STATISTICS for PREV MED II

I. THE BASICS
Descriptive Statistics
Involves summarizing data by describing the average or mean and the minimums and maximum. e.g.
tabulation, graphical presentation, computation of averages as well as measures of variability
Inferential Statistics
Used to make predictions or infer things from data (usually using a sample, taken from a larger group
which is referred to as a population).
Parameters & Statistics
When we want to make inferences about populations, we use samples taken from that population
(more cost-efficient and practical). We use the average from a sample as our best guess at the
population average.

Parameter Statistic
(Unknown Population Average) (Known Sample average)
Mean μ !
Variance σ2 s2
Standard Deviation σ s
Proportion π p
Difference between two means μ 1- μ 2 x 1- x 2
Difference between two proportions
π 1- π 2 p1-p2

Estimation
A point estimate of a population parameter is a single value of a statistic. [e.g. sample statistics (s or p),
reliability coefficient (z-value or t-value), standard error]

An interval estimate is defined by two numbers, between which a population parameter is said to lie.
e.g. a < < b is an interval estimate of the population mean μ. It indicates that the population mean is
greater than a but less than b. [e.g. confidence intervals]

II. SAMPLING DISTRIBUTION

- a computed statistic [e.g. mean, proportion, standard deviation] for each sample.
Variance: numerical value used to indicate how widely individuals in a group (vary from the mean).
(*variance is = to SD2) This is dependent on sample size (n).

Population Sample

Standard Deviation
summation - Σ each value - x
mean - μ or ! number of values - N or n
Standard Error (i.e. SD of the distribution of sample means)
> measures variability, or the amt. of error we can expect due to using a
sample mean to estimate a population mean

Applications of Sampling Distribution

1) Determine the probability of obtaining a sample statistic with a pre-specified magnitude from a given
population
2) Estimate parameters
3) Test hypothesis regarding parameters
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III. NORMAL DISTRIBUTION
- Bell-shaped and symmetrical about the mean
- Completely determined by two parameters, μ and σ
- Mean, median and mode are equal
- Total area under the curve is equal to 1 or 100%
- Tails that extend infinitely on both ends
- μ ± 1 = 68.5% ; μ ± 2 = 95% ; μ ± 3 = 99.7%

Central Limit Theorem

The sampling distribution of the sampling means approaches a normal distribution as the sample size
gets larger. So the sample means will be normally distributed (when sample size > 30), even if the
population is positively skewed, negatively skewed or binomial (having only 2 outcomes).

To obtain probability, the normal distribution is transformed to a z- distribution

The normal distribution curve Standard normal curve [ μ = 0, σ = 1 ]
The actual measurement [x-value] Z-value [standard variate/score

Z-Score for_a Single Value

Example:
Assuming that the distribution of systolic blood pressure of non-hypertensive men has a mean of 110
mmHg and a standard deviation of 15 mmHg. What is the proportion of non-hypertensive men who have
systolic blood pressure above 120 mmHg? Proportion of non-hypertensive men with systolic blood pressure
of less than 90 mmHg ?

Proportion between 90 and 120 mmHg?

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 _ a Sample Mean
Z-score for _ Example:
Suppose a health care provider wants to detect adverse
effects of systolic BP in a random sample of 25 patients using
a drug that causes vasoconstriction. The provider decides that
a mean systolic BP in the upper 5% of the distribution is cause
Example: for alarm; therefore, the provider must determine the value that
Suppose a health care provider studies a randomly selected divides the upper 5% of the sampling distribution from the
group of 25 men and women between 20 and 39 years of lower 95%
age and finds that their mean systolic BP is 124 mmHg.
How often would a sample of 25 patients have a mean
systolic BP this high or higher?
Assuming that the systolic BP is a normally distributed
random variable with a known mean of 120 mmHg. and a
standard deviation of 10 mmHg in the population of normal
healthy adults.

(0.023)

Example: Percentiles
Most IQ tests have means of 100 and standard deviations of 15. Let's say you take an IQ test and get the score of 125.
Which percentile do you belong to?

z = (125-100)/15 = 1.6667
*1.667 in a table of normal values = 0.9522
Therefore, you’re in the 95% percentile.

Maybe you think many of your friends might score between 115 and 125. What percent of the population would we
expect to score between these values?

1. Convert each raw score to a z-score

zlower = (115-100)/15 = 1
zupper = (125-100)/15 = 1.6667
2. Find the area for the two z-scores (use Table)
zlower = .8413
zupper = .9522
3. Subtract the smaller area from the larger area
.9522-.8413 = .1109. Or about 11% of the population
would score between a 115 and 125.

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IV. HYPOTHESIS TESTING - Formal procedures used by statisticians to accept or reject statistical
hypotheses.
Steps in Hypothesis Testing
1) State the research question in terms of statistical hypotheses
Null hypothesis – HO; sample observations result purely from chance (always incl. ʻ=ʼ sign)
Alternative hypothesis - H1 or HA; sample observations are influenced by some non-random cause. May or
may not have direction (one-tailed or two-tailed).
One-tailed (directional) Two-tailed (no direction) - more conservative, since α/2
Is one mean < or > than the other? Is there a difference between two means?

2) Decide on the appropriate test statistic

*Parametric test statistic
- based on assumptions made concerning the parameters of the population from which the sample was drawn
- Validity depends on whether these assumptions about the nature of the sampled pop. are satisfied or not
- Scales of measurement – interval or ratio
- EXAMPLES: Tests of Significance (z-test, t-test, X2 Test, ANOVA); Tests of Relationship (Simple linear
regression and correlation)
Non-parametric test statistic (Distribution-free)
- Has fewer and less stringent assumptions
- No attempt is made to specify and identify the form of the population from which the sample was drawn
- Scales of measurement – nominal or ordinal
- EXAMPLES: Tests of Significance (Binomial test, Kolmogorov-Smirnov Two Sample Test, Sign test); Tests of
Relationship (Spearman Rank Correlation Coefficient)

3) Select the level of significance (α)

- The probability of committing Type 1 error Level of Level of z-value for alternative
i.e. the error of rejecting a true (null) Confidence Significance hypothesis
hypothesis; kind of like a false positive (1-α) (α) one-tailed two-tailed
90% .10 1.28 1.64
95% .05 1.64 1.96
4) Determine the Critical ratio or value
99% .01 2.33 2.58
Factors:
- Level of significance
- Test statistic used
- Direction of the alternative hypothesis
- Sample size

5) Perform the calculation

6) Draw and state the conclusion

Reject Ho if...
Computed value > critical value (é common)
Computed value < α
Left or Right rejection region?
Check your HA…
Less than sign ! gReater than sign
Left-sided Rejection !
Region Right-sided
Rejection Region

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V. P-VALUES TRUE STATE OF NATURE

- a number between 0 and 1 Ho is true Ho is false

Correct Type II
- used to measure the strength of evidence in Accept Ho decision (1- error (β)
support of a null hypothesis. Suppose the α)
test statistic is equal to S. The P-value is the DECISION Reject Ho Type I error Correct
probability of observing a test statistic as (assume HA (α) decision
extreme as S, assuming the null hypothesis is true) (1 - β)
is true.
- i.e. if p.value < α of 0.05 (which is 5%), you have less than 1 in 20 chance of making a Type I error.
Conversely, you can say with 95% Confidence Level (1-α) that you have made the correct decision
[Confidence coefficient – refers to the degree of reliability one may place in the estimate of the parameter (1-α)]

Decision Errors
Type I error: rejecting the null hypothesis when it is true. The probability of committing a Type I error
deals with the significance level (or alpha, α).
Type II error: failing to reject a null hypothesis that is false. The probability of committing a Type II
deals with the Power of the test (or beta, β).

