DNP 825 Topic 5 DQ 1

DNP 825 Topic 5 DQ 1

DNP 825 Topic 5 DQ 1

In creating a new community-based health program, what program development model would you use and why? What recommendations would you suggest to make the program successful and sustainable? Provide examples and relevant literature to support your response.

When developing a new community-based health program, it is imperative to complete an assessment to ensure the program is needed within the community. After it is developed, an evaluation needs to be performed to ascertain the program is meeting the desired outcomes. In order to plan and evaluate, the PRECEDE-PROCEED model is practical, simple, and logical. While this model is commonly used to develop and evaluate educational programs, it can be applied in various types of community-health programs (Kim et al., 2022). As one type of a community-based model, Kim et al. (2022) found it was commonly used for disease management and health promotion programs.

 PRECEDE stands for Predisposing, Reinforcing, and Enabling Constructs in Educational Diagnosis and Evaluation. Part of the PRECEDE model includes conducting a social assessment, epidemiologic assessment, ecological or education assessment, and policy assessment (Kim et al., 2022). The social assessment evaluates the social needs of a group of people or a community. The epidemiological assessment prioritizes goals based on data and identified problems. The ecological assessment considers the impact of different behaviors or environmental factors. Whenever implementing a new community health program, policies and procedures need to be considered. Policies and procedures need to support the new program and influence or guide the interventions (Rural Health Information Hub, 2023). The PROCEED portion is the evaluation component for this model. Whenever implementing a new process, it is prudent and necessary, to examine and evaluate outcomes. By reviewing the impact and outcomes, programs can ascertain whether the intended outcomes were met and if the program was efficient and cost-effective. Ultimately, this leads to a sustainable framework.

The PRECEDE-PROCEED seems to address major considerations for new community health programs. In their systematic review, Kim et al. (2022) found people were more involved in health promotion behaviors (despite the type of chronic condition) as knowledge improved which was supported by this model. Pourhaji et al. (2020) found this model effective in promoting low back pain prevention behaviors for healthcare workers. When addressing the needs for a community, there is a diverse demographic to consider. Using the PRECEDE-PROCEED model is one model that provides the constructs to create programs to support the variety within a community.

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References

Kim, J., Jang, J., Kim, B. & Lee, K. H. (2022). Effect of the PRECEDE-PROCEED model on health programs: a systematic review and meta-analysis. Systematic Reviews, 11 (213). Doi: https://doi.org.10.1186/s13643-022-02092-2.

Pourhaji, F., Hossein, M., Sedigheh, D., Tavafian, S., Niknami, S. & Pourhaji, F. (2020). Effects of educational program based on Precede-Proceed model in promoting low back pain behaviors (EPPLBP) in health care workers Shahid Beheshti University of medical sciences: randomized trial. Heliyon6(10). https://doi-org.lopes.idm.oclc.org/10.1016/j.heliyon.2020.e05236.

Rural Health Information Hub. (2023). PRECEDE-PROCEED. https://www.ruralhealthinfo.org/toolkits/health-promotion/2/program-models/precede-proceed#:~:text=The%20PRECEDE%2DPROCEED%20model%20is,and%20focused%20public%20health%20program.

RESPOND HERE

 Some community-based health programs have become less significant despite of using heavy financial resources. Lack of assessment or poor evaluation has been blamed for these programs’ failure. Assessment is important in knowing the value of the program on the targeted population (Cénat et al., 2020). Detailed assessment provide critical information that will guide future activities. In order to plan and evaluate, the PRECEDE-PROCEED model is practical, simple, and logical. Complex planning and evaluation may complicate other activities. Therefore, considering a simple and logical model is a good decision. In the PRECEDE-PROCEED model, PRECEDE stands for Predisposing, Reinforcing, and Enabling Constructs in Educational Diagnosis and Evaluation. The PROCEED portion is the evaluation component for this model (Bhaumik et al., 2020). The two portions are part of the model that can be used in various types of community-health programs. Part of the PRECEDE model insists on intensive assessment. The assessment includes examining the health needs of the residents and the impact of the community-based health program.

