Program Planning: Planning, Implementing & evaluating health Promotion Programs, A primer 7 e

Community

"A group of people who have common characteristics." Can be defined by, location, race, ethnicity, age, occupation, problems, outcomes, or other common bonds. Characterized by: ■ Membership- s sense of identity & belonging. ■ Common symbol systems- language, rituals, ceremonies. ■ Shared values & norms ■ Mutual influence ■ Shared needs & commitment to meeting them. ■ Shared emotional connection- common history, experiences, & Mutual support.

Decision makers

(those who have the authority to approve a plan; e.g., administrator of an organization, governing board, chief executive officer) give approval to the resulting comprehensive program plan, planners & facilitators are empowered to implement the program. Provide & allocate the necessary Resources:, money that can be turned into staff, supplies, etc. Support: Policies, values, decision making.

1. Major tasks during the program Pre-planning: ● Rationale - An Inverted 🔽triangle

1). A written document used to gain the support of key people/decision-makers. 2). Identify & describe the target population and health issues. 3). Thoroughly supported by data & the research literature. 4). Discusses the benefits of health promotion programs. ​ 5). Often several Pages long.

Six Phases of Policy Making

1). Agenda setting 2). Policy formulation 3). Policy adoption 4). Policy implementation 5). Policy Assessment 6). Policy modification

2. Major tasks during the program Pre-planning: ● Problem Statement

1). Contained within the rationale 2). Concise explanation of: ● what issue/s need to be addressed ● Why it is a problem ● Why it needs to be dealt with. 3). Must include some supporting data 4). Several paragraphs long 1 page.

Three F's of program planning "Helps with selecting appropriate model"

1). Fluidity- Steps in the planning process are sequential, or they build on one another. 2). Flexibility- Planning adapts to the needs of stakeholders. 3). Functionality- the outcome of planning is improved health conditions, not the production of the plan.

Benefits of Understanding the Generalized Model

1). Helps you adapt & respond to complex planning challenges you will experience. 2). Quickly assimilate & interpret varying or competing stakeholder preferences for planning into a guiding paradigm that will keep you on track. 3). Its principles are the building blocks for all other planning models. 4). The ability to apply an important process closely related to program planning- grant writing. Requirements listed in Requests for applications (RFAs) or Requests for proposals (RFPs) related to grant announcements will be developed by the funding agency/organization, including preferences for language & terminology. Health funding request requirements are often related to the Generalized Model steps.

4 Steps to Writing a Rationale

1). Identify appropriate background information 2). Title the rationale 3). Write the contents of the rationale ***Literature review/ background ***Problem statement *** "Sales Pitch"- Using economics to sell the program. ***Social Math ***Cost-benefits analysis ***Return on investment ***Evidence-Based Best Practices 4). List the references

Planning scenarios where needs assessment may not be used.

1). If another needs assessment had been conducted recently, Unavailability of funding for a new program. 2). Where the program planners are employed by an agency that deals only with specific needs that are already known e.g., cancer & the American cancer society, or the agency has received CATEGORICAL FUNDS earmarked or dedicated to specific diseases e.g., HIV/AIDS; health determinant e.g., risk factor, or program e.g., Immunization.

PRECEDE PHASE 4: Administrative and Policy Diagnosis / Intervention Alignment

1). Interventions Alignment- marching appropriate strategies & Interventions with the identified needs. 2). Administrative & Policy Assessment- determines if capabilities & resources are available to develop & implement the program. The PRECEDE " Assessment portion " ends & PROCEED begins between 4and 5.

Needs Assessment WHY?

1). It's a logical place to start (Needs must be identified & measured). 2). Helps ensure the appropriate use of planning resources where they can give maximum benefits. (Undetermined & non-prioritized needs can waste resources on unsubstantiated programming). 3). Allows planners "apply the principles of equity & social justice in practice" to focus on those in greatest needs. 4). Lack of one may prevent or delay adequate attention directed to a more important health problem "e.g., A health problem that creates high emotional response among parents is the trauma linked to bicycle injuries in children." 5). Can determine the capacity of a community to address specific needs. 6). Develops a focus for an intervention to meet the needs. 7). Provides a reference point for future assessments. (can be compared)

Steps of Intervention Mapping

1). Need Assessment- Establishes a participatory planning group, assesses community capacity, and Links the needs assessment to help outcomes and quality of life goals. 2). Matrices of Change Objectives- specifies who and what will change. 3) Theory-based Methods & Practical Applications- Guides the planner through a process of selected Theory-based interventions and strategies. 4). Program Production- The scope, sequence, completed program materials, and Protocols are outlined. 5). Adoption & Implementation 6). Evaluation Planning

4-Types of Community Needs

1). Perceived Needs- Based on what individuals feel their needs are. 2). Expressed Needs- defined by the number of individuals who sought help. 3). Absolute Needs- needs deemed universal including those for survival 4). Relative Needs- Needs to be rendered necessary based on equity.

Selecting a Program planning Model to apply will be based on many factors:

1). Preferences of stakeholders -Decision-makers, program partners, consumers 2). Time & Funding 3). Resources for data collection & analysis (or lack thereof) 4). Involvement of partners -Client, population, community 5). Preferences of a funding agency.

In Practice: Selecting a specific planning model for application will be based on many factors:

1). The preference of stakeholders (e.g., decision-makers, program partners, consumers). 2). How much time & funding are available for planning purposes? 3). How many resources are available for data collection & analysis? 4). The degree to which clients are actually involved as partners in the planning process or the degree to which your planning effort will be consumer-oriented (i.e., planning is largely based on the wants & needs of consumers or the planning process is owned by the community itself). 5). Preferences of a funding agency (in the case of a grant or contract award).

2 Major tasks during the program Pre-planning:

1). Write a rationale & Problem statement 2). Forming a planning committee ● Get support from decision-makers in the community Support comes from decision-making, an employee, parents, health educators, and the population

Needs Assessment Answers-

1). who is the priority population? 2). what are the needs of the priority population? 3). Why do these needs exist? 4). What factors create or determine the need? 5). Which subgroups within the priority population have the greatest need? 6). Where are these subgroups located geographically? 7). what resources are available to address the needs? 8). what is currently being done to resolve identified needs? 9). How well have the identified needs been addressed in the past? Capacity Building: activities that enhance the resources of individuals, organizations, & communities to improve their effectiveness to take action.

Primary Data: Town hall Meetings "Good source of information for preliminary needs assessment or various aspect of evaluation."

1. Community- Town hall meeting, organized by priority population. (labor, civic, religious, or service organizations, parent-teachers association "PTA"). Recorders- take notes or record sessions to ensure accurate documentation. 2. Organizational meeting- organized by an agency for its employees & stakeholders 3. Coalition meeting- organized by coalition members.

Secondary data sources

1. Data collected by government agencies. (Data mandated by law- Census, births, deaths, notifiable 2. Data collected by non-governmental agencies & organizations. 3. Data from existing databases. 4. Data from the academic literature. 5. Healthy People Data sets. ​

Steps of Needs Assessment

1. Determining the purpose and scope 2. Gathering data 3. Analyzing data 4. Identifying risk factors linked to health problems 5. Identifying the program focus 6. Validating the need

Primary Data: Photo Voice

1. Individuals in the priority population are provided with cameras & skills training. 2. They use photo voice to convey their own images of the community's problems & strengths. Data was collected by the community under guidance from the program planner.

The five traditional channels of communication include:

1. Intrapersonal- (one-on-one) Health care, healthy coaches, hotlines 2. Interpersonal- (small groups) Small classes, support groups 3. Organizational- Church bulletins, company or agency newsletter. 4. Mass media- Newspapers, billboards, magazines. PSAs, & more. 5. Social media ( Interactive Media) ▪︎ User or consumer-generated, organized, & distributed. ▪︎ Information can be revised or updated almost immediately. ▪︎ Typically low cost in terms of creation & maintenance. ▪︎ Facebook. blogs, LinkedIn, Twitter, and Text messaging.

Generalized Model

1. Pre-planning: ●Writing a rationale & Problem statement; ●Forming a planning committee 2. Assessing needs: ●Collecting & analyzing data to determine the health needs of the priority population; setting priorities; & selecting the priority population. 3. Setting goals and objectives: ●What will be accomplished. 4. Developing intervention: ●How goals & objectives will be achieved. 5. Implementing interventions: ●Putting intervention into action. 6. Evaluating results: ●Improving quality & determining effectiveness.

Cross-sectional: when priority population cannot respond.

1. Proxy report- Data collected from someone on behalf of a person who cannot respond for themselves. 2. Proxy measure- Outcome measure that provides evidence that behavior has occurred. e.g., Low blood pressure-medication taking; Body weight-exercise & dieting; Nicotine in blood- tobacco use; Empty alcoholic beverages in the trash- Alcohol consumption; Another person reporting on the compliance of his/her partner. 3. Indirect measures-unmistakable signs that a specific behavior has occurred.

Objectives Elements that ensure its Usefulness

1. The OUTCOME to be achieved, or what will change. 2. The CONDITIONS under which the outcome will be observed, or when the change will occur. 3. The CRITERION For deciding whether the outcome has been achieved, or how much changes. 4. The PRIORITY will change POPULATION, or who

Impact Evaluation

2nd level objectives in the hierarchy. ● comprises three different types of objectives: Learning, Behavioral, & Environmental. ● They described the immediate observable effects of a program (e.g., changes in awareness, knowledge, attitudes, skills, behavior. or the environment) ● They form the groundwork for impact evaluation.

The Components of a Grant Proposal

1. Title ( or cover) Page. When writing the title, be concise and explicit; avoid words that add nothing. 2. Abstract or executive summary. Provides a summary of The Proposal project. maybe the most important part of the proposal. should be written last and be about 200-300 words long. 3. Table of Contents. May or may not be needed, depends on the length of the proposal. it is a convenience for the reader. 4. Introduction. Should begin with a capsule statement, be comprehensible to the informed layperson, and includ the statement of the problem, significance of the program, and purpose (or aim) of the program. 5. Background. Should include the proposes previous related work and the related literature. 6. Description of proposed program. Should include the objectives, description of the intervention, evaluation plan, and the time frame. 7. Description of relevant institutional/agency resources. Should identify the resources the proposer's organization will bring to the project. 8.. List of references. Should include references cited in the proposal. 9. Personnel section. Should include the biographical sketch (i.e., biosketch), curriculum vitae, or resumes of those who are to work with the program. 10. Budget & Narrative. Should include financial needs for personnel (salaries and wages), equipment, materials and supplies, travel, services, other needed item, and indirect costs, as well as an explanation for the amount needed and how the amount were were calculated.

Example of Program Goals

1. To prevent the spread of HIV in the youth of Indiana. 2. To reduce the incidence of influenza in the residents of Delaware County Home. 3. To reduce the incidence of cardiovascular disease in the employee of the Smith Company. 4. To eliminate all cases of measles in the City of Kensington. 5. To reduce the cases of lung cancer caused by exposure to secondhand smoke in Elizabethtown, PA.

