Social Determinants of Mental and Physical Health MAPP Annual Meeting April 29, 2011
Community Health Analysis MPH607. Understand the development of the MAPP process by examining...
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Transcript of Community Health Analysis MPH607. Understand the development of the MAPP process by examining...
Community Health AnalysisMPH607
Understand the development of the MAPP process by examining earlier models of health improvement.
Identify the steps key concepts underlying each model
Review models: ◦ Precede/Proceed ◦ PATCH◦ APEXPH◦ IOM CHIP Model◦ MAPP
PROGRAM PRECEDE /PROCEED
PATCH
APEXPH
CHIP (IOM)
MAPP SYSTEM
Developers: L. Green, M. Krueter Years of origin 1968 - 1974 for PRECEDE, late
1980s for PROCEED. Principles:
Success in achieving change is enhanced by the active participation of members of the target audience. The important role of the environmental factors as determinants of health and health behavior such as media, industry, politics, and social inequities
Source: THE PRECEDE/PROCEED MODEL.
PRECEDE is an acronym for Predisposing, Reinforcing, Enabling, Causes in, Educational Diagnosis and Evaluation.
PROCEED is an acronym for Policy,
Regulatory, Organizational Constructs in Educational and Environmental Development.
1 Social: identify and evaluate the social problems which impact the quality of life
2 Epidemiological: identify specific health problems and non-health factors
3 Behavioral: analysis of behavioral links to the problems identified in the first
phases Environmental: parallel analysis of factors in the social/physical environment
4 Education & Organizational: looks at the specifics that hinder or promote behaviors
5 Administrative & Policy: assessment of policy resources, circumstances that could impact implementation.
PROCEED: added to the framework . Recognition of the need for health
promotion interventions that goes beyond traditional educational approaches to changing health behaviors.
Flows from the PRECEDE:◦ to promote the plan or policy, regulate the
environment, and organize the resources and services, as required by the plan or policy.
6 IMPLEMENTATION
7 PROCESS EVALUATION evaluates:◦ the process by which the program is being
implemented. 8 IMPACT EVALUATION measures
◦ effectiveness related to intermediate objectives◦ changes in predisposing, enabling, and reinforcing
factors. 9 OUTCOME EVALUATION measures
◦ change in overall objectives and ◦ changes in health and social benefits or the quality
of life.
Phase 1Social Assessment
Phase 3Behavioral & Environmental Assessment
Phase 2Epidemiologic Assessment
Phase 4Educational & Ecological Assessment
Phase 5Administrative Policy Assessment
Phase 6Implementation
Phase 7Process Evaluation
Phase 8ImpactEvaluation
Phase 9Outcome Evaluation
Health services
HealthEducation
Health Promotion
Policy,Regulation
Predisposingfactors
Reinforcingfactors
Enablingfactors
Behavior &lifestyle
Environment
Health Quality of life
Developed 1983; by CDC Program focus. Assist local health agencies to partner with
local communities Evaluate health promotion/prevention
programs Improve linkages within/between
communities, health depts, universities, etc
1) mobilizing the community,
2) collecting and organizing data,
3) choosing health priorities,
4) develop comprehensive intervention plan
5) evaluation.
PATCH increases community (1) organizing and data use skills, (2) awareness and interest in health, (3) networking and ability of groups and
organizations to work together, and (4) the number of health promotion interventions
activities.
Strengths: Tested the application of theory Facilitated the link between research and
practice in community health education and health promotion.
Practical/user friendly approach
A collaborative project of The American Public Health Association The Association of Schools of Public Health The Association of State and Territorial Health
Officials The Centers for Disease Control The National Association of County Health Officials The United States Conference of Local Health
Officers Funded through a Cooperative Agreement between
the Centers for Disease Control and the National Association of County Health Officials (NACCHO)
1987-1991.
Part I, Organizational Capacity Assessment ◦ an internal review of a local health department.◦ an assessment of department's basic administrative capacity
and to undertake Part II.
Part II, The Community Process◦ involving key members of a community and department staff ◦ assessing the health of the community and identifying the role of the health
department in relation to community strengths and health problems. ◦ use of objective health data ◦ use of community's perceptions of community health problems.
Part III, Completing the Cycle◦ integrates the plans developed during Part 1 and Part II◦ into the ongoing activities of a health department and the community it
serves. ◦ discusses policy development, assurance, monitoring, and evaluation of
plans
INTERNAL
1. Prepare for the organizational capacity assessment
2. Score indicators for importance and current status
3. Identify strengths and weaknesses
4. Analyze and report strengths
5. Analyze weaknesses6. Rank problems in order of
priority7. Develop and implement
action plans8. Institutionalize the
assessment process
EXTERNAL
1. Prepare for the community process
2. Collect and analyze health data
3. Form a community health committee
4. Identify community health problems
5. Prioritize community health problems
6. Analyze community health problems
7. Inventory community health resources
8. Develop a community health plan
Strengths:◦ Strengthened health department’s role◦ True organizational assessment◦ Adaptable to fit local situations and resources.