Confidence Interval (CI)

A 95% CI is the interval that you are 95% certain contains the hypothesized population value as it
might be estimated from a much larger study.
- e.g. Two-tailed test, where α and confidence level add to 100%, you can reject H0 if μ0 (the value you
were checking) is not in the confidence interval.
Cl = Sample statistic ± [Critical value x Standard Deviation/ Error]
❘_____________________mar gin o f e rror ________________________❘

95% Confidence Interval for z-test 95% Confidence Interval for t-test 95% Confidence Interval for single
pop. proportion

EXAMPLES

= =
= 22 ± 1.96 (2.1213) = 96 ± 2.1448 (9.04)
= 22 ± 4.16 = 96 ± 19.4 = .41 ± 1.96 x .0289
17.84, 26.16 76.6, 115.4 = .41 ± .06
= .35, .47
Hypothesized parameter μ0 = 25 Hypothesized parameter μ0 = 120 Hypothesized parameter μ0 = .5
CANNOT REJECT HO REJECT HO REJECT HO

VI. HYPOTHESIS TESTING FOR ONE POPULATION

n < 30
Normal Distribution + t-test
Sample Unknown Pop Variance
Mean n > 30
Normal Distribution +
One
Known Pop Variance
population

z-test 5
RSMV Sample
proportion

Example: z-test for Mean w/ Known Pop. Variance
Suppose a researcher, interested in obtaining an estimate of
the average level of some enzyme in a certain human
population, takes a sample of 10 individuals, determine the
level of the enzyme in each, and computes sample mean x =
22. Suppose further it is known that the variable of interest is
approximately normally distributed with a variance of 45. Can
we conclude that the mean enzyme level in this population is
different from 25 ? Use α = .05
1. State the hypothesis
Ho: The population mean enzyme level is = 25
HA: The population mean enzyme level is ≠ 25
2. Select the appropriate test statistic – Z test
3. Select the level of significance - .05
4. Determine the critical ratio/value - z(α/2) = ±1.96
5. Do the computation of the test statistic
6. Draw and state the conclusion
We are unable to reject Ho since -1.41 is not in the rejection
region. We conclude that μ may be equal to 25.
Example: t-test for Mean w/ Unknown Pop. Variance,
n <30
Researchers collected serum amylase values from a random
sample of 15 apparently healthy subjects. They want to know
whether they can conclude that the mean of the population
from which the sample of serum amylase determinations
came is different from 120. The mean and standard deviation
computed from the sample are 96 and 35 units/100 ml,
respectively. Use α =.05.
1. State the hypothesis
Ho: The population mean serum amylase is = 120units/100ml
HA: The population mean serum amylase is ≠ 12units/100ml
2. Select the appropriate test statistic – t test
3. Select the level of significance - .05
4. Determine the critical ratio/value - t(α/2, n-1)=±2.1448
5. Do the computation of the test statistic
6. Draw and state the conclusion
Reject Ho since -2.65 falls in the rejection region. The
population mean is not equal to 120 units/100ml.
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Example: z-test for Mean w/ Unknown Pop. Variance, n
> 30
In a health survey of a certain community 150 persons were
interviewed. One of the items of information obtained was the
number of prescriptions each person had had filled during the
past year. The average number for the 150 people was 5.8
with a standard deviation of 3.1. The investigator wishes to
know if these data provide sufficient evidence to indicate that
the population mean is greater than 5. Let α = .05
1. State the hypothesis
Ho: The average number of prescriptions is ≤ 5
HA: The average number of prescriptions is > 5
2. Select the appropriate test statistic – Z test
3. Select the level of significance - .05
4. Determine the critical ratio/value z(α) = 1. 645
5. Do the computation of the test statistic
6. Draw and state the conclusion
Reject Ho since 3.2 is the region of rejection. The average
number of prescriptions is greater than 5.
Example: z-test for single Pop. Proportion (assuming
normal dist. in accordance w/ CLT
Suppose we are interested in knowing what proportion of
automobile drivers regularly wear seat belts. In a survey of
300 adult drivers, 123 said they regularly wear seat belts.
Can we conclude from these data that in the sampled
population the proportion who regularly wear seat belts is
not .50 ? Let α = .05.
1. State the hypothesis
Ho: The pop. proportion who regularly wear seat belts = .50
HA: The pop. proportion who regularly wear seat belts ≠ .50
2. Select the appropriate test statistic – z test
OR
3. Select the level of significance - .05
4. Determine the critical ratio/value - z(α/2) = ±1.96
5. Do the computation of the test statistic
6. Draw and state the conclusion
Reject Ho since -3.11 is in the region of rejection. The pop.
proportion who regularly wear seat belts is not equal to 0.5.
6
1

VII. HYPOTHESIS TESTING FOR TWO POPULATIONS

*Variance is assumed to be equal when the sample distribution

(n,! , s) are of similar magnitude (exact range wasnʼt specified in lecture) Paired t-test

Related Samples Normal distribution +

Unknown Pop Variances t-test
Diff. between (assumed to be unequal
2 Pop means Independent or equal)
Samples
Two Normal distribution +
Populations Known Pop Variances

Not normally distributed

but n > 30
Assumed normal
distribution of p1-p2 z-test
Diff. between
2 Pop Testing for
proportions - goodness of fit
X2 test
- independence
- homogeneity

Example: z-test for independent samples, normal
distribution, known pop variances OR non-normal
distribution, n > 30 (just substitute σ for s)
A hospital administrator wished to know if the population which
patronizes hospital A has a larger mean family income than does the
population which patronizes hospital B. The data consist of the family
incomes of 75 patients admitted to hospital A and of 80 patients
admitted to hospital B. The sample means are x1= Php 6,800.00 and
x2= Php 5,450.00. The standard deviations are s1= Php 600.00 and s2=
Php 500.00. Let α = .01.
1. State the hypothesis
Ho: The mean diff. in family income between the two pops is ≤ zero
H : The mean diff. in family income between the two pops is > zero
A A
2. Select the appropriate test statistic
Example: t-test for independent samples, normal
distribution, unknown pop variances but assumed to be
equal**
A research team collected serum amylase data from a sample of
health subjects and froma sample of hospitalized subjects. They wish
to know if they would be justified in concluding that the population
means are different. The data consist of serum amylase
determinations of n2=15 health subjects and n1=22 hospitalized
subjects. Let α = 0.5
x1 = 120 units/ml x2 = 96 units/ml
s1 = 40 units/ml s2 = 35 units/ml
1. State the hypothesis
Ho: The mean diff. in serum amylase bet. healthy and hosp. = 0.
H : The mean diff. in serum amylase bet. healthy and hosp. ≠ 0.
2. Select the appropriate test statistic

μ1 - μ2 always
defaults to 0

3. Select the level of significance = .01

4. Determine the critical ratio or critical value = 2.33 (one-tailed)
5. Perform the calculation for the test statistic 3. Select the level of significance = .05
4. Determine the critical ratio or critical value = α/2,(n1+n2)-2 = 2.0301
5. Perform the calculation for the test statistic

6. Draw and state the conclusion

Reject Ho since 15.17 is in the rejection region. These data indicate 6. Draw and state the conclusion
that the population patronizing hospital A has a larger mean family Unable to reject Ho since 1.88 is in the region of non-rejection.
income than does the population patronizing hospital B. Cannot conclude that the two population means are different.

