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Planning Health Promotion Programs

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Title: Planning Health Promotion Programs


1
Planning Health Promotion Programs
2
Planning Health Promotion Programs
  • Models for Health Promotion Interventions
  • Starting the Planning Process
  • Assessing Needs
  • Measurement, Measures, Data Collection, and
    Sampling
  • Mission Statement, Goals, and Objectives
  • Theories and Models Commonly Used for Health
    Promotion Interventions
  • Interventions

3
Models for Health Promotion Programs
  • A Generalized Model for Program Planning

Understanding and engaging
Assessing needs
Setting goals and objectives
Developing an intervention
Implementing the intervention
Evaluating the results
4
Selecting a Specific Planning Model to apply will
be based on
  • The preferences of stakeholders (e.g., decision
    makers, program partners, consumers)
  • How much time is available for planning purposes
  • How many resources are available for data
    collection and analysis
  • The degree to which clients are actually involved
    as partners in the planning process or the degree
    to which your planning efforts will be
    consumer-oriented (i.e., planning is based on the
    wants and needs of consumers) and
  • Preferences of a funding agency (in the case of a
    grant or contract award)

5
Consider Three Important Criteria
  • Fluidity Steps in the planning process are
    sequential, or that they build upon one another
  • Flexibility Planning is adapted to the needs of
    stakeholders
  • Functionality the outcome of planning is
    improved health conditions, not the production of
    a program plan itself

6
Common Models Used by Planners in Health
Promotion Settings
  • PRECEDE-PROCEED (practitioners-driven)
  • MATCH (practitioners-driven)
  • CDCYNERY (consumer-based planning health
    communication planning)
  • SMART (consumer-based planning social marketing
    planning)

7
Precede-Proceed Model
  • The best-known and most often used theory of
    implementation. It has two major components
    PRECEDE, PROCEED, which are comprised of nine
    phases, or steps (Green Kreuter, 2005).
  • The first five phases consists of a series of
    planned assessments that generate information
    that will be used to guide subsequent decisions.
    This series of phases involves considerable
    sifting and sorting and is refereed to as PRECEDE
    which is an acronym for predisposing,
    reinforcing, and enabling constructs in
    educational/ecological diagnosis and evaluation
    (Green Kreuter, 2005, p. 9).
  • The second component, which consists of last four
    phases, is marked by the strategic implementation
    of multiple actions based on what was learned
    from the assessments in the initial phase. This
    second component Is named PROCEED for policy,
    regulatory, and organizational constructs in
    educational and environmental development (Green
    Kreuter, 2005, p. 9).

8
PRECEDE
Phase 5 Administrative And policy assessment
Phase 4 Educational And ecological assessment
Phase 3 Behavioral and Environmental assessment
Phase 2 Epidemiological assessment
Phase 1 Social assessment
Health promotion
Predisposing factors
Health education
Reinforcing factors
Behavior And lifestyle
Quality of life
Health
Policy regulation organization
Enabling factors
Environment
Phase 6 Implementation
Phase 7 Process evaluation
Phase 8 Impact evaluation
Phase 9 Outcome evaluation
PROCEED
9
The Nine Phases of the PRECEDE-PROCEED Model
  • Phase 1. Social assessment assessing both
    objective and subjective terms of high-priority
    problems or aspirations for the common good,
    defined for a population by economic and social
    indicators and by individuals in terms of their
    quality of life
  • Phase 2. Epidemiological assessment delineating
    the extent, distribution, and causes of a health
    problem in a defined population
  • Phase 3. Behavioral assessment Delineating the
    specific health-related actions that will most
    likely cause a health outcome. Environmental
    assessment systematically assessing factors in
    the social and physical environment that interact
    with behavior to produce health effects or
    quality-of-life outcomes.

10
The Nine Phases of the PRECEDE-PROCEED Model
  • Phase 4. Educational assessment delineating
    factors that predispose, enable, and reinforce a
    specific behavior or that through behavior affect
    environmental changes. Predisposing factor any
    characteristics of a person or population that
    motivates behavior prior to the occurrence of the
    behavior Enabling factor any characteristics
    of the environment that facilitates action and
    any skill or resource required to attain a
    specific behavior. Reinforcing factor any
    reward or punishment following or anticipated as
    a consequence of a behavior, serving to
    strengthen the motivation for or against the
    behavior.
  • Phase 5. Administrative assessment an analysis
    of the policies, resources, and circumstances
    prevailing in an organization to facilitate or
    hinder the development of the health promotion
    program.

