Improving EPSDT Use: Development and Application of a Practice-Based Model for Public Health Nursing Research


  • Maija L. Selby Dr.P.H., R.N., C,

    Corresponding author
    1. Dr. Selby is Associate Professor and Director of Research, School of Nursing, University of North Carolina at Greensboro.
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  • Roberta Riportella-Muller Ph.D.,

    1. Dr. Riportella-Muller is Research Assistant Professor, Department of Social Medicine, School of Medicine, and Research Associate, Center for Health Promotion and Disease Prevention, University of North Carolina (UNC)-Chapel Hill.
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  • James R. Sorenson Ph.D.,

    1. Dr. Sorenson is Professor and Chair, Department of Health Behavior and Health Education, School of Public Health, UNC-Chapel Hill.
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  • Clara R. Walters M.S., R.N.

    1. Ms. Walters is Clinical Associate Professor, School of Nursing, UNC-Chupel Hill.
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  • This project was made possible by support from United Way of North Carolina Social/Behavioral Sciences Research Award; Biomedical Research Support Grant: University Research Council Research Award, UNC at Chapel Hill; and Health Promotion/Disease Prevention Program Research Award, School of Public Health. UNC at Chapel Hill.

Address correspondence to Dr. Maija L. Selby, School of Nursing. UNC-Greensboro, NC 27412-5001.


The purposes of this article are to describe the process of adapting an existing model to create a framework suitable for public health nursing (PHN) practice and to demonstrate how the resulting model can guide research for PHN practice. Using the PRECEDE (predisposing, reinforcing, and enabling causes in educational diagnosis and evaluation) model as a base, we synthesized concepts of health behavior, health education, health promotion/disease prevention, and program evaluation to develop a model for planning and evaluating aggregate-level PHN interventions to improve the use of the Early and Periodic Screening, Diagnosis, and Treatment Program (EPSDT) in rural North Carolina. The model provided the framework for identifying variables relevant to EPSDT use, designing interventions to improve use, and planning a research evaluation of the effectiveness, efficacy, and cost effectiveness of the interventions. This model, and the process used in adapting it for PHN practice, should be helpful for others investigating methods of reaching and bringing effective health-promotion/disease-prevention information to underserved, low-education members of minority groups.