Community Health Nursing Test 1

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Community-Oriented Nursing
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Focus: Health of the community as a whole. Client: Community Activity: Surveillance and evaluation of the community’s collective health, and the implementation of strategies to promote health and prevent disease.
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Community-Based Nursing
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Focus: Health of individuals, families, and groups within a community. Client: Individuals, family, or group of individuals Activity: Provision of direct primary care in the settings where individuals and families live, work, and “attend” (schools, camps, parishes)
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Community Health Nursing
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Systematic processes to deliver care to individuals, families, or community groups with a focus on promoting, preserving, protecting, and maintaining health care provided contributes to the health of the community.
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Public Health Nursing
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Nursing and public health, disease and disability prevention, promoting and protecting the health of the entire community
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Eight domains of public health
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Distinguishes public health nursing from other nursing specialties by adherence to the eight principles: Analytical assessment skills Policy development and program planning skills Communication skills Cultural competency skills Community dimensions of practice skills Basic public health science skills Financial planning and management skills Leadership and systems thinking skills
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Three primary functions of public health
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1. Assess health care function 2. Develop policy that provides access to services 3. Ensure services are delivered and outcomes achieved
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Health People 2020: Four main goals
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1. Eliminate preventable diseases, disability, injury, and premature death 2. Achieve health equity, eliminate disparities, and improve health of all age groups 3. Create social and physical environments that promote good health for all 4. Promote healthy development and health behaviors across every stage of life
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Social determinants
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Impact whether someone is able to attain/maintain health; (Income, social status, education, literacy, environment, support networks, gender, culture, available health care)
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Disparities
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Gaps in care experienced by one population compared to another
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Health care changes in the 21st century
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Increased patient acuity and number of services in the community. Patient centered care Increased patient responsibility for own health Increased use of technology
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Florence Nightingale
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Studied nursing in Germany then established nursing schools in England
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District Nursing
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A mode of service delivery in which a community health nurse is responsible for addressing all the health needs of a given population
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Lemuel Shattuck
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First use of demographic data to look at population health birth and death records
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Dorthea Dix
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Established first hospital for the mentally ill in the US
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Clara Barton
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Civil war nurse: Established the American Red Cross (providing aid for natural disasters)
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Lillian Wald
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Found of public health nursing in the US; Founded the Henry Street Settlement and Visiting Nurse Service which provided nursing and social services and organized educational and cultural activities. She is considered the founder of public health nursing
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Mary Breckenridge
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Pioneer in nurse-midwifery; established the Frontier Nursing Service – nurses traveled on horseback to reach mothers in the hills of Kentucky
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World Health Organization
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International center that collects data, advances initiatives, and offers support related to public health
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US Department of Health and Human Services (USDHHS)
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US branch of government responsible for health and welfare of citizens
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Nongovernment Agencies
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Agencies that acquire resources from private sources to assist others
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Philanthropic Agencies
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Organization that uses endowments or private funding to address the needs of individuals, families, and populations
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Center for Disease Control
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(CDC) is a United States federal agency under the Department of Health and Human Services. It works to protect public health and safety by providing information to enhance health decisions, and it promotes health through partnerships with state health departments and other organizations.
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Difference in US health care system and public health
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The US has an individual focus on curative measures while public health focuses on the population or community as a whole and focuses on disease reduction and improved health
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Local Level of Government
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Implement public health activities within the community; Governed by the state department; Structure varies based on community needs
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State Level of Government
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Focuses on regulation of the community of program responsibility and resource allocation
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Federal Level of Government
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Focuses on policy development and financing
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Health
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A quality, an ability to adapt to change or a resource to help cope with challenges and processes of daily living
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Well Being
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A subjective perception of full functional ability as a human being
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USDHAHS 10 Components of public health practice
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1. Preventing Epidemics 2. Protecting the environment, workplaces, and sources of food and water 3. Promoting health behavior 4. Monitoring the health status of the population 5. Mobilizing community resources into service 6. Responding to disasters 7. Assuring the public there are trained personnel 8. Reaching out to those at high risk 9. Researching risk, disease acquisition, and ways to prevent injury 10. Influencing policy to acquire resources to effect change
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Epidemiological Health Promotion Model
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The study of relationships among an agent, a host, and an environment. The interaction determines the development, and cessation of communicable disease.
