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Elements of Successful Nutrition & Health Promotion Programs

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Elements of Successful Nutrition & Health Promotion Programs Laura Bellows, PhD, MPH, RD Carlynn Fitzgerald, MS-candidate Desktop Training February 11, 2010 – PowerPoint PPT presentation

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Title: Elements of Successful Nutrition & Health Promotion Programs


1
Elements of Successful Nutrition Health
Promotion Programs
  • Laura Bellows, PhD, MPH, RD
  • Carlynn Fitzgerald, MS-candidate
  • Desktop Training
  • February 11, 2010

2
Todays Purpose
  • Purpose To provide background information on
    key components of health promotion programs to be
    used for consideration in program adoption.

3
Outline
  • Introduction to the steps used in designing
    community interventions
  • Discuss individual steps and key considerations
  • Examine how this looks out in the community
    Case Study

4
Program Planning Steps
  • 1. Initial Planning
  • 2. Formative Research
  • 3. Strategy Formation
  • 4. Program Development
  • 5. Program Implementation
  • 6. Evaluation

2
3
1
4
6
5
Grier, S Bryant, C. Ann Rev Public Health,
2005.
5
Initial Planning
  • Questions
  • What is the problem you are addressing?
  • What is the context in which the problem exists?
  • What services/programs might already exist
  • Who is your target audience(s)?

6
  • Actions
  • Set Initial Goals Objectives
  • Review Literature
  • Conduct Needs/Community Assessment
  • Identify Funding Resources
  • Establish Community partnership/coalition
    building

7

8
Whos Your Target Audience?
9
Formative Research
  • Formative research helps your organization find
    its audience understand the needs and interests
    of the audience and design programs, services,
    and products that address those needs.
  • What do we know?
  • What dont we know?
  • What do we want to know?

10
Formative Research
  • Questions
  • How does your target audience think and behave as
    related to the problem?
  • What are their values, beliefs, attitudes,
    behaviors?
  • What can you offer and will that appeal to the
    target audience?
  • How can you best reach your target audience?
  • What messages, strategies, materials, programs
    work best with target audience?

11
Understanding your Target AudienceCost vs.
Benefit
12
Walking your Dog
  • Benefits
  • Costs
  • Health
  • Refreshing
  • Social opportunities
  • Better behaved dog
  • Access to Parks/Trails
  • Tired / Lack of Energy
  • Time
  • Weather
  • Safety
  • Access to Parks/Trails

13
How do we Influence the audiences costs
benefits?
  • Gathering Data

14
Types of Formative Data
  • Primary Data
  • Original data that you collect and analyze
  • Secondary Data
  • Information that was collected by someone else,
    but which you can analyze or re-analyze
  • Qualitative Data
  • Data presented in narrative form that generally
    cannot be expressed numerically
  • Quantitative Data
  • Data presented in numerical terms

15
Methods for Collecting Data
  • Focus Groups
  • Key Informant Interviews
  • Community Forum
  • Group Discussions/Interviews
  • Surveys

16
Focus Groups
  • A qualitative method involving a small group of
    people whose discussion is carefully planned and
    led by a trained moderator
  • Advantages Relative small sample, structured
    questions, creative atmosphere, clarification
    capability
  • Disadvantages Moderately expensive and/or time
    consuming, need trained moderators, can be
    challenging to analyze

17
Key Informant Interviews
  • A qualitative method of conducting in-depth
    interviews with a small number of individuals
    carefully selected for their personal experiences
    and knowledge
  • In-person or telephone
  • Advantages Inexpensive (telephone), easy to
    administer, can cover wide region, gain in-depth
    data
  • Disadvantages Expensive (in-person), interviewer
    bias, trained interviewer, maybe difficult to
    analyze

18
Community Forums
  • Large group method of collecting qualitative
    information from community members that is larger
    and less formal than a focus group.
  • Advantages Large N, low cost, low time, audience
    can participate on own terms, identify people
    with increased interest
  • Disadvantages Large N, silent majority, strong
    leader (argumentative), scheduling

