Chapter 3: Program Planning Models in Health Promotion

assessing needs

process of collecting and analyzing data to determine the health needs of a population and includes setting priorities and selecting a priority population

implementing interventions

process of putting interventions into action

planning models

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

phase 3: four MAPP Assessments

(1) the community themes and strengths assessment: community or consumer opinion (2) the local public health assessment: capacity of the local health department and local health system (3) community health status assessment: measurement of the health of the community by use of morality, morbidity, risk factor, and other related data (4) the forces of change assessment: legislation, technology, and other environmental or social phenomena that do or will impact the community - Provides insights on the gaps that exist between current status un the community and what was learned in the visioning phase and the direction for foals and strategies. Gives an framework for the types of data collection that should be part of any comprehensive needs assessment.

Summary

- A model can provide the framework for planning a health promotion program: the Generalized Model, Evidence-Based Planning Framework for Public Health, MAPP (Mobilizing for Action through Planning and Partnership), MAP-IT (Mobilize, Assess, Plan, Implement, Track), PRECEDE-PROCEED, Intervention Mapping, Healthy Communities (CHANGE tool), and SMART (Social Marketing Assessment and Response Tool). - Generalized Model is recommended as template for learning basic principles of planning and evaluation: (1) assessing needs (2) setting goals and objectives (3) developing interventions (4) implementing interventions (5) evaluating results.

phase 1: organizing for success and partnership development

- Assess whether MAPP process is timely, appropriate, or even possible. Involves assessing resources, the expertise of personnel, support of key decision makers and other stakeholders, and general interest of community members. - If resources are not available, the process is not undertaken. If do proceed with MAPP process, work groups are created: (1) core support system team that prepares for the material needed for the planning process (2) MAPP committee, composed of key sponsors, stakeholders (3) community which provides input, representation, and decision making

The Eight Phases fo PRECEDE-PROCEED

- Begins by identifying the desired outcome, to determine what causes it, and design an intervention aimed at reaching the desired outcome. Begins with the final consequences and works backward to the causes. Once causes are known, intervention may be designed.

phase 6: implementation

- Clarifying everyone's role, including external partners. Procedures are communicated and documented AND TIMELINES ARE DEVELOPED AND FOLLOWED. - Communication and distribution plans are activated and the actual program and interventions are offered. Program is refined continually based on consumer feedback.

Mobilizing for Action Through Planning and Partnerships (MAPP)

- Created in 1997 by CDC and NACCHO. Foundational approach to planning and evaluation in public health settings, mainly in local health departments, it has a broad relevance to all health promotion settings. - Intended to improve health and quality of life through mobilizing partnerships and taking strategic action. - 6 phases of MAPP and 4 MAPP assessments.

Intervention Mapping

- Designed to fill a gap in health promotion practice by translating data collected in the PRECEDE phases of PRECEDE-PROCEED into appropriate interventions - Planners are guided by diagrams and matrices that incorporate outputs of the assessment process with relevant theory. - Intervention Mapping used to develop breast and cervical cancer screening program for Hispanic farm-workers, physical activity intervention, explore development of sex education programs, and reducing heavy drinking among college students. - six phases - Makes a significant contribution in the identification of goals and objectives and is considered a basic tool of the model.

Evidence-based Planning Framework for Public Health

- Developed by Ross Brownson. This framework very similar to most planning models like the Generalized Model. - Seven phases: community assessment, quantifying the issue, developing a concise statement of the issue, determining what is known using scientific literature, developing and prioritizing program and policy options, developing an action plan and implementing interventions, and evaluating the program and policy - Phase 1 and 2 is the needs assessment. - Most planning models are composed of the same basic elements.

phase 4: determining what is known using scientific literature

- Directs planners to identify evidence based solutions related to the root causes and related problems from the statement of the issue. - Search resources to categorize potential solutions as recommended with strong evidence, sufficient evidence, insufficient evidence and not recommended (no evidence). Use Guide to Community Preventive Services, scientific journals, books, government reports etc. - Leads to planners to various interventions that can address the root causes of the health problems.

phase 5: developing and prioritizing program and policy options

- Directs planners to prioritize specific interventions or action steps by using methods like the Delphi technique, Nominal Group technique, BPR model, multi-level voting, and other process that is systemic, objective, and allows for standardized comparisons. - Planners are encouraged to identify priorities related to actions that lead to improved health outcomes.

phase 4: track

- Equivalent of evaluation. - Answers are we evaluating our work appropriately (formative), did we follow the plan (process), what did we change (impact), did we reach our goal (outcome). - Encourages regular evaluations to measure and track progress over time and draws attention to the quality of the data being collected, limitations of self-reported data, and the validity and reliability of the data collected.

