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N430 Community Health Nursing > Week 7: Change Strategies > Flashcards

Week 7: Change Strategies Flashcards

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1
Q

What are the 5 main change strategies?

A
  1. Health Belief Model
  2. Transtheoretical Model
  3. Diffusion of Innovation Theory
  4. 5 A’s
  5. Mass Media
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2
Q

What does the health belief model consist of?

A

Individual Perception: susceptibility to disease, the severity of the disease, benefits & barriers, consequences of the behaviour
Likelihood of Action: perceive there is an action available that will reduce their susceptibility or minimize the consequences, perceived benefits of action minus perceived barriers

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3
Q

What are the 7 transtheoretical models?

A
  1. Precontemplation - no plans
  2. Contemplation - aware, thinking
  3. Preparation - intention
  4. Action - short term
  5. Maintenance - longer term
  6. Termination - no fear of relapse
  7. Relapse - reverts, guilty feelings
    = long-term process
    =self-directed change
    =strategies depend on stage
    =people go through ups and downs in the process of developing new habits
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4
Q

What is the Diffusion of Innovation Theory?

A

-social change model
-emphasizes the importance of communication and peer networks
-eventually, there is a saturation point
-guides technological innovation where the innovation itself is modified and presented in ways that meet the needs across all levels of adopters
-a process that occurs as people adopt a new idea, product, practice, philosophy and so on

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5
Q

What are the 5 categories of Diffusion of Innovation Theory?

A
  1. innovators - venturesome, risk takers, motivated by the idea of change agents, gatekeepers, and peer educators
  2. early adopters - opinion leaders, trendsetters, role models, adventurous, and excellent tester subjects
  3. early majority - deliberate contact, opinion leaders, avoid risk, prudent
  4. late majority - responds to peer pressure, skeptical, cautious, technologically shy, requires bullet-proof solutions
  5. laggards - isolated from opinion leaders, suspicious of innovations, wants to maintain the status quo
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6
Q

What are the 5 A’s of behaviour change for self-management?

A
  1. Ask 1. Assess
  2. Assess 2. Advise
  3. Advise 3. Agree
  4. Agree 4. Assist
  5. Assist 5. Arrange
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7
Q

What is the advantage of mass media?

A

simultaneous influence of attitudes and behaviours

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8
Q

What is the disadvantage of mass media?

A

no opportunity to modify messages to respond to an individual’s reactions or needs.

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9
Q

What is mass media?

A

it is independent communication and lacks/and or free from person-to-person contact

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10
Q

What are cues to action?

A

-may help modify behaviour
-internal: Symptoms
-external: education, media, reminders, illness of family or friends, advice from others

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11
Q

What are the 5 potential failure points?

A

-1. Innovation failure:
poor design, inadequate evaluation, dishonest representation
2. Communication failure:
Lack of awareness of innovation
3. Adoption failure:
Differing value systems, user’s lack of resources
4. Implementation failure:
Lack of implementation plan, poor instructor training
5. Maintenance failure:
The successful program rapidly declines

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12
Q

What are the 2 approaches of mass media and health promotion?

A
  1. Media Advocacy:
    Gain media attention about an issue, send a message to legislators to influence public policy
  2. Social Marketing:
    Application of marketing principles to influence individual behaviour,
    “…introduced in 1971 to describe the use of marketing principle and technique to advance a social cause, idea or behaviour” (Lind, Lind-Kosten & Loewen, 2016, p. 157).
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13
Q

What is media advocacy?

A

-Uses media to influence the development of healthy public policy by changing the nature of the public debate on issues that affect health
-Increase public awareness of an issue to create the political will to change policies
-Tool to exert pressure on policy-makers & legislators
-PHC=community participation in policy-making
-Ottawa Charter=strengthen community action

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14
Q

What are the 3 steps of media advocacy?

A
  1. Setting the Agenda
  2. Shaping the Debate
  3. Advancing the Policy
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15
Q

What occurs during the “setting the agenda” step of media advocacy?

A

-Framing for success
-Present the issue in a way that will capture the attention of the media (demonstrate is newsworthy) in order to capture the attention of policy makers
-Might create an event that will be interpreted as news

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16
Q

What occurs during the “shaping the debate” step of media advocacy?

A

-Framing for content – telling the story the way you want it told - emphasizing causes & who should fix the problem
-Tell the story from a population perspective - emphasize broad social issues
-Frame the story to make the solution you are seeking obvious

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17
Q

What occurs during the “advancing the policy” step of media advocacy?

A

-Put forward the policy solution or approach you wish in order to address the problem
-Mass media applies pressure on policymakers

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18
Q

What is the key role in media advocacy?

A

community participation

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19
Q

What are the roles of community participation?