The two major task During Program Pre-Planning

1. Writing a rationale & Problem statement 2 Forming a planning committee HESp. Must first get support from Decision Makers in the Community. Decision Makers Provide & collect the necessary: ● Resources: money that can be turned into staff, supplies, etc. ● Support: policies, values, decision making

8- Steps to increase Cross-sectional data collection Accuracy:

1. select measures that clearly reflect the program outcomes. 2. select measures that have been designed to anticipate the response problem and that have been validated. 3. Conduct a pilot study with the priority population. 4. Anticipate and correct any major source of unreliability. 5. Employ quality-control procedures to detect other sources of error. 6. Employ multiple methods. 7. Use multiple measures. 8. Use experimental and control groups with random assignment to control for biases in self-reports. ​

Primary Data: Cross-Sectional (point -in-time) Survey "Single-step Survey"

1. written questionnaires 2. Face-to-Face interviews 3. Telephone interviews 4. Electric interviews Data is collected from individuals or respondents/participants (self-report) with an instrument designed by the program planner. Asked to recall/report accurate information The only way to measure "safe sex" behavior.

Health Education Strategies

10 General Principles of Learning ( Keep in mind before & during curriculum design) ■ Appeal to multiple senses (e.g., seeing, hearing, speaking). ■ Get the learner active in the Learning process. ■ Limit distractions. ■ Make sure they are ready to learn. ■ Make the subject relevant to the participants. ■ Use repetition. ■ Make sure Learning is recognized & encouraged. ■ Move from simple to complex concepts. ■ Make the concept applicable to several settings. generalize. ■ Find an appropriate pace.

***Return on investment- ROI

A common way to report a CBA. Measures the cost of a program ( I.e., the investment) versus the financial returns realized by the program. Formula: a). General comparisons of Dollars invested vs Benefits produced ROI= (Benefits of investment- amount invested)/ amount invested b). Investment in prevention program: Compares savings produced, the net cost of the program, and program cost: ROI= net savings/ cost of intervention c). When ROI = 0, the program pays for itself. When ROI is greater than 0 the program is producing savings that exceed the program cost. ***Example of ROI: A study that examines the economic impact of an investment of $10 per person per year in a proven community-based program to increase physical activity, improve nutrition, & prevent smoking/ other tobacco use.​ ***The result showed that the nation could save billions of dollars and have RIO in a year of 0.96-1, 5.6-1 in 5 years, & 6.2-1 in 10-20 years.

Tools of health communication include:

A communication channel is a route through which a message is disseminated to the priority population. ● Video and audio teleconferencing ● Telephones ▪︎ Individual initiated, e.g., helplines ▪︎ Outreach - called by health educator/counselor/coach ● Mass media ● In person ● Printed materials ● Computers, Internet, tailored emails

Generalized Model for Program Planning

A complete understanding will help HESp. adapt & respond to complex planning tasks in professional practice. 1). It streamlines the planning process with a common framework. 2). The principles are the building blocks for all other models. 3). It is linear, yet fluid-moving back & forth between the steps. 4). It aligns with the grant writing process.

A canned program

A curriculum developed by an outside group and includes the basic components and materials necessary to implement a program

Primary Data: Delphi Technique

A process that generates consensus through a series of assessments/questionnaires administered via mail or electronic mail given to experts. Data is collected from experts with a series of modified instruments designed by the program planner. The facilitator seeks individual assessment from a pool of experts. -------> Step 1 -------> Experts- respond to the request, receive feedback, & revise their response. --------> Steps 2,4,6 ------->Facilitator: Experts <---------steps 3 & 5 Facilitator-compiles the responses & send a revised set of questions to each expert. Several cycles of feedback may be needed.-------> Step 7 Final Report-Facilitator produces Report on experts' responses noting key outliers.

Expanded Community Groups

A task force or coalition. ● Task Force: "A self-contained group of "doers" that is not ongoing. It is convened for a narrow purpose over a defined timeframe at the request of another body or committee" ● Coalition: " A formal alliance of organizations that come together to work for a common goal" ● Coalition -"Develop internal decision-making & leadership structure that allows member organizations to speak with a united voice & engage in shared planning & implementation activities. Link to outside organizations & communication channels is formal. Member organizations are willing to pull resources from existing systems & seek new resources to develop a joint budget. Agreements, benchmarks, roles, & assignments written" ● Building and maintaining effective coalitions have increasingly been recognized as vital components of effective community organization & community building.

Market Segmentation

A way to divide the priority population into smaller, more homogeneous, or similar groups. ■ Goal - is to create groups of people who share similar characteristics or qualities who would respond in a similar way to intervention. e.g., Provident mobile screening for those already aware that yearly mammogram screening saves lives, and a promotion strategies for those unaware. ● Advantages: Helps planners narrow the focus of the marketing strategy. Helps thunderous to be more effective and efficient with limited resources because they are able to identify groups of the prayer of population who have similar needs & who will respond to the marketing strategy in a similar way. Helps Sanders to make the best decision in terms of where to offer the product, how to make the price affordable, and how to tailor the promotion strategies including message and Communication channels to the priority population.

BPR (Basic Priority Rating) Model-Components & Scores:

A). Size of the problem (0-10) B). Seriousness of the problem (0-20) C). Effectiveness of the possible interventions (0-10) D). Proprietary, economics, acceptability, resources, & legality (PEARL)(0 or 1) Basic Priority Rating (BPR)=(A+B)C/3×D BPR model 2.0: ​an updated version of the basic priority rating

1). Pre-planning (quasi phase before planning begins).

Allows a core group of people (or steering committee) to gather answers to key questions that are critical to the planning process before planning begins. It helps clarify & give direction to planning, & helps stakeholders avoid confusion as the planning progresses. Planning a health promotion program is a multi-step process. The Planning process doesn't always start the same way because of the variety of settings & resources. A successful program may need to be reworked to continue its success. Planners need to create a rationale to gain support from key people to obtain the necessary resources & ensure program success.

Criteria & Guidelines for Developing Health Promotion Interventions.

APHAs/CDCs' five guidelines for establishing the feasibility &/or the appropriateness of a health promotion program include: 1). Address "risk factors" that are carefully defined, measurable, modifiable, & prevalent among the members of a chosen target group. 2). Reflect a consideration of the special characteristics. needs. & preferences of its "target group(s)

Intervention=Program

An Intervention /treatment is an activity or set of activities that help to achieve the outcome stated in the goal & objectives. ■ A theory-based strategy or experience to which those in the priority population will be exposed or in which they will take part. ■ Occurs between two points in time. An intervention should be: ■ Effective (lead to the desired outcome) ■ Efficient ( use resources in a responsible manner). ■ Multiplicity: number of components or activities ■ Dose-number of program units delivered; how many times offered.

Primary Data: Windshield Survey

An informal survey where the health professional drives around the community/area they are researching, & records his/her observations. These tours are particularly useful when the area to be observed is large, & certain aspects/features can be seen from the road. Data is collected by the program planner through observation.

Steps to Writing a Rationale ● Step 3- The Problem Statement

Answers: What issue/s need to be addressed. Why it is a problem. Why it needs to be dealt with. Data: "Big Picture", global data Local data, confirming the needs of the community Summary statement - Human Impact - Quotation may be used

Summative Evaluation

Any combination of measurements permits conclusions about the impact, outcome, or benefits of the program. This includes- ■ Impact evaluation: focuses on intermediate indicators such as awareness, knowledge, attitudes, skills, environment, & most importantly, behaviors, as well as outcome evaluation. ■ Outcome evaluation focuses on long-term program measures such as mortality, morbidity, or disability. ■ Indicators used in Summative Evaluation. might include years of potential life lost (or saved), the prevalence of tobacco use, reduction in diabetes mortality, a decrease in Incidence of HIV/AIDS, reduced absenteeism (measured in worksite settings), number of pounds lost, & healthcare costs saved due to health promotion programs.

Stakeholders

Any person, community, or organization with a vested interest in a program; e.g., decision-makers, partners, clients) informed.

Health Promotion

Any planned combination of educational, political, environmental, regulatory, or organizational mechanisms that support actions and conditions of living conducive to the health of individuals, groups, and communities. (joint committee on terminology) Green & Kreuter: Any planned combination of educational, political, regulatory, & organizational supports for action & conditions of living conducive to the health of individuals, groups, & communities.

Evaluating Impact of delivered Message (CHES)

Ask, What do we want people to think or do as a result of the communication intervention? (Flu shot or wear a bike helmet?) 3- common Measures for Health communication include changes in: ● Knowledge ● Attitude ● Behavior

Process of community Organization & Community Building 2:

Assessing the community--------->Determining the priorities & setting goals-----------> Arriving at a solution & selecting intervention strategies----------> Implementing the plan----------> Evaluating the plan of action--------> Maintaining outcomes in the community---------->Looping back

Impact: Learning Objectives Example

Awareness level: After the American Heart Association pamphlet on the cardiovascular health risk factor has been placed in grocery bags, at least 20% of the shoppers will be able to identify two of their own risks. ■ Outcome (what): Identify their own risks. ■ Priority population (who): Shoppers ■ Conditions (when): After the distribution of pamphlets ■ Criterion ( how much): 20% Knowledge level: When ask over the phone, one out of three viewers of the heart special television show will be able to explain the four principles of cardiovascular conditioning. ■ Outcome (what): Able to explain the four principles of cardiovascular conditioning. ■ Priority population (who): Television viewers ■ Conditions (when): When asked over the phone ■Criterion (how much): One out of three Attitude Level: During one of the class sessions, 50% of the participant will send their reason for regular exercise. ■ Outcome (what): Defend their reasons for regular exercise ■ Priority population (who): Class participants ■ Conditions (when): During one of the class sessions ■ Criterion (how much): 50% Skill development level: After you are in the video "How to Exercise," half of those participating will be able to locate their pulse and count it every time they are asked to do it. ■ Outcome (what): Locate their pulse and count it ■ Priority population (who): Those participating ■ Conditions (when): After viewing the video ■ Criterion (how much): Half of those participating ​

Analyzing the Data: Basic Priority Rating (BPR)Model

Basic Priority Rating: BPR model or "Priority rating process" was introduced in an attempt to prioritize health problems. Elements in the model give more weight to the impact of a communicable disease as compared to chronic diseases which were changed by Neiger et al. Requires Planners to rate 4 different components of Needs identification and insert the rating into a formula to determine the rating "0-100"

Steps to Writing a Rationale ● Step 3-Write the content of the Rationale ● Step 4-List all references

Begin with a full description of background information using data found in step 1. Problem Statement: " Big Picture" perspective -->Local problem "Sales Pitch" ROI ($) invested-->Economic Impact: Social Math, Cost-Benefit Analysis, Return on Investment Solutions: Evidence-Based Best Practices

Impact: Environmental objectives Example

By the year 2020, 10% of the clinic's patients will have been able to schedule an appointment either after 5 p.m. or on a Saturday. ■ Outcome (what): Will be able to schedule ■ Priority population (who): The clinic's patients. ■ Conditions (when): By the year 2020 ■ Criterion (how much): 10%

Health-Related Community Service Strategies

Examples include ■ HRAs (Health Risk Assessment) ■ Clinical (biometric) screening for BP, cholesterol, and glucose. ■ Services, tests, or treatments to improve health-flu shots & other immunizations. ■ Check-ups, exams ■ Reduce barriers to the services- be mindful of affordability, and accessibility. ■Referrals & follow-ups are important; link with priority populations' health care providers. ​

Community Capacity in Needs Assessment Why?

