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https://med.libretexts.org/Courses/Glendale_Community_College/Public_Health_101_(Calderone)/12%3A_Occupational_Health/12.03%3A_Workplace_Injuries_and_Illnesses/12.3.03%3A_Globalization | 12.3.3: Globalization
An increasingly global economy means that many products are manufactured in multiple countries and regions around the world. Companies pursuing lower costs and higher profits will take advantage of this system, and procure the raw materials or parts of a product from countries with lower labor costs, and fewer worker protections (Frumkin, 2016). The International Labour Organization (ILO) estimates that over 160 million children are victims of child labor as of 2020; working in conditions that are unsafe, working hours that are too long, and/or work that interferes with their education (ILO, 2024b). The ILO has set standards for “decent work” including the abolition of forced labor, minimum age requirements, occupational safety and health standards, as well as gender equality and the right to organize. However, the ILO has no power to enforce these standards, and instead relies on commitments and partnerships with various countries to drive change (ILO, 2024a). The United Nations Sustainable Development Goal #8 strives to “promote sustained, inclusive and sustainable economic growth, full and productive employment and decent work for all” (U.N. Department of Economic and Social Affairs, 2023). | libretexts | 2025-03-17T22:26:18.835065 | 2024-10-22T01:29:17 | {
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https://med.libretexts.org/Courses/Glendale_Community_College/Public_Health_101_(Calderone)/12%3A_Occupational_Health/12.04%3A_Employee_Wellness_Programs | 12.4: Employee Wellness Programs
A full-time employee spends about a third of their day on the job, five days a week (CDC, 2021). While technological advances can be at least partially credited for making jobs safer, they have also made work more sedentary. Over 80% of modern jobs are mostly sedentary, which combined with other factors such as mental stress and the availability of high calorie foods has contributed to the rise in noncommunicable diseases such as obesity, diabetes, and cardiovascular disease (CVD). This has prompted calls to update the OSH Act to include lifestyle factors such as a lack of physical activity and access to healthy foods in the workplace as health hazards (Duffy et al., 2021). Workplaces represent a significant opportunity to promote healthy behaviors for a good portion of a worker’s day. And maintaining a healthy workforce benefits the company through improved morale and productivity, fewer sick days, and potentially reduced healthcare costs and worker’s compensation claims (CDC, 2021).
According to a study done by the Rand Corporation in 2013, wellness programs were offered by about 50% of U.S. employers, and larger companies were more likely to offer comprehensive wellness programs. These programs often include health screening or health risk assessments, as well as interventions such as fitness, nutrition, smoking cessation, health education, and stress-management programs (Mattke et al., 2013). The Affordable Care Act included grants to help small businesses begin offering wellness programs (Shi & Singh, 2017). Over the last decade these programs have grown in popularity. As of 2021, 58% of small companies and 83% of large companies offered some sort of wellness program to their employees (Vankar, 2022). Corporate wellness as a global industry was valued at $53 billion in 2022, and is expected to grow over 4% annually through 2030, in spite of a short decline during the COVID-19 pandemic (Grand View Research, 2022).
Research regarding the efficacy of workplace wellness programs is still mixed, and depends highly on the type of program delivered and the metrics used to measure success of the program (Horn et al., 2020). Employee wellness programs might be as limited as offering a discount on gym memberships, or annual health screenings for blood pressure, cholesterol, and blood glucose, or they might be as comprehensive as offering on-site health education classes, fitness classes, stress management sessions, and support groups or behavioral coaching. Some companies may use the physical work environment to promote physical activity by providing standing or walking desks, or providing healthy meals in cafeterias and healthy snacks in vending machines. Still others create policies and stimulate a work culture of health; employees may have more flexible work hours or locations, managers might conduct “walking meetings” or the company might host competitions encouraging employees to get more daily steps or lose weight (Mattke et al., 2013, Horn et al., 2020). Because of the wide variety of programs offered at different companies, and varying levels of employee engagement (not all employees may participate, and often those already focused on their health do), it can be difficult to determine the best practices for worksite wellness programs in general. However, a few reviews suggest that well-designed and implemented workplace wellness programs have the potential to:
- Increase productivity (Marin-Farrona et al., 2023),
- Decrease absenteeism (Marin-Farrona et al., 2023),
- Improve cardiorespiratory fitness, muscular fitness, and decrease musculoskeletal symptoms (fatigue, postural control, etc.) (Marin-Farrona et al., 2023)
- Improve health metrics such as body mass index (BMI) (Mattke et al., 2013, Peñalvo et al., 2021), body composition blood pressure, blood cholesterol (Marin-Farrona et al., 2023, Peñalvo et al., 2021), and blood glucose (Peñalvo et al., 2021),
- Increase the amount of physical activity that employees perform throughout the week (Mattke et al., 2013, Marin-Farrona et al., 2023),
- Improve some nutritional habits, such as eating more fruits and vegetables and less fat (Peñalvo et al., 2021),
- Reduce smoking behaviors (Mattke et al., 2013),
- Improve employee’s perceptions of their own health (Marin-Farrona et al., 2023),
- Reduce work-related stress (Marin-Farrona et al., 2023),
- Reduce healthcare costs and provide a monetary return on investment to the employer in some studies (Astrella, 2017, Baicker et al., 2010, Lerner et al., 2013, Mattke et al., 2013).
It is possible that the full benefits of workplace wellness programs will not be realized for several decades. The noncommunicable diseases that most wellness programs aim to prevent are also chronic - they take several decades to develop. The lifestyle behaviors that improve health and prevent diseases may then need to be consistently practiced for many years in order to achieve the goal of disease prevention and healthcare cost savings (Astrella, 2017). | libretexts | 2025-03-17T22:26:18.891051 | 2024-10-22T01:29:19 | {
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https://med.libretexts.org/Courses/Glendale_Community_College/Public_Health_101_(Calderone)/12%3A_Occupational_Health/12.05%3A_Summary | 12.5: Summary
Employers have a responsibility to provide safe and healthy working conditions for their employees. Workers spend a good portion of their day at the job, and may have much higher exposures to health hazards at work than the general public does. When injuries and illnesses do happen, it has a huge impact on the worker, their families, and their community. Thus, protecting the workforce from unnecessary hazards is a high priority for public health, and promoting health at the workplace could have benefits for the company and community at large. | libretexts | 2025-03-17T22:26:18.943575 | 2024-10-22T01:29:21 | {
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https://med.libretexts.org/Courses/Glendale_Community_College/Public_Health_101_(Calderone)/12%3A_Occupational_Health/12.06%3A_References | 12.6: References
Astrella, J. A. (2017). Return on investment. JONA: The Journal of Nursing Administration , 47 (7/8), 379–383. https://doi.org/10.1097/nna.0000000000000499
Baicker, K., Cutler, D., & Song, Z. (2010). Workplace wellness programs can generate savings. Health Affairs , 29 (2), 304–311. https://doi.org/10.1377/hlthaff.2009.0626
BLS. (2020, April). Workplace violence in healthcare, 2018 : U.S. Bureau of Labor Statistics . Bureau of Labor Statistics. https://www.bls.gov/iif/factsheets/w...hcare-2018.htm
BLS. (2023a). IIF home . U.S. Bureau of Labor Statistics. https://www.bls.gov/iif/home.htm
BLS. (2023b). National census of fatal occupational injuries in 2022 . Bureau of Labor Statistics, U.S. Department of Labor. https://www.bls.gov/news.release/pdf/cfoi.pdf
BLS. (2024, July 5). Table A-1. Employment status of the civilian population by sex and age - 2024 Q02 Results . Bureau of Labor Statistics. https://www.bls.gov/news.release/empsit.t01.htm
CDC. (2021, May 12). Workplace health model . CDC. https://www.cdc.gov/workplacehealthp...del/index.html
CDC. (2024, May 30). About workplace violence . Violence. https://www.cdc.gov/niosh/violence/about/
CDC/NIOSH. (2022, August 11). Fast facts- traumatic occupational injuries . CDC. https://www.cdc.gov/niosh/injury/fastfacts.html
Duffy, E. Y., Hiremath, P. G., Martinez-Amezcua, P., Safeer, R., Schrack, J. A., Blaha, M. J., Michos, E. D., Blumenthal, R. S., Martin, S. S., & Cainzos-Achirica, M. (2021). Opportunities to improve cardiovascular health in the new American workplace. American Journal of Preventive Cardiology , 5 , 100136. https://doi.org/10.1016/j.ajpc.2020.100136
Grand View Research. (2022). Corporate wellness market size & share report, 2023-2030 . Grand View Research. https://www.grandviewresearch.com/in...ellness-market
Guyton, G. P. (1999). A Brief History of Worker’s Compensation. Iowa Orthopedic Journal , 19 , 106–110. PubMed Central.
Horn, D., Randle, N. W., & McNeil, S. R. (2020///Winter). A Cross-Disciplinary Framework to Measure Workplace Wellness Program Success: Quarterly Journal. S.A.M.Advanced Management Journal, 85(1), 4-12. https://libwin2k.glendale.edu/login?url=https://www.proquest.com/scholarly-journals/cross-disciplinary-framework-measure-workplace/docview/2708789994/se-2
ILO. (2024a). Up-to-date conventions and recommendations . International Labour Organization, a United Nations Agency; NORMLEX Information System on International Labour Standards. https://normlex.ilo.org/dyn/normlex/en/f?p=1000:12020 ::::::
ILO. (2024b, January 28). Child labour . International Labour Organization. https://www.ilo.org/topics/child-labour#factoids
Lerner, D., Rodday, A. M., Cohen, J. T., & Rogers, W. H. (2013). A systematic review of the evidence concerning the economic impact of employee-focused health promotion and wellness programs. Journal of Occupational & Environmental Medicine , 55 (2), 209–222. https://doi.org/10.1097/jom.0b013e3182728d3c
Manzo IV, F., Jekot, M., & Bruno, R., PhD. (2021). The Impact of Unions on Construction Worksite Health and Safety. Illinois Economic Policy Institute .
Marin-Farrona, M., Wipfli, B., Thosar, S. S., Colino, E., Garcia-Unanue, J., Gallardo, L., Felipe, J. L., & López-Fernández, J. (2023). Effectiveness of worksite wellness programs based on physical activity to improve workers’ health and productivity: A systematic review. Systematic Reviews , 12 (1). https://doi.org/10.1186/s13643-023-02258-6
Maryville University. (2023, February 28). What is the gig economy, and who are its workers? Maryville University Online. https://online.maryville.edu/blog/wh...e-gig-economy/
Mattke, S., Liu, H., Caloyeras, J. P., Huang, C. Y., Van Busum, K. R., Khodyakov, D., & Shier, V. (2013). Workplace Wellness Programs Study Final Report . RAND Health. https://www.dol.gov/sites/dolgov/fil...-full-text.pdf
Mikolajczyk, S. (2022, July 28). Workers’ compensation for agricultural workers . National Agricultural Law Center. https://nationalaglawcenter.org/work...tural-workers/
National Safety Council. (2024a). Work injury costs . Injury Facts; National Safety Council. https://injuryfacts.nsc.org/work/cos...-injury-costs/
National Safety Council. (2024b). Workplace violence . National Safety Council. https://www.nsc.org/workplace/safety...place-violence
OSHA. (n.d.-a). Commonly used statistics . Occupational Safety and Health Administration. Retrieved July 15, 2024, from https://www.osha.gov/data/commonstats
OSHA. (n.d.-b). OSHA at 50 . Occupational Safety and Health Administration. Retrieved July 9, 2024, from https://www.osha.gov/osha50/
OSHA. (n.d.-c). Young workers - Real stories . Occupational Safety and Health Administration. Retrieved July 10, 2024, from https://www.osha.gov/young-workers/real-stories
Peñalvo, J. L., Sagastume, D., Mertens, E., Uzhova, I., Smith, J., Wu, J. H. Y., Bishop, E., Onopa, J., Shi, P., Micha, R., & Mozaffarian, D. (2021). Effectiveness of workplace wellness programmes for dietary habits, overweight, and cardiometabolic health: A systematic review and meta-analysis. The Lancet Public Health , 6 (9), e648–e660. https://doi.org/10.1016/s2468-2667(21)00140-7
Riley, K., Wilhalme, H., Delp, L., & Eisenman, D. (2018). Mortality and morbidity during extreme heat events and prevalence of outdoor work: An analysis of community-level data from Los Angeles County, California. International Journal of Environmental Research and Public Health , 15 (4), 580. https://doi.org/10.3390/ijerph15040580
Schuman, M. (2017a, January). History of child labor in the United States—part 1: Little children working : Monthly Labor Review: U.S. Bureau of Labor Statistics . Bureau of Labor Statistics; Monthly Labor Review. https://www.bls.gov/opub/mlr/2017/ar...tes-part-1.htm
Schuman, M. (2017b, January). History of child labor in the United States—part 2: The reform movement : Monthly Labor Review: U.S. Bureau of Labor Statistics . Bureau of Labor Statistics. https://www.bls.gov/opub/mlr/2017/ar...m-movement.htm
Seabert, D., McKenzie, J. F., & Pinger, R. R. (2021). McKenzie’s an introduction to community & public health . Jones & Bartlett Learning.
Sherer, J., & Mast, N. (2023, December 21). Child labor laws are under attack in states across the country: Amid increasing child labor violations, lawmakers must act to strengthen standards . Economic Policy Institute. https://www.epi.org/publication/chil...-under-attack/
Shi, & Singh, D. A. (2017). Delivering health care in america . Jones & Bartlett Learning.
Tiesman, H. M., Hendricks, S. A., Wiegand, D. M., Lopes-Cardozo, B., Rao, C. Y., Horter, L., Rose, C. E., & Byrkit, R. (2023). Workplace violence and the mental health of public health workers during COVID-19. American Journal of Preventive Medicine , 64 (3), 315–325. https://doi.org/10.1016/j.amepre.2022.10.004
U.N. Department of Economic and Social Affairs. (2023). Goal 8 . United Nations Department of Economic and Social Affairs. https://sdgs.un.org/goals/goal8
Vankar, P. (2022, November 16). Companies offering health/wellness programs by firm size 2021 . Statista. https://www.statista.com/statistics/...taining-costs/ | libretexts | 2025-03-17T22:26:19.011335 | 2024-10-22T01:29:22 | {
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https://med.libretexts.org/Courses/Glendale_Community_College/Public_Health_101_(Calderone)/13%3A_Community_Organizing_and_Health_Promotion_Programming | 13: Community Organizing and Health Promotion Programming Last updated Save as PDF Page ID 99049 Erin Calderone Glendale Community College Learning Objectives Define important fundamental concepts in community/public health. Outline the process of community organizing and health promotion programming. 13.1: Introduction 13.2: Behavioral Change Theories and Models 13.3: Theory of Planned Behavior 13.4: Health Belief Model 13.5: Social Cognitive Theory 13.6: Self-Determination Theory 13.7: Transtheoretical Model (Stages of Change) 13.8: The Social-Ecological Model 13.9: Community Intervention Models 13.10: Health Promotion Program Planning 13.10.1: Generalized Model 13.10.2: Needs Assessment 13.10.3: Goals, Objectives, and Activities 13.10.4: Implementation 13.10.5: Evaluation 13.11: Mobilizing Action through Planning and Partnerships (MAPP) 13.12: PRECEDE-PROCEED Model 13.13: Case Studies 13.14: Case Study 1Wins Fitness 13.15: Case Study 2- Our Choice/Nuestra Opción- The Imperial County, California, Childhood Obesity Research Demonstration Study (CA-CORD) 13.16: Summary 13.17: References | libretexts | 2025-03-17T22:26:19.106285 | 2024-08-27T08:13:19 | {
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https://med.libretexts.org/Courses/Glendale_Community_College/Public_Health_101_(Calderone)/13%3A_Community_Organizing_and_Health_Promotion_Programming/13.01%3A_Introduction | 13.1: Introduction
The U.S. spends more on healthcare than many other countries (OECD, 2023), and spends far more on healthcare than on public health (Pilar et al., 2020). Yet several of the leading causes of death are strongly influenced by lifestyle behaviors. This has led several researchers to quantify the actual causes of death in terms of behaviors and environmental factors. Prior to the COVID-19 pandemic, actual causes of death in 2017 were identified as the following list, with the percentage of total deaths associated in parenthesis. Note that these percentages will not add up to 100% because there are other causes of death not on this list, and many diseases have multiple causes.
- Poor nutrition (19%)
- Tobacco use (18%)
- Toxic agents (7%)
- Microbial agents (4%)
- Illicit drug use (4%)
- Alcohol use (3%)
- Physical inactivity (3%)
- Firearms (1%)
- Motor vehicles (1%)
- Sexual behavior (1%) (Pilar et al., 2020).
A recent study looked at trends in self-reported healthy behaviors between 1999-2000 and 2017-2020 using data from the National Health and Nutrition Examination Survey (NHANES). Results indicate that over the last few decades, more Americans are avoiding smoking tobacco (57.7%), being physically active at least 150 minutes per week (69.1%), and eating a healthy diet (24.5%). However, we are still gaining weight: those reporting a healthy weight status decreased from 33.1% to 24.6%, and our alcohol consumption has remained about the same. Those who reported 4 or more healthy lifestyle behaviors increased slightly from 15.7% to 20.3%. This study also showed consistent disparities in race and ethnicity, education level, and income level, suggesting that social determinants of health (SDOH) are still powerfully associated with healthy behaviors (Li et al., 2023).
It makes sense then that many community health interventions target changing lifestyle behaviors in a population in order to prevent a disease or injury from occurring in the first place (i.e. primary prevention). In order to effectively change human behavior on a large scale, we need to first understand what makes humans behave the way they do. In this chapter, we will go over a few (not all) of the behavioral change models used in public health practice, as well as community intervention models, and program planning models. At the end of this chapter we will discuss two examples of community interventions targeting physical activity and childhood obesity. | libretexts | 2025-03-17T22:26:19.161476 | 2024-10-22T01:29:28 | {
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https://med.libretexts.org/Courses/Glendale_Community_College/Public_Health_101_(Calderone)/13%3A_Community_Organizing_and_Health_Promotion_Programming/13.02%3A_Behavioral_Change_Theories_and_Models | 13.2: Behavioral Change Theories and Models
Why do people engage in some health behaviors and not others? One of the earliest models describing behavior is classical conditioning, as demonstrated by Ivan Pavlov’s experiments with dogs. In these experiments, Pavlov noticed that the dogs would salivate when hearing noises associated with feeding time. He then began to ring a bell before feeding them, and eventually they associated the bell with food and would salivate at the sound of the bell. Classical conditioning has been used as a model to treat cravings, phobias, or even bedwetting (Rehman et al., 2023). Subsequent behavioral researchers like B.F. Skinner proposed a stimulus response model that is based on the behavior’s subsequent result - either reinforcement or punishment (McKenzie et al., 2017). These reinforcements or punishments may be artificially imposed by ourselves or authority figures such as parents, employers, or government, or they may be natural consequences of behaviors. For example, if a person discovers that they are in a better mood after they exercise, they are more likely to continue the exercise behavior because they expect the happy feelings to follow. Alternatively, if they associate exercise with debilitating muscle soreness, they are likely to avoid it!
Is human behavior really this simple though? Perhaps on the surface, for an individual person who is trying to change their own behavior or prompt a child’s (or perhaps a dog’s) behaviors, these models can be useful. However, they tend to ignore the rest of that individual’s life and lived experience; including the complexities of intrapersonal factors (such as beliefs and attitudes), interpersonal factors (such as cultural and social norms, and support systems), and environmental factors (such as economics, their physical environment, and politics). Other models of behavior expand into these different areas. | libretexts | 2025-03-17T22:26:19.215182 | 2024-10-22T01:29:29 | {
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https://med.libretexts.org/Courses/Glendale_Community_College/Public_Health_101_(Calderone)/13%3A_Community_Organizing_and_Health_Promotion_Programming/13.03%3A_Theory_of_Planned_Behavior | 13.3: Theory of Planned Behavior
The Theory of Planned Behavior (TPB) was built by Icek Ajzen on a prior theory (Theory of Reasoned Action, first proposed by Martin Fishbein and Ajzen), which describes how an individual might intend to make a behavioral change. This intention is essentially the decision made by the person to “do the thing” right before they do it - intention immediately precedes the behavior. The TPB model involves 3 factors that influence intention: behavioral beliefs, subjective norms, and perceived behavioral control. Behavioral beliefs are those ideas that we hold internally about the behavior; like whether or not it is effective at giving us the desired outcome (McKenzie et al., 2017). As a hypothetical example, if someone believes that exercise is an effective way to improve their health, they are more likely to start a fitness program. Conversely, if they believe that exercise is ineffective, too hard, takes too much time, not worth the effort etc., they probably won’t. These beliefs may be founded in scientific evidence, personal experience, or something else entirely, but they are highly influential on someone's readiness to change a behavior.
The second component of the TPB is the subjective norms of that person’s social circle. These social norms may influence the beliefs that the person has about the behavior, and vice versa (McKenzie et al., 2017). These social norms can also be “positive peer pressure” to engage in healthy behaviors. Using our previous example, if most of a person’s family and friend circle are regular exercisers or involved in sports, they will think of physical activity as the “norm”. Evidence suggests that children and teens are far more physically active when parents are supportive. This support might include role modeling an active lifestyle, taking them to sporting practices and games, verbally encouraging them, or even just active play (Su et al., 2022).
Lastly, in order for a person to change a behavior they need to have “perceived behavioral control”. That is, they need to have the belief that they can change that behavior, they have what it takes. This may include actual behavioral control - meaning the skills, resources, and environment needed to change the behavior - but even if the actual control is there, if the person doesn’t believe they have control over their behavior they are not likely to change it (McKenzie et al., 2017). This concept is very similar to self-efficacy, presented in other models of behavioral change (below). If our hypothetical person believes that exercise improves health, and those around them exercise also, but they don’t believe they’ll ever be able to stick with a fitness program themselves, this alone may prevent them from exercising. See Fig. \(\PageIndex{1}\) for a diagram of the TPB.
The TPB has been successfully utilized in several experimental and quasi-experimental studies aiming to improve nutrition, increase physical activity, change traffic safety behaviors (like seat belt wearing in cars or helmet wearing while riding a bicycle), increase safe-sex behaviors, reduce alcohol and drug use, and even improve behaviors at work (like ergonomics and stress reduction). Practitioners can use techniques like providing information, persuasion, skill development, planning, social encouragement, goal setting, motivation, self-monitoring, modeling, and others to help people change their behavioral, normative, and control beliefs - thus increasing their intention to change. Some strategies work better to help a person increase their motivation, which leads to intention. Other strategies might work better after the person has expressed an intention to change; they have the motivation already and now just need the tools (actual control) to reach their goals (Steinmetz et al., 2016). | libretexts | 2025-03-17T22:26:19.269200 | 2024-10-22T01:29:34 | {
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https://med.libretexts.org/Courses/Glendale_Community_College/Public_Health_101_(Calderone)/13%3A_Community_Organizing_and_Health_Promotion_Programming/13.04%3A_Health_Belief_Model | 13.4: Health Belief Model
The Health Belief Model (HBM) was actually proposed by researchers working for the U.S. Public Health Service in the 1950s, who were attempting to explain why some people might not opt for health screenings (such as a tuberculosis test) or vaccinations (such as those for polio), especially if these were offered at little to no cost (Rosenstock, 1974). This model asserts that in order for a person to take action, they must have certain beliefs, including:
- That the consequences of not taking action are severe,
- That the person themselves is susceptible,
- And that the perceived benefits outweigh the perceived costs of taking action.
There also need to be cues in the environment that prompt the person to take action. Subsequent applications of the HBM to more complex behaviors highlighted the importance of including self-efficacy in this process as well (McKenzie et al., 2017). Self-efficacy is the belief that a person has about their own abilities to take a specific action. Thus, a lack of self-efficacy could be considered a substantial perceived barrier in this model (McKenzie et al., 2017). See Fig. \(\PageIndex{1}\) below for a diagram of the HBM.
Both the TPB and the HBM are intrapersonal models, meaning they focus mostly on what the individual thinks, believes, and decides about the behavior themselves. The TPB certainly recognizes the influence of social norms, and the HBM perhaps implicitly includes some environmental aspects into the perceived barriers and benefits, yet these models may not fully explain how a person develops beliefs or self-efficacy. The next model attempts to do just that. | libretexts | 2025-03-17T22:26:19.323258 | 2024-10-22T01:29:37 | {
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"book_url": "https://commons.libretexts.org/book/med-97107",
"title": "13.4: Health Belief Model",
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https://med.libretexts.org/Courses/Glendale_Community_College/Public_Health_101_(Calderone)/13%3A_Community_Organizing_and_Health_Promotion_Programming/13.05%3A_Social_Cognitive_Theory | 13.5: Social Cognitive Theory
Social cognitive theory (SCT) was developed by Albert Bandura in the 1980s, and built upon an earlier theory of his about societal learning. Learning is an important component of SCT, characterized by reinforcement of a particular behavior. Bandura provided the SCT as a loose framework, where each component had a bidirectional influence: it influenced the other factors and was influenced by them. Personal factors include the person’s own experiences, thoughts and feelings, which are highly influenced by their environment, and also influence the behaviors they engage in. Their environment includes the people in their social circles who may both model behaviors and provide reinforcement for those behaviors - but the individual also has influence on that circle. Finally, the behaviors themselves and the experiences from engaging in the behaviors will have an effect on the environment and the person’s thoughts and feelings (LaMorte, 2022).
Included in this theory are several concepts which tie these factors together: behavioral capability, self-efficacy, expectancies, and reinforcements. The first is behavioral capability , which refers to the knowledge and skills that individuals must possess in order to adopt a new behavior. Self-efficacy is the personal belief that the person has this knowledge and skill, and can effectively engage in the behavior. For example, if someone wants to start a healthy dietary pattern, they must first know what a healthy diet is, and secondly how to prepare these foods (behavioral capability). They must also believe that this dietary change is possible for them (self-efficacy). Something that contributes to developing both behavioral capability and self-efficacy is observational learning; which just means that people learn from watching others. If a child observes their parents preparing fruit for a snack, they are more likely to copy them. And observational learning works for adults too - if a person sees their neighbors taking walks every day, they might be more likely to do so themselves. Expectancies are the value that the person places on the anticipated outcome of the behavior. For example, if a person values healthy eating over enjoying the taste of a food, they are more likely to eat health-promoting foods - whether they taste good or not. Finally, reinforcements happen as a result of the behavior, and can be a natural consequence or imposed by the person or their social group. A reinforcement to eating a healthy diet might be that the person feels good, or that they reward themselves with a treat, or still further that a friend or family member gives them praise. Reinforcements are a key component of the SCT model (LaMorte, 2022, McKenzie et al., 2017). See Figure 13.3 for a diagram of the SCT. | libretexts | 2025-03-17T22:26:19.377436 | 2024-10-22T01:29:39 | {
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"title": "13.5: Social Cognitive Theory",
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https://med.libretexts.org/Courses/Glendale_Community_College/Public_Health_101_(Calderone)/13%3A_Community_Organizing_and_Health_Promotion_Programming/13.06%3A_Self-Determination_Theory | 13.6: Self-Determination Theory
Another theory that emerged in the 1970s and 80s was the self-determination theory, developed by psychologists Edward Deci and Richard Ryan. This model focuses on what motivates a person to perform a task or work towards a goal, whether it is an academic, occupational, or health-related goal. Instead of assuming that people will or will not perform a behavior based on the reward or punishment they might receive afterward, this model describes a person’s motivation based on how much autonomy they feel they have (O’Hara, 2017). Motivation is described as “psychological energy directed at a particular goal” (Patrick & Williams, 2012). Traditional concepts of motivation include extrinsic or external motivation (as when someone is motivated by an external reward), vs. intrinsic or internal motivation (as when someone enjoys the behavior itself). Intrinsic motivation is considered the most powerful and long lasting type of motivation, and is therefore valued much more than extrinsic motivation. But Deci and Ryan proposed that there are still powerful types of extrinsic motivation, particularly for behaviors that people may not ever enjoy doing - and must therefore find a “why” that keeps them going.
