2. Policies 3. Programs 4. Interventions 5 Identify factors that may impact the assessment process.

Analyze the data to determine the health of the priority population (s) & the factors that influence health (1.3)

HESp. must Identify & prioritize the behavioral, environmental, & social risk factors that are associated with health. The CDC's social determinants of health are conditions in which people are born, live, work, play, & age that affect health risk, health, daily functioning, & quality of life. Modifying these factors or determinants is pertinent to improving the health status of individuals & communities. The type & number of risk factors vary as influences themselves. People have different learning styles, some learn by making connections with previous knowledge & experiences. Acknowledge learning impact & select methods for delivering health education, health promotion, and health messages tailored to the specific priority population.

Roles & Partnering Efforts (1.1.5)

HESp. must carefully consider the type & level of engagement needed, and determine the knowledge, skills, resources, & experiences needed that stakeholders, partners, & priority populations can bring to the planning activity when forming a team. Relationships developed with this group will result in an effective planning team to conduct a needs assessment, develop, implement & evaluate the program. Advisory & planning committees are two types of partnering efforts that are task-oriented & critical throughout the process. For larger community-wide initiatives that require intense, complex, & detailed efforts, another level of partnering & coalition must be considered.

Identifying existing available resources, policies, programs, practices, & interventions (1.1.3)

HESp. must identify resources, policies, programs, practices, & interventions that already exist or are available fr the priority populations, health topics (s), of focus, & assessment process. Adding value, ensuring a more comprehensive analysis of the community/ priority population needs & enhancing the effectiveness of the program planning efforts.

Recruiting Members for planning Teams (1.1.5)

HESp. must-have strategy to recruit members for the planning team depending on team size, type (stakeholders, partners, & priority populations), skills, experience, & knowledge needed for the team. Example: Members of the priority population could be considered volunteers; their motivating factors might differ from paid staff. Compared, recruiting a partner organization may be determined by establishing common goals & objectives. The planning committee must be diverse & reflect the priority population with the health problem.

During the Development of the Assessment Plan (1.1.2)

HESp. should research other needs assessments related to the target community that has been conducted in order to avoid duplication of effort. Relevant assessment will add value to ensure a more comprehensive analysis of the community needs.

Report assessment findings (1.4.5)

HEsp. Needs to consider to whom they will disseminate the findings.( prepare the population, researcher, funding agencies, or stakeholders.). ■ Decide who should write the report, receive the report, what format it should be distributed, when it should be distributed, use variety of dissemination method to present information. ■ Reports can be formal or mundated to be distributed through an organizations website such as public health departments or hospitals for community health benefit assessment. ■ Example: ● Preparing a user-friendly, easy-to -read report. ● Writing a separate executive summary of the report. ● Developing a press release, then hold a press conference in conjunction with the Press release. ●Creating a newsletter, newspaper article, or fact sheet. ● Developing a PowerPoint presentation. ● Making verbal presentations to community groups, priority population,stakeholder, & using the powerpoint, other demonstrations, or visual image to report the findings. ● Constructing professionally design graphic, charts, and display for use in reporting sessions. ● Making short videos or audio tapes for presenting the results. ● Using social media to report information, such as facebook, youtube, or instagram.

Sources for literature review (1.2.3)

If systemic review, meta-analyses, & pooled analyses are not available. Information on the topic can be found in Indices, abstracts, government documents, & computerized databases. (with evolving methods for research computer database provide full-text copies of the latest research & evaluation findings) Valid &/or reliable database: BIOETHICSLINE, ERIC, HAPI, MEDLINE, National library of medicine, & TOXNE. High-level evidence-based information: Cochrane Library, PubMed, & SUMSearch. Government documents: national Center for Health Statistics(NCHS) via CDC. Also, Heath science librarians to locate the source.

Community Assets (1.1.3)

Many of the resources listed are considered community assets or strengths. individual, institutional, organizational, governmental, cultural, physical & land.

Partners (1.1.5)

Individuals or Organizations bringing knowledge, skills, or resources to the table are willing to share risks, responsibilities, & rewards.

