research on community health nursing

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Exploring community health nursing research topics: a comprehensive guide for nursing students, carla johnson.

• August 25, 2023
• Essay Topics and Ideas

Community health nursing is a dynamic and vital field within the nursing profession, focused on providing holistic care to populations within a defined community. This specialized branch of nursing goes beyond individual patient care, extending its reach to families, groups, and entire communities. This article will delve into community health nursing, explore its significance, and provide valuable resources for nursing students to engage in research, evidence-based practice (EBP) projects, capstone projects, research paper topics, research questions, and essay ideas.

What You'll Learn

Understanding Community Health Nursing: A Holistic Approach

Community health nursing emphasizes preventive care , health promotion, and disease prevention within a specific community. This holistic approach involves understanding the community’s unique needs, cultures, and challenges to provide targeted interventions that improve health outcomes. As nursing students, you will find this field to be a gateway to understanding the broader healthcare landscape and the interconnectedness of various factors that influence health.

PICOT Questions on Community Health Nursing

• P: Adult population in psychiatric care ; I: Implementation of daily RS questionnaire; C: Units without the daily survey; O: Reduction in utilization of restraint and seclusion; T: 6 months. Can the implementation of a daily RS (Restraint and Seclusion) questionnaire for adults in psychiatric care lead to a significant decrease in the utilization of restraint and seclusion within a period of 6 months?
• P: Pediatric population in school settings; I: Introduction of daily exercise regimen; C: Schools without daily exercise; O: Improvement in BMI and overall fitness; T: 1 academic year. Does introducing a daily exercise regimen in school settings for pediatric populations result in a noticeable improvement in BMI and overall fitness over the course of 1 academic year?
• P: Elderly population in assisted living facilities; I: Implementation of fall prevention program; C: Facilities without fall prevention program; O: Reduction in fall-related injuries; T: 1 year. Is there a significant reduction in fall-related injuries among the elderly residing in assisted living facilities after the implementation of a comprehensive fall prevention program within 1 year?
• P: Low-income pregnant women; I: Provision of prenatal education classes; C: Those without access to prenatal education; O: Increase in prenatal knowledge and healthier pregnancy outcomes; T: Throughout gestation. Can providing prenatal education classes to low-income pregnant women lead to increased prenatal knowledge and improved pregnancy outcomes when compared to those without access to such education?
• P: Diabetic population within the community; I: Establishment of a mobile diabetic clinic; C: No mobile clinic available; O: Enhanced diabetic management and reduced hospitalizations; T: 2 years. Does the establishment of a mobile diabetic clinic within the community lead to better diabetic management and a decrease in hospitalizations over a span of 2 years?
• P: Adolescent population in schools; I: Implementation of comprehensive sexual education; C: Schools with standard sexual education; O: Reduction in teen pregnancies and sexually transmitted infections (STIs); T: 3 years. Over a period of 3 years, does the implementation of comprehensive sexual education in schools result in a significant decrease in the rates of teen pregnancies and STIs among adolescents compared to schools with standard sexual education?
• P: Homeless population; I: Launch of mobile healthcare unit; C: No access to regular healthcare; O: Improvement in overall health status and decrease in emergency room visits; T: 1 year. Can the introduction of a mobile healthcare unit for the homeless population improve their overall health status and a noticeable reduction in emergency room visits within a year?
• P: Rural elderly population; I: Initiation of telehealth services ; C: Lack of telehealth services; O: Enhanced access to healthcare and better management of chronic conditions; T: 18 months. Does the introduction of telehealth services for the rural elderly population lead to increased access to healthcare services and improved management of chronic conditions over the course of 18 months?
• P: New mothers; I: Implementation of postpartum support groups; C: No postpartum support groups available; O: Reduction in postpartum depression rates and improved maternal well-being; T: 1 year. Can the implementation of postpartum support groups for new mothers lead to a significant reduction in postpartum depression rates and an overall improvement in maternal well-being within a year?
• P: LGBTQ+ youth; I: Creating safe spaces in schools; C: Absence of designated safe spaces; O: Decreased mental health challenges and higher academic achievement; T: Ongoing. Does creating safe spaces within schools for LGBTQ+ youth lead to a noticeable decrease in mental health challenges and a rise in academic achievement over an ongoing period?

