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Nursing Resources

The Community Guide

A Living Resource for Nursing Practice

Suzuki, Laura K. MPH, RN, CPH; Edmonds, Joyce K. PhD, MPH, RN, PHCNS-BC, CPH

Author Information
AJN, American Journal of Nursing: March 2020 - Volume 120 - Issue 3 - p 55-57
doi: 10.1097/01.NAJ.0000656352.36531.5d
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Abstract

The Guide to Community Preventive Services, more commonly known as the Community Guide (www.thecommunityguide.org), is an online collection of evidence-based recommendations from the Community Preventive Services Task Force (CPSTF) that identifies promising, cost-effective ways to improve community and population health. Robust and continuously updated, the Community Guide covers a broad range of health topics and conditions, offering more than 240 findings and recommendations for community preventive programs, services, and policies in 21 priority health topic areas. Since its launch in 2001, the Community Guide has evolved and expanded, keeping pace with the development of new and relevant evidence and identifying a growing number of uses for and users of the nationwide programs and interventions it recommends.

Despite its easy accessibility, however, the Community Guide remains underutilized. Most public health nurses are well acquainted with it, but nurses in other specialties may be less familiar with it and how it can be used. Its potential to improve nursing care and health promotion efforts in a wide variety of settings—such as work sites, schools, military bases, and integrated health systems—is enormous.

The Community Guide helps nurses, health care providers, and other decision makers develop interventions based on the collective expertise of the public health community. Nurses can use its recommendations to form the building blocks of their own care delivery interventions or health promotion initiatives, adapting them for specific circumstances and populations—thus eliminating the need to “reinvent the wheel.” This article describes the Community Guide's content, function, and purpose, as well as its utility to nurses in guiding health promotion and disease prevention efforts across practice settings.

THE CPSTF

Established in 1996 by the U.S. Department of Health and Human Services (HHS), the CPSTF is an independent advisory body to the federal government.1 It is congressionally mandated to identify cost-effective community-based health interventions to improve Americans' quality of life and increase longevity.2 Its members are public health and prevention experts, including nurses, with a broad range of experience and knowledge in practice, research, and policy. The work of the CPSTF is informed by 32 liaisons from federal agencies, state and local health departments, health care organizations, professional organizations, the U.S. Armed Forces, and other national organizations.3 Nurses are represented by the Council of Public Health Nursing Organizations (formerly the Quad Council Coalition of Public Health Nursing Organizations) and the American Association of Nurse Practitioners.

METHODOLOGY OF EVIDENCE REVIEW

The methodological process the CPSTF uses to prioritize and evaluate findings and recommendations is described in the literature4-7 and on the Community Guide's website (see www.thecommunityguide.org/about/our-methodology). In brief, the CPSTF identifies effective interventions through systematic review of the literature on community preventive services, programs, and policies in health-related areas. Areas considered are those that address a significant disease burden or contemporary health issue, identify health disparities, or align with other national health initiatives (for instance, Healthy People 2020).

Systematic reviews conducted by the CPSTF seek to evaluate interventions by

  • analyzing all available evidence on what works to promote health and prevent disease, injury, and disability. Who does it work for? How well? Is the benefit seen consistently? Are there barriers to implementation?
  • assessing the economic benefits of interventions found to be effective. What is the cost? Is the magnitude of the benefit worth the cost? Does it provide value?
  • identifying where more evidence is needed. Are there unanticipated outcomes that may be harmful or costly? Is the available evidence of sufficient quantity and quality?

EMERGING HEALTH PRIORITIES

Health information technology and health communication are two rapidly emerging areas addressed by the Community Guide. Increasingly, interventions related to mobile health, also known as mHealth, have been endorsed. Examples of promising mHealth interventions recommended in the guide are the use of mobile phones to improve treatment adherence in patients with cardiovascular disease or other chronic conditions, mobile apps for type 2 diabetes self-management, and activity monitors for tracking and encouraging physical activity.

Other digital tools and social media platforms are becoming instrumental in supporting personal health and delivering health care services. These tools can target individuals and can be highly effective in increasing a patient's success with self-care and self-management of chronic conditions, as well as in facilitating real-time, direct communication between providers and patients—both of which can lead to better individual health decision making, fewer complications, and improved overall health. Among such tools addressed by the Community Guide are Internet-based programs for tobacco cessation support, clinical decision support systems to improve cardiovascular disease management outcomes through screening and preventive services, and the use of immunization information systems to boost vaccination rates through client reminder and recall notices, provider feedback, and many other information system–supported interventions.

HEALTH INEQUITIES

To address the critical priority of equity in health care, the CPSTF has begun to focus on interventions that reduce health inequities among racial and ethnic minorities and low-income populations. As a result, recommendations regarding cultural competency and diversity among health care professionals have recently been added to the Community Guide. Also included are findings on designing culturally specific health care settings, using medically trained interpreters to provide linguistically accessible care, and tailoring health education materials to align with the population being served.

ALIGNMENT WITH HEALTHY PEOPLE 2020

The Community Guide is intended to be used to identify interventions and develop practice strategies that are most likely to facilitate reaching the HHS's Healthy People 2020 goals.6 While the Healthy People initiative provides quantitative health promotion and disease prevention goals for communities, with specific measurable objectives to gauge progress,8 it does not offer specific actions or strategies to achieve these targets. The Community Guide, along with its companion, the U.S. Preventive Services Task Force's Guide to Clinical Preventive Services,9 provides a means by which the Healthy People objectives can be met.

THE COMMUNITY GUIDE IN ACTION

The Community Guide in Action section of the website highlights examples of how the guide's recommendations are being implemented. The following examples illustrate how to use the recommended interventions in practice and offer insight into challenges encountered and lessons learned.

