HLSC 3643 Community Health

Planning and Promotion

University of Arkansas

Dr. Jones

Overview of Health Planning Models

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

“Imagination is more important than knowledge.”

Albert Einstein

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 - PROCEED 9 Phases 5 Phases are diagnostic – PRECEDE 4 Phases are evaluative – PROCEED

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 Planned Approach Toward Community Health

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 Multilevel Approach Toward Community Health

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?

Does Using a Model Help? Advantages Caveats Challenges

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

Challenges Learning before doing Patience Understanding theory/model Finding the data Letting go

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…

Some Evidence! Reduces AIDS risk Reduces weight Builds coalitions/partnerships

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?

Bibliography Insert from other ppt.

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

Class ActivityDevelop surveillance form for a

specific disease, illness or injury.

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 & 4To Identify What Causes the Causes

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

Behavioral & Environmental Diagnosis Steps

Step 7: Set Objectives Who? What? How much? When?

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.)

Phases 5 & 6

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.

Project Timelines: Gantt Chart

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

Media Advocacy Strategies Gain access to media Use paid advertising

Limitations Lack of guidelines Complex skills Time requirements Movement away from behavior Controversial and confrontive

Media Advocacy Planning GOTME

Goals Objectives Target Message Evaluation

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: Messaging Relevant-news Appropriate Concise (10-15 seconds) Memorable Actionable

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)

Types of Evaluation Formative Process (Phases 5 and 6)

Program Implementation

Impact (Phases 3 and 4) Behavior Environment P, R, and E Factors

Outcome (Phases 1 and 2) Health Quality of life

Cost Effectiveness Cost Benefit