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Flashcards in Exam 3 (Final) Deck (76):
1

Health education ...

Seeks to influence a range of behavior

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Health education includes (4)

health promoting activities

use of health services

health supervision of children

adherence to medical and nutrition regimens

3

Health promotion

includes a broad range of interventions

4

Health promotion includes (6)

educational

policy

organizational

environmental

economic

Supports behavior and living conditions conducive to health

5

Community engagement..

often involves partnerships and coalitions that help mobilize resources.......

6

Who are we engaging in community engagement

the process of working collaboratively with and through groups of people affiliated by geographic proximity, special interest, or similar situations to address issues affecting the wellbeing of those people

7

Constituency is:

a group of supporters or patrons a group served by an organization or institution

8

Public health's constituency:

people who benefit from public health actions, people who support improved health of the public

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Goals of community engagement (3)

achieve dialogue

develop shared constituent leadership in determining health improvement actions

gain shared ownership for achieving health improvement

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Leadership challenges in engaging communities and constituents (3)

Identifying all constituents or stakeholders

low/no readiness or large variation of readiness among different community groups

developing relationships with a diverse group of constituents and stakeholders

developing common goals and shared understanding of what needs to happen

11

4 strategies to guide interactions with constituents (ACCD):

Authoritative: used when an org has authority over its environment

Competitive: seeks to attract support for public health goals relative to a "competitor"

Cooperative: agreements that offer mutual benefits

Disruptive: disrupt the resources generating capacity of the adversary

12

Ways to develop relationships with community

Design: establishing and maintaining networks
- relationships
- communication channels
- exchange systems that promote linkages
- opportunities to leverage resources

Constituent groups are both formal and informal

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Dunbar's number:

suggested cognitive limit to the number of people with whom one can maintain stable relationships

14

Performance management is

the use of standards, measurement and performance management to change capacity, processes and outcomes

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Performance management applies to

individual
Programs
agency or department
public health system itself

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How does performance management work?

To improve something we must be able to control it

To control it we must be able to understand it

To understand it we must be able to measure it

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1st quadrant of performance management model

Performance standards (what can be accomplished)
- Identify relevant standards
- Select indicators
- Set goals and targets
- Communicate expectations
- Targets
- Benchmarking levels of excellence

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2nd quadrant of performance management model

Performance Measures (what was accomplished)
- Collect data
- Refine indicators and define measures
- Develop data systems
- Quantitative assessment of actual performance

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4th quadrant of performance management model

Reporting of Progress (Our progress)
-Develop a regular reporting cycle
- Analyze data
- Performance trends
-Comparisons of actual to desired levels

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3rd quadrant of performance management model

Quality Improvement Process (Our pathway to improvement)
-Use data for decisions to improve policies, programs, and outcomes
-Use of standards
- Manages changes
-Creates a learning organization

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Benefits of performance management (9)

Clear goals

identification of strengths and weaknesses

opportunities for collaboration (internal and external)

Clearer lines of accountability

improved quality

better tracking of progress over time

more effective communication

better resource allocation and deployment

strengthened organization effectiveness

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Performance indicator is

a performance measure that is used to determine whether or to what extent a performance standard is achieved

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Performance standard:

a LHD will conduct a community health needs assessment once every three years

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How to measure performance in public health (CPOO)

Capacity: capabilities, resources, "raw materials"

Processes: any activity, action that falls within the 10 essential services

Outputs: programs & services

Outcomes: organizational performance, program performance

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Public health workforce definition

Composed of individuals whose primary work focus is delivery of one or more of the essential services of public health, whether or not those individuals are on the payroll of an official, voluntary, or not-for-profit public health agency

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Definition of performance management

use of standards, measurement and performance improvement to change capacity, processes and outcomes.

Regular collection and reporting of data to track work that is performed and results that are achieved

Results in more effectively addressing needs of community served

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3 Key principles of performance management:

1) To improve something, we must be able to control it

2) To control it, we must be able to understand it

3) To understand it, we must be able to measure it

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4 Quadrants of Performance Management model:

1) Performance standards: (WHAT CAN BE ACCOMPLISHED)
- Identify relevant standards
- Select indicators
- Set goals and targets
- Communicate expectations

2) Performance Measurement: (WHAT WAS ACCOMPLISHED)
- Refine indicators and define measures
- Develop data systems
- Collect data
- Quantitative assessment of actual performance

3) Reporting of Progress (OUR PROGRESS)
- Analyze data
- Feed data back to managers, staff, policy makers and consultants
- Develop a regular reporting cycle
- Performance trends
- Comparison of actual to desired levels

4) Quality Improvement Process (OUR PATHWAY TO IMPROVEMENT)
- Use of standards, measurement in change management process
- Use data for decisions to improve policies, programs and outcomes
- Manage changes
- Create a learning organization

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The psychological impact of measurement on human behavior

Performance management systems impact on managers: goals and measurement
- increased manager's understanding of their specific roles and responsibilities (role clarity)

