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99 Cards in this Set
- Front
- Back
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Community
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a grouping of people residing in a specific locality who interact and connect through a definite social structure to fulfill a wide range of daily needs
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Four components of a community
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-people
-a location in space -social interaction -shared values |
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Community nutrition strives to..
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-improve health
-nutrition -well-being |
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Focuses/Arenas of community nutrition
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-People – Individuals who will benefit from community nutrition programs
-Policy – Course of action chosen by public authorities to address a given problem, accomplished through laws, regulations, and programs -Programs – Instruments used to seek behavior changes that improve nutritional status and health |
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Public health focuses...
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on protecting, promoting, and restoring peoples’ health through applications of science, practical skills, and collective actions
**Increased emphasis on preventative health measures |
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Health Defined by World Health Organization
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A state of complete physical, mental, and social well-being …… not merely the absence of disease
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Health promotion focuses on...
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lifestyle (behavior) change to work toward optimum health
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A health promotion activity is called
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An intervention,
*It focuses on promoting health and preventing disease. |
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3 types of prevention efforts
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•primary prevention – preventing disease by CONTROLLING RISK FACTORS
•secondary prevention – detecting disease early through SCREENING and other forms of risk appraisal •tertiary prevention –TREAT AND REHABILITATE people with illness or injury |
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Two broad goals of healthy people 2010
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•Goal 1: Increase quality and years of healthy life
•Goal 2: Eliminate health disparities |
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4 Goals of healthy people 2020
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•Eliminate preventable disease, disability, injury, and premature death
•Achieve health equity, eliminate disparities, and improve the health of all groups •Create social and physical environments that promote good health for all •Promote healthy development and healthy behaviors across every stage of life |
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Intrapreneur
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the corporate employee who is creative and innovative
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Creativity and innovation
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assist the community nutritionist in achieving the broad goal of improved health for all
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A community nutrition Needs Assessment does the following...
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•Describes nutrition-related problems that exist in the community
•Indicates the felt or perceived needs of the community and its desire for a solution •Establishes priorities and identifies resources that exist to deal with the problem |
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Steps in Community Nutrition Assessment
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-Define the problem
-Set the parameters of the assessment -Collect data about the community, background conditions, and people who represent the target population -Analyze and interpret the data -Share the findings of the assessment |
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Elements in the statement of the nutrition problem...
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1.Issue (percentage of population with problem behavior or health outcome)
2.Risk 3.Key data – incidence or prevalence 4.Compare data to standard 5.Reasons for differences in data |
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Steps in setting the parameters of the assessment
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•Define “community”
•Determine purpose of assessment •Define target population •Set goals and objectives •Specify types of data needed |
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Steps to determining the target population
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-Background conditions
-Community conditions -Living, Working, and Social conditions -Individual lifestyle factors -Health/Nutrition status |
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Clearly Defined Goals and Objectives Determine
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1.Data to be collected
2.How data will be used |
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Goals
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-Broad statements about what assessment should accomplish
***One goal-->Several objectives |
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Objectives
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-Statement of outcomes and activities needed to accomplish goals
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Qualitative data is...
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-Subjective
***Can be obtained from key informants and stakeholders |
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MOST IMPORTANT PLANNING ACTIVITIES:
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a.Review purpose, goals, and objectives
b.Develop questions related to target population’s nutritional problem, how it developed, and factors that influence it c.Choose a method to obtain answers to these questions |
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Screening
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•In both clinical practice & community settings
•Value is compared with predetermined cut point or risk level |
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Focus Groups
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•Consisting of 5 – 12 people, in sessions of 1 – 3 hours
•Obtain insight about new services, opinions about creative concepts •Open-ended questions ***avoid bias |
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Sensitivity
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– proportion of individuals with the disease or condition
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Specificity
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– proportion without the disease or condition
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Validity
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– “accuracy” of instrument used to assess measurements
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Reliability
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– repeatability or precision
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Interviews with Key Informants
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•Should be done face to face
•People “in the know” in community •Discover if the target population perceives problem •Learn culturally appropriate actions |
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Factors That Trigger Program Planning
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1.Results of the community needs assessment
2.Mandate from an organization’s national office or from a federal agency 3.Research findings 4.Community leader or coalition 5.Availability of funding for new programs 6.Policy change |
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Reviewing results of community needs assessment...
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•Provides information about target population’s nutritional problem or need
•When a gap in services is identified, a new program may be developed to fill the gap •Provides information on health status, health behaviors, values of people in the community, availability of health services |
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Outcome objectives
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measurable CHANGES IN HEALTH or nutritional outcome
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Process objectives
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measurable activities carried out by team members of program, PROGRAM DELIVERY
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Structure objectives
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measurable activities surrounding budget, staffing, PROGRAM MANAGEMENT, resources, coordination
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The Intervention strategy...