References

Bhaumik, S., Moola, S., Tyagi, J., Nambiar, D., & Kakoti, M. (2020). Community health workers for pandemic response: a rapid evidence synthesis. BMJ Global Health5(6), e002769. http://dx.doi.org/10.1136/bmjgh-2020-002769

Cénat, J. M., Mukunzi, J. N., Noorishad, P. G., Rousseau, C., Derivois, D., & Bukaka, J. (2020). A systematic review of mental health programs among populations affected by the Ebola virus disease. Journal of Psychosomatic Research131, 109966. https://doi.org/10.1016/j.jpsychores.2020.109966

Health promotion by community-based health programs is needed to provide health services to meet the needs of the population, improve access to health services, improve efficiency of the health system, and address inequities (Scott et.al., 2018). In creating a new community-based health program, the PROCEED-PRECEDE planning model can be used to complete a comprehensive assessment on the health needs of the population to design, implement, and evaluate health promotion. PRECEDE refers to Predisposing, Reinforcing, and Enabling Constructs in Educational Diagnosis and Evaluation. It involves a social assessment, epidemiological assessment, ecological assessment, and matching appropriate interventions that encourage desired changes. PROCEED refers to Policy, Regulatory, and Organizational Constructs in Educational and Environmental Development. PROCEED involves designing interventions, identifying resources, implementing the program, evaluating processes and desired outcomes, evaluating change in behavior, and the evaluation of incidence and/or prevalence of disease process attempting to improve (Precede-proceed model, n.d.).  

A community-based health program this DNP learner has envisioned collaborating on is a Sickle Cell Center to aide patients with Sickle Cell Disease (SCD) in receiving outpatient/community care in order to decrease the incidence of hospitalizations for acute SCD Vaso-occlusive crisis. The previous medical director of the Emergency department has discussed overseeing such a program as San Bernardino and Riverside County of California has a high population of patients with SCD. Many SCD patients seek primary healthcare in emergency departments with a high percentage requiring admissions. In order to make such a program successful and sustainable, the PROCEED-PRECEDE model will aid in development and sustainability. Furthermore, the program requires direction and oversight by community members who have a passion for working with patients with SCD. The success of programs also stems from networking and allocating resources (Ibemere, 2018).  

Ibemere, S. (2018). A case for community health programs for sickle cell anemia in low- to middle-income countries: An integrative review. Public Health Nursing35(6), 499–507. https://doi.org/10.1111/phn.12519 

Precede-proceed model – rural health promotion and disease prevention toolkit. PRECEDE-PROCEED Model – Rural Health Promotion and Disease Prevention Toolkit. (n.d.). Retrieved January 7, 2023, from https://www.ruralhealthinfo.org/toolkits/health-promotion/2/program-models/precede-proceed 

Scott, K., Beckham, S.W., Gross, M. et al. (2018) What do we know about community-based health worker programs? A systematic review of existing reviews on community health workers. Hum Resour Health 16, 39. https://doi.org/10.1186/s12960-018-0304-x 

REPLY

 I agree with you that community-based health programs is a form of health promotion. These programs have positive impact on the well-being of residents. However, some community-based health programs fail due to poor assessment. Effective assessment examines chances of the program attaining its goals. Choosing the right planning and evaluation model is a critical stage in developing successful community-based health program (Leyenaar et al., 2021). The PROCEED-PRECEDE planning model can be used to complete a comprehensive assessment on the health needs of the population to design, implement, and evaluate health promotion. The model provides the information required to decide whether to continue with the program or seek alternatives. Detailed assessment of the community-based health programs improve understanding (Khubchandani et al., 2021). The examination provides crucial information that influence future critical decision when running the project. PRECEDE refers to Predisposing, Reinforcing, and Enabling Constructs in Educational Diagnosis and Evaluation. PROCEED involves designing interventions, identifying resources, implementing the program, evaluating processes and desired outcomes. Both portions complement each other in the evaluation process.

References

Khubchandani, J., Sharma, S., Price, J. H., Wiblishauser, M. J., Sharma, M., & Webb, F. J. (2021). COVID-19 vaccination hesitancy in the United States: a rapid national assessment. Journal of community health46(2), 270-277.