Capacity= Individual, organizational, & community resources " leadership, relationship, operations, structures, infrastructure, politics, & systems" that can enable a community to take action. Community capacity= characteristics of communities that affect their ability to identify, mobilize, & address social & public health problems. Helps HESp. to think about existing community strengths that can be mobilized to address social, economic, & environmental conditions affecting health inequities. 1).places-parks, libraries 2). Organizations-education, healthcare, faith-based groups, social services, volunteer groups, businesses, local government, law enforcement & various sectors of the community. Important!!!!! 1) Identify the nature of relationships across these sectors e.g., norms, and values. 2). With the community e.g., civic participation. 3). Among various subgroups within the community e.g., distribution of power & authority, trust, and identity.

Process Example

Changes that occur because of planning & implementing the program. By 2020, the program planners will increase the number of heart-healthy educational sessions offered to county residents from the baseline of 15 to 25 per year. ■ Outcome (what): Increase the number of heart-healthy educational sessions. ■ Priority Population: (who): Program planners ■ Conditions (when): BY 2020 ■ Criterion (how much): From the baseline to 15 to 25 per year.

Community Mobilization Strategies

Community Mobilization Strategies involve helping the community to identify & take action on shared concerns using participatory decision-making, & include a method of empowerment.

Community Organization & Community Building Topology Model

Compares & contrasts needs & strengths with consensus & conflict.

***Cost-benefit analysis- CBA (used in creating a rationale)

Cost: salaries & supplies Benefits: Better Health; Reduced Costs; satisfaction A CBA of a health promotion program will yield the dollar benefit received from the dollars invested in the program. Other non-monetary costs & benefits, such as time, health, & quality of life. (Used when rationale includes an economic component, it is reported based on a CBA)

Acquiring Needs Assessment Secondary data

Data already collected by someone else, & are available for your use; Often collected via no-contact methods. Advantages: already exists & fairly inexpensive. Disadvantages: might not identify the true needs of the priority population. Drawback: Information might not identify the true needs of the priority population because of "how" & " when" data was collected, variables considered, & from whom the data was collected. Good Rule: Move cautiously and ensure data is applicable to the situation before use.

Community Organization Background

Four population-based approaches: ● Community-based ● Community empowerment ● Community participation ● Community Partnership Seven assumptions of Community Organizing ● Communities can develop the capacity to deal with their own problems. ● People want to change and can change. ● People should be the participants in making changes. ● Self-imposed & Self-developed changes are more lasting. ● "Holistic" is preferred over a "fragmented" approach. ● Democracy requires cooperation and participation. ● Communities need help with problems just like individuals do.

PRECEDE Phase 1: Social Assessment/ Situational Analysis

Define the quality of life " problems & priorities" of the priority population. Quality of life social indicators: achievement, alienation, comfort, crime, discrimination, happiness, self-esteem, unemployment, &welfare. ​

Steps or requirements related to requests for health funding often relate back to general Model Steps.

Example: CDC & other Federal or National Organizations' general funding requests requirements 1). Background & statement of need related to the needs assessment 2). Work plan 3). Management plan 4). Evaluation 5). Budget Parallel with the Generalized Model: 1). Background & statement of needs; needs assessment. 2). The work plan-goals & objectives description of interventions. 3). The Management plan- requirements for program implementation.

PRICE: the 2nd "P" Marketing Mix Variable

Financial, physical, psychological, time. (CHES). What does it cost to put the Priority population to obtain the product and its associated benefit? It is what they have to "give up" e.g., $ 20 USD ● Health promotion intervention the costs are non-financial. They involve social, mental, emotional, behavioral, or psychological costs. Price is not the same thing as barriers. ■ Barriers or what kept people from responding to an intervention or doing a behavior. one factor may be cost or price.

Phase 3: Program Management: Establishing a System of management:

Management is essential in the implementation process. Good management is needed to ensure that programs are: ■ Effective: meet stated goals & objectives. ■ Efficient: well-organized, cost-effective & vital to its long-term success. Program managers must know how to manage: ● Human resources ● Financial resources ● other resources

Program Goals: "Specific, Measurable, Achievable, Relevant, and Time-Bound"

Goals are less specific than objectives. Goals are used to explain the general intent of the program. Broad statements that describe the expected outcomes of the program. Goals set the fundamental, long-range direction. Goals need not be written as complete sentences or a set number of stated goals. Must be simple & concise & include 2- basic components: Who will be affected What will change due to the program? Goal Verbs: Evaluate, Know, Improve, Increase, Promote, Protect, Minimize, Prevent, Reduce, Understand.

MAPP Phase 2: Visioning

Guides the community through the process that results in a shared vision (what the ideal future looks like) Common values (principles & beliefs that will guide the remainder of the planning process). Facilitators conduct the visioning process & involve 50-100 participants including the Advisory & MAPP committee; key community leaders. Occurs In the Pre-Planning stage 9generalized model).

Primary Data: Health Risk Assessment (HRA) or Health Risk Appraisal Primary Data: Self Examination

HRA: A health questionnaire is used to provide individuals with an evaluation of their health risks & quality of life. Data is collected from individuals (self-report). Self Assessment: A self-exam is a technique that allows an individual to examine his/her body for any physical or visual changes. Data is collected from the individual (self-report)

Outcome objectives Example

Half of all those in the county who complete a regular, aerobic, 12-month exercise program will reduce their "risk age" on their follow-up health risk assessment by a minimum of two years compared to their preprogram results. ■ Outcome (what): Will reduce their "risk age" ■ Priority population (who): Those who complete an exercise program. ■ Conditions (when): After the 12 months exercise program. ■ Criterion (how much): Half

SWOT analysis

Has been associated with strategic planning efforts in the business and marketing sector. Rapid internal and external skin allow planners to implement interventions in a much shorter time frame; however, connecting can lead to poorly planned programs and must be used with caution. Commonly uses 2x2 metrics that list strengths and weaknesses along the horizontal axis and opportunities and threats along the vertical axis. (look at internal, & external; helpful. harmful) 1). Strengths: What the organization does well, resources, personnel, partnership. 2). Weaknesses: Poor reputation, codes, regulations, policies, or management restrictions. 3). Opportunities- Unfulfilled consumer needs, loosening or removing barriers, a new funding stream, or a newly organized coalition. 4). Threats- Consumer trends, organizational competition, or private industry.​

Health Communication Strategies

Health Communication: The study and use of Communication strategies to inform & influence individuals& community decisions that affect Health. Designed to inform and influence individual and community decisions to influence health. ● Usually a part of cost, interventions & are useful in reaching many goals and objectives. ● High Penetration Rate ( The number of people exposed or reached). ● More cost-effective & less threatening than other strategies.

PRODUCT: 1st "P" Marketing Mix Variable

Health behaviors, programs, or ideas (CHES). What planners are offering that will meet the consumer's needs, make it easy and convenience to do the behavior, and provide a benefit that consumers value. (tangible Items or services). e.g. LED light bulbs. ● Augmented Products: either tangible items or services. e.g., Social marketing-related products. Provides the priority population with choices to help change behaviors. ■Benefits: People buy products for (core products) benefits or value. e.g., Protect the environment or Save money on the electric bills.

Health Education Strategies defined terms:

Health education & health communication are not mutually exclusive categories. Health education provides the opportunity to gain in-depth knowledge about a particular health topic. ■ Curriculum (course of study)- what will those in the priority population be taught? ■ Scope- refers to the breadth & depth of material covered. ■ Sequence- defines the order in which the material is presented. ■ Unit of Study (Curriculumplan, Modules, & Strands)- " An orderly. self-contained collection of activities educationally designed to meet a set of objectives. ■ lessons- outlines for the lessons are called ● lesson plans- are composed of an introduction, and body. & conclusion. Many teaching methods include lecture/discussion, group work, audiovisual, etc.

Secondary Prevention- measures that lead to early diagnosis & prompt treatment of a disease, illness, or injury to minimize progression of health problem.

Health status: Presence of disease, illness, or injury Intervention example: Activities directed at early diagnosis, referral, & prompt treatment, e.g., mammograms, self-testicular exams, laboratory tests to diagnose diabetes, hypercholesterolemia, hypothyroidism, programs to prevent reinjury

Tertiary Prevention-m measure aimed at rehabilitation following significant disease, illness, or injury

Health status: disability, impairment, or dependency Intervention example: Activities directed at rehabilitation to return a person to maximum usefulness, e.g., disease management programs, support groups, and cardiac rehabilitation programs.

Primary prevention- measures that forestall the onset of a disease, illness, or injury.

Health status: healthy, without signs & symptoms of disease, illness, or injury. Intervention Example: Activities directed at improving well-being while preventing specific health problems, e.g., Legislation to mandate safe practices, exercise programs, immunizations, and fluoride treatments.

PLACE: 3rd "P" Marketing Mix Variable

How & when learning will take place. (CHES) Where the priority population has access to the product. e.g., Events at local Home Depot & Costco stores during October. planners should place the program in a desirable location.

PRECEDE Phase 3: Educational & Ecological Assessment

Identify factors that influence behavior: 1). Determine predisposing factors-impact motivation. Include individual knowledge & effective traits such as a person's attitude, beliefs, & perceptions. & values that can hinder a person's motivation to change, & can be altered through direct communication. 2). Enabling factors- Those that make possible a change in behavior, barriers & vehicles such as skills, access, availability, rules, & laws. Barriers or facilitators are created mainly by societal forces or systems. Access to healthcare facilities, or other healthcare services, availability of resources, referrals to appropriate providers, transportation, negotiation & Problem-solving skills. 3). Reinforcing factors- feedback & encouragement, rewards received after behavior change may encourage or discourage the continuation of behavior. Social benefits such as recognition, appreciation, incentives, & disincentive. Priorities become the focus of interventions. It could be delivered by family members, friends, peers, teachers, self, & others controlling rewards.​

Health Policy/ Enforcement Strategies

Include executive orders, laws, ordinances, policies, position statements, regulations,& formal/ informal rules. ▪︎ Mandated or regulated activities; e.g., State laws to raise cigarette taxes. ▪︎ May be controversial; may be political, and can take away freedoms. pride, $, psyche Based on the common good; protect the public's health.

Key Informants

Individuals with unique knowledge about a particular topic. e.g., A person with a specific issue I.e, losing weight talks about barriers experienced. A person who was denied health insurance coverage through the exchange.

How to write an objective: ■ Priority population (Who)

Outcome (what) + Priority Population (who)+ Condition(when) + Criterion (how much)= A well-written objective. Who will change? ● "1000 teachers" ● " 25% of employees of a company " ● "All residents of Sunnyvale"

Items to Consider When Creating a Health Promotion Intervention

Key Term: ■ Best practices- using interventions that have undergone critical reviews of multiple research & evaluation studies. ■ Best experience- falls short of best practice but shows promise ■ Best processes- original interventions based on theory. ■ Segmenting- diving a broader population into smaller groups. ■ Tailoring- intervention created for specific needs, interests, & circumstances.