- created a sense of empowerment in managers to exert action to attain goals (enhanced motivation)

30

Performance management applies to

any level of an organization

individual
programs
agency or department
interorganizational efforts
public health system itself

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Importance of performance management in public health

Impressive record of improving performance in public/private sectors

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Goals of community engagement (3)

1) Achieve dialogue

2) Develop shared constituent leadership in determining health improvement actions

3) Gain shared ownership for achieving health improvement

33

Leadership challenges in engaging communities and constituents (3)

1) Applying different approaches to achieve participation from all community constituents potentially impacted by the proposed community health improvement intiative

2) Avoiding adversarial relationships that evoke defense responses

3) Limited communication

34

Leadership challenges in engaging communities and constituents (4)

4) Identifying all constituents or stakeholders

5) Low/no readiness OR large variation of readiness among different community groups

6) Developing relationships with a diverse group of constituents and stakeholders

7) Developing common goals and shared understanding of what needs to happen

35

Incentives for Community Participation (4)

Sense of community

See involvement as relevant

Believe benefits of participation outweigh costs (exchanges)

View the process as participative, open, supportive- they have a voice

36

The Organizational Management for Effective Constituency Interaction (4)

1) Knowing the community and its constituents

2) Establishing positions and strategies that guide the organization’s interaction with constituents

3) Building and sustaining formal and informal networks necessary for maintaining relationships, communicating messages, and leveraging resources

4) Mobilizing constituents for community-based decision making & action

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Describe (1) "Knowing the community & its constituents"

What do you need to know?

more than epidemiological assessment, factors that
- motivate constituents
-assessment of assets

Analysis of group characteristics- values, demographic groupings beliefs, customs, cultures

Organizational & leadership structures of constituent groups

History of groups working with others

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(2) Establishing positions and strategies to guide interactions with constituents (4) (ACCD)

Authoritative: used when an org has authority over its environment

Competitive: seeks to attract support for public health goals relative to a competitor

Cooperative: agreements hat offer mutual benefits

Disruptive: disrupt the resource generating capacity of the adversary

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(3) Building andSustaining Networks

How do you develop relationships with a “community”?

Design: establishing and maintaining networks

Relationships

Communication channels

Exchange systems that promote linkages
Opportunities to leverage resources

Constituent groups are both formal and informal

Network analysis can serve as useful tools to understand network construction

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(4) Mobilizing Constituencies

Mobilization – assemble resources needed to collectively take action

-Operating structure

-Physical facilities & equipment

-Fiscal resources

- Information

- Technical capacities to prepare constituencies for action

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Strategies for Mobilizing Constituents

Tap into existing structures Facilitate development of structures



Structured, organized, connected unstructured, disorganized, not connected

42

Social Marketing definition:

The adaptation and adoption of commercial marketing activities, institutions, and processes as a means to induce behavioral change in a targeted audience on a temporary or permanent basis to achieve a social goal

43

Goal of social marketing:

To instill a behavioral change


Merely increasing knowledge or changing attitudes does not automatically lead to behavioral change

“Thought is the predecessor of action”, but thought does not always result in action

Challenge in public health

Changing multiple behaviors is needed

Selecting one behavior to focus on at a time

Change diet, THEN change amount of exercise

44

Key Concepts of Social Marketing (2):

Exchange – benefit of the action, inaction, decision, purchase, etc., must outweigh the costs of the same

The idea of “cost” is highly subjective



Self-Interests – in most situations people will act in their own self-interests

Marketing must position appeals accordingly

“If you spend this…you will get this…”

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4 P's of Marketing Statement:

PROMOTE the “right PRODUCT at the right PRICE at the right PLACE” in such a way as to make it rewarding for individuals to change their behavior

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4 P's of Social Marketing:

Product

Price

Place

Promotion

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PRODUCT of Social Marketing (CAA):

CORE product – the BENEFITS of acquiring the product (feel better, live longer, peace of mind, self-confidence)

ACTUAL product – behavior being promoted of discouraged (increased physical activity)
- BEHAVIOR that produces product

AUGMENTED product – goods or services that ENHANCE the adopted behavior (e.g., website, pocket guide; not in every campaign)

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PRICE of Social Marketing:

Costs that are EXCHANGED for the benefits of the product

May be tangible or intangible

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PLACE of Social Marketing:

PHYSICAL LOCATION where behavior adoption occurs

TIME when most likely performed

WHERE augmented product is distributed

LOCATION OF ORGANIZATION (gym, doctor’s office)

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PROMOTION of Social Marketing

Promotion – method of communicating with target audience

-Advertising
-Media relations
-Promotional event
-Personal selling
-Billboards

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2 other P's!

