Community as Partner:Community as Partner:Assessment & System FrameworkAssessment & System Framework

By By

Faraz Siddiqui Faraz Siddiqui

Institute of Nursing Institute of Nursing

Dow University of Health SciencesDow University of Health Sciences

Objectives Objectives

• At the end of this session students will At the end of this session students will be able to be able to

• Define community Define community

• Explain reasons for assessing Explain reasons for assessing communitiescommunities

• Identify the process of assessing Identify the process of assessing communitiescommunities

• Understand different modelsUnderstand different models

What is a Community?What is a Community?

• Many definitions of communityMany definitions of community

• These may change according to specific These may change according to specific circumstancescircumstances

• Community as a specific geographic locationCommunity as a specific geographic location

• Community as a social settingCommunity as a social setting

Conti…..Conti…..

• Community as a social structureCommunity as a social structure

• Community as sentiment/affiliationCommunity as sentiment/affiliation

• Varied nature of communities requires Varied nature of communities requires flexibility when assessing themflexibility when assessing them

Why Assess Communities?Why Assess Communities?

• Essential first step in the process of health Essential first step in the process of health planning:planning:

• To identify the health status of a communityTo identify the health status of a community

• To provide a baseline to evaluate planned and To provide a baseline to evaluate planned and potential interventionspotential interventions

• To identify factors that may be influencing health To identify factors that may be influencing health statusstatus– Both positive and negativeBoth positive and negative

• To identify community resourcesTo identify community resources• To identify key stakeholders in the communityTo identify key stakeholders in the community

• To solicit the opinions of community membersTo solicit the opinions of community members

• To engage community members in thinking about To engage community members in thinking about the health of their communitythe health of their community

How Can Communities be Assessed?How Can Communities be Assessed?

• Both Both comprehensivecomprehensive and and focussed focussed assessment assessment approaches can be usedapproaches can be used

• NursingNursing and and non-nursing modelsnon-nursing models exist exist

ModelsModels

• A model can come in many shapes, sizes, and A model can come in many shapes, sizes, and styles. It is important to emphasize that a styles. It is important to emphasize that a model is not the real world but merely a model is not the real world but merely a human construct to help us better understand human construct to help us better understand real world systems.real world systems.

Conceptual ModelConceptual Model

• Conceptual Models are qualitative models that Conceptual Models are qualitative models that help highlight important connections in real help highlight important connections in real world systems and processes. They are used as world systems and processes. They are used as a first step in the development of more a first step in the development of more complex models.complex models.

OROR

• A conceptual model is the synthesis of a set of A conceptual model is the synthesis of a set of concepts and the statements that integrate concepts and the statements that integrate those concepts into a whole.those concepts into a whole.

Medical ModelMedical Model

• A model with which health workers identified A model with which health workers identified for many years was the medical model, that is, for many years was the medical model, that is, a a disease-oriented, illnessdisease-oriented, illness and and organ-focusedorgan-focused approach to patients, with an emphasis on approach to patients, with an emphasis on pathologypathology..

Why Medical Model is not useful?Why Medical Model is not useful?

Important aspects of care, such as Important aspects of care, such as psychologicalpsychological, , socioculturalsociocultural, and , and spiritualspiritual areas, are not explicitly included in the areas, are not explicitly included in the medical modelmedical model

Thus, a community-as-partner model should Thus, a community-as-partner model should encompass all aspects of health and encompass all aspects of health and

incorporate long-range goals and planningincorporate long-range goals and planning..

Prerequisites of Health ModelPrerequisites of Health Model

• There is general agreement that four concepts There is general agreement that four concepts are central to health disciplines: person, are central to health disciplines: person, environment, health, and the body of environment, health, and the body of knowledge relating to the specific health knowledge relating to the specific health discipline (e.g., nursing, social work, discipline (e.g., nursing, social work, medicine, nutrition).medicine, nutrition).