Leyenaar, M. S., Allana, A., Sinha, S. K., Nolan, M., Agarwal, G., Tavares, W., & Costa, A. P. (2021). Relevance of assessment items in community paramedicine home visit programmes: results of a modified Delphi study. BMJ open11(11), e048504. http://dx.doi.org/10.1136/bmjopen-2020-048504

Community-based programs usually do seek individual-level behavior change. But, sometimes, they may also change the social environment, deliberately or otherwise, through recruitment of persons with healthy behavior and out-migration of those with risky behavior, e.g., a worksite health promotion program may succeed in institutionalizing a preference for nonsmokers in hiring decisions, and it may make workplace smoking policies uncomfortable for smokers so that they seek jobs elsewhere. A distinction can be made between community-based prevention and community-placed prevention, or community interventions versus interventions in communities, although both take a population-based approach. Community-based activity involves members of the affected community in the planning, development, implementation, and evaluation of programs and strategies. An example of this type of prevention effort is community-based participatory research, in which academic researchers who are usually in control of the decisions on the research question, design, methods, and interpretation of results invite or concede at least an equal partner role to community members in formulating, conducting, and interpreting the research. It is important to note that rarely are all members of a community involved and that for those who are, the level of involvement can vary tremendously (Health communities 2020).

The Community-based program development model to use is the Planned Approach to Community Health (PATCH) which is a community health planning model that was developed in the mid-1980s by the Centers for Disease Control and Prevention (CDC) in partnership with state and local health departments and community groups. PATCH is a process that many communities use to plan, conduct, and evaluate health promotion and disease prevention programs. The PATCH process helps a community establish a health promotion team, collect, and use local data, set health priorities, and design and evaluate interventions. Adaptable to a variety of situations, it can be used when a community wants to identify and address priority health problems or when the health priority or special population to be addressed has already been selected. It can also be adapted and used by existing organizational and planning structures in the community. The goal of PATCH is to increase the capacity of communities to plan, implement, and evaluate comprehensive, community-based health promotion programs targeted toward priority health problems. CDC promotes the use of PATCH in helping achieve the year 2000 national health objectives. These objectives aim to reduce the prevalence of modifiable risk factors for the leading causes of preventable disease, death, disability, and injury (Kreuter MW. 2017).

An important recent trend in health promotion and disease prevention has been the increasing number and scope of community-based interventions. These programs are aimed at entire populations, which are usually geographically defined, and they attempt to change health behavior and disease risk through mass media campaigns, activation of existing community organizations, or changes in the physical or sociocultural environment (Nelson, C.F et al. 2017).

References

Health communities 2020: Model standards, guidelines for community attainment of the year 2O2O national health objectives. (2020). Washington DC: American Public Health Association.

Kreuter MW. 2017. PATCH: its origin, basic concepts, and links to contemporary public health policy. Journal of Health Education 23(3):135–139. Available online at http://www​.cdc.gov/nccdphp/patch/.

Nelson, C.F., Kreuter, M.W., Watkins, N.B. & Stoddard, R.R. (2017). Planned Approach to community health. In P. Nutting, Community oriented primary care: From principle to practice. Washington DC: Department of Health and Human Services, DHHS HRSA-PR -86.

REPLY


It is true that individual-level behavioral change can also be an option for community-based health programs. However, the expected behavioral transformation is always positive. The transformation may seek to reduce vulnerabilities or improve community resilience levels to different health issues (Haldane et al., 2019). Assessment is a critical element that guarantee positive results out of behavioral change. Effective assessment examine the value of the proposed community-based health program. The target population is also involvement in assessment process. The findings from the assessment can be used in the implementation and running of community-based health programs. Community-based activity involves members of the affected community in the planning, development, implementation, and evaluation of programs and strategies (Assefa et al., 2019). The members of the victim community have accurate information that can be used to improve the reliability and significance of community-based activity. However, these members should work alongside other stakeholders including experts. Every part should be assigned different duties with the project.

References

Assefa, Y., Gelaw, Y. A., Hill, P. S., Taye, B. W., & Van Damme, W. (2019). Community health extension program of Ethiopia, 2003–2018: successes and challenges toward universal coverage for primary healthcare services. Globalization and health15(1), 1-11.

Haldane, V., Chuah, F. L., Srivastava, A., Singh, S. R., Koh, G. C., Seng, C. K., & Legido-Quigley, H. (2019). Community participation in health services development, implementation, and evaluation: A systematic review of empowerment, health, community, and process outcomes. PloS one14(5), e0216112. https://doi.org/10.1371/journal.pone.0216112

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