Other Planning Models

- Evidence-Based Planning Framework for Public Health, MAPP, MAP-IT, PRECEDE-PROCEED< Intervention Mapping, Healthy Communities (CHANGE tool), and SMART are good models and can be used to successfully plan, implement, and evaluate programs. - Also can use Community-Based Prevention Marketing, Health Communication Model, Healthy Plan-It, and SWOT (a decision making strategy than a traditional planning model).

phase 3: market analysis

- Examines the fit between the focus of interest (desired behavior change) and important marketing variables within the PP. - Marketing mix is a term that used in both commercial and social marketing. Composed of the four components: product, price, place, and promotion. - At the conclusion, have a better understanding of important market variables that influence consumers. Combine with consumer and channel analysis, market analysis provides a combo of useful information about consumers, the environment they live in, and strengths and weakness associated with social marketing interventions.

phase 2: visioning

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

Healthy Communities

- Healthy Cities. Movement that began in 1980s in Canada with the help of the WHO. - Characterized by community ownership and empowerment and driven by the values, needs, and participation of community members with consultation from health professionals. Has a diverse partnership. - Factors to predict success: local investment in communities, providing venue for local communities to learn about effective strategies, mobilizing networks for change, and providing tools to communities to achieve health equity and prevent chronic disease. - Lesson learned is the idea that the pursuit of shared values in ownership and empowerment is a viable approach to improving health in the community.

phase 3: educational and ecological assessment

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

phase 6: developing an action plan and implementing interventions

- Implementation. Goals and objectives are developed and action strategies (interventions) are planned. - Logic models are developed to display the relationship between inputs (resources) and outputs (what will be accomplished). - Management of action strategies, personnel, and communication with partners and community members are addressed.

Final Thoughts on Choosing a Planning Model

- Important criteria: three Fs of program planning = fluidity, flexibility, and functionality. - When decision on a planning model, it is important to ensure that the model is conducive to planning a population-based approach and that it uses a ecological framework. Population-based approach is when processes pertain to large population segments of larger populations. - Planners need to understand interaction between a PP and the communities in which they live. - Planners need to work with PP within context of broad environments. - In pre-planning, planners need to determine the extent to which members of the PP will be involved in the planning process and in decision making. Ranges from no community involvement to community-based participatory research. - Ideally, planning efforts should use a partnership-based approach in the context of community empowerment and mobilization where professionals work in unison with community members in taking actions to improve health and reduce disease.

phase 1: preliminary planning

- Includes the panning elements of pre-planning and needs assessment. Allows program planners to objectively assess all health problems and determine. which one is most appropriate to address. - Accomplished through analysis of epidemiology data, including mortality and morbidity rates and associated risk factor data. Include objective priority setting with predetermined criteria. - Single health problem is determined, it Is defined in terms of behaviors. Risk factors, or contributing facets then become the focus of the social marketing process. - SMART model suggests the planners have the expertise and responsibility to use data sets to oversee and determine priority health problems within a community in partnership with members of the PP. After the priorities are identified, the remained of the process is consumer driven. - Health professional may determine the entail program direction, SMART model directs that consumers drive the development and implementation of interventions. - Goals are outlined but not objectives because consumer research has not been performed. Goals are general stamens of intent or direction but they do not spicy program components or direct courses of actions. - Develop preliminary plans for evaluation. Made early to take into account for personnel, time, and budget requirements. Important to determine hoe baseline and post-program data will be collected and to identify valid survey or data collection instruments. Planners can control for bias or error in data collection if considered early. - Program costs needs to be projected. - At the end, have identified the focus interest in terms of modifiable behaviors, developed goals that provide general direction, outlined preliminary plans for evaluation, and estimated total project costs. With this, planners and organizations can make informed decisions about costs and benefits of the project and application of social social marketing.

