Post on 23-Dec-2015
Purpose of Notes To provide students with:
Overview of planning models Describe common caveats Describe research on impact Strategies to overcome barriers of models
Objectives Discuss the importance of planning
relevant, practical programs for social change
Explain types of planning models Explain the planning process Discuss concerns and issues
Health Programs Health programs are are a set of planned
and organized activities carried out over time to accompish specific health-related goals and objectives
Overview of Planning Planning for programs has various
approaches: “Hit the ground running” approach “Purpose-driven” approach “Process-oriented” approach “Model-driven” approach
Planning Models PRECEDE-PROCEED (Green and Kreuter) PATCH (CDC, 1985) MATCH (Simons-Morton, D., Simons-
Morton, B., Parcel, & Bunker, 1988) Generalized Model for Program Planning
(McKenzie and Smeltzer, 2001) CDCynergy (CDC, 1998)
PRECEDE 1st Phase: Social Diagnosis 2nd Phase: Epidemiological Diagnosis 3rd Phase: Behavioral/Environmental 4th Phase: Educational/Ecological 5th Phase: Administrative/Policy
PROCEED 6th Phase: Implementation 7th Phase: Process Evaluation 8th Phase: Impact Evaluation 9th Phase: Outcome Evaluation
PATCH Phase I: Mobilizing the community Phase II: Collecting and organizing data Phase III: Choosing priorities Phase IV: Developing a comprehensive
intervention plan Phase V: Evaluating PATCH
MATCH Phase 1: Goal Setting Phase 2: Intervention Planning Phase 3: Program Development Phase 4: Implementation Preparations Phase 5: Evaluation
Generalizing Model for Program Planning
1. Assessing Needs
2. Identifying the Problems
3. Setting Goals and Objectives
4. Developing and Intervention
5. Implementing the Intervention
6. Evaluating the Results
CDCynergy Phase 1: Problem definition and description Phase 2: Problem analysis Phase 3: Communication program planning Phase 4: Program and evaluation
development Phase 5: Program implementation and
management Phase 6: Feedback
EMPOWER A computer-based
planning program Enabling methods of
planning and organizing within everyone’s reach.
Based on PRECEDE-PROCEED
Common Components Most of the models have these in common:
Asking “why” instead of “how” Gathering data Identifying goals/objectives Strategy/intervention selection Implementation Evaluation Follow-up/Feedback
So many models…But do they work?
Is a model suppose to work?
Or is it just to allow for a structured process in organizing programs?
What evidence is there to support the use of a model over the other?
Advantages Provides direction Non-biased approach Uncovers hidden problems Provides evaluation measures Ability to use theories within model
Caveats Takes time and resources before
implementation Create problems for un-experienced
program planners Difficult to determine where theories fit May never implement program Evaluation is never ending
Do Planning Models Work? How effective are planning models if used
correctly in the success of a program or project activity?
Research on Effect Some models are new and don’t have
effectiveness data. PRECEDE-PROCEED has most use Results…
Strategies Use planning models over other
approaches Using one or two parts of a model can still
help Use theories with conjunction with a
planning model
Case Studies For each case study, provide the following:
What should be the first step? How would you provide the rationale? Methods used to determine impact. Should the program be implemented? What should be the focus of evaluation efforts?
Case Study 1 A plastic surgeon has observed many
children needing reconstructive surgery due to lawnmowers. The surgeon asked for support to do a program on lawnmower safety to parents in the tri-county areas. You are the head of a foundation that supports research efforts and program in the region and your organization has a board of directors.
Case Study 2 The student services director of a small
urban college is concerned about the attrition of first years students. The director makes a bold move to start a program that seeks to retain students through offering incentives for second and third year students. You are a faculty member of the student services board. What would be your comments?
Case Study 3 A local non-profit agency that offers
assistance to the homeless is establishing a new program that will help the homeless find work. It is seeking financial support from local business to provide immediate housing for homeless people who find employment. What would be some problems and how could planning help?
Social Assessment Guidelines1. Engage community members as active partners
in social diagnosis.