Evidence-Based Practice Projects Ideas

• Evaluating the effectiveness of community-wide vaccination drives in reducing vaccine-preventable diseases.
• Assessing the impact of a smoke-free policy in public spaces on community members’ respiratory health.
• Investigating the outcomes of a nutrition education program in improving dietary habits among low-income families.
• Analyzing the effectiveness of a community-based mental health awareness campaign in reducing stigma and increasing help-seeking behavior.
• Exploring the outcomes of a diabetes management intervention using mobile health apps in urban communities.
• Studying the effects of a community gardening initiative on physical activity levels and nutrition awareness.
• Investigating the utilization and impact of telemedicine services in remote rural areas.
• Assessing the benefits of a community fitness program on cardiovascular health and overall well-being.
• Evaluating the effectiveness of a school-based anti-bullying campaign on students’ mental health.
• Analyzing the outcomes of a community-driven initiative to increase access to clean drinking water in underserved areas.

Nursing Capstone Project Ideas

• Developing a comprehensive disaster preparedness plan for a local community.
• Designing and implementing a culturally sensitive prenatal care program for immigrant populations.
• Creating a curriculum for training community health workers in identifying and addressing social determinants of health.
• Establishing a support network for caregivers of elderly individuals living at home.
• Designing a mental health first aid training program for community leaders and volunteers.
• Implementing a community-based program to promote physical activity among children with obesity.
• Creating a resource guide for LGBTQ+ youth to access healthcare services without discrimination.
• Developing a community-wide initiative to combat opioid misuse and overdose.
• Establishing a telehealth platform for remote health consultations in underserved regions.
• Designing a comprehensive sexual education curriculum for high schools to address varying cultural norms.

Nursing Research Paper Topics

• The impact of community health nursing interventions on reducing health disparities .
• Exploring the role of community health nurses in disaster response and recovery.
• Analyzing the effectiveness of school-based health clinics in improving student health outcomes.
• Investigating the barriers and facilitators of healthcare access in underserved rural communities.
• The role of community health nursing in promoting healthy aging and elderly care.
• Addressing mental health stigma through community-based interventions led by nurses.
• Analyzing the outcomes of community health education programs on reducing tobacco use .
• Exploring the relationship between community engagement and positive maternal-child health outcomes.
• The effectiveness of telehealth services in bridging healthcare gaps in remote areas.
• Investigating the impact of community health nursing in preventing and managing chronic diseases.

Community Health Nursing Research Questions

• How does the presence of community health nurses influence health outcomes in underserved urban neighborhoods?
• What are the key components of successful school-based vaccination programs , and how do they impact disease prevention?
• How do cultural competence and sensitivity affect the effectiveness of community health nursing interventions?
• What are the main challenges community health nurses face in addressing social determinants of health ?
• How does community engagement contribute to the sustainability of community health initiatives led by nurses?
• What strategies effectively promote mental health awareness and reduce stigma within communities?
• How do telehealth services improve access to healthcare for individuals in geographically isolated regions?
• What role do community health nurses play in detecting and managing chronic diseases ?
• How do community health interventions impact healthcare utilization patterns and costs?
• What are the outcomes of community health nursing programs focused on improving maternal and child health?

Essay Topic Ideas & Examples

• The Role of Community Health Nursing in Promoting Population Health.
• Addressing Health Disparities: The Impact of Community Health Nursing.
• Community-Based Approaches to Preventing Teenage Pregnancy .
• Telehealth: Bridging Healthcare Gaps in Underserved Communities.
• Cultural Competence in Community Health Nursing: Challenges and Strategies.
• Disaster Preparedness and Response: The Critical Role of Community Health Nurses.
• The Influence of Social Determinants of Health on Community Health Nursing Interventions.
• Community Health Education: Strategies for Promoting Healthy Lifestyles.
• Exploring the Connection Between Mental Health and Community Well-being.
• Innovations in Community Health Nursing: Harnessing Technology for Better Outcomes.

As nursing students, you are poised to become the next generation of community health nurses, armed with the knowledge and skills to impact the health and well-being of diverse populations positively. Community health nursing offers numerous opportunities for research, practice, and advocacy. By delving into PICOT questions, evidence-based practice projects, capstone projects, research paper topics, and research questions, you can deepen your understanding of this vital field and contribute to its growth. Don’t hesitate to seek our writing services if you need assistance with your community health nursing assignments or essays. We understand the demands of nursing education and are here to support you in your academic journey. Your dedication to improving community health is commendable, and together, we can pave the way for healthier, more vibrant communities.