Self-determination theory expands on extrinsic motivation and includes the “internalization” of external forces; people can internalize social pressures and even be self-motivated for external benefits of a behavior (Patrick & Williams, 2012). Thus extrinsic motivation becomes a continuum including the following types of self-regulation:
- External regulation (in pursuit of a reward, or avoiding a negative impact),
- Introjected regulation (feeling guilty or obligated to others, or trying to prove something to themselves or others)
- Identified regulation (the behavior is important to them)
- Integrated regulation (the behavior aligns with their personal goals and values)(Patrick & Williams, 2012) (See Figure 13.4 above).
Intrinsic motivation is still identified as doing something simply for the sake of doing it, because the person enjoys the behavior itself. But the expansion of extrinsic motivation into a continuum also recognizes that with health behaviors in particular, someone can value a behavior and be strongly motivated without actually enjoying the behavior itself. Some behaviors may always have an extrinsic level of motivation, like “eating your vegetables”. A person can also have several types of motivations for their health behaviors, and can move between these levels of extrinsic motivation over time (Patrick & Williams, 2012). The first two, external and introjected regulation, are considered “controlled motivation” because they are largely based on external pressures. Identified and integrated regulation are considered “autonomous motivation” because the reasons for changing are derived from the person themselves, rather than pressures from others (Sheeran et al., 2020). The more autonomous types of motivation are considered stronger and more persistent over time. See Figure 13.4 above for a diagram of the extrinsic motivation continuum.
The SDT is further built on the concept that humans have 3 basic psychological needs that influence their motivation: autonomy, relatedness, and competence. Autonomy is the sense that someone has that they are in control of their life and making their own decisions. Relatedness refers to the social connections that the person has with others, particularly supportive relationships. Competence describes the person’s perceptions of their own capabilities relative to achieving their goal - essentially their self-efficacy. In order for a person to develop longer-lasting and powerful types of extrinsic motivation, they need to have these three needs met (Patrick & Williams, 2012). See Fig. (\PageIndex{2}\) for a diagram of the SDT needs.
Physicians, therapists, and coaches can use several strategies that support an individual’s perceived autonomy, competence, and relatedness. For example, instead of simply telling a patient with obesity that they must diet and exercise to lose weight, a practitioner might ask the patient about their prior experiences with attempting to lose weight, validate their feelings of apprehension about trying again, explore why losing weight is important to them. They might ask the patient about how this weight loss aligns with their health goals and values, and provide some information on evidence-based weight-loss methods. This supports the patient’s autonomy in making their own decisions about their weight management. Practitioners can help patients build self-efficacy and competence by reviewing past experiences, and reframing “failures” as short successes - even leveraging memories of success in other areas of life. They can help the patient set small, achievable goals that will add up to the larger goal - giving them small “wins” to reinforce their competence. Finally, supporting the patient in setting their own goals, outlining a plan, and strategizing for potential challenges can allow for the patient to feel more autonomy - and more competence when they are successful. It is especially important that the practitioner provides their support ( relatedness ) in a non-judgmental way, putting the patient in the “driver’s seat” rather than taking control themselves. Several interventions have shown that SDT can be successful in helping people to quit smoking, lose weight, take their medications, and even practice better oral hygiene (like flossing and brushing techniques) (Patrick & Williams, 2012). | libretexts | 2025-03-17T22:26:19.433074 | 2024-10-22T01:29:40 | {
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"book_url": "https://commons.libretexts.org/book/med-97107",
"title": "13.6: Self-Determination Theory",
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https://med.libretexts.org/Courses/Glendale_Community_College/Public_Health_101_(Calderone)/13%3A_Community_Organizing_and_Health_Promotion_Programming/13.07%3A_Transtheoretical_Model_(Stages_of_Change) | 13.7: Transtheoretical Model (Stages of Change)
Unlike the previous theories which mostly describe why a person engages in a particular behavior, or antecedents (prerequisites) to behavioral change, the Transtheoretical Model (TTM) instead describes the process of changing behavior. Drawing from several different behavioral theories (hence the name), psychologists James Prochaska and Carlo DiClemente developed the TTM in the late 1970’s. The TTM makes the (perhaps obvious) assertion that behavioral change is not immediate: people do not wake up one morning and start exercising and eating a healthy diet, nor does someone quit smoking overnight. Instead, behavior change is a process, and not even a linear process - people usually enter for the first time at the first stage but then may exit or re-enter the process at any stage in a somewhat circular fashion. Each stage in the TTM is based on the person’s individual readiness to change their behavior. (LaMorte, 2022a, McKenzie et al., 2017). Below are the 5 stages with a description of each, followed by a diagram in Figure 13.6.
- Precontemplation. Before a person decides to make any change to their behavior, they may be unaware of the risks of not changing behavior, or they may be resistant to change. In this stage, a person has no intention of changing their behavior in the next 6 months.
- Contemplation. At this stage, a person is considering changing their behavior in the next 6 months, and they may be thinking about all of the pros and cons to making this change. Barriers can be perceived as enormous, and it may be difficult to see the path forward, especially if the person lacks self-efficacy in this area.
- Preparation. This stage begins when the person intends to change their behavior in the near future, usually within the next month. They may have already started to make a few small changes, are in the process of planning how they will change their behavior, and believe that this is an important thing to do.
- Action. A person in the action stage has begun to change their behavior recently (within the last 6 months). The risk of relapse is high in this stage.
- Maintenance. This stage is reached when the new behavior has been relatively consistent for 6 months or more. A person in the maintenance stage intends to continue this behavior, and the longer they do so the more a part of their lifestyle it becomes.
Relapse, or exiting the stages of change and reverting back to old behavior patterns can occur at any stage, but is less likely the longer a person stays in maintenance. A sixth stage, called termination, occurs when the new behavior is so ingrained in the person’s lifestyle that they have no risk of relapse. For many health behaviors, termination is impossible since the temptation to go back to old behaviors still lingers, or since barriers to the behavior must still be planned for and overcome. Most public health practitioners will therefore not use the termination stage (LaMorte, 2022a, McKenzie et al., 2017). See Fig. \(\PageIndex{1}\) for a diagram of the TTM.
There are also 10 processes that people can use to move from one stage to the next. Some processes work better for earlier stages and others for later stages. These processes include the following (adapted from LaMorte, 2022a):
- Consciousness raising. Learning information about the behavior change, the risks of not changing, and the benefits of changing can help in the decision-making process, particularly in early stages.
- Dramatic relief. Many decisions to change behavior are emotional decisions. Experiencing a significant event can often bring this on (such as a diagnosis, or loss of a loved one), but so can taking the time to consider what a person’s dreams and desires are. When a person experiences this emotional response - whether positive toward the new behavior, or negative toward the consequences of not changing - it can spur motivation to take action.
- Self re-evaluation. This involves creating a discrepancy between where the person is now and where they want to be, as well as the realization that the desired behavior is part of who they want to be.
- Environmental re-evaluation. Other people are affected by an individual’s behavior, often those that are close to them. Knowing how their behavior affects others can become a significant motivator as well.
- Social liberation. There need to be opportunities that demonstrate the new, healthy behavior as being socially accepted. This helps to “normalize” the healthy behavior.
- Self liberation. When a person has self-efficacy, and believes that change is possible for them, they can make a commitment to the new behavior.
- Helping relationships. Identifying social support is key to both starting and maintaining a new behavior.
- Counter conditioning. This involves substituting negative behaviors and thoughts for change-inducing behaviors and thoughts. For example, a person might have had negative thoughts like “I’ll never be able to change, it’s too hard”, and will need to reframe those thoughts to more positive statements such as “I’ve had challenges in the past, and I will learn from them moving forward”. If a specific behavior happens to be a trigger to relapse into old habits, a similar but healthier behavior can be substituted. For example, driving is often a trigger for former smokers. Other behaviors like snacking on sunflower seeds or carrots can be a substitute.
- Reinforcement management. Rewards can still be helpful to reinforcing behaviors, especially if the person chooses the reward themselves. They can also reduce the “rewards” from the undesired behavior, by making it less pleasant.
- Stimulus control. This involves changing the environment to remove triggers for the undesired behavior and instead place conspicuous cues for the desired behavior. For example, if someone wants to stop snacking while watching TV at night, they can avoid purchasing common snack foods. If a person wants to exercise in the morning, they might lay out their workout clothes the night before.
Any and all of the aforementioned behavioral change models can be potentially useful in helping people change their behavior. They might be used by medical professionals, addiction specialists, counselors and therapists, or nutrition and fitness practitioners as helpful tools. However, some of them may have slight conflicts with public health goals. For example; SDT values autonomy in decision-making. Therefore, if a person decides that they do not want to quit smoking, that choice should be affirmed by practitioners (Sheeran et al., 2020). This obviously conflicts with a public health interest of reducing smoking behaviors! Another potential problem with these models is that they focus exclusively on the individual - their experiences, motivations and/or sense of behavioral control (aka self-efficacy, or competence). Social influences are recognized in several of the models, yet other influences such as environment, politics and public policy, health literacy, access, and economic variables are not. These models describe how an individual may change their own behaviors, but not necessarily how to nudge a group, community, or larger population in the direction of health-behaviors. Therefore, we need to “zoom out” and take a look at human behavior in the larger context of the community. | libretexts | 2025-03-17T22:26:19.491976 | 2024-10-22T01:29:42 | {
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"title": "13.7: Transtheoretical Model (Stages of Change)",
"author": "Erin Calderone"
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https://med.libretexts.org/Courses/Glendale_Community_College/Public_Health_101_(Calderone)/13%3A_Community_Organizing_and_Health_Promotion_Programming/13.08%3A_The_Social-Ecological_Model | 13.8: The Social-Ecological Model
The Social-Ecological Model is a framework for identifying the causes, risk factors, and protective factors that contribute to health outcomes in a community and populations at large. This model asserts that health outcomes - and perhaps more specifically, health behaviors - are influenced by the interaction between an individual, their community, and the physical, social, and political environments in which they live. Figure 13.7 is a visual representation of this model.
Each circle describes specific risk factors or protective factors for a health outcome, and therefore also provides opportunities for public health approaches at each level.
- The individual circle includes each individual’s own risk factors or protective factors. Genetics, age, personal history, education, income, attitudes, beliefs, and behaviors are included in this circle. All of these factors can make a person more or less likely to engage in a specific health behavior, and have an effect on their health status. For example, a person who experienced childhood trauma or abuse may be more likely to abuse drugs or drink alcohol. Someone who never graduated from high school may earn less income over their lifetime, and therefore not have consistent access to healthcare - or even avoid going to the doctor over concern about the medical costs. In a more positive example, a person who has experienced the benefits of eating a healthy diet and being physically active as a child is more likely to continue those healthy habits into adulthood - particularly because they may have a positive attitude towards nutrition and exercise.
- Relationships with other people are highly influential in a person’s attitudes, beliefs, and behaviors - and vice versa - these relationships are influenced by that person. Primary relationships are especially important, and include a significant other or spouse, parents, siblings, and children, as well as close friends. If a person is part of an abusive relationship, they will probably be more likely to be the victims of or to perpetrate violence. Conversely, if a person has a physically active friend group, they are more likely to engage in physical activity themselves.
- The community level includes organizations that the individual is a part of, and the broader social context in which they live. This could also include the built environment, and socio-political landscape of that person’s community. An example of this could be the social support provided by schools, churches, sports and recreation clubs. A built environment could encourage less stress and physical activity with accessible parks and greenspaces, or it could promote higher stress levels and alcohol consumption with high traffic roads and several liquor stores in the neighborhood.
- At the societal level we also have social norms, macro-economic and political factors, and environments that affect health outcomes. For example, social norms around alcohol consumption influence alcohol use at young ages, alcohol abuse, and addiction. Economic poverty is associated with higher crime rates, drug abuse, and mental illness. Political administrations can create laws that support or undermine public health efforts, and either provide or cut funding to public health programs ( The Social-Ecological Model: A Framework for Prevention , 2022, McKenzie et al., 2016). | libretexts | 2025-03-17T22:26:19.546710 | 2024-10-22T01:29:44 | {
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"book_url": "https://commons.libretexts.org/book/med-97107",
"title": "13.8: The Social-Ecological Model",
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https://med.libretexts.org/Courses/Glendale_Community_College/Public_Health_101_(Calderone)/13%3A_Community_Organizing_and_Health_Promotion_Programming/13.09%3A_Community_Intervention_Models | 13.9: Community Intervention Models
The social-ecological model identifies several potential areas for intervention and health promotion within a community at each different circle. Yet, just as individuals have varying levels of readiness to change behaviors, so do communities have varying levels of readiness for intervention (McKenzie et al., 2017). Due to group dynamics, physical environments, and political powers which are involved in every community, we cannot necessarily apply the same behavior change theories to a group that we might to an individual. Several researchers have described different approaches to community interventions, some which emphasize looking for deficits (needs-based) and others that emphasize identifying what is already working well (strengths-based). These different models work via social action, advocacy, capacity building, grassroots organizing, and leadership development in order to cause positive change (Seabert et al., 2021).
Community-based health promotion programs often take a holistic approach, in that they are not limited to a single location (like a hospital), they often have multiple, coordinated interventions, and may also focus on environmental and policy changes to support the desired behaviors (Merzel & D’Afflitti, 2003). There are four major models that most community-based interventions fall into according to McLeroy et al. (2003). Most successful community interventions are not only multi-faceted, they also utilize more than one of these models.
- Community as a setting . Sometimes the community is simply the geographical location in which the intervention takes place. Health promotion programming might take place at various locations within the community, such as city parks, community centers, churches or other faith-based organizations, hospitals, schools, worksites, or other non-profit organizations. Mass media (like billboards, paper flyers, radio, T.V., or Youtube advertisements, etc.) may be used to convey specific health messaging. When the community is the setting, the goal of the intervention is to elicit personal behavioral change. Therefore, any improvement in population health is the sum of all of the individual behaviors. This model may fail to address environmental, economic, or political influences of behavior and health.
- Community as a target . Interventions that target the community seek to make changes to the environment, programs, and/or policies available to community members. Instead of focusing on individual health behaviors as outcomes, these interventions might focus on other environmental or policy measures related to health, such as acreage of park-space per person, or the number of seniors participating in a free lunch program. The assumption is that if the community environment is changed, this will improve healthy behaviors and quality of life.
- Community as a resource . This approach seeks to utilize the people and resources within the community to either drive or at least contribute to health-promoting changes. A public health practitioner might bring a health priority to the community and seek input on intervention design as well as leveraging and supporting current resources, or they might ask the community members themselves to identify the highest priority for the community, and build an intervention from there.
- Community as an agent . This model assumes that the community already has the solutions and resources to its own health problems. It attempts to “meet people where they are” in supporting the community itself to identify needs, come up with solutions, and implement them. This model might fail to address disparities in social determinants of health that many communities face such as economics, environment, and policy.
Public health interventions are indelibly tied to current cultural perceptions and beliefs about society, and their success depends upon how well they are designed, received, and implemented. To what extent does the responsibility for health lie within each person (individualism) or within society (collectivism)? What role should the government play in protecting and promoting health? As McLeroy et al. (2003) states:
Public health is more than a body of theory and intervention methods. We cannot separate how we do public health from why we do public health. Whether we talk about changing behavior, changing community structures, or building community capacity, these changes cannot be separated from our ideals about what constitutes a good community or a good society. | libretexts | 2025-03-17T22:26:19.602536 | 2024-10-22T01:29:46 | {
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"book_url": "https://commons.libretexts.org/book/med-97107",
"title": "13.9: Community Intervention Models",
"author": "Erin Calderone"
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https://med.libretexts.org/Courses/Glendale_Community_College/Public_Health_101_(Calderone)/13%3A_Community_Organizing_and_Health_Promotion_Programming/13.10%3A_Health_Promotion_Program_Planning | 13.10: Health Promotion Program Planning
In order for any type of health intervention to be successful, it should first be evidence-based - the rationale, design, implementation, and assessment of the program rooted in scientific evidence. It may not be possible, however, to simply find a peer-reviewed research article on a successful intervention for a specific health behavior in a similar community, and then “copy and paste” that intervention into a new community. Effective program planning therefore involves a thoughtful process, taking into account the specific needs, desires, and capacities of the community, as well as considering funding, timing, and how the program will be evaluated for efficacy (whether or not it worked). Most community-based programs are grant funded, and so must demonstrate this process in order to justify the use of those funds. Below are a few of the most widely used health promotion programming models. | libretexts | 2025-03-17T22:26:19.655728 | 2024-10-22T01:29:47 | {
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"book_url": "https://commons.libretexts.org/book/med-97107",
"title": "13.10: Health Promotion Program Planning",
"author": "Erin Calderone"
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https://med.libretexts.org/Courses/Glendale_Community_College/Public_Health_101_(Calderone)/13%3A_Community_Organizing_and_Health_Promotion_Programming/13.10%3A_Health_Promotion_Program_Planning/13.10.01%3A_Generalized_Model | 13.10.1: Generalized Model
The generalized model includes four basic steps: conducting a needs assessment, setting goals and objectives, implementing an intervention, and evaluating the intervention.
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The generalized model includes four basic steps: conducting a needs assessment, setting goals and objectives, implementing an intervention, and evaluating the intervention. | libretexts | 2025-03-17T22:26:19.716206 | 2024-10-22T01:29:49 | {
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"book_url": "https://commons.libretexts.org/book/med-97107",
"title": "13.10.1: Generalized Model",
"author": "Erin Calderone"
} |
https://med.libretexts.org/Courses/Glendale_Community_College/Public_Health_101_(Calderone)/13%3A_Community_Organizing_and_Health_Promotion_Programming/13.10%3A_Health_Promotion_Program_Planning/13.10.02%3A_Needs_Assessment | 13.10.2: Needs Assessment
The first step in the generalized model is to conduct a needs assessment of the target population or community. A needs assessment is important for several reasons; whether or not the program planner is a part of the target community, they may have their own biases and priorities that may not actually reflect the needs or priorities of the community. A well-conducted needs assessment also provides justification for funding (as most community programs are funded by grants), and can also be used to get buy-in from the community members, while preventing duplication of resources or programs that already exist. It can also establish a baseline level for goals and objectives which will need to be measured at the beginning and end of the program (and sometimes mid-program) in order to evaluate whether the program is working or not. According to Seabert et al. (2021), a needs assessment includes the following 6 steps:
- Designing the needs assessment. This includes determining both the purpose of the needs assessment, and how it will be conducted - including the personnel needed. What tools will be used (i.e. surveys, interviews, etc.)? Whom is the target population? How long will the needs assessment take to complete? Getting input from community members can be extremely helpful in designing an effective assessment, since they may have insights into the communication preferences of the target population, and how to recruit the maximum number of respondents.
- Gathering data. Once the purpose and scope of the needs assessment have been decided on, then the data must be collected. Two main types of data can be used: primary and secondary. Primary data includes surveys, interviews, or any data gathered from the target population itself. Secondary data is information gathered on a similar population or on the target population but for a different purpose. This could include nationally representative surveys (i.e. vital statistics, behavior risk factor surveillance system data) or health insurance claims, health risk assessments etc. collected earlier from the target population. Care must be taken to respect Health Insurance Portability and Accountability Act (HIPAA) Privacy rules for health data.
- Data analysis. Formal statistical analysis is typically only performed in research studies, since it requires more sophisticated software and controlling for potential biases and confounding factors. Many program planners do an informal analysis of the data to identify the most pressing problems for the community. Once again, getting input from community members can be invaluable in this process. Often there are many potential health problems, but a program can only be designed to address one or two, so they must be ranked according to which problems have the highest need, and can be addressed most easily and effectively.
-
Identifying risk factors. After the health problems have been prioritized, risk factors that contribute to those health problems should also be identified. There are three types of factors involved in a behavior:
- Predisposing factors , or those needs that a person has before starting a behavior. For example, knowledge of the health risks of smoking is a predisposing factor for smoking cessation. If someone does not know that smoking poses a risk to their health, they are unlikely to try to quit.
- Enabling factors , or those things that help someone perform the behavior. For example, if someone wants to start exercising, it helps if they have access to a gym, park, walking paths, exercise classes, etc.
- Reinforcing factors , or those that keep a person going in healthy behaviors. Social support, for example, is especially powerful in maintaining a behavior. Reinforcing factors might include workplace wellness programs, recreational clubs, or support groups (like Alcoholics Anonymous).
- Setting the focus of the program. The program planner will now have the information needed to identify the direction of the program: which health problems are priorities, and which behavioral risk factors are going to be targeted. The planner should always pursue those problems and factors that have the greatest importance: either because of the severity of the health problem, number of people affected, and/or because community members have identified it as being important to them. But they also need to prioritize health problems that are changeable - that is there is scientific evidence that community interventions can be effective for this problem. Finally, planners should always take into account the resources available (funds, personnel, space, time, etc.) If there are not enough resources to address the problem effectively, then perhaps the particular grant funds they are working with is better used to target another priority problem on the list.
- Validating prioritized needs. Once again community input can be helpful in double-checking the assessment results. This also allows for the planner to identify if anything is already being done to address the priority health problem, or if other interventions have been attempted in the past. Additionally, they should check for redundancies or programs that are already addressing that need in the community. Are there ways to support those programs that are already in existence and successful, rather than competing with them? | libretexts | 2025-03-17T22:26:19.771818 | 2024-10-22T01:29:52 | {
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"title": "13.10.2: Needs Assessment",
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https://med.libretexts.org/Courses/Glendale_Community_College/Public_Health_101_(Calderone)/13%3A_Community_Organizing_and_Health_Promotion_Programming/13.10%3A_Health_Promotion_Program_Planning/13.10.03%3A_Goals_Objectives_and_Activities | 13.10.3: Goals, Objectives, and Activities
A goal of a program is the overarching target that the program is attempting to accomplish. This is usually stated in a single sentence, and encompasses the general mission of the program. Below are some examples of program goals:
- To increase the number of adults achieving the minimum physical activity recommendations.
- To help breast cancer patients access social support resources.
- To reduce teen violence incidents in high school.
Goals are written in a very broad and general way, but include both who will be affected (target population) and what will be changed (outcome) (Seabert et al., 2021).
Objectives are specific outcomes that will lead to the overall goal being achieved. Objectives come in different forms, and must be written in a very specific way, as they are typically describing outcomes that are measured at the beginning and end of the program in order to determine its effectiveness. Well-written objectives follow the SMART acronym:
- S - specific. The objective states specifically what will change, and by how much. It should be stated in quantifiable terms.
- M - measurable. The objective needs to have a metric that will be measured at the beginning and end of the program (or part of the program). Vague objectives such as changing things like knowledge or perceptions can often be measured by validated surveys or tests, which can be quantified (represented numerically) by a score.
- A - achievable. The objective has to be achievable given the resources available and the baseline measurement. This is where the scientific evidence - studies of previous interventions - can help the program planner set reasonable expectations.
- R - realistic. The objective must be realistic for the given timeframe. Not only should these objectives be evidence-based, they should also be realistically achievable for the target community. If more or fewer resources are available, or if a shorter or longer timeframe is utilized, that can change the effectiveness of the program.
- T - timeframe. All objectives should have an “end date”, or date which the objective is re-measured. This may not be the end date of the program itself, particularly if it is an ongoing project, but it will be the target date for the completion of the objective, and the evaluation of the program.
Compare the following objectives against the SMART acronym:
- In the next 6 months, program participants will improve their scores on the single-leg balance test by 10%.
- Senior citizens will improve their balance.
- The community pool will be utilized more by the end of the year.
- More children will know how to swim at the end of the summer.
- The employees of the local grocery store chain will have no low back pain complaints by the end of the year.
The first objective is the only one that follows all of the guidelines in the SMART acronym. It provides a specific population (program participants), a specific measurement (score on the single-leg balance test), and a specific, achievable outcome (improvement by 10%), as well as a realistic timeframe (6 months).
Objectives can be set for different aspects of the program. Some objectives will be process objectives , or targets of the implementation of the program itself. Process objectives might include activities like:
- Distributing a specific number of flyers.
- Hiring personnel (e.g. a Registered Dietician)
- Recruiting participants (getting people to sign up for the program)
- Purchasing equipment
- Conducting a certain number of health education classes
Impact objectives include outcomes that affect the target population’s learning, behaviors, or environment. For example, learning objectives assess the knowledge or skills obtained, such as:
- Test scores on a written test.
- Survey results identifying knowledge of a specific resource.
- Pass rate of a skills test.
Behavioral objectives include specific behaviors performed by community members. These could be things like:
- Getting blood pressure, cholesterol, or blood glucose levels checked.
- Performing regular exercise.
- Reporting consumption of fruits and vegetables.
- Attendance in support group meetings.
Environmental objectives include changes to the environment in which the target population lives, works, or plays. For example:
- The city enacts smoke-free policies in all public places.
- There is no longer a waitlist for the seniors free-lunch program.
- Cardiopulmonary Resuscitation (CPR) classes are offered every weekend at the community center.
Lastly, outcome objectives are the actual measures that will lead to the overarching goal of the program. These are health outcomes that address the health problems identified in the needs assessment. Some examples might be:
- A decline in the number of teen pregnancies.
- Improvements in Health-Related Quality of Life (HRQL) as reported on a community-wide survey.
- Program participants decrease their body mass index (BMI).
Designing the intervention itself will typically include activities or specific actions or pieces of the program which are designed to achieve the objectives. If possible, these activities should be evidence-based, or at least based on previous best-experiences (whether or not these prior interventions have been published as peer-reviewed research). Typically, multiple activities tend to be better than a single activity (Seabert et al., 2021). Community members and key stakeholders can provide invaluable feedback on whether planned activities are likely to work within a particular community. The cultural values, beliefs, attitudes, and behaviors of the target population are important to understand before designing a program - otherwise it may not be well-received or at worst, it may make the health problem worse. Lastly, behavioral change theories and models can be useful in this stage to help inform the program design and select the appropriate activities.
