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Steps to Delivering Programs
Planning
Implementation
Evaluation
Assessment
Early Planning Process
Feasibility study - Research activities designed to help an organization determine whether a program should or should not be developedNeeds Assessment - Research activities designed to help an organization determine how a program should be developed
Early Planning Process
Community Needs Assessment – evaluating the community as a
whole in terms of its health and nutrition status its needs & the resources available to address
those needs
Importance of early planning…
Removes guessworkProvides baseline infoHelps determine how best to use resources, deliver a program, etc.Helps match services with needsEncourages community participationRaises awareness, understanding and acceptance
Steps in community needs assessment
Step 1 Define the nutritional problem
Step 2 Set the parameters of the assessment
Step 3 Collect data
Step 4 Analyze and interpret data
Step 5 Share findings
Step 6 Set priorities
Step 7 Choose a plan of action
Step 1: Define the nutritional problem
Develop a concise statement of the problem of concern
External catalyst often begins processStimulus may point to perceived or “felt” need of community organizational mandate research findings
Step 2: Set parameters of assessment
Define the “community”Define purpose Set goals/objectives Define target groupDefine types of data needed
Step 3: Collect Data – Type
Community organizational power & structure data understand community power
structures community leaders
Step 3: Collect Data – Type
Community characteristics demographics economic structures sociocultural factors ecological data
Step 3: Collect Data - Type
Community Health health statistics from existing
sources Rates of disease, disability, and
death ID who is at risk for being
malnourished Describes population’s health &
nutritional problems
Step 3: Collect Data - Type
Existing community services & programs helps pinpoint gaps in service builds inventory of nutrition
services and programs
Step 3: Collect Data - Type
Rarely need all data Depends on purpose of needs assessmentProvides precise information to clearly define nut’l problem
Step 3: Collect Data - Sources
LibraryComputerized searchGovernment documentsDiscussions with key informants
Step 3: Collect Data - Sources
National Population Health Survey
Canadian Community Health Survey
Nova Scotia Community Counts
Nova Scotia Health Survey
http://www.hc-sc.gc.ca/fn-an/surveill/nutrition/population/national_health_survey-enquete_nationale_sante_e.html
http://www.statcan.ca/english/concepts/health/cchsinfo.htm
http://www.gov.ns.ca/finance/communitycounts/default.asp
http://www.gov.ns.ca/health/1995-survey/default.htm
Step 3: Collect Data - Sources
National Longitudinal Survey for Children and Youth
Canadian Institute for Health Information
Children’s Lifestyle and School Performance Study
GPI Atlantic
Step 3: Collect Data - Methods
Nutritional surveys/questionnaires existing survey data often cost
effective may not adequately represent
target population
Survey Design
Design & conduct own surveyMore than a clipboard & list of questions
Survey Design
Survey design analysis a discipline in itselfUsually requires a team of experts with many backgrounds
Survey Design
Series of scientific & practical decisionsNeeds clearly defined purposeEach question must yield data to answer specific planning questions
Instrument Development
Establish the Framework
Develop a Skeleton
Determine Validity
Make Revisions
Determine Reliability
Make Revisions
Complete Instrument
Survey Design
Specify target population Choose best method to reach the target, i.e., how to conduct survey?
Who will design, conduct & analyze survey
Survey Design
Is survey reliable and valid?Are norms available?Are survey questions easy to read and understandable?Is the format of the questionnaire clear?Are responses clear?
Survey Design
Is the survey comprehensive but brief? Respondent burden minimized?
Does the survey ask “value laden” questions?Are the questions culturally appropriate?