Frequently Asked Questions (FAQs) About Community Health Nursing

• Is community health nursing the same as nursing? Community health nursing is a specialized branch of nursing that focuses on providing holistic care to populations within specific communities. While nursing is a broader field encompassing various specialties, community health nursing is distinct in its emphasis on preventive care and health promotion within communities.
• What are the qualifications of a community health nursing? To practice community health nursing, one typically needs a registered nurse (RN) license. Many community health nurses also hold a Bachelor of Science in Nursing (BSN) degree, and advanced practice may require additional education such as a Master of Science in Nursing (MSN) with a specialization in community health.
• Do community health nurses work in hospitals? While community health nurses primarily work in community settings like public health departments, schools, and clinics, they can also collaborate with hospitals to provide education, preventive care, and continuity of care to patients transitioning from hospital to home.
• Can a community health nurse become a doctor? Community health nurses can certainly pursue further education and career advancement, but the path to becoming a doctor is different. Becoming a doctor requires completing medical school and earning a medical degree (MD) or a doctor of osteopathic medicine (DO) degree, whereas community health nursing involves nursing education and training.

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Barclay S, Moran E, Boase S Primary palliative care research: opportunities and challenges. BMJ Support Palliat Care. 2019; 9:468-472 https://doi.org/10.1136/bmjspcare-2018-001653

Bowers B. Evidence-based practice in community nursing. Br J Community Nurs. 2018; 23:(7)336-337 https://doi.org/10.12968/bjcn.2018.23.7.336

Bowers B, Pollock K, Barclay S. Unwelcome memento mori or best clinical practice? Community end-of-life anticipatory medication prescribing practice: a mixed methods observational study. Palliat Med. 2021; https://doi.org/10.1177%2F02692163211043382

Evans CJ, Bone AE, Yi D Community-based short-term integrated palliative and supportive care reduces symptom distress for older people with chronic noncancer conditions compared with usual care: a randomised controlled single-blind mixed method trial. Int J Nurs Studies. 2021; 120 https://doi.org/10.1016/j.ijnurstu.2021.103978

Griffiths J, Ewing G, Wilson C, Connolly M, Grande G. Breaking bad news about transitions to dying: a qualitative exploration of the role of the District Nurse. Palliat Med. 2015; 29:(2)138-146 https://doi.org/10.1177/0269216314551813

James Lind Alliance Priority Setting Partnership. Community nursing top 10. 2021. http://www.jla.nihr.ac.uk/priority-setting-partnerships/community-nursing/community-nursing-top-10-priorities.htm (accessed 19 January 2022)

O'Donnell SB, Bone AE, Finucane AM Changes in mortality patterns and place of death during the COVID-19 pandemic: a descriptive analysis of mortality data across four nations. Palliat Med. 2021; 35:(10)1975-1984 https://doi.org/10.1177%2F02692163211040981

NHS England. Making research matter: Chief Nursing Officer for England's strategic plan for research. 2021. http://www.england.nhs.uk/wp-content/uploads/2021/11/B0880-cno-for-englands-strategic-plan-fo-research.pdf (accessed 19 January 2022)

Royal College of Nursing Archive. Record: Lisbeth Hockey (1918–2004). 2022. https://archives.rcn.org.uk/CalmView/Record.aspx?src=CalmView.Persons&id=DS%2fUK%2f25767&pos=1 (accessed 19 January 2022)

Building a community nursing research community of practice

NIHR School for Primary Care Research PhD student, University of Cambridge, Queen's Nurse

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Catherine Evans

Professor of Palliative Care, Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, and Honorary Nurse Consultant, Sussex Community NHS Foundation Trust

Most health and social care is provided to adults at home and in care homes. The need for community nursing has rapidly risen during the COVID-19 pandemic, with a 41% increase in people dying at home ( O'Donnell et al, 2021 ), and many more people have experienced conditions and health issues requiring community nursing interventions. However, there is a dearth of nurses who are leading and contributing to research on community healthcare and generating evidence to underpin care. Lack of evidence impedes policymakers in commissioning high-quality community healthcare and optimising outcomes for patients and their families. This editorial seeks to establish a Community of Practice for Community Nursing Research working group, collaborating with key partners such as the Queen's Nursing Institute (https://www.qni.org.uk/) and International Collaboration for Community Health Nursing Research (https://www.icchnr.org/). The Community of Practice would create a forum to share ideas, network and build activity in community nurse-led research.

