Ch. 3: Program Planning Models in Health Promotion

1) Social Assessment & Situational Analysis

Seeks to subjectively define the quality of life (problems and priorities) of those in the priority population while involving individuals in the priority population in an assessment of their own needs and aspirations.

MAP-IT (Mobilize, Asses, Plan, Implement, and Track)

A planning model to assist communities in implementing their own adaptations of Healthy People 2020.

Methods used to prioritize interventions used in Phase 5

Delphi technique, Nominal Group technique, Basic Priority Rating model, multi-level voting, or any other process that is systematic, objective, and allows for standardized comparisons.

4) Organize Methods and Applications into an Intervention Program

Describes the scope and sequence of the intervention, the completed program materials, and program protocols.

8. Building the Community Action Plan

Involves translating prioritized data from the summary statements to measurable objectives and action steps with assignments, and creates strategies for evaluation and reassessment.

4. Gather Data

"Sites" or locations that have data related to the questions associated with each sector are identified and specific data collection strategies such as observations, interviews, focus groups and surveys are used to gather new or existing data.

In the Track Phase of MAP-IT, coalition partners ask and answer specific questions such as:

- Are we evaluating our work appropriately (i.e. formative evaluation)? - Did we follow the plan (i.e. process evaluation)? - What did we change (i.e. impact evaluation)? - Did we reach our goal (i.e. outcome evaluation)?

5. Develop Interventions, Materials, and Pretesting

- Data from formative research must be analyzed and categorized appropriately to assure that planners understand what they have seen, heard, and observed. - Materials and methods should represent what was learned in formative research - Once a program prototype is developed, return to the priority population and test the concepts before implementing a widespread campaign.

1. Preliminary Planning

- Identify the focus of interest in terms of modifiable behaviors - Develop goals that provide general direction - Outline preliminary plans for evaluation - Estimate total project costs

In the Planning Phase of MAP-IT, these following questions are addressed:

- What do we need to do to reach our goals? - How will we know when we have reached our goals?

In the Assess Phase of MAP-IT, direct planners answer questions such as

- Who is affected by key health problems in our community? - What resources do we have to address the problems that we identify? - What resources are required to have a meaningful impact?

1) If the decision is made to proceed with MAPP process the following groups are created:

1) A Core Support Team: prepares most of material needed for planning process 2) The MAPP Committee: composed of key sponsors and stakeholders who guide and oversee the process 3) The Community Itself: provides input, representation & decision making

The Generalized Model

1) Assessing Needs 2) Setting Goals & Objectives 3) Developing Interventions 4) Implementing Interventions 5) Evaluating Results

Phases of MAP-IT

1) Mobilize 2) Assess 3)Plan 4) Implement 5) Track

MAPP Phases

1) Organize for success & partnership development 2) Visioning 3) 4 MAPP assessments 4) Identify strategic issues 5) Formulate goals & strategies 6) The Action Cycle

Phases of the SMART Model

1) Preliminary Planning 2) Consumer Analysis 3) Market Analysis 4) Channel Analysis 5) Develop Interventions, Materials, & Pretest 6) Implementation 7) Evaluation

Phases of the CHANGE Tool

1. Assemble the Community Team 2. Develop a Team Strategy 3. Review all five CHANGE sectors 4. Gather Data 5. Review Gathered Data 6. Enter Data 7. Review Consolidated Data 8. Build the Community Action Plan

Phases of Intervention Mapping

1. Conduct a Needs Assessment 2. Create Matrices of Change Objectives 3. Select Theory-Based Intervention Methods and Practical Applications 4. Organize Methods and Applications into an Intervention Program 5. Plan for Adoption, Implementation, and Sustainability of the Program 6. Generate and Evaluation Plan

Factors that predict the success of Healthy Communities:

1. Local investment in communities 2. Providing a venue for local communities to learn about effective strategies 3. Mobilizing networks for change 4. Providing tools to communities to achieve health equity and prevent chronic disease

4) 1. Intervention Alignment 2. Administrative & Policy Assessment

1. Match appropriate strategies and interventions with projected changes and outcomes identified in earlier phases 2. Planners determine if the capabilities and resources of existing personnel and participating organizations are available to develop an implement the program.

