COMMUNITY HEALTH NURSING CONCEPTS Definition of Community Health Nursing According to Jacobson: ● It is a learned practice discipline with the ultimate goal of contributing to the promotion of the client's OLOF (Optimum Level of Functioning) through teaching and delivery of care - promote health According to WHO: ● It is a special field of nursing that combines the skills of nursing, public health and some phases of social assistance and functions for the promotion of health, improvement of social and physical conditions and rehabilitation of illness and disability - health centers offer free services and medicines By American Nurses Association (ANA). ● “The synthesis of nursing practice and public health practice applied to promoting and preserving the health of the populations.” – population group ● ● ● ● Philosophy of Community Health Nursing A philosophy is defined as “a system of beliefs that provides a basis for and guides action.” A philosophy provides the direction and describes the whats, the whys and the hows of activities within the profession. Philosophy: According to Dr. Margaret Shetland, the philosophy of CHN is based on the worth and dignity of a man ○ treat everyone equally “ We should do what we can to make life better for our brothers and sisters around the world” Principles of Community Health Nursing by Mary S. Gardner and Cobb/Jones Leahy 1. Community Health Nursing is based on the recognized needs of communities, families, groups and individuals. 2. The Community Health Nurse must fully understand the objectives and policies of the agencies she represents. 3. In Community Health Nursing, the family is the unit of service. 4. Community Health Nurse must be available to all. 5. Health teaching is the PRIMARY responsibility of the Community Health Nurse 6. The Community Health Nurse works as a member of the health team - The nurse should collaborate with other healthcare members for CURATIVE, PREVENTIVE & REHABILITATIVE aspect 7. There must be provision for periodic evaluation of Community Health Nurse services 8. Opportunities for continuing staff education programs for nurses must be provided by the agency. 9. The Community Health Nurse makes use of available community health resources 10. The Community Health Nurse utilizes the already existing active organization in the community 11. There should be accurate recording and reporting in Community Health Nursing Features of Community Health Nursing ● Preventive Approach to health ○ Primary – related act directed and preventing problem before its occurs by other susceptibility or other exposure or other susceptible individuals ○ Secondary – refers early detected and prevention during the period of early disease pathogenesis ○ Tertiary – target population that has experiences disease or injury and focuses on limitation of this ability and rehabilitation ● It is characterized by being population or aggregate – focused. – move direct care to individuals & family ● It is developmental in nature ● With existence of prepayment mechanism for consumers of community health nursing services ● Care for different levels of clientele Different Fields of Community Health Nursing Community Health Nursing is considered a broader and more general specialty area that encompasses subspecialties which includes: 1. Public Health Nursing ➔ Seen as a subspecialty nursing practice generally delivered within “official” or government agencies. 2. School Health Nursing ➔ Aims to promote the health of school personnel and pupils/students. ➔ It aims to prevent health problems that could hinder students learning and performance ● Legal Basis: - Republic Act 124 mandates that all schools are to provide school clinics for the treatment of minor ailments and emergency cases ● Eight Components of School Health Services are: - Health Education, Physical EducationHealth Services, Nutrition Services, Counseling, psychological and social services, Healthy School Environment, Health Promotion for Staff. Lastly, the Family & CommunityInvolvement ● Health Appraisal Activities To Be Performed By The School Nurse: ○ I. Health Assessment - Done once a year. Priority should be given to Grade I enrollee; ○ II. Rapid ClassroomInspection - It should be done after a long vacation, between health examination, or when there is an impending or actual epidemic; ○ III. Vision Testing - Test for visual acuity should be done once a year, preferably at the beginning of school year; IV. Height and Weight Measurement a. Measurement of height, weight is done at beginning & end of school year. b. Pupils who are recipients of rehabilitative supplementary feeding programs should be weighed every quarter. ● Health Status Of Public School Pupils In Public Schools: - infectious diseases (respiratory tract infections and diarrhea), worm infestations and Dental caries 3. Occupational Health Nursing ● As defined by American Association of Occupational Health Nurses (AAOHN) as a specialty practice that focuses on promotion, prevention and restoration of health within the context of a safe and healthy environment. ● It includes the prevention of adverse health effects from environmental hazards. ● It provides for and delivers occupational health and safety programs and services to clients. 