Health Risk Appraisals
Survey tool used to characterize general health status of groupWidely used as screening tool
Health Risk Appraisals
Asks questions about lifestyle factors that influence disease riskOften gives user a score which categorizes their health risk
Health Risk Appraisal
Heart Age Tool www.becel.ca Yields Heart Age score
Evidence-based Using knowledge on CVD risk factors
from Framingham Heart Study over 60 years of study – 1948 to 2008
Algorithm designed 2008 to incorporate weighting of various risk factors
Direct Assessment of Nutrition Status
Dietary Assessment Individuals
recalls, food records, diet histories, food frequency questionnaire
Householdhousehold inventories, food records
Nation food balance sheets, market
databases
Direct Assessment of Nutrition Status
Laboratory Methods biochemical tests functional biochemical tests
invasive and expensive
Direct Assessment of Nutrition Status
Anthropometric Methods body composition physical dimensions require trained data collectors
Clinical Methods physical signs symptoms
Screening
Detect disease or developmental delays early Clinical practice history height/weight/head circumference vision/hearing/development
Community settings health risk appraisal, blood pressure,
serum cholesterol levels
Focus Groups
Information on values and concerns of community members5-12 people in sessions 1 to 3 hours
Group talks about their concerns, beliefs, experiences and problems in a specific areaFacilitator guides the discussion
Nutrition Status Indicator
Quantitative measure guides screening, diagnosis and program
evaluation
Units of info that reflect nutritional status of populationEstimates nutritional healthNo single “best” indicator, so several may be used Health status, health outcomes,
determinants of health, health system
Nutrition Status Indicator
Examples include: weight loss of 10 pounds or more
over short time below or above healthy weight access to safe, adequate food supply weight for height serum cholesterol levels breastfeeding initiation rates and
duration times
Reference Data
“Standard” against which collected data will be compared Growth charts from NCHS BMI and WHR standards for
healthy adults RNI/DRI, CFGHE, or international
standards from FAO/WHO
Step 5: Analyze & Interpret Data
Consult a statistician or qualitative data analyst descriptive statistics reliability and validity of
information thematic analysis of qualitative
data
Step 5: Sharing Findings
Describe process usedSummarize Presenting quantitative and
qualitative data
Portray current and desired situations Show trends – what do the themes
and statistics say? Look at “don’t know” answers
Highlight gaps
Step 6: Set Priorities
Who is to get what at whose expenseGive priority to community preferences and concernsHigher priority to common problems than to rare onesHigher priority to more serious problems
Step 6: Set Priorities
Higher priority to nutrition issues with easier solutionsHigher priority to nutrition issues with increasing frequency of occurrence
Step 6: Set Priorities
How important is the problem?Are there solutions or programs and services that could address the problem?How many people are potentially at risk by the problem?
Step 6: Set Priorities
How many are affected by the problem now?What is potential impact of doing nothing? Potential years of life lost, loss of
earning/productivity, etc. economic burden to health
system and community
Step 7: Choose Plan of Action
Share key findingsUse findings to change public policyAlter an existing programOrganize a workshop to obtain more input?Develop new programPostpone action at this point
Step 7: Choose Plan of Action
What financial and human resource adjustments are needed? Consider costs of each proposed
action plan build into budget plan
Step 7: Choose Plan of Action
What are the timelines?Do actions fit within short-term and long-term business plans?Can you achieve reasonable results in the timelines set?
Step 7: Choose Plan of Action
What changes or additions do you need to make to the performance measure established in your business plan?
Needs/Assets
Traditional Needs Assessment: “what is wrong within the community that needs to be fixed”
Asset Mapping: focuses on strengths & opportunities already present within the community
Kretzmann and McKnight. (1993)
Community AssetsLocated inside the community, largely under community control Assets located within the community but largely controlled by outsiders.Resources originating outside the community, controlled by outsiders.
Kretzmann and McKnight. (1993)
Asset Mapping
Goals To ID assets &
capacities To design an asset
map to graphically show connections
To develop a community resource
Connect community citizens and nurture relationships
Asset Mapping
Important Elements
Emphasizes the positive
Belief that everyone has a talent or gift to share with others
Community dialogue
Outcomes include: Planning, Action, Connections & Resources
Yarmouth Stroke Project: Asset MappingPurpose:
• Discover the assets of organizations in relation to persons with stroke and their caregivers;
• Discover the assets of individuals associated with organizations in the community who have a particular expertise or special interest in stroke;
• Identify the location and accessibility of the community’s assets in relation to stroke victims and their families/caregivers.
Yarmouth Stroke Project: Asset Mapping
Methods:Designed questionnaireIdentified key contacts and built contact listConducted face-to-face interviewsCreated a database of resources/servicesAnalysis to identify strengths, opportunities and gaps
Mapping Food Security Assets in Antigonish
Honours Thesis by Rita MacAuley (2002)Assessed contributions of programs and services Categorized by six components of
food security Developed linkages mapping of
assets present
Health Impact Assessment
“any combination of procedures or methods by which a proposed policy or program can be judged as to the effects it may have on the health of the population” (Frankish et al., 1996)
Health Impact Assessment
“…enables government departments to work across jurisdictional boundaries to consider the broad spectrum of factors that determine health, thus assisting policy makers as they make decisions about the impact of their programs and policies on the health of the population they serve.” (Gillis, 1999)
Community Health Impact Assessment
“Used as a strategy by the PATH project to increase public understanding of the broad determinants of health and, through this educational process, to empower citizens to have an active voice in decisions influencing their health.” (Gillis, 1999) PATHways to Building Healthy Communities
in Eastern Nova Scotia
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