A nurse is reviewing the record of a client who has a new diagnosis of diabetes mellitus and an A1C of 9. The client has attended multiple workshops about diabetes management but reports not using the meal plan to assist with nutrition and feels unmotivated to start an exercise regimen. According to the Theory of Reasoned Action/Planned Behavior, which of the following explains the likelihood of this client having good outcomes in follow-up clinic visits?

Choice A Reason:
Considering the individual characteristics first focuses on personal attributes such as age, gender, genetics, and personal health behaviors. While these factors are important, the ecological model emphasizes the broader context in which individuals live. Starting with individual characteristics may overlook the larger environmental and social influences that significantly impact health outcomes.

Choice B Reason:
Close social circles, including family, friends, and immediate social networks, play a crucial role in shaping health behaviors and providing support. These relationships can influence lifestyle choices, stress levels, and access to resources. However, focusing on close social circles first may not capture the broader environmental and societal factors that also affect health.

Choice C Reason:
Social and cultural factors encompass the norms, values, and practices of the community. These factors influence health behaviors, access to healthcare, and overall well-being. While social and cultural factors are vital, they are part of a larger context that includes the physical environment. Addressing these factors without considering the environment may provide an incomplete picture of the community's health.

Choice D Reason:
The environment includes the physical, social, and economic conditions in which people live. This encompasses factors such as housing quality, access to green spaces, pollution levels, and availability of healthcare services. The environment sets the stage for individual and community health by influencing exposure to risks and access to resources. Starting with the environment provides a comprehensive understanding of the context in which individuals and communities operate, making it the most appropriate starting point for an ecological assessment.

Choice A Reason:
The first step assists with how to perform a collection of evidence. While collecting evidence is an important part of many toolkits, the University of Kansas toolkit is specifically designed to guide users through a comprehensive process. The focus is on a structured approach rather than just the initial step of evidence collection.

Choice B Reason:
It is used in planning community initiatives. This statement is true but not specific enough to be the standout feature of the toolkit. Many toolkits are used for planning community initiatives. The unique aspect of the University of Kansas toolkit is its structured, step-by-step methodology, which sets it apart from other resources.

Choice C Reason:
It uses a step-by-step approach. This is the correct answer because the University of Kansas toolkit is designed to provide a clear, structured process for users. This approach ensures that all necessary steps are followed systematically, making it easier for community groups to plan and implement their initiatives effectively. The step-by-step methodology is a core feature that enhances the usability and effectiveness of the toolkit.

Choice D Reason:
It is a proprietary document that is used solely within the state of Kansas. This statement is incorrect. The toolkit provided by the University of Kansas is intended for broader use and is not restricted to the state of Kansas. It is designed to be a resource for community groups and organizations regardless of their location, promoting best practices in community planning and development.