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–Addresses how program will be implemented to meet target population’s nutritional need
–Can be directed toward individuals, communities, systems |
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Levels of Intervention
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Level I: Build awareness – PER-CONTEMPLATIVE TO CONTEMPLATIVE
Change attitudes and beliefs, increase knowledge of risk factors, seldom results in behavior change Level II: Change lifestyles – PLANNING TO ACTION Successful with small changes over time, using combination of behavior modification and education Level III: Create supportive environment for change - MAINTENANCE Create environments that support behavior changes made by individuals |
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Steps in developing a program
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•Set goals and objectives for the program
•Design the nutrition education component •Specify the program format •Choose program identifiers •Develop a marketing plan •Specify partnerships |
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Personnel Structure
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employees responsible for overseeing program and determining whether it meets objectives
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Data Systems
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manner in which data about clients, use of program, and outcome measures are recorded and analyzed
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Management Costs
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Calculate costs of program
***Includes direct and indirect costs |
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Direct costs
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salaries and wages, materials, travel, expenses
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Indirect costs
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office rental, utilities, janitorial
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Steps in program planning
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1.Review results of community needs assessment
2.Define program goals and objectives 3.Develop a program plan 4.Develop a management system 5.Identify Funding Sources 6.Implement the Program 7.Evaluate Program Elements and Effectiveness |
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Evaluate Program Elements and Effectiveness is important to...
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•Determine progress toward goals and objectives
•Determine whether goals are still appropriate •Ensure that program resources are being used properly |
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Reasons for undertaking evaluations
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•IMPROVE your program
•JUSTIFY your program or show accountability •DOCUMENT your program |
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Who conducts evaluation of the program?
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-Program staff
-other agency staff -outside consultants who are familiar with all aspects of the program ***best to be unbiased but informed |
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The program evaluation process may...
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-focus on one program element – the primary goal, objective
-be comprehensive and examine design, delivery, and use |
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Formative evaluation
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-testing and assessing program elements before implementing
Training to be delivered to teachers – test on pilot group to determine its effectiveness – improve if needed before program implementation |
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Process evaluation
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-examining program activities and how program is delivered
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Impact evaluation
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determining whether and to what extent a program ACCOMPLISHED ITS GOALS
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Outcome evaluation
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measuring whether program changed overall health status of target population
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Structure evaluation
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evaluating personnel and environmental factors related to program delivery
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Fiscal evaluation
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how outcomes compare with costs
(has Cost-benefit analysis and Cost-effectiveness analysis) |
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Challenges of multicultural evaluations develop based on...
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preliminary cultural assessment
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Epidemiology
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Study of the DISTRIBUTION and DETERMINANTS of health-related states and events, in specified populations, with the goal of understanding and controlling health problems
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Epidemiologists work with other health professionals to...
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•to identify causes of disease
•to propose strategies for controlling or preventing health problems in populations |
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Epidemiology can be used to
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•describe a community’s health problems
•determine whether health is improving or getting worse |
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Risk
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likelihood of individuals exposed to risk factors developing a particular health problem
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Relative Risk =
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Risk of disease or death for exposed persons/
Risk of disease or death for unexposed persons ***comparison of the risk between two groups |
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Relative risk number ranges
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RR = 1 association neutral
RR > 1 an increased risk for the outcome, association harmful RR < 1 a reduced risk for the outcome, association protective |
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Incidence
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proportion of a population that develops a disease over time
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Prevalence
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proportion of a group possessing a disease at a specific
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Epidemiological Method
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1.Observing
2.Counting cases or events 3.Relating cases or events to the population at risk 4.Making comparisons 5.Developing the hypothesis 6.Testing the hypothesis 7.Drawing scientific inferences 8.Conducting experimental studies 9.Intervening and evaluating |
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Hypothesis testing
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Identify a cause-effect comparison to be tested
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Bias
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The observation was incorrect because a synthetic error was introduced)
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Chance
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The observation was incorrect because of error rising from random variation
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Truth
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The observation is correct
***This explanation should be accepted only after the others were excluded |
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Ecological or correlational studies
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Compare disease rates with per capita consumption of specific food components
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Cross-sectional or prevalence studies
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"Snapshot” of a population – comparing dietary intake, disease, other variables in a population at one time
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Cohort or incidence studies
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A group of people are followed over time to see who develops a particular disease and what risks they have been exposed to
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Case-control studies
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Comparing a group with a disease with a group that does not have it
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Controlled trials
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Compare intervention group with usual care group
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Levels of food consumption
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-National level – food balance sheets
-Household level – household food consumption -Household level – household food consumption **(diet record is the gold standard) |
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Steps in interpreting epidemiological data:
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•Evaluate criterion for causal association carefully
•Assess causal association critically for bias and chance **Need to critically evaluate scientific literature before formulating new nutrition policies or offering advice about eating patterns |
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HILL’S CRITERIA
For Interpreting Data Related to Causality and Association |
1.Chronological Relationship
2.Strength of Association 3.Intensity or Duration of Exposure 4.Specificity of Association 5.Consistency of Findings 6.Plausibility |
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Policy making
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process by which authorities decide what actions to take to address a problem or set of problems
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Problem
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“substantial discrepancy between what is and what should be” plenty of food and still malnutrition among children
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Policy
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course of action chosen by public authorities to address a given problem
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The process of policy making
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1.Problem definition and agenda setting
2.Formulation of alternatives 3.Policy adoption (can occur on a local, state, or national level) 4.Policy implementation (May involve a large number of people and organizations to carry out the process) 5.Policy evaluation 6.Policy termination |
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Who makes policy?