2
**Pooled Sample Variance, s p:
2 2
weighted average of the variances (s1 and s2 )
RSMV ! We pool the variances because the larger sized sample would account for 7
more
2

Example: t-test for independent samples, normal Example: paired t-test (usually used for before and after
distribution, unknown and unequal pop variances comparisons)
The objective: eliminate a maximum number of sources of
extraneous variation by making the pairs similar with respect to as
many variables as possible.
Researchers wish to know if two populations differ with respect to the Twelve subjects participated in an experiment to study the
mean value of total serum complement activity (C H50). Data was collected effectiveness of a certain diet, combined with a program of exercise,
on apparently normal subjects (n2=20) and subjects with disease in reducing serum cholesterol levels. Do the data provide sufficient
(n1=10). Let α = 0.05. The sample means and standard deviations are: evidence to conclude that the diet exercise program is effective in
reducing serum cholesterol levels? Let a = .05
x1 = 62.6 x2 = 37.2
s1 = 33.8 s2 = 10.1 Serum Cholesterol Difference (d)
Subject Before (x ) After (x ) (after–before)
1 2
1 201 200 -1
1. State the hypothesis 2 231 236 +5
Ho: The mean diff. in value of C H50 between normal and diseased 3 221 216 -5
4 260 233 -27
subjects is = zero 5 228 224 -4
H : The mean diff. in value of CH50 between normal and diseased 6 237 216 -21
A
subjects is ≠ zero. 7 326 296 -30
8 235 195 -40
2. Select the appropriate test statistic
9 240 207 -33
10 267 247 -20
11 284 210 -74
12 201 209 +8

1. Solve for required data

3. Select the level of significance = .05 Average of

4. Determine the critical ratio or critical value = 2.255 difference of
means __________________
Standard
_____
__________________
(-1-(-20.17))+(5-(-20.17))…2
=
deviation d _____ 11
Standard
where w = s 2 /n , t = t for n1-1 degrees of freedom Error
i 1 1 1 1-α/2

2. State the hypothesis

Ho: The mean difference in serum cholesterol between before
and after diet-exercise program is ≥ zero
(= 2.255) H : The mean difference in serum cholesterol between before
A
and after diet-exercise program is < zero

3. Select the appropriate test statistic

5. Perform the calculation for the test statistic

4. Determine the critical ratio or critical value = α/2,(n-1) = 1.7959

5. Perform the calculation for the test statistic

6. Draw and state the conclusion

Reject Ho since 2.33 is in the rejection region. There is a difference in
the mean value of total complement activity between normal subjects
and diseased subjects.
6. Draw and state the conclusion.
Reject Ho since - 3.02 is in the non-rejection region. The mean
difference in the serum cholesterol between before and after diet
exercise program is less than zero. Therefore, the diet-exercise
program is effective.

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 Example: z-test for difference between two proportions
In a study designed to compare a new treatment for migraine headache with the standard treatment, 78 of 100 subjects who
received the standard treatment responded favorably. Of the 100 subjects who received the new treatment 90 responded
favorably. Do these data provide sufficient evidence to indicate that the new treatment is more effective than the standard? Let
α = .05
1. State the hypothesis 5. Perform the calculation for the test statistic
Ho: The difference in proportion between the standard and
new treatment is ≤ zero p = 78 / 100 = .78 p = 90 / 100 = .90
1 2
H :. The difference in proportion between the standard and
A
new treatment is > zero
2. Select the appropriate test statistic

Std Error = 6. Draw and state the conclusion

_ Reject Ho since 2.32 is in the rejection region.

Pooled estimate of the hypothesized common proportion (p): The new treatment is more effective that the standard.

3. Select the level of significance = .05

4. Determine the critical ratio or critical value = 1.645

X2 test = Using Chi-Square to Compare Frequencies/Proportions in 2 Groups (variable is QUALITATIVE)

Goodness of Fit: hypothesis ! whether or not a sample of values was drawn from a normally distributed population
Test of Independence: most common; hypothesis ! are the two criteria of classification independent?
Homogeneity: hypothesis ! whether samples drawn from populations are homogeneous with respect to some criterion of
classification (i.e. are frequency counts distributed identically across different populations?)
Even if the hypothesis implies a 2-tailed test, DO NOT DIVIDE α/2
*Different in concept and sampling procedure but use the same formula (i.e. mathematically identical)

Expected frequency (E) _______________________________________________

= row total for row containing cell x column total for column containing cell
Total number of observations (n)
Example: Goodness of Fit grand total (n)
Suppose that a research team making a study of hospitals in the United States collects data on a sample of 250 hospitals which enables
the team to compute for each the inpatient occupancy ratio, a variable that shows, for a 12-month period, the ratio of average daily
census to the average number of beds maintained. Suppose the sample yielded the distribution of ratio (expressed as percents).
We wish to know whether these data provide sufficient evidence to indicate that the sample did not come from a normally distributed
population.
( Observed( Expected(( (
Inpatient(occupancy( Number(of(hospitals( Class( frequency( frequency( (OiJEi)2(/(Ei(
ratio( interval( Oi)( (Ei)(
0.0(to(39.9( 16( <40.0( 16( 14.55( .145(
40.0(to(49.9( 18( 40.0(to(49.9( 18( 22.18( .788(
50.0(to(59.9( 22( 50.0(to(59.9( 22( 38.65( 7.173(
60.0(to(69.9( 51( 49.62( .038(
60.0(to(69.9( 51(
70.0(to(79.9( 62( 50.48( 2.629(
70.0(to(79.9( 62( 80.0(to(89.9( 55( 38.38( 7.197(
80.0(to(89.9( 55( 90.0(to(99.9( 22( 21.88( .001(
90.0(to(99.9( 22( 100.0(to(109.9( 4( 9.92( 3.533(
100.0(to(109.9( 4( 110.0(and(greater( 0( 4.35( 4.350(
(Total( 250( (
Total( 250( 250.00( 25.854(

RSMV 9
 1. State the hypothesis
Ho: In the population from which the sample was drawn, inpatient
occupancy ratios are normally distributed
HA: The sampled population is not normally distributed
2. Select the appropriate test statistic
3. Select the level of significance = .005
4. Determine the critical ratio or critical value:
2
x (.005, 6 df) = 18.548
5. Perform the calculation of the test statistic
- Compute for the mean and standard deviation of the sample
x = 69.91 and s = 19.02
- Compute for the expected frequencies in each cell
see above
6. Draw and state the conclusion
Reject Ho since 25.854 is in the region of rejection.
Conclude that in the sampled population, inpatient occupancy
ratios are not normally distributed.

