Chapter 08 ppt

Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Chapter 8: Planning for
Community Change

Chapter Highlights
• Health planning at the state, national, and global levels
• Social and environmental determinants of health and
disease
• Social ecological model and multilevel interventions
• Community as partner
• Health equity and social justice

Chapter Highlights (cont.)
• Lewin’s change theory, force field analysis, and levers of
change
• Planning tools, including logic models and Gantt chart
• Role of the community health worker
• Funding community health interventions
• Social marketing
• Community nursing centers

Question
Is the following statement True or False?
Health planning occurs on both an ongoing and an
episodic bases.

Answer
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 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
• The impetus for health planning and program
development may come from the decision at the local or
state level to address a health problem (bottom-up
approach); or from a regional, national, or global
initiative to improve health status (top-down approach).

Timing of Health Planning
• Health planning occurs on both an ongoing and an
episodic bases.
• 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 Approaches
• Healthy People series
– Healthy People 2020 Priorities
– Action Model for Achieving Healthy People 2020
Goals
• World Health Organization
• State departments of public health

Question
The people and organizations that are coalitions are
commonly called stakeholders.

Answer
False
Rationale: The people and organizations that are
stakeholders are commonly included in coalitions.

Models, Frameworks, and Tools
for Use in Health Planning
• Planning health promotion or prevention interventions at
the community level can be a complex process.
• Several models and frameworks help organize some or
all of the steps in the planning process.

Community Assessment
• Identify the community health problems that are the
priorities for intervention as well as community resources
available to address each health problem or need
• Key informant—person knowledgeable about specific
aspects of a problem and the community’s current and
past attempts to address it

Community as Partner
• Defining the community of interest
• Coalition—group of consumers, health professionals,
policy makers, and others working together to improve
community health status or to solve a specific community
health problem
• Stakeholder—an individual, organization, or group that
has an interest (stake) in a specific community health
issue or the outcome of a community-level intervention

Social Ecological 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.

Multilevel Interventions
• Upstream—at the societal, environmental, or policy level
• Mainstream—at the population or community level
• Downstream—at the individual level
• The technique of mapping the web of causation can help
the community health or public health nurse identify
multiple determinants of a community health problem.

Health Disparities
• Systematic disadvantages in access to basic needs or
health care services
• Systemic deficiencies in the organization and delivery of
health care services due to financing problems or lack of
cultural or linguistic competence

Health Equity and Social Justice
• Health equity is based on the principles of fairness and
social justice, as well as the belief that all people have an
equal value.
• Social justice refers to an equitable sharing of both the
common burdens and the common benefits or
advantages in society.

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

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

Change Theory
• Lewin’s Model of Change
– Unfreezing
– Changing
– Refreezing
• Sustainability must always be a concern when planning
changes in health beliefs, knowledge, behavior, or social
conditions.

Force Field Analysis
• Involves identifying factors within a community or
organization that are driving or reinforcing change in the
desired direction as well as those that are restraining or
resisting change

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

Community Involvement in Change
• Health behavior change, whether at the individual or
community level, requires sustained effort and results
that may not be evident in the short term.
• Community participation in all steps of the change
process helps to increase the potential for program
success and sustained change in community health
status.
• Community readiness to change needs to be considered
in selecting the most appropriate types and levels of
interventions.

Logic Model
• A logic model for a community health program is a visual
representation of the logic behind the operation of the
program
– who will receive services (target population)
– what will be done (activities)
– when it will happen (timeline)
– Where
– why (program theory)

SMART Objectives
• Specific
• Measurable
• Achievable
• Relevant
• Time bound

Gantt Chart or Project Timeline
• Identifying the major milestones or critical points of a
project that must be completed before the next phase or
activity may begin
• Marking the deadlines for the critical points on the Gantt
chart first. It is necessary to work backward from the
critical points to identify all of the steps required to reach
them, the time needed for each step or task, and the
sequence of related steps
• Developing subsidiary charts for each major program
activity

Gantt Chart or Project Timeline (cont.)
• Using color coding to indicate the person, committee, or
group with primary responsibility for completion of each
step
• Taking into account the time required in each step for
organizational review and approval or involvement of
coalition or team members so that outside deadlines may
be met
• Planning for time to hire and train new employees, if
needed, and to order supplies and equipment

Funding Community-level Intervention
Programs
• Lead agency
• Accountability
• Sustainability
• Program replication

Documenting Community Support
• Name of the program
• Name of the funding source
• Statement of the problem to be addressed, including data
from the community assessment
• Goals or purpose of the program

Documenting Community Support (cont.)
• Target population to be served
• Expected outcomes or results
• Ways the organization or person writing the support
letter is or may become involved in the program
• Track record of successful collaboration between the
organization writing the letter of support and the one
requesting it

Project Funding
• Government agencies
• Private foundations
• Local resources

Community Benefit Programs
• Emphasis on communities with disproportionate unmet
health-related needs
• Emphasis on primary prevention
• Building a seamless continuum of care between the
hospital and the community
• Building community capacity
• Collaboration with community stakeholders as full
partners

Writing Proposals
• Try to present the problem statement, background
information, proposed program goals and measurable
objectives, expected outcomes, and timeline in two
pages.
• Attach a budget clearly indicating all program expenses
and sources of income in addition to the funds being
requested.

Writing Proposals (cont.)
• Provide a written budget justification to give detail
behind each line item.
• Use attachments such as the logic model, list of coalition
members, organizational chart, or support letters
appropriate to the program and the specific funding
source to supplement the proposal narrative.

Community Nursing Centers
• Community health workers can help bridge the gap
between the community health or public health nurse and
the community, especially when there are cultural and
language differences.
• Community nursing centers (CNCs) are organized and
managed by nurses in partnership with the communities
they serve to provide community health services and
primary care to vulnerable and underserved population
aggregates.

Chapter 08 ppt

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Chapter 08 ppt