Community health promotion using ecological models and participatory strategies

Community Health Promotion Proposal

The objective of this study is propose a community health initiative. This will be accomplished by reviewing priorities for health promotion stated by Healthy People 2020.

The work of Navarro et al. (2007) entitled "Charting the Future of Community Health Promotion: Recommendations From the National Expert Panel on Community Health Promotion" published by the Centers for Disease Control and Prevention reports "In the decades since chronic illnesses replaced infectious diseases as the leading causes of death, public health researchers, particularly those in the field of health promotion and chronic disease prevention, have shifted their focus from the individual to the community in recognition that community-level changes will foster and sustain individual behavior change." (p. 1) It is stated that the National Center for Chronic Disease Prevention and Health Promotion and the Division of Adult and Community Health "invited an external panel of experts to participate in the National Expert Panel on Community Health Promotion" in order to identify methods that these problems could be addressed at the local and national levels. (Navarro et al., 2007, p. 1) Community health promotion is such that "emphasizes the social, cultural, and environmental contexts that shape health status and works through collaborative partnerships to improve the health of a population within a defined geographic area. Community-based participatory strategies, such as community organization and mobilization, bring to bear shared values and experiences of community members, who are viewed as having the best knowledge of and perspective on improving the health of their community. The community is regarded as an influential determinant of health, and community members are involved in all aspects of public health research, interventions, and evaluations." (Navarro et al., 2007, p. 1) It is reported that the largest challenge that presents to public health leaders is the emphasis of the "important role of long-term community health promotion in addressing the social and environmental determinants of health in an atmosphere that demands evidence of health impact and return on investment." (Navarro et al., 2007, p. 1)

Findings stated by the expert panel include that "ecological models have been useful in furthering community health promotion efforts, particularly as they relate to environmental influences on health status and behavior. In addition, the panel acknowledged CDC's valuable role in validating effective practices of community health promotion and supporting community-based participatory research and public health surveillance. The panel also affirmed CDC's role in disseminating public health knowledge across communities and serving as the voice among federal agencies for community health promotion." (Navarro et al., 2007, p. 1)

The expert panel is reported to have noted that "… even the best operational measures of the socioecological approach missed critical opportunities for change, including mental health and wellness, spirituality, and complementary and alternative medicine; access to care; political and economic contexts of decisions; race, racism, and discrimination; cultural beliefs and values as risk factors and protective factors; and elements of community efficacy, such as social capital and community competencies. The panel reported the need for an ecological approach to be sufficiently flexible to allow community choices based on available resources and local realities. Additionally, future approaches should facilitate discussions on power relationships, the political process, chronic social stressors (e.g., poverty), acute situations (e.g., hurricanes), and the engagement of nontraditional partners." (Navarro et al., 2007, p. 1)

Included among the panel recommendations are the following stated recommendations: (1) there needs to be enhancement of "surveillance systems beyond the tracking of individual risk factors to include community health indicators and social determinants of health; (2) promotion of participatory research that is community based; (3) training and capacity building need to be supported to make sure that the public health workforce is in possession of the "knowledge, skills, and tools necessary to implement community health promotion approaches; (4) promotion of a "state-of-the-art e-mechanism to share expertise and knowledge about community health promotion"; (5) support of a focus on wellness to include "mental health, spirituality, and complementary and alternative medicine (CAM); (6) There is a need to "shift a measurable part of NCCDPHP's community health promotion programs to focus on improving living conditions across the lifespan"; (7) there is a need for maximizing the "impact of federal resources dedicated to community health promotion"; and (8) a need exists to provide "funding tailored to the realities of community health." (Navarro et al., 2007, p. 1)

The work of Freudenberg and Ruglis (2007) entitled "Reframing School Dropout as a Public Health Issue" published by the Centers for Disease Control and Prevention reports that good education is predictive of "good health, and disparities in health and in educational achievement are closely linked. Despite these connections, public health professionals rarely make reducing the number of students who drop out of school a priority, although nearly one-third of all students in the United States and half of black, Latino, and American Indian students do not graduate from high school on time." (p.1) Additionally reported by Freudenberg and Ruglis is that while education is "highly correlated with income and occupation, evidence suggests that education exerts the strongest influence on health." (2007, p. 1) In fact, education of a formal nature is reported as "consistently associated with lower death rates, while less education predicts earlier death. The less schooling people have, the higher their levels of risky health behaviors such as smoking, being overweight, or having a low level of physical activity." (Freudenberg and Ruglis, 2007, p. 1) Health interventions focused on reductions in school dropout rates are such that have the objective of changing "individuals, families, schools, school systems, or public policies related to poverty, welfare, or employment. Interventions that have the potential to improve school achievement and reduce school dropout rates by improving the health of students are of particular interest to health professionals." (Freudenberg and Ruglis, 2007, p. 1) Interventions that are school-based are reported to include "coordinated school health programs; health clinics; mental health programs; substance abuse prevention and treatment programs; comprehensive sex education, human immunodeficiency virus infection prevention, and pregnancy prevention programs; special services for pregnant and parenting teens; violence prevention programs; and interventions to change the schools' social climate." (Freudenberg and Ruglis, 2007, p. 1)