• A model serves the following purposes:A model serves the following purposes:

Provides a map for the problem-solving Provides a map for the problem-solving processprocess

Gives direction for assessment Gives direction for assessment

Guides analysisGuides analysis

Dictates community health diagnosesDictates community health diagnoses

Assists in planningAssists in planning

Facilitates evaluationFacilitates evaluation

A model is nothing more or less than an A model is nothing more or less than an explication of practice. A model not only explication of practice. A model not only

describes what is but also provides a describes what is but also provides a framework for making decisions about framework for making decisions about

what could be.what could be.

Systems ModelSystems Model

• Based on Neuman’s 1972 Systems Model of a Based on Neuman’s 1972 Systems Model of a total-person approach to viewing client total-person approach to viewing client problems.problems.

Community as Partner ModelCommunity as Partner Model

• The community-as-client model was The community-as-client model was developed by Anderson and McFarlane in developed by Anderson and McFarlane in 1986 to illustrate the definition of community 1986 to illustrate the definition of community health nursing as the synthesis of public health health nursing as the synthesis of public health and nursing.and nursing.

Community DiagnosisCommunity Diagnosis

• Several approaches to the writing of Several approaches to the writing of community diagnosescommunity diagnoses

• Complete community diagnosis has 4 Complete community diagnosis has 4 componentscomponents

Conti…Conti…

1.1. Statement of the problem or strength (issue) Statement of the problem or strength (issue) 2.2. Identification of the Identification of the

aggregate/population/community affected aggregate/population/community affected (focus)(focus)

3.3. Identification of the factors that are causally Identification of the factors that are causally linked to the problem or strength (etiology)linked to the problem or strength (etiology)

4.4. Identification of the evidence that supports Identification of the evidence that supports the diagnosis (manifestation)the diagnosis (manifestation)

Conti…Conti…

• All 4 elements are important because they also All 4 elements are important because they also form the basis for:form the basis for:– Program planningProgram planning

– Evaluation of the intervention(s)Evaluation of the intervention(s)

Risk of low birth weight (issue)Risk of low birth weight (issue)

among pregnant teens living in downtown area (focus)among pregnant teens living in downtown area (focus)

related to:related to:

a) inadequate income (etiology)a) inadequate income (etiology)

as manifested by (manifestations):as manifested by (manifestations):– Insecure housingInsecure housing

– Use of food bankUse of food bank

– Unemployment rates in this groupUnemployment rates in this group

Risk of low birth weight (issue)Risk of low birth weight (issue)

among pregnant teens living in downtown area among pregnant teens living in downtown area (focus)(focus)

related to:related to:

b) tobacco use (etiology)b) tobacco use (etiology)

as manifested by (manifestations)as manifested by (manifestations)– Smoking rates among pregnant teensSmoking rates among pregnant teens

Determining PrioritiesDetermining Priorities

• No easy process to determine prioritiesNo easy process to determine priorities

• Ideally, after diagnoses have been formulated, Ideally, after diagnoses have been formulated, should be a community consultation processshould be a community consultation process

• Allows community members to rank prioritiesAllows community members to rank priorities

• Even then, unlikely that consensus would be Even then, unlikely that consensus would be achievedachieved

Conti…Conti…

Factors that can help determine priorities:Factors that can help determine priorities:1.1. Magnitude of concern expressed by Magnitude of concern expressed by

communitycommunity2.2. Number of people potentially/actually Number of people potentially/actually

affectedaffected3.3. Severity/urgency of the problemSeverity/urgency of the problem4.4. Capacity of existing resources to deal with Capacity of existing resources to deal with

the problemthe problem

Problem AnalysisProblem Analysis

• Once priorities established, each issue or Once priorities established, each issue or problem selected for intervention can be problem selected for intervention can be further analyzedfurther analyzed

• Assists in establishment of objective & Assists in establishment of objective & strategiesstrategies

• Example of one approach:Example of one approach:

Underlying Risk Factor(s)

Immediate Risk Factor(s)

Priority Issue Short-Term Negative Consequences

Long-Term Negative Consequences

Underlying Risk Factor Underlying Risk Factor →→ Immediate Risk Factor Immediate Risk Factor →→ Priority Issue Priority Issue ↓↓

Lack of access to contraceptivesLack of access to contraceptives Low contraceptive use among Low contraceptive use among sexually active teenagerssexually active teenagers