PRECEDE-PROCEED Phases:

1. Social Assessment 2. Epidemiological Assessment 3. Educational & Ecological Assessment 4. Administrative & Policy Assessment & Intervention Alignment 5. Implementation 6. Process Evaluation 7. Impact Evaluation 8. Outcome Evaluation

3) The 4 MAPP Assessments

1. The community themes and strengths assessment (community/consumer opinion) 2. The local public health assessment (general capacity of the local health department and the local health system) 3. The community health status assessment (measurement of the health of the community by use of mortality, morbidity, risk factor and other related data, etc.) 4. The forces of change assessment (forces such as legislation, technology, and other environmental or social phenomena that do or will impact the community) - Overall, provides insight on the gaps that exist between current status in the community and what was learned in the visioning phase as well as strategic direction for goals and strategies.

Selecting a specific planning model to apply will be based on:

1. The preferences of stakeholders 2. Time and funding 3. Resources for data collection and analysis (or lack thereof) 4. Involvement of partners 5. Preferences of a funding agency (in the case of a grant or contact award)

The Community Tool Box

A Website designed to assist health professionals with various tasks, outlines the standard components of a grant proposal.

4) Implement

A detailed work plan and communication plan, including all of the information developed in Phase 3, is assembled to identify clear action steps, describe who is responsible for completing the action steps, display a timeline with related deadlines, and to outline how planers will reach and recruit participants and communicate the benefits engaging in the program.

Healthy Communities Model

A planning model that came from a movement that began in the 1980s, with assistance from the WHO to mobilize and empower partnerships within cities and communities to enhance health and well-being.

CHANGE (Community Health Assessment aNd Group Evaluation) tool

A program planning model created by the CDC to aid in the design and delivery of health community initiatives by gathering data on community strengths and assets as well as provide opportunities to create policy, systems, and environmental change through a community action plan.

SMART Model (Social Marketing Assessment and Response Tool)

A seven phase social marketing planning model developed in 1998.

Intervention Mapping Model

A six-phase program planning model guided by diagrams and matrices that incorporate outputs of the assessment process with relevant theory to help develop appropriate interventions for priority populations.

2. Consumer Analysis

AKA Formative Research, defined as a process that identifies difference among subgroups within a population, identifies a subgroup, determines the wants and needs of the subgroup, and identifies factors that influence its behavior, including benefits, barriers, and readiness to change; a priority population is identified at the end of this phase.

Developing an Action Plan and Implementing Interventions

AKA implementation, in this step, goals and objectives are developed and action strategies (i.e. interventions) are planned.

Flexibility

Adapts to needs of stakeholders.

Another benefit of the Generalized Model is...

An increased ability to apply an important process closely related to program planning--grant writing.

Predisposing Factors

Any characteristic of a person or population that motivates behavior prior to the occurrence of the behavior.

Enabling Factors

Any characteristic of the environment that facilitates action and any skill or resource required to attain a specific behavior.

Reinforcing Factors

Any reward or punishment following or anticipated as a consequence of a behavior, serving to strengthen the motivation for the behavior after it occurs.

Assessing Needs

Collecting and analyzing data to determine the health needs of a population; setting priorities; and selecting a priority population.

Community Audits

Collecting new data (i.e. documenting observations about the community)

4. Channel Analysis

Communication channels are identified that are consistent with preliminary messages, and product distribution points and potential communication and intervention partners are identified.

PRECEDE-PROCEED

Composed of 8 phases, the underlying approach of this model is to begin by identifying the desired outcome, to determine what causes it, and finally to design an intervention aimed at reaching the desired outcome.

1) Conduct a Needs Assessment

Conducted by using the PRECEDE phases and includes establishing a participatory planning group, assessing community capacity, and linking the needs assessment to health outcomes and quality of life goals.

3) Plan

Developing goals and objectives, planners determining what will be measured (e.g. a decrease in smoking among adults), the baseline (e.g., % of adults in the community who smoke), and the targeted decrease (e.g. a decrease of 3% in 5 years); as well as identifying specific interventions that will be used to accomplish the identified goals and objectives.

Determining What Is Known using Scientific Literature

Directs planners to identify evidence-based solutions/interventions related to the root causes and related problems identified in the statement of issue (Phase 3).