Example of Mission Statements

Mission Statement or Program overview/Aim is a short narrative that describes the purpose & focus of the program. It describes the current focus of the program and the philosophy behind it. it helps to develop goals & objectives. Don't confuse it with the vision statement. Mission = What is the main focus of our program? Vision = What do we want our community to look like as a result of our program? 1). The mission of the walkup Health Promotion Program is to provide a wide variety of primary prevention activities for residents of the community. (community setting). 2). This program is in to help patients and their families to understand and cope with physical and emotional changes associated with recovery following cancer surgery (health care settings) 3). School District #77 wants happy and healthy students. to that end, the district Personnel strives, through a whole school, whole community, and whole child model program, to provide students with experiences that are designed to motivate & enable them to improve or maintain their health. (School setting) 4). The purpose of the employee health promotion program is to develop High employee morale. this is to be accomplished by providing employees with a work environment that is conducive to good health and by providing an opportunity for employees and their families to engage in behavior that will improve and maintain good health. (Works Site Setting)

Specific Program Planning Models

Most Common Model: 1). Evidence-Based Planning Framework or Public-Health. 2). MAPP 3). MAP-IT 4). PRECEDE-PROCEED 5). SWOT Other Models: 1). Intervention Mapping 2). SMART (Social Marketing Model) 3). Healthy Communities & CHANGE Tool 4). Healthy Plan-It 5). PATCH (Planned Approached to Community Health)

NEEDS ASSESSMENT " also known as community analysis, assessment, & diagnosis"

NEEDS: The difference between the present situation & a more desirable one. Actual Need = true need Perceived need = reported need Needs Assessment: A process of identifying, analyzing, & priority the needs of a priority population. The most critical step in planning. 1). It provides objective data to define important health problems. 2). Sets priorities for program implementation. 3) Establishes a baseline for evaluating program impact.

The first step of the Generalized Model

Needs Assessment: is the process of collecting and analyzing data to determine the health needs of a population and is usually included prior to settings identification of the priority population. 2). Setting goals and objectives: identifies "what" will be accomplished 3). Interventions or Programs: "how" goals & objectives will be achieved. 4). Implementation: putting intervention into action. 5). Evaluation: Improving the quality of the intervention (formative evaluation) & determine the effectiveness (summative evaluation). These phases define planning & evaluation at its core. ​

Objectives

Objectives break the goal down into smaller parts that provide Specific, Measurable actions by which the goal can be accomplished. Specific, Measurable, Achievable, Realistic, Time-phase ● Objectives are the bridge between needs assessment & planned intervention. "Objectives are crucial" ● More precise than goals. Represent smaller steps that lead to reaching goals. ● Outline specific changes to occur. Written in measurable terms. ● Several levels of Objectives. ●Answers " WHO is going to do WHAT, WHEN, and TO WHAT EXTENT "

Multidirectional Communication Model (MDC)

Occurs through a combination of: ■ Senders top-down (vertical) Expert-Generated messages. ■ Consumer-created bottom-up user-Generated messages. ■ Consumer-shared horizontal (side-to-side) Information sharing messages. ■ Consumers seeking information.​

Impact: Behavioral objectives Example

One year after the formal exercise class has been completed, 40% of those who complete a majority of the classes will still be involved in a regular aerobic exercise program. Outcome (what): Will still be involved ■ Priority population (who): Those who complete the majority of the class ■ Conditions (when): One year after the class ■ Criterion (how much): 40%

How to write an objective: ■ Outcome (What) 1st element of an objective

Outcome (what) + Priority Population (who)+ Condition(when) + Criterion (how much)= A well-written objective. ■ Outcome "result" to be achieved, or what will change: ● Process = Changes that occur after planning an implementation ● Impact = Changes in learning, Behavior, or the environment ( short-term changes) ● Changes in QOL or health status (long-term changes) ■ Verbs: apply, argue, build, compare, demonstrate, evaluate, exhibit, judge, perform, reduce, spend, state, & test. ( must refer to something measurable & observable). ■ Words not referred to something measurable or observable: appreciate, no, internalized, and understand.term-107

How to write an objective: ■ Conditions (when)

Outcome (what) + Priority Population (who)+ Condition(when) + Criterion (how much)= A well-written objective. ■ The conditions under which the outcome will be observed, or when the change will occur. ● "Upon completion of the exercise class..." ● "As a result of participation in the training event..." ● After viewing the film...."

How to write an objective: ■ Criterion (how much)

Outcome (what) + Priority Population (who)+ Condition(when) + Criterion (how much)= A well-written objective. ■The Criterion for deciding whether the outcome has been achieved, or how much change will occur ● "By 10% over the baseline" ● "300 pamphlets" ● "A reduction of 75%"

PRECEDE-PROCEDE Planning Model

PRECEDE: Predisposing, reinforcing. & enabling construct in educational/ecological diagnosis & evaluation. Developed in the early 1970s The first 4-phase are assessment phases. PROCEED Policy. regulatory, & organizational constructs in educational & environmental development. Developed in the 1980s Last 4- Phases are implementation & evaluation (process, impact. & outcome evaluation).

Eample Lesson Plan Format

Parts: 1st Row: Title of Program: ‐-‐‐------, Title of lesson:-----, Page ------of----- Unit: ---- Lesson No.:------- Priority Population: --------- Lenght of Lesson:-------- 2nd Row: Resources & References| Content (below content) ▪︎Introduction ▪︎ Body: 1.,2.,3., ▪︎ Conclusion: | Teaching Method Bottom Row: Evaluation

Evidence-based Planning Framework for Public Health (Brownson & Associates-Prevention Research Center (PRC)

Phase 1- Community Assessment- Understanding community context. Phase 2- Quantifying the Issue- Uses descriptive epidemiology derived from surveillance systems & other secondary data sets. Phase 3- Developing a Concise Statement of the Issue- Summarizes an analysis of root causes/ health problems. Phase 4-Determining what is known using Scientific Literature-Identifies evidence-based solutions related to the root causes identified in the statement of the issue. Phase 5- Developing & Prioritizing Program & Policy Options -Prioritize specific interventions or action steps. Phase 6- Developing an Action Plan & Implementing Intervention-Develop goals & objectives,plan action strategies. Phase 7- Evaluating the Program or Policy-Planners take measures to improve the existing program or policy & measure effectiveness.

Phases of the PRECEDE-PROCEED Model

Phase 1- Social Assessment-----> Phase 2- Epidemiological Assessment--‐----> Phase 3 Educational & Ecological Assessment------> Phase 4 -Administrative & Policy Assessment & Intervention Alignment---‐----->Phase 5- Implementation ------> Phase 6- Process Evaluation----‐> Phase 7- Impact Evaluation-------> Phase 8-Outcome Evaluation. It begins with the final consequences and work backwards to the causes. Once the causes are known, an intervention can be designed. ​

MAPP (Mobilizing for Action through Planning and Partnerships) Developed by the National Association of County & City Health Officials (NACCHO). Goal: to aid city or county health departments

Phase 1: Organizing for success & Partnership Development-Assess the process, if appropriate, if possible, and the timeliness of MAPP. Assess resources(i.e., budget, personnel expertise, key decision-makers support, other stakeholders, & general community members' interest. when deciding to proceed, these working groups are created: 1). A core support team-which prepares most, of the materials needed for the planning process. 2). The MAPP committee, key sponsors,( influential people or organizations from the private sector-lend support & other resources) 3). The community-provides input, representation, & decision-making. It answers questions about the general feasibility, resources, & appropriateness of the MAPP process

MAPP Phase 4: Identify Strategic Issues MAPP Phase 5: Formulate Goal & Strategies MAPP Phase 6: Action Cycle

Phase 4: Develop a prioritized list of the most important issues facing the health of the community. Only issues that jeopardize the community's vision & values are considered. Consider the effect of unaddressed issues, understand why an issue is strategic, consolidate overlapping issues, & identifying a prioritized list. Phase 5: Create goals related to the vision & prioritize the strategic issues, & select strategies to accomplish the goals. Phase 6: Similar to the implementation & evaluation phase. Consider evaluation plan development (gather credible evidence), implementation details, & result dissemination plan.

Program Evaluation

Planning----> Start of Implementation----> End of Implementation Formative--->Process Summative--Impact/Outcome

Neighborhood Assets Map: Building Blocks "Assets" of Community

Primary building blocks: most accessible; located in the neighborhood & largely under the control of those who live in the neighborhood. ● Individual assets-skills & abilities of residents ● organizational assets- community groups Secondary building block: Locate in the neighborhood but largely controlled by people outside. ● Private & Non-Profits- Higher education, hospitals ● Public institutions & services- Schools, Police, parks, library ● Physical resources-Land Potential building blocks: Least accessible; resources originating outside the neighborhood & controlled by people outside (e.g., Public Information)

Acquiring Needs Assessment Primary Data

Primary data: Self-collected data " survey. a focus group, in-depth review, interview, windshield tour" that answers unique questions related to the assessment of your specific needs; Often collected via interactive contact methods or minimal contact observational methods. Advantages: directly answers questions planners want to be answered. Disadvantages: expensive & can take a great deal of time.

Phase 2 (Implementation): Identifying & prioritizing the task to be completed:

Prioritize a number of small tasks. ● reserving space where the program will be held ● making sure audiovisual equipment is available when requested ● ordering the correct number of participant education packets or manuals. ● Arranging for interpreters when working with a diverse population. ■ Type of timetables & timelines include: ● Basic timelines ● Task Development timelines "TDTLs" ● Gantt charts ● PERT charts ● Critical path method "CPM"

Process Objectives

Process objectives are the daily tasks, activities, and work plan that leads to the complement of all other levels of objective. ● Helps you shape/ form program ● Focus on all program inputs/resources (All that is needed to carry out a program). ● Implementation activities ( presentation of the program) ● Stakeholders' reactions. These objectives focus on : ● Program resources such as materials, funds, and space. ● Appropriateness of intervention activities ● Priority population exposure, attendance, participation, & feedback ● Feedback from other stakeholders such as funding & sponsoring agencies ● Data collection techniques. □ Form the groundwork for process evaluation.

Secondary data sources Examples Literature

PsycInfo-APA is an abstracting (not full text) & indexing database Medline- Primary component of & access to PubMed, the U.S. Library of medicine a premier bibliography database. Education Resource Information Center(ERIC)-Digital library of education literature sponsored by the Institute of Education Science(IES)of the U.S. Department of Education. Cumulative Index To Nursing & Allied Health Literature (CINAHL)-Updated monthly, Provides an index of journals from Nursing & other allied health disciplines. Provides Index for health books, and dissertations. PubMed- Provides citations from biomedical literature from Medline, life science journals, & online books.

Primary Data: Focus Group

Qualitative Research has grown from group therapy. Group interviews are used to obtain information about the feelings, opinions, perceptions, insights, beliefs, & attitudes of a group of people. 1. A small group of 8-12 people. 2. Must not know each other. 3. By invitation only 1- 3 weeks in advance. 4. Given general information about the session at invitation but no specifics. 5. A skilled moderator collects data " written notes or audio-video recordings" using predetermined interview guides ( protocol). The level of skis increases with the more controversial topic. Limitations: Non- randomized sample selection but by attributes e.g., low-income individuals, city dwellers, parents of disabled children, or chief executive officers of major corporations. Results are not generalizable.

