Health Ch 4-8

Advocacy Roots In Theories p.183

Community mobilization theory supports advocacy through its focus on individuals' taking action organized around specific health issues at a site. Social network and social support theory, with its emphasis on relationship building based on mutual support and shared interest, reinforces for advocates the importance of building social support and networks when advocating. The more people involved with advocacy the better. Communication theory, the diffusion of innovations model, and social marketing all help to shape how and with whom program staff, stakeholders, and participants talk in order to champion a program.

Chapter 8 - Communicating Health Information Effectively

Effective health communication, similar to advocacy (discussed in the preceding chapter), is a thread that runs through all the phases of a program.

Capacity Assessment

assessment of the site to determine available resources to address identified needs. Looking for things such as: health promo materials, technology, internet access, web sites,etc. Provides early insight into the culture and climate of a setting. KEY element is empowerment of participants, staff and stakeholders to mobilize forces to address and solve the health problems or concerns identified in the N.A.

Physical Health

being free from pain, disabilities, illness, diseases that require treatment by doctor- also increased longevity

Activities

brings into focus the specific strategies and interventions that were selected during the planning process on the basis of the staff and stakeholders' understanding of the underlying problem, its context, the program's theoretical framework, and the desired outcomes.

Culturally Appropriate Communications

culturally appropriate health communications are an essential component of health promotion programs that seek to eliminate health disparities. Culturally appropriate communication includes assessing participants' health information needs and learning from them the most appropriate and meaningful way (channel) of communicating health information to them.

Direct Lobbying

direct lobbying, individuals make contact with a legislator, a member of the staff of a legislator, or a government official who is involved in formulating legislation. A request may be made, for instance, that a senator vote yes on a bill. This request is direct lobbying because it is an attempt to directly influence legislation

Health Communication Defined p.204

is defined as the art and technique of informing, influencing, and motivating individual, institutional, and public audiences about important health issues (U.S. Department of Health and Human Services, Steps to a Healthier US, 2004). It has been described further as "a multifaceted and multidisciplinary approach to reach different audiences and share health-related information with the goal of influencing, engaging and supporting individuals, communities, health professionals, special groups, policy makers and the public to champion, introduce, adopt, or sustain a behavior, practice or policy that will ultimately improve health outcomes"

Climate according to Moos 1979

is the social atmosphere of a setting or the learning environment in which different individuals have different experiences depending on the protocols set up by staff and admin.

mission statement

is usually a short statement that describes the general focus or purpose of a program answers the question of why a health promotion program is being developed and established. sometimes referred to as the philosophy of a health promotion program.

Action Plan

lists everything that must be accomplished by date and by the person responsible,goals and objectives. The action plan does provide the staff with useful information, but completing a Gantt chart that puts all activities on a common calendar allows the staff to make sure that nothing is overlooked and to see at a glance what activities need to be accomplished—and by when.

Advocacy and Technology

Blogs, vlogs, e-mails, blog carnivals (blog articles with links pointing to more blog articles on a particular topic), Twitter, social networking sites (for example, Facebook, LinkedIn), and podcasts are ways to reach large numbers of people very quickly.

Logic Model Sample p.156-157

logic model is a visual depiction of the underlying logic of a planned initiative. It shows the relationship between the program's resources (inputs), its planned activities (outputs), and the changes that are expected as a result (outcomes). Logic models can take many forms, but they all are designed to provide a simple graphic illustration of the relationships assumed between the actions that will be initiated and the results anticipated. The logic model thus shows what the planners are assuming will happen as the program progresses. It also allows the staff and stakeholders to track any changes from what was assumed and analyze the impact of those changes on program outcomes. NO TIMELINE

zone of drastic mutation

modifying an intervention is acceptable up to a zone of drastic mutation; after that point, further modification will compromise the program's integrity and effectiveness

Health Literacy defined

most commonly accepted definition is the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions health literacy expands beyond reading and writing skills to include the ability to comprehend and assess health information in order to make informed decisions about healthy behaviors, self-care, and disease management

Primary Data

new original data that didnt exist before. obtained directly from people at the site. usually by survey, interview, focus groups, or observation. Data will be used to answer questions. -more expansive and time consuming than 2nd -requires technical expertise in sampling, design, data analysis etc -can be constrained by the populations ability to read, communicate and access technology -Initial phases should be interactive group processes such as focus group

Mortality

number and variety of deaths

Morbidity

number and variety of diseases

Process Objectives (or administrative) 123

used to identify the needed changes or tasks in the administration of the program itself (hiring staff, providing professional development for staff, seeking additional funding etc.)