Nurse-led research is vital to generate high-quality evidence that answers priority research questions for patients, families and practitioners. The impact of community nursing research on clinical care extends back to past community nursing leaders, like Lisbeth Hockey (1918-2004 ) ( Royal College of Nursing Archive, 2022 ), to current and future leaders that are conducting research to enhance the provision of high-quality community healthcare ( Griffiths et al, 2015 ; Bowers et al, 2021 ; Evans et al, 2021 ). The recent Community Nursing Research Priority Setting Partnership between community nurses and the James Lind Alliance is a great example of the power of engaging practitioners to drive the research agenda forward ( James Lind Alliance Priority Setting Partnership, 2021 ). The Partnership was led by senior community nurses and supported by the 70@70 National Institute of Health Research (NIHR) Senior Nurse and Midwife Research Leader Programme. The Partnership identified the top ten research evidence priorities for community nursing, with the number one priority being: ‘How can community nurse teams better meet the complex needs of patients with multiple health conditions?’ ( James Lind Alliance Priority Setting Partnership, 2021 ). These questions tell us about what matters most to patients, families and community nurses, and can inform priorities for research funders.

A policy priority for the NHS is to grow and support nurse-led research across care settings. In 2021, NHS England launched ‘Making research matter: the Chief Nursing Officer for England's strategic plan for research’ ( NHS England, 2021 ). The ambition is to ‘create a people-centred research environment that empowers nurses to lead, participate in, and deliver research … for public benefit’ ( NHS England, 2021 ). There is opportunity to build on this growing momentum and advance community nurse-led research. Historically, community nurses have had limited opportunities to pursue research ( NHS England, 2021 ). The lack of opportunity, role models and mentorship in research means community nurses can lack the confidence and experience to get involved. Valuable studies can experience considerable delays when community nurses lack the time and confidence to engage in research activities ( Barclay et al, 2019 ). Consequently, the evidence to inform community-based nursing care remains underdeveloped, and nurses must draw on research conducted primarily in hospital-based settings, often with different patient populations ( Bowers, 2018 ; NHS England, 2021 ).

We invite community nurses and clinical academics to work with us and key partners to form a Community Nursing Research Community of Practice. The Community of Practice is for all community nurses, regardless of experience with research. Our intention is to be inclusive and reflect the priorities of members. A similar community of practice for trainees in palliative medicine, the UK Palliative care trainees Research Collaborative, was formed to share and build research activities, such as audits of practice at scale and engagement in research projects. Our Community of Practice aims to strengthen research capacity in community-based nursing research through similar activities and promoting and supporting opportunities for doctoral research from the NIHR Schools for Primary Care Research (www.spcr.nihr.ac.uk) and Social Care Research (www.sscr.nihr.ac.uk/), and the NIHR integrated clinical academic pathway (www.nihr.ac.uk/explore-nihr/academy-programmes/hee-nihr-integrated-clinical-academic-programme.htm).

We invite you to get in touch by email ([email protected]; [email protected]) or Twitter (@Ben_Bowers__; @CatherineJanee1) to get involved and build the community.

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How nursing research informs nursing practice

Research can help improve patients’ outcomes as well as nurses’ professional lives, National Institute of Nursing Research director says at UND

Last Friday, a high-profile member of the nursing profession visited the UND College of Nursing & Professional Disciplines. The visitor was Shannon Zenk, director of the National Institute of Nursing Research, a part of the National Institutes of Health that conducts research and establishes a scientific basis for evolving nursing practices.

During a 45-minute fireside chat with CNPD Dean  Maridee Shogren , Zenk shared her insights with the nearly 250 students in attendance. She emphasized the importance of the symbiotic relationship between nursing practice and research.

“They need to be interconnected. One informs the other,” Zenk said. “What we see in our practice informs the types of research questions we ask, and it’s really important that we take the evidence generated from research and apply it to our practice. There’s a continuum, and nurses are involved in the whole process.”

Zenk developed an interest in research after transitioning from the more traditional surgical-medical setting to one focusing on homecare. As she visited patients in their homes and interacted more directly with communities, she began to recognize common problems faced by populations with higher rates of illness — and this led to a growing interest in research.

“I was really struck by the differences in the resources people have, the differences in the communities and the implications that those factors had for people’s health,” Zenk said.

Early on in their conversation, Shogren asked Zenk what she believes to be the most urgent struggles faced in healthcare. Zenk replied that research increasingly shows a need to address gaps in health outcomes based on socioeconomic and racial differences.

“These disparities are among the biggest challenges we face, and we cannot address those challenges unless we take a big-picture approach to understanding health detriments and solutions,” Zenk said. “That means we’re looking upstream at the most fundamental drivers of what shapes our health: poverty, race, housing and food access and affordability.”

An increased focus on research regarding “upstream” contributors to overall health will equip healthcare professionals with the tools to address the root causes of illness before they manifest, Zenk said. And nurses, she said are uniquely positioned to help identify and solve these problems.

“The scope of our practice, the depth of our knowledge — from biological to societal — and our focus on individual patients, families and the community makes nursing research distinct,” she said. “Nurses have always had a really holistic perspective on health, and I think social determinants are a part of that.”

