Chapter 2: Starting the Planning Process

return on investment (ROI)

- Common way of reporting CBA through a metric. Measures the cost of a program (investment) versus the financial return realized by that program. - ROI calculation: (benefits of investment - amount invested) / amount invested OR net savings / cost of intervention - ROI = 0 means that the program pays for itself. ROI > 0 program is producing savings that exceed the cost of the program (better). - Proving economic impact of health programs are heard because there are multiple causes of health problems, complex interventions needed to deal with those problems, and difficulty of carrying out rigorous research studies. - McGinnis donut that health promotion programs are health to a different standard the medical treatment programs when cost-effective is being considered.

Values or Benefits from Health Promotion

- Community: good health as norm; improved QOL, improve economic well-being; provide model - Employee/individual: improved health status; reduction in health risks; improved health behavior; job satisfaction; lower out of pocket costs for health care; well bing, self image, and self esteem - Employer: increased morale, enhance performance, recruitment and retention, reduce absenteeism and presenteeism, reduce disability days/claims, reduce health care costs; enhanced corporate image

4. Comparison between the proposed program and the health plan for the nation or a state

- Compare the health needs of the priority population with those other citizens of the state or all of America. Enable planners to show compatibility between the goals of the program and those if the nation's health.

Chronic Disease Cost Calculator Version 2

- Created by he CDC and RTI International - Helps to build economic impact and cost-effectiveness of health promotion programs as part of program rationale.

Collaborator Multipler

- Created by the Prevention Institute - Framework/tool that is based on the understanding that sectors have different understandings of issues and divergent reasons for engaging in the same effort.

Measuring Decision Makers' Support for Health Promotion

- Della, DeJoy, Goetzel, Ozminkowski, and Wilson created the Leading by Example: measurement instrument to assess leadership support for health promotion programs in work settings - Four factor scale: business assignment with health promotion objectives, awareness of the economics of health and worker productivity, worksite support for health promotion, and leadership support for health promotion. - LBE used: through single administration to assess areas in which health promotion climate might support/hinder programmatic efforts OR to administer two different times to monitor change in support for health promotion programs over time.

Planning Committee

- Establish a committee to develop a clearer and more comprehensive planning approach. Number of people involved in the process depends on resources and circumstances of a given situation. - One of the planner's first task is to identify individuals who will be willing to serve as members of the planning committee. Referred to as steering committee or advisory board or planning team. - When planning a committee, consider the concept of partnering to meet eventual goals of the program that will be planned.

Steps in Creating a Program Rationale

- Gaining the support of decision makers is one of the most important steps in the planning process. Planners need to have a sound rationale for creating a program that is supported by evidence that the proposed program will benefit those for whom it is planned. 1. Identifying appropriate background information 2. Titling the rationale 3. Writing the content of the rationale 4. Listing the references used to create the rationale

Step 3: Writing the Content of the Rationale

- Identify the health problem from a global perspective. - (1) Begin the rationale by presenting the problem at the macro level for which supporting data are available (like international information for HIV/AIDS). If none is available, move down to the next level where the presentation can be supported. Also include economic costs of problem to strengthen the rationale. - Most decision making that occurs for change to occur is based on financial considerations and change within an organization must be supported by positive return on investment. Need financial support and firm understanding of the financial implications. Presenting problems at higher levels shows decision makers that dealing with the health problem is consistent with the concerns of others. - (2) Basically, show the relationship of the health problem to the bigger picture at the international, national, and/or state levels. - (3) Next, identify the health problem that is the focus of the rationale (problem statement). When presenting the problem statement, use social math. - (4) Propose a solution to the problem. Include the named purpose of the proposed health promotion program and overview of what the program may include. Writing the rationale comes before the formal planning process so give the general overview of the program based on the best guess. Include statements indicating what can be gained from the program. Align the potential values and benefits of the program with what is important to the decision makers. - (5) State why the program will be successful. Use results that are evidenced based practice to support the rationale. Point out similarities of the priority population to others with which similar programs have been successful. Use the argument the timing is right (there is no better time than now to work to solve the problem facing the priority population).

