| Abstrakt: |
Within an integrated conceptual framework made up of the social cognitive theory and the theory of fundamental causes, we assess the impact of 37 ecological strategies and 126 programs and action plans on three prioritized health issues in a community health improvement plan implemented in a Mid-Western Region of the United States from 2016 to 2018. We perform z tests comparing performance values to both baseline and established targets in 16 objectives which are tied to two priority health issues: healthy behavior; and healthcare capacity, access, and delivery. For three objectives tied to a third priority issue: changes in policy, system and environment, we conduct descriptive as well as thematic and interpretive analysis of responses to open-ended questions. Based on z-test results with statistically significant margins of 0.05 or less, performance values for 5 out of 16 quantitative outcome objectives met established targets and /or were better than baseline data including adult nutrition choices, adult physical activity, and capacity for both inpatient and outpatient mental health and addiction services for all ages. Qualitative data reveals an overall positive perception of performance in the changes in policies, systems, and environment priority issue area even as members desire an expansion of representation, and a strategic focus on leadership and media advocacy. Most unmet objectives are related to system capacity and resource needs. As predicted and explained in the theory of fundamental causes and the social cognitive theory, findings suggest that efforts to improve community health might have been slow or failing because of unfavorable socio-economic, resource, and structural factors that shape the micro, mezzo, and macro environments in which healthy behavior modification takes place. The results also underscore the difficulties in transforming individual risk and community health status without addressing socio-economic factors. [ABSTRACT FROM AUTHOR] |