Techniques to Improve the Hiring Process 168

• Create high-quality job announcements. An effective job announcement will describe the organization, program, minimum qualifications, and desired skills and experiences in an easy-to-understand and attractive format. Interested candidates will know how to apply, to whom, and by what deadline. • Distribute job announcements widely. Circulate the job announcement in multiple formats and places, including Internet career sites, electronic mailing lists, professional journals, and local bulletin boards. The object is to generate the largest possible pool of qualified applicants . • Screen applicants systematically. Identify leading candidates by using a grid that rates each applicant on qualifications, skills, and experience. Table 6.1 shows a sample grid in which applicants' attributes are rated on a scale of 1 (lowest) to 5 (highest). Such grids help clarify which traits are applicants' strengths and which are most important to the project. Augment this rating process with brief telephone interviews of ten to fifteen minutes as necessary. The object is to create a short list of three to five candidates who will be interviewed.

Evaluating Program Materials for Appropriateness

• Do the program materials enable the objectives to be met? • Do they deliver the intended theoretical methods and practical strategies? • Do the materials fit with the target population? • Are the materials attractive, appealing, and culturally appropriate? • Are the messages delivered by the materials consistent with the program objectives? • Will the materials be properly used in the planned intervention?

Why Put Policies in Writing p.139

• It creates a supportive health-promoting environment. • A written policy may be required by a law or by the organization's insurance carriers . • It makes legal review possible. • It provides a record of the organization's efforts and a reference if the policy is challenged. It may protect the employer from certain kinds of claims by stakeholders such as employees, families, or students.

Low Health Literacy p.208

• Older adults • Racial and ethnic minorities • People with low education levels • People with low income levels • Non-native speakers of English • People with compromised health status

Selective preventive interventions:

• Selective preventive interventions: The target population is individuals or a subgroup of the population whose risk of developing illness or disorders is significantly higher than average. Examples include an education program to encourage construction workers to wear earplugs or protective devices when operating noisy machinery and grief counseling sessions provided to students who are experiencing a traumatic loss.

Moving from Action Plan to GANNT Chart

• Which activities need to be done before others? • What are the critical deadlines for each activity • How much time will be needed for each activity? • Are there any scheduled holidays, vacations, or other predictable periods in which less work might get accomplished or activities won't be successful? • When are our evaluation and progress reports due?

GANTT Chart (Program Timeline)

A Gantt chart is a visual depiction of a schedule for completing a program's objectives. Has a timeline. Gantt chart should be no more than a single page, even for a complex project. The goal is to show in clean and simple lines the development of the project across time and on time.

Elevator Speech

A concise statement, usually fifteen or so seconds long, that highlights program features such as mission, goals, setting, and outcomes.

Budget

A detailed explanation of what resources available to a program (income) and what it costs to implement it (expenses). In the planning phase, the budget is a reasoned prediction; in the implementation phase, the budget is a living document, changing as resources come in and funds are spent.

Advocacy Agenda

A document that defines a health promotion program's advocacy efforts and articulates its advocacy strategies, answering five key questions: What health problem does the program address? Who needs to take action? What message does this target audience need to hear? Whom does the audience need to hear the message from? What actions will you use to make your point?

Needs Assessment

A formalized approach to collecting data in order to identify the needs of a group of individuals determining how the health of a group at a site might be improved by collecting information on their current health status and their ideal health status They describe: participants(demo, race, sex, orientation, etc) and identify individuals with health problems- diabetes, obesity, etc. Must be culturally appropriate

Goal

A goal sets a program's direction and intent clarify what is important in the health promotion program and state the end results of the program. A goal includes the program's target population and, in general, uses action words such as reduce, eliminate, or increase. Society for Public Health Education (SOPHE). Health Promotion Programs: From Theory to Practice (Kindle Locations 2779-2780). Wiley. Kindle Edition.

Law

A local, state, or federal bill that has been passed by a legislative process (for example, a federal law passed by the U.S. Senate and the House of Representatives and signed by the president)

Health Communication Plan

A plan that guides and develops information exchange between and among a health program's staff, stakeholders, and participants, so that program communications deliver clear messages that are received and acted on with behavior that is consistent with the program's goals and objectives.

Talking Points

A prepared list of issues and concepts that can be used in a variety of advocacy efforts such as meeting with a legislator, developing a public service announcement, or writing a letter to the editor. Talking points need to be succinct, on topic, and developed with a specific message in mind.

Bill

A proposed law presented for approval to a legislative body

Advocacy 182

ADVOCACY is action in support of a cause or proposal. It can be political, as in lobbying for specific legislation, or social, as in speaking out on behalf of those without a voice. Broadly, advocacy is part of being a professional in a health field. Advocacy is a thread that runs through all the phases of health promotion planning, implementation and evaluation. Advocacy is about affecting the larger environment of public policy, and raising awareness of a single program is insufficient to create lasting social change.

Adaptation 137

Adaptation defines the degree to which an intervention undergoes change in its implementation to fit the needs of a particular delivery situation. The apparent antithesis of fidelity, adaptation could alter program integrity if an intervention is adapted so drastically that it is not delivered as originally intended. However, it is possible for an intervention to be rendered more responsive to a particular target population through the adaptation process. For example, adaptation could increase an intervention's cultural sensitivity and its fit within a new setting.