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Learning Theory
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Goal established and reinforced by nurse; Rewards given for partial accomplishment
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Health Belief Model
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Cues used to remind people of health behavior and promote action; Perceived risk influences action
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Transtheoretical Health Promotion Model
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5-Step approach: Pre-contemplation, Contemplation, Preparation, Action, Maintenance
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Reasoned Action Health Promotion Model
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Performance of a behavior is determined by a persons intention to perform the behavior; Intentioned determined by attitude and behavior
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Social Support Health Promotion Model
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Change influenced by support of friends, families, and communities
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Primary Level of Prevention
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Utilize prevention strategies, address modifiable risk factors, and maximize health and wellness
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Secondary Level of Prevention
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Planned effort to minimize the impact of disease and injury once it has occurred
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Tertiary Level of Prevention
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Maximizing health and wellness through strategies set in place at the end-stage of disease and injury
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Epidemiology
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The study of the distribution and determinants of health and illness
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Rate
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Primary measurement used to describe either the occurrance or the existence of a specific state of health or illness
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Outbreaks
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Epidemic usually limited to a localized increase in the incidence of the illness
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John Graunt
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Father of demographics. recognized importance of recording birth and death rates and age structure of human population
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William Farr
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Set up a system of data collection for causes of death in difference occupations, gender, and imprisonment. Importance of definition of illness and population comparison, groups, and factors such as age, health, and environment can affect statistics
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John Snow
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Used mapping and rates as an objective measure to compare populations
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Epidemiological Triad
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Model based on the belief that health status is determined by the interaction of the characteristics of the host, agent, and environment
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Wheel of Causation
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Epidemiologic model that deemphasizes the agent as the sole cause of disease while emphasizing the interplay of physical, biological, and social environments
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Web of Causation
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Epidemioligcal model that strongly emphasizes the concept of multiple causation while deemphasizing the role of agents in explaining illness
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Natural History of Disease
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Course of disease or condition from the onset to resolution
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Rate
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Primary measure used to describe either the occurrence or existence of a specific state of health or illness within a group during a specific time frame
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Ratio
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Fraction that represents the relationship between two numbers; Divide one quantity by another quantity Ex: # boys in class/# girls in class
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Proportion
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Type of ration Ex: # boys/ total students
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Crude Rate
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Measures the occurrence of the condition in the whole population; May obscure info because it does not consider factors such as age, race, gender Numerator: Number of events Denominator: Total population (not just those at risk)
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Adjusted Rate
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Controls for differences between populations-used for comparison
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Incidence
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Measures probability that people without a condition will develop the condition over time; measures pace of new illness
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Prevalence
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Existence of a condition during a period/interval at a specific point; Studies number of people diagnosed in the past and length of illness; Longer length=greater the prevalence-indicates burned of community
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Mortality Rates
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Crude mortality: probability of dying from any cause; # deaths in a year/total population
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Proportional Mortality Ratio
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Compares death from a specific illness with deaths from all causes; # deaths from specific cause within a time frame/total deaths
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Incidence Density
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Used when unequal periods of observation for study subjects; Accounts for people who die, drop out of a study, or acquire an illness
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Attributable Risk
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The risk of a condition occurring in an exposed group that is attributable to an exposure, not other factors
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Relative Risk Ratio
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Measure of the risk of developing a condition; Ratio of incidence in exposed and incidence in non-exposed
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Sensitivity
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Ability of the test to correctly identify people who have the health problem
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Specificity
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Specific incidence and prevalence rates calculated based on specific characteristics (demographic data), variations based on location and variations in time (short-outbreak, periodic- seasonal, long-years)
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Crude Rate Formula
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# events within time period/population at risk with same time pt
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Incidence Rate
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#new cases during time period/population at risk in the same time period
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Causality
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Strengths of Association Consistency Temporality Plausibility Biological Gradient
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Case Studies
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In-depth analysis of individual or group, often first clue to a problem
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Cohort Studies
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(Longitudinal Studies) Monitor over time to find associations between risk factors and health; Minimize selection bias; Relative risk is the ratio of disease incidence in an exposed population; Indicates strength of exposure to illness causality
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Case Control
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Compare group with health problems (cases) to group without (control)
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Key Informants
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Persons knowledgeable about specific aspects of a problem and the communities current and past attempts to address it
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Stakeholders
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An individual, organizational, or group that has interest (stake) in a specific community health issue or the outcome of a community level intervention
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Gantt Chart
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Visual of the sequence of steps to achieve objectives; Developed in planning stages to identify steps, a tool for scheduling tasks, monitor progress
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Community of Interest
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People and groups/aggregate that will be affected by change; Those that will help bring about change
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Upstream Approach to Health Care
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Changes at societal level may impact health of community without change is individual behavior
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Sustainability
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How to maintain change, support system in place
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Social Justice
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Health care is a risk; Address root cause of illness
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Health Equities
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Requires elimination of health disparities in living and working conditions
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SMART objectives
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S- Specific M- Measurable A- Achievable R- Relevant T- Time
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Coalition Building
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Community members participate in planning and implementing changes at the community level; Need clear mission, goals, objectives, expectations, leadership, accountability, and should be heterogenous
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Community Readiness
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Assess readiness to undertake change process-issue specific
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Web of Causation
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Identify multiple factors that contribute to chronic disease
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Lewins Model for Change
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Unfreezing: Changing: Freezing:
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Levers of Change
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Increase driving/reinforcing forces Decrease restraining/resisting forces
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Force Field Analysis
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Identify factors within a community that impact change and forces that cannot be changes
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Geopolitical Population
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Has identified designated boundaries with the same governing structure
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Phenomenological Population
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Group with common interests or beliefs who have interpersonal and intrapersonal connection
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Community of Solution
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Formed by aggregate to address a health problem

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