Five priorities for action were recommended by Freudenberg and Ruglis including the following stated five recommendations: (1) Targeting of schools and cities that had the highest rates of dropout for problems that needed intensive intervention; (2) Development, implementation and evaluation of health interventions that serve to bring about improvement in completion rates of students; (3) Strengthening of support for teachers of health education as well as the development and implementation of "new approaches to school-based health education and health services that can reduce dropout rates will require well-trained school health education teachers, nurses, and mental health professionals, each currently in short supply" (Freudenberg and Ruglis, 2007, p. 1); (4) Advocacy for interventions that are evidence-based and that serve to improve health as well as bring about a reduction in dropout rates; and (5) Placement of the reduction of "high school dropout rates on the public health agenda." (Freudenberg and Ruglis, 2007, p. 1)

I. Health Promotion Initiative

The health promotion initiative chosen for this study is one that involves health promotion at the community level led by nurse practitioners. The information previously reviewed in the introduction of this study supports health promotion, education promotion and due to the shortage of health professionals available in today's workforce, specific promotion of educational initiative and opportunities in the field of health care is at focus.

III. Supporting Education for Nursing Students

The American Association of Colleges of Nursing reports that "Nursing colleges and universities across the country are searching for creative solutions to increase the number of registered nurses in response to the growing shortage. Budgetary constraints, a limited pool of nursing faculty, insufficient clinical sites, and a lack of scholarship monies are all barriers to expanding student capacity and meeting the projected demand for nursing care." (2014, p. 1) Overcoming these challenges is requiring collaboration between nursing institutions and their clinical partners in addition to other stakeholders in what is described as an "effort to build student capacity and satisfy mutual needs." (American Association of Colleges of Nursing, 2014 p. 1)

It is additionally reported that these are partnerships that are taking "many forms and serve various functions." (American Association of Colleges of Nursing, 2014 p. 1) The report states that some of the colleges and schools are utilizing "expert practitioners to augment the nursing faculty supply. Others involve collaborative arrangements among nursing education programs to increase student enrollments. Some service partners share physical resources and infrastructure with schools as a means of overcoming limitations in clinical, classroom, and research space. Still others form partnerships to provide tuition forgiveness to students in exchange for work commitments." (American Association of Colleges of Nursing, 2014 p. 1)

The report relates that the initiative is making great progress towards supporting the advance of the nursing profession and making a difference in the shortage in nursing. American Association of Colleges of Nursing, 2014 p. 1) The community health nursing professional or the nurse practitioner has the unique potential to form such types of partnerships with universities for example "The University of Cincinnati has established a long-standing collaboration with the university hospital to develop and implement an institute for nursing research. Through this relationship, the college has access to an acute care setting ideal for implementing faculty-led research programs, and the hospital obtains research expertise needed to maintain an active program of evidence-based nursing practice. The hospital also provides an ideal site for graduate students to collaborate with agency personnel on research projects" (American Association of Colleges of Nursing, 2014 p. 1) In fact, the report relates that this collaboration "Since 1996…has resulted in more than $700,000 in grants, contracts, and income to the hospital, while the college has benefited from an annual substantial gift from the hospital to support college personnel." (American Nurses Association, 2014 p. 1) In yet another initiative,

"Georgia Governor Roy E. Barnes announced the establishment of a $4.55 million public/private partnership between Georgia health care providers and the University System of Georgia, which will increase the number of health professionals in the state by more than 500 over the next two years. Participating health care employers have committed to providing jobs for new fast-track graduates in 19 Georgia communities, bringing much needed health care services to citizens. With the vast majority of grants awarded to fund nursing education, the partnership will produce 294 registered nurses prepared at the baccalaureate level and 180 nurses prepared at the associate degree level." (American Association of Colleges of Nursing, 2014 p. 1)

Capstone College of Nursing at the University of Alabama is reported to have "launched a Cooperative Education Program that allows students to alternate full-time study with work in a local hospital. Through this arrangement, students are paid to work full-time at a hospital during their summers and for two spring semesters while upperclassmen. As students gain more training and experience, they advance in their work responsibilities and earn more money." (American Association of Colleges of Nursing, 2014 p. 1)

The American Association of Colleges of Nursing additionally reports that the University of Miami has an initiative that involves the pursuit of "collaborations with a regional Health Alliance with the goal of graduating more nursing students and improving attrition rates. Through this partnership, the Alliance builds relationships with potential nursing recruits by pairing students with nurses in their system who serve as mentors, offering scholarships, and funding a faculty position to support students at risk. Students have especially enjoyed the mentor-mentee relationship and the chance to learn from an experienced nursing professional." (American Association of Colleges of Nursing, 2014 p. 1)

Summary and Conclusion

Accomplishing these types of partnerships is time-consuming and requires a great deal of communication and meeting with others in forming the partnerships. The community health promotion initiative requires that the nurse practitioner focus on building these types of partnerships between health care institutions and local schools colleges and universities.

Support of higher levels of attendance in school by students will additionally serve to promote the health of the community since as demonstrated in the literature reviewed in this study, the higher level of educational achievement of the individual supports higher levels of health maintenance due to the greater knowledge of the individual and the community-at-large about how to maintain their health.

Community educational initiatives such as the one related in this study in a community to educate them about clean water is just one of the ways that the nurse practitioner can support health at the community level.

The greatest need in community health promotion is collaboration and cooperation between the nurse practitioner, various actors and stakeholders including schools, colleges and universities.