Example: Test of Independence (comparison of observed and expected frequencies)

“large” difference = two criteria of classification are INDEPENDENT (reject Ho)
“small” difference = two criteria of classification are DEPENDENT(
A 2 X 2 Contingency Table: e.g. 2x2 Contingency table, if n = 30; E are in brackets
Second(criterion( First(Criterion(of( (
of(classification(Classification( ( CRITERION A
Total( CRITERION B A1 A2 TOTAL
1( 2(
B1 6 8 14
1( a( b( a(+(b( (4.344) " E<5 (9.66)
2( c( d( c(+(d( cannot use X2
Total( a(+(c( b(+(d( n( test
CANNOT USE X2 TEST IF…. B2 3 12 15
n < 20 or 20 < n < 40 and any expected frequency is <5. (5.20) (10.34)
(When n ≥ 40 an expected cell frequency as Small as 1 can be tolerated) TOTAL 9 20 29

(
e.g. Expected frequency for A1B1
(R x C)/n = (9x14)/29 = 4.344
EXAMPLE: 1. State the Hypothesis
A sample of 500 elementary school children in a certain school Ho: Nutritional status and academic performance are
system were cross-classified by nutritional status and academic independent
performance. The researchers wished to HA: The two variables are not independent
know if they could conclude that there is arelationship between
nutritional status and academic performance. 2. Select appropriate test statistic
Let α = .05
Academic Nutritional Status
Performance Total OR
Poor Good
Poor 105 15 120
Satisfactory 80 300 380
Total 185 315 500 3. Select the level of significance = .05
4. Determine the critical ratio α,d.f.=(r-1)(c-1) =
Observed Expected 3.841
frequency frequency (Oi – Ei)2 (Oi – Ei)2 / 5. Perform the calculation of the test statistic
(Oi) (Ei) Ei
105 44.4 3672.36 82.71
15 75.6 3672.36 48.58
80 140.6 3672.36 26.12
300 239.4 3672.36 15.34
6. Draw and state conclusion
Total 172.75 Reject Ho since 169.907 is in the rejection region
Conclude that the two variables are not independent

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 VIII. HYPOTHESIS TESTING FOR THREE POPULATIONS
Completely randomized
design (one-way ANOVA)
Population
mean (Analysis
of Variance) Factorial experiment
(Two-way ANOVA)
Three
Populations Randomized block design

Population
proportion X2 test

IX. LINEAR REGRESSION

http://stattrek.com/regression/slope-test.aspx?Tutorial=AP

RSMV 11
 PREVMED2: Introduction to Community Health II Bambam2017

SOCIAL MOBILIZATION and PRIMARY HEALTH CARE (PHC)

Trans by AMFV, 8/28/2014

CODE:
Normal Font: Slides from Lectures It’s more expensive than it should be, when we see
Italicized: Side Notes, Trans ng Recordings patients at the following stages:
Purple: Lalabas daw sa quiz.
STAGE 2 (Screening for symptomacity)
COMMUNITY HEALTH II STAGE 4 (Rehabilitation, Outcome)
STAGE 1 (Wellness)
Meeting 1: Social Mobilization
PHC (Primary Health Care) Q: What are the traits of a THOMASIAN PHYSICIAN?
Meeting 2: National Health Situation
Healthcare Delivery 1. Competence
Meeting 3: Comprehensive Community Health 2. Compassion
3. Commitment
Development
- Community Profiling However, meron din tayong tinatawag na 5-star
- Community Diagnosis physician. Ano yon?
- Community Health Worker’s
Training “STAR PHYSICIAN”
COPAR PAFP, Inc., 1994
Meeting 4: Situational Analysis APMC Internship Program
Meeting 5: Community Health Workers
Communication Skills 1. Health Care Provider
a. we are exposed to the clinical sciences
Submission Deadlines: in med school
Individual (Case Analysis): 15 Oct 2014 b. kaya tayo may clinical cases
Group (Community Health Development 2. Educator/Teacher
Program): 31 Oct 2014 3. Scientist/Researcher
a. why we have the subject Clinical
TODAY’S COVERAGE: Epidemiology (1st yr to 4th yr in
Social Mobilization medical school)
Primary Health Care 4. Admin/Manager
5. Social Mobilizer
Okay, so we are familiar with terms: Health,
Community. For example, for a person with HPN and diabetes, we
So, what do we mean by good health care? Ha? What? could prevent possible morbid/mortal outcomes by:
There should be a balance in all Health Elements.
What are these elements? RRR – Relative Risk reduction
ARR – Absolute Risk reduction
1. Societal
2. Intellectual Possible morbid/mortal outcomes:
3. Psychological
4. Spiritual 1. organ damage (retinopathy, etc.)
5. Sexual 2. premature death
6. Environmental 3. heart attack (myocardial infarction)
7. Ecologic
Exercise Medicine: use of exercise to prevent target
DOCTOR’S NOTE organ damages

Endowed w/ power, authority, respect

Recognized for his skill and dedication POTENTIALS OF PRIMARY CARE CONSULTATION
Advocates patient’s best interest (1979)

Anong pinakaimportant na bullet dyan? Yes, that’s A: Management of presenting problems

right. Advocates patient’s best interest. B: Modification of help-seeking behaviors
C: Management of continuing problems
Q: At what stage of disease do we usually see D: Opportunistic health promotions
Filipino patients? STAGE 3 (Clinical feature)

UST-FMS Batch 2017 Section D [A.M.F.V.] 1

 PREVMED2: Introduction to Community Health II Bambam2017

So, anong pinakaimportante dyan? Ung B and C. MORBIDITY: LEADING CAUSES (2010)
Modification of help-seeking behaviors at Opportunistic
health promotions. 1. Acute Respiratory Infection**
2. Acute Lower Respiratory Tract Infection and
We have two types of.. (illness yata). Pneumonia*
3. Bronchitis
1. Acute cases communicable diseases 4. HPN
2. Chronic cases lifestyle diseases, 5. Acute Water Diarrhea
noncommunicable 6. Influenza
7. UTI
In UK, the following are included in primary care: 8. TB Respiratory
9. Injuries
culposcopy (OB) 10. Disease of the Heart
threadmill (cardio)
*In 2008, the leading cause of morbidity is Pneumonia
NEW MILLENIUM **In 2010, Acute Respiratory Infection was added.
Population will continue to be young Oh eto, pang two points nyo sa quiz.
Increasing elderly population due to high life
expectancy Leading communicable cause of morbidity:
Emerging health problems Respiratory infections (in general)
Q: In the Philippines, what do you expect of the Life
Leading noncommunicable cause of morbidity:
Expectancy in the future?
Hypertension
Life expectancy will continually increase (male
and female Filipinos will reach 70+) because: MORTALITY: LEADING CAUSES (2009)
o technology, new medicine, etc.
1. Diseases of the Heart*
o Remember: our pyramid is EXPANSIVE
2. Diseases of the Vascular System
o The base is young Filipinos, if they
3. Malignant Neoplasms
will be able to survive, life
4. Pneumonia
expectancy increases
5. Accidents
Advances in Changes in
*In 2002, the leading cause of mortality is CVD
Technology and Fields (cultural, (Cardiovascular disease).
Communication biological)
Medical Science Mortality Figures
and care (decrease TB - #6 cause of death
mortality rate) Diabetes - #8 cause of death
Health Indicators cousins: #1, #2 and diabetes (Okay sorry, di ko
(birth rate alam kung anong table ung tinutukoy nya dito.
remains high) I don’t know kung ano ung #1 and #2 na sinabi
nya. And di ko alam kung anong year pa tong
DISEASE PATTERNS statistics na tinutukoy nya.)

