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