functionality

Means that the outcome of planning is improved health conditions, not the production of a program plan itself. Plan is only a tool to help planners accomplish their real work to improve health and decrease diseases and disability.

phase 4: intervention alignment and administrative and policy assessment

- Intervention alignment is to match appropriate straggles and interventions with changes and outcomes identified in earlier phases. - Administrative and policy assessment planners determine if the capabilities and resources of existing personnel and participating organizations are available to develop and implement the program. - Between phases 4 and 5 PRECEDED (assessment portion) ends and PROCEED (implementation and evaluation) begins. No break, they run together and planners can move back and forth.

phase 3: plan

- Involves developing goals ad objectives, measures, baselines, and targets. Planners determine what will be measured, the baseline, and the targeted decrease. - Planners also identify specific interventions that will be used to accomplish the identified goals and objectives. - Answers the question what do we need to do to reach out goals, how will we know when we have reached our goals? - Live developing goals and objectives in interventions.

phase 2: assess

- Like a needs assessment. - Answers who is affected by the key health problems, what resources do we have to address the problems that we identify, what resources are required to have a meaningful impact? - Examine the problems and the assets within a community to help planners focus on what the community can do versus what it would like to do. - Both state and local data are collected and analyzed to help coalition members set priorities. - MAPP-IT helps planners to examine the social determinants, or root causes of the problems associated with the data collected.

MAPP-IT

- Mobilize, Assess, Plan, Implement, and Track - MAPP-IT was developed to help communities in implementing their own adaptation of Healthy People 2020.

phase 1: mobilize

- Mobilizing key individuals and organizations into a coalition that can work together to improve the health of the community. - Partners are identified, coalition is organized, roles are established for each partner and responsibilities are assigned. - Responsibilities can be facilitating community input through meetings and other events, developing and presenting education or training programs, leading fundraising or policy initiatives, and providing technical assistance. - Similar to pre-planning in the GM.

phase 5: develop interventions, materials, and pretest

- Once formative research is collected, data are transferred or infused into the design of programs, interventions, and communication strategies. - Data must be analyzed and categorized to assure that planners understand what they have seen, heard, and observed. Should refer to formative data. Discussion and decisions should reflect data and represent consensus. Materials and methods should represent what was learned in formative research. - Once program prototype is developed, return to the PP and tests the concepts before implementing a widespread campaign. Social marketing is a process of continually returning to consumers until the program and its support mechanisms are consistent with their views and preferences. - Methods to perform pretesting: pilot test where program can be implemented with the PP on a smaller, less expensive scale.

phase 4: implement

- Organizing the coalition so it can put the plan into action. - Detailed work plan is assembled to identify clear action steps - describe who is responsible for completing the action steps, and display a timeline with related deadlines. Communication plan is made to outline how program partners will reach and recruit participants and communicate the benefits of engaging in the program.

PRECEDE-PROCEED

- PRECEDE: Predisposing, Reinforcing, Enabling Constructs in Educational /Ecological Diagnosis and Evaluation. - PROCEED: Policy, Regulatory, and Organizational Constructs in Educational and Environmental Development - One of the oldest and most enduring planning models used in health promotion. Integral in better understanding decision's for breast exam, oral health strategy, developing intuitive eating approach, ad improve QOL for elders. - PRECEDE First 4 stages = a series of planned assessments that generate information that will be used to guide subsequent decisions - PROCEED Final 4 stages = the strategic implementation of multiple actions based on what was learned from the assessments in the initial phase

phase 5: formulate foals and strategies

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

phase 4: identify strategic issues

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

phase 7: evaluating the program or policy

- Planners take measures to improve existing program or policy (formative evaluation) as well as measure effective (summative, impact, or outcome evaluation). - Basic decisions are made like whether to conduct quantitative or qualitative evaluation and whether to use descriptive or inferential statistics. - Planners decide on appropriate outcomes to measure, then deicide how to collect, record, analyze and dissipate data.

phase 2: epidemiological assessment

- Planners use data to identify and rank the health goals or problems that may contribute or interact with problems identified in phase 1. - Data include indicators analyzed in needs assessments (mortality, morbidity, and disability data) and genetic, behavioral, and environmental factors. - Important to rank the health problems because there can be not enough resources to deal with all or even multiple problems. - Model is used to plan health programs. - Arrows fo backward to connect genetics, behavior, and environment boxes of phase 2 with the health box and with quality of life box of phase 1. - Once identified, risk factors or conditions related to the health problem need to be prioritized.

