“The Modern Health System”

Health planning and program evaluation is a key component in the management of health systems. An integral part of the planning and evaluation process is the community needs assessment (Iowa State University Extension Online) Broadly defined, community needs assessment is a method used in measuring opinions, preconceptions, needs, important issues, and/or assets within a defined community. (French Online) It is of vital importance when decisions on the allocation of resources need to be made and in the establishment of programs that will meet the aspirations of the community (Iowa State University Extension Online)

There are several health program design theories. The health belief model posits that people have various preconceived notions about the benefits that a particular intervention program will confer to them or the barriers or threats they will face in accessing the intervention and as such choose to take or not to take preventive measures based on these perceptions. These preconceived notions can be broadly categorized as perceived threats, perceived benefits, and perceived barriers. (Haber 134)

Perceived threats are those notions held by an individual regarding the dangers that a particular condition exposes him or her to and their degree of potency. Persons who see a particular threat as posing a grave danger to them have the motivation to act. Conversely, persons who will perceive a particular threat to be minor will have no reason to seek a correcting intervention. (Haber 134) Perceived benefits refer to the belief that certain actions taken by an individual facing a threat will eliminate or reduce the chance of undesirable outcomes or increase the likelihood of positive results.

When the likelihood of positive results outweighs perceived barriers, then the individual facing the threat is motivated to take an action. Stated differently, when the end result of a certain action brings an advantage greater than resources deployed in carrying out the action then the action will be pursued. (Haber 134) Perceived barriers serve to prevent initiation of an action and may include financial limitations, ignorance, lack of transportation, or potential pain or discomfort and inconvenience.

However, beliefs are not entirely the only determinants that account for action. Other factors including, but not limited to, environmental influences and skill development often come into play. (Haber 134) Formulated in 1980, the theory of planned behavior is an extension of the theory of reasoned action which has it that the central predictor of behavior is intention. Intention is defined as a person’s readiness to carry out an act and is determined principally by his or her perceived behavioral control (am I able to carry out this behavior?

), his or her subjective norms (what will the people I care about think about my behavior? ), and his or her attitude towards that very behavior. A favorable attitude and subjective norm coupled with a strong perceived behavioral control gives a stronger intention. The theory of planned behavior has an additional focus on the perceived ease or difficulty of carrying out a behavior (University of Twente Online). The social cognitive theory is broadly underpinned by various concepts in which behavior, personal considerations, and environmental factors interact.

One is that observational learning or modeling is critical to learning. Change can be influenced by observing others in the same class as self or by observation of visible results. Secondly, the intrinsic environment is equally important in the learning process. Stated differently, mental states impact greatly on the learning process. As such, self efficacy or the confidence in one’s power to carry out an action and persist in it is a vital requirement. . (University of Twente Online)

Thirdly, not all learning leads to behavioral change. Fourthly, Change in behavior also occurs through interaction between a person and the environment and is bi-directional, a concept termed as reciprocal determinism. The theory seeks to rationalize the various psychosocial mechanics influencing health behavior and how to advance the change in behavior. (Communication Initiative Network Online) Diffusion of innovations seeks to demonstrate that adoption of ideas in a community follows a certain consistent and definable pattern.

(Trisha Greenhalgh, Paul Bate, Olivia Kyriakidou, Richard Peacock, Glenn Robert & Fraser MacFarlane). A slow initial phase, the lag phase, characterizes the initial adoption followed by a rapid acceleration in the people adopting the idea. A slow down – the decline phase- then follows and finally the last people adopting the idea result in the final tail. (Rodgers, Online). For any health planning and program evaluation to succeed, communication must be effectively managed.

Communication, the transmission of information through space and time and stated by Lasswell as “who says what to whom in what channel with what effect,” has been theorized differently based on various perspectives. The social scientific theory is derived from work done according to scientific rules and methods. Normative theory states how work should be carried out in specific cases based on values and ideological considerations. Common-sense theory is informed by our experiences.

Working theory is not just normative but also practical (Paul Norman, Charles Abraham, and Mark Conner Online). The health belief and the social cognitive models would be ideal for a smoking cessation program in the workplace. Behavioral change among smokers would be easily tackled by managing perceptions about smoking, with the amplification of benefits attained through cessation juxtaposed against obvious conditions caused by smoking such as lung cancer and social and financial limitations imposed by smoking.

Concurrently, barriers preventing cessation of smoking would be targeted for elimination. (Haber 134) The social cognitive model would contribute with the provision of knowledge about the risks of smoking through provision of information and training, incorporate experiences of people who successfully quit smoking and point out role models to emulate through observational learning and modeling. (University of Twente Online) Emphasis is on their self-efficacy i. e.

ability to quit smoking while using persuasion and encouragement and approaching the change in behavior in small steps and pointing out their strengths, (Norman et al 3) manage their expectations by pointing out likely results of their behavior change in advance, involving the smokers and others in changing the work environment if it is a contributing factor in their smoking habit, and reinforcing their responses which decrease their chances of relapsing to smoking by providing incentives, praise and rewards to successful persons.

The social cognitive model would be highly effective as it touches on their intentions and changes them thus relapsing would not readily occur. (University of Twente Online) A training program for employees in my facility – a fresh-produce processing plant- would have the goal of reducing the bacterial count in the swabs conducted weekly.

Objectives would include having the workers observe strict hygiene practices and target areas would be having them wash their hands thoroughly using provided disinfectants every 30 minutes and after every visit to the toilet, wear hair nets, nose masks, and white coats; eat only in designated places; remove shoes while getting in the plant and use only the sterilized boots in the plant. (University of Twente Online) Works cited Communication Initiative Network, “Social Learning Theory – or Social Cognitive Theory”. Retrieved from: http://www. comminit. com/en/node/27159 Published 2003.

French, Charlie, “Community Needs Assessment Tools” Retrieved from: http://64. 233. 169. 104/search? q=cache:yV9CJeLi-BIJ:extension. unh. edu/CommDev/ToolBox/CNATools. ppt+community+needs+assessment&hl=en&ct=clnk&cd=1&gl=ke January, 2008. Greenhalgh, Trisha. Bate, Paul. Kyriakidou, Olivia. Peacock, Robert ,Richard Glenn & MacFarlane, Fraser “Diffusions of Innovations in Health Service Organizations: A Systematic Literature Review”. Published 2005 Iowa State University, “Needs Assessment Strategies for Communities and Groups”. Retrieved From: http://www. extension. iastate.

edu/communities/tools/assess/ March 01 2001. Paul Norman, Charles Abraham, Mark Conner, “Understanding and Changing Health Behaviors: From Health Beliefs to Self Regulation” Retrieved from: http://books. google. com/books? id=zIZvXySP_YcC Published 2000. Rodgers, Everett, “Diffusion of Innovation Theory”. Retrieved from: http://www. ciadvertising. org/studies/student/98_fall/theory/hornor/paper1. html March 1976. University of Twente, “ Health Brief Models. ” http://www. tcw. utwente. nl/theorieenoverzicht/Theory%20clusters/Health%20Communication/Health_Belief_Model. doc/ June 9, 2004. .

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