This photograph depicts Ryan Lacson, a high school biology teacher and 2019 Centers for Disease Control and Prevention (CDC) Science Ambassador Fellow, as he was leading a Biology for Public Health course at Galena High School in Missouri. To design the course, Lacson used his experience as a Science Ambassador Fellow, and partnered with his county health department to identify the county's most pressing public health issues. As part of the course, students partnered with a local community organization to train other high schoolers on mental health first aid. | libretexts | 2025-03-17T22:26:19.835564 | 2024-10-22T01:29:55 | {
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"title": "13.10.3: Goals, Objectives, and Activities",
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https://med.libretexts.org/Courses/Glendale_Community_College/Public_Health_101_(Calderone)/13%3A_Community_Organizing_and_Health_Promotion_Programming/13.10%3A_Health_Promotion_Program_Planning/13.10.04%3A_Implementation | 13.10.4: Implementation
Once the program has been designed, it’s time to actually put it into action. Implementing a program may require many smaller administrative tasks, as well as staying organized so as to make sure that the different pieces of the program come together smoothly. For example, if personnel must be hired, it may be necessary to have the human resources (HR) department post a job description, interview potential candidates, and then finalize the hiring process. Grant funds may take time to be released, and then be encumbered (assigned) to different departments. Equipment may need to be purchased, locations and rooms may need to be reserved or rented, and staff may need to be trained. Once the program gets started these different moving parts may need to be monitored and outcomes tracked or tested at different times. Often program planners will use logic models to help them organize the steps in the process, or a Gantt chart to give them an overview of priority tasks (McKenzie et al., 2017). See Table \(\PageIndex{1}\) for an example of a Gantt chart.
|
Tasks First Year |
J |
F |
M |
A |
M |
J |
J |
A |
S |
O |
N |
D |
|---|---|---|---|---|---|---|---|---|---|---|---|---|
|
Conduct needs assessment |
x |
|||||||||||
|
Design program (goals, objectives, activities) |
x |
|||||||||||
|
Create pilot program |
x |
|||||||||||
|
Procure resources for next phase (personnel, equipment, locations) |
x |
x |
x |
|||||||||
|
Create marketing tools |
x |
|||||||||||
|
Market program |
x |
x |
x |
x |
x |
x |
x |
|||||
|
Pilot test program (6 weeks) |
x |
x |
||||||||||
|
Assess pilot program |
x |
|||||||||||
|
Conduct phase 1 program |
x |
x |
x |
|||||||||
|
Conduct phase 2 (full) program |
x |
x |
x |
x |
||||||||
|
Assess and evaluate program |
x |
Running a smaller version of the program, or pilot program, can help identify challenges or issues early on. Pilot programs can be run at a single site instead of multiple locations, and include fewer participants, and be conducted for a shorter period of time. The pilot program can then be assessed, and necessary changes can be made to the program plan before expanding it to full implementation. For example, perhaps the pilot of a senior fall prevention program is conducted at a local community center, but the participants have trouble getting transportation to attend the program classes. This might inform the program planner that the location needs to be changed, or that transportation needs to be provided in order for the full program to be successful. After the pilot program and assessment, the program might have a phase-in process where a slightly larger version of the program is implemented, then expanded. Phasing-in can be beneficial on several levels: not all of the resources have to be ready at the same time, and challenges or barriers can be addressed before they affect the program at large. The process of phasing-in can be done by adding locations, by expanding the number of participants or the level of ability, and/or by adding activities of the program. For example, a smoking-cessation program might begin with support group meetings, then add stress management classes. Or a program might begin in one neighborhood park, then expand to others across the city (McKenzie et al., 2017, Seabert et al., 2021). | libretexts | 2025-03-17T22:26:19.996678 | 2024-10-22T01:29:56 | {
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"title": "13.10.4: Implementation",
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https://med.libretexts.org/Courses/Glendale_Community_College/Public_Health_101_(Calderone)/13%3A_Community_Organizing_and_Health_Promotion_Programming/13.10%3A_Health_Promotion_Program_Planning/13.10.05%3A_Evaluation | 13.10.5: Evaluation
An important component of any successful program is evaluating it for both its quality and efficacy. Evaluation occurs throughout all the phases of the program - in fact, the needs assessment is one form of evaluation. If the program includes a pilot test and phasing in, the assessments done at each of those steps can also be used to make changes to the program to make it better. This type of evaluation that seeks to test the quality of the program and make changes while it is ongoing is called formative evaluation (McKenzie et al., 2017, Seabert et al., 2021).
The second type of evaluation is the summative evaluation which typically takes place at the end of the program (or at a designated time if the program is ongoing). The objectives of the program must be assessed to determine whether or not it was effective. Evaluation of the impact objectives is called impact evaluation , and evaluation of the outcome objectives is termed outcome evaluation . These evaluations are often provided in a report which is shared to key stakeholders and decision makers in order to either justify continued funding of the program, suggest improvements to the program, or provide a rationale for the program to end. Of course, if the evaluation is done by the program planner, there is always the potential for bias and the temptation to portray the outcomes in the most positive light! Therefore it may be helpful to have an independent evaluation and/or make every effort to remain as objective as possible (McKenzie et al., 2017, Seabert et al., 2021). The Centers for Disease Control and Prevention (CDC) has created a framework to help guide program evaluation to ensure that it is ethical, accurate, and useful (CDC, 2023). | libretexts | 2025-03-17T22:26:20.050481 | 2024-10-22T01:29:57 | {
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"title": "13.10.5: Evaluation",
"author": "Erin Calderone"
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https://med.libretexts.org/Courses/Glendale_Community_College/Public_Health_101_(Calderone)/13%3A_Community_Organizing_and_Health_Promotion_Programming/13.11%3A_Mobilizing_Action_through_Planning_and_Partnerships_(MAPP) | 13.11: Mobilizing Action through Planning and Partnerships (MAPP)
The MAPP model was originally created through a partnership between the CDC and the National Association of County and City Health Officials (NACCHO) in 2001. It has since been updated to MAPP 2.0, which “emphasizes community engagement, data-driven assessments, and a focus on health equity” (NACCHO, 2024). The redesigned MAPP model emphasizes the recognition of social determinants of health and the social inequities that cause them, including power dynamics and involving the community in the decision-making process. The MAPP 2.0 uses the following 3 phases (Clayton et al., 2020):
- Phase 1: Building the Community Health Improvement (CHI) Foundation. This phase involves identifying the people in the community who will have an effect on the program and whom the program will affect - the stakeholders. A committee is then created out of these stakeholders, and a shared community vision established. In this phase, the resources, budget, and administrative organization of the project is created.
-
Phase 2: Tell the Community Story. This is where the community assessments are designed and performed. There are three assessments as part of the MAPP:
- Community Partner Assessment - community partners such as local government agencies, non-profit organizations, medical offices, hospitals, schools, community health centers, faith-based institutions, and private businesses can assess themselves for strengths and capacities to improve health and health equity in the community.
- Community Status Assessment - data collected on demographics, current health status, and health inequities of community members. This includes health behaviors and social determinants of health, as well as the systems of power that influence health outcomes.
- Community Context Assessment - the historical and current socio-political context of the community includes the “community strengths and assets, built environment, and forces of change”. This assessment relies on the views and lived experiences of the people experiencing the health inequities (NACCHO, 2023).
- Phase 3: Continuously Improve the Community. The MAPP involves an ongoing process of community engagement, prioritization of issues, analysis of power (factors, people, and institutions that contribute to health), developing long-term goals and measures of success, creating action plans including short-term objectives, and finally setting up ongoing evaluation and assessment for continuous improvement (Clayton et al., 2020, NACCHO, 2023). | libretexts | 2025-03-17T22:26:20.105228 | 2024-10-22T01:29:58 | {
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"book_url": "https://commons.libretexts.org/book/med-97107",
"title": "13.11: Mobilizing Action through Planning and Partnerships (MAPP)",
"author": "Erin Calderone"
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https://med.libretexts.org/Courses/Glendale_Community_College/Public_Health_101_(Calderone)/13%3A_Community_Organizing_and_Health_Promotion_Programming/13.12%3A_PRECEDE-PROCEED_Model | 13.12: PRECEDE-PROCEED Model
PRECEDE-PROCEED is an acronym that defines the planning and implementation stages of a community health intervention. PRECEDE stands for Predisposing, Reinforcing, and Enabling Constructs in Educational Diagnosis and Evaluation. This model attempts to “reverse engineer” the program, by starting with identifying the desired outcome, and then working backwards from that to design the intervention. While this may certainly sound daunting, it’s really describing a process of assessing the needs and context of the community, including the following phases (summarized from McKenzie et al., 2017, HRSA, 2024, University of Kansas, 2024):
- Phase 1: social assessment and situational analysis. A social assessment identifies the subjective needs of a population, including things like quality of life, perception of safety, and their own goals and aspirations for the community. This requires substantial input from the community members themselves on their own subjective experiences, needs and desires. This might include surveys, telephone or face-to-face interviews, focus groups, or questionnaires. The goal of this phase is to envision the ultimate outcome that the community wants to achieve.
- Phase 2: epidemiological assessment. This level of data collection and assessment involves more objective data, including mortality and morbidity rates, disability status, and behavioral, genetic, and environmental factors that influence health outcomes. Prioritizing health problems in this phase is important, as well as connecting them to the subjective needs and desires of the community (identified in phase 1). Program planners will need to use both scientific evidence and an understanding of the community resources available, as well as the priorities of the community itself, in order to appropriately prioritize health problems. For example, the program planner may identify that rates of type II diabetes are higher in the community than the national average, and community members might therefore benefit from a Diabetes Prevention Program (DPP). However, community members may identify that residential street safety is a much more pressing concern in phase 1. If the program planner tries to “shoehorn” or force their agenda on the community intervention, however well intentioned, it may not be well-received and at worst may lead to public distrust of health interventions.
- Phase 3: educational and ecological assessment. This last level of assessment looks to identify those factors that influence the behaviors, lifestyles, and health risks in the community. These include predisposing, enabling, and reinforcing factors (described earlier). Factors can include a lack of access or resources, an educational or informational gap, environmental influences, policies or something else. Often there are multiple factors that influence a health risk, necessitating multiple components in the intervention to address them.
- Phase 4: health program and policy development. At this stage the program is being designed based on the findings from the previous assessments, along with “best evidence” or “best practice” (using scientific evidence and/or behavioral change theory). The program should be connected back to both the social assessment and the epidemiological assessment, and should focus on those factors that were identified and predisposing, enabling, and/or reinforcing behaviors in phase 3. Another key component of this phase is to do an administrative and policy assessment, which determines two things: whether or not existing resources - including funding and personnel - are available and adequate to implement the program, and if there are any policies (local laws, regulations, etc.) that may influence the program implementation. An example of this might be a program designed to offer exercise sessions in a local park, which would require the program planner to check with the city parks and recreation office to find out if a contract or memorandum of understanding (MOU) is required, if liability insurance is adequate, and if there are any requirements for participants to sign liability waivers or other paperwork. Personnel may need to be hired and trained to lead exercise sessions, and equipment may need to be purchased.
The second part of the model is the acronym PROCEED, which stands for Policy, Regulatory, and Organizational Constructs in Educational and Environmental Development. This is the process of implementing and evaluating the intervention created in the first four phases, and evaluating each different piece (see Figure 13.9 for a diagram of all of the phases together). Once again, there are 4 phases dedicated to this process, outlined below (summarized from McKenzie et al., 2017, HRSA, 2024, University of Kansas, 2024):
- Phase 5: implementation. This is where the intervention actually takes place! Phase 5 might include a pilot program, and/or phasing in process. It may be helpful to use a Gantt chart or other project management tools to ensure that each piece of the program is implemented in the right order. Phases 6 and 7 can be conducted as the program is ongoing, in order to provide valuable feedback that can be used to make the program better.
- Phase 6: process evaluation. Is the program being implemented as planned? This evaluation seeks to determine whether the activities of the intervention are actually being delivered. For example, are health education sessions being offered? Did some need to be canceled? If so, why? What can be done to address problems with the program implementation early on, so that it actually gets completed as promised?
- Phase 7: impact or short-term evaluation. This evaluation addresses the impact that the program is having on knowledge, behaviors, or environmental objectives (see earlier in this chapter for definitions). These might be intermediate or short-term assessments, done in the middle of the program, as well as at the end of it. For example, if the program involves offering health education courses with the objective of improving knowledge about health eating patterns, has that knowledge actually improved for the participants? Do they score higher on a questionnaire about healthy eating? Performing impact assessments while the program is ongoing also helps to identify if changes need to be made to make the program more effective.
- Phase 8: outcome or long-term evaluation. The final assessment should be on the outcome objectives, which are typically the ultimate desired changes to health status for the community. Some of these changes may take years or even decades to be demonstrated. For example, the ultimate desired goal for a community might be a reduction in cardiovascular disease (CVD) rates. However, many of the participants in the community program might not be at risk for developing cardiovascular disease for several years, but the program activities may be helping them to prevent CVD. Sometimes a different marker can be targeted that is associated with the ultimate goal - such as an improvement in cardiovascular fitness, a reduction in body mass index (BMI), or lower blood cholesterol levels - but these will need to be maintained over the years in order to reach the ultimate goal of CVD prevention.
There are several other program models that have proven successful besides those presented here (McKenzie et al., 2017). Ultimately each model is a guide that can be used to provide structure for a program planner. Each of these models highlights the importance of involving the community members themselves in both planning and implementation of the community health intervention, as well as the need for regular assessments of the program to ensure it is actually working to improve the health and lives of the population. | libretexts | 2025-03-17T22:26:20.162339 | 2024-10-22T01:30:00 | {
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"title": "13.12: PRECEDE-PROCEED Model",
"author": "Erin Calderone"
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https://med.libretexts.org/Courses/Glendale_Community_College/Public_Health_101_(Calderone)/13%3A_Community_Organizing_and_Health_Promotion_Programming/13.13%3A_Case_Studies | 13.13: Case Studies
With the two following case studies we will take a look at community interventions targeting health behaviors like physical activity and nutrition. With the first case study, we’ll discuss it through the social-ecological model lens - how does this intervention affect each different level? The second case study is a great example of a multi-component community intervention which utilized several different program planning models to inform its design. | libretexts | 2025-03-17T22:26:20.214669 | 2024-10-22T01:30:04 | {
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"book_url": "https://commons.libretexts.org/book/med-97107",
"title": "13.13: Case Studies",
"author": "Erin Calderone"
} |
https://med.libretexts.org/Courses/Glendale_Community_College/Public_Health_101_(Calderone)/13%3A_Community_Organizing_and_Health_Promotion_Programming/13.14%3A_Case_Study_1-_3Wins_Fitness | 13.14: Case Study 1Wins Fitness
- 103855
This first case study illustrates the use of the social-ecological model in a health promotion program to promote physical activity in a community. At California State University, Northridge (CSUN), the Kinesiology department began a fitness intervention in an underserved community nearby - the City of San Fernando. This program provided free exercise classes instructed by undergraduate students from the university to participants at several local parks spaces in the city. The program brought some portable fitness equipment, and was awarded grant money to install permanent exercise equipment at one of the parks. Moreover, the program also partnered with other programs and local businesses to provide opportunities for nutritional education, physical therapy consults, and even video lectures on weight loss and mindfulness. The 3 Wins Fitness program ran for 12 years and involved over 400 participants over its duration. The idea of “3 Wins” in the program were that there were benefits to three stakeholders:
- the student - via professional skill development, experience and networking,
- the participant - by providing structure and coaching for exercise, and
- the community - by providing programs that improve health and well-being of community members as well as utilizing park space for health promotion (3 Wins Fitness, 2017).
The 3 Wins Fitness program had an effect on students at CSUN and citizens of San Fernando on multiple levels of the social-ecological model, as analyzed in several academic papers (Chaudhari et al., 2022, Derose et al., 2022).
Individual
Participants in the program reported improving health measures such as A1C levels (a measure of blood sugar management and risk for diabetes), lowered resting blood pressure, weight loss, and improved mental health. Additionally, many participants reported improved physical fitness including mobility, and stamina (Chaudhari et al., 2022).
Interpersonal
Both participants and student-instructors in the 3Wins program reported social-emotional benefits from the program. Participants were motivated to exercise by the instruction and encouragement of the student-instructors, and the comradery from their peers in the program. Student-instructors in turn, also developed a sense of community with other students and participants, which supported their academic and career goals. Lastly, family members of the participants could be affected by the increased focus on physical activity and health (Chaudhari et al., 2022).
Organizational
Several organizations were affected positively by the 3 Wins Fitness program. First, the parks and recreation system within the city had a continuous, no-cost exercise program to offer residents. Parks in underserved communities are notoriously underfunded, less maintained, and underutilized greenspace (Derose et al., 2022). One park in particular benefited with additional grant funding for exercise equipment installation. Local churches got involved with marketing and awareness efforts for the program. Many local religious organizations are neighborhood hubs for social gathering, and also have a vested interest in connecting their members with health-promoting programs (Derose et al., 2022). As an academic institution, CSUN benefitted from the program providing opportunities for research and as a source of internships for students in kinesiology and public health.
Community
The American Council on Exercise (ACE) supported research with 3 Wins Fitness, and provided scholarships and personal trainer certification opportunities for the student instructors. This connected these undergraduate students to the larger community of fitness professionals, and opened doors for them through certification and professional networking (American Council on Exercise, 2023). For the local community in the city of San Fernando, the 3 Wins program utilized the park system heavily, and helped to create demand for other health and fitness related programs offered by the city - including an annual 1-mile run event through the heart of the city. Local and large businesses sponsor this event, creating a public-private partnership for the community ( Recreation & Community Services , n.d.).
Policy
While the 3 Wins Fitness program offered by CSUN ended in the Fall of 2023, the City of San Fernando committed to expanding its own exercise offerings in parks and recreation for at least another year; creating part-time job opportunities for fitness instructors, and continuing exercise classes at no cost for community members. Additionally, research has been conducted on the program and calls for action by local, state and federal policymakers to prioritize funding community-based physical activity opportunities (3 Wins Fitness, n.d.).
While this example demonstrates a specific program that was implemented using the social-ecological model, it also highlights how each of these areas determines health behaviors and eventually affect health outcomes. The health of an individual is affected by their interpersonal relationships, the community in which the person lives, works, and plays. The health of those members in a community is affected by the organizations they are a part of, the built environment of their community, the economic and political landscape, as well as specific policies that directly or indirectly relate to health. There are stark disparities that exist in the opportunities that individuals and communities have to achieve health, that are not solely based on individual choices. A holistic approach that recognizes the social determinants of health and advances change at all levels of the social-ecological model is necessary (National Academies of Sciences, Engineering, and Medicine, 2023). | libretexts | 2025-03-17T22:26:20.273967 | 2024-10-22T01:30:05 | {
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https://med.libretexts.org/Courses/Glendale_Community_College/Public_Health_101_(Calderone)/13%3A_Community_Organizing_and_Health_Promotion_Programming/13.15%3A_Case_Study_2-_Our_Choice_Nuestra_Opcion-_The_Imperial_County_California_Childhood_Obesity_Research_Demonstration_Study_(CA-CORD) | 13.15: Case Study 2- Our Choice/Nuestra Opción- The Imperial County, California, Childhood Obesity Research Demonstration Study (CA-CORD)
A CDC funded program focusing on addressing childhood obesity in Southern California took a similar approach to address multiple drivers of health at the same time. In Imperial County, a community along the border of California and Mexico, the population is predominantly of Mexican origin. Communities are somewhat rural and surrounded by agricultural land, and poverty rates are higher than the national average. One significant health disparity exists there as well: childhood obesity rates in these communities are higher than the state and national average, something that this study aimed to change.
Using various theories of behavioral change, models of organizational change, and family systems theory to inform this project, the researchers took a multi-sector approach: involving pediatricians, community health workers, school teachers, restaurant owners, and families. The program included a healthcare approach for overweight and obese children and their families at federally funded healthcare clinics. Family workshops with trained Community Health Workers (CHWs), included education on healthy eating and physical activity. The CHWs also followed up with motivational interviewing phone calls to parents, and newsletters were sent to the families to encourage them in continuing healthy behaviors. Since local elementary schools didn’t have specialized Physical Education teachers, current staff attended training sessions and received new PE equipment to use, both sponsored by the project. A few local restaurants worked with the program to develop healthy kid’s menus. Additionally, the project funded community and school gardens to help families learn more about backyard gardening for fresh produce (Ayala et al., 2015, Renner, 2014).
While projects like these are time consuming and require the buy-in and contributions of many people, they can be instrumental in causing lasting changes in communities by addressing multiple social determinants of health at once. Ultimately, no single policy or program is likely to cause significant improvements to the social determinants of health alone. Using the social-ecological model (and other theories) can help public health practitioners design effective, meaningful programs that initiate positive changes for individuals, families, communities, and eventually - whole populations. | libretexts | 2025-03-17T22:26:20.328321 | 2024-10-22T01:30:06 | {
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https://med.libretexts.org/Courses/Glendale_Community_College/Public_Health_101_(Calderone)/13%3A_Community_Organizing_and_Health_Promotion_Programming/13.16%3A_Summary | 13.16: Summary
Many health outcomes are related to behaviors, which are also influenced by individual experiences and beliefs, self-efficacy, social and cultural norms, as well as the communities in which we live - including the social, physical, economic and political environments that make them up. Changing behaviors at a population level may seem like an insurmountable task - akin to turning a cruise ship - but societies have done so over the course of history so it is not impossible or even improbable. Well-designed health promotion programs can be a part of initiating and continuing behavioral and societal changes that bring about better health for all. | libretexts | 2025-03-17T22:26:20.381154 | 2024-10-22T01:30:08 | {
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https://med.libretexts.org/Courses/Glendale_Community_College/Public_Health_101_(Calderone)/13%3A_Community_Organizing_and_Health_Promotion_Programming/13.17%3A_References | 13.17: References
ACE - CertifiedTM: August 2023 - ACE-SUPPORTED RESEARCH: Does 3 WINS fitness provide the wins it promises? (n.d.). Retrieved April 18, 2024, from https://www.acefitness.org/continuin...s-it-promises/
Ayala, G. X., Ibarra, L., Binggeli-Vallarta, A., Moody, J., McKenzie, T. L., Angulo, J., Hoyt, H., Chuang, E., Ganiats, T. G., Gahagan, S., Ji, M., Zive, M., Schmied, E., Arredondo, E. M., & Elder, J. P. (2015). Our choice/nuestra opción: The Imperial County, California, childhood obesity research demonstration study (CA-CORD). Childhood Obesity , 11 (1), 37–47. https://doi.org/10.1089/chi.2014.0080
CDC. (2023, April 27). Framework for program evaluation . CDC Office of Policy, Performance, and Evaluation. https://www.cdc.gov/evaluation/framework/index.htm
Chaudhari, L. S., Lang-Balde, R., Carlos, J., & Loy, S. (2022). Qualitative analysis of a kinesiology student-led sustainable exercise program targeting underserved communities. Journal of Physical Activity and Health , 19 (12), 820–827. https://doi.org/10.1123/jpah.2022-0277
Clayton, A., Verma, P., & Weller Pegna, S. (2020). MAPP Evolution Blueprint Executive Summary . National Association of County and City Health Officials (NACCHO). https://www.naccho.org/uploads/full-...y-V3-FINAL.pdf
Derose, K. P., Cohen, D. A., Han, B., Arredondo, E. M., Perez, L. G., Larson, A., Loy, S., Mata, M. A., Castro, G., De Guttry, R., Rodríguez, C., Seelam, R., Whitley, M. D., & Perez, S. (2022). Linking churches and parks to promote physical activity among Latinos: Rationale and design of the Parishes & Parks cluster randomized trial. Contemporary Clinical Trials , 123 , 106954. https://doi.org/10.1016/j.cct.2022.106954
National Academies of Sciences, Engineering, and Medicine. Federal policy to advance racial, ethnic, and tribal health equity. (2023). https://doi.org/10.17226/26834
HRSA. (2024, January 17). PRECEDE-PROCEED model . Rural Health Promotion and Disease Prevention Toolkit; The Rural Health Information Hub. https://www.ruralhealthinfo.org/tool...recede-proceed
In the news – 3 WINS fitness . (n.d.). Retrieved April 18, 2024, from https://www.3winsfitness.com/in-the-news/
LaMorte, W. W. (2022a). The transtheoretical model (stages of change) . Boston University School of Public Health. https://sphweb.bumc.bu.edu/otlt/mph-...theories6.html
LaMorte, W. W., . (2022b). The social cognitive theory . Boston University School of Public Health. https://sphweb.bumc.bu.edu/otlt/mph-...theories5.html
Li, Y., Xia, P.-F., Geng, T.-T., Tu, Z.-Z., Zhang, Y.-B., Yu, H.-C., Zhang, J.-J., Guo, K., Yang, K., Liu, G., Shan, Z., & Pan, A. (2023). Trends in self-reported adherence to healthy lifestyle behaviors among US adults, 1999 to march 2020. JAMA Network Open , 6 (7), e2323584. https://doi.org/10.1001/jamanetworkopen.2023.23584
McKenzie, J. F., Neiger, B. L., & Thackeray, R. (2017). Planning, implementing, and evaluating health promotion programs: A primer (7th ed.). Pearson Education.
McLeroy, K. R., Norton, B. L., Kegler, M. C., Burdine, J. N., & Sumaya, C. V. (2003). Community-Based interventions. American Journal of Public Health , 93 (4), 529–533. https://doi.org/10.2105/ajph.93.4.529
Merzel, C., & D’Afflitti, J. (2003). Reconsidering community-based health promotion: Promise, performance, and potential. American Journal of Public Health , 93 (4), 557–574. https://doi.org/10.2105/ajph.93.4.557
NACCHO. (2023). MAPP 2.0 User’s Handbook . https://cdn.wildapricot.com/296815/r...K27MGQSHTHAGGF
NACCHO. (2024). Mobilizing for Action through Planning and Partnerships (MAPP) . NACCHO. https://www.naccho.org/programs/publ...ssessment/mapp
OECD. (2023). Health expenditure per capita. . OECD iLibrary: Health at a Glance 2023: OECD Indicators. https://www.oecd-ilibrary.org/sites/...nt/675059cd-en
O’Hara, D. (2017, December 18). The intrinsic motivation of Richard Ryan and Edward Deci. Https://Www.Apa.Org . https://www.apa.org/members/content/...sic-motivation
Our mission – 3 WINS fitness . (n.d.). Retrieved April 18, 2024, from https://www.3winsfitness.com/our-purpose/
Patrick, H., & Williams, G. C. (2012). Self-determination theory: Its application to health behavior and complementarity with motivational interviewing. International Journal of Behavioral Nutrition and Physical Activity , 9 (1), 18. https://doi.org/10.1186/1479-5868-9-18
Pilar, M. R., Eyler, A. A., Moreland-Russell, S., & Brownson, R. C. (2020). Actual causes of death in relation to media, policy, and funding attention: Examining public health priorities. Frontiers in Public Health , 8 . https://doi.org/10.3389/fpubh.2020.00279
Recreation & Community Services . (n.d.). City of San Fernando. Retrieved April 18, 2024, from https://ci.san-fernando.ca.us/sfrecreation/#sfv-mile
Rehman, I., Mahabadi, N., Sanvictores, T., & Rehman, C. I. (2023). Classical conditioning. StatPearls .
Rosenstock, I. M. (1974). Historical origins of the health belief model. Health Education Monographs , 2 (4), 328–335. https://doi.org/10.2307/45240621
Seabert, D., McKenzie, J. F., & Pinger, R. R. (2021). McKenzie’s an introduction to community & public health . Jones & Bartlett Learning.
