Linking Practice and Community Through a Focus on Capability (Text Ver

Slide presentation from the AHRQ 2011 conference.

On September 20, 2011, Robert Lewis Ferrer made this presentation at the 2011 Annual Conference. Select to access the PowerPoint® presentation (13.4 MB). Plugin Software Help.


Slide 1

Linking Practice and Community Through a Focus on Capability

Linking Practice and Community Through a Focus on Capability

Robert L. Ferrer, MD, MPH
Dept. of Family & Community Medicine
University of Texas Health Science Center at San Antonio

Slide 2

A Medical Assistant-Based Program to Promote Healthy Behaviors in Primary Care

A Medical Assistant-Based Program to Promote Healthy Behaviors in Primary Care

  • Robert Ferrer, MD, MPH.
  • Sherrie Gott, PhD.
  • Priti Mody-Bailey, MD, MA.
  • Carlos Jaén, MD, PhD.
  • Sara Araujo, BA.
  • Melissa Talamantes, MS.

Annals of Family Medicine 2009;7:544-512.

Slide 3

Service Outcomes: % Attending Interventions

Service Outcomes: % Attending Interventions

 InterventionControlDifferenceP
Smoking75.328.646.7<.001
EtOH000 
Diet60.622.338.3<.001
Activity75.026.348.7<.001
Any67.421.845.6<.001

Slide 4

Behavioral Outcomes: % of Pts Improved

Behavioral Outcomes: % of Patients Improved

 InterventionControlDifferenceP
Smoking25.021.5  3.50.40
EtOH33.314.219.10.04
Diet16.111.1  5.00.60
Activity25.037.5-12.50.64
Any21.716.9  4.80.26

Slide 5

"Capability"

"Capability"

  • The practical opportunities to live the life one wishes.

Images of two book covers by Amartya Sen are also shown.

Slide 6

Capability Model

Capability Model

Image of a flowchart with the following information:

Inputs (Means to achieve):

  • Available goods & services.
  • Community resources.
  • Income and other assets.
  • Built environment.

Conversion factors:

  • Literacy.
  • Functional status.
  • Social support.
  • Autonomy.
  • Respect.

Capability Set (Freedom to achieve):

  • Opportunity set of achievable functioning.

Choice:

Achieved functioning (Achievement).

Adapted from Robeyns, 2005.

Slide 7

Why can't you go walking?

  • Q: Why can't you go walking?
  • A: Because I don't know how to drive.

Slide 8

Physicians' Advice on Healthy Behaviors

Physicians' Advice on Healthy Behaviors

 %
Doctor encourages healthy eating93.8
Doctor encourages physical activity93.5
Doctor understands how hard to be physically active56.8
Doctor understands how hard to eat healthy37.3


Slide 9

Opportunities for Healthy Behaviors

Opportunities for Healthy Behaviors

 %
Available fruit & vegetables where I shop95.9
Easy to get to food store85.6
Local fruit & vegetables of high quality74.3
Can afford fresh fruit & vegetables69.9
Can afford lean meat & fish57.0
Nearby outdoor physical activity71.9
Easy to walk places in neighborhood57.2
Nearby indoor physical activity49.8
Feel safe walking after dark27.3

Slide 10

Barriers to Healthy Behaviors

Barriers to Healthy Behaviors

 %
Partner sometimes forbids physical activity14.0
Partner sometimes refuses healthy foods30.6
Too tired to cook own meals32.2
Care of family leaves little time for physical activity35.3
Not treated with respect38.6
Illness gets in way of physical activity55.5
Feeling depressed keeps from physical activity56.4
Can’t afford groceries over whole month70.8

Slide 11

Multiple Vulnerabilities: Healthy Eating

Multiple Vulnerabilities: Healthy Eating

1. No grocery in neighborhood.
2. Groceries too expensive over whole month.
3. Little time to prepare own meals.
4. Family doesn't allow to eat recommended foods.

81.2% have 2 or more

# present% of sample
03.1
115.8
229.8
340.4
411.0

Slide 12

Image: A school is shown.

Image: An elementary school is shown.

Slide 13

Image: A whiteboard is shown.

Image: A whiteboard is shown.

Slide 14

Image: Fruits, vegetables, and juices are shown.

Image: Fruits, vegetables, and juices are shown.

Slide 15

Image: A pot of soup is shown.

Image: A pot of soup is shown.

Slide 16

Image: Two doors are shown.

Image: Two doors are shown.

Slide 17

Image: A number of computers are shown.

Image: A number of computers and monitors are shown.

Page last reviewed March 2012
Internet Citation: Linking Practice and Community Through a Focus on Capability (Text Ver. March 2012. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/news/events/conference/2011/ferrer/index.html