midterm Flashcards
How many phases are in the precede proceed model?
lecture 1
8 phases
What is the precede-proceed model?
lecture 1
health assessment and planning model
What does precede do?
Precede is phases 1-4
lecture 1
specify measurabe objectives and baselines
in other words: assessment
What does proceed do?
Proceed is phases 5-8
lecture 1
monitor and continue quality improvement
in other words: implementation and evaluation
Define intervention
lecture 1
an action/set of activities designed to positively influence health behavior, knowledge, and attitude within specific populations, aimed to prevent disease and improve health by targeting modifiable factors that contribute to health
What factors might affect community health?
lecture 1
- physical factors
- social factors
- individual behavior
- community organization
Define factors that might affect community health
physical factors
lecture 1
- geography
- environment
- community size
- industrial development
Define factors that might affect community health
social factors
lecture 1
- community
- economy
- politics
- social norms
- socioeconomic status
- culture
- religion
- beliefs, traditions, norms
Define factors that might affect community health
individual behavior
lecture 1
examples are the following:
- drinking while driving (affects community)
- not eating healthy –> fast food (affects individual)
Define factors that might affect community health
community organization
lecture 1
how a community can solve problems
helps us in implementing intervention by highlighting community assets and providing resources and not duplicating services
Phase 1 focuses on what?
lecture 1
social assessment
- quality of life indicators
bigger picture; emotions
Phase 2 focuses on what?
lecture 1
epidemiological assessment
- health issue (disease, illness, etc.)
- behavior
- environment
- genetic
Phase 1 - Social Assessment
What is the goal of a social assessment?
identify gaps between what exists and what ought to exist so that you can design a program to reduce those gaps
Phase 1 - Social Assessment
What do we do for a social assessment?
lecture 2
gauge needs, opinions, assumption, key issues and/or assets within a community
Phase 1 - Social Assessment
What are the need categories?
lecture 2
- health
- educational
- resources
- social
Phase 1 - Social Assessment
What are the two types of needs?
lecture 2
- actual needs - what the community needs based on data
- perceived needs - what the community wants (for this you can go to close ones of individuals to find out more info if needed)
Phase 1 - Social Assessment
What is primary data vs secondary data?
types of data
lecture 2
primary: going to the target population and finding information by self
secondary: viewing reports from organizations such as CDC, WHO, etc.
Phase 1 - Social Assessment
Define quality of life
Quality of Life
lecture 2
perception of an individual/group that their needs are being met
Phase 1 - Social Assessment
What are some quality of life indicators?
Quality of Life
lecture 2
- safety
- social belonging
- governance
- politics
- income
- employment
- work-life balance
- education
- leisure
- relationships
- stress
Phase 1 - Social Assessment
What are some QOL tools?
Quality of Life
lecture 2
- asset mapping and capacity analysis
- social reconnaissance
- forums and group discussion
- individual data collection
Phase 1 - Social Assessment
asset mapping (1) and capacity analysis (2)
Quality of Life Tools
lecture 2
1) describing and literally mapping the assets in a given community
2) assessment of the capacities and skills of individuals
- primary building blocks: entities that exist by the community and in the community
- secondary building blocks: entities that exist in the community but are controlled outside of the community
- potential building blocks: resources that if they existed would solve an issue in the community
this promotes community empowerment
Phase 1 - Social Assessment
social reconnaissance
Quality of Life Tools
lecture 2
the use of community leaders to determine relevant aspects of social structure, processes, and the needs of community
they will do the following:
- identify perceived needs
- rank and prioritize needs/problems
- organize the community
- assist in the devlopment of the action plan
Phase 1 - Social Assessment
nominal group technique
Quality of Life Tools
lecture 2
small group consisting of 5-7 individuals
brainstorming method where individuals generate ideas independently, share them in a group, discuss for clarity, and then rank or vote to prioritize the best options
pros:
- equal participation