Sheeran, P., Wright, C. E., Avishai, A., Villegas, M. E., Lindemans, J. W., Klein, W. M. P., Rothman, A. J., Miles, E., & Ntoumanis, N. (2020). Self-determination theory interventions for health behavior change: Meta-analysis and meta-analytic structural equation modeling of randomized controlled trials. Journal of Consulting and Clinical Psychology , 88 (8), 726–737. https://doi.org/10.1037/ccp0000501
Steinmetz, H., Knappstein, M., Ajzen, I., Schmidt, P., & Kabst, R. (2016). How Effective are Behavior Change Interventions Based on the Theory of Planned Behavior? Zeitschrift Für Psychologie , 224 (3), 216–233. https://doi.org/10.1027/2151-2604/a000255
Su, D. L. Y., Tang, T. C. W., Chung, J. S. K., Lee, A. S. Y., Capio, C. M., & Chan, D. K. C. (2022). Parental influence on child and adolescent physical activity level: A meta-analysis. International Journal of Environmental Research and Public Health , 19 (24), 16861. https://doi.org/10.3390/ijerph192416861
The social-ecological model: A framework for prevention . (2022, January 18). CDC. https://www.cdc.gov/violencepreventi...icalmodel.html
University of Kansas. (2024). Chapter 2. Other models for promoting community health and development . Community Tool Box; University of Kansas Center for Community Health and Development. https://ctb.ku.edu/en/table-contents...-proceder/main | libretexts | 2025-03-17T22:26:20.447206 | 2024-10-22T01:30:09 | {
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https://med.libretexts.org/Courses/Glendale_Community_College/Public_Health_101_(Calderone)/14%3A_Healthcare_Administration_and_Policy | 14: Healthcare Administration and Policy Last updated Save as PDF Page ID 99050 Erin Calderone Glendale Community College Learning Objectives Analyze the organization, financing and delivery of various medical and population-based services in the U.S. healthcare system. 14.1: Introduction 14.2: The U.S. Healthcare Model 14.3: Privately Funded Healthcare 14.3.1: Indemnity Plan 14.3.2: Managed Care Organizations 14.3.3: Premiums 14.3.4: Deductables 14.3.5: Copayments 14.3.6: Coinsurance 14.3.7: Out-of-Pocket Maximum 14.3.8: High Deductible Plans and Health Savings Accounts 14.4: Publicly Funded Healthcare 14.5: Medicare 14.5.1: Part A 14.5.2: Part B 14.5.3: Part C 14.5.4: Part D 14.6: Medicaid 14.7: Other Sources of Public Healthcare 14.7.1: Community Health Centers 14.8: Health Policy and the Future of Healthcare 14.8.1: The Affordable Care Act 14.8.2: Cost Control 14.9: Summary 14.10: References | libretexts | 2025-03-17T22:26:20.538674 | 2024-08-27T08:26:01 | {
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https://med.libretexts.org/Courses/Glendale_Community_College/Public_Health_101_(Calderone)/14%3A_Healthcare_Administration_and_Policy/14.01%3A_Introduction | 14.1: Introduction
Compared to other wealthy countries, the U.S. is unique in that it does not have a universal or government-sponsored healthcare system. Instead, the federal government (through Medicare and Medicaid) and a few large health insurance companies are the primary payers for healthcare. Health insurance is either provided by an employer, or purchased privately by individuals. The Affordable Care Act provided subsidies for low income individuals which did help increase coverage - but to date has never reached 100%. In 2023, the uninsured were at the lowest percentage yet - only 7.7% or around 25.3 million Americans still lacked health insurance coverage. In this chapter, we will cover the basics of the U.S. healthcare system: government funded programs, health insurance terms, and a few key issues facing U.S. healthcare. | libretexts | 2025-03-17T22:26:20.590062 | 2024-10-22T01:30:11 | {
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https://med.libretexts.org/Courses/Glendale_Community_College/Public_Health_101_(Calderone)/14%3A_Healthcare_Administration_and_Policy/14.02%3A_The_U.S._Healthcare_Model | 14.2: The U.S. Healthcare Model
The United States has a long history and culture of independence, self-reliance, and individualism. There is a cultural belief that those who work hard over time will be successful, and reward should not be universal, but based on merit. This strong emphasis on the individual also seeps into the U.S. healthcare model and creates resistance against the more collectivist models utilized in other countries. Combine this sense of individualism with gigantic healthcare, pharmaceutical, and health insurance markets, and we get a sense of the U.S. healthcare model. Yet a long healthy life free from illness or injury is not guaranteed to those who work hard, nor is the healthcare market ever a “free” market - it will always be imperfect (Shi & Singh, 2017). The demand for healthcare is based on the health status of individuals, which is influenced by genetics, biology, environment, and behaviors, as well as other social determinants. On the supply side, technology, specialization, and accessibility will all play into how healthcare is delivered and distributed.
Thus, the United States healthcare system can be visualized as a four-part system or quad-function model (see Fig. \(\PageIndex{1}\) below). This includes the financing, insurance, payment, and delivery of care. Sometimes these components overlap or are closely integrated.
According to the Center for Medicare and Medicaid Services, the National Healthcare Expenditure in 2022 was up 4.1% from the previous year at $4.5 trillion, or about 17.3% of Gross Domestic Product (GDP). Essentially, 17.3% of the U.S. economy is taken up by healthcare. This amounts to about $13,493 per person. The average growth in healthcare expenditures has been about 4.8% per year on average between 2014-2020. In 2022, the federal government spending was the largest piece of the expenditure pie at 33%, and households (including premiums and out of pocket costs) were close behind at 28%, whereas private businesses contributed 18%. See Fig. \(\PageIndex{2}\ below.
Although this chapter focuses on U.S. healthcare, it is enlightening to compare per-capita healthcare spending with other countries of similar wealth. The Organization for Economic Cooperation and Development (OECD) recorded the average spending for similar nations was equal to approximately $5000 U.S. dollars (USD) per capita in 2022. For example, Switzerland and Germany spent an average of $8000USD per capita, and Australia, New Zealand, and Canada spent between $6000-$7000USD. Several other European and South American countries have considerably lower expenditures (OECD, 2023). When expressed as a percentage of the gross domestic product (GDP) for each country, the U.S. healthcare expenditure still outpaces other wealthy countries. See Fig. \(\PageIndex{3}\) below. | libretexts | 2025-03-17T22:26:20.645274 | 2024-10-22T01:30:14 | {
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https://med.libretexts.org/Courses/Glendale_Community_College/Public_Health_101_(Calderone)/14%3A_Healthcare_Administration_and_Policy/14.03%3A_Privately_Funded_Healthcare | 14.3: Privately Funded Healthcare
Health insurance originally began as catastrophic insurance - that is, if you were ill or injured enough to land in a hospital, it would help to pay for your stay so that you didn’t experience financial ruin. One of the earliest of these plans was Blue Cross - which helped fund a person’s stay at hospitals which were largely religious or charitable organizations. At first, Blue Cross was a non-profit entity, created along those same lines of charity. In the early part of the 20th century, technology was just beginning to advance medicine, and so often hospitals were solely places for those on death’s door. After WWII, due to labor shortages and wage freezes, employer-sponsored health insurance emerged as a way to increase compensation for workers - and employers didn’t have to pay taxes on it either. Thus, health insurance started to become an employment benefit more than a privately purchased commodity (Rosenthal, 2017).
In recent decades, the profit motive has started to affect health insurance substantially. For-profit health insurance companies like Aetna and Cigna came on the scene in the 1950’s, and began to enroll primarily young, healthy people - who are obviously more profitable: they tend to pay premiums for longer, and they don’t get sick as much. Over the decades, this has caused non-profit health insurers to have to become more like for-profit companies. All health insurance companies have focused on ways to control or cut costs, reduce risks, and many of them have been accused of prioritizing CEO pay and investor dividends over patient health outcomes (Rosenthal, 2017). Prior to the Affordable Care Act (ACA) of 2010 (aka “Obamacare), health insurers could deny coverage for patients with “pre-existing conditions”, thus leaving those chronically ill on their own financially. The ACA also included an emphasis on preventative healthcare, which many health insurance plans have turned their focus to in order to decrease costs down the road.
Kaiser Permanente (KP), a non-profit organization, was originally developed for workers building dams, aqueducts, and eventually military ships. They prioritized prevention, and worker’s health and safety. Over the decades they have evolved to include three parts: the Kaiser Permanente Foundation Health Plan, Kaiser Foundation Hospitals, and the Permanente Medical Group (practitioners) - and have grown to become the largest healthcare provider in the U.S. (Permanente, 2023, Kissell, 2024). The KP model provides just some examples of how the healthcare system can decrease costs: their large size, use of primary care physicians as “gatekeepers” to refer to specialists, integration of systems and emphasis on preventative care all help to reduce healthcare expenditures. All of these measures have both benefits and drawbacks.
Many people lack an understanding of healthcare systems and health insurance in general (see also Health Literacy in chapter 8). Below is a brief breakdown of common terms used in health insurance and their implications to the beneficiary (aka insured person).
Health Insurance Terminology
Health insurance plans come in a variety of types, with different coverages and costs to employers and beneficiaries. Here are some of the most common types of health insurance plans. | libretexts | 2025-03-17T22:26:20.699867 | 2024-10-22T01:30:18 | {
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https://med.libretexts.org/Courses/Glendale_Community_College/Public_Health_101_(Calderone)/14%3A_Healthcare_Administration_and_Policy/14.03%3A_Privately_Funded_Healthcare/14.3.01%3A_Indemnity_Plan | 14.3.1: Indemnity Plan
The oldest type of health insurance plan allowed for the insured person to visit any doctor - including primary care physicians and specialists. The doctor would then bill the insurance company for any visits or procedures done, the insurance company would pay the portion outlined in the plan, and then the doctor would bill the patient for the remainder. This type of insurance plan is also known as a fee-for-service model, and although it used to be the most common type of employer-sponsored healthcare plan, it is almost non-existent today. The problem with this fee-for-service model is that neither the doctors nor the insurance companies were incentivized to control costs and avoid any unnecessary “utilization” or medical procedures. In fact, doctors are incentivized to do just the opposite - perform as many tests and procedures as they could justify, thereby making more money from treating each patient. Similarly, insurance companies could simply pass on the high costs to employers by increasing premiums year over year. Since the 1990s, these plans have become untenable for most employers and beneficiaries (who could be charged large balance-bills), and so very few health insurance organizations offer indemnity plans (Shi & Singh, 2017). | libretexts | 2025-03-17T22:26:20.752845 | 2024-10-22T01:30:21 | {
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https://med.libretexts.org/Courses/Glendale_Community_College/Public_Health_101_(Calderone)/14%3A_Healthcare_Administration_and_Policy/14.03%3A_Privately_Funded_Healthcare/14.3.02%3A_Managed_Care_Organizations | 14.3.2: Managed Care Organizations
Managed Care Organizations (MCOs) include both Preferred Provider Organizations (PPOs) and Health Management Organizations (HMOs). MCOs make up the majority of health insurance plans in the marketplace today, including those offered by employers and on state or national marketplaces created by the Affordable Care Act (ACA). Doctors and other healthcare providers are paid in different ways, either through capitation (a per-member-per-month fee) or through established amounts for similar services (often called prospective reimbursement). Some organizations contract with a provider organization which pays doctors and other healthcare providers salaries, eliminating the need for doctors to be involved with costs at all. These methods reduce the incentives for doctors to perform unnecessary medical procedures or tests, and helps prevent premiums from rising uncontrollably. The primary difference between a PPO and an HMO is the choice of doctors. A PPO typically has contracts with providers (or provider organizations), and those “in-network” providers are covered by the insurance plan at a specific percentage. A PPO patient can go see another doctor, but an “out-of-network” doctor visit would be covered at a lower percentage. For example, an 80/60 plan would cover 80% of the cost of an in-network provider, but only 60% of the cost of an out-of-network provider. An HMO on the other hand, only covers specific providers, and requires a referral from a primary care physician for someone to see a specialist (Shi & Singh, 2017) | libretexts | 2025-03-17T22:26:20.804994 | 2024-10-22T01:30:23 | {
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https://med.libretexts.org/Courses/Glendale_Community_College/Public_Health_101_(Calderone)/14%3A_Healthcare_Administration_and_Policy/14.03%3A_Privately_Funded_Healthcare/14.3.03%3A_Premiums | 14.3.3: Premiums
Premiums are the monthly costs of the health insurance plan, similar to a subscription for a streaming service for music or television shows. Typically these are set for a year at a time, and often insurance companies increase premiums in subsequent years to offset ongoing increases in healthcare costs. Premiums are paid by the employer, the insured, or shared by both, and are based on the number of people covered under the healthcare plan (i.e. whether a single person, their spouse and/or dependent children are covered). Premiums are not based on usage - so the premiums are the cost of the insurance regardless of how frequently the beneficiaries see the doctor or what their healthcare costs are. By collecting premiums, healthy people who visit the doctor less essentially cover the costs of sicker people who use healthcare more. If the insurance company has more healthy folks than sick folks paying premiums, then their financial risk is lower. | libretexts | 2025-03-17T22:26:20.857483 | 2024-10-22T01:30:24 | {
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"title": "14.3.3: Premiums",
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https://med.libretexts.org/Courses/Glendale_Community_College/Public_Health_101_(Calderone)/14%3A_Healthcare_Administration_and_Policy/14.03%3A_Privately_Funded_Healthcare/14.3.04%3A_Deductables | 14.3.4: Deductables
A deductible is the amount that the insured person must pay for their healthcare before the insurance “kicks in” to pay the remainder. If a person never gets sick or injured and doesn’t visit the doctor throughout the year, they won’t have to pay any more than their premiums. If they do get sick or injured, then they’ll have to pay up to the deductible amount, after which insurance pays the rest. Deductibles vary by plan, but typically have an inverse relationship with premiums. If premiums are high, deductibles tend to be lower, and if premiums are lower, deductibles tend to be high. For example, if a person breaks their arm and has a trip to the emergency room (ER), the entire visit might cost $2000. If their deductible is $3500, they would have to pay the full $2000. However, if they required surgery and a hospital stay that totaled $150,000, they would only be responsible for the $3500 deductible amount before their insurance would begin to help cover the cost. This doesn’t mean that the insurance would pay the remainder of the bill however - see coinsurance and out of pocket maximum below (Cigna Healthcare, 2023). | libretexts | 2025-03-17T22:26:20.910290 | 2024-10-22T01:30:30 | {
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https://med.libretexts.org/Courses/Glendale_Community_College/Public_Health_101_(Calderone)/14%3A_Healthcare_Administration_and_Policy/14.03%3A_Privately_Funded_Healthcare/14.3.05%3A_Copayments | 14.3.5: Copayments
Copayments or copays are a flat rate that is charged at the point of service for specific services, such as doctor visits (apart from the yearly physical), specialty visits or therapy sessions. For example, if a person visits urgent care for a persistent cough, then is referred to a specialist, each of those visits might incur copayment costs. These don’t usually factor into the deductible (Cigna Healthcare, 2023). | libretexts | 2025-03-17T22:26:20.962296 | 2024-10-22T01:30:31 | {
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https://med.libretexts.org/Courses/Glendale_Community_College/Public_Health_101_(Calderone)/14%3A_Healthcare_Administration_and_Policy/14.03%3A_Privately_Funded_Healthcare/14.3.06%3A_Coinsurance | 14.3.6: Coinsurance
Coinsurance is a cost-sharing arrangement for medical expenses when the insurance does “kick in”. It’s typically a percentage of the total cost that is paid by the insured vs. the insurance company. So for example, our broken arm from earlier turns into an ER visit, X-rays, a hand surgery, and hospital stay, totaling $150,000. If the deductible is $3500, the patient would pay that first. Then let’s say they had an 80/20 coinsurance plan: their insurance company would pay 80% and they would pay 20% of the remaining bill (Cigna Healthcare, 2023). | libretexts | 2025-03-17T22:26:21.092910 | 2024-10-22T01:30:33 | {
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https://med.libretexts.org/Courses/Glendale_Community_College/Public_Health_101_(Calderone)/14%3A_Healthcare_Administration_and_Policy/14.03%3A_Privately_Funded_Healthcare/14.3.07%3A_Out-of-Pocket_Maximum | 14.3.7: Out-of-Pocket Maximum
Most plans also have an annual out-of-pocket maximum, which is the total amount the beneficiary would have to pay that year. Deductibles, copays, and coinsurance all count toward this maximum. So let’s add to our previous example that the person who broke their arm had a $7000 out of pocket maximum. They had already paid their $3500 deductible, then would be responsible for 20% of the remaining costs (coinsurance), up until that $7000 out-of-pocket maximum is met - then the insurance company is responsible for 100% of the remainder of the bill. So let’s say that after this broken arm/hand surgery scenario, they required physical therapy visits. Normally they would have to pay a $50 copayment for each visit, but since their out-of-pocket maximum had been met the insurance company covers the copayment for the rest of the year. Now, if the broken arm had only required the ER visit and an X-ray, and the total bill was $5000, the insured would have to pay the $3500 deductible, then 20% of the remaining $1500 ($300), and would have to pay those $50 copays for physical therapy until the out-of-pocket maximum had been met for the year (Cigna Healthcare, 2023). | libretexts | 2025-03-17T22:26:21.145277 | 2024-10-22T01:30:34 | {
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"author": "Erin Calderone"
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https://med.libretexts.org/Courses/Glendale_Community_College/Public_Health_101_(Calderone)/14%3A_Healthcare_Administration_and_Policy/14.03%3A_Privately_Funded_Healthcare/14.3.08%3A_High_Deductible_Plans_and_Health_Savings_Accounts | 14.3.8: High Deductible Plans and Health Savings Accounts
Certain High Deductible Health Plans (HDHPs) are also eligible for Health Savings Accounts (HSAs). These accounts are pre-tax savings accounts that rollover each year and can help someone put aside money to have in case of a medical emergency. By law, the HDHPs must have between certain minimum and maximum deductible and out-of-pocket maximum amounts. For 2024, the minimums were $1600 deductible for a single person, and $3200 for a family, and the maximum amounts were $8,050 and $16100 respectively (IRS, 2024). Often HDHPs will have a deductible that is close to the out-of-pocket maximum, so also having the HSA can help prevent medical debt from accruing on credit cards or causing bankruptcy in the event of a very costly medical bill. HDHPs tend to have lower premiums, and so are popular with younger, healthy folks who tend to not need a lot of doctor’s visits, medications, or procedures (Healthcare.gov, n.d.). | libretexts | 2025-03-17T22:26:21.197951 | 2024-10-22T01:30:38 | {
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https://med.libretexts.org/Courses/Glendale_Community_College/Public_Health_101_(Calderone)/14%3A_Healthcare_Administration_and_Policy/14.04%3A_Publicly_Funded_Healthcare | 14.4: Publicly Funded Healthcare
Publicly funded healthcare in the U.S. is offered for specific groups, based on income, age, or military service. The beneficiaries, or people that benefit from these programs, must be in one of the covered groups in order to be eligible for coverage - and they may also be required to pay premiums or copays for certain aspects of their healthcare. | libretexts | 2025-03-17T22:26:21.249618 | 2024-10-22T01:30:39 | {
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https://med.libretexts.org/Courses/Glendale_Community_College/Public_Health_101_(Calderone)/14%3A_Healthcare_Administration_and_Policy/14.05%3A_Medicare | 14.5: Medicare
Title 18 of the Social Security Act Amendments of 1965 created a healthcare fund for seniors - anyone over the age of 65. In 1973 two other groups were added to the list: anyone receiving social security benefits, and those with end-stage renal disease (ESRD) who require dialysis (HHS/CMS, 2009). Medicare began with Part A and B, and more recently added Part C and D. The different parts of Medicare are funded through federal employer and payroll taxes, as well as premiums for those who sign up for additional coverage. Since it is a federal program, it has the same coverage no matter what state the beneficiary resides in, and anyone who qualifies can enroll - regardless of how much money they make. There are specific income-based subsidies for premiums though, designed to assist low-income seniors (Shi & Singh, 2017). Those who don’t qualify for Medicaid can also purchase supplemental insurance coverage (Medigap) from private insurance companies, which can help to offset the costs of the typical Medicare deductibles and coinsurance (Medicare.gov, n.d.-b). | libretexts | 2025-03-17T22:26:21.302774 | 2024-10-22T01:30:40 | {
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https://med.libretexts.org/Courses/Glendale_Community_College/Public_Health_101_(Calderone)/14%3A_Healthcare_Administration_and_Policy/14.05%3A_Medicare/14.5.01%3A_Part_A | 14.5.1: Part A
Hospital Insurance constitutes Part A Medicare. The purpose of this insurance was to prevent financial ruin for seniors from an expensive hospital stay - which many seniors may experience. Part A does not require that beneficiaries pay monthly premiums if they or their spouse paid Medicare taxes for 10 years or more. If this is not the case, they can still receive Medicare but will have to pay a monthly premium (or the premiums may be covered by Medicaid if they cannot afford it) (Shi & Singh, 2017). Medicare Part A does have a deductible that must be paid for each benefit period before the insurance covers the rest. For example in 2024: the deductible is $1632 for each stay at a hospital or skilled nursing facility, and a benefit period is any incidence separated by 60 days or more. So if a person was admitted to a hospital for a week, and then came back the next week, they wouldn’t have to pay their deductible again. However, if they had a hospital stay at the beginning of the year and then another admittance 3 months later, they would need to again pay that deductible for the second stay as well (Humana, 2023). Long-term care at a skilled nursing facility, home healthcare, and hospice care are also covered under Part A. | libretexts | 2025-03-17T22:26:21.355282 | 2024-10-22T01:30:44 | {
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"title": "14.5.1: Part A",
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https://med.libretexts.org/Courses/Glendale_Community_College/Public_Health_101_(Calderone)/14%3A_Healthcare_Administration_and_Policy/14.05%3A_Medicare/14.5.02%3A_Part_B | 14.5.2: Part B
Because Part A is only for inpatient care (aka staying in a hospital or skilled nursing facility), Medicare Part B was created to cover doctors visits and other medical needs such as the purchase of medical equipment. For 2024, the deductible for Part B is $240, after which patients pay a 20% coinsurance for the remaining expenses (Humana, 2023). It is important to note that Medicare also sets reimbursement rates for doctors. Doctors can either participate in accepting Medicare or non-participating practitioners may charge patients at the time of service. Then, either the doctor or the patient can submit a claim to medicare to get reimbursed. Non-participating doctors cannot charge over 15% higher prices than what Medicare has approved for a service (Medicare.gov, n.d.). | libretexts | 2025-03-17T22:26:21.406960 | 2024-10-22T01:30:46 | {
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"title": "14.5.2: Part B",
"author": "Erin Calderone"
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https://med.libretexts.org/Courses/Glendale_Community_College/Public_Health_101_(Calderone)/14%3A_Healthcare_Administration_and_Policy/14.05%3A_Medicare/14.5.03%3A_Part_C | 14.5.3: Part C
Also called Medicare Advantage, Part C allows Medicare enrollees to use a plan offered by a private insurance company that includes Parts A, B, and D. This is often an MCO, and may require insureds to use in-network providers. However, there may be other benefits such as lower out-of-pocket costs and vision, hearing, and/or dental benefits (Medicare.gov, n.d.-b). | libretexts | 2025-03-17T22:26:21.458934 | 2024-10-22T01:30:47 | {
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"title": "14.5.3: Part C",
"author": "Erin Calderone"
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https://med.libretexts.org/Courses/Glendale_Community_College/Public_Health_101_(Calderone)/14%3A_Healthcare_Administration_and_Policy/14.05%3A_Medicare/14.5.04%3A_Part_D | 14.5.4: Part D
Prescription drugs are covered under Part D, which can also be provided by a Medicare Advantage plan (Part C). As part of the Inflation Reduction Act signed into law by President Joseph Biden in 2022, Medicare will begin negotiating prescription drug costs which will take effect in 2026. The first 10 drugs that were chosen for negotiation are used to treat common, chronic diseases like diabetes and cardiovascular diseases (Centers for Medicare & Medicaid Services, 2024). | libretexts | 2025-03-17T22:26:21.510190 | 2024-10-22T01:30:49 | {
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"title": "14.5.4: Part D",
"author": "Erin Calderone"
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https://med.libretexts.org/Courses/Glendale_Community_College/Public_Health_101_(Calderone)/14%3A_Healthcare_Administration_and_Policy/14.06%3A_Medicaid | 14.6: Medicaid
Medicaid was first enacted as part of the social security act (title 19), with the intention of providing medical care to those experiencing extreme poverty. It is a joint-financed program with at least 50% of the funding coming from the federal government, and the remaining funds from the state. Wealthier states end up contributing more than poorer states (Shi & Singh, 2017). Along with the Children’s Health Insurance Program (CHIP), Medicaid provides insurance to 77.9 million Americans. People are eligible for the program if they: have a disability or blindness, are over the age of 65, or are children whose family makes up to 133% of the Federal Poverty Level (FPL) in income. Recently, Medicaid expanded coverage to any adult that met the income threshold up to 138% of the FPL, but states can opt to participate in this expansion or not. (Centers for Medicare & Medicaid Services, n.d.). The expansion extends eligibility to nearly all adults making up to $20,783 per year, or $1731 per month (for an individual adult) in 2024. To date, only 10 states have opted out of the expansion: Alabama, Florida, Georgia, Kansas, Mississippi, South Carolina, Tennessee, Texas, Wisconsin and Wyoming. Texas has the lowest income threshold above which people are ineligible for Medicaid: for parents in a family of three this is just $4131 per year or $344 per month (Lopez et al., 2024). Many childless adults in these states fall into the “coverage gap” where they make too much income to qualify for Medicaid but not enough to qualify for federal subsidies to purchase healthcare through the marketplace. These folks often work low wage and/or part time jobs, and either may not be offered employer-sponsored healthcare coverage, or may find it too expensive (Drake et al., 2024).
During the COVID-19 era, states were required to maintain all enrollees during the emergency period. After the emergency period ended in March 2023, states began the process of “unwinding”, or reexamining eligibility for the millions of Americans receiving Medicaid (Unwinding and Returning to Regular Operations after COVID-19, n.d.). Due to technical errors and the complicated enrollment and renewal processes, many Medicaid recipients were either incorrectly dropped or found it difficult to renew their Medicaid insurance. About 8% of those previously receiving Medicaid are now ineligible, and consider purchasing health insurance cost-prohibitive. The unwinding process is adding to the number of uninsured Americans (Lopez et al., 2024). | libretexts | 2025-03-17T22:26:21.563608 | 2024-10-22T01:30:51 | {
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"title": "14.6: Medicaid",
"author": "Erin Calderone"
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https://med.libretexts.org/Courses/Glendale_Community_College/Public_Health_101_(Calderone)/14%3A_Healthcare_Administration_and_Policy/14.07%3A_Other_Sources_of_Public_Healthcare | 14.7: Other Sources of Public Healthcare
Publicly-funded healthcare is also provided to the military and Department of Defense, federal employees, prisoners, American Indian and Alaska Natives (through the Indian Health Service) and veterans (through the Veterans Administration). The Veterans Health Administration (VHA) includes 172 VA Medical Centers and over 1100 outpatient facilities that provide for the healthcare needs of over 9 million veterans. The VHA also contracts with other community based clinics to provide easier access for outpatient services like primary care visits (Veterans Health Administration, 2023). This partnership was due to legislation passed by Congress in 2014 called the Veterans Choice Act, which was in response to increasing awareness and media coverage of the long wait times that veterans experienced at VA medical facilities. Because the VHA traditionally functions as both the provider and the payer, contracting the provider services out to community-based facilities creates new challenges for coordinating care to meet veterans’ needs (Rasmussen & Farmer, 2023).