4. Community Mental Health Nursing ● Unique clinical process that includes concepts of nursing, mental health, social psychology and community networks including social sciences. Focus is on the Mental Health Promotion ● The application of specialized knowledge to populations and communities to promote and maintain mental health and rehabilitate communities. Goal of Community Health Nursing ● ● ● ● ● ● ● Promote healthy lifestyle Prevent disease and health problems Provide direct care Educate community about managing chronic conditions and making healthy choices Evaluate a community’s delivery of patient care and wellness projects Institute health and wellness programs Conduct research to improve healthcare Theoretical Models / Approaches How Theory Provides Direction to Nursing By Chinn & Kramer Goal of theory is to improve nursing practice < > Theory or part of theoretical framework will guide practice achieve the goal > < Using theory in NCP guides in assessing nursing situation - allows to plan & not get lost > Theory-based practice By Barnum Theory is like a Map… not in full terrain BUT picks out area that are imp By Schwartz-Barcott Ruling in & Ruling out Concept < guides data collection & interpretation Definition of Theory by Woods & Catanzaro ● A systematic VISION of reality, a set of interrelated concepts that is USEFUL for PREDICTION & CONTROL by Torres ● Theory provides a way of thinking about & looking at the world around us ● Organizes relationships between complex events that occur in nursing situation so that we can assist human being by Dickoff & James ● Conceptual system or framework invented for purpose. ● Purpose varies, so too the structure & complex of system by Chinn & Kramer ● Creative/ Rigorous structuring of ideas ● Projects tentative, purposeful, systematic view of phenomena by Pry, Machuk ● Set of ideas, hunches, hypotheses ● Provides prediction, explanation of the world Theoretical Models / Approaches 1. Health Benefit Model (HBM): 1958 ➔ Developed in 1958 by a group of U.S. ➔ Public Health Service social psychologists. ➔ Believed that individual must know what to do and how to do it before they can take action. Major limitation of HBM is that it places the burden of action exclusively on the client. ➔ a theoretical model that can be used to guide health promotion and disease prevention programs ➔ used to explain and predict individual changes in health behaviors –wanted to explain why do few people participates in programs to prevent & detect tuberculosis ➔ it is one of the most widely used models for understanding health behaviors Key Concept and Definition of HBM 1) Perceived Susceptibility: One's belief regarding the chance of getting a given condition 2) Perceived Severity: One's belief regarding the seriousness of a given condition 3) Perceived Benefits: One's belief in the ability of an advised action to reduce the health risk or seriousness of a given condition 4) Perceived barriers: One’s belief regarding the tangible and psychological costs of an advised action 5) Cues to Action: Strategies or conditions in one's environment that activate readiness to take action 6) Self-efficacy: One's confidence in one's ability to take action to reduce health risks TAKE NOTES: the higher the perception (information, knowledge, knowing) – the higher behavior could they have Key Variables of HBM 1) Degree of perceived risk of disease: this variable includes perceived susceptibility of contracting a health condition and its perceived severity once contracted (Their perspective,What would you do? Do you want to be treated?) 2) Perceived benefits of diet adherence: A second benefit is the believed effectiveness of dietary strategies designed to help reduce the threat of disease. 3) Perceived barriers to diet adherence: includes potential negative consequences that may result from taking particular health actions (We know the negative consequences but we still continue) 4) Cues to action: events that motivate people to take action in changing their dietary habits are crucial determinants of change 5) Self-efficacy: a very important variable is the belief in being able to successfully execute the dietary behavior required to produce the desired outcomes (Motivation) 6) Other variables: demographic, socio-psychological, and structural variables affect an individual’s perceptions of dietary change ● Major limitation: places burden of action exclusively on the client. 2. Milio’s Framework for Prevention Nancy Milio (1976) provides a complement to the HBMs ➔ It stated that diseases associated with excess (e.g. obesity and alcoholism) afflict affluent societies, and the diseases that result from inadequate or unsafe food, shelter and water afflict the poor ➔ .Includes concepts of community-oriented, population focused care ➔ main determinant for unhealthful behavioral choice is a LACK OF KNOWLEDGE ➔ The range of available health choices is critical in shaping a society’s overall healthstatus. ➔ National level policy making was the best way to favorably impact the health of most people rather than concentrating efforts on imparting information in an effort to change individual patterns of behavior. ➔ Health – promoting choices must be readily available and less costly than health-damaging options ➔ Health Deficits result from an imbalance between a population’s health needs and its health-sustaining