- reduces bias and groupthink (more anonymity)
- efficient prioritization
- structured and organized
cons:
- time consuming
- limited in-depth discussion
- potential for voting too quickly without properly analyzing
- less representative b/c of few people
Phase 1 - Social Assessment
focus group
Quality of Life Tools
lecture 2
medium group of community members 6-12
those involved are homogenous on relevant characteristics to help represent a larger group. unstructured interviews are done to discuss topic and share feelings, attitudes, and ideas. everything is then analyzed to draw conclusions about the attitudes and practices of the larger group the focus group represents
pros:
- low cost
- easy to arrange and doesn’t require too much time from participants
- rich in depth data
cons:
- moderator required so possible bias can stem and members are dependent on the moderator’s skill
- small so generalizing their interaction to larger groups are not easy
- yield data that are exclusively qualitative
Phase 1 - Social Assessment
community forum
Quality of Life Tools
lecture 2
an open meeting with all interested persons invited to attend/participate
pros:
- inclusive
- encourages engagement
- identifies local health issues
- cost effective
cons:
- dominant voices
- lack of depth
- potential for conflict
- limited representation
Phase 1 - Social Assessment
observation
Quality of Life Tools
lecture 2
pros:
- real world data
- unbiased insights when unaware of being observed
- useful for studying behavior
- can be low cost
cons:
- privacy issues
- observer bias
- time consuming
- limited control
- not representative of whole
Phase 1 - Social Assessment
surveys
Quality of Life Tools
lecture 2
- structured interview (face-to-face)
- telephone surveys
- mail-out questionnaires
- delphi technique
- traditional knowledge test
Phase 1 - Social Assessment
What characteristics must be kept in mind when choosing a QOL tool
Quality of Life Tools
lecture 2
- representativeness of the sample
- reliable: consistency of the answers
- valid: accuracy of the measurement, aka, is the survey well designed
Phase II
What is Phase 2?
lecture 2
epidemiologic assessment
Phase II
What is the 2 step process for this phase?
lecture 2
- Identify specific health issues or conditions that contribute to the social problem (the quality of life issue)
- Select the health problems deserving the most attention
- do this by: reviewing and analyzing epidemiological health related data
Phase II
What makes up phase 2?
lecture 2
- health
- genetic
- behavior
- environment
Phase II
What factors does genetics consist of?
lecture 2
- age
- gender
- family history
- race and ethnicity
Phase II
What factors does behavior consist of?
lecture 2
- compliance
- consumption patterns
- preventative actions
- coping
- self-care
- utilization
Phase II
What factors does environment consist of?
lecture 2
- economic
- physical
- services
- social
Phase III
What is Phase 3?
lecture 3
educational & ecological assessment
Phase III
What are the influential factors of Phase 3 ?
lecture 3
PRE
- predisposing factors (knowledge)
- reinforcing factors (peers)
- enabling factors (environment)
has to do with behavior
Phase III
What is the goal for Phase 3?
lecture 3
to identify the educational and ecological factors which have the greatest potential to promote behavioral and environmental change
Phase III - Predisposing
What are predisposing factors?
lecture 3
knowledge, attitudes, beliefs, values, or self-efficacy that exist prior to the engagement of a health-related behavior
these factors predispose an individual to do/not do certain behaviors
Phase III - Reinforcing
What are reinforcing factors?
lecture 3
physical, social and emotional responses of referent others (those around us) / institutions which reward the continued engagement in a behavior
engaging in a behavior bc it makes you feel good
Phase III - Enabling
What are enabling factors?
lecture 3
internal and external conditions directly related to the issue that help people adopt and maintain healthy or unhealthy behavior and lifestyles
characteristics of the environment that facilitate action
Phase IV
What is Phase 4?
lecture 4
administrative and policy assessment and intervention alignment
Phase IV
What are administrative objectives?
lecture 4
used to help stay on track
SMART
- specific
- measurable (documenting)
- achievable
- relevant
- time bound
Phase IV
What is an intervention?
lecture 4
how planners attempt to achieve the stated outcomes or goals
- generally consisting of a combination of different activities
goal: may be to increase knowledge, change behavior, influence or change policy, etc.