This broader approach to looking at community health outcomes has sparked an increased interest in healthcare equity, which Shogren says she’s seen flourishing in UND’s programs.

“We’ve seen a growing number of our students being especially interested in Indigenous health,” Shogren said, referencing the  Recruitment & Retention of American Indians into Nursing  or RAIN program. “We know that 79 percent of our nursing graduates from that program have gone on to be employees in Indigenous health centers in their home communities.”

In reply, Zenk said that that supporting a more diverse workforce is the next step toward creating a more equitable healthcare system.

“Both practice and research settings require people with diverse perspectives and diverse experiences to come together to really understand what is needed to improve people’s health,” she said. “We want to bring in people who haven’t had as much chance to have a seat at the table and give them opportunities to engage in research.”

Accordingly, Zenk hopes that as the table expands, nurses and nurse researchers will have more opportunities to improve the health of their communities.

“I’m always looking for opportunities to bring the nursing perspective — our voice, our viewpoint — to the table,” she said. “I hope that, as we move forward, we’ll apply our expertise and our experience to make a difference in reducing and eliminating health disparities.”

Following Shogren and Zenk’s discussion, the leaders opened the floor to questions from students and faculty, including questions about how students can get involved with research as undergraduates and how to find internships in the state.

A student looking ahead to graduation in May asked how she could integrate nursing research into her career when she is a practicing nurse.

“Don’t let go of those skills and the motivation you’re acquiring in class to look at and understand the research and literature,” Zenk replied. “I think it’s critically important to stay on top of the evidence and best practices to inform what you’re doing.”

Another student, interested in a research career, asked what being a nurse researcher is like. Zenk replied that while research roles and career paths are varied, the most fulfilling part of her work is the ability to connect with patients and the community.

“The most enjoyable part in my role is getting to talk with people and engage with communities to learn what’s important to them and what they think will work to improve their health,” she said. “Just like in practice, you’re getting to spend time with patients, families and communities. In research, that just looks a little different.”

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What is “community health”? Examining the meaning of an evolving field in public health ☆

Richard a. goodman.

a Office of the Director, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, USA

b Office of the Assistant Secretary for Health, U.S. Department of Health and Human Services, USA

Rebecca Bunnell

c Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, USA

Samuel F. Posner

In this commentary, we review definition frameworks for community health and examine factors having core relevance to shaping the meaning of this term and growing field. We conclude by suggesting a potential framework for conceptualizing and advancing this field of public health practice through improved understanding of the meaning, scope, and science of community health.

Introduction

The evolution of public health has led to substantial changes in approaches to improving the health of members of communities. In the United States, these changes reflect the influence of many community-centered health developments, including the creation of national-level programs enacted by Congress, the establishment of dedicated governmental units at federal and state levels, and the implementation of innovative health programs at the community level by a variety of other organizations. For example, in 2011, the federal Centers for Disease Control and Prevention (CDC) created an organizational unit for community health to lead the implementation of some congressionally-enacted initiatives, such as Communities Putting Prevention to Work (CPPW), Racial and Ethnic Approaches to Community Health (REACH), and other programs designed to improve health status within communities ( Bunnell et al., 2012 ; Centers for Disease Control, Prevention 2011 ).

Despite these developments, the meaning and strategic significance of community health remain challenging to fully define and to clearly distinguish from related areas of public health practice, community engagement, or other related community development activities. The uncertainties surrounding the meaning of community health are apparent even in the term’s deconstruction, as suggested by MacQueen and colleagues who – in commenting on the need for consensus on the definition of “community” within a public health context – noted that “… the lack of an accepted definition of community can result in different collaborators forming contradictory or incompatible assumptions about community and can undermine our ability to evaluate the contribution of community collaborations to achievement of public health objectives” ( MacQueen et al., 2001 ).

These and other constraints on the shared understanding of the meaning and scope of community health may hamper the growth and effectiveness of this field. To address these challenges and help foster improved understanding of science and practice in “community health”, in this commentary we review definition frameworks for community health and examine factors having core relevance to shaping the meaning of this term and growing field. We conclude by suggesting a potential framework for conceptualizing and advancing this field of public health practice through improved understanding of the meaning, scope, and science of community health.