Community: A community capacity (1.2.7)

Inventory & community asset maps are tools for identifying community resources & issues. This typically involves the development of a list of skills, & talents of individual community members, associates, & other resources in the neighborhood as a whole. Simple Surveys, walking. & windshield tours. interviews, community newspapers or directories. & other assessment methods can be used to gather information. Community members creates asset maps as they "map" local resources. abilities & other buildings blocks for community growth & change. A community asset map.is a visual representation of the physical assets of a community's physical and social support structures for achieving community goals, such as libraries. playgrounds. schools, parks. & houses of worship.

Delphi Panel (1.2.7)

Is a group process that generates consensus by using a series of mailed & emailed questionnaires. Involves individuals from 3 groups: decision-makers, & staff. & program participants. A questionnaire containing 1 or 2 board questions is sent to the group, the answers are then analyzed, & based on the analysis of responses, a second questionnaire with more specific question is developed, then sent to the same group of respondents. Their response is analyzed & another questionnaire developed and sent again. On average questionnaires are analyzed & sent out 3 to 5 times.

Method or strategy for collecting primary data (1.2.7)

Is based on questions being asked, data needed participants from whom the data will be collected, & resources needed to collect data. HESp. should develop a comprehensive data analysis plan including multiple approaches based on program needs. E.g., HESp. should consider the feasibility of collecting data among different subpopulations to identify disparities & take into account potential bias results from data collection methods in the analysis plan. ■ Data credibility can be improved by utilizing multiple methods for data collection. HESp. can integrate primary & secondary data to obtain different yet thorough, perspectives on health needs & to compare data from the priority population with data from similar populations. This combination can develop a rationale for program needs. Method selection will include a consideration of the resources available and population characteristics. preferences, & time-frame to conduct an assessment. HESp.'s understanding of the advantages & disadvantages of various data collection methods assists in the decision-making during the planning process.

The assessment process (1.1.1)

It might involve recruiting members of the priority population to participate throughout all steps in the assessment, planning, implementation, & evaluation process. The needs assessment provides HESp. with a roadmap that provides an overview of the process, resources needed, activities, & results supporting the goals & objectives of the assessment providing a clear direction and ensuring all aspects of the process are completed.

HESp. must consider the following to assist & identify potential factors related to the assessment's scope & purpose. Policies (1.1.3)

Laws, regulations, both formal/informal at the sector/organizational, local, state &/or federal level that influence the priority population's action or behavior.

Examining the factors & determinants te Influence the assessment process (1.1.4)

Multi-level comprehensive interventions are needed to develop effective programs. HESp. must consider many levels of influence, such as investigating the role of each level of the socioecological model individual, family, relational, community/peers & societal /cultural.

Identify the social, cultural, economical, political, &environmental factors that impact the health or learning processes of the priority population(s) (1.3.3)

Opportunities to make healthy choices are shaped by the availability of choices. Social norms & policies created by social & economic conditions in health & non-health sectors determine these opportunities which are not always distributed equitably across population groups. Health improvement strategies need to be developed & implemented where people live, learn, work, play, & worship. USDHHS defined Social determinants of health as " conditions in the environments where people are born, live, grow, play, worship & age that affect a wide range of health, functioning & quality-of-life outcomes & risk" These circumstances shape the distribution of money, power, & resources at global, national,& local levels.

Primary data collection resources (1.2.1)

Primary data allows HESp. obtaining accurate data on the problem, influences, & potential solutions to health issues in the community. The types of strategies used will depend upon the type of data needed for the needs assessment.

Define Purpose and scope of the assessment (1.1.1)

Provides the direction necessary to develop the scope and detail of the assessment effort. Questions the planning committee should ask address including: 1. what is the goal of the needs assessment? 2. What does the planning committee hope to gain from the needs assessment? 3. How extensive will the needs assessment be? 4. What resource will be available to conduct the needs assessment? 5. What type of needs assessment is appropriate? (e.g., Comphrensvie, focused). Critically consider who should be involved & what decisions will be based on needs assessment.