The history of the Indian Health Service (IHS) was covered briefly in chapter 3. Healthcare services covered through the IHS are funded differently than Medicare and Medicaid in that they are a part of the federal government’s discretionary budget. Tribes can also have more local control via “compacting” ,which provides a block grant for the tribe to coordinate and provide their own healthcare services according to local needs. Health disparities still exist and access to healthcare is still challenging for many of the 2 million American Indian/Alaskan Natives (AI/AN) served through the IHS, due in large part to chronic underfunding, a lack of trained professionals, a lack of access to healthcare in remote locations, and the need for culturally sensitive healthcare practices (Kruse et al., 2022). | libretexts | 2025-03-17T22:26:21.617438 | 2024-10-22T01:30:52 | {
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https://med.libretexts.org/Courses/Glendale_Community_College/Public_Health_101_(Calderone)/14%3A_Healthcare_Administration_and_Policy/14.07%3A_Other_Sources_of_Public_Healthcare/14.7.01%3A_Community_Health_Centers | 14.7.1: Community Health Centers
Community Health Centers or local clinics provide comprehensive medical services to underserved populations - including those who lack health insurance or housing, those with low incomes, seniors (over age 65), and immigrants or refugees. Patients may be charged for medical services, but on a sliding scale - which means that fees are set based on what patients are able to pay (HRSA, 2024). These health centers receive funding in multiple ways: through block grants from the Health Resources & Services Administration (HRSA), the Centers for Disease Control and Prevention (CDC), Title X Service Grants (for sexual and reproductive health services), and reimbursement from Medicare, Medicaid, and CHIP or the VA. In order to become a Federally Qualified Health Center (FQHC), the clinic must:
- Be located in or serve a high need community.
- Be governed by a community board that is at least 51% made up of health center patients.
- Provide comprehensive healthcare services on a sliding fee scale based on ability to pay.
- Become a Health Center Program award recipient or Health Center Program look-alike. (CA Department of Health Care Services, n.d.)
- These clinics provide a broad range of services including:
- Primary care
- Dental and vision care
- Physical and occupational therapy
- Mental health services
- Substance abuse and addiction treatment
- STI/HIV testing and treatment
- Reproductive, maternal and pediatric healthcare
- Vaccines
- Health education
In order to receive Title X funding for reproductive healthcare, clinics must provide a variety of family planning methods, including contraception and infertility assistance. They must provide testing and treatment for sexually transmitted infections (STIs) including HIV. They may not provide abortion services, or even discuss abortion as an option (OASH, 2022). If the clinic does provide abortion services, there are recent (2019) requirements for clearly designating physical separation of those services in a different part of the clinic which receives a different source of funding. These requirements for separation caused many clinics to withdraw from title X funding (Seabert et al., 2021). | libretexts | 2025-03-17T22:26:21.672049 | 2024-10-22T01:30:59 | {
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https://med.libretexts.org/Courses/Glendale_Community_College/Public_Health_101_(Calderone)/14%3A_Healthcare_Administration_and_Policy/14.08%3A_Health_Policy_and_the_Future_of_Healthcare | 14.8: Health Policy and the Future of Healthcare
Policymaking is an important part of public health. Typically we think of policies as laws, regulations, or funding requirements created and enforced by governments. In the U.S., public health is governed at the local, state, and national levels. The interplay between different bureaucracies - at times cooperative and at others in opposition with each other - can actually have just as much of an impact on health policies as the politicians (and interest groups) who propose them (Shi & Singh, 2017).
A prime example of health policies are those associated with smoking. At the national level, the sale of tobacco products to anyone under 21 years of age is prohibited, and the products must all carry a warning label from the Surgeon General. Additionally, the Food and Drug Administration (FDA) has authority to regulate tobacco products (Office on Smoking and Health, CDC, 2023). At the state level, California was one of the first states to ban smoking in indoor public spaces and workplaces in 1995. Smoking had been previously banned in public schools and daycare centers, and taxes are levied on cigarette purchases to fund tobacco-prevention programs through the CA Department of Public Health. In the 2000’s, additional state legislation made smoking illegal on all government property - including state universities and community colleges - and it is also illegal to smoke in a car with a minor present (California Air Resources Board, n.d.). Cities can also enact local smoking bans to protect its residents from environmental tobacco smoke (secondhand smoke), as the city of Burbank in California has done. In Burbank, smoking is prohibited in or around any city facility or park, on any public transit or at any station, on sidewalks in the downtown area, outdoor cafes and event venues, as well as service areas (such as a delivery dock for a restaurant, or a ticket line for a concert) (Burbank Municipal Code, 2024).
Health policies also include the appropriation of tax revenue to fund specific government agencies. The Department of Health and Human Services (HHS) budget for 2024 was $2.37 trillion, which includes funding for Medicare/Medicaid, the Centers for Disease Control and Prevention (CDC), National Institute of Health (NIH), Food and Drug Administration (FDA), Health Resources and Services Administration (HRSA), Substance Abuse and Mental Health Administration (SAMHSA), and Indian Health Service (IHS) as well as other agencies (USAspending.gov, 2024). | libretexts | 2025-03-17T22:26:21.725603 | 2024-10-22T01:31:01 | {
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https://med.libretexts.org/Courses/Glendale_Community_College/Public_Health_101_(Calderone)/14%3A_Healthcare_Administration_and_Policy/14.08%3A_Health_Policy_and_the_Future_of_Healthcare/14.8.01%3A_The_Affordable_Care_Act | 14.8.1: The Affordable Care Act
The largest piece of healthcare reform legislation was passed in 2009 under President Barack Obama, titled the Patient Protection and Affordable Care Act (ACA) and known colloquially as “Obamacare”. Different portions of it went into effect over the following years. One key piece of the ACA was the individual mandate - requiring that every U.S. adult provide proof of healthcare coverage or pay a tax fee - was eliminated by Congress during the subsequent administration of President Donald Trump. However, many states continued to enforce such a mandate or impose a state tax. Yet, other provisions have remained, and proved somewhat effective at reforming healthcare for Americans. Below are some of the most important actions of the ACA.
- Protection for pre-existing conditions. Health insurance companies can no longer deny enrollment to people who have pre-existing conditions, charge them higher premiums, or refuse to cover those conditions. These conditions include things like diabetes, asthma, pregnancy, and cancer. Previously, many insurance companies would reduce their financial risk by refusing to enroll people with pre-existing conditions (at the time of enrollment), or enrolling them but refusing to cover services related to those conditions. These practices are now illegal, however some insurance plans that existed before March 23rd, 2010 were given “grandfathered” status to continue without these protections (Assistant Secretary for Public Affairs (ASPA), 2022, U.S. Centers for Medicare & Medicaid Services, 2022).
- Allowance for young adults to stay on their parent’s insurance plans up until age 26. Young adults may be more likely to work part-time jobs and may not be able to afford purchasing health insurance on their own. They may also not be as concerned about getting coverage thinking they are “young and healthy”, yet 1 in 6 in this age group still has chronic health problems (CMS.gov, 2023).
- Expansion of Government subsidies. The ACA expanded Medicaid coverage to anyone earning up to 138% of the federal poverty level (FPL), and allowed states to choose whether or not to participate in the expansion (with up to 90% of the additional cost covered with federal funds). Additionally, federal subsidies for purchasing healthcare via the marketplace insurance plans can provide assistance via tax credits for people who have higher incomes (KFF, 2023).
- Emphasizing preventative care. The ACA made requirements that marketplace healthcare plans cover 10 essential services, which include the typical hospital stays and emergency services, as well as women’s health, pregnancy, maternity and newborn care, preventative and wellness visits, rehabilitative services, mental health and substance use disorder services, pediatric visits, labs and prescription drugs. The ACA also increased funding for Community Health Centers (Assistant Secretary for Public Affairs (ASPA), 2022)
Other provisions also emphasized health equity by establishing the Offices of Minority Health and focusing resources on improving STI and mental health awareness and access to treatment for the most vulnerable populations (Assistant Secretary for Public Affairs (ASPA), 2022). | libretexts | 2025-03-17T22:26:21.779525 | 2024-10-22T01:31:03 | {
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https://med.libretexts.org/Courses/Glendale_Community_College/Public_Health_101_(Calderone)/14%3A_Healthcare_Administration_and_Policy/14.08%3A_Health_Policy_and_the_Future_of_Healthcare/14.8.02%3A_Cost_Control | 14.8.2: Cost Control
One of the biggest challenges facing healthcare administration today is the ballooning costs of healthcare. Healthcare expenditure increases have historically outpaced general inflation (Shi & Singh, 2017) up until the Covid-19 pandemic. During the pandemic, healthcare expenditure increased significantly, with a lot of it being emergency funding for public health initiatives such as research and development of testing kids and vaccines. At the same time, the economy was experiencing a decline due to closures, layoffs, and supply chain disruptions. So healthcare expenditures during 2021 were at an all time high of 19.5% of Gross Domestic Product (GDP), but have since returned to pre-pandemic levels as GDP recovered and Covid-19 policies and funding expired. Still, the general trend since the 1980s has been that healthcare costs are growing faster than general inflation, and taking up a larger and larger portion of the total economy (McGough et al., 2023). Healthcare costs incurred by a third-party payer (such as a private insurance company) are often passed on to the funder - the government, employer, or patient via premium hikes or cost-sharing (coinsurance and deductibles).
It is likely that the cause of increasing healthcare costs is the result of multiple factors. First, healthcare in the U.S. functions in an imperfect or “quasi-market”, not an idealized “free-market” of capitalism. The typical patient does not pay directly for their own healthcare, so they are not going to do the same researching of cost and quality that they might for a different purchase (like when buying a car) (Shi & Singh, 2017). As mentioned earlier, medical operations and medicines are also often needed for survival or physical function, and so patients have no option to wait or save up money. On the supply side of this market, doctors have a lot of control over what healthcare services are utilized. The saying “when you’re a hammer, everything looks like a nail” seems to apply to doctors too - in particular for procedures that have more controversy on their efficacy. Health services research has found that the number of procedures can vary by geographic location based on the availability and practices of specific providers - not any variation in demographics or need. This can result in an overuse of healthcare services, and potentially unnecessary procedures (Schneider, 2020). For example, some doctors might immediately recommend a hysterectomy for women experiencing severe endometriosis, and yet this procedure may not be the cure or remove all of the pain - and can have significant consequences for the patient’s life (Mayo Clinic, 2021).
Secondly, the U.S. population is aging, due to the baby boomer generation (those born between 1946 and 1964) who began reaching retirement age in 2011. Along with those in the previous “silent” generation, baby boomers make up over a quarter of the total U.S. population (Korhonen, 2023). While medical technology has increased the average life expectancy for several decades, this also means the potential for more healthcare utilization and an exponential increase in healthcare costs for this generation in the coming years (USC Sol Price School of Public Policy, 2023). Americans also have increasing rates of obesity and obesity-related diseases like diabetes, heart disease, and certain cancers, which may require long-term medication or treatment (CDC, 2022).
Thirdly, technology and culture surrounding healthcare in the U.S. emphasizes getting “the best of the best”, cutting-edge medicine. American culture still emphasizes individualism and capitalism in healthcare, and this ideology resists top-down government control of healthcare costs. Technology can be both costly and cost-saving, as with electronic health records (EHRs) and telehealth. Transitioning to EHRs may be initially costly, but may increase efficiency and reduce human errors (Shi & Singh, 2017). Similarly, telehealth is becoming more popular, particularly post-pandemic. Telehealth visits, particularly for mental health services, show promise at increasing access and removing some disparities in care (Egan et al., 2022). The use of telehealth highlights other needs such as broadband internet access in rural areas, and patient familiarity with the use of technology. Other advances in medical technology may not always be worth the costs they present (Shi & Singh, 2017).
Other potential reasons for increasing costs include: the practice of “defensive medicine” which is the utilization of procedures, diagnostics, or medications in order to avoid potential lawsuits, and fraud or system abuse. Well-meaning doctors may wish to provide their patients with procedures that might be considered lower-risk, such as performing an unnecessary C-section to reduce the risk of injury or legal liability from a vaginal birth (Shi & Singh, 2017). Medicare and Medicaid fraud are also big problems for the system, but don’t typically stem from improper use by beneficiaries. Organized crime and unethical billing practices by doctors and other healthcare providers are commonly the sources of costly fraud schemes (Zamost & Brewer, 2023).
When access to healthcare improves - whether that be through the expansion of government-sponsored health insurance, or the availability of local resources (like the building of a new healthcare facility) - the utilization of healthcare services increases. When people get on a health insurance policy and all of a sudden have access to a doctor, they might go in for check-ups and procedures they had been putting off due to the cost. The availability of a new diagnostic tool, surgical procedure, or medication might influence doctors to utilize it more, and patients to request it more. Yet the more utilization of visits, diagnostics, medicines and procedures occurs, the more healthcare expenditures continue to climb. One oft-cited study done by the Rand Corporation between 1971-1982, compared individuals in a variety of healthcare plans including a free version, and one with high coinsurance (95%) . The results of the study indicated that cost-sharing (with high coinsurance for patients) helped decrease utilization and avoid unnecessary doctor’s visits, but didn’t necessarily decrease health outcomes compared to free insurance plans. However, poor individuals with chronic diseases benefited greatly from free healthcare (Brook et al., 2006). Is it necessarily bad that more access equals more usage of the healthcare system? Does the utilization of healthcare services always reflect a direct need? Does the potential for profits drive the research and development of new and better medical care? The U.S. spends the most on healthcare compared to other wealthy nations, and yet has worse health outcomes in several areas (Peter G. Peterson Foundation, 2023). The discussion around healthcare costs and efficacy in the U.S. is certainly a complicated one.
So what measures are being taken to control costs, and who is taking them? With MCOs, the primary care physicians (aka PCPs, family doctors, internists, etc.) are responsible for “gatekeeping”, or referring patients to a specialist, ordering laboratory or diagnostic tests (such as MRIs or X-rays) - thus preventing patients who don’t need these services from taking up important resources. Health insurance companies have also moved away from fee-for-service models to paying providers with capitation (a fixed amount per patient per month), or with diagnosis-related groups (DRGs - a fixed amount for a specific type of illness or treatment), or with cheaper negotiated fees within networks. All of these changes in payment systems attempt to control costs and incentivize providers to provide both economical and effective care. Other methods include focusing on performance - using quality assessments and peer review to advise reimbursements or fee negotiations. Employers may also decide to increase cost-sharing with patients in order to deter them from overutilizing healthcare for unnecessary ailments. (Shi & Singh, 2017).
One of the areas that contributes to high expenditures in the U.S. but not in other countries is healthcare administration (Peter G. Peterson Foundation, 2023). It can be argued that this is mostly due to the complicated system of funding, paying, and providing healthcare, as well as the for-profit, capitalist model. Other OECD countries have different systems of providing healthcare that cost less to administer, including nationalized health insurance (as in Canada), nationalized health systems (as in the U.K.), and socialized health insurance (as in Germany) (Shi & Singh, 2017). This is also evidenced by the lower administrative costs incurred by traditional Medicare, vs Medicare Advantage plans (Part C) which are contracted out to insurance companies to administer via HMOs and PPOs. As more baby boomers are eligible for Medicare, and as Medicare Advantage plans are becoming more popular, these administrative costs are going up (Cubanski & Neuman, 2023). | libretexts | 2025-03-17T22:26:21.835061 | 2024-10-22T01:31:04 | {
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https://med.libretexts.org/Courses/Glendale_Community_College/Public_Health_101_(Calderone)/14%3A_Healthcare_Administration_and_Policy/14.09%3A_Summary | 14.9: Summary
Healthcare in America is complicated, and fraught with corporate and political agendas. While public health is focused mostly on primary prevention at the population level, the healthcare industry meets the needs of individuals and communities for primary, secondary, and tertiary care. Access, cost, and quality of healthcare are all important factors for population health. Public health professionals may work within or adjacent to the medical field, or on policymaking at the local, state, or national level, and so should understand the history, current needs and political climate surrounding healthcare. | libretexts | 2025-03-17T22:26:21.887658 | 2024-10-22T01:31:06 | {
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https://med.libretexts.org/Courses/Glendale_Community_College/Public_Health_101_(Calderone)/14%3A_Healthcare_Administration_and_Policy/14.10%3A_References | 14.10: References
Centers for Medicare & Medicaid Services. (n.d.). Medicaid eligibility . Medicaid. Retrieved April 16, 2024, from https://www.medicaid.gov/medicaid/el...ity/index.html
Centers for Medicare & Medicaid Services. (2024, January 5). Medicare drug price negotiation . CMS; CMS.gov. https://www.cms.gov/inflation-reduct...ce-negotiation
Assistant Secretary for Public Affairs (ASPA). (2022, March 18). Fact sheet: Celebrating the Affordable Care Act . HHS.Gov; U.S. Department of Health and Human Services (HHS). https://www.hhs.gov/about/news/2022/...-care-act.html
Brook, R. H., Keeler, E. B., Lohr, K. N., Newhouse, J. P., Ware, J. E., Rogers, W. H., Davies, A. R., Sherbourne, C. D., Goldberg, G. A., Camp, P., Kamberg, C., Leibowitz, A., Keesey, J., & Reboussin, D. (2006, January 1). The RAND health insurance experiment: What you need to know . RAND. https://www.rand.org/pubs/research_briefs/RB9174.html
Burbank Municipal Code. (2024, March 19). Burbank municipal code . Codepublishing.Com. https://www.codepublishing.com/CA/Bu...rbank0401.html
California Air Resources Board. (n.d.). California Tobacco Laws that Reduce ETS Exposure . California Air Resources Board. Retrieved April 23, 2024, from https://ww2.arb.ca.gov/our-work/prog...e-ets-exposure
CDC. (2022, July 14). Why it matters . Centers for Disease Control and Prevention. https://www.cdc.gov/obesity/about-ob...t-matters.html
Centers for Medicare & Medicaid Services. (2023, December 13). NHE fact sheet . CMS; cms.gov. https://www.cms.gov/data-research/st...nhe-fact-sheet
Cigna Healthcare. (2023, October 1). Defining coinsurance, copays, and deductibles . Cigna Healthcare. https://www.cigna.com/knowledge-cent...es-coinsurance
CMS.gov. (2023, September 6). Young adults and the affordable care act: Protecting young adults and eliminating burdens on families and businesses . CMS. https://www.cms.gov/cciio/resources/...ild_fact_sheet
Cubanski , J., & Neuman, T. (2023, January 19). What to know about medicare spending and financing . KFF. https://www.kff.org/medicare/issue-b...and-financing/
Department of Health Care Services. (n.d.). Federally Qualified Health Centers and Rural Health Clinics . Dhcs.ca.Gov. Retrieved April 16, 2024, from https://www.dhcs.ca.gov/services/med.../FQHC_RHC.aspx
Drake, P., Tolbert, J., Rudowitz, R., & Damico, A. (2024, February 26). How Many Uninsured Are in the Coverage Gap and How Many Could be Eligible if All States Adopted the Medicaid Expansion? KFF. https://www.kff.org/medicaid/issue-b...aid-expansion/
Egan, R. P., Hurley, D. B., Goetz, M. C., Smith, C. S., Palmer, B. A., & St. Hill, C. A. (2022). Disparities in mental health access before and after transitioning to telehealth. Journal of Rural Mental Health , 46 (4), 271–276. https://doi.org/10.1037/rmh0000214
Healthcare.gov. (n.d.). What are HSA-eligible plans? HealthCare.Gov. Retrieved April 12, 2024, from https://www.healthcare.gov/high-dedu...e-health-plan/
HHS/CMS. (2009). BRIEF SUMMARIES of MEDICARE & MEDICAID Title XVIII and Title XIX of The Social Security Act as of november 1, 2009 .
HRSA. (2024, March). What is a Health Center? Bureau of Primary Health Care. https://bphc.hrsa.gov/about-health-c...-health-center
Humana. (2023, November 7). Medicare deductibles 2024 - Parts A and B . Humana. https://www.humana.com/medicare/medi...ctibles-review
IRS. (2024). Health Savings Accounts and Other Tax-Favored Health Plans publication 969. Department of the Treasury, Internal Revenue Service .
KFF. (2023, October 30). FAQs: Health insurance marketplace and the ACA . KFF. https://www.kff.org/faqs/faqs-health...opic=579145046
Kissell, C. (2024, March 21). Largest health insurance companies 2024. Forbes . https://www.forbes.com/advisor/healt...nce-companies/
Korhonen, V. (2023, August). U.S. population share by generation 2022 . Statista. https://www.statista.com/statistics/...by-generation/
Kruse, G., Lopez-Carmen, V. A., Jensen, A., Hardie, L., & Sequist, T. D. (2022). The Indian Health Service and American Indian/Alaska native health outcomes. Annual Review of Public Health , 43 (1), 559–576. https://doi.org/10.1146/annurev-publ...-052620-103633
Lopez, L., Sparks, G., Presiado, M., Tolbert, J., Rudowitz, R., Diana, A., & Kirzinger, A. (2024, April 12). KFF survey of medicaid unwinding . KFF. https://www.kff.org/medicaid/poll-fi...aid-unwinding/
Mayo Clinic. (2021, October 8). One-size-fits-all treatment not ideal for patients with endometriosis . Mayo Clinic. https://www.mayoclinic.org/medical-p...s/mac-20521594
McGough, M., Winger, A., Rakshit, S., & Amin, K. (2023, December 15). How has U.S. spending on healthcare changed over time? Peterson-KFF Health System Tracker; Peterson-KFF. https://www.healthsystemtracker.org/...s,%201970-2022
Medicare.gov. (n.d.-a). Does your provider accept Medicare as full payment? Medicare. Retrieved April 15, 2024, from https://www.medicare.gov/basics/cost...ccept-Medicare
Medicare.gov. (n.d.-b). Parts of medicare . Medicare. Retrieved April 15, 2024, from https://www.medicare.gov/basics/get-...ts-of-medicare
OASH. (2022). Title X program handbook (July 2022) . HHS Office of Population Affairs. https://opa.hhs.gov/sites/default/fi...08-updated.pdf
OECD. (2023). Health expenditure per capita . OECD iLibrary: Health at a Glance 2023: OECD Indicators. https://www.oecd-ilibrary.org/sites/...nt/675059cd-en
Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion. (2023, November 24). Legislation . CDC. https://www.cdc.gov/tobacco/basic_in...tion/index.htm
Permanente, K. (2023, October 17). How Kaiser Permanente evolved. Kaiser Permanente . https://about.kaiserpermanente.org/w...it-all-started
Peter G. Peterson Foundation. (2023, July 12). How does the U.S. healthcare system compare to other countries? Pgpf.Org. https://www.pgpf.org/blog/2023/07/ho...ther-countries
Rasmussen, P., & Farmer, C. (2023). The promise and challenges of VA community care: Veterans’ issues in focus. Rand Health Quarterly , 10 (3). https://doi.org/10.7249/pea1363-5
Rosenthal, E. (2017, May 20). How health insurance changed from protecting patients to seeking profit . Stanford Medicine Magazine. https://stanmed.stanford.edu/how-hea...eeking-profit/
Schneider, M.-J. (2020). Introduction to public health . Jones & Bartlett Learning.
Seabert, D., McKenzie, J. F., & Pinger, R. R. (2021). McKenzie’s an introduction to community & public health . Jones & Bartlett Learning.
Shi, & Singh, D. A. (2017). Delivering health care in America . Jones & Bartlett Learning.
Unwinding and returning to regular operations after COVID-19 . (n.d.). Medicaid. Retrieved April 18, 2024, from https://www.medicaid.gov/resources-for-states/coronavirus-disease-2019-covid-19/unwinding-and-returning-regular-operations-after-covid-19/index.html
U.S. Centers for Medicare & Medicaid Services. (2022). Pre-existing conditions . HealthCare.Gov. https://www.hhs.gov/healthcare/about-the-aca/pre-existing-conditions/index.html
USAspending.gov. (2024, February 28). Agency Profile: Department of Health and Human Services (HHS) . https://www.usaspending.gov/agency/d...rvices?fy=2024
USC Sol Price School of Public Policy. (2023, November). The baby boomer effect and controlling healthcare costs . USC EMHA Online. https://healthadministrationdegree.u...lth-care-costs
Veterans Health Administration. (2023). VA.gov . Veterans Health Administration. https://www.va.gov/health/aboutvha.asp
Zamost, S., & Brewer, C. (2023, March 9). Inside the mind of criminals: How to brazenly steal $100 billion from Medicare and Medicaid. CNBC . https://www.cnbc.com/2023/03/09/how-...or-the-us.html | libretexts | 2025-03-17T22:26:21.958124 | 2024-10-22T01:31:08 | {
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https://med.libretexts.org/Bookshelves/Allied_Health/Vital_Sign_Measurement_Across_the_Lifespan_(Lapum_et_al.)/01%3A_Introduction | 1: Introduction Last updated Save as PDF Page ID 16788 Lapum et al. Ryerson University (Daphne Cockwell School of Nursing) via Ryerson University Library 1.1: Introduction 1.2: General Points to Consider in Vital Sign Measurement | libretexts | 2025-03-17T22:26:22.033475 | 2019-11-19T05:24:55 | {
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https://med.libretexts.org/Bookshelves/Allied_Health/Vital_Sign_Measurement_Across_the_Lifespan_(Lapum_et_al.)/01%3A_Introduction/1.01%3A_Introduction | 1.1: Introduction
The purpose of this textbook is to help you develop best practices in vital sign measurement. It will provide you with the opportunity to read about, observe, practice, and test vital sign measurement. Boxes with helpful tips are provided throughout the chapters:
- Technique Tips provide helpful information about measurement techniques, and
- Points to Consider highlight key points to consider about vital sign measurements and findings.
A Chapter Summary and Printable Flashcards highlighting techniques for each vital sign measurement are provided at the end of each chapter. These printable flashcards are all located together in the textbook’s conclusion chapter.
You can review the full textbook or advance to sections that you have identified as areas you want to work on. The textbook has a self-directed format and provides an interactive and engaging way for you to learn about and develop competence in the measurement of vital signs while integrating knowledge about anatomy and physiology.
You will learn about various vital signs including temperature, pulse, respiration, blood pressure, and oxygen saturation. Measurement of vital signs is a foundational, psychomotor skill for healthcare providers and students in post-secondary health-related programs such as nursing, medicine, pharmacy, midwifery, paramedics, physiotherapy, occupational therapy, and massage therapy. These measurements provide information about a person’s overall state of health and more specifically about their cardiovascular and respiratory status. These measurements can also reveal changes in a client’s vital signs over time and changes in their overall state of health. Proficiency in vital sign measurement is essential to client safety, care, and management. Measurements can influence clinical decision-making related to therapeutic interventions.
This book is best viewed via the online, pressbooks format. However, a pdf format is made available. | libretexts | 2025-03-17T22:26:22.087091 | 2019-11-19T05:24:59 | {
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https://med.libretexts.org/Bookshelves/Allied_Health/Vital_Sign_Measurement_Across_the_Lifespan_(Lapum_et_al.)/01%3A_Introduction/1.02%3A_General_Points_to_Consider_in_Vital_Sign_Measurement | 1.2: General Points to Consider in Vital Sign Measurement
Therapeutic Environment and Informed Consent
It is important to seek informed consent while creating a therapeutic and safe environment during all encounters with clients. You will usually begin by introducing yourself by name and designation so the client knows who you are. Next, explain what you are going to do and always ask permission to touch before beginning vital sign measurement. For example, an appropriate introduction is:
It is also important to ensure the client’s privacy by closing the curtains or the door to the room.
Infection Prevention and Control
Clean hands and clean equipment are essential to infection prevention and control when measuring vital signs. Ensuring cleanliness helps reduce communicable and infectious diseases, particularly nosocomial infections, which are infectious organisms acquired by a client while in hospital. Common infections include clostridium difficile (C. diff), vancomycin-resistant enterococcus (VRE), and methicillin-resistant staphylococcus aureus (MRSA).
