Community Needs Assessment in Gerontology Nursing

Introduction to Program Planning

• Course: POH705, School of Occupational and Public Health, Toronto Metropolitan University
• Week: 11

Lesson Objectives

• Explore the PRECEDE-PROCEED planning framework
• Understand how the framework can be used to develop a health education program.
• Inform health educators on how to plan an efficient program.

Imagine, as a health educator

• A problem has been identified, and action is needed.
• Applying health behavior theories is crucial for effective program design and delivery.
• The PRECEDE-PROCEED framework provides a structure for applying theories into programs.
• It is a tool for designing, implementing and evaluating health education/promotion programs.

The PRECEDE-PROCEED Planning Framework

• PRECEDE is the diagnostic phase (identifying the problem/need).
• Educational diagnosis precedes the intervention plan.
• Interventions are planned to meet demonstrated needs.
• PROCEED is the intervention/implementation phase focused on social determinants influencing health behaviours.
• Participation of the target audience is important in defining the problem, goals and solutions.

PRECEDE and PROCEED

• PRECEDE:
  • P - Predisposing
  • R - Reinforcing
  • E - Enabling
  • C - Constructs in
  • E - Educational
  • D - Diagnosis
  • E - Evaluation
• PROCEED:
  • P - Policy
  • R - Regulatory
  • O - Organizational
  • C - Constructs in
  • E - Educational
  • E - Environmental
  • D - Development

The Precede-Proceed Planning Framework: Overview

• The framework works backwards, starting with the health outcome to diagnose effective intervention strategies.
• It involves prioritizing targets, and identifying measurable objectives.

Precede-Proceed Planning Framework (Diagram)

• The diagram illustrated various phases with connections between them (e.g., Phase 1 Social Assessment connects to Phase 2 Epidemiological, Behavioral, and Environmental Assessment).
• It shows relationships between phases.

Case Study: Smoking Cessation Program for Older Canadians in Nursing Homes

• Developed to address high rates of smoking among older adults in nursing homes.
• Used PRECEDE-PROCEED model to guide program development.
• Based on health behavior theories (e.g., Health Belief Model, Social Learning).

What is the first step in developing a program?

• Analyzing the needs and understanding of the community.

Phase 1: Social Assessment, Participatory Planning, and Situation Analysis

• Emphasizes broad participation to gain a comprehensive understanding of community aspirations.
• Multiple data collection activities (e.g., community forums, focus groups, surveys, key informant interviews, secondary data analysis).
• Identification of community perceptions, needs, challenges, capacity, strengths, resources, and readiness to change is essential.
• Identifying key stakeholders, like advisory council members, educators, and youth, is important.

How do we engage and collect this info?

• Planning committees
• Community forums
• Focus groups
• Surveys
• Key Informant interviews
• Secondary data analysis (e.g. StatsCan, population health assessments)

Example of Community-Engaged Planning

• Community-based research often starts with needs assessments in order to identify community priorities.
• Includes using digital tools alongside participatory methods.

Example: Needs Assessment with Ile-X

• Identification of priority areas for community health (e.g., COVID-19, climate change, mental health, food security).
• The methods used for this example are focus groups, key informant interviews.
• Identifying community perceptions, needs, desires, relevance, timing of issues, capacity, strengths, resources, readiness to change, determining who can lead, and identification of possible resources and existing infrastructure are important for community-based assessment.

PHASE 2: Epidemiological, Behavioural and Environmental Assessment

• Identifying health priorities.
• Determining factors influencing health priorities.
• Translating priorities to measurable objectives and creating program focus.
• Classifying factors as distal, proximal, or intermediate.
• Understanding how social and environmental factors influence health outcomes.
• Using secondary data and may require collection of primary data.

PHASE 3: Education and Ecological Assessment

• Identifies precursors and reinforcing factors for desired or undesired behavior change.
• Identifying predisposing, reinforcing, and enabling factors.
• Formulates objectives based on priorities.

Predisposing, Reinforcing, and Enabling factors

• Predisposing: antecedents related to motivation.
• Reinforcing: factors that influence behavior repetition.
• Enabling: antecedents that facilitate or hinder behavioral change.

What theories are relevant for Phase 3?

• Individual-level theories (e.g., Health Belief Model)
• Interpersonal-level theories (e.g., Social Cognitive Theory)
• Community/Organizational theories (e.g., Organization Change Theories).

Goal of the Program

• Broad general statements describing goals and objectives.
• Provides direction and focus for objectives.
• Defines the scope.

SMART Objectives

• Specific
• Measurable
• Achievable
• Realistic
• Time-sensitive

2 Types of Objectives

• Process objectives: Focus on activities completed within a set amount of time.
• Outcome objectives: Define expected results, answering who, what, where and when.
• Short-term objectives.
• Intermediate-term objectives
• Long-term objectives.

Case Study: PHASE 3

• Identify Contributing factors to smoking rates.
• Identify encouraging factors that either support or discourage smoking.
• Recognize Barriers and Facilitators to smoking.

Predisposing, Reinforcing, and Enabling Factors (in smoking cessation)

• Predisposing: Attitudes, knowledge, beliefs, personal preferences, skills of smokers and other staff.
• Reinforcing: Organizational, social, psychological, economic, and cultural factors that influence smoking rates in nursing homes.
• Enabling: Motivations, environmental factors that influence smoking behaviour.

Case Study: PHASE 5-8

• Identifying interventions based on policy and administrative diagnoses.
• Identifying desired individual and community-level interventions (e.g., smoke cessation counseling, prevent second-hand smoke).

PHASE 4: Administrative and Policy Assessment

• Selecting and aligning program components based on priorities and goals (determined by prior assessments).
• Prioritization of determinants of change.
• Identifying resources, organizational barriers/facilitators, and policies needed for implementation.
• Determining the level of alignment between assessment of these factors and selection of interventions.

Macro level interventions

• Interventions aimed at predisposing, reinforcing, and enabling factors.
• Includes individual, peers, and family influences on behavior change.
• Examples include media, counselling and advocacy.

Case Study PHASE 4 (Resource/Materials Needed for a Smoking Cessation Program)

• Human resources: nurses, behavioral therapists, addiction specialists, smoking cessation consultants.
• Material resources: pamphlets, lecture rooms, and medical supplies.
• Potential Barriers: (e.g., lack of resources, administration).
• Potential facilitators: (e.g., community support).

PHASE 5-8: Implementation and Evaluation

• Process evaluation: How a smoking cessation program is enacted (following protocols).
• Impact evaluation: Assessing changes in predisposing, reinforcing, and enabling factors, as well as in behavioral and environmental factors (e.g., smoking rates, exposure to smoke).
• Outcome evaluation: Determining the effect of the program on health and quality of life indicators.
• Includes formative, process, impact, and outcome evaluation.

Applied Examples

• Diabetes Management: Using the PRECEDE-PROCEED model for identifying health management strategies.
• Physical Activity Intervention: Using the PRECEDE-PROCEED model for tailoring and evaluating community-based interventions.
• Creating an inclusive environment: A living-lab case study applied the PRECEDE-PROCEED model to develop and evaluate an inclusive environmental program.
• Provides examples of applying the framework and potential outcomes.
• Includes specific outcome measures (e.g., changes in blood glucose levels, measures of physical activity, and inclusivity, measures through surveys and community feedback).

Canadian Best Practices Portal

• Resources for planning and evaluating programs.
• (URLs provided)

Final Exam:

• December 4.
• Consult the D2L announcements for exam details.