Epidemiological Measures

Ratio(R): The value obtained by dividing one quantity by another. R=x/y (the # of men to The # of women: #men/#women) ■ Proportion: P=A/(A+B) (A ratio where the numerator is a part of the denominator) (# of AIDS in Men= 450,451; # of AIDS in femails= 89,895) Proportion of male death by AIDS=4550,451/(450,451+89,895)=0.83 (written as a percent). ■ Percentage: A proportion multiplied by 100. P=A/(A+B) x 100. ■ Rate (r): a type of ratio where the numerator is usually the count, & the denominator is the time elapsed (allows comparison among different populations). r=x/⨺t. ■ Incident Rate = # of new cases /the population at risk x 100,000 (allow for comparison across different population) ■ Prevalence = (# of persons ill/Total # persons in the group/Population) C.O.V.I.D-19 Prevalence in Passaic County=(47587/51,826)= 0.095 or 9.5%

Bloom's taxonomy (1.5.1. Table 1.57th edition)

Relates to the classification of learning objective developed for learners. Which proposed that learning in the cognitive domain should apply the higher order process instead of lower order objectives that are traditionally seen.

Analyze & Synthesize Information (1.2.3)

Research findings, results of assessments, & program evaluations, including current trends & issues, are made available in published literature. HESp. used synthesis of professional literature to provide evidence of effective approaches to Health education problems. Must refer to peered-reviewed journals. Strategy used in the planning phase of the literature review process provides the bases for the analysis and synthesis of information gathered. The systematic method of organizing identified constructs into subheadings provides the basis to analyze, synthesize, & write the review.

Secondary data resources (1.2.1)

Second data is used by HESp. to gain insight community capacity, assets, and needs. It involves gathering epidemiological data such as health status, risk factors, incidents and/ or prevalence rate, death rate, & birth rate.

Contributions of Partners and Stakeholders (1.1.5)

The Priority population, partners and stakeholder's increased involvement will improve needs assessment process and other program planning, implementation, & evaluation also increase the value of the result. HESp. can suggest ways to gather information of give useful information relevant to the situation. A strong planning team needs trusted effective leadership, members motivated to achieve, &have the power or capacity to effect change.

Framing the assessment factors & determinants: Needs Assessment Models (1.1.4)

The breadth & depth of information collected in needs assessment can vary depending on the model. There are 5 models for conducting needs assessments: epidemiological, public health, social, asset, & rapid. HESp. must consider the many levels of influence: behavioral, organizational, cultural, community, policy, & environment (SEM).

Social determinants of health (1.3.1)

The conditions in which people are born, grow, live, work, and age." ■ These conditions are impacted by economics, social policies, and politics. ■ Social determinants of health affect health status because of the overlapping connection to health disparities & health equity. ■ Shaped by the distribution of money, power, and resources at global, national, and local levels.

Determine the knowledge, attitude, beliefs, skills, & behaviors that impact the health & health literacy of the priority population(s) (1.3.2)

The factors of health & health literacy of the priority population must be determined. Factors can be cognitive & behavioral. 1. Individual factors: educational, social & cultural characteristics. Factors also include a person's knowledge, attitude, and beliefs, perceptions related to health. An individual's culture, religious or spiritual beliefs as well as skill set must be considered when assessing influences on health behavior. 2. Behavioral (lifestyle) factors are behaviors or actions of an individual, groups, or communities. This may include compliance, consumption and utilization pattern, coping, preventative actions, and self-care. Attitudes and beliefs are shaped by physical, cultural, social, & community norms. Family values, religion, & the environment also shape attitudes & beliefs. 3. HESp. must understand the dynamics of priority populations to build relationships, respect, & trust, & identify ways to collaborate effectively on interventions. diversity in background, experiences, & cultures must be acknowledge in health education/promotion interventions to ensure success & to effectively engage priority population and other stakeholders.

Interrelated components that influence likeliness of disease (1.3.3)

The interrelation of various components & their combined effect influences the likelihood of disease, functional capacity, health behavior, & well-being. Determinants varied by specific health issues. Needs & capacity assessments aides in a better understanding of influences on the health & well-being of individuals & groups. Understanding the influence on health can help individuals & communities make informed decisions & take appropriate steps to enhance health.

Descriptive Epidemiology

The occurrence of disease according to the following variables: ■ Person- Who is affected (Stratify data by males & females) ■ Place- Where the condition occurs (Using a telephone survey to collect state data about the U.S. residents regarding their flu shot vaccination behaviors). ■ Time- When & over what time period the condition has occurred. (Reporting adults aged 65+ who had a flu shot within the past year in NJ in 2018). A descriptive epidemiologic study is one that is "... concerned with characterizing the amount & distribution of health & disease within a population." (Occurences of disease/death related to disease; data can be displayed by time & by Place). ■ Prevention of disease ■ Design of interventions ■ Conduct additional research. Types of Descriptive Epidemiologic Studies: ■ Case reports ■ Case Series ■ Cross-sectional studies (the focus on public health)

Stakeholders (1.1.5)

Those who affect & are affected by change & those who are interested in results & what would be done with the results. Can gather useful information relevant to the situation. By identifying these stakeholders, a collaboration could be formed to create an effective planning team to conduct a needs assessment and develop, implement, and evaluate programs.