phase 4: channel analysis

- Plays a secondary role in communicating important messages about the product. Communication not the focal point of social marketing campaign. - Formative research also includes questions about the type of communication channels consumers believe are most appropriate for the behavior change being addressed. - At the conclusion, communication channels are identified that are consistent with preliminary messages AND product distribution and communication and intervention partners are identified.

phase 2: consumer analysis

- Process is similar to formative research (process that identifies differences among subgroups within a population, identifies a subgroup, determines the wants and needs of the subgroup, and identifies factors that influence its behavior, including benefits, barriers, and readiness to change. - Useful to have multiple types of data collection methods to gain a better perceptive of the PP. - Formative research involves use of focus groups, in-depth interviews, surveys to understand consumer preferences. - At the conclusion of this phase, PP is identified. Formative research yields data about major themes, directions, and consumer preferences related to health problem and interventions. - Phase 2 can provide context for the other two phases.

phase 2: quantifying the issue

- Process of using descriptive epidemiology (occurrence and distribution of disease by person, place, and time) from surveillance systems and other secondary data sets to analyze and display disease frequencies. - Data is presented in tables and figures as prevalence or incidence rates, or percentages, to help stakeholders make decisions about health concerns in the community. With the data from community members the most significant health problems in the community begin to emerge.

phase 1: community assessment

- Requires to understand the community context (characteristics and circumstances that define the community) and the health concerns of community members and how to implement programs most effectively to them. - Requires collecting new data, community audits (documenting observations about the community), involves organizing and examining existing data.

Introduction

- Responsibilities and competencies for health education specialists: area II plan health education promotion. - Health promotion programs are the product of coordinated effort and are usually based on systemic planning model or approach. - Generalized Model used to teach principles of planning and evaluation emphasized in most planning models. Simple composite of what is represented in most, if not all other models. Both a teaching model and framework for professional practice.

phase 6: action cycle

- Similar to implementation and evaluation. - Implementation are considered and evaluation plans are developed and plans for disseminating results are made.

SMART

- Social Marketing Assessment and Response Tool - Does a better job of orientating program interventions to the preferences of consumers throughout the entire planning process. - Consumer data are collected continually, to understand the wants and needs consumers and then to test all aspects of intervention and communication strategies. - More robust social marketing models currently in practice, the other is Community Based Prevention Marketing Model. - Used in serine-learning to teach community health, treat schizophrenia, and in developing support program for patients with diabetic kidney disease. - Compose of several social marketing planning frameworks but differs because its multistep focus on the consumer. SMART has been used from start to finish in successful marketing interventions. - 7 phases. The central focus of SMART is consumers. The heart is phase 2 through 4: directs planners to acquire brand understanding of the consumers who will be recipients of a program and its interventions. These phases seek to understand consumers before interventions are developed or implemented.

phase 1: social assessment and situation analysis

- Subjectively defines the QOL (problems and priorities) of the in the PP while involving individuals in the PP in an assessment of their own needs and aspirations. - Social indicators of QOL include achievement, alienation, comfort, crime, discrimination, happiness, self-esteem, unemployment, and welfare.

phase 3: developing a concise statement of the issue

- Summarizes an analysis of root causes of the most significant health problems in the community. - Root causes can be the lack of interventions to address risk factors or inadequate policies, social determinants.

phase 7: evaluation

- Use preliminary evaluation strategies in Phase 1. Evaluation gas two major objectives: improve the quality of the program and determine the effectiveness of the program, - The quality, program planners assess the degree to which the PP is actually receiving the program or interventions. Also assess immediate impact the program is having and whether the interventions and related support strategies are acceptable and engaging to the PP. - Planners ensure that program delivery is consistent with protocol and at least consistent with developed timelines. - Evaluation concerns itself with measuring the outcomes. Planners and evaluators make sure that evaluation results are folded back into the program to make it improve. Requires communicating evaluating results to stakeholders.

phase 6, 7, 8: process, impact, and outcome evaluation

- Whether three of these final phases are used depends on the evaluation requirements of the program. - Usually resources needed to conduct evaluations of impact (7) and outcome (8) are greater than those needed to conduct process evaluation (6).

