Community Health Chapter 4

Front 1

Behavior Change models

Back 1

models that assist clients, groups, and communities to redirect activities toward health and wellness

Front 2

Ecological model

Back 2

Models that consider intrapersonal attributes, interpersonal dynamics, person/environment interactions, cultural beliefs, and attitudes

Front 3

Health

Back 3

A quality, an ability to adapt to change, or a resource to help cope with challenges and processes of daily living

Front 4

Health belief model

Back 4

A behavior change model that considers the severity of the potential illness or physical challenge, the level of conceivable susceptibility, the benefits of taking preventive action, and the challenges that may be faced in taking action toward the goal of health promotion

Front 5

Learning model

Back 5

A behavior change model emphasizing reinforcement of social competence, problem solving, autonomy, and sense of purpose

Front 6

Modifiable risk

Back 6

Susceptibility to disease or injury that can be controlled by individual people, families, or communities

Front 7

Motivational interviewing

Back 7

Client-centered communication style for eliciting behavior change by helping clients and groups explore and resolve ambivalence to change.
Very interdependent with the stages of change model.
One of the things we do is help patients come to an awareness of whatever the issue is that causes them ambivalence

Front 8

Primary prevention

Back 8

Pre-pathology
Maximizing health and wellness through strategies that are set in place before illness or injury are present

Front 9

Secondary prevention

Back 9

During early pathology
Maximizing health and wellness through strategies that are set in place at the early and active chronic stages of pathogenesis of illness and injury

Front 10

Tertiary prevention

Back 10

Late stage of pathology
Maximizing health and wellness through strategies that are set in place at the palliation and end-stage of disease and injury trajectories

Front 11

Relapse prevention model

Back 11

A change model that is used primarily to assist those struggling with relapse and recovery from substance use

Front 12

Risk reduction

Back 12

Decreasing the chance of developing an illness, experiencing an injury, or being faced with chronic sequelae of both

Front 13

Social learning

Back 13

A behavior change model that considers environmental influences, personal factors, and behavior as key components to change

Front 14

Theory of reasoned action

Back 14

A behavior model emphasizing that individual performance of a given behavior is primarily determined by a person's intention to perform that behavior

Front 15

Transtheoretical model

Back 15

sequential approach to behavior change on the basis of process across stages and timely readiness of the learner. The stages are as follows:
1. Precontemplation
2. Contemplation
3. Preparation
4. Action
5. Maintenance
6. Relapse

Front 16

Well-being

Back 16

A subjective perception of full functional ability as a human being

Front 17

What are the ten key components of public health practice that are central to keeping populations healthy and safe?

Back 17

o Preventing epidemics
o Protecting the environment, workplaces, and sources of food and water
o Promoting health behavior
o Monitoring the health status of the population
o Mobilizing community resources into service
o Responding to disasters
o Assuring the public that there are trained personnel to assist them and that there is access to areas for health care
o Reaching out to those at high risk
o Researching risk, disease acquisition, and ways to prevent injury through interventions
o Influencing policy to acquire resources to effect change

Front 18

What are the two main components of the healthy people initiatives?

Back 18

• To increase quality and years in health life
• To eliminate any barriers to accessing care, specifically through health disparities.

Front 19

What is the focus of epidemiological model of prevention?

Back 19

Modifiable risk factors

Front 20

How do epidemiologists make conclusions about the direction of further study?

Back 20

By considering relative risk of an agent causing a problem, consistency, exposure, and timing

Front 21

Describe the precontemplative stage of change in the transtheroetical model

Back 21

little thought about problem or solution
Eg. you come to the doctor and discover for the first time that you have high blood pressure

Front 22

Describe the contemplative stage of change in the transtheroetical model

Back 22

problem and potential methods, costs, and benefits are evaluated
This is where a nurse can be especially helpful in guiding the patient’s thinking and understanding about his health issues
Costs may include a yucky pill

Front 23

Describe the preparation/determination stage of change in the transtheroetical model

Back 23

focus on specific course of action/timetable to commit energies to change

Front 24

Describe the action stage of change in the transtheroetical model

Back 24

steps taken on regular basis, behavior change made

Front 25

Describe the maintenance stage of change in the transtheroetical model

Back 25

“action” stage behaviors become the new normal

Front 26

Describe the relapse phase of the transtheoretical model of change

Back 26

return to an earlier stage
Relapse is the norm for the majority of behavior change efforts
Letting the patient know will take the stigma away from it

Front 27

What are important factors involved in motivational interviewing?

Back 27

• MI based on Reactance – people motivated to maintain autonomy, therefore become resistant when perceiving that autonomy is threatened
• People more likely to change behavior if NOT pressured from the outside
• Exhorting, threatening dire consequences, criticizing, inspiring do not seem to work
• Most patients do not enter an encounter seeking/ready to change behavior
oPatients don’t anticipate illness – they expect you to tell them that everything is great
• Clinician’s role is to instruct and acknowledge that there may be ambivalence about changing behavior
• Major criticism is that this is very time-consuming

Front 28

What are the general principles of motivational interviewing?

Back 28

• Express Empathy, reflective listening
• Develop Discrepancy between client goals and current problem behavior by use of reflective listening and objective feedback
• Areas of discrepancy may include behaviors versus goals
• Roll with Resistance rather than confronting or opposing it – avoid argumentation by assuming that the client is responsible for the decision to change
• Support Self-efficacy and optimism for change

Front 29

What does RULE stand for? (related to MI)

Back 29

• Resist the righting reflex
• Understand your patient’s dilemma and motivations
• Listen to and
• Empower your patients

Front 30

What does OARS stand for? (related to MI)

Back 30

• Open-ended questions
• Well-timed affirmations
• Reflective listening
• Summarize

Front 31

What are caveats related to MI?