19
Group Discussions/Interviews
  • A qualitative method of conducting in-depth
    interviews with a small group of people less
    formal than focus group
  • Advantages Small N, high response rate,
    efficient and economical, stimulate others
  • Disadvantages Intimidation, fosters conformity,
    group pressure may influence responses

20
Surveys
  • A quantitative method involving systematic data
    collection from a sample of individuals selected
    from a target population
  • Data used to generate group-level summary
  • In-person, web-based, email
  • Advantages inexpensive, anonymity, large N, easy
    to administer, quantitative and qualitative data
  • Disadvantages low response rate, lengthy
    process, no opportunity to clarify, restrictive
    answers

21
Mixed Methodology
  • Audience
  • Phase of Formative Research
  • Budget

22
Weve gathered and Analyzed the data. Now what?
  • Strategy Formation

23
Strategy Development
  • Translate Data into Priorities
  • Refine Goals and Objectives
  • Are they measurable?
  • Where how are you going to reach your target
    audience?
  • Identify resources, community assets

24
Social Ecological Model
25
Utilize Resources
  • Research-based program
  • incorporates strategies, activities and
    principles that have been shown through
    scientific research and evaluation to be
    effective and reliable.
  • Evidence-based program
  • (a) evaluation research shows that the program
    produces the expected positive results
  • (b) the results can be attributed to the program
    itself, rather than to other extraneous factors
    or events
  • (c) the evaluation is peer-reviewed by experts in
    the field

26
Program Development
27
Approach vs. Framework vs. Theory
  • Framework systematic strategy used to plan
    programs
  • Theory explains food choices, nutrition
    related behaviors, and how they change
  • Theory gives planners tools for moving beyond
    intuition to design and evaluate health behavior
    and health promotion interventions based on
    understanding of behavior.
  • Approach describes the best way to teach
    information to your target audience

28
Frameworks
  • Logic Model
  • Social Ecological Model
  • Social Marketing - Systematic planning process
    used to promote personal and societal welfare
  • Know your target audience (formative research)
  • Four Ps of marketing
  • Behavior change theories are often embedded
    within frameworks

29
Types of Theory
  • Explanatory
  • Explanatory theory describes the reasons why a
    problem exists.
  • It guides the search for factors that contribute
    to a problem and can be changed.
  • Behavior Change
  • Change theory guides the development of health
    interventions.
  • It spells out concepts that can be translated
    into program messages and strategies, and offers
    a basis for program evaluation.
  • Change theory helps program planners to be
    explicit about their assumptions for why a
    program will work.

30
Behavior Change TheoriesSocial Learning Theory
  • Most useful for understanding what drives
    behavior how we can influence behavior change
  • Attempts to bridge the intention-behavior gap
  • Reciprocal determinism personal, behavioral,
    and environmental factors work together to
    influence behavior
  • Outcome expectancies and self efficacy are
    driving forces

31
Social Learning Theory Constructs
  • Personal factors (thoughts and feelings)
  • Outcome expectations vs. expectancies
  • Self-efficacy
  • Behavioral factors (knowledge and skills)
  • Factual and procedural knowledge
  • Cognitive and behavioral skills
  • Self regulation
  • Environmental factors
  • Imposed vs. selected vs. created environments
  • Observational learning and guided mastery

32
Behavior Change TheoriesStages of Change
  • Describes processes people go through in order
    for behavior change to occur
  • Stages categorize people according to readiness
    to act
  • Decisional balance and self efficacy important to
    move people through stages
  • Activities must match the stage

33
Stages of Change
  • Precontemplation unaware, uninterested,
    uninformed
  • Provide information, increase awareness
  • Contemplation considering a change in near
    future (6 mo)
  • Motivational activities
  • Preparation ready to change in immediate future
    (1 mo)
  • Action-oriented activities
  • Action started new behavior
  • Action-oriented activities
  • Maintenance new behavior has become part of
    lifestyle
  • Support, encouragement, reward
  • Relapse most likely to occur during action and
    maintenance
  • use it as a learning experience