The Need for Creating a Rationale to Gain the Support of Decision Makers

- Important that program has support from the highest level of the community for which the program is being planned (board of health, officers, church elders). Top-level decision-making positions are able to provide the needed resource support for the program. - Ideas for programs can come from top-level people, so don't have to sell the idea to people. OR it begins at a level below the decision makers which means that those who want to create a program must sell it to the decision makers. Decision makers need to perceive a set of values/benefits associated with the proposed program to fund resources and support into the health program planning. - Behrens: Health promotion programs in business and industry have higher success if all levels of management are committed and supported (supported for all settings). - If they need to gain support of decision makers, program planners should develop a rationale for the program's existence. Problem because few people are motivated by health concerns alone. Decisions by top-level management to develop new programs depend on variety of factors. In order to sell program, planners need to develop a rationale that shows how the program will help decision makers to meet the organization's goals and to carry out its mission. Planners need to position their program rationale politically, in line with the organization.

2. epidemiologic data

- Information and data that describe the status of a health problem within a population - data results from process of epidemiology - Data available form sources like governmental agencies, governmental health agencies, non-governmental health agencies, and health care systems - Sources on page 22 - Epidemiologic data gains significance when it can be shown that the describe heath problem is the result of modifiable health behaviors and that spending money to promote healthy lifestyles and prevent health problems makes good economic sense. Examples: smoking and diabetes (cost on medical care, productivity, disability, premature deaths, work loss).

Creating a Rationale

- Logical format for putting ideas together to help guide planners to create a rationale. 1. Identify the health problem in global terms, backing it up with data (international, national, or state). Include economic costs of the problem. 2. Narrow health problem by showing its relationship to the priority population. Create problem statement. State why it is a problem and why it should be dealt with. Back up with data. 3. State solution to the problem (name and purpose of the proposed health promotion program). Provide overview of the program. 4. State what can be gained from the program in terms of values and benefits to the decision makers. 5. State why program will be successful. 6. Provide references used in preparing the rationale.

3. Creating a rationale by showing how potential outcomes align with what decision makers feel is important

- Look at mission statement, annual report, budget for health-related items to see what decision makers value. - Can survey decision makers to determine what is important to them.

6. Don't overlook the most important resource of any community

- Look at the people who make up the community. - Promoting, maintaining, and restoring human health should be at the core of any health promotion program. - Better health of priority population provides better quality of life. - Protecting the health should be noted in developing a rationale. - People can be the single biggest asset.

Step 1: Identifying appropriate background information

- Need to identify appropriate sources of information and data that can be used to sell program development (before planners begin to write program rationale). Do it by conducting a search on existing literature. - A search helps planners gain a better understanding of the health problems of concern, approaches to reducing or eliminating the health problem, and an understanding of the people for whom the program is intended (priority population). - Types of info and data that are useful for writing a rationale include: (1) express the needs and wants of the priority population (2) describe the status of the health problem within a given population (3) show how outcomes of the program align with what the decision makers feel is important (4) show compatibility with the health plan of a state or the nation (5) provide evidence that the proposed program will make a difference (6) show how the program will protect and preserve the single biggest asset of most organizations and communities- the people. - Many of these types of information and data can be generated through a review of the literature; however needs and wants of the priority population is not.

Step 2: Title the Rationale

- Once identified and are familiar with sources of information and data, begin the process of putting a rationale together. "A Rationale for (Title of Program): (Name of Priority Population)". After title list people who contributed to the authorship of the rationale.

Parameters for Planning

- Once support of the decision makers are gained and planning committee is formed, members must identify the planning parameters within which they will work. Ask questions: 1. What is the decision makers philosophical perspective on health promotion programs? Values and beliefs? Important or extras? 2. What type of commitment to the program? Institutionalized (program becomes embedded within the host organization, so that the program becomes sustained and durable)? One time polite program? 3. What type of financial support? 4. Consider changing the organizational culture so that there is a culture of health? (decision makers interested in establishing health supporting culture that is based on health-related values, beliefs, and practices? 5. Will individuals in the PP hav the opportunity to take advantage of the program or available to certain groups? 6. What type of committee will it be? Permanent or temporary (ad hoc)? A permanent committee indicate that decision makers want the planning committee to be a part of the ongoing structure of the organization. 7. What is the authority of the planning committee? Advisory or programmatic decision making group?