Procure secondary data (1.2.4)

To obtain meaningful secondary related to the purpose & scope of assessment. HESp. must have a thorough understanding of the strength & weaknesses of the dataset/information source. Computerize reference databases: Universities &Public libraries. American Factfinder(free): United States Census Bureau, BRFSS, National library of Medicine's PubMed, Google Scholar, and ERIC-Education Resources Information Center.

Adhere to established procedures to collect data (1.2.8)

Types of data collection: (1) Quantitative data are collected in numerical form (e.g., mortality rate or number of cigarettes smoked). or translated to numerical form (patient satisfaction using 5-point scale ratings). (2) Qualitative data are in narrative form, collected to better understand motivation, thoughts, feelings, & behaviors. Both are valuable throughout the program planning, implementation, & evaluation process. To ensure quality: Find reliable, trustworthy, & skilled people to collect, enter, analyze, & manage the data.

Nongovernment Agencies and Organizations (1.2.1)

a) Healthcare system:- Hospital discharge data, -emergency room visit data, -injury/hospitalization records. b) Voluntary Health Agencies:- American Heart Association, American Cancer Society c) Business, Civic, & Commerce Groups (United Way) d) County Health Rankings- Henry J. Kaiser Family Foundation

Existing Records & Literature (1.2.1)

a) Heath data collected as a by-product of service, such as clinical records, - data from immunization program, -clinical indicators, Data from physicians offices, -data on absenteeism, -data from insurance claims. Literature: Peered-review Published scientific Studies & reports

Nominal Group Process (1.2.7)

is highly structured with a few representatives from the priority population asked to respond to specific questions based on what the health education specialist need to know. Group consists of 5 to 7 persons with each member having an equal voice in the discussion & voting. All opinions are shared by privately ranking proposed ideas, sharing the rankings with the group in a round-robin fashion. It is time consuming & requires a large meeting space depending on the number of people.

Cross-Sectional Study

■ A type of prevalence study- ■ A type of investigation "...that examines the relationship between disease (or other health-related characteristics) & other variables of interest as they exist in a defined population at one particular time" ■ Exposures & outcomes measured at the same time. Example: the behavioral risk factor surveillance system (BRFSS) an on-going telephone survey of health-related behaviors( alcohol consumption, chronic disease, HIV, Healthcare access etc.). ■ National HIV Behavioral Surveillance(NHBS)-Ongoing surveillance system focused on HIV related health outcomes or health behavior. Repeated cross-sectional study annually.

Multiple influences according to the ecological models (1.3.2)

■ Behaviors have multiple influences including factors at the intrapersonal, interpersonal, organizational, community, and public policy levels. Influences interact across different levels. ■ After health behavior is determined & factors that influence behavior are identified, more information is needed to know how these factors influence the behavior or impact health. ■ The importance & changeability of the factors against available resources for the program must be weighed. Using the ecological prospect HESp. can provide a multi-level and interactive approach as health education specialists explore the relationship between risk factors. HESp.can contribute to the impact of the program by understanding the relationships of the multidirectional flow of influence with and between levels & apply that understanding to the development of an intervention.

Birth Rate

■ Birth Rates: The number of births among women in a specific age group or in a specific social group. E.g., Birth rate by age of mother; the Birth rate for unmarried women. From 2017 to 2018, birth rates decreased for females aged 15-34, and increased for females aged 35-44. Comparison=A/B ■ Crude Birth Rate = # of live births within a given period/ Population size at the middle of that period x 1,000 population. E.g., 3,932,181 babies were born in the U.S.A. in 2013, when the population was 316, 128, 839. Crude birth rate=3,932,181/316,128,839=12.4 per 1,000 population

Case Fatality Rate and Proportional Mortality Rate (%)