2. Identify ultimate values and subjective concerns with quality of life or conditions of living in the population.
3. Verify and clarify these subjective concerns either through existing data sources or new data from surveys or interviews.
Social Assessment Guidelines4. Demonstrate how social concerns and ultimate
values can serve to heighten awareness of and motivation to act on health problems.
5. Assess the capacities and assets of a community.
6. Make explicit the rationale for the selection of priority items.
7. Use the documentation and rationale from social assessment as one of the variables on which to evaluate the program.
Types of Social Assessment Qualitative vs. Quantitative
Qualitative = quality, low numbers, lots of information, open ended questions
Examples: interviews, focus groups, nominal group process
Quantitative = lots of numbers, limited information, closed ended questions.
Examples: surveys by telephone, mail, or self administered.
Qualitative Research Methods Focus Groups Nominal Groups Community Forum Observation Depth Interviews Projective Techniques
Focus Groups Group interviews
where a moderator guides the interview while the group discusses the topics that are asked.
Steps in Focus Group Process Step 1: Prepare for the Group
Select a focus group facility Recruit the participants
Step 2: Select a Moderator Create a discussion guide for moderator
Step 3: Conduct the Group Step 4: Prepare the Focus Group Report
Qualitative Research Methods Nominal Groups
Using groups of five to 10 people who have knowledge of issues under consideration.
Community Forums Identify needs of a community through public meetings
Observations Observing target audience for visual and auditory cues
which may provide understanding of issues being investigated.
Qualitative Research Methods Depth Interview
One-on-one interviews that probe and gain detailed answers to questions that try to uncover hidden motivations
Projective Techniques Trying to tap respondents’ deepest feelings by
having them “project” those feeling into an unstructured activity or situation.
Priorities of Health Programs1. Which problem has the greatest impact in terms
of death, disease, days lost from work rehabilitation costs, disability, etc.
2. Are certain subpopulations, such as children, mothers, ethnic minorities, refugees, indigenous populations at special risk?
3. Which problems are most susceptive to intervention?
Priorities for Health Programs
4. Which problem is not being addressed by other agencies in the community?
5. Which problem, when appropriately addressed, has the greatest potential for an attractive yield?
6. Are any of the health problems highly ranked as a regional or national priority?
Epidemiological Assessment/Diagnosis
Epidemiology—Branch of medicine dealing with a combination of knowledge and research methods concerned with the determinants and distribution of health and illness in populations.
Surveillance The ongoing process and systematic collection,
analysis, and interpretation of health data.
In surveillance, the following questions should be asked concerning disease, illness, and injury: What: specific disease, illness, injury Who: person variables: age, gender, race, etc. How: causes, risk factors of disease When: when did the disease occur Where: where did person acquire disease
Fall Injury ReportSpringdale Safe Communities
Location of Fall: Home Work Street Sports/RecreationOther (Where?_________________________________)
Age:_________ Gender: Male Female
Ethnicity: African-American Hispanic CaucasianOther (specify:_______________________)
Severity of Fall: Fatal Hospitalized Ambulatory (fracture, loss of consciousness only)
Type of Fall: Same Level Different level
Same Level Location: Bathtub Other bathroomBedroom Kitchen Living RoomBasement Attic Home yard Sidewalk
Street Public Building Private BuildingSports field Other (Where?_________________)Not applicable
Different Level Location: Exterior stairs to house entrance Stairs to upper floors Stairs to atticStairs to basement Stairs to public building Stairs in nonresidential
private building
Home porch or landing Window Roof TreeCliff or dropoff Ladder
Horse Other (Explain_______________________)
Probable Cause of Fall: Alcohol/Drug Poor Vision WeatherMedications Physical Capabilities BehaviorInattention Possible Brittle Bone/Osteoporosis
Unsafe Environment Sports/Recreation Activity (What?____________)
Prevention Measure: Skid strips in tub Skid strips on stairs Nonskid rugsNonskid shoes Handrail Snow/ice clearanceSoft carpet Stair repairs Fence or other barrierSports equipment (What?____________________________________)
Other (What?_____________________________________________)
Phases 3 & 4 Assumption 1: A specific health problem
has been identified.