Approaches to defining “community health”

In the United States, the field of community health is anchored in a rich history of innovations in public health methods and programs directed at reducing risk factor prevalence, decreasing acute and chronic disease burden and injury occurrence, and promoting health. Among these are seminal community intervention trials in the 1970s – such as the Stanford Three Community Study, North Karelia Project, and Stanford Five-City Project ( Farquhar et al., 1977 ; Fortmann et al., 1995 ; McAlister et al., 1982 ; Salonen et al., 1981 ; Stern et al., 1976 ; Wagner, 1982 ) – and a spectrum of community-centered efforts, including CDC’s Planned Approach to Community Health program in the early 1980s ( Kreuter, 1992 ). Examples of programs introduced more recently include CDC’s Steps Program, Healthy Communities Program, REACH, and CPPW ( Bunnell et al., 2012 ; CDC, Steps Program; CDC, Healthy Communities Program). Examples of non-governmental, community-based organizations and programs are the North Carolina Community Health Centers Association (North Carolina Community Health Center Association), Kellogg Health Scholars (Kellogg Health Scholars), and Robert Wood Johnson Foundation’s Community Health Leaders Program (Robert Wood Johnson Foundation Community Health Leaders Program; Robert Wood Johnson Foundation Community Health Leaders Award).

Despite this long history of community health programs, approaches to defining the meaning and scope of community health, as available in the peer review and pedagogical literature, are limited in number. Previous efforts to define “community health” were developed primarily for academically-centered texts and other information sources. These definitions largely have not been positioned to frame the expanding field of community health in public health practice and the importance of community engagement. For example, in their 1999 text on community and population health, Green and Ottoson defined community health as referring to “… the health status of a community and to the organized responsibilities of public health, school health, transportation safety, and other tax-supported functions, with voluntary and private actions, to promote and protect the health of local populations identified as communities.” A community was defined as “a group of inhabitants living in a somewhat localized area under the same general regulations and having common norms, values, and organizations” ( Green and Ottoson, 1999 ). In their 2005 text, McKenzie and colleagues offered this definition: “Community Health refers to the health status of a defined group of people and the actions and conditions, both private and public (governmental), to promote, protect, and preserve their health” ( McKenzie et al., 2005 ). In general, earlier programs and academic descriptions tended to frame communities as mutually exclusive and as having minimal within-community variation. Although this approach may be useful in simplifying study design and program implementation, it typically does not reflect the reality of the situation.

The term “community health” also appears in the titles of units and programs in a small number of state and federal public health agencies, academic programs, and other settings, such as health care systems. But for these, too, the meaning of community health is not readily apparent through publicly-available mission statements or other information sources. For example, in Georgia, the state-level executive branch agency responsible for health is the Georgia Department of Community Health which specifies that its mission is to provide Georgians with “… access to affordable, quality health care through effective planning, purchasing and oversight” (Georgia Department of Community Health). The Michigan Department of Community Health’s mission is to “… protect, preserve, and promote the health and safety of the people of Michigan with particular attention to providing for the needs of vulnerable and under-served populations” (Michigan Department of Community Health). Within the federal government, CDC’s Division of Community Health strengthens community-level health efforts and helps communities prevent disease and promote healthy living through an emphasis on reaching people who experience the greatest burden of death, disability, and suffering from chronic diseases (CDC Division of Community Health). Examples of other programs are Kaiser Permanente’s “Community Health Initiatives” — a collaboration with community-based organizations and residents to focus on prevention by supporting policies and environmental changes that promote healthy eating and active living in neighborhoods, schools, and work-places (Kaiser Permanente Community Health Initiative), and the Stanford School of Medicine’s Office of Community Health with a focus on sustained community engagement in local health issues and training leaders in community health (Stanford School of Medicine Office of Community Health).

These examples of definitions demonstrate the ambiguity and overly general use of the term “community health”. The value of developing a definition for “community health” that reflects the diversity and values of communities, and how communities make decisions, while providing some modicum of order that supports the systematic generation of evidence, is critical to the advancement and maturation of the field.

Focus areas that frame the meaning of “community health”

As we have suggested, existing definitions for community health –including those presented above in academic venues and public agencies – are not positioned to frame the expanding field of community health in public health practice settings as exemplified by many contemporary programs and, therefore, may not meet the needs of the communities such programs are intended to serve. Nonetheless, these definitions do provide important cues for helping to shape the meaning of community health in the context of newly emerging programs and priorities. These cues sort into four basic focus areas that collectively help to frame a definition of community health.