AMIGAS intervention. Studies have shown that a high number of Hispanic women—especially Mexican American women—do not regularly receive Pap tests, a primary prevention strategy for cervical cancer.10, 11 In 2005, the CPSTF found that printed educational materials (such as brochures) were effective in increasing the number of women who obtained Pap tests, and, in 2010, they found that one-on-one counseling and client reminders also increased the rate of cervical cancer screening.11 Using this evidence as its basis, the Ayudando a las Mujeres con Información, Guía, y Amor para su Salud (AMIGAS) program was developed. AMIGAS is a bilingual intervention using body diagrams; message cards; a promise sheet, on which women indicate the next steps they will take; and one-on-one counseling aimed at increasing rates of Pap testing among Hispanic women of Mexican descent.11 A randomized controlled trial studying the effect of the AMIGAS intervention in three cities (Houston and El Paso, Texas, and Yakima, Washington) found that it increased cervical cancer screening rates twofold.10

CityHealth initiative. The CityHealth initiative, an effort of the de Beaumont Foundation and Kaiser Permanente, aims to recognize cities that implement evidence-based preventive public health policies.12 Using Community Guide recommendations, CityHealth selected nine policies that fall within cities' jurisdictional authorities and focus on key social determinants of health, such as education, housing, and alcohol and tobacco use. It annually evaluates and awards cities based on the quality and strength of their laws as they relate to the nine policies. Boston, Chicago, Dallas, Los Angeles, and New York City are among the cities awarded “gold” status in 2019.13

RELEVANCE TO NURSES

As more nurses use the Community Guide, its reach has extended beyond the realm of public health nursing into a multitude of settings in which health promotion and disease prevention are priorities. Nurses in primary care settings may find useful the recommendations on chronic disease management of cardiovascular disease or diabetes, as well as findings related to nutrition and physical activity. School nurses may find useful the recommendations on adolescent health or asthma self-management. Community-based nurses may find useful the recommendations for improving vaccination rates or the recommendations related to HIV–AIDS and sexually transmitted infection risk reduction. While many of the interventions in the Community Guide are aimed at population-level efforts, individual strategies are increasingly included, and “all of the intervention approaches are intended to improve health directly.”1

The Community Guide is fully indexed and searchable. It offers a search tool on its website, GuideCompass, whereby users can navigate content by identifying as a specific type of provider and by selecting a health content area or program or planning phase, such as development, implementation, or evaluation. Links to useful sections of the Community Guide's website can be found in Quick Links: The Community Guide. The Community Guide is also on Twitter: @CPSTF.

Quick Links: The Community Guide

Community Guide

The home page.

www.thecommunityguide.org

Community Guide in Action

Exemplars from the field.

www.thecommunityguide.org/content/the-community-guide-in-action

GuideCompass

Navigation tool to access findings.

www.thecommunityguide.org/guidecompass

Tools for Getting Started

www.thecommunityguide.org/tools

Using the Community Guide

Tailoring interventions to your setting.

www.thecommunityguide.org/about/using-community-guide

Select Topic Areas

Diabetes

www.thecommunityguide.org/topic/diabetes

Emergency Preparedness

www.thecommunityguide.org/topic/emergency-preparedness

Health Communication and Technology

www.thecommunityguide.org/topic/health-communication-and-health-information-technology

Health Equity

www.thecommunityguide.org/topic/health-equity

REFERENCES

1. Community Preventive Services Task Force (CPSTF). About the community guide. n.d. https://www.thecommunityguide.org/about/about-community-guide.
2. Community Preventive Services Task Force (CPSTF). Role of Community Preventive Services Task Force liaison organizations and agencies. Atlanta; 2018.
3. Community Preventive Services Task Force (CPSTF). Liaisons to the Community Preventive Services Task Force. n.d. https://www.thecommunityguide.org/task-force/liaisons-community-preventive-services-task-force.
4. Briss PA, et al Developing an evidence-based guide to community preventive services—methods. The Task Force on Community Preventive Services. Am J Prev Med 2000;18(1 Suppl):35–43.
5. Carande-Kulis VG, et al Methods for systematic reviews of economic evaluations for the Guide to Community Preventive Services. Task Force on Community Preventive Services. Am J Prev Med 2000;18(1S):75–91.
6. Truman BI, et al Developing the Guide to Community Preventive Services—overview and rationale. The Task Force on Community Preventive Services. Am J Prev Med 2000;18(1S):18–26.
7. Zaza S, et al Data collection instrument and procedure for systematic reviews in the Guide to Community Preventive Services. Task Force on Community Preventive Services. Am J Prev Med 2000;18(1S):44–74.
8. Secretary's Advisory Committee on National Health Promotion and Disease Prevention Objectives for 2020. Evidence-based clinical and public health: generating and applying the evidence. Washington, DC: U.S. Department of Health and Human Services; 2010 Jul 26. https://www.healthypeople.gov/sites/default/files/EvidenceBasedClinicalPH2010.pdf.
9. Agency for Healthcare Research and Quality. Guide to clinical preventive services. Recommendations of the U.S. Preventive Services Task Force. Rockville, MD; 2014 May. AHRQ Pub. No. 14-05158.
10. Byrd TL, et al AMIGAS: a multicity, multicomponent cervical cancer prevention trial among Mexican American women. Cancer 2013;119(7):1365–72.
11. Smith JL, et al AMIGAS: building a cervical cancer screening intervention for public health practice. J Womens Health (Larchmt) 2013;22(9):718–23.
12. CityHealth. About CityHealth. 2019. https://www.cityhealth.org/about.
13. CityHealth. Creating the new gold standard for health and well-being in cities. 2019. http://cityhealthdata.org/city.
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