Linking Practice and Community Through a Focus on Capability (Text Ver
On September 20, 2011, Robert Lewis Ferrer made this presentation at the 2011 Annual Conference. Select to access the PowerPoint® presentation (13.4 MB). Plugin Software Help.
Slide 1
Linking Practice and Community Through a Focus on Capability
Robert L. Ferrer, MD, MPH
Dept. of Family & Community Medicine
University of Texas Health Science Center at San Antonio
Slide 2
A Medical Assistant-Based Program to Promote Healthy Behaviors in Primary Care
- Robert Ferrer, MD, MPH.
- Sherrie Gott, PhD.
- Priti Mody-Bailey, MD, MA.
- Carlos Jaén, MD, PhD.
- Sara Araujo, BA.
- Melissa Talamantes, MS.
Annals of Family Medicine 2009;7:544-512.
Slide 3
Service Outcomes: % Attending Interventions
| Intervention | Control | Difference | P | |
|---|---|---|---|---|
| Smoking | 75.3 | 28.6 | 46.7 | <.001 |
| EtOH | 0 | 0 | 0 | |
| Diet | 60.6 | 22.3 | 38.3 | <.001 |
| Activity | 75.0 | 26.3 | 48.7 | <.001 |
| Any | 67.4 | 21.8 | 45.6 | <.001 |
Slide 4
Behavioral Outcomes: % of Patients Improved
| Intervention | Control | Difference | P | |
|---|---|---|---|---|
| Smoking | 25.0 | 21.5 | 3.5 | 0.40 |
| EtOH | 33.3 | 14.2 | 19.1 | 0.04 |
| Diet | 16.1 | 11.1 | 5.0 | 0.60 |
| Activity | 25.0 | 37.5 | -12.5 | 0.64 |
| Any | 21.7 | 16.9 | 4.8 | 0.26 |
Slide 5
"Capability"
- The practical opportunities to live the life one wishes.
Images of two book covers by Amartya Sen are also shown.
Slide 6
Capability Model
Image of a flowchart with the following information:
Inputs (Means to achieve):
- Available goods & services.
- Community resources.
- Income and other assets.
- Built environment.
Conversion factors:
- Literacy.
- Functional status.
- Social support.
- Autonomy.
- Respect.
Capability Set (Freedom to achieve):
- Opportunity set of achievable functioning.
Choice:
Achieved functioning (Achievement).
Adapted from Robeyns, 2005.
Slide 7
- Q: Why can't you go walking?
- A: Because I don't know how to drive.
Slide 8
Physicians' Advice on Healthy Behaviors
| % | |
|---|---|
| Doctor encourages healthy eating | 93.8 |
| Doctor encourages physical activity | 93.5 |
| Doctor understands how hard to be physically active | 56.8 |
| Doctor understands how hard to eat healthy | 37.3 |
Slide 9
Opportunities for Healthy Behaviors
| % | |
|---|---|
| Available fruit & vegetables where I shop | 95.9 |
| Easy to get to food store | 85.6 |
| Local fruit & vegetables of high quality | 74.3 |
| Can afford fresh fruit & vegetables | 69.9 |
| Can afford lean meat & fish | 57.0 |
| Nearby outdoor physical activity | 71.9 |
| Easy to walk places in neighborhood | 57.2 |
| Nearby indoor physical activity | 49.8 |
| Feel safe walking after dark | 27.3 |
Slide 10
Barriers to Healthy Behaviors
| % | |
|---|---|
| Partner sometimes forbids physical activity | 14.0 |
| Partner sometimes refuses healthy foods | 30.6 |
| Too tired to cook own meals | 32.2 |
| Care of family leaves little time for physical activity | 35.3 |
| Not treated with respect | 38.6 |
| Illness gets in way of physical activity | 55.5 |
| Feeling depressed keeps from physical activity | 56.4 |
| Can’t afford groceries over whole month | 70.8 |
Slide 11
Multiple Vulnerabilities: Healthy Eating
1. No grocery in neighborhood.
2. Groceries too expensive over whole month.
3. Little time to prepare own meals.
4. Family doesn't allow to eat recommended foods.
81.2% have 2 or more
| # present | % of sample |
|---|---|
| 0 | 3.1 |
| 1 | 15.8 |
| 2 | 29.8 |
| 3 | 40.4 |
| 4 | 11.0 |
Slide 12
Image: An elementary school is shown.
Slide 13
Image: A whiteboard is shown.
Slide 14
Image: Fruits, vegetables, and juices are shown.
Slide 15
Image: A pot of soup is shown.
Slide 16
Image: Two doors are shown.
Slide 17
Image: A number of computers and monitors are shown.
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