Community as Partner: Assessment & System Framework

By
Faraz Siddiqui Institute of Nursing Dow University of Health Sciences

Objectives
At the end of this session students will be
able to Define community Explain reasons for assessing communities Identify the process of assessing communities Understand different models

What is a Community?
Many definitions of community These may change according to specific
circumstances

Community as a specific geographic location Community as a social setting

Conti..
Community as a social structure Community as sentiment/affiliation Varied nature of communities requires
flexibility when assessing them

Why Assess Communities?

Essential first step in the process of health
planning:

To identify the health status of a community To provide a baseline to evaluate planned and
potential interventions

 To identify factors that may be influencing health

status
Both positive and negative

To identify community resources To identify key stakeholders in the community To solicit the opinions of community members

To engage community members in thinking about

the health of their community

How Can Communities be Assessed?

Both comprehensive and focussed assessment
approaches can be used

Nursing and non-nursing models exist

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

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

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

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

Why Medical Model is not useful?

Important aspects of care, such as psychological, sociocultural, and spiritual areas, are not explicitly included in the medical model

Thus, a community-as-partner model should encompass all aspects of health and incorporate long-range goals and planning.

Prerequisites of Health Model

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

 A model serves the following purposes:

Provides a map for the problem-solving process Gives direction for assessment Guides analysis Dictates community health diagnoses Assists in planning Facilitates evaluation

A model is nothing more or less than an explication of practice. A model not only describes what is but also provides a framework for making decisions about what could be.

Systems Model
Based on Neumans 1972 Systems Model of a
total-person approach to viewing client problems.

Community as Partner Model

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

Community Diagnosis
Several approaches to the writing of
community diagnoses

Complete community diagnosis has 4

components

Conti
1. Statement of the problem or strength (issue) 2. Identification of the
aggregate/population/community affected (focus) 3. Identification of the factors that are causally linked to the problem or strength (etiology) 4. Identification of the evidence that supports the diagnosis (manifestation)

Conti
All 4 elements are important because they also
form the basis for:
Program planning Evaluation of the intervention(s)

Risk of low birth weight (issue) among pregnant teens living in downtown area (focus) related to: a) inadequate income (etiology) as manifested by (manifestations):
Insecure housing Use of food bank Unemployment rates in this group

Risk of low birth weight (issue) among pregnant teens living in downtown area (focus) related to: b) tobacco use (etiology) as manifested by (manifestations)
Smoking rates among pregnant teens

Determining Priorities
No easy process to determine priorities
Ideally, after diagnoses have been formulated,
should be a community consultation process Allows community members to rank priorities Even then, unlikely that consensus would be achieved

Conti
Factors that can help determine priorities: 1. Magnitude of concern expressed by community 2. Number of people potentially/actually affected 3. Severity/urgency of the problem 4. Capacity of existing resources to deal with the problem

Problem Analysis
Once priorities established, each issue or
problem selected for intervention can be further analyzed

Assists in establishment of objective &

strategies

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 Lack of access to contraceptives

Immediate Risk Factor Low contraceptive use among sexually active teenagers

Priority Issue High rate of unplanned teen pregnancies

Problem
Rate of unplanned teen pregnancy in community x is 30% greater than the provincial average Sub-Objective Access to affordable contraception for sexually active adolescents will be increased within 6 months of the beginning of the program Objective To increase the rate of contraceptive use among sexually active adolescents in community x by 30% within 1 year of beginning of program Goal To reduce the number of unplanned teen pregnancies in community x by 30% by 2007

Strategy
Provide free confidential contraceptive services in high school 1. Strategy Activity Negotiate consensus amongst key stakeholders, school board, administrators, etc.

2. Strategy Activity

Identify appropriate space for school nurse to use in the school setting

Planning Interventions
One level of planning involves establishing:
1. Goals (based on issue contained in community diagnosis)

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

3. Objectives (based on etiology contained in

community diagnosis

4. Indicators of success (based on

manifestations contained in community diagnosis)

Implementing the Intervention(s)

Evaluating the Intervention(s)

3 types of evaluation

1.Formative (process) 2.Impact (summative) 3.Outcome

 Formative evaluation
Assesses the program implementation as soon
as it begins Enables improvements in the plan during the implementation phase

Impact evaluation

Assesses the immediate effects of the program on:

Knowledge Attitudes Skills Perceptions Beliefs Access to resources Social support

Outcome evaluation

Assesses population level impact of the

program Measures changes in incidence & prevalence of risk factors

References
Anderson, E. T. & McFarlane, J. (2000). Community as partner (3rd ed., pp. 153164). Philadelphia: Lippincott Williams & Wilkins. Beddome, G. (1995). Community-as-client assessment. In B. N. Neuman, (Ed.), The Neuman systems model (3rd ed., pp. 567580). Norwalk, CT: Appleton & Lange. Neuman, B. N. (Ed.). (1995). The Neuman systems model (3rd ed). Norwalk, CT: Appleton & Lange.