The first focus area – “community” – encompasses population groups and the locus (e.g., place, venue, or other unit) of programs, interventions, and other actions. These elements can overlap and, therefore, are not mutually exclusive, and include: (i) as suggested by MacQueen and colleagues, “A group of people with diverse characteristics who are linked by social ties, share common perspectives, and engage in joint action in geographical locations or settings” ( MacQueen et al., 2001 ); (ii) venues or areas that are identified with key activities, such as residence, work, education, and recreation; and (iii) venues or areas that are physically-, geographically-, culturally-, and administratively- or geopolitically-defined. Examples of the latter include groups of persons who are defined by locality (e.g., block, neighborhood, precinct, village, town, city, county, region, other), or who are defined (sometimes self-defined) by racial-ethnic, age, or other characteristics. Most people are members of multiple types of communities (e.g., physical, work, social, spiritual) that may have different priorities, needs, cultures, and expectations.

The second area – “health” – may be defined differently as a function of a community’s experience and expectations. The definition of health in a given community may further define the enterprise of community health and how community health is put into action (e.g., the methods, measures, process, and outcomes used for implementing a community health effort in a given setting).

The third area – interventions – encompasses the scope of the intervention(s) being delivered within the community, and reflects the input, needs, perspectives, and goals of communities as they work to improve their health. This may include interventions such as creating safe and healthful environments; ensuring health equity for all members of the community ( Centers for Disease Control, Prevention —Division of Community Health, 2013 ); implementing programs to promote health and to prevent disease and injury; and fostering linkages between community and clinical programs and other resources to support health ( Bauer UE et al., 2014 ).

The final area – the “science of community health” – encompasses the methods that are used by the field to develop and evaluate the evidence base that underlies the conception, design, implementation, evaluation, and dissemination of interventions. Community health draws upon a multitude of applied and theoretical public health, medical, and other scientific disciplines in terms of methods (e.g., surveillance and surveillance systems [such as the Behavioral Risk Factor Surveillance System and Youth Risk Behavioral System], epidemiology, evaluation), and expertise (e.g., prevention effectiveness, health economics, anthropology, demography, policy, health education, behavioral sciences, and law). However, the evidence base for community health may be inherently limited because of the absence of consensus, or even general agreement, on the definition and scope of a target “community”. Because of the complexity of working in communities, the “clean” scientific methods used in experimental design often are not relevant and cannot be directly applied. Thus, one of the greatest challenges also represents an opportunity for the field of “community health” to develop innovative methods that account for the complexity of communities, variability in how health in communities is defined, and how evidence can be generated that reflects the reality of the communities in which people live, work, and play.

In their assessment of what had been learned about contributions of community-based interventions to public health, Merzel and D’Afflitti suggested several other factors that help to explain the lack, or limited strong effect, of such programs, including methodological challenges to study design and evaluation, concurrent secular trends, smaller-than-expected effect sizes, limitations of the interventions, and limitations of theories used ( Merzel and D’Afflitti, 2003 ). To this list can be added the need for better integration of “practice-based” evidence which is critical to enable public health scientists to understand the community and generate evidence that will be relevant to practice. For many public health outcomes, particularly decreases in chronic diseases, the full benefits of community level efforts to reduce chronic disease risk factors, such as obesity and tobacco use, may not be evident for many years, further challenging program evaluation. The outcomes often are influenced by many factors that might be addressed differently in different communities. The evidence base also may be influenced by circumstances associated with the creation of some community health programs — circumstances that have the potential for constraining the optimal application of scientific methods. However, even in the face of such constraints, the evidence from these practical studies might in reality be more relevant in addressing problems in the communities being served.

Core principles for advancing community health

We have suggested that there is a need for a broader construct for “community health” that affirms this area as a distinct field within public health practice, and that fostering understanding of a contemporary definition of this maturing field will assist in advancing its goals. To that end, based on the focus areas outlined in this commentary, we offer the following as an example of a definition of community health that accords with needs of U.S. public health practice: “ Community health is a multi-sector and multi-disciplinary collaborative enterprise that uses public health science, evidence-based strategies, and other approaches to engage and work with communities, in a culturally appropriate manner, to optimize the health and quality of life of all persons who live, work, or are otherwise active in a defined community or communities.”

The core principles of community health are built on an understanding of core functions of community health programs and science. In many ways these resemble core public health functions; however, at their core they are explicitly focused on the intersection of the community’s needs, the community’s understanding of and priorities for health, and the best methods for documenting the evidence garnered from practice in the community, as well as the evidence from the science of community health.