■ Case Fatality Rate (CFR%): the number of death due to disease that occurs among persons who are afflicted with that disease. CFR(%)= # of deaths due to disease "X"/ # of cases of disease "X" x 100 (during a time period) Use to compare death rates of C.O.V.I.D 16.9% & Influenza 5.8% =16.9%/5.8%=2.9 (people were 3 times more likely to die from COVID-19 than Influenza). ■ Proportional Mortality Rate (PMR%): The number of death within a population due to a specific disease or cause divided by the total number of deaths in the population multiplied by 100. PMR(%)= # of death in the population 611,105 from heart disease in the U.S/ Total # of deaths from all causes in the U.S. 2,596,993 x 100 = (611,105/2,596,993)x100=23.5% of all death is due to heart diseases. e.g. Total # of deaths due to COVID-19 in January 2021=61,954. Total # of deaths from all causes in January 2021=220,924 PMR(%) for COVID-19? = 61,954/222,924)*100=28% of the total death is from COVID-19

Prioritize health education and promotion needs (1.4.2)

■ Criteria fir prioritizing health needs: ● How serious is the problem? ● How urgent critical is the nature of the problem? ● How severe is a problem? ● What is the morbidity/mortality severity, duration, &/or stability associated with the problem? ● What medical costs are associated with the problem? ● How many people are affected by the problem? ■ Effectiveness of possible interventions. ● How effective are health education intervention in addressing the problem? Are they meeting stated goals and objectives? ● Are the potential intervention accessible to the affected population? ● How were the needs of the potential program determined? Are the needs of the population being met? If not, why? ■ Appropriateness, economics, acceptability, resources, & legality of the possible intervention. ● What health education programs are presently available to the populations affected? ● Are the programs being utilized? If not, why? ● Given population, is the intervention appropriate & in accordance with the societal/group norms? ● Are dear sufficient resources for implementation? ● Is the intervention legal?

Asses Existing & available resources, policies, programs, practices, & interventions (1.3.4)

■ Determining the effectiveness of Programs & Interventions; HEsp. can use recommendations from a variety of sources, e.g., scientific literature, program staff, program stakeholders, & program decision makers. The use of a Community Guide Preventative Services (https://www.thecommunityguide.org) will help HEsp. to access systemic reviews & meta-analyses of evidence-based practices. ■ Knowledge of & Understanding of policies related to health education /promotion are important to develop comprehensive public health policy development to support health efforts.

Determine primary data collection needs, instruments, methods, and procedures (1.2.7)

■ Existing instruments that may be applicable to the health education specialist assessment efforts and priority population should be identified. ■ Using or adopting a valid and reliable data collection instrument May provide details on methods used for development, collection, implementation, & Analysis.

Levels of system change-Feedback and delays & System element, (1.3.3)

■ Feedback and delays: Providing information about the results of different actions by System elements to the source /administration of the action. ● Change: create or change the feedback loop, I didn't feedback loop or change feedback delays. ■ System elements: Actors & physical elements of the system connected through activities & information flow (Communication). Examples of systems: Neighborhood Schools Communities Health systems Worksites Health Insurers

Compare findings to norms. existing data, & other information (1.4.1)

■ Findings must be validated by comparisons to Norms and other standards of acceptability. ■ Common standard of acceptability include mandates "policies, statues, and laws," values, norms, comparison/control groups & the "how much: in an objective for program. ■ The purpose of comparison is to improve the quality of program and measure their effectiveness.

Develop recommendations based on finance (1.4.4)

■ Focus on positive aspects & areas that made improving based on results of today's and capacity assessment. ■ Recommendations should be frame so that priority population can make decision regarding what needs to , or can, be done & in what order of priority. ● Example the Affordable Care Act (ACA) includes a Mandate to non-profit Health Organization to conduct a community health needs assessment. ■ Identifying Gaps in service is the purpose of assessment & implementing strategies to address gaps. " Needs of each group of stakeholders must be addressed when developing recommendations"

Identify data caps (1.2.6)

■ HESp. must note where there are little data that inform the key questions of the needs assessment this includes certain health problems, help behaviors, attitudes, beliefs, or other theoretical construct related to health behaviors as data are analyzed. ■ This might lead to further data collection together with information or to the prioritization of health issues among a population based on these gaps in the data. Theories and models are useful for program planning, intervention, & evaluation. ■ HESp. can I apply explanatory theories and models to identify gaps in the data to help understand why a health problem exists, or to guide the search for modifiable risk factors in the needs assessment stage?