11
The Nine Phases of the PRECEDE-PROCEED Model
  • Phase 6. Implementation the act of converting
    program objectives into actions through policy
    changes, regulation, and organization.
  • Phase 7. Process evaluation the assessment of
    policies, materials, personnel, performance,
    quality of practice or services, and other inputs
    and implementation experiences.
  • Phase 8. Impact evaluation the assessment of
    program effects on intermediate objectives
    including changes in predisposing, enabling, and
    reinforcing factors, as well as behavioral and
    environmental changes.
  • Phase 9. Outcome evaluation an assessment of
    the effects of a program on its ultimate
    objectives, including changes in health and
    social benefits or quality of life.

12
Features
  • Complicated at first glance
  • Follows a logic sequence beginning by
    identifying the desired outcome, to determine
    what causes it, and finally to design an
    intervention aimed at reaching the desired
    outcome (McKenzie et al., 2005, p. 18).

13
An Application
  • Consider a hypothetical example using a school
    setting
  • Phase 1 planners seek to define the quality of
    life of the priority population so that the
    desired outcomes can be identified
  • Involving all parties (teachers, parents, PE
    teachers, health evaluators, students) in the
    process of assessing needs.
  • Identifying social indicators health status,
    fitness, self-esteem, class attendance, academic
    performance

14
An Application (cont.)
  • Phase 2 planners use data to identify and rank
    health goals or problems that are associated with
    economic concerns and school conditions
  • Collecting and analyzing data
  • Ranking those health concerns as they related to
    the quality-of-life issues identified in Phase 1
  • e.g., overweight and obesity, physical inactivity
    (through epidemiological assessment) ? health
    status, fitness, self-esteem, school performance

15
An Application (cont.)
  • Phase 3 planners determines what risk factors or
    determinants contribute to overweight and
    obesity, and physical inactivity
  • Lack of rigorous physical activity program?
  • Lack of access to physical activity facilities?
  • Unhealthy school lunch program?
  • Easy access to high carbohydrate/calorie
    food/drinks?

16
An Application (cont.)
  • Phase 4 planners conduct educational and
    ecological assessment
  • Surveying students and teachers about their
    knowledge of health risk factors
  • Conducting an evaluation of existing programs and
    environment
  • Observing students levels of physical activity.
  • Deciding an appropriate health promotion
    intervention (comprised of an education
    component, behavior change, and new policies that
    promote school-wide physical activity)

17
An Application (cont.)
  • Phase 5 planners determine what organizational
    and administrative support and resources are
    available to carry out the health promotion
    intervention.
  • Health education built into the curriculum?
  • Hiring a health educator/consultant?
  • Increasing level of intensity in PE?
  • Restructuring school lunch program?
  • More after school physical activity and/or sport
    programs?
  • More education on promoting healthy nutrition and
    physical activity habits.

18
An Application (cont.)
  • Once the availability of program resources is
    determined, Phase 6, implementation, can begin
  • The evaluation components (Phases 7,8, and 9) of
    this program will be based on the objectives that
    were created during assessment phases.
  • Ensure that criteria (standards of acceptability)
    noted in each objective were clear.

19
An Application (cont.)
  • e.g., in phase 7 (process evaluation), planners
    may be concerned with determining the
    availability of the educational component of the
    intervention for each student.
  • e.g., in phase 8 (impact evaluation), planners
    would be interested in evaluating changes in the
    behavior of the students (e.g., become more
    active?) and the school environment (e.g.,
    program availability, access to healthy school
    foods, etc.)
  • As for outcome evaluation, Phase 9, planners may
    be looking for an overall increase in school-wide
    physical activity and consumption of healthy food
    (i.e., low-calorie and nutritious).

20
The MATCH Planning Model
  • MATCH is an acronym for Multilevel Approach to
    Community Health
  • By Simons-Morton, D. G., Simons-Morton, B. G.,
    Parcel, G.S., Bunker, J.F. (1988). Influencing
    personal and environmental conditions for
    community health A multilevel intervention
    model. Family and Community Health, 11(2), 25-35.