Ensuring your hands are clean is the best way to prevent and control infection. Hand hygiene can include cleansing with hand gel (see Figure 1.1) and hand washing. (see Figure 1.2). Use an alcohol-based sanitizer before and after contact with clients. Place gel on your hands and rub all hand surfaces for at least fifteen seconds. When washing hands using soap and water, wet your hands and apply soap. Rub all hand surfaces for about fifteen seconds, then rinse your hands. If the tap is not automatic, then turn it off with a paper towel.
Points to Consider
Hand gel is the preferred method of hand hygiene because it kills more bacteria and is easily accessible to healthcare providers. Soap and water is used when hands/gloves come into contact with bodily fluids.
Figure 1.1: Hand gel
Figure 1.2: Hand washing
Equipment
Healthcare providers always inspect equipment before use to ensure it is in good working condition. Equipment (e.g., stethoscopes, pulse oximeters) can be cleaned with alcohol-based solutions to disinfect the surfaces. Automated devices should be regularly serviced to ensure accuracy. Biomedical technicians/experts are responsible for preventative maintenance and calibration to optimize functioning.
Pain Assessment
A pain assessment is conducted in conjunction with the measurement of vital signs because pain can influence the findings. Pain can activate the sympathetic nervous system and increase pulse, respiration, and blood pressure. Pain is a complex issue, and a comprehensive discussion of pain assessment is beyond the scope of this e-book.
Briefly, because pain is subjective, self-reports are the most effective way to assess pain. The choice of pain assessment tool depends on the client situation: healthcare providers frequently use a numeric rating scale such as “rate your pain on a scale of 0 to 10 with zero being no pain and ten being the very worst pain that you have ever felt.” The response is often recorded on the vital sign record and expanded on in the narrative notes. Another common tool is the PQRSTU mneumonic in which each letter corresponds to a series of questions.
- P – Provocative/Palliative (e.g., what makes the pain worst? what makes the pain better?)
- Q – Quality/Quantity (e.g., can you describe what the pain feels like? how bad is the pain?)
- R – Region/Radiation (e.g., where is the pain located? does it radiate anywhere else?)
- S – Severity (as noted above, rate the pain on a scale of zero to ten)
- T – Timing/Treatment (when did the pain begin? is it constant? have you taken anything to help the pain? If so, what?)
- U – Understanding (what do you think is causing the pain?)
Order of Vital Sign Measurement
The order of vital sign measurement is influenced by the client situation. Healthcare providers often place the pulse oximeter probe on a client while proceeding to take pulse, respiration, blood pressure, and temperature. However, in some situations this order is modified and the healthcare provider needs to critically assess the situation to prioritize the vital sign measurement order. For example, with newborns/infants, it is best to proceed from least invasive to most invasive, so it is best to begin with respiration, pulse, oxygen saturation, temperature and if required, blood pressure. In an emergency situation or if a person loses consciousness, it is best to begin with pulse and blood pressure. Generally, it is important to conduct a complete set of vital signs unless otherwise indicated.
Significance of Measurements
Determining the significance of vital sign measurements involves a process of diagnostic reasoning. The healthcare provider analyzes client data and makes decisions about whether the vital signs are normal or abnormal and whether the findings are significant: the following chapters provide normal vital sign ranges. The healthcare provider also considers agency policy, if applicable, about vital sign ranges to assess any abnormal variations and clinical significance. Additionally, the healthcare provider considers the client’s baseline vital signs to obtain a better sense of the client’s ‘normal’ and allow comparison (e.g., of trends) over time. The diagnostic reasoning process also involves considering other available objective and subjective data.
Documentation
Timely documentation of vital sign measurements is imperative as a form of communication, to observe trends in vital sign measurements, and to ensure effective intervention when needed. Documentation occurs on paper-based vital sign records or electronic systems depending on the agency. Healthcare providers follow the agency’s documentation policy and the professional standards of practice. If using a vital sign record, healthcare providers use the symbols noted on the legend of the record. | libretexts | 2025-03-17T22:26:22.228138 | 2019-11-19T05:24:58 | {
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"title": "1.2: General Points to Consider in Vital Sign Measurement",
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https://med.libretexts.org/Bookshelves/Allied_Health/Vital_Sign_Measurement_Across_the_Lifespan_(Lapum_et_al.)/02%3A_Temperature | 2: Temperature Last updated Save as PDF Page ID 16789 Lapum et al. Ryerson University (Daphne Cockwell School of Nursing) via Ryerson University Library 2.1: Finding the Error Activity- Tympanic Temperature 2.2: Finding the Error Activity- Tympanic Temperature – Feedback 2.3: Try it Out 2.4: Try it Out- Oral Temperature 2.5: Try it Out- Tympanic Temperature 2.6: Try it Out- Axilla Temperature 2.7: Test Yourself 2.8: Test Yourself- Answers 2.9: Test Yourself- List in the Correct Order 2.10: Test Yourself- List in the Correct Order – Answers 2.11: How Best to View this Chapter? 2.12: Chapter Summary 2.13: What is Temperature? 2.14: Why is Temperature Measured? 2.15: Methods of Measurement 2.16: What are Normal Temperature Ranges? 2.17: Oral Temperature 2.18: Tympanic Temperature 2.19: Axillary Temperature 2.20: Rectal Temperature | libretexts | 2025-03-17T22:26:22.321614 | 2019-11-19T05:24:55 | {
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"url": "https://med.libretexts.org/Bookshelves/Allied_Health/Vital_Sign_Measurement_Across_the_Lifespan_(Lapum_et_al.)/02%3A_Temperature",
"book_url": "https://commons.libretexts.org/book/med-16787",
"title": "2: Temperature",
"author": "Lapum et al."
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https://med.libretexts.org/Bookshelves/Allied_Health/Vital_Sign_Measurement_Across_the_Lifespan_(Lapum_et_al.)/02%3A_Temperature/2.01%3A_Finding_the_Error_Activity-_Tympanic_Temperature | 2.1: Finding the Error Activity- Tympanic Temperature
Now you have an opportunity to find errors in measurement techniques. This first activity involves looking at an image.
What error in technique is this healthcare provider making while taking the temperature of an adult client?
Figure 2.8: Error while taking the temperature of an adult
Go to the next page for information about the correct technique in measuring tympanic temperature. | libretexts | 2025-03-17T22:26:22.376234 | 2019-11-19T05:25:06 | {
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"url": "https://med.libretexts.org/Bookshelves/Allied_Health/Vital_Sign_Measurement_Across_the_Lifespan_(Lapum_et_al.)/02%3A_Temperature/2.01%3A_Finding_the_Error_Activity-_Tympanic_Temperature",
"book_url": "https://commons.libretexts.org/book/med-16787",
"title": "2.1: Finding the Error Activity- Tympanic Temperature",
"author": "Lapum et al."
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https://med.libretexts.org/Bookshelves/Allied_Health/Vital_Sign_Measurement_Across_the_Lifespan_(Lapum_et_al.)/02%3A_Temperature/2.02%3A_Finding_the_Error_Activity-_Tympanic_Temperature__Feedback | 2.2: Finding the Error Activity- Tympanic Temperature – Feedback
An incorrect technique is being demonstrated in Figure 2.9 because the helix is not being pulled up and back. For an adult/older child, the correct technique (Figure 2.10) involves gently pulling the helix up and back so that the ear canal is visualized and the light can reflect off of the tympanic membrane.
Incorrect technique of taking tympanic temperature
Figure 2.9: Incorrect technique
Correct technique of taking tympanic temperature
For an adult/older child, gently pull the helix up and back while stabilizing the client’s head with your hand.
Figure 2.10: Correct technique | libretexts | 2025-03-17T22:26:22.432750 | 2019-11-19T05:25:06 | {
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"title": "2.2: Finding the Error Activity- Tympanic Temperature – Feedback",
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https://med.libretexts.org/Bookshelves/Allied_Health/Vital_Sign_Measurement_Across_the_Lifespan_(Lapum_et_al.)/02%3A_Temperature/2.03%3A_Try_it_Out | 2.3: Try it Out
Next, you have an opportunity to watch film clips on accurate measurement techniques. There are three activities that involve film clips that you can watch, and then try out yourself. Check it out!
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Next, you have an opportunity to watch film clips on accurate measurement techniques. There are three activities that involve film clips that you can watch, and then try out yourself. Check it out! | libretexts | 2025-03-17T22:26:22.494119 | 2019-11-19T05:25:07 | {
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"title": "2.3: Try it Out",
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https://med.libretexts.org/Bookshelves/Allied_Health/Vital_Sign_Measurement_Across_the_Lifespan_(Lapum_et_al.)/02%3A_Temperature/2.04%3A_Try_it_Out-_Oral_Temperature | 2.4: Try it Out- Oral Temperature
Watch this short film clip 2.1 and see how oral temperature is taken correctly. After watching the clip, try the technique yourself. You can watch the clip and practice as many times as you like.
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Watch this short film clip 2.1 and see how oral temperature is taken correctly. After watching the clip, try the technique yourself. You can watch the clip and practice as many times as you like. | libretexts | 2025-03-17T22:26:22.556240 | 2019-11-19T05:25:08 | {
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"title": "2.4: Try it Out- Oral Temperature",
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https://med.libretexts.org/Bookshelves/Allied_Health/Vital_Sign_Measurement_Across_the_Lifespan_(Lapum_et_al.)/02%3A_Temperature/2.05%3A_Try_it_Out-_Tympanic_Temperature | 2.5: Try it Out- Tympanic Temperature
Watch this short film clip 2.2 and see how tympanic temperature is taken correctly. After watching the clip, try the technique yourself. You can watch the clip and practice as many times as you like. | libretexts | 2025-03-17T22:26:22.610496 | 2019-11-19T05:25:09 | {
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"book_url": "https://commons.libretexts.org/book/med-16787",
"title": "2.5: Try it Out- Tympanic Temperature",
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https://med.libretexts.org/Bookshelves/Allied_Health/Vital_Sign_Measurement_Across_the_Lifespan_(Lapum_et_al.)/02%3A_Temperature/2.06%3A_Try_it_Out-_Axilla_Temperature | 2.6: Try it Out- Axilla Temperature
Watch this short film clip 2.3 and see how axilla temperature is taken correctly. After watching the clip, try the technique yourself. You can watch the clip and practice as many times as you like.
Alternatively, if viewing textbook as a pdf, use this link: https://www.youtube.com/embed/m71ISuIJRlA?rel=0
An interactive or media element has been excluded from this version of the text. You can view it online here: pb.libretexts.org/vitalsign/?p=78
Film clip 2.3: Axilla temperature | libretexts | 2025-03-17T22:26:22.663703 | 2019-11-19T05:25:10 | {
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https://med.libretexts.org/Bookshelves/Allied_Health/Vital_Sign_Measurement_Across_the_Lifespan_(Lapum_et_al.)/02%3A_Temperature/2.07%3A_Test_Yourself | 2.7: Test Yourself
Now that you have completed this chapter, it’s time to test your knowledge. Try to answer the following questions (you may want to review parts of the chapter before answering). Write your answers down on a piece of paper.
1. What is the most accurate way to take the temperature of a one-year-old client?
a. Oral temperature
b. Rectal temperature
c. Axillary temperature
d. Tympanic temperature
2. An adult client is drinking coffee. How should the healthcare provider measure the client’s temperature? Select all that apply.
a. Take the client’s oral temperature right away
b. Take the client’s axillary temperature right away
c. Take the client’s tympanic temperature right away
d. Take the client’s rectal temperature in five minutes
e. Wait two minutes and take the client’s oral temperature
3. What is the best way to measure temperature in a client who is confused? Select all that apply.
a. Oral temperature
b. Rectal temperature
c. Axillary temperature
d. Tympanic temperature
e. Temporal artery temperature
4. An infant’s tympanic temperature is 37.7°C. How should the healthcare provider respond?
a. Apply a cold compress
b. Re-take in the other ear
c. Recognize this as normal
d. Take a rectal temperature
5. How should the healthcare provider take the temperature of an adult client who is post-operation day two following oral surgery?
a. Avoid measuring temperature
b. Take rectal temperature once a shift
c. Take tympanic temperature as necessary
d. Take oral temperature every four hours | libretexts | 2025-03-17T22:26:22.722841 | 2019-11-19T05:25:10 | {
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https://med.libretexts.org/Bookshelves/Allied_Health/Vital_Sign_Measurement_Across_the_Lifespan_(Lapum_et_al.)/02%3A_Temperature/2.08%3A_Test_Yourself-_Answers | 2.8: Test Yourself- Answers
1. What is the most accurate way to take the temperature of a one-year-old client?
a. Oral temperature
b. Rectal temperature **
c. Axillae temperature
d. Tympanic temperature
Rationale: The correct answer is b (rectal temperature). Rectal temperature is the most accurate measurement method for children under two years of age, who are not able to readily follow directions.
2. An adult client is drinking coffee. How should the healthcare provider measure the client’s temperature? Select all that apply .
a. Take the client’s oral temperature right away
b. Take the client’s axillary temperature right away **
c. Take the client’s tympanic temperature right away **
d. Take the client’s rectal temperature in five minutes
e. Wait two minutes and take the client’s oral temperature
Rationale: The correct answers are b and c (take the client’s axillary or tympanic temperature right away). Recent consumption of a hot drink or cold drink alters a client’s oral temperature. Thus, temperature is taken via the axillary or tympanic route if a client has recently had a hot or cold drink. You can take an oral temperature if you wait 15 minutes after hot drink consumption.
3. What is the best way to measure temperature in a client who is confused? Select all that apply.
a. Oral temperature
b. Rectal temperature
c. Axillary temperature **
d. Tympanic temperature **
e. Temporal artery temperature **
Rationale: The correct answers are c, d, and e (axillary, tympanic and temporal artery temperature). A client who is confused often cannot follow directions, so they may not follow directions to close their mouth as required when taking an oral temperature. Additionally, it is not safe to measure rectal temperature when a client is confused. Thus, it is best to measure axillary, tympanic, or temporal artery temperature.
4. An infant’s tympanic temperature is 37.7°C. How should the healthcare provider respond?
a. Apply a cold compress
b. Re-take in the other ear
c. Recognize this as normal **
d. Take a rectal temperature
Rationale: The correct answer is c (recognize this as normal). A temperature of 37.7°C is normal for an infant, so no further action is required.
5. How should the healthcare provider take the temperature of an adult client who is post-operation day two following oral surgery?
a. Avoid measuring temperature
b. Take rectal temperature once a shift
c. Take tympanic temperature as needed **
d.T ake oral temperature every four hours
Rationale: The correct answer is c (tympanic temperature). Taking oral temperature is avoided after oral surgery, and taking rectal temperature is avoided in the adult population. Thus, the best method is to measure tympanic temperature. | libretexts | 2025-03-17T22:26:22.781955 | 2019-11-19T05:25:11 | {
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https://med.libretexts.org/Bookshelves/Allied_Health/Vital_Sign_Measurement_Across_the_Lifespan_(Lapum_et_al.)/02%3A_Temperature/2.09%3A_Test_Yourself-_List_in_the_Correct_Order | 2.9: Test Yourself- List in the Correct Order
List the steps below in the correct order for each of the following techniques. Write your list on a piece of paper.
Oral Temperature Technique
- Place the thermometer in the mouth under the tongue in the posterior sublingual pocket (slightly off-centre) and instruct client to keep mouth closed and not to bite on the thermometer
- Remove the probe from the device and place a probe cover (from the box) on the oral thermometer without touching the cover with your hands
- Note the temperature on the digital display of the device
- Remove the thermometer when the device beeps
- Place the probe back into the device
- Discard the probe cover in the garbage (without touching the cover)
Tympanic Temperature Technique
- Turn the device on
- Remove the tympanic thermometer from the casing and place a probe cover (from the box) on the thermometer tip without touching the cover with your hands
- Activate the device
- Gently insert the probe into the opening of the ear
- For an adult or older child, gently pull the helix up and back to visualize the ear canal. For an infant or younger child (under 3), gently pull the lobe down.
- Discard the probe cover in the garbage (without touching the cover) and place the device back into the holder
- Note the temperature on the digital display of the device
Axillary Temperature Technique
- Place the thermometer in the client’s armpit as high up as possible into the axillae, on bare skin, with the point facing behind the client, and ask the client to lower his/her arm
- Remove the probe from the device and place a probe cover (from the box) on the thermometer without touching the cover with your hands
- Ask the client to raise the arm away from his/her body
- Discard the probe cover in the garbage (without touching the cover) and place the probe back into the device
- Note the temperature on the digital display of the device
Rectal Temperature Technique
- Remove the probe from the device and place a probe cover on it
- Lubricate the cover
- Ensure the client’s privacy and wash your hands and put on gloves
- Position the client appropriately
- Gently insert the probe 2–3 cm inside the rectal opening of an adult, or less depending on the size of the client
- Discard the probe cover in the garbage (without touching the cover) and place the probe back into the device
- Remove your gloves and wash your hands
- Note the temperature on the digital display of the device
Go to the next page to see the correct order of steps for these techniques. | libretexts | 2025-03-17T22:26:22.843192 | 2019-11-19T05:25:11 | {
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https://med.libretexts.org/Bookshelves/Allied_Health/Vital_Sign_Measurement_Across_the_Lifespan_(Lapum_et_al.)/02%3A_Temperature/2.10%3A_Test_Yourself-_List_in_the_Correct_Order__Answers | 2.10: Test Yourself- List in the Correct Order – Answers
The steps are listed in the correct order for each of the following techniques. These are printable flashcards to help you memorize and practice the techniques.
Oral Temperature Technique
- Remove the probe from the device and place a probe cover (from the box) on the oral thermometer without touching the cover with your hands
- Place the thermometer in the mouth under the tongue in the posterior sublingual pocket (slightly off-centre) and instruct the client to keep mouth closed and not to bite on the thermometer
- Remove the thermometer when the device beeps
- Note the temperature on the digital display of the device
- Discard the probe cover in the garbage (without touching the cover)
- Place the probe back into the device
Tympanic Temperature Technique
- Remove the tympanic thermometer from the casing and place a probe cover (from the box) on the thermometer tip without touching the cover with your hands
- Turn the device on
- For an adult or older child, gently pull the helix up and back to visualize the ear canal. For an infant or younger child (under 3), gently pull the lobe down
- Gently insert the probe into the opening of the ear
- Activate the device
- Note the temperature on the digital display of the device
- Discard the probe cover in the garbage (without touching the cover) and place the device back into the holder
Axillary Temperature Technique
- Remove the probe from the device and place a probe cover (from the box) on the thermometer without touching the cover with your hands
- Ask the client to raise the arm away from his/her body
- Place the thermometer in the client’s armpit as high up as possible into the axillae on bare skin, with the point facing behind the client, and ask the client to lower arm
- Note the temperature on the digital display of the device
- Discard the probe cover in the garbage (without touching the cover) and place the probe back into the device
Rectal Temperature Technique
- Ensure the client’s privacy and wash your hands and put on gloves
- Position the client appropriately
- Remove the probe from the device and place a probe cover on it
- Lubricate the cover with a water-based lubricant
- Gently insert the probe 2–3 cm inside the rectal opening of an adult, or less depending on the size of the client
- Note the temperature on the digital display of the device when it beeps
- Discard the probe cover in the garbage (without touching the cover) and place the probe back into the device
- Remove your gloves and wash your hands | libretexts | 2025-03-17T22:26:22.903576 | 2019-11-19T05:25:11 | {
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https://med.libretexts.org/Bookshelves/Allied_Health/Vital_Sign_Measurement_Across_the_Lifespan_(Lapum_et_al.)/02%3A_Temperature/2.12%3A_Chapter_Summary | 2.12: Chapter Summary
Temperature is an important vital sign because it provides current data about the client’s health and illness state. Changes in body temperature act as a cue for healthcare providers’ diagnostic reasoning.
There are many ways to measure temperature. In determining the best method, the healthcare provider considers agency policy, the client’s age and health and illness state, and the reason for taking the temperature. Healthcare providers must use the correct technique when measuring temperature, because this can influence client data.
When determining the relevance of the temperature, the healthcare provider considers the client’s baseline data and the situation. Diagnostic reasoning about temperature always involves considering additional data including other vital sign measurements and subjective and objective client data. | libretexts | 2025-03-17T22:26:22.980615 | 2019-11-19T05:25:12 | {
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"title": "2.12: Chapter Summary",
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https://med.libretexts.org/Bookshelves/Allied_Health/Vital_Sign_Measurement_Across_the_Lifespan_(Lapum_et_al.)/02%3A_Temperature/2.13%3A_What_is_Temperature | 2.13: What is Temperature?
Temperature refers to the degree of heat or cold in an object or a human body. In humans, the brain’s hypothalamus acts as the body’s thermostat and is responsible for regulating its temperature (OER #2). See Figure 2.1 of the hypothalamus.
The human body is constantly adapting to internal health states and environmental conditions, and the hypothalamus is programmed to tell the body to generate heat if the body temperature is low. For example, the hypothalamus can activate peripheral vasoconstriction and shivering (contraction of skeletal muscles) to prevent a decrease in body temperature. The hypothalamus can also reduce heat if the body temperature is too high. For example, it can activate peripheral vasodilation to increase heat loss and cause a person to perspire, which cools the body.
Figure 2.1: Hypothalamus (Illustration credit: Hilary Tang)
_________________________________________________________________________
Part of this content was adapted from OER #2 (as noted in brackets above):
© Apr 10, 2017 OpenStax Anatomy and Physiology. Textbook content produced by OpenStax Anatomy and Physiology is licensed under a Creative Commons Attribution License 4.0 license. Download for free at http://cnx.org/contents/7c42370b-c3ad-48ac-9620-d15367b882c6@12 | libretexts | 2025-03-17T22:26:23.035438 | 2019-11-19T05:25:00 | {
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"book_url": "https://commons.libretexts.org/book/med-16787",
"title": "2.13: What is Temperature?",
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https://med.libretexts.org/Bookshelves/Allied_Health/Vital_Sign_Measurement_Across_the_Lifespan_(Lapum_et_al.)/02%3A_Temperature/2.14%3A_Why_is_Temperature_Measured | 2.14: Why is Temperature Measured?
Healthcare providers measure a client’s temperature because it can give information about their state of health and influence clinical decisions. Accurate measurements and interpretation are vital so that hyperthermia and hypothermia can be identified and appropriate interventions determined.
Hyperthermia refers to an elevated body temperature. It can be related to an internal or external source. External sources that increase body temperature could include exposure to excessive heat on a hot day or being in a sauna or hot tub. Internal sources that may increase body temperature include fever caused by an infection or tissue breakdown associated with physical trauma (e.g., surgery, myocardial infarction) or some neurological conditions (e.g., cerebral vascular accident, cerebral edema, brain tumour). Hyperthermia that is associated with an infectious agent, such as a bacteria or virus (e.g., the flu) is referred to as febrile. Unresolved hyperthermic body states can lead to cell damage.
Hypothermia refers to a lowered body temperature. It is usually related to an external source such as being exposed to the cold for an extended period of time. Hypothermia is sometimes purposefully induced during surgery, or for certain medical conditions, to reduce the body’s need for oxygen. Unresolved hypothermic body states can slow cellular processes and lead to loss of consciousness. | libretexts | 2025-03-17T22:26:23.090152 | 2019-11-19T05:25:01 | {
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"title": "2.14: Why is Temperature Measured?",
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https://med.libretexts.org/Bookshelves/Allied_Health/Vital_Sign_Measurement_Across_the_Lifespan_(Lapum_et_al.)/02%3A_Temperature/2.15%3A_Methods_of_Measurement | 2.15: Methods of Measurement
Methods of measuring a client’s body temperature vary based on developmental age, cognitive functioning, level of consciousness, state of health, safety, and agency/unit policy. The healthcare provider chooses the best method after considering client safety, accuracy, and least invasiveness, all contingent on the client’s health and illness state. The most accurate way to measure core body temperature is an invasive method through a pulmonary artery catheter. This is only performed in a critical care area when constant measurements are required along with other life-saving interventions.
Methods of measurement include oral, axillary, tympanic, rectal, temporal artery and dermal routes.
Oral temperature can be taken with clients who can follow instructions, so this kind of measurement is common for clients over the age of four, or even younger children if they are cooperative. Another route other than oral (e.g., tympanic or axillary) is preferable when a client is on oxygen delivered via a face mask because this can alter the temperature.
For children younger than four, axillary temperature is commonly measured unless a more accurate reading is required.
Rectal temperature is an accurate way to measure body temperature (Mazerolle, Ganio, Casa, Vingren, & Klau, 2011). The rectal route is recommended by the Canadian Pediatric Society for children under two years of age (Leduc & Woods, 2017). However, this method is not used on infants younger than thirty days or premature infants because of the risk of rectal tearing. If the rectal method is required, the procedure is generally only used by nurses and physicians.
Temporal artery temperature is not a common method of measurement, but may be used in some agencies; this process involves holding the device and sliding it over the skin of the forehead and then, down over the temporal artery in one motion. Dermal strips can be placed on the forehead to measure skin temperature, but are not yet widely used, and the accuracy of this method has not yet been verified.
Points to Consider
The accuracy of measurements is most often influenced by the healthcare provider’s adherence to the correct technique.
The following pages detail the normal temperature ranges and techniques associated with each of the temperature methods. | libretexts | 2025-03-17T22:26:23.145294 | 2019-11-19T05:25:01 | {
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https://med.libretexts.org/Bookshelves/Allied_Health/Vital_Sign_Measurement_Across_the_Lifespan_(Lapum_et_al.)/02%3A_Temperature/2.16%3A_What_are_Normal_Temperature_Ranges | 2.16: What are Normal Temperature Ranges?
The human body’s core temperature (internal body temperature) is measured in degrees Celsius (ºC) or Fahrenheit (ºF). In Canada, degrees Celsius is most commonly used.
In adults, the normal core body temperature (referred to as normothermia or afebrile) is 36.5–37.5ºC or 97.7–99.5ºF (OER #2).
A wider temperature range is acceptable in infants and young children, and can range from 35.5–37.7ºC or 95.9–99.8ºF. Infants and children have a wider temperature range because their heat control mechanisms are less effective. They are at risk for heat loss for many reasons including having less subcutaneous fat than adults, a larger body surface area in comparison to weight (and larger head size in proportion to the rest of the body), immature metabolic mechanisms (e.g., they may be unable to shiver), and limited ability to produce heat through activity. They are also at risk of excessive heat production due to crying and restlessness as well as external factors such as being wrapped in too many blankets.
Older adults tend to have lower body temperatures and are at risk for hypothermic states; reasons for this may include having less subcutaneous tissue acting as insulation, loss of peripheral vasoconstriction capacity, decreased cardiac output with resultant lowered blood flow to the extremities, decreased muscle mass resulting in reduced heat production capacity, and decreased metabolic responses.
Points to Consider
It is important to monitor and regulate temperature in newborns and infants because of the temperature fluctuations that place them at higher risk for hypothermia and hyperthermia, whereas temperature changes in older adults are often minimal.
See Table 2.1 for normal temperature ranges based on method. The normal ranges vary slightly for each of the methods. As a healthcare provider, it is important to determine the significance of the temperature by considering influencing factors and the client’s overall state of health.
Table 2.1: Normal Temperature Ranges
| Method | Range |
|---|---|
| Oral | 35.8–37.3ºC |
| Axillary | 34.8–36.3ºC |
| Tympanic | 36.1–37.9ºC |
| Rectal | 36.8–38.2ºC |
Other factors that influence temperature include diurnal rhythm, exercise, stress, menstrual cycle, and pregnancy. The diurnal cycle causes a fluctuation of 1ºC, with temperatures lowest in the early morning and highest in the late afternoon. During exercise, body temperature rises because the body is using energy to power the muscles. Temperature can rise as a result of stress and anxiety, due to stimulation of the sympathetic nervous system and increased secretion of epinephrine and norepinephrine. Body temperature varies throughout a woman’s menstrual cycle due to hormonal fluctuations, rising after ovulation until menstruation by about 0.5–1ºC. Body temperature is slightly elevated during pregnancy as a result of increased metabolism and hormone production such as progesterone.