Phase IV
How do activities help?
lecture 4
they are developed to help the target population achieve program objectives and ultimately the program goal
Phase IV: Activities
communication activities
define
lecture 4
seek to convey message
- handouts
- brochures
- media
- ads
Phase IV: Activities
educational activities
define
lecture 4
seek to increase knowledge
Phase IV: Activities
behavior modification activities
define
lecture 4
seek to change behavior
Phase IV: Activities
environmental change activities
define
lecture 4
seek to alter or change environment
Phase IV: Activities
regulatory activities
define
lecture 4
implementing laws, policy, ordinances, regulations, etc.
Phase IV: Activities
community advocacy activities
define
lecture 4
involving community members to influence social change
Phase IV: Activities
organization/culture activities
define
lecture 4
changing environment inside an organization
Phase IV: Activities
incentive and disincentive activities
define
lecture 4
seek to influence health outcomes
Phase IV: Activities
health status evaluation activities
define
lecture 4
seek to increase awareness of individual’s health
Phase IV: Activities
social activities
define
lecture 4
seek to create social support systems for behavior change
Phase IV: Activities
technology-delivered activities
define
lecture 4
using technology to deliver education
Phase IV
What are some strategies to increase knowledge?
lecture 4
- chunking
- advanced organizers
- associated imagery
- cues
- tailoring
- facilitated discussion
- active learning
Phase IV
define chunking
lecture 4
taking information and chunking them together to help remember better
Phase IV
define associated imagery
lecture 4
mental pictures to connect with the information you are trying to learn
Phase IV
What are some strategies to change attitudes?
lecture 4
self-reevaluation: urge them to think about how life can be improved if they change health behavior
environmental reevaluation: how does the environment around the individual affect action
arguments: promoting behavior change by highlighting the negatives and promoting the positives
Phase IV
What are some strategies to change social influence?
lecture 4
- making peer expectations known to the target populaton
- build resistance to the social pressure to engage in the risk behavior by increasing motivation to comply with positive social pressure
- attempt to shift focus away from the risk behavior
Phase IV
What are some strategies to build skill and self-efficacy?
lecture 4
- break behavior into a series of tasks
- teach each task as a separate skill
- take small steps in successive increments
- include feedback, reinforcement and correction in each practice session
Phase IV
What should you keep in mind in regards to the activities, strategies and methods?
lecture 4
- use existing material
- tailor your intervention to the characteristics of your group
(cultural appropiateness, translation of materials, etc.) - how? Gatekeepers
(will increase acceptance of the intervention by target population and increase efficacy in intervention)
Phase V
What is Phase 5
lecture 4
Implementation
Phase V
What does implementation mean?
lecture 4
acting on the plan!
just doing it!
Goals and Objectives
What is a goal?
lecture 6
a future event toward which a commited endeavor is directed
Goals and Objectives
What makes up a goal?
lecture 6
- provides overall direction for a program
- is general in nature
- usually takes longer to complete
Goals and Objectives
What are 3 components to consider for goals?
lecture 6
- Who will be affected?
- What will change as a result of the program?
- Where is the target population?
who, what , where
Goals and Objectives
What are some words that may be used to start off a goal?
lecture 6
“To…“
- eliminate
- improve
- increase
- promote
- protect
- minimize
- prevent
- reduce
this is the most formal part
Goals and Objectives
What are objectives?
lecture 6
more precise than goals and represent smaller steps than program goals
- the steps, if completed, will lead to reaching the program goal
Goals and Objectives
What should objectives be?
lecture 9
- future oriented
- SMART
- measurable outcomes: who, what, where, when, how much
- one should be able to ascertain the precede/proceed factor from a well-written objective (know which is being addressed)
Goals and Objectives
What are SMART objectives?
lecture 6
- specific: concrete, using action verbs
- measurable: numeric, descriptive, quantity
- achievable: feasible in reference to goal
- realistic: attainable in reference to resources
- time oriented: indentifies target dates, includes interim steps to monitor progress
Goals and Objectives
What type of objectives go with what phase?
