1 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Chapter 17 Promoting Healthy Communities Using Multilevel Participatory Strategies

2 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Objectives 1. Describe health promotion, illness prevention, and illness care in the context of the ecological model and social determinants of health (SDOH). 2. Analyze participatory approaches and the interrelationships among communities, populations, and interprofessional health care providers in the application of health promotion strategies.

3 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Objectives, Cont’d 3. Describe evidence-based practice at multiple levels of the patient system: individual, family, aggregate, and community. 4. Analyze nursing and interprofessional roles that are essential to health promotion, illness prevention, and illness care.

4 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. The Ecological Approach to Community Health Promotion Ecological Perspectives on Population Health The Social Determinants of Health An Integrative Model for Community Health Promotion

5 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Ecological Perspectives on Population Health  Lifestyle improvement efforts have typically focused on the individual.  However, the public health perspective sees that health behaviors are influenced beyond the individual.  Internal and external determinants  Society determinants

6 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Interaction of Multiple Determinants of Health

7 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. The Social Determinants of Health  Defined as “the circumstances in which people are born, grow up, live, work, and age, and the systems put in place to deal with illness. These circumstances are in turn shaped by a wider set of forces: economics, social policies, and politics.” (WHO)  Assessments and interventions must be directed to multiple levels of the patient system.  Curve-shifting principle  Built environment

8 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. An Integrative Model for Community Health Promotion  Developed by Laffrey and Kulbok (1999)  Helps nurses to see the continuity of care at multiple levels  Helps nurses to describe their own areas of expertise within the complex health care system  Provides a basis for collaboration and partnerships among nurses, other health care providers, and the population  Assumptions

9 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. An Integrative Model for Community Health Promotion, Cont’d

10 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Historical Perspectives, Definitions, and Methods Health and Health Promotion Assessing Health within Health and Illness Frameworks Community

11 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Health and Health Promotion  Historical perspectives  Nightingale  Holistic view based on ancient Greek’s view of health  LaLonde (1974) identified four major determinants of health: Human biology Environment Lifestyle Health care  Healthy People

12 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Health and Health Promotion, Cont’d  Definitions of Health  WHO (1953)  Smith’s (1981) Idea of Health  Defining population health  Definitions of Health Promotion  Leavell and Clark’s (1965) levels of health promotion (primary, secondary, tertiary)  WHO (1984)  Kulbok’s (1985) Resource Model of Health Behavior  Laffrey (1990) differentiated health promotion, illness prevention, and health maintenance  Pender, Murdaugh, and Parsons (2011) differentiated health-protecting and health-promoting behaviors

13 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Assessing Health within Health and Illness Frameworks  Illness prevention:  Risk appraisal  Guidelines for clinical preventive services  Health risk appraisal (HRA) instruments Advantages Disadvantages  Wellness inventories

14 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Community  Historical perspectives:  Emphasis on community as target of practice has gained attention since mid-1970s United States government, Canadian government, and private health researchers attributed declining mortality and morbidity rates to better standards of living  Healthy People in Healthy Communities

15 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Community, Cont’d  Community models and frameworks  Community as patient  Community for a systems perspective  Anderson and McFarlane’s (2000, 2008) Community-as-Partner model Eight major community subsystems  Keller et al’s (1998, 2005) Intervention Wheel  Los Angeles County Public Health Nursing (LAC PHN) practice model  Social ecological model  Healthy Hawaii Initiative

16 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Community, Cont’d  Influential multilevel community studies:  Framingham Heart Study (initiated 1949)  Human Population Laboratory’s longitudinal survey in Alameda County, CA (initiated 1970s)  Stanford Five-City project (initiated 1979)  North Karelia Project  Pawtucket Heart Health program  Minnesota Heart Health program  Dutch Heart Health Community Intervention

17 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Interprofessional Application to Nursing and Public Health Community-Based Participatory Research (CBPR) Photovoice Method and Projects

18 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Community-Based Participatory Research (CBPR)  Provides the philosophical and theoretical basis for forming partnerships and for collaboration with the community  Has been used to conduct ecological, community, and environmental assessments  Partnerships are active, and community members are involved in assessing, planning, implementing, and evaluating change.  Examples of CBPRs

19 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Photovoice Method and Projects  A novel method used in CBPR projects that integrates the strengths of social support and engagement, building local capacity to identify and address community concerns  Allows participants to photograph, contemplate, and then verbalize stories or simple descriptions about their photo(s) taken in response to a particular prompt, thereby allowing their voices to be heard  Ngudo Nga Zwinepe (NNZ) Learning through Photos projects

20 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Application of the Integrative Model for Community Health Promotion Infant Mortality Obesity and the Built Environment

21 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Infant Mortality  Illness care  Individual, family, aggregate, and community levels  Illness prevention  Individual, family, aggregate, and community levels  Health promotion  Individual, family, aggregate, and community levels

22 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Obesity and the Built Environment  Illness care  Individual, family, aggregate, and community levels  Illness prevention  Individual, family, aggregate, and community level  Health promotion  Individual, family, aggregate, and community level