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•An organization’s or committee’s executives, administrators, committees
•Elected officials •Employees of municipal, state or federal agencies •Members of Congress and state legislators •Street-level bureaucrats |
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Laws passed tend to be...
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***vague
They define the broad scope of the policy to permit maximum flexibility of interpretation for diverse populations and a range of resources •Administrative bodies must interpret the law and provide detailed regulations known as “Secondary Legislation” |
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How an idea becomes a law
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1.A concerned citizen, group, or organization brings an ISSUE to the attention of a legislative representative at the local, state, or national level.
2.A BILL IS WRITTEN AND SUBMITTED to the clerk where it is numbered and printed. It must be SPONSORED by at least one legislative member (House, Senate, or both). 3.Bill REFERRED to committee and subcommittee – the greatest challenge is getting out of committee with a favorable vote. 4.MARKUP sessions by subcommittee and committee revise the original bill 5 COMMITTEE VOTES on whether to send the bill forward to the full House or Senate with a favorable vote or table it 6.Approved bills go before the FULL MEMBERSHIP for debate, amendment, and vote 7.If the bill PASSES, it goes to the OTHER BODY of legislature or Congress for the same actions 8.Finished versions of the bill will probably differ between bodies, so a conference COMMITTEE will meet to resolve differences 9.Modified bill that is agreed upon is sent to the PRESIDENT (GOVERNOR) for action |
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The presidential (governor) can...
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•Sign into law
•Veto and return to legislature (Congress) – need 2/3 vote by each house to override •Take no action while Congress is in session – the bill automatically becomes law |
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Enactment
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•Law is referred to appropriate agency responsible for issuing guidelines or regulations
•Agency writes guidelines or regulations •Publication of proposed guidelines for public review •Mandatory comment period of 30–60 days for public response |
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Mandatory spending
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For entitlements – programs that require payments to anyone who is eligible
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Discretionary spending
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Choices made in defense, energy assistance, nutrition assistance
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Budget Authorization
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•establishes programs
•sets a ceiling on spending •does not provide money |
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Budget Appropriation
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•provides money for programs; may be for
•a single year •specified period of years (multi-year appropriations) •an indefinite number of years (no-year appropriations) |
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How You Can Influence the Policy Making Process
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-Make your opinion known
•Write letters to local, state, or federal legislators •Make telephone calls to elected officials •Conduct a public forum on an issue -Become directly involved •Run for political office •Collect signatures for a petition to send to legislature -Join an interest group •Trade associations •Professional organizations •Public interest groups |
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Political Action Committees (PACs)
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•“political arm” of interest group
•raises money to support candidates whose views are favorably aligned with the group’s missions and goals |
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Lobbying
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provide technical information to policy makers to help pass legislation
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Building coalitions (networks and other alliances)
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joining with smaller groups to influence the political system
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Pandemic
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Worldwide
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Epidemiology
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-Can be used to describe the health status of a community
-Prevention and population (not treatment and individual) |
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Vision of healthy people 2020
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A society in which people live long, healthy lives
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Mission of healthy people 2020
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-Identify nationwide health improvement priorities
-Increase public awareness and understanding of the determinants of health, disease, and disability and the opportunities for progress -Provide measurable objectives and goals that can be used at the national, state, and local levels -Identify critical research and data collection needs |
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healthy literacy
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the degree of which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions
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Ways to promote good health
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-safe environment
-enhance immunity -sensible behavior -good nutrition -well-born children -prudent health care |