Limit size/scope of effort.◦ Focused on community as partners in health
improvement
Challenges:◦ Commitment of time and resources◦ Priorities may not align with program funding◦ Lacked environmental health component
Focuses on a broader definition of health:◦ Health is a state of well-being and the capability
to function in the face of changing circumstances” (IOM 1997).
Underlying themes:◦ The origins of good health are multiple and cross-
sectorial. ◦ A focus on the origins of health:
emphasizes the need for cross-sectorial assumptions of responsibilities
creates multiple options for intervention
A model of the determinants of health. Source: Reprinted from R.G. Evans and G.L. Stoddart, 1990, Producing Health, Consuming Health Care, Social Science and Medicine 31:1347–1363
Two Cycles:Problem Identification
and PrioritizationAnalysis and
Implementation
Emphasizes ongoing nature of community improvement process
Focuses on bringing community stakeholders together in a coalition
Monitoring community-level health indicators
Identifying specific health issues as community priorities.
Analyzing a health issue (for determinants )
Assessing resourcesDetermining:
How to respond Who should respond
Assess outcomesPerformance
monitoring Community indicators
Continuing and evolving process – measure along the way
Shared responsibility and accountability Not outcomes (disease) alone:
◦ using a limited number of indicators that can track critical processes AND outcomes over time and among accountable stakeholders;
◦ collecting and analyzing data on those indicators; ◦ making the results available to inform
assessments of the effectiveness of an intervention AND the contributions of accountable entities.
Move toward “systems” approach.
Developed by the National Organization of City and County Health Officials (NACCHO) and CDC
a community-wide strategic planning tool for improving public health,
an action oriented process to help communities prioritize public health issues, identify resources, take action
Strategic Thinking
Community Driven Process
Focus on the Local Public Health System
Requires broad-scale information gathering
Encourages exploration of alternatives
Places emphasis on future implications of present decisions
Facilitates communication and participation
Accommodates divergent interests and values
Mobilizing and engaging the community Action with and by the community Planning driven by the community Partnerships to strengthen the
community
MCOs
Home Health
Parks
Economic Development
Mass Transit
Employers
Nursing Homes
Mental Health
Drug Treatment
Civic GroupsCHCs
Laboratory Facilities
Hospitals
EMS Community Centers
Doctors
Health Department
Local Public Health System
Churches
Philanthropist
Elected Officials
Tribal Health
Schools
Police
Fire
Corrections
Environmental Health
Phases Organize for Success
and Partnership Development◦ Who should we include◦ Who is part of the public
health system in our community?
Visioning◦ What will the public health
system look like if it is substantially providing the Ten Essential Public Health Services
◦ What will our community look like?
◦ What will our community’s health look like?
◦ What would we like to see?◦ What mission and values
drive this process?
Four MAPP Assessments◦ Community Themes and
Strengths “What is important to our
community?”◦ Local Public Health
System “How are the Essential
Services being provided?”◦ Community Health Status
“How healthy is are our residents?”
◦ Forces of Change What is occurring or
might occur that affects the health of our community or LPHS?”
Identify Strategic Issues◦ Focus on issues, not
programs and services◦ Not limited to health
outcomes
Formulate Goals and Strategies◦ Goals and objectives◦ Responsibilities and
accountability
Action Cycle◦ Plan◦ Implement◦ Evaluate
National Public Health Performance Standards (NPHPSP) – (“model standards”) is used within MAPP to assess the local public health systemhttp://www.cdc.gov/od/ocphp/nphpsp/overview.htm
10 Essential Services framework ensures a comprehensive picture of public health
MAPP can help address Healthy People 2020 objectives
Public Health community health improvement planning has evolved from program oriented process to system level processes.
Incorporates strategic planning principles Broadened definition of health and
determinants Increasing emphasis on community input and
shared responsibility for public health Focus on evidence based planning – link to
standards and measures
REFERENCES
THE PRECEDE/PROCEED MODEL. Retrieved 1/15/2010, 2010, from http://74.125.95.132/search?q=cache:6pIfKamWIPYJ:www.infosihat.gov.my/artikelHP/bahanrujukan/HETheory/The%20Precede.doc+preceed+proceed+terms&cd=5&hl=en&ct=clnk&gl=us
http://wonder.cdc.gov/wonder/prevguid/p0000064/P0000064.asp
PATCH: Its origin, basic Concepts/Links to health policy. Retrieved 1/15/2010, 2010, from http://wonder.cdc.gov/wonder/prevguid/p0000064/P0000064.asp
APEXPH:Assesment protocol for excellence in public health. Retrieved 1/18/2010, 2010, from http://wonder.cdc.gov/wonder/prevguid/p0000089/p0000089.asp
Mobilizing for action through planning and partnerships (MAPP) | NACCHO. Retrieved 1/18/2010, 2010, from http://www.naccho.org/topics/infrastructure/MAPP/index.cfm