Summarize the capacity of prayer to populations to meet the needs of the priority populations (1.4.3)

■ Health programs should be tailored to values, wants & needs of the priority population. ■ Tailoring programs helps to ensure the programs are really accepted by the population. ■ Programs with Multiplicity multi-component and support- the appropriate built-in reinforcement component to assist participants with the expected level of involvement or behavioral change, enhances the capacity of the prayer to population.

Table 1.2 paradising at base importance and changeability of the health program (1.4.1)

■ High Changability ● High important - High priority for intervention ● Less important-High priority for intervention ■Low changability ● High important- High priority with innovative program. ● Less important- No program

Other areas that increase the priority population capacity to meet needs (1. 4.3)

■ Inclusion- the right type and number of partners. ■ Recruitment, reach, & response- promoting the program and ensuring the priority population is aware of the program, has the opportunity to participate in the program, & has an adequate number of actual participants in the program. ■ Dose- the number of units are program component that are actually delivered to the priority population ■ Interaction & satisfaction- the degree to which practitioners effectively work & communicated with program participants & how satisfied participants are with the program in general or with specific components. ■ Context- access the presence of any confounding factors in the environment that may affect program participantion or initial result

Benefits of System Change (1.3.3)

■ It input more than a single entity (e.g., school, worksite, clinic) and maximize the reach of its effect. E.g., Affordable Care Act (ACA)- has a policy that all health plans under it must provide free preventative services to all enrollees; individuals have access & no costs for vaccines, cancer screenings, blood pressure &

Measures describing Natality, & Mortality

■ Maternal Mortality: Maternal death results from causes associated with pregnancy. Maternal mortality rate =# of Mothers who die in childbirth/ # of Live birth x 100,000 live birth (during a year). ■ Infant Mortality Rate: The number of infant death among infants aged 0-365 days during a year divided by the number of live birth during the same year. (expressed as a rate per 1,000 live birth). (I.M.) rate = # of Infant death among infants 0-365 days during the year/ # of live births during the year x 1,000 (live births). E.g., In 2013, 23,440 deaths were among infants under 1 year and 3,932,181 live births. IMR= (23,440/3,932,181) x 1,000 = 5.96 per 1,000 live births.

Norming (1.4.1)

■ Maybe comparing data found in your community group or County to the state or national level. Example: comparing a proportion of adults who are physical active in their County to the proportion of in the neighborhood counties as well as the proportion listed in healthy people 2030 as a standard.

A Descript Levels of System Change - Paradigm, Goal & System Structure (1.3.3)

■ Paradigm: The mindset or belief of how the system work & refers to goals, policies,& structure. ● Change: Shift or reinforcement of the Paradigm. ■ Goal: Aims of the system ● Change: Focus or change the system. ■ System Structure: Parts of the system, actors ( e.g., leadership, staff, partners), & interconnection between the parts. ● Change: modifying linkages within the system, system elements, or incorporating new elements

Needs of the priority population(s) (1.3.6)

■ The final step in these assessment is validating needs identifying assessment, "double checking" or making sure that an identified need is an actual need. ■ Methods to validate assessment findings: ● Rechecking the steps followed in the needs assessment to eliminate any biases. ● Conducting focus group with some individuals from the priority population to determine the reaction to the identified needs. ● Getting a second opinion from other health professionals.

Reliability and Validity (Research Method)

■ Reliability or Precision is demonstrated when consistent answers are given to similar questions or when an assessment yields the same outcome when repeated several times. ■ Validity or accuracy of a survey instrument (or diagnostic test or other assessment tools) when the response or measurements are shown to be correct.

Reliability Vs Validity (Epidemiology)

■ Reliability: Refer to the stability of a measuring instrument to give consistent results on repeated trials(precision). ■ Validity: The ability of the measuring instrument to give a true measure of the entity being measured (accuracy). ■ It is possible for a measure to be invalid & reliable, but not valid & unreliable.

Measures of Validity

■ Sensitivity-the ability of the test to identify correctly all screened individuals who actually HAVE THE DISEASE. ■ Specificity- the ability of the test to identify only nondisease individuals who actually DO NOT HAVE THE DISEASE. ■ Positive predictive value- Probability that an individual who has a POSITIVE test result truly DOES HAVE the infection. ■ Negative predictive value- Probability that an individual who has a NEGATIVE test result truly DOES NOT have the infection.

