PATCH: PLANNED APPROACH TO COMMUNITY HEALTH

The Planned Approach to Community Health (PATCH) was developed in the mid-1980s as a model for planning community health promotion programs. Although orig-inally developed by the public health sector, PATCH has been adapted and used by universities, private hospitals, businesses, voluntary health organizations, and other groups. The model has been applied in hundreds of diverse communities to address a range of health problems, including cardiovascular disease, teen pregnancy, drug abuse, access to health care, and quality of life. Over the years, PATCH has achieved wide dissemination and acceptance as a community development model that helps communities to mobilize; collect and use local data; set priorities; design and imple-ment effective interventions; and perform process, impact, and outcome evaluations. PATCH was developed by the National Center for Chronic Disease Prevention and Health Promotion at the Centers for Disease Control and Prevention (CDC) in partnership with state and local health departments and community groups.

PATCH follows the PRECEDE (predisposing, reinforcing, and enabling constructs in educa-tional/ environmental diagnosis and evaluation) model, and incorporates five elements that CDC considers critical to success in developing a community health promotion program: (1) community members participate in the process; (2) data guide the devel-opment of programs; (3) participants develop a comprehensive health promotion strategy; (4) evaluation emphasizes feedback and improvement; and (5) the community capacity for health promotion is increased. The model encourages the formulation of a comprehensive intervention plan that applies multiple strategies (e.g., educational, policy, environmental) within various settings (e.g., health care facilities, schools, work sites) and that targets the community as a whole as well as specific groups. A recently revised manual, Planned Approach to Community Health: Guide for the Local Coordinator 1995, was issued, joining concept guides, meeting guides, tools, and handouts for car-rying out PATCH in a community as well as guidelines for adapting the process to a particular community.

Between 1988 and 1992, the PATCH process was evaluated three times. A national working group carried out the first evaluation; and researchers at the University of North Carolina and the Research Triangle Institute carried out the second and third evaluations. Among other findings, evaluators determined that using PATCH increases within the community (1) organizing and data use skills, (2) awareness and interest in health, (3) networking and ability of groups and organizations to work together, and (4) the number of health promotion interventions activities.

To plan an effective intervention, a community must go through its own process of assessing needs, setting priorities, formulating solutions, and establishing program ownership. Interventions are more effective if linkages are formed both within the community and between the community and state health departments, universities, and regional and national organizations that can provide data, resources, and consul-tation. A program will be more successful if it has a strong and enthusiastic coordina-tor and program champion; adequate resources; supportive management within key organizations; and true ownership by the community. Community ownership helps ensure that the interventions are appropriate and effective.

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