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Community Health Analysis MPH607.  Understand the development of the MAPP process by examining earlier models of health improvement.  Identify the steps.

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Presentation on theme: "Community Health Analysis MPH607.  Understand the development of the MAPP process by examining earlier models of health improvement.  Identify the steps."— Presentation transcript:

1 Community Health Analysis MPH607

2  Understand the development of the MAPP process by examining earlier models of health improvement.  Identify the steps key concepts underlying each model  Review models: ◦ Precede/Proceed ◦ PATCH ◦ APEXPH ◦ IOM CHIP Model ◦ MAPP

3 PROGRAM PRECEDE /PROCEED PATCH APEXPH CHIP (IOM) MAPP SYSTEM

4 Developers: L. Green, M. Krueter Years of origin for PRECEDE, late 1980s for PROCEED. Principles: Success in achieving change is enhanced by the active participation of members of the target audience. The important role of the environmental factors as determinants of health and health behavior such as media, industry, politics, and social inequities Source: THE PRECEDE/PROCEED MODEL.

5 PRECEDE is an acronym for Predisposing, Reinforcing, Enabling, Causes in, Educational Diagnosis and Evaluation. PROCEED is an acronym for Policy, Regulatory, Organizational Constructs in Educational and Environmental Development.

6 1 Social: identify and evaluate the social problems which impact the quality of life 2 Epidemiological: identify specific health problems and non-health factors 3 Behavioral: analysis of behavioral links to the problems identified in the first phases Environmental: parallel analysis of factors in the social/physical environment 4 Education & Organizational: looks at the specifics that hinder or promote behaviors 5 Administrative & Policy: assessment of policy resources, circumstances that could impact implementation.

7  PROCEED: added to the framework.  Recognition of the need for health promotion interventions that goes beyond traditional educational approaches to changing health behaviors.  Flows from the PRECEDE: ◦ to promote the plan or policy, regulate the environment, and organize the resources and services, as required by the plan or policy.

8  6 IMPLEMENTATION  7 PROCESS EVALUATION evaluates: ◦ the process by which the program is being implemented.  8 IMPACT EVALUATION measures ◦ effectiveness related to intermediate objectives ◦ changes in predisposing, enabling, and reinforcing factors.  9 OUTCOME EVALUATION measures ◦ change in overall objectives and ◦ changes in health and social benefits or the quality of life.

9 Phase 1 Social Assessment Phase 3 Behavioral & Environmental Assessment Phase 2 Epidemiologic Assessment Phase 4 Educational & Ecological Assessment Phase 5 Administrative Policy Assessment Phase 6 Implementation Phase 7 Process Evaluation Phase 8 Impact Evaluation Phase 9 Outcome Evaluation Health services Health Education Health Promotion Policy, Regulation Predisposing factors Reinforcing factors Enabling factors Behavior & lifestyle Environment Health Quality of life

10  Developed 1983; by CDC  Program focus.  Assist local health agencies to partner with local communities  Evaluate health promotion/prevention programs  Improve linkages within/between communities, health depts, universities, etc

11 1) mobilizing the community, 2) collecting and organizing data, 3) choosing health priorities, 4) develop comprehensive intervention plan 5) evaluation.

12 PATCH increases community (1) organizing and data use skills, (2) awareness and interest in health, (3) networking and ability of groups and organizations to work together, and (4) the number of health promotion interventions activities. Strengths: Tested the application of theory Facilitated the link between research and practice in community health education and health promotion. Practical/user friendly approach

13 A collaborative project of The American Public Health Association The Association of Schools of Public Health The Association of State and Territorial Health Officials The Centers for Disease Control The National Association of County Health Officials The United States Conference of Local Health Officers Funded through a Cooperative Agreement between the Centers for Disease Control and the National Association of County Health Officials (NACCHO)

14 Part I, Organizational Capacity Assessment ◦ an internal review of a local health department. ◦ an assessment of department's basic administrative capacity and to undertake Part II. Part II, The Community Process ◦ involving key members of a community and department staff ◦ assessing the health of the community and identifying the role of the health department in relation to community strengths and health problems. ◦ use of objective health data ◦ use of community's perceptions of community health problems. Part III, Completing the Cycle ◦ integrates the plans developed during Part 1 and Part II ◦ into the ongoing activities of a health department and the community it serves. ◦ discusses policy development, assurance, monitoring, and evaluation of plans

