CHAPTER 26 Public Health Practice in Communities 325 I. STEPS IN DEVELOPING A HEALTH Are healthier food options in grocery stores available and affordable? Are they of goo PROMOTION PROGRAM low many homes, parks, hospitals, and schools have easy access to tobacco and are exposed to tobacco adver- Community Health Assessment and Group Evaluation. Are there tobacco-free campus policies in hospitals, on CHANGE is a comprehensive data collection tool and college campuses, and in multiunit housing? resource for con munity program planning with the follo ing steps(see Table 26-1) 1. PRECEDE/PROCEED Model 1. Define a strategy and assemble a team. 2. Identify primary health issues The PRECEDE-PROCEED tool, a planning model devel 3. Develop objectives to measure progres oped by Green and Kreuter, provides a comprehensive struc- 4. Select effective interventions ture for(1)assessing health and quality-of-life needs and (2) 5. Implement innovation for designing, implementing, and evaluating health promo- 6. Evaluate tion and other lic health programs to meet those nee Enforcing Some c Program and Enabling Constructs in Educational Diagnosis and Evaluation--outlines a diagnostic planning process to assist resources/programs are described in the development of targeted and focused public health where they have a strong emphasis. programs. The second part, PROCEED, provides an imple- mentation and evaluation program--Policy and Organizational Constructs in Educational VI- A. Define Strategy and Assemble Team PRECEDE. The process starts with desired outcomes and Broad-based participation in the planning process from the works backward to identify a mix of strategies for achieving participants include physicians, nurses, social workers, teach PRECEDE comprises the following five steps ers, emergency medical services(EMS)personnel, health come from churches, businesses, dental clini i educators, parents, and police. However, partners can alse Step I: Social assessment. Determining the quality of life ial problems and needs of a given population. To It is important to stress that building a coalition should come onduct a social assessment, the practitioner may use before gathering any data. There is no reason to gather data ultiple data collection activities(e. g, key informant on problems nobody is willing or able to change. Sustainable interviews, focus groups, participant observation, surveys) oalitions are those that utilize preexisting partnerships, have to understand the community's perceived need access to at least minimal levels of funding, are perceived as Step II: Epidemiologic assessment. Identifying the health well functioning, and plan for sustainability. determinants of these problems and needs. The epide iologic assessment may include secondary data ana- lysis or original data collection to prioritize the communitys health needs and establish program goals B. Identify Primary Health Issues and objectives The second step in program planning is to identify the Step Ill: Behavioral and environmental assessment. Ana primary health issues concerning the community. This yzing the behavioral and environmental determinants of involves a needs assessment(areas for improvement)as well the health problems. This step identifies factors, both asset mapping(identifying the people, institutions, av internal and external to the individual, that affect the able funds, and capacity to solve problems). Tools used in health problem. Reviewing the literature and applying creening and identifying overall problems in the commu theory are two ways to map out these factors nity include the following: Step IV: Educational and ecological assessment. Identifying the factors that predispose to, reinforce, and enable the PRECEDE-PROCEED model behaviors and lifestyles. Practitioners can use individual a Planned Approach to Community Health(patch) interpersonal, or community-level change theories to Mobilizing for Action through Planning and Partnerships classify determinants of behavior into one of these three (MAPP categories and rank their importance. Because each type National Public Health Performance Standards Program of factor requires different intervention strategies, classi NPHPSP) fication helps practitioners consider how to address com- u Data sources(see Chapter 25) Tools within the CHANGE process Step V: Administrative and policy assessment Ascertaining Examples for a needs assessment that emphasizes the which health promotion, health education, and policy environmental factors of diet, exercise, and smoking include related interventions would best be suited to encourage the following questions": PROCEED comprises four additional phases, as follows" Do sidewalks make walking(walkability) and biking(bike ability) easy and safe? Are they connected, continuous, Step VI: Implementation. Carrying out the interventions free from barriers and safe from traffic and crime from step V