resources. ➔ Compared to HBM, Milio’s framework includes economic, political and environmental health determinants. ➔ Lifestyle are patterns of choices made from available alternatives according to people socioeconomic circumstances and how easily they are able to choose some over others ➔ Provide mechanism for directing attentions and exact mini opportunity for nursing intervention at the population classes ➔ It relates to individual’s ability to improve healthful behavior, in the society's abilities to provide accessible and socially informing for healthy choices 6 Propositions of this framework are related to the ff: 1) Population health deficits results from deprivation &/or excess of critical health resources ➔ The health status of populations is the result of deprivation and or excess of critical health sustaining resources. 2) Behavior of the population results from selection from limited choices; arises from actual or perceived options available as well as beliefs and expectations, resulting from socialization, education and experience. ➔ Behavior patterns of populations are a result of habitual selection from limited choices, And this habit of choice are: a. Actual and perceived options available; b. Beliefs and expectations developed and refined over time by socialization, formal learning and immediate experience (Dengvaxia) 3) Organizational Dimension & policies dictate many of the options available and influence their choices ➔ Organizational behavior (decisions or policy choices made by government or ngo national or lgu's; organizations) sets the range of options available to individuals for their personal choice-making 4) Individual choices related to health promotion or health damaging behaviors are influenced by efforts to maximize valued resources. ➔ The choice-making of individuals at a given point in time concerning potentially health promoting or health damaging selections is affected by their effort to maximize valued resources 5) Alterations in pattern of behavior resulting from decision -- making of a significant number of people in a population can result in social change. ➔ Social change may be thought of as changes in patterns of behavior resulting from shift in the choice making of significant numbers of people within a population 6) Without concurrent availability of alternative health-promoting options, for investment of personal resources, health education will be largely ineffective on changing behavior patterns ➔ Health education, as the process of teaching and learning health-supporting information can have a significantly extensive impact on behavior patterns 3. Nola Pender’s Health Promotion (HPM) ➔ Developed in 1980’s and revised in 1996. Explores many biophysical factors that influence individuals to pursue health promotion activities but does not include threat as a motivator. ➔ It defines health as a positive dynamic state not merely the absence of disease. Health promotion is directed at increasing a client's level of well-being ➔ Pender's model focuses on three categories: a. individual characteristics and experiences, b. behavior-specific cognitions and affect, and c. behavioral outcomes. Details are as follow: Individual Characteristics and experiences Prior Related Behavior Personal Factors This influence subsequent behavior through perceived self-efficacy This are Biological, Psychological, socio cultural in nature Personal Factors ● Personal biological factors: ➔ Include variables such as age, gender, body mass index, pubertal status, aerobic capacity, strength, agility, or balance (senior citizen, different beliefs) ● Personal psychological factors: ➔ include variables such as self-esteem, self-motivation, personal competence, perceived health status and definition of health (does he want to be treated? Is he a positive or negative thinker?) ● Psy Behavior-specific cognition and affect ● Perceived Benefits of Action: ➔ These are strong motivators through intrinsic and extrinsic benefits. ➔ Anticipated positive outcomes that will occur from health behavior ● Perceived Barriers to Action: ➔ Are perceived unavailability, inconvenience, expense,difficulty or time regarding health behaviors. ➔ anticipated, imagined or real blocks and personal costs of understanding a given behavior ● Perceived Self-efficacy: ➔ Is one’s belief that he or she is capable of carrying out behavior. ➔ Judgment of personal capability to organize and execute a health-promoting behavior ● Activity-related affect: ➔ Feeling associated with behavior likely affects individuals to repeat/maintain behavior. ➔ As the subjective positive or negative feelings that occurs based on the stimulus properties of the behavior itself (I’ll die anyways: negative, I’ll go to the health center to get treated: positive) ● Interpersonal Influences ( family, peers, provident ), Norms, Support, Model: ➔ These are feelings or thoughts regarding the beliefs or attitudes of others. ➔ Is the cognition concerning behaviors, beliefs, or attitudes of the others ➔ interpersonal influences include: norms (expectations of significant others), social support ● Situational influences (Options, Demand characteristics, Aesthetics): ➔ These are perceived options available, demand characteristics and aesthetic features of the environment where the behavior will take