Community Development_Study notes.docx

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Health and Human Performance
HAHP 3000
Karen Gallant

HPRO 3397 – Study Notes 1 HPRO 3397: Community Health Promotion Strategies – Midterm Study Notes Week 1: Difference between program planning, community development and health promotion strategies - Egger et al., 2005 o Lifestyle related and other chronic diseases are on the rise o Need CHPS to address individual, group, and population levels o Obesity is hard to battle as it has an effect on many different areas of health  Top contributor to disease o Health promotion strategies can have varying effects depending on:  The intended recipients  Temporal factors (readiness)  Program factors  Level of community acceptance & participation o ―The Human Factor: - never underestimate the power of the person making the [CHPS] happen…that is most significant for the success of any health promotion [initiative]‖ (p. 22). - Fertman et al., 2010 o Ecological levels of health influence:  Intrapersonal  Interpersonal  Population  Institutional factors  Social capital factors  Public policy factors o Settings for health promotion intervention  Schools  Workplaces  Health care organizations  Communities - Public Health Agency of Canada, 2008 o Seniors and falling o Involved many different parties in solution  Including engineers, seniors, building managers, health promoters, nurses and more Week 2: Theory - Goodson, 2010 o Theory is overly focused on individuals o No human can completely be individual HPRO 3397 – Study Notes 2 o Should use theories based on a community or population level - Hillier et al., 2011 o Must include community members in interventions/planning  This means that the population will be catered to, specifically, not treated as the average population - Norr et al., 2004 o Botswana women ran interventions  HIV and safe sex peer group program  Gave women empowerment Week 3: Evidence - Metzler et al., 2007 o Kenya  Community based intervention  Not enough money to continue the clean up o Khoj  Built their own groups and supported the health of their community on their own  Created groups for support o Colombia  School Nutritional Strengthening Program  Community wanted traditional foods to be used in the schools and they worked to make this happen o Evaluation type questions to ask yourself about your intervention:  How does this intervention seek to alter the social determinants of health?  How does this intervention seek to achieve health equity?  How have empowerment approaches been facilitated?  How have innovative alliances been developed and how have they functioned?  How is sustainability conceptualized and approached?  What is the role of professionals? o What are the 4 key criteria in establishing an evidence base of effectiveness in community health promotion?  Page 227 o Do we need to wait for more ‗evidence‘ to take action on health inequities (‗paralysis analysis‘)? - Shakeshaft et al., 2012 o School based alcohol interventions o Would be best to promote the use of harm reduction techniques in schools, rather than abstinence HPRO 3397 – Study Notes 3 Week 4: Harm reduction - Parker et al., 2012 o HIV in rural areas in the Atlantic Provinces - Jorgensen et al., 2006 o Harm minimization among teenage drinkers in Denmark o I do not think that this article has validity - Marlatt et al., 2010 o Harm reduction programs mentioned:  Needle exchanges  Safe injection facilities  Opioid substitution  Overdose prevention  School-based substance use prevention  Brief alcohol screening and intervention for college students  Web-based or computer-administered interventions  Trauma centres  Workplace substance abuse prevention  Treatment approaches for co-occuring disorders Week 5: Public policy - Low et al., 2008 o Lessons forgotten and lessons to learn o Remind us about the need to do less individual and more community/population o Does not offer solutions for how to make this happen - Masotti et al., 2006 o Healthy natural occurring retirement communities  Lead to happier and healthier seniors o Need more information on how to change natural occurring retirement communities into healthy natural occurring retirement communities - Raphael et al., 2001 o Policy decisions and quality of life for seniors o Participatory research  Include seniors and health care providers - Gahagan et al., 2011 o Routine screening for HIV in Nova Scotia o People do want this to be a normalized routine o An additional test at the same time as annual PAP smears o Is it worth the cost to do this? Is there a big enough need for HIV testing for the entire population? HPRO 3397 – Study Notes 4 Week 6: Media and social marketing - Baker et al., 2012 o Closing the gap of access for people with disabilities and seniors  Social and work reasons o Some may not have access to the internet o Requires further research - McKenzie et al., 2001 o Diffusion theory of innovation o Four Ps of marketing  Product  Price  Place  Promotion  [Politics?] o Audience segmentation  The cube o Marketing and in which method you will present your program should always be in the programmers mind (in order to have a successful program) - Young et al., 2006 o Web based training for tobacco control policy change Week 7: Health advocacy and health inequalities; “do for” or “do with” - Banister et al., 2004 o Free writing o Role playing o Tracing of the body - Grant et al., 2012 o Men‘s health forum o Recognized need for change  Widened target population o Catered to new populations  Translators and programs offered in Spanish o Testing/screening offered at breaks so the men did not have to miss programs to participate in screening and testing - Susser, 2000 o Poverty and disease o Poverty – ―Mother of disease‖ o Inequalities by occupation and social