15 INTERNAL 1. Prepare for the organizational capacity assessment 2. Score indicators for importance and current status 3. Identify strengths and weaknesses 4. Analyze and report strengths 5. Analyze weaknesses 6. Rank problems in order of priority 7. Develop and implement action plans 8. Institutionalize the assessment process EXTERNAL 1. Prepare for the community process 2. Collect and analyze health data 3. Form a community health committee 4. Identify community health problems 5. Prioritize community health problems 6. Analyze community health problems 7. Inventory community health resources 8. Develop a community health plan

16 Strengths: ◦ Strengthened health department’s role ◦ True organizational assessment ◦ Adaptable to fit local situations and resources.  Limit size/scope of effort. ◦ Focused on community as partners in health improvement Challenges: ◦ Commitment of time and resources ◦ Priorities may not align with program funding ◦ Lacked environmental health component

17 Focuses on a broader definition of health: ◦ Health is a state of well-being and the capability to function in the face of changing circumstances” (IOM 1997). Underlying themes: ◦ The origins of good health are multiple and cross- sectorial. ◦ A focus on the origins of health:  emphasizes the need for cross-sectorial assumptions of responsibilities  creates multiple options for intervention

18 A model of the determinants of health. Source: Reprinted from R.G. Evans and G.L. Stoddart, 1990, Producing Health, Consuming Health Care, Social Science and Medicine 31:1347–1363

19 Two Cycles: Problem Identification and Prioritization Analysis and Implementation Emphasizes ongoing nature of community improvement process

20 Focuses on bringing community stakeholders together in a coalition Monitoring community-level health indicators Identifying specific health issues as community priorities.

21 Analyzing a health issue (for determinants ) Assessing resources Determining: How to respond Who should respond Assess outcomes Performance monitoring Community indicators

22 Continuing and evolving process – measure along the way Shared responsibility and accountability Not outcomes (disease) alone: ◦ using a limited number of indicators that can track critical processes AND outcomes over time and among accountable stakeholders; ◦ collecting and analyzing data on those indicators; ◦ making the results available to inform assessments of the effectiveness of an intervention AND the contributions of accountable entities. Move toward “systems” approach.

23  Developed by the National Organization of City and County Health Officials (NACCHO) and CDC  a community-wide strategic planning tool for improving public health,  an action oriented process to help communities prioritize public health issues, identify resources, take action

24  Strategic Thinking  Community Driven Process  Focus on the Local Public Health System

25  Requires broad-scale information gathering  Encourages exploration of alternatives  Places emphasis on future implications of present decisions  Facilitates communication and participation  Accommodates divergent interests and values

26  Mobilizing and engaging the community  Action with and by the community  Planning driven by the community  Partnerships to strengthen the community

27

28 Phases  Organize for Success and Partnership Development ◦ Who should we include ◦ Who is part of the public health system in our community?  Visioning ◦ What will the public health system look like if it is substantially providing the Ten Essential Public Health Services ◦ What will our community look like? ◦ What will our community’s health look like? ◦ What would we like to see? ◦ What mission and values drive this process?

29  Four MAPP Assessments ◦ Community Themes and Strengths  “What is important to our community?” ◦ Local Public Health System  “How are the Essential Services being provided?” ◦ Community Health Status  “How healthy is are our residents?” ◦ Forces of Change  What is occurring or might occur that affects the health of our community or LPHS?”

30  Identify Strategic Issues ◦ Focus on issues, not programs and services ◦ Not limited to health outcomes  Formulate Goals and Strategies ◦ Goals and objectives ◦ Responsibilities and accountability  Action Cycle ◦ Plan ◦ Implement ◦ Evaluate

31  National Public Health Performance Standards (NPHPSP) – (“model standards”) is used within MAPP to assess the local public health system htm  10 Essential Services framework ensures a comprehensive picture of public health  MAPP can help address Healthy People 2020 objectives

32  Public Health community health improvement planning has evolved from program oriented process to system level processes.  Incorporates strategic planning principles  Broadened definition of health and determinants  Increasing emphasis on community input and shared responsibility for public health  Focus on evidence based planning – link to standards and measures

33 REFERENCES THE PRECEDE/PROCEED MODEL. Retrieved 1/15/2010, 2010, from my/artikelHP/bahanrujukan/HETheory/The%20Precede.doc+preceed+pro ceed+terms&cd=5&hl=en&ct=clnk&gl=us my/artikelHP/bahanrujukan/HETheory/The%20Precede.doc+preceed+pro ceed+terms&cd=5&hl=en&ct=clnk&gl=us PATCH: Its origin, basic Concepts/Links to health policy. Retrieved 1/15/2010, 2010, from APEXPH:Assesment protocol for excellence in public health. Retrieved 1/18/2010, 2010, from Mobilizing for action through planning and partnerships (MAPP) | NACCHO. Retrieved 1/18/2010, 2010, from


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