phase 5: implementation

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

An Application of the Generalized Model

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phase 5: review data gathered

Members discuss what was discovered and rate each item (specific questions related to each sector) using a five point scale. Involves making judgments about whether the condition of each item is improving, getting worse, or staying the same.

enabling factors

Barriers or facilitators created by societal forces or systems, which include access to health care facilities or other health-related services, availability of resources, referrals to appropriate providers, transportation, negotiation and problem-solving skills, among others.

phase 4: gather data

Begins the assessment phase. Sites or locations that have data related to the question with each sector are identifies and specific data collection strategies (observations, interviews, focus groups, and surveys) are used to gather new or existing data.

Community Health Assessment aNd Group Evaluation tool

CHANGE. Enables stakeholders and community team members to gather data on community strengths and assets and provide opportunities to create policy, systems, and environmental change through a community action plan. Tool or model represents a viable planning framework for organizations and communities engaging in the Healthy Communities approach. 8 phases. CHANGE action guide provides instructions on how to complete the eight phases of the process. Includes pre-plannnig ad visioning, needs assessment, priority setting, selecting appropriate policy, systems, or environmental interventions, and evaluating the quality and effectiveness of interventions.

community-based participatory research.

Community itself owns the program and is the unit of identity, solution, and practice involved in all aspects of program development and delivery.

phase 1: conduct a needs assessment

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

phase 4: organize methods and applications into an intervention program

Describes the scope and sequence of the intervention, the completed program materials, and program protocols. Program materials are pretested with the PP prior to the implementation.

phase 2: develop a team strategy

Directs the community team to make decisions about how to operate most efficiently and effectively. This can be reorganizing the larger team into smaller work groups with specific tasks or creating decision making procedures, like how to reach consensus

phase 3: review all five CHNAGE sectors

Divides the work of data collection and analysis in five sectors: community a large sector, community institution/organization sector, healthcare sector, the school sector, and the worksite sector. Each sector has specific questions related to data elements associated with policy, systems, or environmental change that needs to be addressed.

Generalized Model

Five basic phases or steps: 1. assessing needs 2. setting goals and objectives 3. developing interventions 4. implementing interventions 5. evaluating results - Pre-planning is a quasi-phase in the model but is not included formally since the actions occur before the planning.

phase 3: theory-based intervention methods and practical applications

Guides the planner through a process of selected theory-based interventions and strategies that hold greatest promise to change health behaviors of individuals in the PP.

ecological framework

Helps planners better appreciate that families, schools, employers, social networks, organizations, commutes, and societies exert an influence on individuals and PP as they attempt to change health behavior and improve their health.

predisposing factors

Includes knowledge and affective traits like attitude, values, beliefs, and perceptions. These factors facilitate or hinder a person's motivation to change and can be altered through direct communication.

phase 6: enter data

Incorporates CHANGe Sector Excel files which organizes data for analysis.

reinforcing factors

Involves different types of feedback and rewards that those in the PP receive after behavior change, which can encourage or discourage the continuation of the behavior. Can be delivered by family, friends, peers, teachers, self, and others who control rewards.

phase 8: building the community action plan

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

phase 1: assemble the community team

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

phase 6: generate an evaluation plan

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

flexibility

Planning is adapted to the needs of stakeholders. Planning is usually modified as the process unfolds. Strict adherence to a model will lead to frustration among partners and less desirable outcomes.

phase 5: plan for adoption, implementation, and sustainability of the program

Requires development of matrices that focuses on adoption and implementation of performance objectives. Instead of focusing on who and what will change within the PP, the focus is on what will be done by whom among planners or program partners.

phase 2: create matrices of change objectives

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

fluidity

Suggests that steps in the planning process are sequential, or that they build on one another. It is a problem if certain steps in the planning process are performed out of sequence like in the GM. Like you cannot develop gals and objectives until a needs assessment has be performed and priority health problem has been identified.

phase 7: review consolidated data

Transfer data into CHANGE summary statements for quick reference of all sites with related ratings across all five sectors.

developing interventions

are the means by which the goals and objectives will be achieved; how goals and objectives will be achieved

setting goals and objectives

identifies what will be accomplished

evaluating results

improving quality (formative evaluation) and determining effectiveness (summative evaluation)