Infectious vs. Chronic Diseases HEALTH CARE PROBLEMS

Environmental and Occupational Issues
Health problems of women and children Access to health care
o financial
MORTALITY: LEADING CAUSES (2004-2008, 2009) o nonfinancial issues
5 ½ Year Average
CARE PROVISION
6. TB
7. Chronic Lower respiratory diseases Patient-centered
8. DM o the patient in context of the family
9. Nephritis, Nephrotic syndrome & nephrosis Family-focused
10. Certain conditions originating in the perinatal o the family unit itself
period Community-oriented
o the community as it affects the family

UST-FMS Batch 2017 Section D [A.M.F.V.] 2

 PREVMED2: Introduction to Community Health II Bambam2017
SOCIAL MOBILIZATION
Generating and sustaining the creative and
coordinated of all sectors at various levels to
facilitate improvement of a certain group
Changing the behavior of individuals in the
family and community towards adopting
more acceptable health promotive habits
CHALLENGES IN HEALTH CARE
Broader perspectives in health: Global and
Local challenges
People Empowerment in Health & Community
Environment
Yan, sa environment. We’ll talk about risk taking
behaviors. Mahilig kasi tayong mga Filipinos magtake
ng risk. Example of a risk-taking behavior. Even if may
gas emission testing na for all vehicles, marami ka pa
ring makikitang smoke-belching, di ba?
(Tapos biglang singit:)
Types of Emitted substances:
Primary pollutants – carbon monoxide
Secondary pollutants – aerosols, vehicles
MOBILIZING FOR HEALTH
Empower individuals, families & communities
Promotes wellness and health maintenance
Sensitized citizenry, awareness, community
eager to participate
Remember: MOBILIZATION = EMPOWERMENT
We could promote social mobilization by
Sensitizing everyone = Make every people
aware of all the problems
Steps in social mobilization:
1. sensitization
2. enablement
3. empowerment
*An empowered individual –proactive, working for the
betterment, promoting wellness
COPAR (Ano ba to?) – We’ll handle this next time.
THE HEALTH CARE DELIVERY SYSTEM IN THE
PHILIPPINES
(MILESTONES):
1977 – refinement (?)
1978 – Alma Ata, Russia
1979 – Adoption of PHC
1983 – Executive Order (FO) 851
Integration of Public Health & Hospital
Services
1987 – Executive Order (FO) 119
Reorganization of DOH
1992 – Local Government Code of 1991 (RA 7160)
Revolution of Health Services
RA 7160 – Landmark legislation (?) by late Pres.
Aquino, authored by Sen. Pimentel
“Attainment of all people of the world by the year
2000, a level of health that will permit them to lead a
social & economical productive life...”
Resolution WHA 30.43
30th World Health Assembly
May 1977
“Primary Health Care (PHC) is the key to attaining the
Health-For-All goal...”
International Conference on PHC
Member States of World Health Assembly 1978
Alma Ata, USSR
DECLARATION OF ALMA ATA
PHC
Essential health care
Based on practical and socially acceptable
methods and tech
Accessed universally by individuals and
families
Participated fully by everyone in the
community
Maintained at every stage of their
development
Cost w/c the community and country can
afford
Develops self-reliance and self-determination
PHC STRUCTURE
The health care system that takes place in the
community
PHC APPROACHES
Partnership with the community
Inter-sectional coordination
Appropriate technology
Suitable manpower
Equitable distribution of health resources
Appropriate distribution of health resources
and self-reliance
Q: Do all Filipinos have access to health care?
A: YES!
Q: Where are we problematic?
A: Lack of suitable MANPOWER
Then this last two slides. Yan. May 5 points na kayo sa
quiz natin next meeting.
UST-FMS Batch 2017 Section D [A.M.F.V.] 3
 PREVMED2: Introduction to Community Health II Bambam2017

GUIDING PRINCIPLES OF PHC

Universal coverage of the population, with

care provided according to need (equity)
Aspects: promotive, preventive, curative &
rehabilative (comprehensive)
Services: effective, culturally acceptable,
affordable and manageable
Communities: involved in the development of
services (promote self-reliance & reduce
dependence)
Approaches to health should relate to other
sectors of society

Accessibility: a service is easily available to users in

terms of time, distance and
Appropriateness: service that which the users
require
Acceptability: services satisfy the reasonable
expectations of users
Responsiveness: services adapt to the expressed
needs of users
Equity: users have equal access and benefits from
services
Effectiveness: services achieve their intended
objectives
Efficiency: services achieve maximum benefit for
stated costs