Developing and Prioritizing Program and Policy Options

Directs planners to prioritize specifics interventions or actions steps using various methods

2. Develop a Team Strategy

Directs the community team to make decisions about how to operate most efficiently and effectively.

3. Review all Five CHANGE Sectors

Divides the work of data collection and analysis into 5 sectors: 1. The Community at Large Sector 2. The Community Institution/Organization Sector 3. The Health Care Sector 4. The School Sector 5. The Worksite Sector

3. Market Analysis

Examines the fit between the focus interest (desired behavior change) and important market variables within the priority population; provides useful information about consumers, the environment they live in, and the strengths and weaknesses associated with potential social marketing interventions.

The 3 F's of Program Planning

Fluidity, flexibility, & functionality

MAPP (Mobilizing for Action through Planning and Partnerships) Model

Foundational approach to planning and evaluation in public health setting, particularly among local (i.e. city or county) health departments, intended to improve health and quality of life through mobilized partnerships and taking strategic action.

In Phase 4, planners search resources such as...

Guide to Community Preventive Services, or scientific journals, books, government reports, etc., and categorize potential solutions as recommended with strong evidence, recommended with sufficient evidence, insufficient evidence, and not recommended evidence.

2) Visioning

Guides the community through a process that results in a shared vision (what the ideal future looks like) and common values (principles and beliefs that will guide the remainder of the planning process).

3) Theory Based Intervention Methods and Practical Applications

Guides the planner through a process of selected theory-based interventions and strategies that hold the greatest promise to change the health behavior(s) of individuals in the priority population.

Ecological Framework

Helps planner better appreciate that families, schools, employers, social networks, organizations, communities, and societies exert an influence on individuals and priority populations as they attempt to change health behaviors and improve their health.

Developing Interventions

How goals and objectives will be achieved

3) Educational & Ecological Assessment

Identifies and classifies the various factors that have the potential to influence a given behavior into 3 categories: predisposing, reinforcing, and enabling.

6) The Action Cycle

Implementation details are considered, evaluation plans (i.e. gathering credible evidence) are developed, and plans for disseminating results are made.

7. Evaluation

Improve the quality of the program (assess the degree to which the priority population is actually receiving the program/interventions) and determine the effectiveness of the program (Assess the immediate impact the program is having and whether the interventions and related support strategies are acceptable and engaging to the priority population).

Evaluating Results

Improving quality of interventions (formative evaluation) and determining their effectiveness (summative evaluation)

6. Enter Data

Incorporates CHANGE Sector Excel files, which organizes data for analysis.

1. Assemble the Community Team

Organize 10-12 individuals, including key decision makers, representing diverse sectors from the community who are willing to collect and analyze data, translate data to an action plan and oversee implementation of related interventions.

Functionality

Outcomes of planning is improved health conditions, not production of the plan.

Evidence-Based Planning Framework for Public Health

Phase 1: Community Assessment Phase 2: Quantifying the Issue Phase 3: Developing a Concise Statement of the Issue Phase 4: Determining What Is Known using Scientific Literature Phase 5: Developing and Prioritizing Program & Policy Options Phase 6: Developing an Action Plan and Implementing Interventions Phase 7: Evaluating the Program or Policy

1) Organizing for Success and Partnership Development

Planners assess whether the MAPP process is timely, appropriate, or even possible, which involves assessing resources, the expertise of available personnel, support of key decision makers and other stakeholders, and the general interest of community members. This phase answers basic questions about the general feasibility, resources, and appropriateness of the MAPP process.

5) Formulate goals and strategies

Planners create goals related to vision and prioritize strategic issues then select strategies to accomplish the goals.

6) Generate an Evaluation

Planners decide if determinants were well specified, if strategies were appropriately matched to methods, what proportion of the priority population was reached, and whether or not implementation was complete and executed as planned.

4) Identify strategic issues

Planners develop a prioritized list of most important issues facing the health community; only issues that jeopardize the vision and values of the community are considered. - Tasks: consideration of what would happen if certain issues were not addressed, understanding why an issue is strategic, consolidating overlapping issues, and identifying a priority list.

Evaluating the program or policy

Planners take measures to improve the existing program or policy (i.e. formative evaluation) as well as measure effectiveness (i.e. summative, or impact and outcome evaluation).