The Foundations of Research Ethics

■ The "Nuremberg Code" in 1947 mandated voluntary consent for experimental studies of humans. ■ The " Declaration of Helsinki " was written by the world Medical Association in 1964 to provide ethical guidelines for Physicians conducting clinical trials.

***Social Math

Refers to inflating national statistics to make the health problem appear more serious to decision-makers. Translating statistics & other data so they become: Influential to decision-makers, Interesting to Journalists, & meaningful to the audience. a). Break the number down by time: Knowledge of how the yearly amount looks by the hour,& minute e.g., For the National average salary of a childcare worker: $15,430 is $7.42 per hour (15,430 / 40 or 37.5 x 52), breaking it down makes the needs for the interventions clearer. b). Breakdown the number by Place: comparing Statistics with a well-known place ( statistic magnitude) e.g., 25,000 children on the childcare subsidy waitlist in California can fit into every seat in the Major League Ballpark in California. c). Provide a comparison with the familiar things: Comparing something familiar: head Start is a successful educational program, but being underfunded it only serves 3/5 of eligible children. applying that proportion to social security would mean almost 1 million currently eligible seniors wouldn't receive benefits d). Provide Ironic comparisons: e.g., the average annual cost of full-time, licensed, center-based care for a child under age 2 in California is twice the tuition at the University of California at Berkeley. e). Localize the number: Make a comparison that will resonate with community members: e.g., Saying, center-based childcare for infants costs $11,450 per year in Seattle, Washington." However, a father making minimum wage spending 79 percent of his income per year on childcare is more powerful to show difficulty.

Formula for a Solid Planning Committee

Representatives of all segments of the priority population ****Doers ****Influencers ****Representatives of sponsoring agency ****Other stakeholders +Good leadership = Solid committee

The Planning Committee Members

Representatives of: The priority population-1/2 of the members should be the people who are going to benefit from the program. Sponsoring agency- 2 representatives from sponsoring organization (very important for the program's success) Other stakeholders- anyone with a vested interest in the program. Defined members based on whom they represent, & expected to communicate people's wants & needs. Role: Doer- Do physical work to make sure the program is properly planned & implemented. Leader-Controls the resources to facilitate the planning of the program. Influencer- Will manage the committee members (Health Educator). Defines members based on the work type they will do. All members have a defined role & are representatives of a group.

MAPP Phase 3: Four MAPP Assessment (these are the arrows around the outside of the model)

Represents the defining characteristics of the MAPP model. 4-assessment include 1). The community themes & strengths assessment (community or consumer opinion). 2). The local public health assessment (general capacity of the local health department & health system). 3). The community health status assessment (measurement of the health of the community by use of mortality, morbidity, risks factor & other related data). 4). The forces of change assessment (forces such as legislation, technology, & other environmental or social phenomena that do or will impact the community). MAPP assessment provides insight on gaps between current status, what is learned in the visioning phase, & strategic direction for goals & strategies. It provides an excellent framework for the type of data collection needed for a comprehensive needs assessment.

The Community Tool Box website is designed to assist professionals with various tasks and outlines a grant proposal's standard component.

Sections: 1) The statement of the problem/needs assessment 2) Project description (goals, objectives &methods/activities). 3) The evaluation plan. 4) The budget request and justification

Identifying & prioritizing task: TASK DEVELOPMENT timelines

Similar to Gantt Chart and composed of rows & columns. ● Rows(horizontal) on the left-hand side of the chart represent the task or activities to be completed. ● Columns (vertical) represent periods of time.(e.g., months, weeks, or days-for short projects -------|----------|-Months|--------|-------|--------- -------|----------|Columns|--------|-------|--------- Rows------------------------------------------------- ● The major difference between a TDTL & Gantt chart is the detail presented. ■ TDTL identifies the tasks that need to be completed & the time frame in which the task will be completed.

Ownership

Someone putting something in a program., & support it.

4-Steps Nominal Group Process Technique

Step 1 Initiate with a different idea, problem, or opportunity. Step 1- Individual members independently record ideas, problems to be solved, or opportunities. Step 2- Each member records an idea, problem, or opportunity with no comment or discussion. Step 3- Each recorded statement is discussed, narrowing them down to the best set. Step 4- Members vote/rank from best to worst on the windowed set of ideas, problems, and opportunities.

Seven Types of Intervention Strategies

Strategies:" A general plan of action for affecting a health problem. a strategy may encompass several activities" ■ CDC develop a system of classification for the most commonly used strategies. 1. Health Communication 2. Health Education 3. Health Policy/ Enforcements 4. Environmental Change 5. Health-related community service 6. Community Mobilization 7. Other Strategies

Resources

The "Human, fiscal, & technical assets are available" to plan, implement, & evaluate a program. ●Data: Primary & Secondary ●Educational Materials: Curriculum, lessons plan ● Equipment ● Funding (fiscal): money for salaries & to make purchases ● Partnerships: Human resources ● Personnel: The "key" resources are people, and volunteers ( incentives, benefits). ●Space ●Supplies: Things used daily that are used up easily. ●Technical: speakers for program, audiovisual.

MAP-IT: "Goal: a planning model guide used to assist communities in adapting "Healthy People 2020" t the state or local level"

The 5-Phase Identical to the Generalized Model 1). Mobilize- Starts by mobilizing key individuals & organizations into a coalition that can work together to improve the health of the community; similar to PRE_PLANNING. 2). Assess-Equivalent to NEEDS ASSESSMENT. Answers; who is affected?; What resources are available to address the problem?; What resources are required to have a meaningful impact? 3). Plan-Develops goals & objectives, measures, baselines, & targets. What will be measured (e.g., decrease in smoking in adults); baseline (percent of smoking adults); Identify specific Intervention that will be used to solve the problem. SETTING GOALS/OBJECTIVES 7 DEVELOPING an INTERVENTION 4). Implement-Organizes the coalition so it can put the plan into action. Detailed work plan, timeline, and assigned responsibilities, Complete action steps, display timelines/ deadlines & communication plan. IMPLEMENTATION 5). Track-Equivalent of EVALUATION, Are the work being evaluated appropriately(formative evaluation)?; Was the plan followed (process evaluation); What was changed (Impact evaluation); was the goal reached (outcome evaluation).

Technical Assistance

The Center for Disease Control prevention acting as a resource to help a small us Community build a Community Coalition for obesity is playing the role of a technical assistant.

PROMOTION: 4th Marketing Mix Variable

The approach used to reach the audience. (CHES) Any form of communication strategy, the message & visuals, graphics & channels used to: ■ Inform- increase product awareness or informed consumers. ■ Persuade- convince people to purchase the product. ■ Reinforce- remind them that the product exists. ■ Differentiate - position the product as being different from the competition. e.g., In-store signage ● Flyers in customer bags ● Direct mail postcards ● Email notifications to energy customers ● A sticky note on newspapers.

Health Numeracy

The degree to which individuals have the capacity to access, process, interpret, communicate, and act on numerical, quantitative, graphical, biostatistical, and probabilistic health information needed to make effective health decisions. Write at a 6th-grade level. ■ Check Readability Level on: ● Fog-Gunning Index ●Flesch-Kincaid Grade Level Readability Formula. ● The Fry Readability Formula. ●The S.M.O.G ( Simple Measure of Gobbledegook)- Calculations: Average = Total# polysyllabic words /Total# of sentences × The # sentences short of 30. ​

Health Literacy

The degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions.

Internal-Validity

The degree to which the change that was measured can be attribute to the program & allows evaluators to speak with more confidence that the program itself actually made a difference. ■ Threats to internal validity ● History ● Maturation ● Testing (e.g., Pretesting) ● Instrumentation ● Selection ● Attrition These can be controlled by Randomization (random selection of participant).

External-Validity (generalizability)

The extent to which the program can be expected to produce similar effects in other populations. ■ Threats to External validity ● Social desirability ● Hawthorne effect ● Halo effect ● Expectancy effect ● Placebo effect It can be counteracted by treating all subjects identically. ■Blind study: participants do not know whether they have been assigned to an experimental group or a control group. ■ Double-blind study: participants do not know the group they are in, and neither does the planner. ■ Tripple blind study: Information is not known to participants, planners, or evaluators.

Measuring Decision Makers' Support for Health Promotion

The measurement tool- Leading by Example (LBE) Instrument- A 4-factor scale. 1). Business assignment with health promotion objectives. 2). Awareness of the economics of health & worker productivity. 3). Worksite support for health promotion. 4). Leadershipsupport for health promotion. Could be used in 2-ways 1). Through a single administration "to assess specific areas in which the health promotion climate might support/hinder programmatic effort" 2). Administer the LBE two different times to monitor changes in support for health promotion programs over time.

Mission Statement, Goals, & Objectives

The mission statement, goals, & objectives provide: A foundation for program planning. Direction for the program. A basis on which to evaluate the program.

Forming the Planning or Steering Committee or Advisory board or planning team-Size

The number of individuals on the planning committee can differ depending on: 1). Setting for the program 2). Size of the priority population 3). Resources available There is no ideal size 5- Common Techniques 1). Asking for volunteers 2). Holding an election 3). Inviting/recruiting people to serve 4). Having members formally appointed by a governing group or individual 5). Having an application process than selecting those with the most desirable characteristics.

2). Assessing needs

The process of identifying, analyzing, & prioritizing the needs of a priority population. It's a multi-step process of data collection and analysis. Do not occur until decision-makers give permission for the planning to begin. Conduct literature review & include epidemiological data (a) Literature: the article, books, government publications, & documents explaining the past & current knowledge about the particular topic. (b) Epidemiology: The study of occurrences & distribution of health-related events states & processes, & the application of this knowledge to control relevant health problems. ***Examples of modifiable health behaviors & health-related costs have been connected: The first deals with smoking. Approximately 17.8% of U.S. adults 18yrs & older are cigarette smokers. The cost of smoking-related illnesses in the U.S is estimated at $300 billion per year.

Steps to Writing a Rationale ● Step 3- The Solution

The proposed solution to the problem: Evidence-based best practices. Interventions that have been shown through careful research & evaluation are effective. State why the program will be successful Use the result from research on "best practices" to support the rationale. Problem- Analyze-Solution- Success.

Steps to Writing a Rationale ●Step 2- Title the Rationale

The title can be quite simple: "A Rationale for X: A program to Enhance the Health of X." Immediately following the title should be a listing of who contributed to the authorship of the rationale.

Phase 4 (Implementation): Putting Plans into Action

There are three major ways of putting plans into action (An upside down triangular model): ■Total Program- all in the priority population are exposed at the same time. ■ Advantages ● More people involved ● Evaluation more meaningful with a larger group ■ Disadvantages ● Big Commitment ● No chance to test the program.

Opinion Leaders: Well respected members in the community . ​

They are: 1. Discriminating is users of the media. 2. Demographically similar to the priority group. 3. Knowledgeable about Community issues and concerns. 4. Early adopters of Innovative Behavior. 5. Active in persuading others to become involved in Innovative Behavior. e.g., Political figures; chief executive officers CEOs of companies; Union leaders; Administrators of local schools districts,

Primary Data: Walking Survey

Walking survey: Systematic observations made on foot. Can be used to assess general community needs- to estimate the poverty level, e.g., to examine more specific facets of the community's physical, social, or economic character. Data is collected by the program planner through observation

4th- components of the Logic model (OUTCOMES)

What are the results? (Intended results) ■ Outcomes are the "intended results" & are broken into ● Short-term (or immediate) outcomes: Changes in awareness, attitudes, knowledge, and skills. ● Mid-term (or Medium) outcome: changes in behavior or the environment. e.g., " Senior citizens participate 3-times a week" ● Long-term: risk reduction, changes in health status, or quality of life. "Take years to change such as morbidity, mortality, incidences, prevalence, health status, disability, changes in life because of the program. ■ Some logic models have outcomes called: ● Impact: the fundamental intended or unintended change occurring in organizations, communities, or systems as a result of programs.