_________________________________________________________________________
Part of this content was adapted from OER #2 (as noted in brackets above):
© Apr 10, 2017 OpenStax Anatomy and Physiology. Textbook content produced by OpenStax Anatomy and Physiology is licensed under a Creative Commons Attribution License 4.0 license. Download for free at http://cnx.org/contents/7c42370b-c3ad-48ac-9620-d15367b882c6@12 | libretexts | 2025-03-17T22:26:23.205074 | 2019-11-19T05:25:02 | {
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https://med.libretexts.org/Bookshelves/Allied_Health/Vital_Sign_Measurement_Across_the_Lifespan_(Lapum_et_al.)/02%3A_Temperature/2.17%3A_Oral_Temperature | 2.17: Oral Temperature
The normal oral temperature is 35.8–37.3ºC (OER #1) or 96.4–99.1ºF. Oral temperature measurement is common and reliable because it is close to the sublingual artery. An oral thermometer is shown in Figure 2.2. The device has blue colouring, indicating that it is an oral or axillary thermometer as opposed to a rectal thermometer, which has red colouring.
Figure 2.2: Oral thermometer
Technique
Remove the probe from the device and place a probe cover (from the box) on the oral thermometer without touching the probe cover with your hands. Place the thermometer in the client’s mouth under the tongue and instruct client to keep mouth closed and not to bite on the thermometer (OER #1). Ensure the thermometer probe is in the posterior sublingual pocket under the tongue, slightly off-centre. Leave the thermometer in place for as long as is indicated by the device manufacturer (OER #1). The thermometer will beep within a few seconds when the temperature has been taken: most oral thermometers are electronic and provide a digital display of the reading. Discard the probe cover in the garbage (without touching the cover) and place the probe back into the device. See Figure 2.3 of an oral temperature being taken.
Figure 2.3: Oral temperature being taken
Technique Tips
Putting the probe cover on takes practice. You need to ensure that it snaps onto the probe. Sometimes the device will turn off after you take the probe out of the device if you take too long to put the probe cover on or insert it in the client’s mouth. If so, discard the probe cover and re-insert the probe into the device to reset it. Then try again.
What should the healthcare provider consider?
Healthcare providers often measure the oral temperature, particularly when the client is conscious and can follow directions. Measurement of the oral temperature is not recommended for individuals who are unconscious, unresponsive, confused, have an endotracheal tube secured in the mouth, and cannot follow instructions.
Certain factors render the oral route less accurate with the potential for falsely high or falsely low findings. If the client has recently consumed hot or cold food or beverage, chewing gum, or has smoked prior to measurement, the healthcare provider should use another route such as tympanic or axillary. Selecting an alternate route under the aforementioned circumstances is most conducive to a fast-paced clinical environment and most respectful of the client’s time. If another route is not available, healthcare providers should wait 15 to 25 minutes to take the oral temperature following consumption of a hot or cold beverage/food. The temperature of the beverage/food also factors into the wait period, as extreme heat or cold will require longer wait times for oral temperature assessment. Healthcare providers should wait about 5 minutes if the client is chewing gum or has just smoked since both of these activities can increase temperature.
_________________________________________________________________________
Part of this content was adapted from OER #1 (as noted in brackets above):
© 2015 British Columbia Institute of Technology (BCIT). Clinical Procedures for Safer Patient Care by Glynda Rees Doyle and Jodie Anita McCutcheon, British Columbia Institute of Technology. Licensed under a Creative Commons Attribution 4.0 International License , except where otherwise noted. Download this book for free at http://open.bccampus.ca | libretexts | 2025-03-17T22:26:23.263661 | 2019-11-19T05:25:02 | {
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"book_url": "https://commons.libretexts.org/book/med-16787",
"title": "2.17: Oral Temperature",
"author": "Lapum et al."
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https://med.libretexts.org/Bookshelves/Allied_Health/Vital_Sign_Measurement_Across_the_Lifespan_(Lapum_et_al.)/02%3A_Temperature/2.18%3A_Tympanic_Temperature | 2.18: Tympanic Temperature
The normal tympanic temperature is usually 0.3–0.6°C higher than an oral temperature (OER #1). It is accurate because the tympanic membrane shares the same vascular artery that perfuses the hypothalamus (OER #1). A tympanic thermometer is shown in Figure 2.4.
Figure 2.4: Tympanic thermometer
Technique
Remove the tympanic thermometer from the casing and place a probe cover (from the box) on the thermometer tip without touching the probe cover with your hands. Only touch the edge of the probe cover (if needed), to maintain clean technique. Turn the device on. Ask the client to keep head still. For an adult or older child, gently pull the helix up and back to visualize the ear canal. For an infant or younger child (under 3), gently pull the lobe down. The probe is inserted just inside the opening of the ear. Never force the thermometer into the ear and do not occlude the ear canal (OER #1). Only the tip of the probe is inserted in the opening – this is important to prevent damage to the ear canal. Activate the device; it will beep within a few seconds to signal it is done. Discard the probe cover in the garbage (without touching the cover) and place the device back into the holder. See Figure 2.5 of a tympanic temperature being taken.
Figure 2.5: Tympanic temperature being taken
Technique Tips
The technique of pulling the helix up and back (adult) or the lobe down (child under 3) is used to straighten the ear canal so the light can reflect on the tympanic membrane. If this is not correctly done, the reading may not be accurate. The probe tip is gently inserted into the opening to prevent damage to the ear canal. The ear canal is a sensitive and a highly innervated part of the body, so it is important not to force the tympanic probe into the ear.
What should the healthcare provider consider?
The tympanic temperature method is a quick and minimally invasive way to take temperature. Although research has proven the accuracy of this method, some pediatric institutions prefer the accuracy of the rectal temperature. The Canadian Pediatric Society found equal evidence for and against the use of tympanic temperature route (Leduc & Woods, 2017). It concluded that tympanic temperature is one option for use with children, but suggested using rectal temperature for children younger than two, particularly when accuracy is vital. The tympanic temperature is not measured when a client has a suspected ear infection. It is important to check your agency policy regarding tympanic temperature.
_________________________________________________________________________
Part of this content was adapted from OER #1 (as noted in brackets above):
© 2015 British Columbia Institute of Technology (BCIT). Clinical Procedures for Safer Patient Care by Glynda Rees Doyle and Jodie Anita McCutcheon, British Columbia Institute of Technology. Licensed under a Creative Commons Attribution 4.0 International License , except where otherwise noted. Download this book for free at http://open.bccampus.ca | libretexts | 2025-03-17T22:26:23.398061 | 2019-11-19T05:25:02 | {
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"book_url": "https://commons.libretexts.org/book/med-16787",
"title": "2.18: Tympanic Temperature",
"author": "Lapum et al."
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https://med.libretexts.org/Bookshelves/Allied_Health/Vital_Sign_Measurement_Across_the_Lifespan_(Lapum_et_al.)/02%3A_Temperature/2.19%3A_Axillary_Temperature | 2.19: Axillary Temperature
The normal axillary temperature may be as much as 1ºC lower than the oral temperature (OER #1). An axillary thermometer is the same electronic device as an oral thermometer, and both have a blue end.
Technique
Remove the probe from the device and place a probe cover (from the box) on the thermometer without touching the cover with your hands. Ask the client to raise the arm away from his/her body. Place the thermometer in the client’s armpit (OER #1), on bare skin, as high up into the axilla as possible, with the point facing behind the client. Ask the client to lower his/her arm and leave the device in place for as long as is indicated by the device manufacturer (OER #1). Usually the device beeps in 10–20 seconds. Discard the probe cover in the garbage (without touching the cover) and place the probe back into the device. See Figure 2.6 of an axillary temperature being taken.
Figure 2.6: Axillary temperature being taken
What should the healthcare provider consider?
The axillary route is a minimally invasive way to measure temperature. It is commonly used in children. It is important to ensure that the thermometer is as high up in the axilla as possible with full skin contact and that the client’s arm is then lowered down.
_________________________________________________________________________
Part of this content was adapted from OER #1 (as noted in brackets above):
© 2015 British Columbia Institute of Technology (BCIT). Clinical Procedures for Safer Patient Care by Glynda Rees Doyle and Jodie Anita McCutcheon, British Columbia Institute of Technology. Licensed under a Creative Commons Attribution 4.0 International License , except where otherwise noted. Download this book for free at http://open.bccampus.ca | libretexts | 2025-03-17T22:26:23.454903 | 2019-11-19T05:25:04 | {
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"book_url": "https://commons.libretexts.org/book/med-16787",
"title": "2.19: Axillary Temperature",
"author": "Lapum et al."
} |
https://med.libretexts.org/Bookshelves/Allied_Health/Vital_Sign_Measurement_Across_the_Lifespan_(Lapum_et_al.)/02%3A_Temperature/2.20%3A_Rectal_Temperature | 2.20: Rectal Temperature
The normal rectal temperature is usually 1ºC higher than oral temperature (OER #1). A rectal thermometer has a red end to distinguish it from an oral/axillary thermometer. A rectal thermometer is shown in Figure 2.7.
Figure 2.7: Rectal thermometer
Technique
First, ensure the client’s privacy. Wash your hands and put on gloves. For infants, lie them down in a supine position and raise their legs up toward the chest. You can encourage a parent to hold the infant to decrease movement and provide a sense of safety. With older children and adults, assist them into a side lying position. Remove the probe from the device and place a probe cover (from the box) on the thermometer. Lubricate the cover with a water-based lubricant, and then gently insert the probe 2–3 cm inside the rectal opening of an adult, or less depending on the size of the client. The device beeps when it is done.
What should the healthcare provider consider?
Measuring rectal temperature is an invasive method. Some suggest its use only when other methods are not available (OER #1), while others suggest that the rectal route is a gold standard in the infant population because of its accuracy. The Canadian Pediatric Society (Leduc & Woods, 2017) has referred to research indicating that rectal temperatures may remain elevated after a client’s core temperature has started to return to normal, but after reviewing all available evidence, still recommends measuring rectal temperature for children under the age of two, particularly when accuracy is vital. Rectal temperature is not measured in infants under one month of age or premature newborns.
_________________________________________________________________________
Part of this content was adapted from OER #1 (as noted in brackets above):
© 2015 British Columbia Institute of Technology (BCIT). Clinical Procedures for Safer Patient Care by Glynda Rees Doyle and Jodie Anita McCutcheon, British Columbia Institute of Technology. Licensed under a Creative Commons Attribution 4.0 International License , except where otherwise noted. Download this book for free at http://open.bccampus.ca | libretexts | 2025-03-17T22:26:23.511088 | 2019-11-19T05:25:05 | {
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"book_url": "https://commons.libretexts.org/book/med-16787",
"title": "2.20: Rectal Temperature",
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https://med.libretexts.org/Bookshelves/Allied_Health/Vital_Sign_Measurement_Across_the_Lifespan_(Lapum_et_al.)/03%3A_Pulse_and_Respiration | 3: Pulse and Respiration Last updated Save as PDF Page ID 16790 Lapum et al. Ryerson University (Daphne Cockwell School of Nursing) via Ryerson University Library 3.1: Respiration Technique 3.2: Finding the Error Activity- Radial Pulse 3.3: Finding the Error Activity- Radial Pulse – Feedback 3.4: Finding the Error Activity- Infant Apical Pulse 3.5: Finding the Error Activity- Infant Apical Pulse – Answer 3.6: Try it Out 3.7: Try it Out- Radial Pulse and Respiration 3.8: Try it Out- Apical Pulse 3.9: Test Yourself 3.10: Test Yourself- Answers 3.11: How Best to View this Chapter? 3.12: Test Yourself- List in the Correct Order 3.13: Test Yourself- List in the Correct Order – Answers 3.14: Chapter Summary 3.15: What is Pulse? 3.16: Why is Pulse Measured? 3.17: What Pulse Qualities are Assessed? 3.18: Radial Pulse 3.19: Carotid Pulse 3.20: Brachial Pulse 3.21: Apical Pulse 3.22: What is Respiration? | libretexts | 2025-03-17T22:26:23.606046 | 2019-11-19T05:24:56 | {
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"book_url": "https://commons.libretexts.org/book/med-16787",
"title": "3: Pulse and Respiration",
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https://med.libretexts.org/Bookshelves/Allied_Health/Vital_Sign_Measurement_Across_the_Lifespan_(Lapum_et_al.)/03%3A_Pulse_and_Respiration/3.01%3A_Respiration_Technique | 3.1: Respiration Technique
Technique
The respiratory rate is counted after taking the pulse rate so that the client is not aware that you are taking it (OER #1). Once you have finished counting the pulse, leave your fingers in place and then begin assessing respiration. Observe the chest or abdomen rise and fall. One respiration includes a full respiratory cycle (including both inspiration and expiration). Thus, the rise and the fall of the abdomen or chest is counted as one full breath. Count for 30 seconds if the rhythm is regular or for a full minute if irregular (OER #1). Report the respiration as breaths per minute, as well as whether breathing is relaxed, silent, and has a regular rhythm. Report whether chest movement is symmetrical.
What should the healthcare provider consider?
Assess the movement of the chest with adults, and the movement of the abdomen with newborns and infants. Adults are normally thoracic breathers (the chest moves) while infants are normally diaphragmatic breathers (the abdomen moves). Some adults are abdominal breathers. Breathing rates are counted for one minute with infants because the respiratory rhythm (tempo) can vary significantly. For example, the breathing rates of infants can speed up and slow down with some short periods of apnea (pauses in breathing).
When assessing respiration, ensure that thick and bulky clothing is removed so you can clearly see the rise and fall of the chest or abdomen. Although respiratory rates are best counted at rest, sometimes this is not possible (e.g., in an emergency situation and with a child who is crying). In this case, document the situation. While assessing respirations, it is important to note signs of respiratory distress, which can include loud breathing, nasal flaring, and intercostal retractions. See Figure 3.7 for signs of respiratory distress. These signs require further assessment and intervention.
Figure 3.7: Signs of respiratory distress (Illustration credit: Paige Jones)
_________________________________________________________________________
Part of this content was adapted from OER #1 (as noted in brackets above):
© 2015 British Columbia Institute of Technology (BCIT). Clinical Procedures for Safer Patient Care by Glynda Rees Doyle and Jodie Anita McCutcheon, British Columbia Institute of Technology. Licensed under a Creative Commons Attribution 4.0 International License , except where otherwise noted. Download this book for free at http://open.bccampus.ca | libretexts | 2025-03-17T22:26:23.662110 | 2019-11-19T05:25:19 | {
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"title": "3.1: Respiration Technique",
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https://med.libretexts.org/Bookshelves/Allied_Health/Vital_Sign_Measurement_Across_the_Lifespan_(Lapum_et_al.)/03%3A_Pulse_and_Respiration/3.02%3A_Finding_the_Error_Activity-_Radial_Pulse | 3.2: Finding the Error Activity- Radial Pulse
Now you have an opportunity to find errors in measurement techniques. This activity involves looking at an image.
What error in technique is this healthcare provider making while measuring the radial pulse of a client?
Figure 3.8: Error in technique while measuring the radial pulse
Go to the next page for information about the correct technique for measuring radial pulse. | libretexts | 2025-03-17T22:26:23.716985 | 2019-11-19T05:25:20 | {
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https://med.libretexts.org/Bookshelves/Allied_Health/Vital_Sign_Measurement_Across_the_Lifespan_(Lapum_et_al.)/03%3A_Pulse_and_Respiration/3.03%3A_Finding_the_Error_Activity-_Radial_Pulse__Feedback | 3.3: Finding the Error Activity- Radial Pulse – Feedback
As per Figure 3.8, an incorrect technique is being demonstrated because the pads of the three fingers are being placed on the ulnar side of the wrist. The correct technique (Figure 3.9) to palpate the radial pulse involves placing the pads of the three fingers along the radius which is on the lateral side of the wrist (the thumb side). The pads of the fingers are placed on the radius bone close to the flexor aspect of the wrist.
Incorrect placement of fingers
Figure 3.8: Incorrect placement of fingers
Correct placement of fingers
While palpating the pulse, gently place the pads of your three fingers along the radial bone at the flexor aspect of the wrist (the thumb side).
Figure 3.9: Correct placement of fingers | libretexts | 2025-03-17T22:26:23.773712 | 2019-11-19T05:25:21 | {
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https://med.libretexts.org/Bookshelves/Allied_Health/Vital_Sign_Measurement_Across_the_Lifespan_(Lapum_et_al.)/03%3A_Pulse_and_Respiration/3.04%3A_Finding_the_Error_Activity-_Infant_Apical_Pulse | 3.4: Finding the Error Activity- Infant Apical Pulse
Now you have an opportunity to find errors in measurement technique. This activity involves looking at an image.
What error in technique is this healthcare provider making while measuring the apical pulse of an infant?
Figure 3.10: Error in technique while measuring the apical pulse
Go to the next page for information about the correct technique for measuring apical pulse in an infant. | libretexts | 2025-03-17T22:26:23.827489 | 2019-11-19T05:25:21 | {
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"title": "3.4: Finding the Error Activity- Infant Apical Pulse",
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https://med.libretexts.org/Bookshelves/Allied_Health/Vital_Sign_Measurement_Across_the_Lifespan_(Lapum_et_al.)/03%3A_Pulse_and_Respiration/3.05%3A_Finding_the_Error_Activity-_Infant_Apical_Pulse__Answer | 3.5: Finding the Error Activity- Infant Apical Pulse – Answer
As per Figure 3.11, an incorrect technique is being demonstrated because the stethoscope is placed on the incorrect side of the chest. The correct technique (Figure 3.12) to auscultate the apical pulse of an infant is to place the stethoscope at the left midclavicular line in the fourth intercostal space.
Incorrect placement of stethoscope
Figure 3.11: Incorrect placement of stethoscope
Correct placement of stethoscope
While taking the apical pulse of an infant, place the stethoscope at the fourth intercostal space at the left mid-clavicular line.
Figure 3.12: Correct placement of stethoscope | libretexts | 2025-03-17T22:26:23.883819 | 2019-11-19T05:25:23 | {
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https://med.libretexts.org/Bookshelves/Allied_Health/Vital_Sign_Measurement_Across_the_Lifespan_(Lapum_et_al.)/03%3A_Pulse_and_Respiration/3.06%3A_Try_it_Out | 3.6: Try it Out
Next, you have an opportunity to watch film clips on accurate measurement techniques. There are two activities that involve two film clips that you can watch and then try out yourself. Check it out!
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Next, you have an opportunity to watch film clips on accurate measurement techniques. There are two activities that involve two film clips that you can watch and then try out yourself. Check it out! | libretexts | 2025-03-17T22:26:23.945317 | 2019-11-19T05:25:25 | {
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"title": "3.6: Try it Out",
"author": "Lapum et al."
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https://med.libretexts.org/Bookshelves/Allied_Health/Vital_Sign_Measurement_Across_the_Lifespan_(Lapum_et_al.)/03%3A_Pulse_and_Respiration/3.07%3A_Try_it_Out-_Radial_Pulse_and_Respiration | 3.7: Try it Out- Radial Pulse and Respiration
Watch this short film clip 3.2 and see how to measure radial pulse and respiration correctly. After watching the clip, try the technique yourself. You can watch the clip and practice as many times as you like.
Alternatively, if viewing textbook as a pdf, use this link: https://www.youtube.com/embed/yxSoB3BiDLo?rel=0
An interactive or media element has been excluded from this version of the text. You can view it online here: pb.libretexts.org/vitalsign/?p=133
Film clip 3.2: Pulse and respiration measurement | libretexts | 2025-03-17T22:26:23.999579 | 2019-11-19T05:25:26 | {
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"title": "3.7: Try it Out- Radial Pulse and Respiration",
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https://med.libretexts.org/Bookshelves/Allied_Health/Vital_Sign_Measurement_Across_the_Lifespan_(Lapum_et_al.)/03%3A_Pulse_and_Respiration/3.08%3A_Try_it_Out-_Apical_Pulse | 3.8: Try it Out- Apical Pulse
Watch this short film clip 3.3 and see how to measure an apical pulse correctly. After watching the clip, try the technique yourself. You can watch the clip and practice as many times as you like.
Alternatively, if viewing textbook as a pdf, use this link: https://www.youtube.com/embed/JJ9VEymVl8Q?rel=0
An interactive or media element has been excluded from this version of the text. You can view it online here: pb.libretexts.org/vitalsign/?p=135
Film clip 3.3: Correct measurement of apical pulse | libretexts | 2025-03-17T22:26:24.053852 | 2019-11-19T05:25:27 | {
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https://med.libretexts.org/Bookshelves/Allied_Health/Vital_Sign_Measurement_Across_the_Lifespan_(Lapum_et_al.)/03%3A_Pulse_and_Respiration/3.09%3A_Test_Yourself | 3.9: Test Yourself
Now that you have completed this chapter, it’s time to test your knowledge. Try to answer the following questions (you may want to review parts of the chapter before answering). Write your answers down on a piece of paper.
1. What is the apical pulse rate?
Listen to the audio clip of the apical pulse. Count the pulse for 30 seconds and report the rate as beats per minute (NOTE: although this clip only allows you to count for 30 seconds, remember, it is best to count the apical pulse for one minute).
An interactive or media element has been excluded from this version of the text. You can view it online here: pb.libretexts.org/vitalsign/?p=137
Audio clip 3.2: Apical pulse
Alternatively, if viewing textbook as a pdf, use this link: https://www.youtube.com/embed/znhbVRZRLfM?rel=0
2. What is the apical pulse rate?
Listen to the audio clip of the apical pulse. Count the pulse for 30 seconds and report the rate as beats per minute (NOTE: although this clip only allows you to count for 30 seconds, remember, it is best to count the apical pulse for one minute).
An interactive or media element has been excluded from this version of the text. You can view it online here: pb.libretexts.org/vitalsign/?p=137
Audio clip 3.3: Apical pulse
Alternatively, if viewing textbook as a pdf, use this link: https://www.youtube.com/embed/Hxd68qJfzhQ?rel=0
3. How should a healthcare provider respond when a newborn has an apical heart rate of 120 beats per minute?
a. Re-take the rate at the brachial location
b. Document the rate and assess it as normal
c. Document the rate and identify it as tachycardia
d. Notify the physician and identify it as bradycardia
4. Which findings should be of most concern to the healthcare provider in an adolescent client?
a. Pulse 40 bpm and respiration 34
b. Respiration 16 and pulse 82 bpm
c. Pulse 68 bpm and sinus arrhythmia
d. Pulse 2+, 78 bpm, and regular rhythm
5. Match the findings that are typically normal for the person listed:
Sinus arrhythmia Athlete
Bradycardia Newborn
Abdominal breather Adolescent | libretexts | 2025-03-17T22:26:24.113462 | 2019-11-19T05:25:27 | {
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https://med.libretexts.org/Bookshelves/Allied_Health/Vital_Sign_Measurement_Across_the_Lifespan_(Lapum_et_al.)/03%3A_Pulse_and_Respiration/3.10%3A_Test_Yourself-_Answers | 3.10: Test Yourself- Answers
1. What is the apical pulse rate?
Listen to the audio-clip of the apical pulse. Count the pulse for 30 seconds and report the rate as beats per minute (NOTE: although this clip only allows you to count for 30 seconds, remember, it is best to count the apical pulse for one minute).
The pulse rate is 76 bpm (38 x 2) with a regular rhythm
2. What is the apical pulse rate?
The pulse rate is 114 bpm (57 x 2) with a regular rhythm
2. How should a healthcare provider respond when a newborn has an apical heart rate of 120 beats per minute?
a. Re-take the rate at the brachial location
b. Document the rate and assess it as normal **
c. Document the rate and identify it as tachycardia
d. Notify the physician and identify it as bradycardia
Rationale: The correct answer is b (document the rate and assess it as normal). An apical heart rate of 120 bpm falls within the normal range for newborns. Newborns have a faster apical heart rate than adults because they have smaller and less muscular hearts. As a result, their stroke volume (volume of blood per contraction) is smaller than that of adults and their hearts must beat faster to pump sufficient blood, oxygen, and nutrients to the body.
3. Which findings in an adolescent client is of most concern to a healthcare provider?
a. Pulse 40 bpm and respiration 34 **
b. Respiration 16 and pulse 82 bpm
c. Pulse 68 bpm and sinus arrhythmia
d. Pulse 2+, 78 bpm, and regular rhythm
Rationale: The correct answer is a (pulse 40 bpm and respiration 34). In adolescents, a pulse of 40 bpm is low and a respiration rate of 34 is high. All of the other findings are normal for adolescents, including sinus arrhythmia, which is common in children and adolescents.
4. Match the findings that are typically normal for the person listed:
Bradycardia——————-Athlete
Abdominal breather———Newborn
Sinus arrhythmia————Adolescent
Rationale: Bradycardia (low pulse) is common in athletes because their hearts are more muscular and pump a larger stroke volume per contraction. As a result, the heart contracts/beats less to pump sufficient blood, oxygen and nutrients. Newborns are abdominal breathers, meaning that the abdomen moves up and down when breathing, as opposed to the thorax. Sinus arrhythmia is common in adolescents. It involves an irregular pulse rhythm in which the pulse rate varies with the respiratory cycle; the heart speeds up at inspiration and decreases back to normal upon expiration. The underlying physiology of sinus arrhythmia is that the heart rate increases to compensate for the decreased stroke volume from the left side of the heart upon inspiration. | libretexts | 2025-03-17T22:26:24.171636 | 2019-11-19T05:25:27 | {
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https://med.libretexts.org/Bookshelves/Allied_Health/Vital_Sign_Measurement_Across_the_Lifespan_(Lapum_et_al.)/03%3A_Pulse_and_Respiration/3.12%3A_Test_Yourself-_List_in_the_Correct_Order | 3.12: Test Yourself- List in the Correct Order
List the steps below in the correct order for each of the following techniques. Write your list on a piece of paper.
Radial Pulse Technique
- Note the rate, rhythm, force, and equality when measuring the radial pulse
- Use the pads of your first three fingers to gently palpate the radial pulse along the radius bone close to the flexor aspect of the wrist
- Press down with your fingers until you can best feel the pulsation
Carotid Pulse Technique
- Gently palpate the carotid artery one at a time
- Note the rate, rhythm, force, and equality when measuring the carotid pulse
- Locate the carotid artery medial to the sternomastoid muscle in the middle third of the neck
- Ask the client to sit upright.
Apical Pulse Technique
- Physically palpate the intercostal spaces to locate the landmark of the apical pulse
- Ask the client to lay flat in a supine position
- Note the rate and rhythm
- Auscultate the apical pulse
Brachial Pulse Technique
- Move your fingers medial from the tendon and about one inch above the antecubital fossa to locate the brachial pulse
- Palpate the bicep tendon in the area of the antecubital fossa
- Note the rate and rhythm
Respiration Technique
- Count for 30 seconds if the rhythm is regular or for a full minute if it is irregular
- Observe the rise and fall of the chest or abdomen
- Leave your fingers in place when you are done counting the pulse, and then begin assessing respiration
- Report the respirations as breaths per minute, as well as whether breathing is relaxed, silent, and has a regular rhythm
Go to the next page to see the correct order of steps for these techniques. | libretexts | 2025-03-17T22:26:24.255551 | 2019-11-19T05:25:28 | {
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https://med.libretexts.org/Bookshelves/Allied_Health/Vital_Sign_Measurement_Across_the_Lifespan_(Lapum_et_al.)/03%3A_Pulse_and_Respiration/3.13%3A_Test_Yourself-_List_in_the_Correct_Order__Answers | 3.13: Test Yourself- List in the Correct Order – Answers
The steps are listed in the correct order for each of the following techniques. These are printable flashcards to help you memorize and practice the techniques.