lecture 6
- outcome/program objectives –> phase 1 or 2
- action/behavioral objectives –> phase 2
- environmental objectives –> phase 2
- learning objectives –> phase 3
- process objectives –> phase 4 or 5
Goals and Objectives
What are outcome objectives?
lecture 6
the ultimate objective of the program - aimed at changes in health or quality of life
written in terms of:
- risk reduction
- morbidity
- mortality
- disability
- quality of life
Goals and Objectives
What are action/behavioral objectives?
lecture 6
the behaviors or actions that the target population will engage in to resolve the health problems identified and move toward reaching the program goal
written in terms of:
- adherence
- compliance
- consumption patterns
- coping
- preventative actions
- self-care
- utilization
Goals and Objectives
What are environmental objectives?
lecture 6
outlines non-behavioral causes of health problems that are present in the environment
examples:
- clean air
- clean water
- learning environment
Goals and Objectives
What are learning objectives?
lecture 6
educational or learning tools needed to achieve desired behavior
consists of:
- awareness
- knowledge
- attitudes
- skills
predisposing, reinforcing, enabling
Goals and Objectives
What are process objectives?
lecture 6
day to day activities which occur to lead to the accomplishment of learning, action, environmental and outcome objectives
entails:
- program resources
- intervention activities
- attendance
- participation
- feedback
Evaluation
Why do we need to conduct an evaluation?
lecture 9
- monitor objectives
- identify program strengths and weaknesses
- cost efficiency
- funding source mandate
Evaluation
What are the levels of evaluation?
lecture 9
1) process: phase 6
- learning (phase 3)
- administrative (phase 4)
2) impact: phase 7
- behavior (phase 2)
- environment (phase 2)
3) outcome: phase 8
- health (phase 2)
- quality of life (phase 1)
Phase VI
What is phase 6?
lecture 9
process evaluation: evaluating procedure
- are you actually doing (phase 5) what you planned (phase 4) –> administrative and implementation
Phase VI
Phase 6 is the assessment of…
lecture 9
intermediate/learning objectives
refers to aspects of health that change more quickly:
- predisposing factors
- reinforcing factors
- enabling factors
also known as: evaluating phase 3!!!!!!
Phase VI
When do you do process evaluation?
lecture 9
throughout the implementation process!!! (phase 5)
example: after each educational session to assess you can
- take attendance
- pre/post test results
Phase VI
Why do we do process evaluation during implementation?
lecture 9
this helps to modify the intervention if needed
Phase VII
What is phase 7?
lecture 9
impact evaluation
factors we are evaluating: behavior and environment
- what proportion of the participants changed or adopted behavior?
- was there a change in the environment?
takes longer to measure + also known as evaluating phase 2!!!
Phase VIII
What is phase 8?
lecture 9
outcome evaluation
factors we are evaluating: health and quality of life
also known as evaluating phase 1+2!!!
Evaluation
What are some things to keep in mind during evaluation (phases 6-8)?
lecture 9
- if you find a gap between your planning and reality (the intervention is not achieving the results you wanted), go back to the assessment portion of the model
- determine what needs to be changed and adjust the plan accordingly
- evaluation is NOT about “passing or failing”, it is to ensure your intervention brings about the outcome in the community you wanted
Overview of P/P model
What is the goal of the precede proceed model?
lecture 1-9
to plan, develop, implement and evaluate a program
Overview of P/P model
What phase/s entail planning?
lecture 1-9
phases 1-4
Overview of P/P model
What phase/s entail developing?
lecture 1-9
phase 4
Overview of P/P model
What phase/s entail implemention?
lecture 1-9
phase 5
Overview of P/P model
What phase/s entail evaluation?
lecture 1-9
phases 6-8
Overview of P/P model
What is the rule and exception to P/P model?
lecture 1-9
to start with phase 1 - social assessment!!!!!
exception: when you work with an organization with a predetermined health focus