3rd- components of the Logic model (OUTPUTS)

What are the results? (Intended results) ■ Outputs are the direct results of the activities & include things such as: ● Products: curricula, educational DVDs, New software, data collection tools. ● Services: in-service training, screening, counseling, events. ● New components of infrastructure: structure, capacity, process, & relationships.

Pretesting

assessments performed before an ad campaign is implemented to ensure that the various elements are working in an integrated fashion and doing what they are intended to do.

2nd- components of the Logic model (ACTIVITIES)

What is done? ( Planned work) ■ Activities are the interventions or strategies to use in a program to bring about change. e.g., creating policies, yoga classes, first-aid kits for the community, and lit walking paths.​ ● establish campus; food pantry

1st- components of the Logic model (INPUT)

What is invested? ( planned work) ■ Inputs are the resources used to plan, implement, & evaluate a program. ● Human resources-& related items like training, technical assistance, and volunteers. ● Partnership, funding sources, equipment, supplies, materials, & community resources e.g., data, educational materials, equipment, Funding, partnerships, Personnel, space, supplies, and gifts. ​

Questions to consider when creating a health promotion intervention

What needs to change? Where is change needed? What level of prevention What level(s) of influence? Any Guide for intervention selection? Best practices or Best experiences if not then Best process. Single or multiple strategies-|--->Resources Available? | Appropriate fit for priority population? Planned Intervention

Space

Where the program is held. ● Depending on the type of program and the intended audience, space may or may not be readily available. ● Inexpensive space can be located in schools, colleges & universities, religious facilities and "in communities service rooms" ● The planner may also be able to trade expertise for space. ● Free space is not always free. ● There maybe a clean up charge (e.g., custodial service).

PROCEED Phase 5

With appropriate resources secured, interventions & strategies selected, & Implementation begins. Phases 5, 6,7, & 8address the process impact, & outcome evaluation, respectively, & are based on the earlier phases of the model, when objectives were outlined. The use of tge three phases depends on the evaluation requirements ot the program. Phase 7- resources needed to conduct evaluation of impact & Phase 8 - outcome are greater than those needed to conduct process evaluation in Phase 6.

Steps to Writing a Rationale: ● Step 1-Identify Background Information

a). Express the NEEDs & WANTS of the priority population. b). describe the STATUS of the Health Problem(s) within a Given Population. c). show how the potential outcomes of the proposed program align with WHAT the decision-makers feel is important. d). Show COMPATIBILITY with the health plan of a state or the nation. e). Provide evidence that the proposed PROGRAM will make a difference d). Show how the proposed program will protect & preserve the single biggest assets of most organization-THE PEOPLE ***Source of Good information: Government reports/websites; Academic/ Research Institutions; Healthy People 2020 resources; Reputable non-profit organizations (American Heart Association, for example)

Steps to Writing a Rationale ● Step 3 -The "Sale Pitch"

a). General comparisons of Dollars invested vs Benefits produced ***ROI= (Benefits of investment- amount invested)/ amount invested b). Investment in prevention program: Compares savings produced, the net cost of the program, and program cost: ROI= net savings/ cost of intervention c). When ROI = 0, the program pays for itself. When ROI is greater than 0 the program is producing savings that exceed the program cost. ***Cost-Benefit analysis-Cost: Salaries, Supplies; Benefits: Better Health, Reduced Costs, Satisfaction. ***Social Math: Translating statistics & other data so that they become: Influential to decision-makers, Interesting to journalists, & meaningful to the audience. ***E.g., immunizing 11,354 seniors at $2.21 will cause the town to lower taxes by 3.4% & Average taxes by $12,347. Homeowners will save $420 annually in property tax.

Formative evaluation

focus on the quality of the program content and program implementation. It collects data and informs stakeholders of the important findings that could potentially improve a program or its delivery, it allows for appropriate changes before the program is fully implemented and complete.

In- kind Support

free or reduced-price space offered by a church, free materials, copying services.

Nominal Group Process

is a highly structured process in which a few representatives (5-7) from the priority population are asked to qualify and quantify specific needs. Data was collected with a questionnaire designed by the program planner & subsequent group discussion/voting.

Logic Models

is a systemic & visual way of manners to share & present their understanding of the relationship among the resources they have to operate a program, the activities they then plan to implement, & the outputs & outcomes they hope to achieve. ( a road Map) ■ Can be linear, circular, or listed & can be presented in various levels of detail ( simple, complex) but depict the relationship & linkages of various components in a graphic display of boxes & arrows. ■ They are often with the summaries of complex processes; as a result, an additional logic model may be needed to "unpack" each component in the original model so that more details can be articulated.

Intervention Mapping

is designed to fill a gap in health promotion practice by translating data collected in the PRECEDE phase of PRECEDE-PROCEED into appropriate intervention (Social. epidemiological, educational, ecological. administrative. organizational, & Policy Assessment) in theoretical-based & otherwise appropriate interventions.

Mapping

is the visual representation of data by Geographic or location, thinking information to places to support social and economic change on a community level it is a powerful tool for these reasons: 1). it makes patterns based on much easier to identify and analyze. 2). it provides a visual way of communicating those patterns to abroad audiences quickly and dramatically. The process of mapping involves: 1). Identify the geographical area that the map will cover. 2). Collecting the necessary data. 3). Importing the data into GIS software so that the data can be placed on maps. 4). Analyzing what is found on the map.

Community Advocacy

process in which those in the community become involved in the institutions and decisions that impact their lives.

Outcome verbs for Objectives

use measurable terms, usually verbs. the verse must refer to something measurable and observable. some words work better with certain levels of objectives e.g., list Vs explained. "WHO is going to do WHAT, WHEN, & TO WHAT EXTENT?" abstract, copy, gather information, offer, round, except, count, generalize, organize, seek, score, order, adopt, create, generate, pair, select, advocate, criticize, adjust, create, deduce, group, etc.

Belmont Report (1979)

was published by the US national commission for the protection of human subjects of biomedical and behavioral research. ■ It defines the key research principle of beneficence, respect for the person, and distributive justice. ■ The Belmont report is a foundational document for current US Federal policies for the protection of human subjects, which is often simply called the "common rule". ■ Common Rule: Nuremberg Code, Declaration of Helsinki, & Belmont report influenced research laws, policies, & regulations globally. ■ IRB was created from the Belmont report.

Educational/ Instructional Resources

■ "Curriculum: Planned set of lessons or courses designed to lead to competence in an area of study" ■ Source of curriculum & othe instructional resources. ● Developing your own (in-house) or having someone else develop them; development time. ● Purchasing for obtaining various materials from outside sources; cost may be a concern. ● Purchasing or obtaining entire "canned" (participant and instructors manual, av, training, and marketing) from a vendor; do they meet the need of the priority population? ● Combination of the above

Human Resources Management (HRM)

■ 4-Functions "or PADS" of HRM ● Planning-defining personnel ● Acquisition- hiring personnel ● Development- training personnel ● Sanction- discipline, rewards, safety ● Professional Development

8-Areas of Responsibility

■ Area I: Assessment of Needs and Capacity. ■ Area II: Planning ■ Area III: Implementation ■ Area IV: Evaluation & Research ■ Area V: Advocacy ■ Area VI: Communication ■ Area VII: Leadership & Management . ■ Area VIII: Ethics & Professionalism

Other Strategies: Behavior Modification

■ Behavior Modification Activities- Often used in intrapersonal-level interventions, include techniques intended to help those in the priority population experience a change in behavior. ■ Process ● keep records (logs, diaries. journals) for a period of time. ● Analyze the records ● Create a plan to modify the behavior.

Community Organization & Community Building

■ Community Organization is the process by which community groups are helped to identify common problems or change targets, mobilize resources, and develop & implement strategies to reach their collective goals. ■ Community building is " an orientation to a community that is strength-based rather than need-based and stressed identification common nature in, and celebrating of community assets.

How to write an objective: ■ Smart Objective Checklist

■ Criteria to assess Objectives Yes/No 1. Is the objective SMART? ● Specific: Who? (Priority population & persons doing the activity) & What? (Actions/activity) ● Measurable: How much change is expected ● Achievable: can be realistically accomp[lished given current resources & constraints. ● Realistic: addresses the scope of the health problem & proposes reasonable programmatic steps. ● Time-phased: Provides a timeline indicating when the objective will be met. 2. does it relates to a single result? 3. Is it clearly written?

Elements of Formative Evaluation Cntd.

■ Customer Orientation- The degree to which the program is adapted to the needs of the priority population. ■ Municipality-Degrees to which multiple components are built in the program. ■ Support- The degree to which a support component is built into the intervention. ■ Inclusion- extend to which an adequate range and number of participants are involving the program. ■ Accountability- the extent to which the staff is fulfilling its responsibilities. ■ Adjustment- the degree to which programs, services, or activities are modified based on feedback received from participants who come up with partners or other stakeholders. ​

Summative Evaluation Measuring Change

■ Data can be collected at three different times: ● After the program ● Both before & after the program. ● Several times before, during, & after the program. ■ Pretest- Measurement before the program begins. ■ Posttest- Measurement after the completion of the program. (a day, week, or month after the program is completed). ​

Behavioral Objectives

■ Describes behavior or action that the. priority population will engage that will resolve health problems, & move closer to achieving the goal. ■ Commonly written about: ●Adherence = regular exercise ●Compliance = taking medication as prescribed ●Consumption patterns = diets ●Coping = stress-reduction Activities ●Preventative Actions = brushing & flossing teeth ● Self-care = first aid ● Utilization =appreciate the use of the emergency room

Identifying & prioritizing task: GANTT Chart

■ Developed by Henry Gnatt in 1917as a production control tool, does the same plus provides an indication of the progress made towards completing the task by using different SIZE lines to distinguish between the project time frame for a task & progress towards completion. ● Composed of rows & columns & used markers above the columns to indicate current dates. ● Provide regular progress updates on the chart.

Type of Cost

■ Direct Cost: is the portion of the cost that is directly expanded in providing a product for service and is expressed as a budget as the actual number of dollars expected to be spent e.g., wages, salaries, & supplies. ■ Indirect Cost: a portion of the cost that is indirectly expanded and provides a product or service. the purpose of the indirect cost is to capture overhead/administrative costs that cannot be connected directly to the program (e.g., cost of telephone, other utilities, insurance, space, and equipment maintenance.)

Other environments include:

■ Economic environment ● Financial cost affordability. ■ Service environment ● accessibility to health care or patient education. ■ Social environment ● social support, peer pressure. ■ Cultural environment ● traditions of an ethnic group. ■ Psychological environment ●emotional learning environment. ■ Political environment ● support for healthy environments.