High rate of unplanned teen High rate of unplanned teen pregnanciespregnancies

Problem Problem ↓↓

Rate of unplanned teen pregnancy in Rate of unplanned teen pregnancy in community ‘x’ is 30% greater than community ‘x’ is 30% greater than the provincial averagethe provincial average

Sub-Objective Sub-Objective ↓↓ ← ← ObjectiveObjective ← ← GoalGoal

Access to affordable contraception Access to affordable contraception for sexually active adolescents will for sexually active adolescents will be increased within 6 months of the be increased within 6 months of the beginning of the programbeginning of the program

To increase the rate of contraceptive To increase the rate of contraceptive use among sexually active use among sexually active adolescents in community ‘x’ by adolescents in community ‘x’ by 30% within 1 year of beginning of 30% within 1 year of beginning of programprogram

To reduce the number of unplanned To reduce the number of unplanned teen pregnancies in community ‘x’ teen pregnancies in community ‘x’ by 30% by 2007by 30% by 2007

Strategy Strategy ↓↓

Provide free confidential Provide free confidential contraceptive services in high schoolcontraceptive services in high school

1. Strategy Activity1. Strategy Activity Negotiate consensus amongst key stakeholders, school board, administrators, Negotiate consensus amongst key stakeholders, school board, administrators, etc.etc.

2. Strategy Activity2. Strategy Activity Identify appropriate space for school nurse to use in the school settingIdentify appropriate space for school nurse to use in the school setting

Planning InterventionsPlanning Interventions

One level of planning involves establishing:One level of planning involves establishing:

1. Goals (based on issue contained in 1. Goals (based on issue contained in community diagnosis)community diagnosis)

2. Target population (based on focus contained 2. Target population (based on focus contained in community diagnosis)in community diagnosis)

3.3. Objectives (based on Objectives (based on etiologyetiology contained in contained in community diagnosiscommunity diagnosis

4.4. Indicators of success (based on Indicators of success (based on manifestationsmanifestations contained in community contained in community diagnosis)diagnosis)

Implementing the Implementing the Intervention(s)Intervention(s)

Evaluating the Intervention(s)Evaluating the Intervention(s)

3 types of evaluation3 types of evaluation

1.1.Formative (process)Formative (process)

2.2.Impact (summative)Impact (summative)

3.3.OutcomeOutcome

• Formative evaluationFormative evaluation

• Assesses the program implementation as soon Assesses the program implementation as soon as it beginsas it begins

• Enables improvements in the plan during the Enables improvements in the plan during the implementation phaseimplementation phase

Impact evaluationImpact evaluation

• Assesses the immediate effects of the program on: Assesses the immediate effects of the program on: – KnowledgeKnowledge– AttitudesAttitudes– SkillsSkills– PerceptionsPerceptions– BeliefsBeliefs– Access to resourcesAccess to resources– Social supportSocial support

Outcome evaluationOutcome evaluation

• Assesses population level impact of the Assesses population level impact of the programprogram

• Measures changes in incidence & prevalence Measures changes in incidence & prevalence of risk factorsof risk factors

ReferencesReferences

Anderson, E. T. & McFarlane, J. (2000). Community as Anderson, E. T. & McFarlane, J. (2000). Community as partner (3rd ed., pp. 153–164). Philadelphia: partner (3rd ed., pp. 153–164). Philadelphia: Lippincott Williams & Wilkins.Lippincott Williams & Wilkins.

Beddome, G. (1995). Community-as-client assessment. Beddome, G. (1995). Community-as-client assessment. In B. N. Neuman, (Ed.), The Neuman systems model In B. N. Neuman, (Ed.), The Neuman systems model (3rd ed., pp. 567–580). Norwalk, CT: Appleton & (3rd ed., pp. 567–580). Norwalk, CT: Appleton & Lange.Lange.

Neuman, B. N. (Ed.). (1995). The Neuman systems Neuman, B. N. (Ed.). (1995). The Neuman systems model (3rd ed). Norwalk, CT: Appleton & Lange.model (3rd ed). Norwalk, CT: Appleton & Lange.