UST-FMS Batch 2017 Section D [A.M.F.V.] 4


LEC 3. COMMUNITY HEALTH DEVELOPMENT
RED = from lecture
BLACK = Community Med Handbook
GREEN = other references (see last page)
Community
1) Geographical or neighborhood basis
- People living in the same area = same concerns
due to geographical proximity
2) Cultural
- Common cultural traditions that go beyond
geographical barriers
- Expectation that members assist each other and
share resources
- Shared ethnic origin/background, language,
religion, customs
e.g. Filipino-Chinese communities
3) Social stratification
- Shared interests that arise as a product of different
social classes e.g. the working class community
- Share support, knowledge, resources that extend
beyond geographical boundaries (i.e. local or
national level)
Community Participation
- Community is involved in the formal processes of
policy making and implementation
- Participation level ranges from high to low
e.g. in Primary Health Care = accessible, affordable,
acceptable and key aspect is involvement of local
people in every stage of decision making
Outreach
- Extension of a professional service into the
community in order to increase its accessibility
- Priorities and desired outcomes are determined by
professionals (i.e. normative needs)
e.g. a mobile bus offering chest radiography and lab
exams to employees at their place of work ! increase
accessibility but predetermined by the professionals
Health Projects
- Organized undertakings to meet people’s health
needs in a community
- Independent (e.g. self-help/voluntary)
Community Development
- Process by which a community…
(1) Identifies/defines, (2) orders/ranks, (3) finds the
resources (internal/external) and (4) takes action to
deal with its needs/objectives
Thereby extending and developing cooperative and
collaborative attitudes and practices in the community
- Both a Philosophy and a Method:
- As a philosophy:
- Commitment to equality & the breaking down of
hierarchies and power relationships
- Emphasis on participation and enabling all
communities to be heard
- Collectivizing of experience and seeing problems
as shared
- Empowerment of individuals and communities
through education, skills development, sharing
and joint action.
! !
RSMV
- As a method:
- Reflection on aspects of reality
- Search and collective identification of root causes
- An examination of their implications
- Development of a plan of action to change reality
Education
- Knowledge/Information (cognitive domain)
e.g. identifying children at risk of becoming
malnurished
- Reinforced in your skills (psychomotor domain)
e.g. using hands skillfully in weighing children and
recording weights on growth charts
- Behavioral change (affective domain)
- Communication skills are required
e.g. convincing parents to get their children
immunized
Endpoint/objective ! ability to influence people to
change habits and practices (i.e. behavior)
Partnership Amongst Health & Local Authorities
1) National Government
2) Local Government Units (Recall ! Local
Government Code of 1991: Devolution of Health
Services)
3) Private (includes NGO)
3) Community itself (most important)
Needs Assessment
Health Need:
- A subjective, relative concept which is judged by an
expert/professional and is influenced by whether the
need can be met
- An objective and universal concept which is a
fundamental right
Type of Need
Normative Defined by experts/professional
groups
Felt Defined by clients, patients, relatives
or service users
! Programs implemented under this
are more effective/successful and
more sensitive to needs of
community
! Greater degree of ownership
(community is less passive) = greater
enablement and empowerment of
individuals
- Results in greater long-term changes
in health state
Expressed When felt needs become a demand
- Not an indicator of demand since it
excludes felt needs that are not
expressed (i.e. community hasn’t
asked for help/information)
Comparative Identified when people, groups, or
areas fall short of an established
standard (community’s services or
resources are lacking compared to
others, therefore community seeks
and desires action from govt. and
other agencies)
! 1
 RSMV
Health Promotion Process according to WHO, 1986 Community Organizing Participatory Action
i.e. Steps in Effective Development Planning Research (CO-PAR) for Community Health
0.5) Needs assessment (maximize limited resources) Development
1) Set priorities - Sr. Carmen Jimenez, 2005 (Philippines)
2) Make decisions “Social development approach that aims to transform
3) Plan strategies (! more effective and efficient) the apathetic, individualistic and voiceless poor into
4) Implement them to achieve better health dynamic, participatory and politically responsive
(achieve desired objectives) community”
5) Evaluation Participatory action research
- At the heart of this process is empowerment of - Investigation on problems and issues concerning life
communities, their ownership and control of their own and environment of the underprivileged. The
endeavors and destinies. underprivileged collaborate on research work with their
representatives and professional researchers
Objectives - Encourage consciousness, develop competence for
Specific – state desired results changing situations and support in organization
Measurable – observable building
Appropriate – approaches relate to problem being - Community – directed process of gathering and
solved; not contrary to the health policy of analyzing information on an issue for the process of
an organization // Attainable taking actions and making changes
Realistic - Consider resources, costs, etc.
Time-bound – set a time frame and target deadlines Emphases of CO-PAR**
- Community works to solve their own problems
Planning Paradigm - Internally directed (rather than externally)
- J Thomas Butler, 2000 (UK) - Development of the capacity to establish a project is
more important than the project
Needs Assessment - There is a consciousness-raising to perceive health
- Population analysis and medical care within the total structure of society
- Determination of
health problems Phases of CO-PAR
- Prioritizing needs 1) Pre-Entry - identify site of development work
Evaluation 2) Entry - work with community
- Assess results 3) Community Study/diagnosis phase (Research
Development of - Determine phase) – facilitate change process by helping
Program plan whether community identify critical areas
- Goals & objectives objectives have 4) Community Organization and Capability-
- Policy formulation been met Building Phase
- Methods & techniques - Determine if 5) Community Action Phase
- Implementation methods used 6) Sustenance and Strengthening Phase
were appropriate
and efficient UK Planning Paradigm CO-PAR Phase
Implementation Needs Assesment 1-3
Development of program Plan 4
RECALL: Implementation 5-6
Criteria for Evaluation
• Effectiveness – the extent to which aims and Traditional PAR
objectives are met - Identify and Research Seek social
• Appropriateness – the relevance of the intervention meet individual Objectives transformation
to needs needs within the
• Acceptability – whether it is carried out in a context of existing
sensitive way social systems
• Efficiency – whether time, money and resources are Defined by Needs Community
well spent, given the benefits researchers or Assessment defines their
• Equity – equal provisions for equal need health care (community needs; becomes
professionals problems – ‘experts of their
(Normative) template for own reality’
analysis) (Felt needs)
Handled and Research Community!
controlled by Problem Data collection to
professionals (responsible analysis
entity)
Based on findings Recommend Community!
and analysis of -ations for recommendations
professionals Actions & action plan

! ! ! 2
 RSMV
Arnstein’s Ladder of Participation (1969) Community Profile
8 Citizen control Degrees of Citizens are - A comprehensive description of the needs of a
7 Delegated power citizen power involved in population that is defined, or defines itself, as a
6 Partnership planning and community, and the resources that exist within a
decision-making community, carried out with the active involvement of
through join the community itself
committees, Purpose: Aid in the development an action plan or
delegated other means of improving the quality of life
representatives
or complete Community Diagnosis
control - Discover a community’s health problem
5 Placation Degrees of Citizens have a - Evaluate measures instituted for their solution
4 Consultation tokenism voice but may - Aids in determining:
3 Informing not be headed - Difference in health of the people served
2 Therapy No Those with - Programs are appropriate for the region/area
1 Manipulation participation power educated - New problems produced as a result of
or cure, citizens elimination of old ones
are recipient
- UK & CO-PAR- seek to attain a high level on the Adequate Community Diagnosis requires answers
Ladder by encouraging participation and greater to SEVEN MAJOR QUESTIONS:
degree of ownership among community
1) What are the magnitude and extent of
Community Action Community Health Problems?
- Any activity undertaken by a community in order to - Health needs of community (4 different types)
effect change and includes lobbying authorities to ! Explore indicators of health (prevalence, incidence,
provide services and the provision of voluntary or self- etc.)
help services to address needs = strengthen
community organizations 2) What is the Extent of Current attempts to
- e.g. medical missions (based on normative needs but alleviate these community health problems?
beneficial when it is incorporated in a development ! Current interventions and programs
program)
3) What are the correlates of community health
Community Profiling (" Helps you choose a problems?
community to work with) ! Social determinants and variables associated with
- Provides a systematic assessment of needs rather health outcomes e.g. economic status, education, etc.
than the subjective view of the health worker
4) What procedures of techniques will be needed
MAIN to effect the desired changes?
ELEMENTS - Based on the answers to the first 3 questions
Health Policy Health Policy - Effectiveness and - Decision-making by both professionals and
implications of community itself
implemented
regulatory 5) What data are needed for program management
measures and evaluation?
Health and Health Service - Statistical indices - Data necessary for management of cases,
Environmental Provision and e.g. morbidity, accounting purposes and assessment of the program
Services Impact mortality, etc.
Social Services (Health - e.g. health 6) What methods of data gathering, recording and
Disease, indices) improvement processing are needed?
disability, death programs ! INCORPORATE 4-6: Primary, secondary data,
Socio- Socio- - Extent of Qualitative vs. Quantitative, etc.
Economic ecological economic activity &
Environment environment unemployment, car 7) To what extent is the program accomplishing its
Physical ownership, objectives?
Environment housing, transport, - Checked at regular intervals
air pollution, etc. - Is the program making a difference? Encouraging
Community The - Age and gender changes which Improve health status?
composition ‘Community’ profile, the way the
(demographics) community is
Community organized and its
organization & capacity to control
Structure its own health
Community
Capacity
! ! ! 3