A

-Involve the public in the public policy cycle
-Form sustainable coalitions to create momentum & keep the issue in the public eye

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20
Q

What are the roles of a health professional?

A

-Contribute to informed public policy debate
-Advocate for social & environmental changes that promote population health and reduce health inequities

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21
Q

What are the tactics of media advocacy?

A

-Social math
-Media bites e.g. Canada plans to phase out coal-powered electricity by 2030

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22
Q

What is the definition of “shaming”?

A

Pointing out unfairness and oppression on victims

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23
Q

What are examples of advocacy and activism in health promotion practices?

A

-Shaming
-Visuals
-Authentic voice: using direct narrative from the victims
-Use of symbolic acts
ie) displaying a crashed car to attract the attention of the government of the public on high rates of accidents

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24
Q

What is social marketing?

A

“…a process to develop, implement, evaluate and control behaviour change programs by creating and maintaining exchanges, such as volunteer time for community recognition or individual effort for the health of future generations.” NIH 1998
-To “sell health” by influencing behaviours (Vollman, 2004, pl. 295)

25
Q

What is the goal of social marketing?

A

to promote healthy behaviours

26
Q

What are the 3 conditions for social marketing?

A
  1. Population must be considering change
  2. Difficult to reach the population through any other means other than social marketing
  3. It may not be effective for people who are adamant about change
27
Q

What is the 6 Andreasen’s guidelines/benchmark for successful social marketing?

A
  1. Voluntary behaviour change – specific measurable behavioural objectives
  2. Consumer research – pre-tested interventions based on values/needs
  3. Segmentation and targeting – tailored strategy according to a segment of a target group
  4. Marketing mix – product, price, place, promotion, policy change, people…
  5. Exchange – what motivates or is offered in exchange
  6. Competition – considered appeal of competing behaviours to apply strategies to minimize the competition
28
Q

What are the 5 steps in social marketing?

A
  1. Problem Description
  2. Market Research
  3. Market Strategy
  4. Intervention
  5. Evaluation
29
Q

What is in the step “problem description” within the steps in social marketing?

A

a) Write a problem statement
i. What is/should be occurring?
ii. Who is affected?
iii. What happens if the problem isn’t addressed?
b) List the causes of the problem
i. Why is this happening? Could this be changed with social marketing?
ii. Identify Potential Audiences **
iii. Segment the audience into distinctive groups
c) Conduct a SWOT Analysis
i. Internal -Human & financial resources, expertise, management support, and internal policy
1. Strengths of your organization
2. Weaknesses of your organization
ii. External - Cultural norms, demographics, economic situation, political or legal issues & the activities of external organizations
1. Opportunities that could affect the campaign
2. Threats that could affect the campaign
d. Example
i. Local data found -
1. Teen pregnancy and rates of STI were high among youth ages 15-19
2. They estimated 45% of high school students were sexually active
3. AIDS diagnosis among the city’s young adults suggested that infection was occurring during the teen years.
ii. Problem Statement: Youth ages 14-18 residing in the Saskatoon area are at unacceptably high risk of HIV infection

30
Q

What is the step of “market research” within the steps in social marketing?

A

a) This is to enhance your understanding of the target audience
i. Characteristics, attitudes, beliefs, values, behaviours, determinants, benefits and barriers to behaviour change
ii. What do you already know and what do you have to discover?
b) Helps to have professionals assist with the step
i. You need to target the right people with the right message

31
Q

What is the step of “market strategy” within the steps in social marketing?

A

a) Break down segments of your target audience – age, activities, beliefs
b) How do they get information?
c)How ready are they to change?
d) What could be changed in the short run?
e) Are they more likely to change with an incentive?
f) What benefit can you offer?
g) Product
i. What behaviour/product is being promoted?
ii. Core – benefits received from behaviour/product … health, financial, social
h) Price
i. Monetary and non-monetary “costs” that individuals associate with adopting the new behaviour
i) Place
i. Distribution channel to reach a target market
j) Promotion
i. Means of persuasion
ii. The messages; Tactics used to deliver the messages; Strategic alliances with appropriate organizations
k) Participation (People)
Involve the consumer in the other four P’s

32
Q

What is an example of a behaviour change goal?

A

a) Who
i. Youth
b) Will do what
i. Will use condoms
c) Under what conditions
i. When having sex
d) In exchange for what
i. In exchange for not getting pregnant or experiencing an STI, and knowing they are less likely to be diagnosed with HIV/AIDS

33
Q

What is the step of “intervention” within the steps in social marketing?

A

a) Resources – time and money
b) Most likely to be effective
c) Is there a tangible object or service to help with change?
d) Will the change cost the target audience anything?
e) Is it convenient?
f) How will you promote the benefits of behaviour change?
g) Is it “fun, easy, and popular”?