2) Epidemiological Assessment

Planners use data to identify and rank the health goals or problems that may contribute to or interact with problems identified in Phase 1. The risk factors that fall into the "more important" and "more changeable" quadrant in the 2 x 2 matrix will be the highest priorities.

Implementing Interventions

Putting interventions into action

Who developed a set of 7 skills that collectively serve as an evidence-based planning framework for public health?

Ross Brownson (and associates at the Prevention Research Center at Washington University in St. Louis)

5) Track

Similar to evaluation, to measure and track progress over time and draw special attention to the quality of data being collected, the limitations of self-reported data, and the validity and reliability of data collected.

1) Mobilize

Similar to pre-planning, mobilizing key individuals and organizations into a coalition that can work together to improve the health of the community.

2) Assess

Similar to the needs assessment, this phase examines both the problems as well as the assets within a community to help planners focus on what the community can do versus what it would like to do.

2) Create Matrices of Change Objectives

Specifies who and what will change as a result of the intervention; create a matrix of change objectives which "state what needs to be achieved in order to accomplish performance objectives that will enable changes in behavior or environmental conditions that will in turn improve the health and quality of life program goals identified in Step 1."

Fluidity

Steps are sequential.

Developing a Concise Statement

Summarizes an analysis of root causes of the most significant health problems in the community.

TRUE OR FALSE: The Generalized Model is used in this book to help you adapt and respond to complex planning challenges you will experience in professional practice.

TRUE

TRUE or FALSE: Intervention Mapping was designed to fill a gap in health promotion practice by translating data collected in the PRECEDE phases of the PRECEDE-PROCEED (i.e., social, epidemiological, educational, ecologist, administrative, organizational, and policy assessments) into theoretically based interventions.

TRUE

TRUE or FALSE: The principles of the Generalized Model are the building blocks of all the other planning models.

TRUE

TRUE or False: In PRECEDE-PROCEED, whether all 3 of the final phases are used depends on the evaluation requirements of the program.

TRUE

TRUE or False: Planning Models such as SMART, with a social marketing focus, generally do a better job of orienting program interventions to the preferences of consumers througout the entire planning process.

TRUE

TRUE or FALSE: It is between Phases 4 and 5 that PRECEDE ends and PROCEED begins.

TRUE, Phases 1-4 are PRECEDE while Phases 5-8 are PROCEED

5. Review Data Gathered

Team members discuss what was discovered and rank each item (specific questions related to each sector) using a 5 point scale.

In 1997 which agencies collaborated on the development of the MAPP model, which was released in 2000?

The CDC and the National Association of County and City Health Officials (NACCHO 2001)

6. Implementation

The communication and distribution plans are activated and the actual program and its interventions are offered; the program is refined continually, based on consumer feedback.

Community Context

The community assessment requires planners to understand these characteristics and circumstances that define the community, and also understand the health concerns of community members and how to implement programs effectively to them.

5) Plan for Adoption, Implementation, and Sustainability of the Program

The focus is on what will be done by whom among planners or program partners.

Quantifying the Issue

The process of using descriptive epidemiology (i.e. occurrence and distribution of disease by person, place, and time) derived from surveillance systems and other secondary data (i.e. existing data) to analyze and display disease frequencies.

7. Review Consolidated Data

Transfers data into "CHANGE summary statements for quick reference of all sites with related ratings across all 5 sectors."

True or False: MAPP has 6 phases and 4 assessments

True

True or False: Models provide planners with direction and a framework from which to build interventions that can improve the health of individual and communities.

True

Phase 1-2, community assessment and quantifying the issue, essentially represent...

a needs assessment

Planning Model

Visual representations and descriptions of steps or phases in the planning process are the means by which structure and organization are given to the successful development and delivery of health promotion programs.

Setting Goals & Objectives

What will be accomplished

The generalized model is used to teach...

basic principles of planning and evaluation emphasized in most planning models; it is a teaching model and a framework for professional practice.

In Phase 2 (Quantifying the Issue)...

data are also presented in tables and figures as prevalence or incidence rates, or as percentages, to help stakeholders make decisions about health concerns in the community.

The community assessment also involves...

organizing and examining existing data (e.g. mortality, morbidity, risk factor data, etc.)

Population-Based Approach

planning processes used with large populations

5) Implementation

With appropriate resources secured, planners select interventions and strategies and implementation begins.