class have increased o Technological backlash HPRO 3397 – Study Notes 5  Biomedical technologies (affordable only for middle to high class)  The US has the highest level of infant mortality and the highest level medical technological intervention - Ridde, 2007 o Population approaches may not reduce inequality o Target inequalities using empowerment Terms: - Community – not just geographic - Community health - ―includes both private and public efforts of individuals, groups, and organizations to promote, protect, and preserve the health of those in the community‖ (McKenzie & Pinger, 1997, p.4) - Determinants of health – moves away from complete focus on the individual (& away from ‗risk groups‘ to risk conditions) - Socio-environmental risk conditions – example: poverty, SES, inadequate housing/homelessness, etc. - Theory - ―A set of interrelated concepts, definitions, and propositions that presents a systematic view of events or situations by specifying relations among variables in order to explain and predict events of the situations‖ (Kreuter, Lezin & Green, 2003) o ―A theory based approach provides direction and justification for program activities and serves as a basis for processes that are to be incorporated into the health promotion program‖ (MacKenzie & Smeltzer, p. 97) - Evidence - ―that which shows or establishes the truth or falsity of something; proof‖ (New Webster‘s Dictionary) - Evidence-based practice – assessing the needs, assessing the causes from previous research, assessing the evidence for effective strategies, assessing through evaluation (Green & Kreuter, p. 224) - Do we need to wait for more ‗evidence‘ to take action on health inequities (‗paralysis analysis‘)? - Value prevention – is the initiative something that the community has recognized as a need, wants to happen, and supports? - Health promotion - A broad concept that includes providing health education and information intended to promote health o ―Promoting health involves advocating increased awareness of personal and community health, changing attitudes so that changes in behavior are possible, and searching for alternatives to improve health‖ (Dignan & Carr, 1987) o ―Health promotion‖ is broad umbrella term within which health education is situated. HPRO 3397 – Study Notes 6 o ―any combination of health education and related organizational, political, and economic interventions designed to facilitate behavioral and environmental adaptations that will improve or protect health‖ (McKenzie & Smeltzer, 1997) - Harm reduction - ―A policy or program directed toward decreasing the adverse health, social, and economic consequences of drug use without requiring abstinence from drug use‖ (Riley et al.,1999) o Involves communities and not simply those directly affected by drug use (why does this matter in the development of CHPS?) o ..."harm reduction" refers to any program, policy or intervention that seeks to reduce or minimize the adverse health and social consequences associated with drug use. This broad perspective would include virtually any drug policy, program or intervention since at some level, the objective of all such measures— including enforcement and abstinence-oriented programs—is to reduce the harmful consequences of drug use in some manner... (p. 2) - Health literacy - Is it really just a matter of: ―the degree to which individuals have the capacity to obtain, possess and understand basic health information and services needed to make appropriate health decisions‖? o What else influences health literacy?  ―mobilize forces from those outside the traditional health polity to truly develop health, ultimately affecting the social, economic, and environmental determinants [of health]‖ p. 234 - Audience segmentation – breaking the population down into subgroups of like people (communities based on specific similarities) Theories: - Rather than applying a theory to a problem – let the problem inform the theoretical approach taken - Cannot expect a particular theory to fit all similar types of health ed/promo problems o A theory targeting weight loss in children may not be appropriate for weight loss in adults or seniors - The theories &/or models used to ‗drive‘ your CHPS must fit with the overall purpose of the CHPS - Micro-level behavioral change theories: o Focuses largely on individual behaviour & how to change/ motivate behaviour change o Social learning theory – stresses interrelationships between people, their behaviour, their environment through ―reciprocal determinism‖ o Theory of reasoned action – focus on the role of personal volition in determining if a behaviour will occur or not HPRO 3397 – Study Notes 7 o Diffusion of Innovations Theory – must be related to a behaviour already doing, simple, low risk, better, flexible o Exchange Theory – foundation for social marketing, ―exchange‖ of time, money, or effort for a good idea or service if they believe in the benefits - Macro-level theories: o Focuses on the individual within the larger social context o Does not simply look at the individual cognitive processes in behaviours or behaviour change o Often connected to structural issues o Can help drive health policy outcomes o Social determinants of health o Social Marketing Theory o Behavioural Community Psychology Theory o Community Development Theory - Self-efficacy theory o What are the 4 key factors associated with self-efficacy? 1.personal experience 2. observational experience 3. verbal persuasion 4. physiological state - Social learning theory o What does this theory involve and where has it been successfully used? o Healthy behaviour change often requires a change to a person‘s environment o Beliefs about healthy behaviours are central o Training is sometimes needed to facilitate behaviour
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