Assumption 2: A common goal has already been established for the overall program.
Behavioral & Environmental Diagnosis Steps
Step 1: Identify and list risk factors Step 2: Differentiate between behavioral
and environmental factors Step 3: Shorten the list. Which factors are
relevant to the program goal?
Behavioral & Environmental Diagnosis Steps
Step 4: Determine Importance. How prevalent is the behavior? Does factor contribute to problem?
Behavioral & Environmental Diagnosis Steps
Step 5: Determine Changeability There is precedence elsewhere for similar
changes. The economic costs are not prohibitive. The proposed change is supported by public
demand.
Behavioral & Environmental Diagnosis Steps
Step 6: Create a matrix.
More Important
Less Important
More Changeable
Less Changeable
Selecting Factors & Priorities Step 1: Identify factors explaining health
behavior.
Step 2: Classify into Predisposing, Reinforcing, and Enabling Factors
Factors Effecting Behavior Predisposing (before behavior)
Motivate behavior related to health. Knowledge Attitudes Beliefs
Factors Effecting Behavior Enabling (before behavior)
Characteristics of environment that facilitate health behavior or attaining skills required to perform behavior.
Skills Peers Other important persons Laws and regulations
Factors Effecting Behavior Reinforcing (after behavior)
Reward or punishment following consequence of health behavior.
Encouragement Reward/punishment Other people
Selecting Factors & Priorities Step 3: Determine the importance of each factor Step 4: Determine the changeability of each
factor. Step 5: Create a matrix to find factors that have a
high importance and high changeability. Step 6: Write measurable learning objectives.
Development of Health Education Learning Objective Components
1. WHO (priority group) Specific group on whom objective will focus on.
2. WHAT What is the target group expected to do? Should contain action verb.
3. HOW MUCH How much is to be achieved by priority group?
Development of Health Education Learning Objective Components
4. WHERE What are the specific geographic boundaries of
program effort?
5. WHEN What amount of time has been allowed for
achieving the objective?
Objective Example Program Goal:
By the year 2000, as a result of the Safe Communities Program, reduce fatal injuries among those aged 15 to 24 caused by motor vehicle crashes in Springdale to no more than 17 per 1,000,000 population. (The current level is 33 per 100,000.)
Administrative Diagnosis Step 1: Resources needed
Time Staff Money
Step 2: Assessment of Available Resources
Administrative Diagnosis Step 3: Assessment of Barriers to
Implementation Staff Commitment and Attitudes Conflict of Goals Rate of Change Familiarity Complexity Space Community Barriers
Policy Diagnosis Step 1: Assessment of Policies,
Regulations, and Organization Loyalty Consistency Flexibility Administrative/Professional Discretion
Policy Diagnosis Step 2: Assessment of Political Forces
Level of Analysis Win-Lose Approach Systems Approach Exchange Theory Power Equalization Approach Power Educative Approach Conflict Approach Advocacy and Educating the Electorate Empowerment Education and Community Development
Components of a Proposal1. Introduction
2. Program goals and objectives
3. Detail of program strategies and activities
4. Evaluation of program
5. Program timeline
Components of a Proposal6. Budget
7. Staff and personnel experience
8. Boilerplate material: Non-profit status Board of directors Committee members Organization information
9. Letters of support
Finding Funding for Project Two Main Sources
Government – produce request for funding (RFP’s) for proposals specific to a disease or prevention activity.
Finding Funding for Project Foundations –
(examples, Wal-Mart, CommunityCare Foundation) – Usually accept proposals on ongoing basis. Most often very specific guidelines and special interests areas for funding (education, arts, community, etc.)
Project Description 1. List major activities.
2. Estimate time for activities.
3. How activity is spread out over time.
Project Timelines: Gantt Chart List of activities with
the time needed to complete each program component.