Learning Objectives

■ Educational or learning tools needed to achieve the desired behavior change. ■ Are based on the analysis of Educational & Ecological Assessments of the PRECEDE- PROCEED, model ​

Equipment & Supplies

■ Equipment ($500+): ● Non-consumable/ Non-expendable items ● owned ●On loan ftom others ■ Supplies: ● Consumable/expendable items ●Planner provides ●Participants provide ​

Keep the following in mind when creating a policy:

■ Have top-level support. ■ Use a representative group to form policies/laws. ■ Get input from the priority population ■ Get expert advice. ■ Seek legal opinion if necessary. ■ Review the issues others have faced. ■ Base policy on sound principle/research. ■ Seek Input and debate/discussion. ■ Write policies in a simple format & include rationale. ■ Consider phasing in the policy over time. ■ Provide education & behavior change programs to help people to comply ■ Once formatted: communicate, apply, enforce, & reviews revise.

Elements of Formative Evaluation

■ Justification- the degree to which the program is mandated/ approved by stakeholders. ■ Evidence- Degree to which the program is evidence-based ■ Capacity- The extent to which professionals have adequate knowledge, skills, & abilities to design & implement the program. ■ Resources- ● Adequacy of resources (e.g., budget, community resources or assistance, assets, time, etc.) ● Cost-identification analysis: compares different interventions available for a program to determine which intervention would be the least expensive. ● Cost-benefit analysis: looks at how resources can best be used. It will yield the dollar benefit received from the dollars invested in the program. ● Cost-effectiveness analysis: quantifies the effects of a program in monetary terms.

Different Level of Objectives: ■ Impact: Learning, Behavioral. & Environmental

■ Learning ● What is being measured (outcomes): Change in awareness, knowledge, attitudes, or skills. ● Types of evaluation: Summative (Impact) ● Possible Evaluation Measures: Increase in awareness, knowledge, attitudes, or skill development/acquisition. ■ Behavioral ● What is being measured (outcomes): Changes in behavior. ● Type of Evaluation: Summative (Impact) ● Possible Evaluation Measures: Possible behavior modified or discontinued, or new behavior adopted. ■ Environmental ●What is being measured (outcomes): Environmental changes. ●Types of Evaluation: Summative (impact) ●Possible Evaluation Measures: Measures associated with economic, service, physical, social psychological, or political environments, e.g., a protection added to, or hazards or barriers removed from, the environment.

Grants

■ Levels for Grants: Local, State, Nation ■ Request for Proposal (REPs): ■ Request for Applications (RFAs): are issued by organizations/agencies in order to solicit for service to complete a specific project. ● outlines the specific service that is needed, the process for application, the timeline for application, the terms of the contract when awarded, and how the proposal/ application should be presented. e.g., A State department may issue an RFP to solicit proposals to train lay personnel to deliver immunization educational programs in the community. those who feel qualified to deliver the training could submit a proposal for review. ■Locating grant money: ●Foundations: Robert Wood Johnson Foundation, WK Kellogg ● Corporations: Gerber, Nike. McGraw Hill ●Voluntary Health Agencies: America Cancer Society, Lion's Club, United Way ● Government: Grants.gov, Federal Registry, Catalog of Federal Domestic Assistant CFDA ● Internet

Social- Marketing:

■ Listen to the needs and wants of customers by looking at the Marketing Mix consisting of the "4-Ps" ■ The use of marketing principles to design programs that facilitate voluntary behavior change for improved personal or societal well-being. ■ Using marketing principles in the planning, implementation, & evaluation of health education programs designed to bring about social change(CHES). ■ Commercial Marketing- a set of processes for, creating, communicating, & delivering value to customers.

Implementation

■ The act of converting planning & objectives into action through administrative structure, management activities, policies, procedures, regulations & Organizational actions of new programs. ■ 5-Phases of Implementation ● Adoption of the program-Great care must go into the marketing process to ensure that a relevant product (health Program) is planned to ensure participation from the intended audience. ● Identifying & prioritizing the task to be completed. ● Establishing a system of management ● Putting the plan into action ● Ending or sustaining a program

Environment Change Strategies

■ Most useful in providing "opportunities, support, & cues to help people develop healthier behaviors" ■Help remove barriers to change in the environment. ● Romoving environmental barriers often helps to make the healthier choice the easier choice. ■ Environmental change tell me the other door strategies are characterized by changes "around" individuals & are not limited to the physical environment.

Process of Community Organizing & Community Building.

■ No single unified model, though there are several methods ■ Three categories of community Organization include: ● Locality development: Seek Community change through broad self-help participation from the local community; build a sense of community. ● Social planning: Task-oriented, focus on problem-solving usually by outside experts.is ● Social action: both task & process-oriented; achieving changes to redress imbalances in power (e.g. Civil rights & gay rights movements). ​

Environmental Objectives

■ Outlines non-verbal causes of health problems that are present in the social, & physical. psychological, economic, service, or political environments. Written about the state of: ■Physical environment. E.g., ● Clean air or water ●Proximity to facilities ● Removal of physical barriers ■ Social environment: Social support. peer pressure ■Psychosocial environment = the emotional learning climate ■ Economic environment = affordability, incentives, disincentive ■ Service environment = Healthcare, equity in Healthcare ■ Political environment = health policy ​

Elements of Summative Evaluation- Overview

■ Overview: includes both impact & outcome evaluation. ● Data collection: Quantitative (deductive) produce numeric (hard) data collection or both such as counts, ratings, scores, or classification. ● Qualitative (inductive) produces narrative data, such as words & description.

Identifying & prioritizing task: PERT Chart

■ P.E.R.T is an acronym for Program Evaluation & Review Techniques. ■ More complex than the Gantt chart & has not been used as much with health promotion programs. ● It is composed of two components: A diagram & a timetable. ● The diagram presents a visual representation of the relationship between and among the tasks to be completed. ● The diagram also indicates the order of completion by sequential number in the task. The task with a lower number is completed before the one with a higher number. ● The timetable of the PERT chart is similar to the Key activities chart but includes three estimates of time for each task. The estimate includes optimistic, pessimistic, and probabilistic time frames.​

Funding: Ways to finance programs include

■ Participant fee: Profit margin? How much? Ownership ■ Third-party support: Someone other than the planning agency or Participant, Employer, or local civic group ■ Cost Sharing ■ Cooperative agreements: Memorandum or understanding ■ Organization/ Agency sponsorships: Voluntary Health Agency, LHD, ACS ■ Seed dollar, in-kind support, RFPs

Phase-In: Implementation

■ Phase-in- limiting the number of people who are exposed, then gradually increasing the numbers; by offering, by location, by ability, by number. Advantages ● Easier to cope with the workload ●Gradual investment Disadvantages ● Fewer people

Implementation Pilot Testing

■ Pilot testing- trying the program out with a small group from the priority population to identify any problems. Advantages ● Opportunity to test program ● Close control of the program Disadvantages ● Very few involved ● Not meeting all needs ● Hard to generalize about results

Generalized Program Planning Model

■ Pre-planning is the step that occurs before beginning the formal program planning process. ● Planning a health promotion program is a multi-step process. ● Because of the variety of settings & resources, the planning process doesn't always start the same way. ● Sometimes, there are obvious needs in the community. ● A program that has been successful in the past may need to be reworked to continue its success. ● Planners often need to gain the support of key people for the program in order to obtain resources & ensure program success.

Testing

■ Pretesting ● Testing components of a program prior to the implementation relates to formative evaluation. ● Collecting Baseline data before the program's implementation that will be compared with post-test data to measure the effectiveness of the program. ■ Pilot Testing ● Assesses programs in limited areas and/or time periods. ● Allows for " dry runs" to measure overall program quality. ● Generally involves collecting data from program participants.

Representatives and their roles

■ Priority Population: For whom the program is intended (1/2 of the members of the planning committee). ■ Doers: do physical work (majority of the committee members) ■ Sponsoring Agency: 1 or 2 representatives from the organization/s that is sponsoring the program. (support important for the program's success). ■ Influencers: The people in control of resources to facilitate the program's planning. (people in positions of authority & have access to resources). ■ Other Stakeholders: others with a vested interest in the program not represented above. (include recruited experts who provide knowledge & services such as health care professionals or local leaders). ■ Leader: Manages the committee, sets tasks, & organizing committee members. (Health Educator, until someone from the community, is identified)

Financial management

■ Process of developing & using the system to ensure that funds are spent for the purpose for which they have been appropriated. ● Accounting, fiscal year, fiscal accountability ● Audits- internal & external Technical resources management ■ All other resources besides human and financial ●Equipment, expertise, information, material, partnerships.

Critical Path Method (CPM) or PERT/CPM

■ Provide a graphical view of the project & predicts the time required to complete the project. ■ It focus on time by showing which tasks are critical to maintaining the planning schedule & which are not . ■ It is indicated & consist of the set of dependent tasks (each dependent on the preceding one) that together take the longest time to complete. ■ Task on the path are critical because any delay in their completion will lengthen program implementation unless appropriate action is taken.

Process of community Organization & Community Building:

■ Recognizing the Issue: 1st step (Initial organizers). a citizen or church leader. ● Grassroots. Citizen-initiated (participation) or Bottom-up Organizing: when there is internal recognition of the issue or concern & organize to take care of them. ■ Gaining Entry into the Community: 2nd step: ● Gatekeepers- the individuals who control, both formally & informally, the "political climate" of the community. Must be culturally sensitive, & work towards cultural competence, & be aware of the cultural differences within the community. ■ Organizing the People: 3rd step ●Executive Participation- small, committed Core Group: leader or coordinator comes from this small group. ● Active Participants: (Doers)- those willing to work: may also include executive participants. ● Occasional Participants: involved on an irregular basis; when decisions need to be made. ■ Supporting Participants: seldom involved in other ways, e.g., via financial or other resources. May form as a coalition; a formal, long-term alliance of individuals representing groups who agree to work together. ■ Assessing the Community: ● Community Building-" Is an orientation to practice focused on community, rather than a strategic framework or approach, & on building capacities, not fixing problems" ● Intend to affirm strong community-rooted traditions, & to build on the good work already going on in communities.

Elements of Formative Evaluation Cont'd 2

■ Recruitment- The degree to which members of the priority population are adequately recruited through appropriate channels and places consists of cultural and other unique characteristics. ■ Reach- Proportion of the priority population actually participating in the program. ■ Interaction- Quality of Interaction between planners & the participants (e.g., customer service). ■ Degree to which the needs of participants are being met, how satisfied they are with the program, service, or activity, & their beliefs that a positive impact is being made in their lives.

Phase 5 (Implementation): Ending or Sustaining the Program

■ Six techniques include: 1). Working to institutionalize 2). Seeking feedback 3). Advocating for the program 4). Partnering with others 5). Revisiting & revising 6). Establishing a resource development committee. ■ Program Sustainability Framework 1). Political Support 2). Funding Stability 3). Partnerships 4). Organizational Capacity 5). Program Evaluation 6). Program Adaptation 7). Communications 8). Strategic

Identifying & prioritizing the task: BASIC Timeline

■ The simplest of the tools. key activities or tasks are placed on a line in the order of completion. It may or may not includes an estimation date when it will take place & completion time. E.g., ● Review of current OPEB Policy___________1-2 week ● Gather data needed__________________1-2 weeks ● Complete typical OPEB________________6-8 weeks ● Review Findings________________________1-2 weeks ● Join the OPEB ______________ Requires a resolution or ordinance by governing body. Depends on the governing body's meeting schedule. ● Start Marketing ARC payments___________2-weeks after adoption.