Back 31

• MI is more about the spirit than clinging desperately to the techniques
• Listen for:
o Change talk: statements that signal desire, commitment to change or
o Resistance talk: oppositional, angry, irritable

Front 32

What are 7 strategies of MI?

Back 32

o Discuss lifestyle and stresses
o Describe a typical day
o The good things and the less good things – find out why the patient thinks something is “less good” – and then summarize the good things and less good things that they identified
o Providing information – eg lab trends
o The future and the present
o Exploring concerns
o Helping with decision making
(hesitance to discuss it is evidence of less readiness to change)

Front 33

What is a brief negotiation interview?

Back 33

• Incorporate MI techniques/spirit
• Particularly useful in settings where time with patient is short – ER< 15 min. primary care visit
• May use adjunctive strategies to supplement brief MI strategies – telephone, mailing printed materials, etc.

Front 34

What is andragogy?

Back 34

Assessing the learner's teaching-learning style
eg. auditory, visual, tactile

Front 35

What are examples of effective teaching-learning strategies for adults?

Back 35

• Active involvement
• Information is repeated
• Important and related to real-world problems
• Relate activities to learner-focused goals
• Answers questions before proceeding
• Listens to and respects opinions of learners

Front 36

What are three key considerations in assessment of the learner?

Back 36

1. Emotional readiness
2. Experiential readiness
3. Barriers to learning

Front 37

What are examples of barriers to learning?

Back 37

• Emotion or experiential non-readiness
• Education level re: how much they can understand
• Changing habits can be very hard
• Their perceptive of YOU

Front 38

What are three components of the Unified Health Communication?

Back 38

1. Cultural competency
2. Health literacy
3. Language proficiency

Front 39

What are three consequences of low literacy

Back 39

• Cancer screening information may be ineffective; as a result, patients may be diagnosed at a later stage
• Treatment options may not be fully understood; therefore, some patients may not receive treatments that best meet their needs
• Informed consent documents may be too complex for many patients and consequently, patients may make suboptimal decisions about accepting or rejecting interventions

Front 40

What are 3 consequences of low literacy related to Type 2 diabetes?

Back 40

o Worse glycemic control
o Higher rates of retinopathy
o Contributes to the disproportionate burden of diabetes and related problems among disadvantaged populations

Front 41

What are five skills needed for health literacy?

Back 41

• Visually literate (able to understand graphs or other visual information)
• Computer literate (able to operate a computer)
• Information literate (able to obtain and apply relevant information)
• Numerically or computationally literate (able to calculate or reason numerically)
• Difficulty with pain scale if not numerically sophisticated

Front 42

What are five skills that patients need for health literacy?

Back 42

• Evaluate information for credibility and quality
• Analyze relative risks and benefits
• Calculate dosages
• Interpret test results
• Locate health information

Front 43

What are two examples of readability tools?

Back 43

Flesch-Kincaid scale
SMOG calculator

Front 44

Are health and well-being subjective or objective?

Back 44

Subjective

Front 45

What are core activities for nurses as defined by the department of Health and Human Services?

Back 45

1. Preventing epidemics
2. Protecting the environment, workplaces, and sources of food and water
3. Promoting health behavior
4. Monitoring the health status of the population
5. Mobilizing community resources into service
6. Responding to disasters
7. Assuring the public that there are trained personnel to assist them and access to areas for healthcare
8. Reaching out to those at high risk
9. Researching risk, disease acquisition, and ways to prevent injury through interventions
10. Influencing policy to acquire resources to effect change

Front 46

What is health promotion?

Back 46

It is an action or effort that supports the well-being of individual people, groups, and communities by reducing risk of illness and injury

Front 47

What are some examples of noncommunicable diseases?

Back 47

- Depression
- Substance abuse
- Obesity
- Workplace injuries
- Genetic disorders (scoliosis, down syndrome)

Front 48

What are some examples of primary prevention?

Back 48

Immunizations
Driver's safety classes
Healthy water quality
healthy air quality
Health education classes
Improving safety designs of equipment
Fire safety
Decreasing exposure to sun
Use of environmentally safe products
Using seat belts
Using earplugs and safety glasses

Front 49

What are two ways of acquiring passive immunity?

Back 49

- Through momma
- Through blood products, including IVIGs

Front 50

To screen effectively for the presence of diseases, a test should be...

Back 50

1. cost-effective
2. easy to use
3. available to large sectors of the population at risk
4. Sensitive and specific enough to identify true positives and true negatives
5. Backed by a healthcare infrastructure that can address programs of care for people who have a verified risk of disease or physical challenge
6. Acceptable to clients

Front 51

What are examples of secondary prevention?

Back 51

1. Mass screening: applied to the entire population
2. Selective screening: performed for specific high-risk populations
3. Multiphasic screening: variety of screening tests applied to the same population on the same occasion. Data can be used for establishing baseline data in a healthcare facility and for risk factor appraisal (multiple blood tests)
4. Case finding: clinician's search for illness as a part of a client's periodic health examination

Front 52

What is sensitivity?

Back 52

Testing correctly to identify persons who have the disease/physical challenge
High sensitivity: true positive
Low sensitivity: False negative

Front 53

What is specificity?

Back 53

Testing to identify persons who do not have the disease
High specificity: true negative
Low specificity: false positive