Budget Items Personnel
Director Staff Administrative
Assistance Consultants Hourly
Equipment
Facilities Cost Travel (Domestic -
International) Materials and Supplies Communications
(phone, fax, etc.) Indirect Costs
Activity: Grants Research and find a grant (with submission
guidelines) opportunity related to your area of interest from: Governmental Source Foundation
Bring to class for discussion
Health Communications Definition - Intention to inform, influence,
and motivate individuals and organization to take action toward health.
Health Communications Health Communications can:
Increase awareness Demonstrate skills Demonstrate a demand for health services Remind or reinforce knowledge
Health Communications Health Communications can’t:
Compensate for lack of health care Produce behavior change Be equally effective with all messages
Social Marketing Theory Definition: Applies concept of traditional
marketing to the "sale" of promotion of healthy behaviors.
Elements include: Market plan, Carefully designed message, Employment of mass media, Consensus building, and Appropriate packaging.
Social Marketing Theory Stresses the importance of understanding
the target audience and designing strategies based on their wants and needs rather than what good health practice directs that they should do.
Social Marketing Theory 8 major components
i. consumer orientationii. exchange theoryiii. audience analysis and segmentationiv. formative researchv. channel analysisvi. marketing mix
1. product2. price3. place4. promotion
vii. process trackingviii. marketing management
What is media advocacy? The strategic use of media as a resource
for advancing a social or public policy initiative.
How can a media opportunity best advance policy goals and shift the debate from individuals to the collective decisions of policies and norms?
Steps in Media Advocacy Media Advocacy Set Public Agenda Public Advocacy Influence legislation Set Policy
How is media advocacy different from health education? Political vs. Behavioral science Individual as advocate vs. Individual as audience Advance healthy public policy vs. Develop health
messages Decentralized and opportunistic vs. Problem and
approach Changes in environment vs. Changes in individual Uses news and paid ads vs. Public service bulletins Target is person power vs. Person with problem Power gap vs. Information gap
Media Advocacy Strategies Cultivating relationships Research (monitoring) Creative epidemiology Creating news Link with other news Use paid advertising
Media Advocacy Strategies Issue framing (access, content)
Access Controversy Milestone Anniversary Irony Celebrity Breakthrough Localize Personalize Injustice
Content Translate individual problem to
social issue Assign primary responsibility Present solution Make practical/policy appeal Develop pictures and images Tailor to audience
Limitations Lack of guidelines Complex skills Time requirements Movement away from behavior Controversial and confrontive
Earned Media Utilizing print, broadcast, and interactive media
to elevate the level of public awareness. Not posters brochures, or other print materials.
Core Principles Messages Target Testing Follow-up
Earned Media: Target Focus to get most for money Maximize efficiency Reach those who need message Example: Drinking and driving
Under-age drinkers 21-34 year olds Hard core drinkers and repeat offenders
Earned Media: No Free Media-Earned!
Focus on issue Local relevance Timeliness-today!! Problem-solution Call to action—call to advocacy
Earned Media: Hooks that Work Crisis-you have a solution Controversy Innovation/creation (visual) Research/Studies Note: does not need to be all original
Earned Media: Tactics/Strategies Proclamation Community event Press conference (few) Ribbon-cutting/ground breaking Speaking engagements
Earned Media: Vehicles Media advisories Calendar of events Press release Letter to the editor PSA Op-Eds Talk radio News media Intenet/new media
(used by most of reporters)
Cable television Community-bulletin
boards
Earned Media: Partners in Programs Research Training Branding Development
Marketing Media Tracking Reporting
Earned Media: Successful Programs
Remain focused Effective materials and messages Generate awareness Foster strategic alliances Provide ease of action Sustain effort
Phases 7-9Evaluation Evaluation is: the comparison of an object of
interest against a standard of acceptability Types of Standards:
Arbitrary Scientific Historical Normative Compromise
Phases 7-9 Evaluation Types of Evaluation Design
Historical Record-Keeping (easy) Periodic Inventory Comparative Controlled-Comparative Controlled Experimental Evaluative Research (more rigorous)