34
Explanatory TheoryHealth Belief Model
  • Most useful for designing motivational component
    of education program
  • Constructs
  • Perceived Threat of Condition
  • Severity and susceptibility
  • Perceived Barriers and Benefits
  • Barriers can be physical or psychological
  • Benefitsgtbarriers action
  • Self Efficacy
  • Lack of self efficacy is a barrier
  • Cues to Action
  • External or internal
  • Influence perceived threat

35
  • For more information on theories refer to the
    National Cancer Institutes Theory at a Glance.
  • http//www.cancer.gov/PDF/481f5d53-63df-41bc-bfaf
    -5aa48ee1da4d/TAAG3.pdf

36
ApproachExperiential Learning
  • Allows people to learn by doing
  • Learner centered
  • Role of educator is to
  • Observe
  • Ask questions
  • Provide feedback and support
  • Role of learner is to
  • Do
  • Reflect
  • Apply

37
Experiential Learning
38
Adult Learning Approach
  • Describes the best way to teach new information
    to adults
  • Four As
  • Anchor Introduce material and ground the topic
    to the learners lives
  • Add Provide the new information
  • Apply Have the learners do something realistic
    with the information (activity)
  • Away Help learns see how they can use new
    information in the future

39
Summary
  • Frameworks, Theories and Approaches are often
    used in combination
  • One is not better than the other. It is
    dependent on the goals and objectives.

40
Program Content
  • Narrow the focus!
  • 2 outcome objectives per 45 minutes
  • No more than 3 outcome objectives per
    presentation
  • Reputable resources
  • Age appropriate

41
Are the sources reputable?
  • Current information
  • Rule of thumb literature should have been
    published or updated in the last 5 years
  • Published scientific journal articles
  • Published professional journal articles
  • Textbooks
  • Fact sheets from other state Extension programs
    or government agencies
  • Websites government (.gov), university (.edu)
  • News paper articles, consumer journals/magazines,
    .com and .net websites are NOT reputable sources

42
Is the program appropriate for the audience?
  • What to consider
  • Age
  • Reading level
  • Know your audience
  • Aim for 5th 8th grade reading level
  • Use laymans terms and short sentences
  • Check with Flesh-Kincaid reading level in
    Microsoft Word
  • Language
  • If working with a diverse group, offer materials
    in the appropriate languages
  • What the audience wants (formative research)

43
Is the program appropriate for preschool learners?
  • Use food-based activities
  • Use developmentally appropriate learning
    activities and play
  • Focus on behaviors
  • Encourage self-regulation
  • Involve parents and families

44
Is the program appropriate for middle childhood
and teen learners?
  • Focus on behaviors children can control
  • Address motivations that are meaningful and
    important to the children
  • Incorporate self-assessment
  • Use activities (food based if possible)
  • Use content appropriate for cognitive development
  • Address social norms and peer influence
  • Encourage self-regulation

45
Is the program appropriate for adult learners?
  • Provide specific information pertinent to their
    lives
  • Create a safe learning environment
  • Develop respectful relationships power-with
  • Empower your learners, let them choose topics
  • Engage learners with activities and facilitated
    discussion
  • Teach skills
  • Build on past experiences
  • Sequence tasks from simple to complex while
    building the strength of new skills
  • Always end with conclusions

46
Implementation
47
Promote your program
  • Does the program come with promotional materials?
  • Promotional materials should be designed and
    tested specifically for your target audience
  • Media newspaper adds, flyers, newsletters,
    magazines, television, radio, word-of-mouth
  • Placement place adds where your target audience
    will see them

48
Present programs as they were designed!
  • Respect the rationale, research, time and effort
    that went into designing the program and
    evaluations
  • Altering a program
  • Will change the content
  • Will change the outcomes
  • Evaluations may no longer be valid
  • Al a cart presentation are designed and evaluated
    piecemeal, series programs are designed and
    evaluated as a full series

49
Evaluation
50
Evaluation Basics
  • Evaluation should be considered early prior to
    program development
  • Purpose to determine the extent to which a
    program or intervention is effective, i.e., to
    determine if it is successful or how well it
    meets its objectives
  • It should be conducted throughout program
    development.

