CONCEPTUAL MODELS IN COMMUNITY HEALTH.pptx

Community health conceptual models

1. CONCEPTUAL MODELS IN COMMUNITY HEALTH BY MARIA NJOKI THIONG’O SHS/BSN/5345-2/2022

2. OBJECTIVES Understand what a Conceptual Model is Describe the Precede-Proceed Model Describe the Donabedian Model Describe the Health Belief System Model

3. WHAT IS A CONCEPTUAL MODEL? Abstract, psychological representations of how tasks should be carried out. Representation of a system that uses concepts and ideas to form said representation. Way to describe physical or social aspects of the world in an abstract way.

4. PRECEDE-PROCEED MODEL

5. PRECEDE-PROCEED MODEL Developed for use in public health but its basic principles transfer to other community issues too. Not only a model for health intervention but for community health in general. Focus: Community is a wellspring of health promotion . Latter half of 20th Century Medical advances shifted focus from treatment of diseases to prevention of illness and recently, to the active promotion of healthy behaviors and attitudes

6. PRECEDE-PROCEED MODEL It is a comprehensive structure for: Assessing health needs, Designing, Implementing & Evaluating health promotion and other public health programs to meet those needs. PRECEDE: provides the structure for planning a targeted and focused public health program. PROCEED: provides the structure for implementing and evaluating the public health program.

7. PRECEDE-proceed model: PRECEDE Stands for: P redisposing, R einforcing, and E nabling Constructs in Educational D iagnosis and E valuation. Involves assessment of various community factors. Has 4 Phases: Phase1-Social Assessment: Determine the social problems and needs of a given population and identify desired results . Phase2-Epidemiological assessment : Identify the health determinants of the identified problems and set priorities and goals . Phase 3-Ecological assessment : Analyze behavioral and environmental determinants that predispose, reinforce, and enable the behaviors and lifestyles identified .

8. PRECEDE CONTD. Phase 4-Identify administrative and policy factors that influence implementation and match appropriate interventions that encourage desired and expected changes. Implementation of interventions

9. PRECEDE-proceed model: Proceed Stands for P olicy, R egulatory, and O rganizational C onstructs in E ducational and E nvironmental D evelopment. Involves the identification of desired outcomes and program implementation. Also has 4 Phases : Phase 5-Implementation: Design intervention, assess the availability of resources, and implement the program. Phase 6-Process Evaluation: Determine if the program is reaching the targeted population and achieving desired goals. Phase 7-Impact Evaluation: Evaluate the change in behavior.

10. PROCEED CONTD. Phase 8-Outcome Evaluation: Identify if there is a decrease in the incidence or prevalence of the identified negative behavior or an increase in identified positive behavior.

11. DONABEDIAN MODEL

12. DONABEDIAN MODEL Developed by Dr. Avedis Donabedian in the year 1966. Provides a framework for examining health services and evaluating the quality of health care. It has 3 components: STRUCTURE PROCESS OUTCOMES BALANCING- additional component . Donabedian believed that structure measures have an effect on process measures and in turn impact outcome measures . These 3 form the basis for what is needed for an effective suite of measures. Patient + structure + process = outcome.

13. Donabedian model: structure measures These are otherwise known as input measures. Reflect the attributes of the service/provider such as staff-to-patient ratios and operating times of the service. Examples: How staff is trained and educated. Treatment protocols and procedures health facilities utilize.

14. Donabedian model: PROCESS measures Reflect on the way systems and processes work to deliver the desired outcome. Examples: Length of time a patient waits for a senior clinical review A patient receives certain standards of care or not If staff wash their hands Recording of incidents and acting on the findings Whether patients are kept informed of the delays when waiting for an appointment.

15. Donabedian model: OUTCOME measures Reflect on the impact on the patient and demonstrate the end result of your improvement work and whether it has ultimately achieved the aim(s) set. Examples: Outcome measures are reduced mortality Reduced length of stay Reduced hospital-acquired infections Reduced emergency admissions and improved patient experience.

16. Donabedian model: BALANCING MEASURES Reflect unintended and/or wider consequences of the change can be positive or negative. Examples: Recognizing these and attempting to measure them and/or reduce their impact if necessary. Monitoring emergency re-admission rates following initiatives to reduce the length of stay.

17. HEALTH BELIEF MODEL

18. HEALTH BELIEF MODEL Developed in the early 1950s by social scientists at the U.S. Public Health Service: to understand the failure of people to adopt disease prevention strategies or screening tests for the early detection of disease. later-for patients' responses to symptoms and compliance with medical treatments. Suggests that a person's belief in a personal threat of an illness or disease & a person's belief in the effectiveness of the recommended health behavior/ action will predict the likelihood the person will adopt the behavior.

19. HEALTH BELIEF MODEL Derives from psychological and behavioral theory with the foundation that the two components of health-related behavior: the desire to avoid illness, or conversely get well if already ill; the belief that a specific health action will prevent, or cure, illness. Individual's course of action often depends on the person's perceptions of the benefits and barriers related to health behavior .

20. HEALTH BELIEF MODEL It has six constructs: Perceived susceptibility: A person's subjective perception of the risk of acquiring an illness or disease. There is wide variation in a person's feelings of personal vulnerability to an illness or disease.

21. HEALTH BELIEF MODEL Perceived severity: A person's feelings on the seriousness of contracting an illness or disease (or leaving the illness or disease untreated). There is wide variation in a person's feelings of severity. Often a person considers the medical consequences (e.g., death, disability) and social consequences (e.g., family life, social relationships) when evaluating the severity.

22. HEALTH BELIEF MODEL Perceived benefits: A person's perception of the effectiveness of various actions available to reduce the threat of illness or disease (or to cure illness or disease). The course of action a person takes in preventing (or curing) illness or disease relies on consideration and evaluation of both perceived susceptibility. Perceived benefit, such that the person would accept the recommended health action if it was perceived as beneficial.

23. Health belief model Perceived barriers: A person's feelings on the obstacles to performing a recommended health action. There is wide variation in a person's feelings of barriers, or impediments, which leads to a cost/benefit analysis. The person weighs the effectiveness of the actions against the perceptions that they may be expensive, dangerous (e.g., side effects), unpleasant (e.g., painful), time-consuming, or inconvenient.

24. Health belief model Cue to action: Stimulus needed to trigger the decision-making process to accept a recommended health action. Can be internal (e.g., chest pains, wheezing, etc.) or external (e.g., advice from others, illness of family member, newspaper article, etc.).

25. HEALTH BELIEF MODEL Self-efficacy: The level of a person's confidence in his or her ability to successfully perform a behavior. This construct was added to the model most recently in mid-1980. Self-efficacy is a construct in many behavioral theories as it directly relates to whether a person performs the desired behavior

26. REFERENCES Community Tool Box https://ctb.ku.edu/en/table-contents/overview/other-models-promoting-community-health-and-development/preceder-proceder/main A Model for measuring quality care https://www.med.unc.edu/ihqi/wp-content/uploads/sites/463/2021/01/A-Model-for-Measuring-Quality-Care-NHS-Improvement-brief.pdf Rural Health Information Hub https://www.ruralhealthinfo.org/toolkits/health-promotion/2/program-models/precede-proceed#:~:text=The%20PRECEDE%2DPROCEED%20model%20is,and%20focused%20public%20health%20program .