Planning Health Promotion Programs

- Planning a health promotion program is a multistep process that begins after pre-planning. Planning is engaging in a process of procedure to develop a method of achieving an end. - Multistep process of planning does not all begin the same way because there are different variables and circumstances of any one setting. Obvious and recognition, successful in the past but needs to be updated, planners create programs that are needed, not obvious, no successful health promotion programs and stakeholders want proof that a program is needed and will be successful - Planning process often begins with planners creating a rationale to gain support of key people to obtain resources to ensure the planning process and implementation proceed smoothly.

After planning parameters are defined...

- Planning committee should understand how the decision makers view the program and should know what type and number of resources and amount of support to expect. - Identifying parameters early will save the planning committee effort and energy through the planning process.

Guide to Community Preventive Services

- Referred as The Community Guide - Summarizes the findings form systemic reviews of public health interventions covering variety of topics. - Developed and updated by the nonfederal Task Force on Community Preventive Services. - Task force in charged with reviewing and assessing the quality of available evidence and developing appropriate recommendations.

5. evidence

- Show evidence that the program will be effective and make a difference if implemented. - Defined as the body of data that can be used to make decisions when planning a program. - Data comes from needs assessment, knowledge about the causes of the health problem, research that has tested the effectiveness of an intervention, and evaluations conducted on other health programs.

Planning committee formed ...

- Someone must be designated to lead it. The leader or chairperson myst be interested and knowledgeable about health promotion programs, organized, enthusiastic, and creative. - Preferable to have someone other than program planners to serve as leader because it helps to spread the workload of the committee, allows the planners to remain objective about the program, and planning committee can serve in an advisory capacity to the planners, and planning committee can serve in an advisory capacity to the planners. - Once organized and leader is selected, committee needs to be organized and well run to be effective. Should have a formal agenda, meet regularly, and keep meeting minutes. Meetings should be productive and represent a food use of the community members' time. Communicate frequently and kept informed.

social math

- The practice of translating statistics and other data so they become interesting to the journalist, and meaningful to the audience. - Present it in a way that makes numbers easier to grasp by putting them in a context that gives instant meaning.

cost-benefit analysis (CBA)

- When a rationale includes an economic component. - Yields the dollar benefit received from dollars invested in the program.

Five techniques by which committee members are chosen:

1. Ask for volunteers by work of mouth, newsletters needs assessment, or some other distributed publication. 2. Hold an election, either through community or by subdivisions of the community. 3. Inviting/recruiting people to serve. 4. Having members formally appointed by a governing group or individual. 5. Having an application process then selecting those with desirable characteristics.

10 guidelines for planning committee

1. Committee should be composed of individuals who represent a variety of subgroups within the priority population. Should have representation from all segments of the PP. Greater number of individuals represented by committee members, greater the chance of the PP developing a feeling of program ownership > better planned programs, greater support of programs, and people who will be willing to help sell the program to others because they feel its theirs. 2. If program that is planned deals with a specific health risk or problem, have that someone be included in the planning committee. 3. Committee include willing individuals who are interested in seeing the program succeed. Select doers and influencers (important to the planning process). 4. Committee include an individual who has a key role within the organization sponsoring the program (someone who support would be most important to ensure a successful program and institutionalization. 5. Committee should include representative of other stakeholders (any person or organization with a vested interest in a program) not represented in the PP. 6. Committee membership should be reevaluated regularly to ensure that the composition lends itself to fulfilling program goals and objectives. 7. New individuals would be added to generate new ideas and enthusiasm. Set them limits. Stagger the length of terms fo that there is a combo of new and experienced members. 8. Be aware of politics. People bring their own agenda to committee work. 9. Make sure committee are large to accomplish the work, but small enough to be able to make decisions and reach consensus. Subcommittees can be used to handle specific tasks. 10. Might be the need for multiple layers of planning committee.

