Chapter 9: Planning for Community Change

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Chapter Highlights #1

Health planning at the state, national, and global levels

Social and environmental determinants of health

Social ecologic model and multilevel interventions

Community coalitions

Chapter Highlights #2

Health impact pyramid

Health equity and social justice

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

Logic models

Role of the community health worker

Chapter Highlights #3

Funding community health interventions

Evaluating community health interventions

Nurse-managed health centers

Question #1

Is the following statement true or false?

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

Answer to Question #1

True

Rationale: The timing of health planning depends on the responsibilities of the planning agency, the type of assessment data, and the nature of the health problem.

Health Planning

Organized and systematic process in which problems are identified, priorities selected, and objectives set for the development of community health programs based on the findings of community health assessments and health surveillance data.

Common Themes

Common themes of current national and international health plans include providing health promotion and disease prevention at the population level, addressing social determinants of health, and achieving health equity.

Levels of Health Planning

Global

National and state levels

Healthy People 2020

National Prevention Strategy

State Departments of Public Health

Community Health Improvement Planning Process

Systematic process that involves all sectors of a community to conduct a comprehensive community health assessment (CHA), identify priorities for action, develop and implement a community health improvement plan (CHIP), and guide future community decisions and resource allocations.

Community Assessment

Systematic process that may use several approaches including key informant interviews, analysis of data on health status and health behavior indicators, observation, and community surveys.

Systems Theory

Social systems engage in reciprocal exchange or flows of information, energy, resources, and goods or services. Systems within the community are interdependent and interconnected.

Working With the Community

Defining the population of interest

Coalitions

Stakeholders and opinion leaders

Social Ecologic Model

Based on general systems theory and health promotion theory

Multiple determinants of health interact at different levels to affect the health status of individual people, population aggregates, or communities.

Question #2

Is the following statement true or false?

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

Answer to Question #2

False

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

Health Impact Pyramid

Useful framework for community health nurses when planning health promotion interventions at multiple levels

Multilevel Interventions

Multilevel interventions are needed to achieve change in complex community health conditions that have multiple determinants.

Social Determinants of Health

Obesogenic and salutogenic environments

Health impact assessment

Health disparities, health equity, and social justice

Community empowerment model

Change Theory

Lewin’s Model of Change

Unfreezing

Changing

Refreezing

Force Field Analysis

Force field analysis is a tool used to identify the forces driving or restraining change.

Levers of Change

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

Public policies such as tax increases on tobacco, alcohol, or soft drinks can serve as policy levers to bring about change in community health status.

Community Readiness for Change

Planning programs or interventions to change community health status include an assessment of the community’s readiness to undertake the change process related to a specific health issue.

Planning Community-Level Interventions

Guide to community preventive services

Logic model

SMART objectives

Collaboration and Teamwork

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

Nurses can play an important role in their professional and personal lives as advocates and champions for health improvement, social justice, and health equity at the local, regional, national, and global levels.

Evaluating Community-Level Interventions

Develop evaluation questions.

Determine indicators or measures you will use to answer your evaluation questions.

Identify where you will find the data you need to measure your indicators and answer your questions.

Decide what method you will use to collect data.

Specify the time frame for when you will collect data.

Plan how you will analyze your data based on the type of data you are using.

Decide how you will communicate your results.

Funding Community-Level Intervention Programs

Accountability

Sustainability

Program replication

Project funding

Government

Private

Local

Community Benefit Programs

Community benefit programs of local or regional hospitals and HMOs may be valuable partners to the public health department or community health nurse in planning, implementing, and funding programs to improve population health.

Social Marketing

Use of marketing principles and practices to change health behaviors or beliefs, social or cultural norms, or community standards to improve health or benefit society

Nurse-Managed Health Centers

Nurse-managed health centers provide health promotion and primary care services to vulnerable and underserved population aggregates.