place. ➔ Personal perceptions and cognitions that can facilitate or impede behavior - Real life community situations ● Commitment to a plan of action: This initiates a behavioral event Behavioral Outcome 4. immediate competing demands (low controls) & preferences (high control) health promoting behavior these are alternative behavior immediately prior to engaging in the intended, planned behavior Goal/outcome PRECEDE-PROCEED Model ➔ Developed by Dr. Lawrence Green and colleagues. ➔ PRECEDE, which stands for Predisposing, Reinforcing and Enabling Constructs in Educational Diagnosis and Evaluation, is used for community diagnosis. ➔ PROCEED, an acronym for Policy, Regulatory, and Organizational Constructs in Educational and Environmental Development, is a model for implementing and evaluating health programs based on PRECEDE. ➔ Predisposing factors refer to people’s characteristics that motivate them toward health-related behavior. This includes attitudes, beliefs and values ➔ Enabling factors refer to conditions in people and the environment that facilitate or impede health related behavior. This includes skills, availability, accessibility & referrals. ➔ Reinforcing factors refer to feedback given by support persons or groups resulting from the performance of the health related behavior. This includes Support from family, peers, teachers,employers, health care providers PRECEDE PHASES ❖ PHASE 1 - SOCIAL DIAGNOSIS ➢ Identifying and evaluating the social problems that affect the quality of life of a population of interest ➢ the program planners try to gain an understanding of the social problems that affect the quality of life of the community and its members, their strengths, weaknesses, and resources; and their readiness to change ➢ check the quality of life, willing to change ❖ PHASE 2 - EPIDEMIOLOGICAL, BEHAVIORAL & ENVIRONMENTAL DIAGNOSIS ➢ epidemiological diagnosis: deals with determining and focusing on specific health issues of the community ➢ behavioral diagnosis: this is the analysis of behavioral links to the goals or problems that are identified in the social or epidemiological diagnosis. ➢ environmental diagnosis: this is a parallel analysis of social and physical environmental factors other than specific actions that could be linked to behaviors ❖ PHASE 3 - EDUCATIONAL & ECOLOGICAL DIAGNOSIS ➢ predisposing factors: are any characteristics of a person or publication that motivate behavior prior to or during the occurrence of that behavior (what is their behavior before the dengue outbreak) ➢ enabling factors: are those characteristics of the environment that facilitate action and any skill or resource required to attain specific behavior (no garbage collector) ➢ reinforcing factors: are rewards or punishments following or anticipated as a consequence of a behavior (what is their reward and punishment) ❖ PHASE 4 - ADMINISTRATIVE & POLICY DIAGNOSIS ➢ Assessment of resources, development and allocation of budgets, looking at organizational barriers, and coordination of the program with other departments ➢ administrative diagnosis: assess policies, resources, circumstances and prevailing organizational situations that could hinder or facilitate the development of the health program ➢ policy diagnosis: assesses the compatibility of program goals and objectives with those of the organization and its administration PROCEED PHASES ❖ PHASE 5 - IMPLEMENTATION OF THE PROGRAM ➢ example of program: seminar (Kabuhayan Center Program) ❖ PHASE 6 - PROCESS EVALUATION ➢ this phase determines whether the program is being implemented according to the protocol, whether the objectives of the program are being met (if met or partially met) ❖ PHASE 7 - IMPACT EVALUATION ➢ this phase measures the effectiveness of the program with their rights to the intermediate objectives as well as the changes in predisposing, and enabling, and reinforcing factors ❖ PHASE 8 - OUTCOME EVALUATION ➢ this phase measures change in terms of overall objectives as well as changes in health and social benefits our quality of life (it takes years to evaluate) CONCEPTS OF THE COMMUNITY Community is a group of people with common characteristics or interests living together within a territory or geographical boundary. It is a place where people under usual conditions are found. TYPES OF COMMUNITY A. Geopolitical community ➔ is “a spatial designation-a geographical or political area or place (Maurer and Smith, 2013) (man-made or natural) ➔ Territorial ➔ ex. school, rural, municipalities, mountain, bridges, railway, barangay, provinces, region B. Phenomenological community ➔ Functional (same characteristics, like mind relationship, same religion etc) ➔ ex. Religious groups ➔ Examples of phenomenological communities include social groups, profession, or religious groups. ● ● CONCEPT OF COMMUNITY System Perspective: - a community is similar to a living creature, comprising different parts that represent specialized functions, activities, or interests, each operating within specific boundaries to meet community needs. - ex: brgy. officials - needs of the community non-government officials., - schools that focus on education - transportation sector focuses on moving of people and products from one place to another - economic entities focus on enterprise and employment of the people in that