makeup of a solid planning/steering committee

1.represnetatives of all segments of priority pop. 2.doers 3.influencers 4.representative of sponsoring agency 5.other stakeholders 6.good leadership = solid committee

examples of social math

Break the numbers down by time, break down the numbers by place, provide comparisons with familiar things, provide ironic comparisons, and localize numbers

Responsibilities and Competencies for Health Education Specialists

I. Assess Needs, Resources, and Capacity for Health Education/Promotion II. Plan Health Education/Promotion V. Administer and Manage Health Education/Promotion VI. Serve as a Health Education/Promotion Resource Person VII. Communicate, Promote, and Advocate for Health and Health Education/Promotion, and the Profession

Step 4: Listing the References Used to Create the Rationale

Include a list of the references used in preparation of the rationale. Shoes decision makers that you studied the available information before presenting your idea.

support

congruent organizational policies, program and concept visibility, expressions of priority value, personal involvement of key managers, a place at the table of organizational power, organizational credibility, and a role in integrated functioning

problem statement or statement of problem

declaration of the health problem - Statement begins with concise explanation of the issue that needs to be addressed, include why it is a problem, and why it should be dealt with. Also, should include supporting data for the problem.

rationale should show

how the benefits of the program align with the values of the decision makers, address the potential return on investment, and be backed by the best evidence available

literature

includes articles, books, government publications, and other documents that explain the past and current knowledge about a particular topic.

resources

money that can be turned to staff, facilities, materials, supplies, utilities, and a myriad number of things that enable organized activity to take place over time

evidence pyramid

objective evidence at the top and more subjective evidence at the base of the pyramid - more objective evidence include systemic reviews, and subjective involve personal experience and observations and anecdotes - Objective is higher quality evidence because it is from a scientific process. Evidence is usually imperfect. - Lots of evidence of various types of health-related programs.

continuum of evidence

one end is by the objective evidence (science based evidence) and subjective evidence

doers

people who will be willing to roll up their sleeves and do the physical work needed to see that the program is planned and implemented properly

global perspective

presenting the problem using information and data at the most at the most macro level (international, national, regional, state, or local)

epidemiology

study of the occurrence and distribution of health-related events, states, and processes, and the application of this knowledge to control relevant health problems

partnering

the association of two or more entities (individuals, groups, agencies, organizations) working together on a project of common interest - Means sharing resources and tasks to be completed. - Reasons to partner and include such as: (1) meeting the needs of the PP which could not be met by the capacities of an individual partner, (2) sharing financial and other resources, (3) solving a problem or achieving a goal that is a priority to several partners, (4) bringing more stakeholders, (5) bring more credibility, (6) work with others that have the same values, (7) seeing and solving a problem form multiple perspectives and creating different effects, (8) creates greater response to need because there is strength in numbers. - When looking for partners (collaborators) planners consider: who is interested in meeting the needs of the PP, who sees the unmet needs, who has unused resources, who would benefit? - After considering partnerships, thought needs to be given to the size of the planning committee. Number of individuals can differ depending on the setting for the program and the size of the PP. - 10 guidelines for planning committee.

1. needs assessment

the process of identifying, analyzing, and prioritizing the needs of a priority population - Generates information and data that express the needs and wants of the priority population. - Carried out through a multiple-step process in which data are collected and analyzed. Analysis creates a prioritized list of needs of the community. - A complete needs assessment does not take place until decision makers give permission for planning to begin. But, a review of literature can generate information about a needs assessment of another related or similar program; which can help develop a rationale.

influencers

those who with a single phone call, email, or signature on a form will enlist other people to participate or will help provide the resources to facilitate the program

evidence-based practice

when program planners systemically find, appraise, and use evidence as the basis for decision making when a planning a health promotion program