Radial Pulse Technique
- Use the pads of your first three fingers to gently palpate the radial pulse along the radius bone close to the flexor aspect of the wrist
- Press down with your fingers until you can best feel the pulsation
- Note the rate, rhythm, force, and equality when measuring the radial pulse
Carotid Pulse Technique
- Ask the client to sit upright
- Locate the carotid artery medial to the sternomastoid muscle in the middle third of the neck
- Gently palpate the carotid artery one at a time
- Note the rate, rhythm, force, and equality when measuring the carotid pulse
Apical Pulse Technique
- Ask the client to lay flat in a supine position
- Physically palpate the intercostal spaces to locate the landmark of the apical pulse
- Auscultate the apical pulse
- Note the rate and rhythm
Brachial Pulse Technique
- Palpate the bicep tendon in the area of the antecubital fossa
- Move your fingers medial from the tendon and about one inch above the antecubital fossa to locate the pulse
- Note the rate and rhythm
Respiration Technique
- Leave your fingers in place when you are done counting the pulse, and then begin assessing respiration
- Observe the rise and fall of the chest or abdomen
- Count for 30 seconds if the rhythm is regular or for a full minute if it is irregular
- Report respiration as breaths per minute, as well as whether breathing is relaxed, silent, and has a regular rhythm | libretexts | 2025-03-17T22:26:24.314660 | 2019-11-19T05:25:28 | {
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https://med.libretexts.org/Bookshelves/Allied_Health/Vital_Sign_Measurement_Across_the_Lifespan_(Lapum_et_al.)/03%3A_Pulse_and_Respiration/3.14%3A_Chapter_Summary | 3.14: Chapter Summary
Measurement of pulse and respiration is important because these vital signs provide current data about the client’s health and illness state. Changes in pulse and respiration act as cues for healthcare providers’ diagnostic reasoning.
Pulse can be measured in many locations. When determining the best location, healthcare providers consider the client’s age and health and illness state, as well as the reason for taking the pulse.
When determining the relevance of pulse and respiration data, healthcare providers consider the client’s baseline data and the situation. Diagnostic reasoning about pulse and respiration always considers additional information, including other vital sign measurements and subjective and objective client data. | libretexts | 2025-03-17T22:26:24.369062 | 2019-11-19T05:25:29 | {
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https://med.libretexts.org/Bookshelves/Allied_Health/Vital_Sign_Measurement_Across_the_Lifespan_(Lapum_et_al.)/03%3A_Pulse_and_Respiration/3.15%3A_What_is_Pulse | 3.15: What is Pulse?
Pulse refers to a pressure wave that expands and recoils the artery when the heart contracts/beats. It is palpated at many points throughout the body. The most common locations to accurately assess pulse as part of vital sign measurement include radial, brachial, carotid, and apical pulse as shown in Figure 3.1. The techniques vary according to the location, as detailed later.
Figure 3.1: Radial, brachial, carotid and apical pulse (Illustration credit: Hilary Tang)
The heart pumps a volume of blood per contraction into the aorta. This volume is referred to as stroke volume. Age is one factor that influences stroke volume, which ranges from 5–80 mL from newborns to older adults.
Pulse is measured in beats per minute, and the normal adult pulse rate (heart rate) at rest is 60–100 beats per minute (OER #1, OER #2). Newborn resting heart rates range from 100–175 bpm. Heart rate gradually decreases until young adulthood and then gradually increases again with age (OER #2). A pregnant women’s heart rate is slightly higher than her pre-pregnant value (about 15 beats). See Table 3.1 for normal heart rate ranges based on age.
Table 3.1: Heart Rate Ranges
| Age | Heart rate (beats per minute) |
|---|---|
| Newborn to one month | 100–175 |
| One month to two years | 90–160 |
| Age 2–6 years | 70–150 |
| Age 7–11 years | 60–130 |
| Age 12–18 years | 50–110 |
| Adult and older adult | 60–100 |
Points to Consider
The ranges noted in Table 3.1 are generous. It is important to consider each client and situation to determine whether the heart rate is normal. For example, heart rate is considered in the context of a client’s baseline heart rate. The healthcare provider also considers the client’s health and illness state and determinants such as rest/sleep, awake/active, and presence of pain. You can expect higher pulse values when a client is in a stressed state such as when crying or in pain; this is particularly important in the newborn. It is best to complete the assessment when the client is in a resting state. If you obtain a pulse when the client is not in a resting state, document the circumstances (e.g., stress, crying, or pain) and reassess as needed.
_________________________________________________________________________
Part of this content was adapted from OER #1 (as noted in brackets above):
© 2015 British Columbia Institute of Technology (BCIT). Clinical Procedures for Safer Patient Care by Glynda Rees Doyle and Jodie Anita McCutcheon, British Columbia Institute of Technology. Licensed under a Creative Commons Attribution 4.0 International License, except where otherwise noted. Download this book for free at
http://open.bccampus.ca
Part of this content was adapted from OER #2 (as noted in brackets above):
© Apr 10, 2017 OpenStax Anatomy and Physiology. Textbook content produced by OpenStax Anatomy and Physiology is licensed under a Creative Commons Attribution License 4.0 license. Download for free at
http://cnx.org/contents/7c42370b-c3a...15367b882c6@12 | libretexts | 2025-03-17T22:26:24.505942 | 2019-11-19T05:25:12 | {
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"book_url": "https://commons.libretexts.org/book/med-16787",
"title": "3.15: What is Pulse?",
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https://med.libretexts.org/Bookshelves/Allied_Health/Vital_Sign_Measurement_Across_the_Lifespan_(Lapum_et_al.)/03%3A_Pulse_and_Respiration/3.16%3A_Why_is_Pulse_Measured | 3.16: Why is Pulse Measured?
Healthcare providers measure pulse because it provides information about a client’s state of health and influences diagnostic reasoning and clinical decision-making.
Tachycardia
Tachycardia refers to an elevated heart rate, typically above 100 bpm (OER #2) for an adult. Developmental considerations are important to consider, such as higher resting pulse rates in infants and children. For adults, tachycardia is not normal in a resting state but may be detected in pregnant women or individuals experiencing extreme stress (OER #2). Tachycardia can be benign, such as when the sympathetic nervous system is activated with exercise and stress. Caffeine intake and nicotine can also elevate the heart rate. Tachycardia is also correlated with fever, anemia, hypoxia, hyperthyroidism, hypersecretion of catecholamines, some cardiomyopathies, some disorders of the valves, and acute exposure to radiation (OER #2).
Bradycardia
Bradycardia is a condition in which the resting heart rate drops below 60 bpm (OER #2) in adults. In newborns, a resting heart rate below 100 bpm is considered bradycardia. However, a sleeping neonate’s pulse may be as low as 90 bpm. People who are physically fit (e.g., trained athletes) typically have lower heart rates (OER #2). If the client is not exhibiting other symptoms, such as weakness, fatigue, dizziness, fainting, chest discomfort, palpitations, or respiratory distress, bradycardia is generally not considered clinically significant (OER #2). However, if any of these symptoms are present, this may indicate that the heart is not providing sufficient oxygenated blood to the tissues (OER #2). Bradycardia can be related to an electrical issue of the heart, ischemia, metabolic disorders, pathologies of the endocrine system, electrolyte imbalances, neurological disorders, prescription medications, and prolonged bedrest, among other conditions (OER #2). Bradycardia is also related to some medications, such as beta blockers and digoxin.
Points to Consider
It is vital that healthcare providers assess clients with tachycardia or bradycardia to determine whether the findings are significant and require intervention.
_________________________________________________________________________
Part of this content was adapted from OER #2 (as noted in brackets above):
© Apr 10, 2017 OpenStax Anatomy and Physiology. Textbook content produced by OpenStax Anatomy and Physiology is licensed under a Creative Commons Attribution License 4.0 license. Download for free at
http://cnx.org/contents/7c42370b-c3a...15367b882c6@12 | libretexts | 2025-03-17T22:26:24.563024 | 2019-11-19T05:25:13 | {
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"book_url": "https://commons.libretexts.org/book/med-16787",
"title": "3.16: Why is Pulse Measured?",
"author": "Lapum et al."
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https://med.libretexts.org/Bookshelves/Allied_Health/Vital_Sign_Measurement_Across_the_Lifespan_(Lapum_et_al.)/03%3A_Pulse_and_Respiration/3.17%3A_What_Pulse_Qualities_are_Assessed | 3.17: What Pulse Qualities are Assessed?
The pulse rhythm, rate, force, and equality are assessed when palpating pulses.
Pulse Rhythm
The normal pulse rhythm is regular, meaning that the frequency of the pulsation felt by your fingers follows an even tempo with equal intervals between pulsations. If you compare this to music, it involves a constant beat that does not speed up or slow down, but stays at the same tempo. Thus, the interval between pulsations is the same. However, sinus arrhythmia is a common condition in children, adolescents, and young adults. Sinus arrhythmia involves an irregular pulse rhythm in which the pulse rate varies with the respiratory cycle: the heart rate increases at inspiration and decreases back to normal upon expiration. The underlying physiology of sinus arrhythmia is that the heart rate increases to compensate for the decreased stroke volume from the heart’s left side upon inspiration.
Points to Consider
If a pulse has an irregular rhythm, it is important to determine whether it is regularly irregular (e.g., three regular beats and one missed and this is repeated) or if it is irregularly irregular (e.g., there is no rhythm to the irregularity). Irregularly irregular pulse rhythm is highly specific to atrial fibrillation. Atrial fibrillation is an arrhythmia whereby the atria quiver. This condition can have many consequences including decreased stroke volume and cardiac output, blood clots, stroke, and heart failure.
Pulse Rate
The pulse rate is counted by starting at one, which correlates with the first beat felt by your fingers. Count for thirty seconds if the rhythm is regular (even tempo) and multiply by two to report in beats per minute. Count for one minute if the rhythm is irregular. In children, pulse is counted for one minute considering that irregularities in rhythm are common.
Pulse Force
The pulse force is the strength of the pulsation felt when palpating the pulse. For example, when you feel a client’s pulse against your fingers, is it gentle? Can you barely feel it? Alternatively, is the pulsation very forceful and bounding into your fingertips? The force is important to assess because it reflects the volume of blood, the heart’s functioning and cardiac output, and the arteries’ elastic properties. Remember, stroke volume refers to the volume of blood pumped with each contraction of the heart (i.e., each heart beat). Thus, pulse force provides an idea of how hard the heart has to work to pump blood out of the heart and through the circulatory system.
Pulse force is recorded using a four-point scale:
- 3+ Full, bounding
- 2+ Normal/strong
- 1+ Weak, diminished, thready
- 0 Absent/non-palpable
Practice on many people to become skilled in measuring pulse force. While learning, it is helpful to assess pulse force along with an expert because there is a subjective element to the scale. A 1+ force (weak and thready) may reflect a decreased stroke volume and can be associated with conditions such as heart failure, heat exhaustion, or hemorrhagic shock, among other conditions. A 3+ force (full and bounding) may reflect an increased stroke volume and can be associated with exercise and stress, as well as abnormal health states including fluid overload and high blood pressure.
Pulse Equality
Pulse equality refers to whether the pulse force is comparable on both sides of the body. For example, palpate the radial pulse on the right and left wrist at the same time and compare whether the pulse force is equal. Pulse equality is assessed because it provides data about conditions such as arterial obstructions and aortic coarctation. However, the carotid pulses should never be palpated at the same time as this can decrease and/or compromise cerebral blood flow. | libretexts | 2025-03-17T22:26:24.622236 | 2019-11-19T05:25:13 | {
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https://med.libretexts.org/Bookshelves/Allied_Health/Vital_Sign_Measurement_Across_the_Lifespan_(Lapum_et_al.)/03%3A_Pulse_and_Respiration/3.18%3A_Radial_Pulse | 3.18: Radial Pulse
Technique
Use the pads of your first three fingers to gently palpate the radial pulse (OER #1). The pads of the fingers are placed along the radius bone, which is on the lateral side of the wrist (the thumb side; the bone on the other side of the wrist is the ulnar bone). Place your fingers on the radius bone close to the flexor aspect of the wrist, where the wrist meets the hand and bends. See Figure 3.2 for correct placement of fingers. Press down with your fingers until you can best feel the pulsation. Note the rate, rhythm, force, and equality when measuring the radial pulse (OER #1).
Figure 3.2: Correct placement of fingers
Technique Tips
Note the first beat felt in your fingers as “1” and then continue to count. Alternatively, start counting at “0” when your watch is at zero and then continue to count.
What should the healthcare provider consider?
You may need to adjust the pressure of your fingers when palpating the radial pulse if you cannot feel the pulse. For example, sometimes pressing too hard can obliterate the pulse (make it disappear). Alternatively, if you do not press hard enough, you may not feel a pulse. You may also need to move your fingers around slightly. Radial pulses are difficult to palpate on newborns and children under five, so healthcare providers usually assess the apical pulse or brachial pulse of newborns and children.
Points to Consider
You can use a Doppler ultrasound device if you are struggling to feel the pulse and are concerned about perfusion into the limbs. This is a handheld device that allows you to hear the whooshing sound of the pulse. The Doppler device is also used following surgery or insertion of a central line to assess blood flow. These devices are most commonly used when assessing peripheral pulses in the lower limbs, such as the dorsalis pedis pulse or the posterior tibial pulse. See Film clip 3.1 for use of a Doppler device. The doppler device is also used to locate the brachial pulse and assess blood pressure in infants.
An interactive or media element has been excluded from this version of the text. You can view it online here: pb.libretexts.org/vitalsign/?p=102
Film clip 3.1: Use of doppler device
Alternatively, if viewing textbook as a pdf, use this link: https://www.youtube.com/embed/cn3aA0G1mgc?rel=0
_________________________________________________________________________
Part of this content was adapted from OER #1 (as noted in brackets above):
© 2015 British Columbia Institute of Technology (BCIT). Clinical Procedures for Safer Patient Care by Glynda Rees Doyle and Jodie Anita McCutcheon, British Columbia Institute of Technology. Licensed under a Creative Commons Attribution 4.0 International License , except where otherwise noted. Download this book for free at http://open.bccampus.ca | libretexts | 2025-03-17T22:26:24.681297 | 2019-11-19T05:25:15 | {
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"book_url": "https://commons.libretexts.org/book/med-16787",
"title": "3.18: Radial Pulse",
"author": "Lapum et al."
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https://med.libretexts.org/Bookshelves/Allied_Health/Vital_Sign_Measurement_Across_the_Lifespan_(Lapum_et_al.)/03%3A_Pulse_and_Respiration/3.19%3A_Carotid_Pulse | 3.19: Carotid Pulse
May be taken when radial pulse is not present or is difficult to palpate (OER #1).
Technique
Ask the client to sit upright. Locate the carotid artery medial to the sternomastoid muscle (between the muscle and the trachea at the level of the cricoid cartilage, which is in the middle third of the neck). With the pads of your three fingers, gently palpate the carotid artery, one at a time. See Figure 3.3 for correct placement of fingers.
Figure 3.3: Correct placement of fingers
What should the healthcare provider consider?
Although other pulses can be taken simultaneously to assess equality, the carotid pulses are NEVER taken at the same time. Gently palpate one artery at a time so that you do not stimulate the vagus nerve and compromise arterial blood flow to the brain. Avoid palpating the upper third of the neck, because this is where the carotid sinus area is located. You want to avoid pressure on the carotid sinus area because this can lead to vagal stimulation, which can slow the heart rate, particularly in older adults.
Technique Tips
Never palpate the carotid pulses simultaneously as this will reduce and/or compromise cerebral blood flow.
_________________________________________________________________________
Part of this content was adapted from OER #1 (as noted in brackets above):
© 2015 British Columbia Institute of Technology (BCIT). Clinical Procedures for Safer Patient Care by Glynda Rees Doyle and Jodie Anita McCutcheon, British Columbia Institute of Technology. Licensed under a Creative Commons Attribution 4.0 International License , except where otherwise noted. Download this book for free at http://open.bccampus.ca | libretexts | 2025-03-17T22:26:24.738886 | 2019-11-19T05:25:15 | {
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"book_url": "https://commons.libretexts.org/book/med-16787",
"title": "3.19: Carotid Pulse",
"author": "Lapum et al."
} |
https://med.libretexts.org/Bookshelves/Allied_Health/Vital_Sign_Measurement_Across_the_Lifespan_(Lapum_et_al.)/03%3A_Pulse_and_Respiration/3.20%3A_Brachial_Pulse | 3.20: Brachial Pulse
Brachial pulse rate is indicated during some assessments, such as with children, in whom it can be difficult to feel the radial pulse. A Doppler can be used to locate the brachial pulse if needed.
Technique
The brachial pulse can be located by feeling the bicep tendon in the area of the antecubital fossa. Move the pads of your three fingers medial (about 2 cm) from the tendon and about 2–3 cm above the antecubital fossa to locate the pulse. See Figure 3.4 for correct placement of fingers along the brachial artery.
Figure 3.4: Correct placement of fingers
What should the healthcare provider consider?
It can be helpful to hyper-extend the arm in order to accentuate the brachial pulse so that you can better feel it. You may need to move your fingers around slightly to locate the best place to most accurately feel the pulse. You will usually need to press fairly firmly to palpate the brachial pulse. | libretexts | 2025-03-17T22:26:24.794514 | 2019-11-19T05:25:17 | {
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"book_url": "https://commons.libretexts.org/book/med-16787",
"title": "3.20: Brachial Pulse",
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https://med.libretexts.org/Bookshelves/Allied_Health/Vital_Sign_Measurement_Across_the_Lifespan_(Lapum_et_al.)/03%3A_Pulse_and_Respiration/3.21%3A_Apical_Pulse | 3.21: Apical Pulse
Apical pulse is auscultated with a stethoscope over the chest where the heart’s mitral valve is best heard. In infants and young children, the apical pulse is located at the fourth intercostal space at the left midclavicular line. In adults, the apical pulse is located at the fifth intercostal space at the left midclavicular line (OER #1). See Figure 3.5 below.
Figure 3.5: Apical Pulse (Illustration credit: Hilary Tang)
Apical pulse rate is indicated during some assessments, such as when conducting a cardiovascular assessment and when a client is taking certain cardiac medications (e.g., digoxin) (OER #1). Sometime the apical pulse is auscultated pre and post medication administration. It is also a best practice to assess apical pulse in infants and children up to five years of age because radial pulses are difficult to palpate and count in this population. It is typical to assess apical pulses in children younger than eighteen, particularly in hospital environments. Apical pulses may also be taken in obese people, because their peripheral pulses are sometimes difficult to palpate.
Technique
Position the client in a supine (lying flat) or in a seated position. Physically palpate the intercostal spaces to locate the landmark of the apical pulse. Ask the female client to re-position her own breast tissue to auscultate the apical pulse. For example, the client gently shifts the breast laterally so that the apical pulse landmark is exposed. See Figure 3.6 below. Alternatively, the healthcare provider can use the ulnar side of the hand to re-position the breast tissue and auscultate the apical pulse. Ensure draping to protect the client’s privacy.
Either the bell or diaphragm are used to auscultate the client’s heart rate and rhythm. There is a pediatric-size stethoscope for infants. Typically, apical pulse rate is taken for a full minute to ensure accuracy; this is particularly important in infants and children due to the possible presence of sinus arrhythmia. Upon auscultating the apical pulse, you will hear the sounds “lub dup” – this counts as one beat. Count the apical pulse for one minute. Note the rate and rhythm.
Figure 3.6: Female client re-positioning her breast in order to auscultate the apical pulse
Listen to Audio clip 3.1 and count the apical pulse. For practice, we have made this clip 30 seconds so you will need to multiply it by two to report it as beats per minute (but remember, the most accurate measurement is to count the apical pulse for one minute). The reported apical rate in Audio clip 3.1 is: 60 bpm (30 x 2) with a regular rhythm
An interactive or media element has been excluded from this version of the text. You can view it online here: pb.libretexts.org/vitalsign/?p=112
Audio clip 3.1: Counting apical pulse rate
Alternatively, if viewing textbook as a pdf, use this link: https://www.youtube.com/embed/yL4E_6PaPgg?rel=0
What should the healthcare provider consider?
Although pulses are best measured at rest, sometimes this is not possible. It is important to document other factors such as when a person is in pain or an infant/child is crying.
Technique Tips
Feel the intercostal spaces to accurately locate the apical pulse and obtain a physical landmark. There is a space below the clavicle, but the first intercostal space is located below the first rib. You can also slide your fingers down the manubrium where it meets the sternum: this is called the sternal angle (angle of Louis). The second rib extends out from the sternal angle.
_________________________________________________________________________
Part of this content was adapted from OER #1 (as noted in brackets above):
© 2015 British Columbia Institute of Technology (BCIT). Clinical Procedures for Safer Patient Care by Glynda Rees Doyle and Jodie Anita McCutcheon, British Columbia Institute of Technology. Licensed under a Creative Commons Attribution 4.0 International License , except where otherwise noted. Download this book for free at http://open.bccampus.ca | libretexts | 2025-03-17T22:26:24.853473 | 2019-11-19T05:25:17 | {
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"book_url": "https://commons.libretexts.org/book/med-16787",
"title": "3.21: Apical Pulse",
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https://med.libretexts.org/Bookshelves/Allied_Health/Vital_Sign_Measurement_Across_the_Lifespan_(Lapum_et_al.)/03%3A_Pulse_and_Respiration/3.22%3A_What_is_Respiration | 3.22: What is Respiration?
Respiration refers to a person’s breathing and the movement of air into and out of the lungs (OER #2). The respiratory system provides oxygen to body tissues for cellular respiration, removes the waste product carbon dioxide, and helps maintain acid–base balance (OER #2). Inspiration is the process that causes air to enter the lungs, and expiration is the process that causes air to leave the lungs (OER #2). A respiratory cycle (or one breath while you are measuring respiratory rate) is one sequence of inspiration and expiration (OER #2).
Respiration is assessed for quality, rhythm, and rate.
The quality of a person’s breathing is normally relaxed and silent. Healthcare providers assess use of accessory muscles in the neck and chest and indrawing of intercostal spaces (also referred to as intercostal tugging), which can indicate respiratory distress. Respiratory distress can also cause nasal flaring, and the person often moves into a tripod position. The tripod position involves leaning forward and placing arms/hands and/or upper body on one’s knees or on the bedside table.
Respiration normally has a regular rhythm. A regular rhythm means that the frequency of the respiration follows an even tempo with equal intervals between each respiration. If you compare this to music, it involves a constant beat that does not speed up or slow down, but stays at the same tempo.
Respiratory rates vary based on age. The normal resting respiratory rate for adults is 10–20 breaths per minute (OER #1). Children younger than one year normally have a respiratory rate of 30–60 breaths per minute, but by the age of ten, the normal rate is usually 18–30 (OER #2). By adolescence, the respiratory rate is usually similar to that of adults, 12–18 breaths per minute (OER #2). The normal respiratory rate for children decreases from birth to adolescence (OER #2). Respiratory rates often increase slightly over the age of sixty-five.
Estimated respiratory rates vary based on the source. Table 3.2 lists a generous range of normal respiratory rates based on age. It is important to consider the client and the situation to determine whether the respiratory rate is normal. Healthcare providers take into consideration the client’s health and illness state and determinants such as rest/sleep, awake/active, presence of pain, and crying when assessing the respiratory rate.
Table 3.2: Respiratory Rate Ranges
| Age | Rate (breaths per minute) |
|---|---|
| Newborn to one month | 30–65 |
| One month to one year | 26–60 |
| 1–10 years | 14–50 |
| 11–18 years | 12–22 |
| Adult and older adult | 10–20 |
_________________________________________________________________________
Part of this content was adapted from OER #1 (as noted in brackets above):
© 2015 British Columbia Institute of Technology (BCIT). Clinical Procedures for Safer Patient Care by Glynda Rees Doyle and Jodie Anita McCutcheon, British Columbia Institute of Technology. Licensed under a Creative Commons Attribution 4.0 International License , except where otherwise noted. Download this book for free at http://open.bccampus.ca
Part of this content was adapted from OER #2 (as noted in brackets above):
© Apr 10, 2017 OpenStax Anatomy and Physiology. Textbook content produced by OpenStax Anatomy and Physiology is licensed under a Creative Commons Attribution License 4.0 license. Download for free at http://cnx.org/contents/7c42370b-c3ad-48ac-9620-d15367b882c6@12 | libretexts | 2025-03-17T22:26:24.913138 | 2019-11-19T05:25:19 | {
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"book_url": "https://commons.libretexts.org/book/med-16787",
"title": "3.22: What is Respiration?",
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https://med.libretexts.org/Bookshelves/Allied_Health/Vital_Sign_Measurement_Across_the_Lifespan_(Lapum_et_al.)/04%3A_Oxygen_Saturation | 4: Oxygen Saturation Last updated Save as PDF Page ID 16791 Lapum et al. Ryerson University (Daphne Cockwell School of Nursing) via Ryerson University Library 4.1: Try it Out- Pulse Oximetry 4.2: Test Yourself 4.3: Test Yourself- Answers 4.4: Test Yourself- List in the Correct Order 4.5: Test Yourself- List in the Correct Order – Answers 4.6: Chapter Summary 4.7: How Best to View this Chapter? 4.8: Oxygen Saturation 4.9: How is Oxygen Saturation Measured? 4.10: What are Normal Oxygen Saturation Levels? 4.11: Oxygen Saturation Technique 4.12: Finding the Error Activity 1- Pulse Oximetry 4.13: Finding the Error Activity 1- Pulse Oximetry – Feedback 4.14: Finding the Error Activity 2- Pulse Oximetry 4.15: Finding the Error Activity 2- Pulse Oximetry – Feedback | libretexts | 2025-03-17T22:26:24.999614 | 2019-11-19T05:24:56 | {
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"book_url": "https://commons.libretexts.org/book/med-16787",
"title": "4: Oxygen Saturation",
"author": "Lapum et al."
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https://med.libretexts.org/Bookshelves/Allied_Health/Vital_Sign_Measurement_Across_the_Lifespan_(Lapum_et_al.)/04%3A_Oxygen_Saturation/4.01%3A_Try_it_Out-_Pulse_Oximetry | 4.1: Try it Out- Pulse Oximetry
Next, you have an opportunity to watch a short film clip on accurate measurement techniques. Watch this film clip 4.2 to see how to measure oxygen saturation correctly using a pulse oximeter. After the clip, try the technique yourself. You can watch the clip and practice as many times as you like.
Alternatively, if viewing textbook as a pdf, use this link: https://www.youtube.com/embed/6KTG1lWQ8bs?rel=0
An interactive or media element has been excluded from this version of the text. You can view it online here: pb.libretexts.org/vitalsign/?p=173
Film clip 4.2: Oxygen saturation taken correctly | libretexts | 2025-03-17T22:26:25.053755 | 2019-11-19T05:25:36 | {
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"title": "4.1: Try it Out- Pulse Oximetry",
"author": "Lapum et al."
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Subsets and Splits