PARTNERS & POLICIES

Partners: that are conducting similar activities

Other organizations credible with the target audience



Policies: Education interventions, social marketing interventions, policy interventions

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Health education seeks to

influence a range of behavior including PARTCIPATION in

health-promoting activities (exercise, diet, behaviors)

appropriate use of health services

health supervision of children

adherence to appropriate medical and nutritional regimens

Child and youth development

53

Health Promotion is

Broad range of interventions: combination of health education with related:

- educational
- policy
- organizational
- environmental
- economic supports

Support behavior and living conditions conducive to health

54

Public health education:

Interventions designed to

INFORM
ELICIT
FACILITATE
MAINTAIN

positive health practices in a large number of people

55

Health education focuses on 3 categories:

Predispose

enable

reinforce...behaviors related to health


Motivates people to voluntarily undertake and sustain actions conducive to their health

56

Health behaviors produce health outcomes:

Voluntary behavior

- Results from health education if it provides for a combination of planned, consistent, integrated learning opportunities and reinforcement


-Behavioral changes resulting from education are freely adopted by people

57

Use evidenced- based approaches applies theories from: (5)

Applies theories from:

Social and behavioral sciences

Epidemiology

Ecology

Administrative science

Communication theory

58

Limits to health education (3)

Not having resources

Local laws and customs

Environmental “toxins” experienced by certain members of the population

-Structured racism
-Stress associated with poverty

59

Basic definition of Evidence-Based Public Health Management:

Managerial decision-making and organizational practices informed by scientific evidence, when available

Management: “should we implement a performance management system throughout our agency?”

Evidence: “¾ of state public health departments report that the use of performance management has improved overall performance.”




60

What is evidence based practice?

Clinical orientation
Began in medicine in 1992

“Evidence-based behavioral practice entails making decisions about how to promote healthful behaviors by integrating the best available evidence with practitioner expertise and other resources, and with the characteristics, state, needs, values and preferences of those who will be affected.” (www.ebbp.org)

Evidence is comprised of research findings derived from the systematic collection of data through observation and experiment and the formulation of questions and testing of hypotheses.

61

Key Components of evidence based practice:

1) Making decisions on the best available scientific evidence

2) Using data and information systems systematically

3) Applying program planning frameworks

4) Engaging the community in decision-making

5) Conducting sound evaluation

6) Disseminating what is learned

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Basic definition of evidence:

The available body of facts or information indicating whether a brief or proposition is true or valid

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Different forms of evidence:

Scientific literature in systematic reviews/journal articles

Public health surveillance data

Program evaluations

Qualitative data
-Community members
- Other stakeholders

Media/marketing data

Word of mouth

Personal experience

64

Benefits of using EBPH

Access to more quality information about what works

Higher likelihood of successful programs being implemented

Increased workforce productivity

More efficient use of resources

Reduces wastes associated with poorly designed interventions and programs

65

Key issues in implementing EBPH

- Need to access scientific information on the types of programs and policies that are most likely to work

- Need to develop the skills to translate science to practice, “marry” peer-review literature to real-world practice

- Dissemination of what worked and what didn’t needs to more consistently occur

66

Basic definition of global health

“the area of study, research, and practice that places a priority on improving health and achieving equity in health for all people worldwide.”

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Why global health is important

Moral:

Humanitarian: 1.8 million deaths due to AIDS in 2010, most from developing countries

Equity: more $ spent on diseases that affect a smaller number of wealthier than a large number of impoverished people


Realized Risk:
Global travel increases risks of infectious disease transmission

Globalization—economic ties more realized

Public Health problems can create national security risk for any nation

Cost of segregation realized across all of society

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Major global health challenges:

Growth in chronic diseases worldwide

Aging population

Rise in infectious disease rates

Bioterrorism

Shortage of health profession workers

The ethics and ramifications of biomedical technology and it proliferation

The growth and inadequacies of health systems

Increased global economic activity

Evidenced-based health care and the need for standardization

69

Occupations in public health

Epidemiologists

Biostatisticians

educators/behavioral scientists

Environmental health specialists

nurses

physicians

nutritionists

health service administrator

dental health workers

generalists and specialists

70

What occupation is the study of distribution and determinants of health-related states or events in specified populations and the application of this study to control health problems

Epidemiologist!

71

Study that focuses primarily on statistical theory, techniques and methods to identify and analyze health problems to evaluate the effectiveness of health services and to analyze data for planning and policy development?

Biostatisticians!

72

Program planning for promoting increased exercise, changing individual eating patterns, and reducing stress is?

Behavioral Scientists!

73

Occupation that strives to ensure a safe and health environment through the control and management of air and water quality, food safety, toxic substances, solid wastes and workplace hazards

Environmental health specialist!

74

Focus on populations rather than individuals and on disease prevention rather than acute or chronic care

Public health nurse!

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Primary care specialities including pediatrics, obstetrics, internal medicine/infectious disease, emergency medicine and pathology?

Physician!

76

Plan and supervise the preparation and service of institutional emails, assist in the prevention and treatment of illnesses by advising on healthy eating habits and evaluate dietary trends in the population

Nutritionists!