We also have suggested that this field relies upon its own “methods of community health” that reflect a blend of approaches from multiple disciplines that have been tailored to this field, but that these approaches are subject to many challenges, some of which are unique to this emerging field. In the face of these challenges, the following core principles are suggested in furtherance of the science of community health:

• Engage communities, governmental, academic, and other stakeholders in developing a shared agenda for applied research on community health in the United States;
• Implement and use results of community health assessments (e.g., measuring and characterizing risk factors within, and the health status of, the community) as a core element in improving a community’s health;
• Identify short- and long-term measures for defining the “healthy community” as an endpoint for the effects of interventions or actions that reflect the community’s interest;
• Improve methods of surveillance for community health, including development of a case definition for a “healthy community”;
• Enhance scientific design principles for generating and documenting both practice- and research-based evidence from programs and interventions that improve community health (using, as indicated, community trials, retrospective cohort studies, cross-sectional surveys and studies, time-series analyses, and ecological studies), and enhancing methods for using “control” communities for evaluation, as well as meeting challenges associated with control communities (e.g., neighborhoods) ( Stern et al., 1976 ; Farquhar et al., 1977 ; Salonen et al., 1981 ; McAlister et al., 1982 ; Wagner, 1982 ; Fortmann et al., 1995 ); and
• Maintain engagement with communities from the start through post-completion of a program or intervention (i.e., community health’s commitment transcends implementation and assessment of an intervention by building evidence through sustained engagement with the community).

Ultimately, improved and shared understanding of the meaning of community health should help in furthering broader attainment of healthier communities that are characterized by better health and quality of life for members of the community, however defined. The field of “community health” reflects the needs of the community and exemplifies the best of public health research and methods to achieve the shared goal of improving health.

Acknowledgments

The authors thank the following for their review of and comments on this manuscript: Lawrence Barker, Peter Briss, and Leonard Jack.

☆ Disclaimer: The findings and conclusions in this report are those of the authors and do not necessarily represent the official positions of the Centers for Disease Control and Prevention.

Conflict of interest statement

The authors declare that there are no conflicts of interest.

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Students win competitive Canada Graduate Scholarships

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Congratulations to the six Ingram School of Nursing (ISoN) master’s students in the research stream who applied for and successfully obtained highly competitive Canada Graduate Scholarships. “We had a 100% success rate, which is a testament to the calibre of our students,” notes Sylvie Lambert, Associate Director – Research at the ISoN.  Congratulations to Katrina Baldassarre, Kyla Christianson, Amanda Guerin, Alisa Knezevic, Sarah Lapin, and Fouad Maghamez.

Katrina Baldassarre, MSc(A) Direct Entry, Year 1

Supervisors: William Archambault & Norma Ponzoni

Project title: “Understanding Nursing Students’ Perceptions towards Artificial Intelligence: Implications for Nursing Education.” As AI becomes more commonplace, it is vital to build an understanding of how these technologies can impact the delivery of nursing education by first understanding how student engage with these technologies.

Kyla Christianson, MSc(A) Advanced Nursing in the Global Health Concentration ,  Year 1

Supervisors: Dr Andraea Van Hulst & Dr Christina Clausen

Project title: “A Description of La Maison Bleue’s Interprofessional Collaboration in Obstetrical Care for Women Experiencing Vulnerability”

Alisa Knezevic. MSc(A), Direct Entry, Year 1

Supervisors: Margaret Purden, Céline Gélinas, Christina Clausen, Kimberly Gartshore

Project title: “Patients’ and family caregivers’ perspectives of the Hospital@Home program at the CIUSSS West-Central-Montreal: A convergent parallel mixed-methods descriptive study”

Sarah Lapin , MSc N - Direct Entry program, Year 1.

Supervisors: Sylvie Lambert and Catherine-Anne Miller.

Project title: "Chronic Illness Management Using Prescription Medication in Migrants with Precarious Status: Healthcare Professionals’ Experiences”. This project will involve interviewing healthcare professionals working at the Clinic for Migrants with Precarious Status operated by the organization Medecins du Monde to learn more about their experiences managing chronic illnesses with prescription medication in patients who are migrants with precarious status and are not covered by the federal or provincial public healthcare systems. Little is known about the healthcare professional perspective of this experience, and this project aims to address that research gap.

Fouad Maghamez , MSc(A) - Nursing Y1 (Global Health Concentration)

Supervisors: Sylvie Lambert and Lia Sanzone

Project Title: "Exploring the Facilitators and Barriers for Sustainability of the Senior Community Health Worker (CHW) Program in Njombe, Tanzania: Perspectives from Stakeholders". This project into the elements that help or hinder the program's ability to continue providing services over time. Understanding these factors will be crucial for shaping future health initiatives that can withstand the challenges of serving an aging population in resource-limited settings.

In the photo, left to right: Katrina Baldassarre, Amanda Guerin, Alisa Knezevic, Fouad Maghamez, Kyla Christianson, Sarah Lapin.

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