21
Insert the MATCH Planning Model here
22
An Application
  • Assumption
  • Needs assessment is complete
  • Heart disease is the focus of the program we are
    planning

Health Problem
Behavioral Risk Factors
Environmental Risk Factors
Heart disease
  1. Lack of exercise
  2. Poor eating habits
  1. Lack of exercise facilities
  2. School lunch program

23
Phase 1 Goal Selection
  • Heart disease is the leading cause of death
  • Several of the behaviors associated with the
    disease are changeable
  • Therefore, optimal health-status goal is to
    reduce the prevalence of heart disease.
  • Target population elementary school children
  • Health behavioral goals ? sedentary lifestyle
    and improve eating habits
  • Environmental goals focus on
  • available exercise facilities,
  • school's curriculum with regard to PA and
    nutrition,
  • School policies that can influence PA and eating
    habits

24
Phase 2 Intervention Planning
  • Identify the following elements
  • the levels of society at which planners plan to
    intervene
  • what intervention objectives will be
  • the mediators with which we will be concerned
  • what intervention approaches we will take

See the Table for Summary
25
Step 1 Focus of Intervention
Step 2 Objectives
Step 3 Mediators
Step 4 Intervention Approaches
Health behaviors Exercise Eating habits
Individual students 5th and 6th graders
Educational Teaching Positive reinforcement
Knowledge Attitudes Skills Behavior
Organizational Change Curricula change School
lunch menu policy in-service training
Organizational Board of education School
administrators Teachers School cafeteria workers
Programs Practices Policies Resources
Knowledge Attitudes Skills Behavior
Governmental City council City parks and
recreation board City parks and recreation
workers
Political Action Lobbying Policy advocacy
Interest-group pressure
Programs Practices Policies Resources
Knowledge Attitudes Skills Behavior
26
Phase 3 Program Development
  • Focus on several program components
  • Training teachers for PA and nutrition
  • Training cafeteria workers to create healthier
    school lunches
  • Soliciting board of education for changes in
    related to curriculum PE and health education
  • Lobbying the city parks and recreation board for
    better equipped parks and exercise facilities

27
Phase 4 Implementation Preparations
  • Planners need to facilitate the adoption,
    implementation, and maintenance of their program
    components by preparing those impacted by the
    program for change
  • Showing these who are affected the possible
    consequences of no change
  • Programs that have been successful
  • Opinion leaders in the community support the
    change
  • Planners need to select and , if necessary,
    training the implementors so they can conduct the
    in-service sessions for the teachers and
    cafeteria workers, and prepare those who will be
    lobbying the city parks and recreation board

28
Phase 5 Program Evaluation
  • Process evaluation will involve
  • Examining the success of the implementation of
    the various program components
  • Quality of the in-service session
  • Pros and cons of the program components
  • Impact evaluation knowledge, attitudes, and
    health practices of the students with regard to
    PA and nutrition, and change in PA facilities at
    the city park level
  • Outcome evaluation (i.e., ? the prevalence of
    heart disease)?

29
CDCynergy Planning Model
  • Developed by the Office of Communication at the
    Cents for Disease Control and Prevention (CDC)
    (Centers for Disease Control and Prevention,
    2003)

30
CDCynergy Planning Model
  • Use six phases involving multiple steps to help
    planners
  • acquire a thorough understanding of a health
    problem
  • Explore a wide range of possible strategies for
    influencing the problem
  • Systematically select the strategies that show
    the most promise
  • Understand the role excommunication can play in
    planning, implementing, and evaluating selected
    strategies
  • Develop a comprehensive community plan

31
CDCynergy Planning ModelPhase 1 Describe Problem
  • Identify and define health problems that may be
    addressed by your program interventions.
  • Examine and/or conduct necessary research to
    describe the problems.
  • Assess factors and variables the can affect the
    projects direction, including strengths,
    weaknesses, and threats (SWOT).

32
CDCynergy Planning ModelPhase 2 Analyze Problem
  • List causes of each problem you plan to address.
  • Develop goals for each problem.
  • Consider strengths, weaknesses, opportunities,
    threats, and ethics of health (1) engineering,
    (2) communication/education, (3)
    policy/enforcement, and (4) community service
    intervention options.
  • Select the types of intervention(s) that should
    be used to address the problem(s).

33
CDCynergy Planning ModelPhase 3 Plan
Intervention
  • Decide whether communication is needed as a
    dominant intervention and/or as support for other
    intervention(s).
  • If communication is used as a dominant
    intervention, list possible audiences.
  • If communication is to be used to support
    Community Services, Engineering, and/or
    Policy/Enforcement interventions, list possible
    audiences to be reached in support of each
    selected interventions.
  • Conduct necessary audience research to segment
    intended audiences.
  • Select audience segment(s) and write
    communication objectives for each audience
    segment.
  • Write a creative brief to provide guidance in
    selection appropriate concepts/messages,
    settings, activities, and materials.