51
Types of Evaluation
  • Formative
  • Strengthen or improve the program being evaluated
  • Needs Assessment, Implementation Process
  • Summative
  • Examine the effects or outcomes of the program
  • Outcome, Impact Cost-Benefit Analysis

52
Characteristics of Good Evaluation
  • It is objective.
  • Self-assessments and subjective judgments of
    those responsible for a program have low
    credibility.
  • It is replicable.
  • Someone else should be able to re-do your
    evaluation and get the same results.
  • It is methodologically strong.
  • Confidence in the evaluation's findings
    evaluation is able to resist criticism and
    attack.
  • Its results are generalizable.
  • The results should apply to the broad range of
    individuals, and situations to which the program
    is aimed.

53
What can be evaluated?
  • Demographics
  • Knowledge
  • Attitudes
  • Behavior
  • Change
  • Intentions
  • Predictors

54
Ecological Model of Predictors of Childhood
Overweight
Davison KK, Birch LL. Obes Rev. Aug
20012(3)159-171.
55
Applying Evaluation Methods
  • Program/Curriculum multiple sessions
  • Behavior change, knowledge, attitudes
  • Presentation one-shot
  • Knowledge, attitudes, intent to change behavior
  • Written Materials newsletter, fact sheet, etc.
  • Knowledge, attitudes

56
Logic Model
57
CASE StudyWhat does this look like in the real
world
58
Agency X
  • Agency X is a statewide initiative aimed at
    reducing overweight and obesity rates and related
    chronic diseases. 
  • A partnership among foundations, health care
    organizations, non-profit organizations and state
    and local public health agencies.
  • Current Objective Develop and Implement a
    statewide Social Marketing campaign
  • Current Organizational Budget 16 million

59
Initial planning
  • Examining State Health Data

60
Disparities ObesityPrevalence of obesity by
race and ethnicity, Colorado Adults, 2007 BRFSS
Body Mass Index gt 30
61
Disparities Fruit VegPrevalence of consuming
5 or more servings of fruits and vegetables per
race and ethnicity, Colorado Adults, 2007 BRFSS
62
Disparities Physical InactivityPrevalence of
physical inactivity by race and ethnicity,
Colorado Adults, 2007 BRFSS
63
Income Disparities ObesityPrevalence of
obesity by income, Colorado Adults, 2007 BRFSS
Body Mass Index gt 30
64
Income Disparities Fruit VegPrevalence of
consuming 5 or more servings of fruits and
vegetables by income, Colorado Adults, 2007 BRFSS
65
Income Disparities Physical InactivityPrevalence
of Physical Inactivity by Income, Colorado
Adults, 2007 BRFSS
66
Who are your target audiences?
  • Hispanics
  • Audiences with Limited Resources

67
(No Transcript)
68
How do we Learn More about these audiences?
  • Focus Groups

69
Focus Group Results
  • Expanded target audience to include women
  • Resulted in strategy formation message
  • Limit emphasis on individual behaviors
  • Promote social support and networks
  • Make it fun
  • Reach those who are tweeners
  • The Power of All of Us!
  • Developed storyboards for Ad campaign

70
Ad / Storyboard Example
71
Will this resonate with the target audience?
  • Will this reach who they want it to reach?
  • Is the scenario representative of the target
    audience?
  • Are the foods culturally appropriate?
  • What emotions are they appealing to?
  • Will stakeholders support it?

72
Dont Assume Anything!
  • The only way to answer these
  • questions is to
  • Ask the Target Audience!

73
What are the goals/Objectives of This Ad?
74
What can you evaluate?
  • Reach
  • Individuals/Communities
  • Demographics
  • Recall
  • Is message on target? How does it relate to goal?
  • Likes/Dislikes
  • Awareness building
  • No change to knowledge or behavior
  • Maybe attitude depending on goal

75
Review Protocol
76
QUESTIONS
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