Health disparities, Health equity, Disparities (1.3.3)

■ Social determinants of health are used to try to reduce health disparities to achieve health equity. 1). Health disparities: are differences among populations in health status, behaviors, & outcomes" that are due to multiple influences including the determinants of health. 2). Health equity: is "reducing & ultimately eliminating disparities in health & its determinants that adversely affect excluded or marginalized group" 3). Disparities: are differences in health that are unnecessary & avoidable, & considered unfair & unjust.

Synthetesize assessment findings to Inform the planning process (1.4)

■ Synthesize all information into a concise & useful format, it should be used priorities for planning intervention. ■ Factors to identify during synthesis: ● Predisposing factors: individual knowledge & effective traits. ● Enabling factors: factors that make possible a change in Behavior. ● Reinforcing factors: feedback & encouragement resulting from a change behavior, perhaps from significant other. These factors have a direct impact on health risk factors & how program is planned & implemented. Factors can serve as either a facilitator or barrier. E.g., knowledge that a behavior could lead to a health issue can facilitate change, but false information can be a barrier to change. These three factors are important in combination. E.g. Knowledge regarding a health issue is an important facilitator, but the absence of knowledge, skills, or support in how to change can severly impact and individuals ability to change

Determine the health status of the priority population (1.3.1)

■ The health status of the population affected by the disease or illness or to whom the program is intended to serve is determined by the intricate mix of individual and population-based behaviors. ■ health status and quality of life are influenced by every aspect of a person's environment and circumstances. it is not merely determined by etiology(I.e., causes of diseases, but by determinants, the underlining factors, or "cause of causes" that bring about disease. ■ These causes are often referred to as social determinants of health.

General Fertility Rate (GFR)

■ The number of live birth reported in an area during a given time interval is divided by the number of women aged 15-44 years in the area. General fertility rate= # of live birth within a year/ # of women aged 15-44 years x 1,000 women aged 15-44 years. E.g., In 2013 62,939,772 women aged 15 to 44 years in the U.S. There were 3,932,181 live births. GFR=3,93211/62,939,772 = 62.5 per 1,00 women aged 15-44 years.

Determining the capacity (available resources, policies, programs, practices, & interventions) to improve &/or maintain Health. (1.3.5)

■ The use of community-building processes focused on the identification, nurturing, & celebration of community assets. ■ To establish realistic program/intervention starting points & determine how programs/ interventions can be sustained reviewing actual & potential availability or resources is essential. ■ Asset-Mapping process or mapping community capacity: helps identify available programs & interventions & can be used to identify a community,s strength ■ Assets & resources: Community contributions that may prevent health problems from occurring or assist in their solutions such as people in the community, a physical resource (buildings or gathering places), services within the community, or businesses within the community. ■ Community empowerment through capacity building helps communities solve their own problems with their own resources.

Determine the Validity & Reliability of the secondary data (1.2.5)

■ Valid data: they are representative of what is intended to be measured in the population. Reliable data are consistent across multiple assessments of a specific measure. (a) HESp. must locate valid & reliable health & environmental data from a variety of sources. (b) With valid & reliable instruments used, a more meaningful comparison of data can be made. (c) The meaningful comparisons allow HESp. to draw conclusions about the need for health programs. (d) Make sound realistic decisions about the appropriateness, credibility, & compatibility of data to meet the needs of the priority population. (e) Role of HESp. include being a resource person & communicating information about the needs, concerns, & resources of the community. (f) Must have skills to evaluate sources of information & must be skeptical, critical consumers of health information.

Needs and Capacity key questions (1.3.5)

■ What is the health problem, & what are the consequences for the state or community? ■ What is the size of the problem overall & in various segments of the population? ■ What are the determinants of the health problem? ■ Who are priority populations? ■ What changes or trends are occurring?

Steps used to infer needs for health education program from obtained data (1.4.1)

●Analyze primary and secondary data. ● Compare data with local, state, national, or historical station. ● Consider the social, cultural, and put political environment(relative needs) ● Set priorities by: ● assessing the size or scope of the problem. ●determining the effectiveness of possible interventions. ●determine the appropriate next, economics, accessibility, resources,& legality of possible intervention.