34
Q

What is the step of “evaluation” within the steps in social marketing?

A

a) Was the strategy
i. Useful
ii. Feasible given the time, resources, and available expertise?
iii. Accurate enough to inform the kinds of decisions being made?
b) Determine what information needs to be gathered
c) Develop an analysis and reporting plan
d) Need a timeline and a budget

35
Q

What are the steps of implementation?

A

a) Plan a program launch
b) Hold a news event to publicize your message
c) Follow your plan
d) Monitor progress
e) Evaluate
f) Modify where necessary

36
Q

What are the 6 Andreasen’s Benchmarks of a Successful Social Marketing Intervention?

A
  1. Behaviour Change
  2. Consumer Research
  3. Segmentation and Targeting
  4. Marketing Mix
  5. Exchange
  6. Competition
37
Q

What are examples of ethical issues?

A

a) Victim blaming
b) Information gap
c) Manipulation
d) Exchange Theory
i.should be voluntary, fair and just
ii. should not control
iii. should offer resources, information, etc. for exchange

38
Q

What are some questions to ask to critically analyze media messages?

A

a) What is the medium?
b) Who is sending the message & why?
c) What is the message?
d) Is the message effective?
e) Is the message accurate?

39
Q

What are some considerations for social media use?

A

-Your posts reflect your personality
-Your online affiliations reflect your professional reputation
-View and review your profile occasionally and make updates to enhance your professional image
-Consider having separate accounts for online and personal activities, even though it can be difficult to separate them
-Privacy settings can limit other users’ access to some of your information

40
Q

What is “crowdsourcing” and its purpose?

A

a) “Crowdsourcing is an online, distributed problem-solving and production model that leverages the collective intelligence of online communities for specific purposes”
b) Crowdsourcing is based on the belief - more people can contribute to a solution that may not be solved by individual experts.
c) The purpose is similar to community engagement and participatory action research but the process is not.

41
Q

What are the long-term risks to average long-term consumption levels as low as one or two drinks per day?

A

causally linked with significant increases in the risk of at least eight types of cancers:
1. mouth
2. pharynx
3. larynx
4. esophagus
5. liver
6. breast
7. colon
8. rectum

42
Q

What are the questions in the substance use test?

A

-Have you been drunk (staggering or slurring words or worse) in the past two weeks?
-Have you used any other mood-modifying substance (Marijuana, coke, ecstasy, pills to change how you are feeling etc.) in the past two weeks?
-In the past two weeks have you used enough drugs or alcohol that you can’t remember parts of the evening?
-In the past two weeks have you thought you should quit or cut down your drug or alcohol use?
-In the past two weeks do you recall craving drugs or alcohol? (This includes thinking about drugs or alcohol a lot when you are not using or getting excited about the possibility of drinking or using)
-Have you been hurt, injured, been in a fight or screaming argument while under the influence of drugs or alcohol in the past two weeks?
-In the past two weeks do you recall being concerned about where you were going to get more drugs or alcohol or where you were going to get money for more drugs or alcohol?
-In the past two weeks has your drug or alcohol use caused you problems with your parents or at school? Include regularly fighting with your parents if you are using and missing class or assignments because you have been drinking/using during the week.
-In the past two weeks have you used drugs or alcohol during the week?
-Have you done anything in the past two weeks while under the influence of drugs or alcohol that you felt bad or guilty about?

43
Q

What are some questions to ask to check your thinking?

A

-Is what you are thinking true?
-Is it really true? (we lie to ourselves)
-How are you feeling or acting because of how you are thinking?
-How would you feel or act if you thought differently?

44
Q

What are examples of social determinants of health?

A

-aboriginal/indigenous status
-Early childhood development
-Healthy child development
-Education/literacy/education systems
-Employment and working conditions
-Food insecurity
-Gender
-Access to health services
-Housing
-Income
-Social safety
-Social exclusion
-Unemployment
-Physical environment
-Biology and genetics
-Social environment
-Social status
-Personal health practices and coping
-Culture
-Race/racism
-Having different abilities
-Migration/dislocation
-Immigration
-Cultural continuity
-Relationships with land/territory
-Colonization
-Politics/war/conflict
-Self-reliance and self-determination

45
Q

What are the essential elements of equity-oriented health service?

A

-INEQUITY-RESPONSIVE CARE
-TRAUMA AND VIOLENCE-INFORMED CARE
-CONTEXTUALLY TAILORED CARE
-Culturally safe care

46
Q

What is harm reduction?