community - faith organizations focus on the spiritual and physical well-being of people - health care agencies focus on the prevention and treatment of diseases and injuries Social Perspective: a community can also be defined by describing the social and political networks that link individuals, community organizations, and leader - Ex: tracing of social ties among individuals may help engagement leaders to identify a community’s leadership, understand its behavior patterns, identify its high-risk groups, and strengthen its networks Churches - Ex. Barangay chairman – how was the engagement to the community - ● ● Virtual Perspective: - Individuals rely more and more on computer-mediated communications to access information, meet people, and make decisions that affect their lives - Examples of computer-mediated forms of communication include email, instant or text messaging, e-chat rooms, and social networking sites such as Facebook, YouTube, and Twitter (Flavian et al., 2005). - Social groups or groups with a common interest that interact in an organized fashion on the Internet are considered “virtual communities” (Rheingold, 2000; Ridings et al., 2002). - Without question, these virtual communities are potential partners for community-engaged health promotion and research. Individual Perspective Individuals have their own sense of community membership that is beyond the definitions of community applied by researchers and engagement leaders. - Moreover, they may have a sense of belonging to more than one community. In addition, their sense of membership can change over time and may affect their participation in community activities (Minkler et al., 2004). - volunteering or joining community activities - CHARACTERISTIC OF HEALTHY COMMUNITY Adapted from Hunt, 1997 and Duhl, 2002 A. Shared sense of being a community based on history and values (ito yung community na makikita sa provinces; magkakasama yung mga ilokano, tagalog at bisaya) B. General feeling of empowerment and control over matters affecting the community as a whole (tackles the barangay chairman of the community) C. Existing structures that allow subgroups in the community (day care center, church, basketball court, playground - kapag daw may ganyan sa community ibig sabihin daw healthy ang isang community) - subgroup to refer to smaller, regionalized groups (Tyler, 2013) - A high-risk aggregate is a subgroup or subpopulation of the community that has a high-risk commonality among its members D. Ability to cope with change, solve problems & manage conflicts within the community E. Open channel of communication (dapat ang type ng leadership ng barangay chairman is democratic) F. Equitable and efficient use of community resources FACTORS AFFECTING HEALTH OF THE COMMUNITY Community has three features. It includes population, location and social systems A. Characteristics of the people or population ● Population size and density influences the number and size of health care institutions (dapat health care institution ay kayang ma-accommodate lahat ng populasyon ang isang barangay) ○ Brgy Commonwealth in QC ○ Brgy Bagong Silang in Caloocan ■ bigger the community = need more health facilities ● Health needs of community varies because of differences in population composition by age, sex, occupation, level of education and other variables ● Other factors are rapid growth or decline of a population affects the health of the community ● Feeling of belongingness and participation in community action are more readily achieved in a culturally homogeneous population. ○ Including level of education and social class. ● Level of education and social class affects health status because of differences in living conditions and degree of access to resources. B. Location of the community ● Health of a community is affected by both natural and man-made variables related to location. ● Natural factors consist of geographic features, climate, flora and fauna ○ flora: vegetation - plants, grasslands, trees ○ fauna: animals living in the community ● Geographic features consist of land and water forms that influence food sources and prevalent occupations. ● Geography plays an important role in disasters ● Effects of climate change on human health are evidenced by seasonal diseases. (pneumonia - raining) ● Geographic location of the Philippines makes it vulnerable to natural hazards. The country in the so called “Ring of Fire,” in which volcanic eruptions and earthquakes are frequent ● Other factors that affect the health of the community are plants and fauna. It also includes community boundaries, air water and soil pollution. ● PLANTS AND FAUNA have both positive and negative effects on the health of the population. ● Factors that contribute to health problem in urban are: higher population density while factors that contribute to health problem in rural area: inequalities of resources and economic opportunities, ● COMMUNITY BOUNDARIES, which is the clear demarcation (action of fixing the boundary or limits of something e.g. kung saang community ka lang, doon ka lang) is necessary since they are basis for determining catchment area of community health workers Factors that contribute to health problem in urban - higher population density with resulting congestion, - concentrated poverty & slum formation; - greater