Process, Impact & Outcome Evaluation Schemes
(Discussed in lecture but the following is from Naidoo
& Wills, 2000)
Process Evaluation
- Formative or illuminative evaluation
-Concerned with assessing the process of program
implementation (step by step monitoring; tedious)
- Addresses participants perceptions and reactions to
health promotion interventions
- Acceptability, integrity, quality of health program
- Methods: interviews, diaries, etc.
e.g. 5 year program ! all throughout (e.g. yearly
intervals)
Impact Evaluation
Impact – the immediate effects such as increased
knowledge or shifts in attitude
- Tends to be the most popular choice, as it is easier
to do
- Can be built into a program as the end stage
- Can assess difference between end results and
baseline
- Measure efficiency and effectiveness
- Were objectives reached?
e.g. 5 year program ! Impact analysis done in Year 5
Outcome Evaluation
Outcome – the longer-term effects such as changes in
lifestyle
- More difficult as it involves monitoring and
assessment of behavior change
- More complex and costly
- Often the preferred evaluation method as it measures
sustained changes that have stood the test of time
- e.g. 5-year program ! 10, 15 years later
e.g. Evaluation in CO-PAR
- In between Phases = Process
- End of program = Impact
- Several years after CO-PAR exposure = Outcome
Situational Analysis
! Diagnosis of health situation by collection of current
data and examining the status of the different
components of the Health Ensemble (below)
- Health Status = Interaction of Health Sector +
Population + Health related SE factors
Health Sector**
Health
Status Population
!
Health-related
Socioeconomic
Factors
! waste disposal, industrial waste disposal, food
- Provides the basis for:
1) Describing the current health situation
2) Making a forecast of the future status
3) Identifying the problems, gaps and seeking
explanations for their occurrence
! !
RSMV
e.g. National Objectives for Health, 2005-2010
- Information collection usually begins with the
available ones of the year immediately preceding the
year when the analysis is being made (in our example,
data collected from1999-2004 was used in planning for
2005-2010).
- The same set of information for Year 1 must be
collected as they occurred in the last year ! used for
estimating trends
e.g. A 4 year plan
- Year 0: The year during which the plan is being
formulated
- Year 1, Year 2, Year 3, etc.: The past years
- Year 4: the last year is called the planning horizon
Levels of Analysis
Community ! District ! Provincial ! Regional !
National
Analysis of Population
- Composition, geographical distribution and the
differences in the magnitude of certain selected vital
indices* among different geographical areas.
- Provides the necessary basis for computation of
disease occurrence rates and accomplishment of
programs.
- Includes Total population, age and sex structure,
population projection (annual rate of pop. increase)
- Sources of data: censuses, vital statistical reports,
surveys
*Crude birth rate, death rate, natural growth rate, infant
mortality, maternal mortality, etc. " can be used to
assess health status inequality among different
geographical areas
Analysis of Health Status
- Includes Leading causes of mortality, morbidity,
infant/maternal mortality, hospital admission/use,
consultation
- May include lists of important causes of disease e.g.
endemic diseases in certain areas
- May group together similar morbidities e.g. Upper
Respiratory infections ! includes pneumonia,
bronchitis, etc.
- Sources of data: surveys, research, statistical
reports
Analysis of Related Socioeconomic Factors
- Broad category; almost everything relates to health
! need to be very selective
- Includes:
- Economic Indices (GNP, unemployment, active
workforce %)
- Social Indices (communication and transport,
education, housing, electrification)
- Environmental indices (safe water supply, human
establishments)
- Nutritional Status (average calorie/protein intake
compared to minimum requirements, level of iron-
deficiency anemia among pregnant women)
! 4
 RSMV
- Sources of data: relevant govt agency/department,
annual reports, surveys, national development plan

Analysis of the Health Sector

Done in terms of…
a) intersectoral relationship e.g. health sector + non-
health sector
b) intrasectoral relationship e.g. medical insurance,
public and private operations
c) health facilities and the programs e.g. hospitals,
govt. health units, etc.
d) health manpower e.g. geographic distribution,
migration of physicians, nurses, etc.
e) finance e.g. healthcare expenditure and budget
f) current projects

Training Community Health Workers (CHWs)

CHWs e.g. barangay health workers, volunteer health
workers
- First point of contact with the health services
- Interface between what the govt. can provide and
what the community needs
- Necessary because there is a limited health
professional workforce (i.e. midwives > nurses >
doctors > dentists > nutritionists)
- If properly trained can deal with the most prevalent
health problems in community

Training Guidelines for CHWs

- Directed to performance of a limited number of
specific tasks and sub-tasks for the improvement of
community’s health
e.g. Community problem is diarrhea. CHWs can
prepare and administer oral rehydration salts for the
dehydrated child, as well as convey to the mother the
importance of this task so that she can repeat it next
time if needed
- Motivation to learn, manage time, and serve the
community ! easier to train
- Main objective of a training course: Carry out needed
tasks (balance of theories, principles and application)
- Information is either “Must learn” (essential) or
“Useful to learn”

Sources
- Community Health Handbook (Revised May 2011)
- Dr. Pinedaʼs lecture (2014)
- Jimenez, Sr. Carmen, (2005),
Community Organizing Participatory Action Research (CO-PAR) for
st
Community Health Development (1 ed), Paranaque, Philippines .
- Naidoo J, Wills J. (2000) Health Promotion: Foundations for
Practice. 2nd ed. Edinburgh.

! ! ! 5
 RSMV
CO-PAR Framework

Phases Activities
- Community consultations/dialogues
- Setting of issues/considerations related to site selection
- Development of criteria for site selection
Pre – entry phase - Site selection
- Preliminary social investigation (PSI)
- Networking with local government units (LGUʼs), NGOs, and
government agencies.
- Integration with the community
- Sensitization of the community/information campaigns
- Continuing social investigation
Entry phase - Core group (CG) formation
• Development of criteria for selection of CG members
• Defining the roles/functions/tasks of the CG
- Coordination/dialogue/consultation with other community organizations
- Self-awareness and leadership training(SALT)/action planning
- Selection of the research team
- Training on data collection methods and techniques/capability-building
(includes development of data collection tools)
Community study/diagnosis phase - Planning for the actual gathering of data
(Research phase) - Data gathering
- Training on data validation (includes tabulation and preliminary
analysis of data)
- Community validation
- Presentation of the community study/diagnosis and recommendations
- Prioritization of community needs/problems for action
- Community meetings to draw up guidelines for the organization of the
community health organization (CHO).
- Election of officers
- Development of management systems and procedures, including
Community Organization and Capability – delineation of the roles, functions and tasks of officers and members of
Building Phase the CHO
- Team building/Action-Reflection-Action (ARA)
- Working out legal requirements for the establishment of the CHO
- Organization of working committees/task groups (e.g., education and
training, membership of committees)
- Training of the CHO officers/community leaders
- Organization and training of community health workers (CHWs)
• Development of criteria for the selection of CHWs
• Selection of CHWs
• Training of CHWs
Community Action Phase - Setting up of linkage/network referral systems
- PIME (planning, implementation, monitoring and evaluation) of health
services/intervention schemes and community development projects
- Initial identification and implementation of resource mobilization
schemes
- Formulation and ratification of constitution and by-laws
- Identification and development of “secondary” leaders
- Setting up and institutionalization of financing scheme for community
health program/activities
Sustenance and strengthening phase - Formalizing and institutionalization of linkages, networks and referral
systems
- Development and implementation of viable management systems and
procedures, committees, continuing education/training of leaders,
community health workers, community residents