Outcome Evaluation

■ The ultimate objectives of the program. ■ Aimed at changes in health status, social benefits, risk factors, or quality of life ■ Outcome or future-oriented ■ Program goal is achieved if these objectives are achieved ■ Are commonly written in terms of health status such as: ● Risk Reduction ●Physiologic indicators ● Signs & Symptoms ● Morbidity ● Disability ●Mortality ●Quality of life measures

Procedures Used in Formative Evaluation

■ Use existing (secondary) data ● Attendance sheet ● Meeting records/minutes ● Protocol checklist ● Timeline or Gantt chart ● Program & evaluation forms ■ Collecting data ( primary) ● Focus groups ● Surveys ● Interviews ● Expert panel reviews ● Direct observation

Personnel

■ Where to get personnel ● Internal- Flex time( e.g., a staff who attends a health fair in their lunch break), on time, and program ownership. ● External (vendor)- public/voluntary/ free (e.g., speaker's bureaus) ● Combination of internal and external. ■ Items related to personnel- volunteers, teamwork, cultural factors, cultural competence.

Message delivery selection (CHES)

■ consider the advantages & disadvantages of the different methods of disseminating educational materials. ■ make sure the intended audience, message, & channel align. e.g., Mass media: Radio & TV can be good for raising awareness among a general audience. ● Social media is good for delivering targeting messages that can easily act on or shared. ● One-on-one counseling can be good for teaching. ■ Require continual monitoring using process evaluation to keep track of message & material delivery.

Definition of Community

● A collective body of individuals is identified by common characteristics such as geography, interests experiences, concerns, or values. E.g., a community could be a religious community, a cancer-survivor community, a workplace community, or a cyber community. ● Priority population: people for whom the program is intended to serve) & the environment in which it exists. Each setting & group is unique with its own nuances, resources, & culture. Never assume to "know" a community. Secure enough background information to yield a better result. Engage the priority population by getting them involved in the planning process. ● Consider when the best time is to plan the program. what data are needed where the planning should occur what resistance can be expected what will enhance the success of the project

Summative Evaluation- Qualitative Method

● Case studies ● Content analysis ● Delphi technique ● Focus Groups ● Interviewing ● Nominal Group Process

Epidemiological Measure 2

● Crude Death Rate (Mortality rate): # of death in a given year/Ref population ( during midpoint o the year) x 100,000 E.g., # of deaths in the U.S. during 2013 = 2,596,993 Population in the U.S. July 2012 = 316,128,839 (2,596,993/316,128,839) x 100,000 = 821.5 per 100,000 ● Case Fatality Ratio (CFR%)= # of deaths due to disease "X"/ # of cases of disease "X" x 100 during a time period ● Proportional Mortality Ratio (PMR%) = Mortality due to a SPECIFIC cause during a period of time/ Mortality due to ALL causes during the same time period x 100 ● Age-Specific Rate (R) = # of death among those aged "X" to "Y" years/ # of persons who are aged "X" to "Y" years x 100, 000 ● Sex-Specific Rate = # of deaths in a sex group/ Total # of persons in the sex group x 100,000

Other Strategies: Disincentive

● Discourages behavior " An anticipated negative or underwrite at a 6th-grade level. Undesirable consequences designed to influence the performance of an individual or group" ● Can range from intrapersonal (e.g., surcharge) to public policy levels (e.g., cigarette taxes).

Different ways of Advocating for health & health education:

● Influencing voting behavior ● Electioneering ● Direct lobbying ● Integration of grassroots lobbying into direct lobbying efforts. ● Use of Interest ● Media Advocacy ​

Epidemiological Data Sources

● International: World Health Organization- world statistic report https://www.who.int/gho/publications/world_health_statistics/en/ ● National: Centers for disease control & Prevention- National Health & Nutrition Examination Survey (NHANES) https://www.cdc.gov/nchanes.htm Nation Center for Health Statistics: National Health Interview Survey (NHIS) https://www.cdc.gov/nchs/nhis.htm ● State: Center for Disease Control & Prevention- Behavior Risk Factor Surveillance System (BRFSS) https://cdc.gov/brfss/about/index.htm ● Youth Risk Behavior Surveillance System (YRBSS) https://www.cdc.gov/healhyyouth/data/yrbs/index.htm -Pennsylvania Department of Health: Health Statistic https://ww.portal.state.pa.us/portal/server.pt/community/health_statistics/14136 ● Local: Robert Wood Johnson Foundation & University of Wisconsin Population Health Institute-County Health Rankings & Roadmaps https://www.countyhealthrankings.org/

Other Strategies: Organizational Cultural Activities.

● Like people, organizations also have a " culture" ● Consists of norms & traditions that are. generated by & linked to the community. ● The culture of an organization expresses what is & what is not considered important for the organization. ● Should begin with an assessment or "culture audit" to determine if the culture hinders or supports health promotion. ■ Cultural Audit is an evaluation of the assumptions, values, normative philosophies, & Cultural characteristics of an organization in order to determine whether they support or hinder the organization's central mission.

Other Strategies: Social Support Activities

● Many people find it much easier to change a behavior if those around them provide support or are willing to be partners in the behavior change process. ● Social support can work as an incentive. ■ Types of support include: ● Support groups ( e.g., Weight Watchers, Overeaters Anonymous) ● "Buddy" system; can be used with contests & contracts. ● Social gathering ● Social networks - a web of social relationships

Epidemiology Measure 3

● Maternal mortality Rate = # of deaths assigned to cause related to childbirth (died in childbirth)/ # of live births 100,000 live birth (during a year). ● Infant Mortality Rate (IM) = # of Infant deaths among infants aged 0-365 days during the year/ # of birth during the year 1,000 live births ● Crude Birth Rate = # of live birth(babies born) within a given period/Resident population in the Middle of that period x 1,000 population E.g., U.S.births in 2013 = 3,932,181 ; U.S. Population = 316,128,839 (3.932.181/316,128,839 x 1,000) = 12.4 per 1,000 ● General Fertility Rate: # of live births within a year/ # of women aged "X" to "Y" years x 1,000 women aged "X" to "Y" years E.g. In 2013 62,939,772 women aged "X" to "Y" years in the U.S. & 3,932,181 live birth. (3,932,181/62,939,772 x 1,000) = 62.5 per 1,000 women aged "X" to "Y" years.

Example of a Problem Statement-● State-Level program

● Overweight & obesity are critical health threats facing the state of ABC, Between 2012 & 2015, the percentage of overweight adults in ABC increased from 34%-35%, while the percentage of obese adults increased from 30%-32%. ● Overweight &obesity are caused by an imbalance in calories consumed vs calories burned ratio. Both being overweight & obese increase the risks of heart disease, stroke, diabetes, & cancer. ● The annual costs (direct & indirect)of these diseases to the state have been estimated at $25 billion. There is good evidence that shows both physical & financial costs of being overweight & obesity are preventable.

Three new categories of Community Organization

● Planning & Policy Practices: Community/public health workers use data to generate persuasive rationals that leads towards & acting particular solution. ● Community Capacity Development: based on him for Windows impacted by a problem with knowledge and skill to understand the problem and then work cooperatively together to deal with the problem. ● Social Advocacy: used to address a problem through the application of pressure, including confrontation, on those who have created the problem or stand as a barrier to the solution to the problem.

Other Strategies: Incentives

● Promotes behavior " An anticipated positive or desirable reward designed to influence the performance of an individual or group" Types- Social, material, miscellaneous

Epidemiological Measure 1

● Ratio: (R) = X/Y ● Proportion: (P) = A/(A+B)- (450,451/(450,451 + 89,895)=0.83 E.g., # of Deaths from AIDS among Males (450,451); # of deaths from AIDS among females (89,895). ● Percent: (P) = A/(A+B) x 100 ● Prevalence = # of persons ill at a period of time/ Total # in that group (deaths= 47,587 ; Population = 501,826) E.g., Passaic COVID-19 Death = (47587/501,826) = 0.095 ● Incidence Rate: # of NEW cases over a period of time/Average population at risk during the same time period X 100,000 (Disease Burden) E.g., Pertussis 2013= 28,639; Average population July 2013 = 316,128, 839. 28,639/316,128, 839x 100,000 =9.1 per 100,000 (rounded).

Common Metrics to evaluate the impact of delivered messages Include: (CHES)

● Reach: number of people exposed to the message. ● Recall: how well people remember seeing or hearing the message. ● Traffic driven to a website: number of unique visitors or hits. ● User interaction & engagement with social media: number of "likes" or "retweets" ● Impressions or mentions in media. ● Changes in behavior: number of people getting the flu shot. ● Changes in attitude or beliefs: number of people who believe the flu shot will help protect them from the flu. Pre (before) & post ( after) Measurements the simplest evaluation design.

Example of a Problem Statement-● Local-Level Program

● The number of children entering kindergarten who have not received two doses of the measles-mumps-rubella (MMR) vaccine in X county continues to increase. In the 2011-12 school year, 95% of children who entered kindergarten received two doses, while only 91% were immunized properly in 2015-16. ● Because the number of cases of MMR does not seem too high to parents/gradians, many do not feel it necessary to subject their children to immunizations. Infectious diseases remain a major cause of illness, disability, & mortality. ● Vaccines are among the most cost-effective clinical preventative services & are a core component of any preventative services package. Childhood immunization programs provide a very high return on investment.

PRECEDE Phase 2: Epidemiological Assessment " used to plan health programs "

● Use data to identify and rank health goals/ problems that may contribute to or interact with identified health problems identified in Phase 1. ● Morbidity, mortality, Incidence, prevalence, disability, genetic, behavioral, & environmental factors. ● Determine & prioritize behavioral(individual) & environmental (external) risk factors associated with health problems. ● There are rarely ever enough resources to address all or even multiple problems. ● Prioritization matrix: BPR-Basic Priority Rating: 2x2 matrix with "more important" & " less important" on the Horizontal axis (importance) and " more changeable" & "less changeable" along the vertical axis (urgency) The risk factor that falls into the "more important " & " more changeable" quadrant will be the highest priority.

Different Level of Objectives: ■ Process or Administrative

● What is being measured (Outcomes): Activities presented & tasks completed. ● Type of evaluation: Formative (process) ● Possible evaluation measures: Number of sessions held, exposure, attendance, participation, staff performance, appropriate materials, adequacy of resources, task on schedule.

Different Level of Objectives: ■ Outcome

● What is being measured (outcomes): Changes in the quality of life (QOL), health status, incidence, prevalence, mortality, morbidity, disability, risk, & social benefits. ●Types of Evaluation: Summative (outcome) ● Possible Evaluation Measures: QOL measures, morbidity data, mortality data, measures of risk (e.g., HRA)

Goals are expectations that:

● is more global ●Includes all aspects of the program ●Provides overall direction ●Is more general ●Takes longer to complete ●Has no deadline ●Is usually not observed ● Is often not measured in exact terms.