A

-Is an approach that represents a continuum of services that embodies a philosophical, pragmatic, and compassionate approach to providing care while minimizing the negative harms associated with substance use
-Strategy targeted at groups or individuals that decrease risks associated with harms related to certain behaviours
i. Goal-oriented
ii. Humanistic
iii. Meeting people where they are at
iv. Non-judgemental
v. Compassionate care
vi. Does not require abstinence
vii. Reducing secondary harm
-Strategies to address health inequalities and to bring meaningful healthcare to those who might be otherwise marginalized
-Looking at the complex social issues from the root cause
-A commitment to change policy, or integrate into existing health policies
-The term was primarily health related to aid people in not developing secondary health issues from dirty supplies.
=Safe injection sites evolved from this but still had the underlying motive of helping people move towards a healthier lifestyle.
-The other HR process that evolved was replacement therapy. Primarily methadone. This was effective at helping individuals stop opiate use but there wasn’t any focus on helping with the underlying problems.
=Substance use was looked at as the problem.
=There was a lack of understanding that it was a symptom.
-Consequently, the majority of people involved in OAT continued on methadone but used cocaine to try to manage their emotional issues.
=Harm Reduction groups started advocating for more access governments complied because of financial cost, it seemed cheaper than providing treatment but the overall costs to society were not considered.
->Outcome: the majority of HR participants stayed in severe SUD (DSM5)
=There is a small percentage of programs that do work hard to help people move to better wellness but the majority are a mix of OAT programs with little support.
=There is an increasing push for funding safe injection sites as well as safe supply. The safe injection sites and safe use sites are touted as harm reduction but really do not make any effort to help people move out of severe SUD.
=The most recent HR move is toward decriminalization. This is advertised as a solution to the substance abuse problem but again does not incorporate any focus on helping people move toward better wellness.

47
Q

When did harm reduction start in Canada?

A

Harm Reduction started in Canada in Vancouver in the late 1980s primarily as a needle exchange
-It was coupled with support to encourage lifestyle changes and help with access to detox and treatment.

48
Q

True or False: Social Justice is an important practice for nurses. It is a part of our Code of Ethics.

A

True!

49
Q

What are the 10 attributes of social justice defined by CNA?

A
  1. Equity (including health equity)
  2. Human rights (including the right to health)
  3. Democracy and civil rights
  4. Capacity building
  5. Just institutions
  6. Enabling environments
  7. Poverty reduction
  8. Ethical practice
  9. Advocacy
  10. Partnerships
50
Q

What is intersectional analysis?

A

-creates more or less disadvantages and impacts health and wellbeing
-CHN needs to recognize and understand intersections of poverty, race, gender, substance use, mental illness, HIV/AIDS, and hepatitis C, bring special circumstances and challenges to successful harm reduction.

51
Q

What are “at risk” populations?

A

used to describe a group or population that has a higher risk of a particular illness (morbidity) or negative life outcome (such as mortality) than might be experienced by other populations

52
Q

What is risk communication?

A

transmission of information about existing or imminent health or environmental risk, the anticipated severity of the risk, and the percentage of people it will impact.
=vital because risks change rapidly with the introduction of new and varied technologies

53
Q

What is risk management?

A

the broad collection of activities involved in addressing health or safety risks, identifies subpopulations or target populations that have a unique health concern or similar risk factors that can lead to several different health concerns.

54
Q

What are prevention interventions?

A

occurs at primordial, primary, secondary, tertiary, or quaternary levels

55
Q

What is primordial prevention?

A

-distal level
-preventing risk factors from existing
-the focus is on the avoidance of illness or injury, addressing issues at a distal level
-disease or injury has not yet occurred in the population
-ie) a more distal initiative of completely removing access to tobacco products and tobacco smoke from public venues

56
Q

What is primary prevention?

A

-more proximal level
-risk factors may occur, but for both, disease or injury has not yet occurred in the population
-targeting particular populations
-ie) promoting properly installed CSA-approved car seats to transport newborn infants home, offering smoking cessation programs, public education to help stop the spread of STIs in all age groups, immunizations against childhood diseases and nurse-managed mass immunizations, safe housing, sanitation, nutrition.

57
Q

What is secondary prevention?

A

-the focus is to halt an illness if possible and perhaps effect a cure, or at least slow the progression of a disease through therapeutic treatments and medications
-ie) screening measures such as examining the skin for signs of melanoma, blood tests for diabetes, testicular self-exam, yearly cholesterol tests, colonoscopies, and successful= Papanicolaou (Pap) smear!

58
Q

What is tertiary prevention?

A

-the goal is to limit disability and rehabilitate or restore the affected person to the maximum possible capability, maximize their quality of life, and meet their self-identified goals.
-ie) rehabilitation for people who have experienced a stroke, counselling for a rape victim
-nurses help a person adapt by identifying potential complications and implementing strategies by considering the preferences, strengths, and vulnerabilities of an individual
-nurses may provide education, monitor treatment effectiveness, or address adverse side effects

N430 Community Health Nursing (7 decks)

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