! ! ! 6
 RSMV
LEC 4. Learning + Communication Example:
RED = from lecture Smoking
BLACK = Community Med Handbook Pre- Introduction/No intro Not aware of
Contemplation to new concept no hazards of
Learning: four things to consider intention on changing cigarette
- Information behavior smoking,
- Requirement for information dedma
Contemplation Aware a problem Considers
- Requirement for skills
exists, no pros/cons of
- Requirement for behavior commitment to action quitting
Preparation Think of ways to Telling
Three Domains of Learning into Action change behavior w/ others that
- Cognitive, Affective, Psychomotor intent on taking he plans to
- Can be converted into objectives or questioning action quit
(i.e. cognitive/affective/psychomotor objectives or (accountabi-
questions lity)
Action Active modification of Stops
1) Cognitive (Knowledge) behavior smoking;
- Learning (acquiring information) uses
- Knowledge (facts, truths, principles) nicotine
gum, patch
Bloom’s Taxonomy of Educational Objectives Maintenance Termination: Quit
Knowledge Naming, defining, listing, Sustained change smoking
identifying (old new) successfully
Comprehension Explaining, describing, interpreting Relapse: Return to Go back to
Application Illustrating, predicting, applying old behaviors smoking
Analysis Analyzing, categorizing,
classifying, differentiating 3) Psychomotor (Skills)
Synthesis Concluding, proposing, - Physical skills (application of accumulated knowledge
synthesizing & attitudes)
Evaluating Contrasting, comparing, evaluating

2) Affective (Internalization Behavior) LEARNING: Concepts & Principles

- Emotions, feelings and attitudes
- Attitudes (people’s perceptions about the
environment and the things in it)
Attitudes About Health
- The acquisition of health concepts that result from
knowledge
- Comprehension
- Application of health knowledge
- One’s beliefs
Processes – Affective Learning
1) Receiving
- being aware of or attending to something in the
environment
2) Responding
- showing some new behaviors as a result of
experience
3) Valuing
- showing some definitive involvement or commitment
4) Organization
- Integrating a new value into one’s general set of
values; giving it some rnaking among one’s general
priorities
5) Characterization by a value/value complex
- acting consistently with the new value
Maturation- a development process during which a
person manifests traits, the blueprint of which is
carried on the genes
Learning- Change of behavior brought about by
experience, insight, perception, or a combination of the
three, that causes the individual to approach future
situations differently
Mediators- Factors that facilitate/help bring about
personal behavior change
e.g. Administrative orders for a smoke-free city,
Clinical conditions (chest pain, heart problems)
Learning Process: Critical Factors
1) Learner
2) Task
3) Procedure
4) Learning situation
Basic Conditions in Teaching Situations
1) The learner understands the objectives of the
educational sessions
2) Instruction proceeds from the known to the
unknown, and from the simple to complex
3) Information and skills are supported with meaningful
methods (examples, practice and feedback) and
assessment

5 Steps of Behavior Change

1
 RSMV
DEVELOPING EFFECTIVE COMMUNICATION Closed “Do you smoke..?”
- yes/no question
Communication: using spoken language and non- Open “Tell me about your smoking”
verbal messages in a face to face (usually one-on-one) Rhetorical “So you haven’t been successful in
setting. stopping smoking before now?”
- Focus on communication process, rather than Hidden “Well, I expect your breathing might be
content of message easier if you quit smoking”
Reflecting “How do you feel about stopping
Forms of Communication smoking?”
- spoken word Directed - For initial assessment of a
- signed or written word group’s/individual’s needs
- non-verbal - Monitor progress, test whether
objectives are being met
Communicating about Health Promotion - Evaluation of health program
- ensure that the communication message is framed in - OPEN and DIRECTED ideal question format
a way that will make the recipient feel valued and - Don’t start a conversation with “why” e.g. why are you
respected here?, Why did you do this?
- willingness of the health promoter to relinquish
control of the interaction to the other person Types of Questioning
Cognitive
Forms of Non-Verbal Communication - Gain attention
Speech-related Timing and pauses, speech - Obtain information
variations - Assess knowledge levels
Non-verbal behavior Posture and position, eye - Reinforce facts
contact, physical contact, Affective
speech variations, voice and - Encouragement
facial expressions to indicate - Develop confidence
listening - Explore feelings, emotions, problem areas
Touch limit to arm and
shoulder to avoid
misinterpretation Barriers to Effective Listening & Communication
Eye contact convey - Mechanical: environment, fatigue, medications,
sincerity impaired sight
Body language Eye contact, gaze, facial - Psychological: differing attitudes, beliefs, values &
super similar to expressions, gestures, prejudices
non-verbal posture and stance - Semantics: Meaning of words
behavior…just
remember DOESN’T Reasons for Failure to Listen
INCLUDE SPEECH The Listener The Speaker The
VARIATIONS Environment
Personal appearance Clothing, hairstyle, smell - Negative attitude to - Poor oral - Noise
Symbols Color, uniforms, art, time speaker/subject presentation - Discomfort
symbolism - Impatience to - insensitivity (heat/cold
Sign language Gesticulating e.g. for hearing speak oneself to feedback /pain/hunger)
impaired - Not understanding - Appearance - Interruptions
Written words Letters, reports, note-taking, due to difficulty of - Lack of
email concepts/information privacy
Tri-media Information & entertainment - Stress/anxiety - Seating &
about understanding distance
Listening - Selective attention
Passive: usually non-responsive and may be - Blocking an
superficial or selective unpleasant message
- Listener is blocking an unpleasant message - Not hearing due to
Active: good listening; a skill learned and improved a physical problem
Attentive: observing the speaking, ensuring proper - Self-consciousness
eye contact, concentrating on both non-verbal and
verbal behavior, being interesting, indicate COUNSELING
attentiveness (head-nodding), being open-minded, - Person to person
tolerate short sentences - Facilitate client’s work in a way that respects the
client’s values, personal resources and capacity to
Questioning Clarifications, amplification of views self-determination
- Helping people to make health-enhancing choices
(personal development)
Types of Questions Types of Counseling
2
 RSMV
Directive Non-Directive
effect change Beat around the
right away bush until you hit
the correct spot
(lol)
Counselor - More active role - Reflective and
Type - Giving guidance more passive role
about behavioral - Giving clients
change time and space to
- Intervening to arrive at their own
increase pace of perceptions/
change solutions to their
predicament
Health - Bringing about - Supporting
Promotion change in health- someone through
related behavior a difficult
/challenging time
e.g. help or for personal
someone change development
harmful drinking
habits e.g. improve
person’s morale
and self-esteem
so they’re more
likely to achieve
desired change
Health - Behavioral - Personal
Education change approach
- Empowerment - Preventative
Levels of - Primary - Secondary
Prevention Inhibit onset of - Tertiary
disease Intervening where
- Secondary disease has
Prevent progressed,
progression of provide quality of
disease life services

*He didn’t mention these topics in the lecture but it’s in

the Handbook (pages 85-87) you might be interested
in reading that, just in case
- Skills of Counseling
- Investigating Health Information
- Role of Mass media

Sources