34
CDCynergy Planning ModelPhase 4 Develop
Intervention
  • Develop and test concepts, messages, settings,
    channel-specific activities, and materials with
    intended audiences.
  • Finalize and briefly summarize a communication
    implementation plan. The plan should include
  • Background and justification, including SWOT and
    ethics analyses
  • Audiences
  • Communication objectives
  • Messages
  • Settings and channels for conveying your messages
  • Activities (including tactics, materials, and
    other methods)
  • Available partners and resources
  • Tasks and timeline (including persons responsible
    for each task, date for completion of each task,
    resources required to deliver each task, and
    points at which progress will be checked)
  • Internal and external communication plan
  • Budget
  • Produce materials for dissemination

35
CDCynergy Planning ModelPhase 5 Plan Evaluation
  • Determine stakeholder information needs
  • Decide which types of evaluation (e.g.,
    implementation, reach, effects) are needed to
    satisfy stakeholder information needs.
  • Identify sources of information and select data
    collection methods.
  • Formulate an evaluation design that illustrates
    how methods will be applied to gather credible
    information.
  • Develop a data analysis and reporting plan.
  • Finalize and briefly summarize an evaluation
    implementation plan. The plan should include
  • Stakeholder questions
  • Intervention Standards
  • Evaluation methods and design
  • Data analysis and reporting
  • Tasks and timeline (including persons responsible
    for each task, date for completion of each task,
    resources required to deliver each task, and
    points at which progress will be checked
  • Internal and external communication plan
  • Budget

36
CDCynergy Planning ModelPhase 6 Implement Plan
  • Integrate, execute, and manage communication and
    evaluation plans.
  • Document feedback and lessons learned.
  • Modify program components based on feedback.
  • Disseminate lessons learned and evaluation
    findings.

37
SMART Planning Model
  • SMART Social Marketing Assessment and Response
    Tool (Neiger, 1998 Neiger Thackeray, 2002).
  • Central focus of SMART is consumers
  • SMART is composed of seven phases.

38
The Phases of SMART
  • Phase 1 Preliminary Planning
  • Integrate, execute, and manage communication and
    evaluation plans.
  • Document feedback and lessons learned.
  • Modify program components based on feedback.
  • Disseminate lessons learned and evaluation
    findings.

39
The Phases of SMART
  • Phase 2 Consumer Analysis
  • Segment and identify the priority population.
  • Identify formative research methods.
  • Identify consumer wants, needs, and preferences.
  • Develop preliminary ideas for preferred
    interventions and communication strategies.

40
The Phases of SMART
  • Phase 3 Market Analysis
  • Establish and define the market mix.
  • Assess the market to identify competitors
    (behaviors, messages, programs, etc.), allies
    (support systems, resources, etc.), and partners.

41
The Phases of SMART
  • Phase 4 Channel analysis
  • Identify appropriate communication channels.
  • Assess options for program distribution.
  • Determine how channels should be used.
  • Assess options for program distribution.
  • Identify communication roles for program
    partners.

42
The Phases of SMART
  • Phase 5 Develop Interventions, Materials, and
    Pretest
  • Develop program interventions and materials using
    information collected in consumer, market, and
    channel analysis.
  • Interpret the marketing mix into a strategy that
    represents exchange and societal good.
  • Pretest and refine the program.

43
The Phases of SMART
  • Phase 6 Implementation
  • Communicate with partners and clarify
    involvement.
  • Activate communication and distribution
    strategies.
  • Document procedures and compare progress to time
    lines.
  • Refine the program.

44
The Phases of SMART
  • Phase 7 Evaluation
  • Assess the degree to which the priority
    population is receiving the program.
  • Assess the immediate impact on the priority
    population and refine the program as necessary.
  • Ensure the program delivery is consistent with
    established protocol.
  • Analyze changes in the priority population.

45
Other Planning Models
  • A Systematic Approach to Health Promotion
    (Healthy People 2010) (USDHHS, 2000)
  • Mobilizing for Action through Planning and
    Partnerships (MAPP) (NACCHO, 2001)
  • Healthy Communities (USDHHS, 2001)
  • Assessment Protocol for Excellence in Public
    Health (APEX-PH) (NACCHO, 1991)
  • SWOT (Strengths, Weaknesses, Opportunities,
    Threats) Analysis (Johnson, Scholes, Sexty,
    1989).
  • The health Communication Model (NCI 2002)
  • Healthy Plan-It (CDC, 2000)

46
Summary
  • Various planning models with the PRECEDE-PROCEED
    model the most popular one in health promotion
  • They all share common characteristics
  • Seek to understand and engage community members,
    assess needs, set goals and objectives, develop
    an intervention, implement the intervention, and
    evaluate the results (back to the Generalized
    Model, Slide 3)

47
10 Minutes Break
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