exposure to health risk/ hazards SLUMS/INFORMAL SETTLEMENTS As informal (and often illegal) housing, slums are defined by: a. Unsafe and/or unhealthy homes (e.g. lack of windows, dirt floor, leaky walls and roofs) b. Overcrowded homes c. Limited or no access to basic services: water, toilets, electricity, transportation d. Unstable homes: weak structures often blown away or destroyed during storms and earthquakes e. No secure land tenure (i.e. the land rights to live there) Factor that contribute to health problem in rural area:: - inequalities of resources - Inequalities of economic opportunities, - poverty more prevalent in rural - limit access to health facilities AIR, WATER AND SOIL POLLUTION poses health hazards to the population. C. Social systems within the community ● ● ● Social system is the patterned series of interrelationships existing between individuals, groups and institutions and forming a coherent whole. A social system is an interdependent set of cultural and structural elements that can be thought of as a unit. This includes the following: family economic, educational, communication, political, legal, religious, recreational and health systems. ROLES AND ACTIVITIES OF COMMUNITY HEALTH NURSE Roles and activities of community health nurse and its sub-specialty are connected with the following: I. Clinician or care provider - provides care along the whole range of wellness-illness continuum; (manage physical needs) - promotion of health, prevention of illness are highlighted. II. Advocate - to help clients find out what services are available, which ones they are entitled to, and how to obtain these services; (guide to make decisions in their own healthcare) - A second goal is to influence change and make the system more relevant and responsible to clients' needs. III. Researcher - CHN engages in systematic investigation, collection, analysis of data to enhance community health practice - Research in community health ranges from simple inquiries to complex agency or organizational studies. - Attributes of nurse researcher include a questioning attitude, careful observation, open-mindedness, analytical skills, tenacity IV. Educator - seek to facilitate client learning on a broad range of topics V. Manager - supervise client care, supervise ancillary staff, do case management, run clinics & conduct community health needs assessment projects; (budgetary decision) - The nurse engages in four steps of the management process of planning, organizing, leading and controlling evaluation. VI. Collaborator - COLLABORATION with clients, other nurses, physicians, social workers, physical therapists, nutritionists, attorneys, secretaries, & other colleagues is part of the role of CHN; - Collaboration is defined as working jointly with others in a common endeavor to cooperate as partners. VII. Leader - Role of LEADER is distinguished from the role of manager. - As a leader, CHN directs, influences, or persuades others to effect change that will positively affect people's health. - Acting as change agent & influencing health planning at local, state, national levels are elements of the role of leader THE INTERVENTION WHEEL INTERVENTION WHEEL: focuses on population and public health interventions Surveillance, Disease and Health Event Investigation, Outreach, Screening Referral and Follow-up, Case Management, and Delegated Functions Health Teaching, Counseling, and Consultation Advocacy, Social Marketing, Policy Development & Enforcement Community Organizing, Coalition-Building, and Community Organizing The Minnesota Intervention Wheel is a tool that illustrates what public health nurses do to improve health outcomes. Descriptions are as follow: ● Surveillance: Describes and monitor health events ● Disease & other health investigation: Systematically gathers & analyzes data regarding threats, ascertain source, what to do & how services can be obtained. ● Outreach: Locates populations & provides information about the nature of concern, what can be done & how services can be obtained ● Screening: Identifies unrecognized health risk factors or asymptomatic disease conditions ● Case finding; Locates those with identified risk factors & connects them with resources ● Referral and follow-up: Assist to identify & access necessary resources to prevent or resolve problems ● Case Management: Optimizes self-care capabilities of individuals & families & capacity of community ● Delegated functions: Direct health task that are carried out ● Health teaching: Communicates facts, ideas and skills that change knowledge , attitudes, values, beliefs, behaviors & practices ● Counseling: Establishes an interpersonal relationship with an intention of increasing / enhancing capacity for self – care. ● Consultation: Seeks information & generates optional solution ● Collaboration: Commits two or more persons to achieve a common goal ● Coalition building: Promotes & develops alliances among organizations or constituencies for common purpose ● Community organizing: Helps community groups identify common problems, mobilize resources & develop/ implement strategies to realize goal collectively ● Image of intervention depicted below shows the individual – focused, community – focused, system – focused & population – based approaches when intervening concerns related to public health
