Chapter 8 Gathering Evidence for Public Health Practice

Chapter 8: Gathering Evidence for Public Health Practice
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Chapter Highlights
Epidemiologic/public health research defined
Observational studies: Descriptive versus analytical research
Strengths and limitations of epidemiologic research
methodology
Applying epidemiologic research to public health nursing
practice
Question #1
Is the following statement true or false?
In descriptive studies, the researcher relies on comparisons
between groups to determine the role of various risk factors in
causing the problem.
Answer to Question #1
False
Rationale: In analytical studies, the researcher relies on
comparisons between groups to determine the role of various
risk factors in causing the problem. In descriptive studies, the

researcher collects information to characterize and summarize
the health event or problem.
Epidemiologic Research
Epidemiologic/public health research can be descriptive or
analytical. Study designs are based on the problem under study
and range in strength on a continuum, with the weakest design
being the retrospective design and the strongest being the
experimental design.
Observational Studies
In descriptive studies, the researcher collects information to
characterize and summarize the health event or problem.
In analytical studies, the researcher relies on comparisons
between groups to determine the role of various risk factors in
causing the problem.
Descriptive Studies
Descriptive studies are most frequently used in public health
research. They may be observational or analytical
Case studies
Survey research
Cross-sectional studies: examine the relationship of health-

related characteristics and other variables of interest in a
defined population at a particular point in time
Analytical Studies
Cohort studies, also called longitudinal studies, examine
phenomena prospectively to observe presumed effects over
time.
Case‒control studies retrospectively compare subjects (cases)
with a condition (disease) and matched subjects/control without
the condition/disease.
Advantages: Allow for the examination of multiple exposures
for a single outcome, suitable for studying rare diseases and
those with long latency periods, require fewer case subjects,
generally quicker, less expensive, and well suited for outbreak
investigation
Disadvantages: Not appropriate for rare exposures, subject to
bias because of the method used to select controls, do not allow
direct measure of incidence
Question #2
Cohort studies involve an in-depth analysis of an individual,
group, or social institution.

False
Rationale: Case studies involve an in-depth analysis of an
individual, group, or social institution. Cohort studies,
sometimes referred to as prospective studies, are longitudinal
studies, which monitor subjects over time to find associations
between risk factors and health outcomes.
Question #3
Case–control studies, also known as prospective studies, work
backward from the effect to the suspected cause.
False
Rationale: Case–control studies, also known as retrospective
studies, work backward from the effect to the suspected cause.
Cohort studies, sometimes referred to as prospective studies, are
longitudinal studies, which monitor subjects over time to find
associations between risk factors and health outcomes.

Intervention (Experimental) Studies
Preventive trials
Therapeutic trials
Question #4
Intervention study is the epidemiologic investigation designed
to test a hypothesized relationship by modifying an identified
factor in a population. The study is preventive.
False
Rationale: Intervention study is the epidemiologic investigation
designed to test a hypothesized relationship by modifying an
identified factor in a population. Studies may be therapeutic
(clinical) or preventive.
Quasi-experimental and Experimental Design
Quasi-experimental and experimental designs are used to
examine causality.
The “gold standard” for research design is the randomized,
control group design.

Question #5
The “gold standard” for research design is the randomized,
experimental group design.
False
Rationale: The “gold standard” for research design is the
randomized, control group design.
Chapter 9: Planning for Community Change
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

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
Funding community health interventions
Evaluating community health interventions
Nurse-managed health centers
Question #1
Health planning occurs on both an ongoing and an episodic
basis.

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

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