Establishing Priorities p.111

Advisory board plays a large role in this 1. Reduce the the info to a manageable number of health concerns 2. Group the Data (types of death, behavioral risk factors, non-behavioral risk factors(social, physical and environmental) 3. Prioritize data in each group and among groups Criteria established by board (importance, feasibility of change, cost, magnitude of problem) determines what new programs are justifiable and which ones can be eliminated.

Chapter 7 Advocacy

Advocacy

Advocacy Definition

Advocacy The processes by which individuals or groups attempt to bring about social or organizational change on behalf of a particular health goal, program, interest, or population

3. Decide what materials to develop p.224

After determining an effective message for the intended audience, begin to consider what format to use to present the message. Some of the decision about format may come from formative research in which audience members reveal which formats they are most likely to look at, read, or listen to. As we discussed earlier, materials can be presented in many formats via interpersonal channels, organizational channels, community channels, mass media channels, or interactive channels.

Training, Coaching and Managing Staff 169

After making good hiring decisions, effective leaders retain qualified staff by investing in staff development: training, coaching, management, and evaluation Staff development focuses on supporting staff so that they can (1) perform their work effectively, (2) contribute meaningfully to the organization's mission, (3) achieve high levels of satisfaction with their job, and (4) continue to expand the depth and breadth of their knowledge of health promotion. The best staff development programs are concrete, tailored to staff needs, and ongoing.

6. Revise and produce materials p.225

After revising the materials and testing them with the audience, send the materials to press and put them to use for the program. Eventually, you will find that developing a set of materials is only the beginning, because as the audience changes, the materials will need to change as well. Thus the process of testing the materials with the audience and making appropriate changes will begin again.

Op-Ed

An abbreviation of opposite the editorial page (though it is often believed to be an abbreviation of opinion editorial ). An op-ed is a newspaper article that expresses the opinions of a named writer who is usually unaffiliated with the newspaper's editorial board. Op-eds are different from editorials, which are usually unsigned and written by members of the editorial board.

Lobbyist

An individual hired to represent the legislative interests of an organization (or related group of organizations) to members of a legislature

Grassroots lobbying

Any attempt to indirectly influence legislators by motivating members of the public to express specific views to legislators and legislative aides

Intervention Definition

Any set of methods, techniques, activities, or processes designed to effect changes in behaviors or the environment

Ecological Approach to Needs Assessment

Assess both the stakeholders and their environment. In the environmental assessment, include an analysis of organizational and community assets and capacity

Chapter 4:

Assessing the needs of program participants

3 Levels of Influence

Assessments can reflect intrapersonal, interpersonal, and population levels of influence

NAAL Literacy Level Basic 22%

Basic means that the person has the skills necessary to perform simple and everyday health literacy activities About 22 percent had basic health literacy, meaning that they could do things like read a clearly written brochure and then identify reasons that a person with no symptoms of a specific disease should be tested for it anyway

NAAL Literacy Level Below Basic 14%

Below basic means that the person has, at most, only the most simple and concrete health literacy skills And 14 percent had below basic health literacy, meaning that they were able to do things like circle the date on a medical appointment slip or identify how often a person should have a specific medical test after reading a clearly written pamphlet

Typology of Health Promotion Interventions

Chart of Levels and Strategies p.130

2. Define the Communications objectives p.213

Communication objectives define what the staff hope to articulate in a program's health communications. Defining the objectives assists with setting priorities should be • Aligned with the program's goals • Realistic and reasonable • Specific to the change desired, the population to be affected, and the time period during which change should occur • Measurable, in order to track progress • Prioritized, to aid in allocation of resources

Direct lobbying

Communication with a legislator or a member of a legislator's staff that gives a viewpoint on a specific piece of legislation

Concept Testing

Concept Testing. Once several concepts have been developed, test these concepts with the intended audience to ensure that the message appeals to them, that they understand the message, and that they are willing to act on the message. Include the creative team in developing at least two message concepts, but three may be best. It is best to test concepts using a variety of data collection methods, for no one method is optimal

2. Develop and Test Message Concepts p.222

Concept development is the process of using the health communication plan (which is often part of the health program's marketing plan) and formative research to generate ideas that can be tested and used in developing materials. Message concepts are messages in general form and are intended to present ideas to the audience. Message concepts are not the final messages.

Interviews 169

Conduct in-person interviews with the short list of candidates. Ask interview questions that will help clarify candidates' relevant skills, experiences, and potential fit with the rest of the program staff and your organization's mission One way to identify the best candidates is by asking them to describe potential approaches to program-specific scenarios. You might also ask applicants to perform some appropriate skill—for example, teaching an abbreviated sample lesson or constructing a letter to a specific group of program participants.

Ranking Priorities Method 3 p.114 Consensus Building p.114

Consensus Building / collaborative problem solving : Brings together the board, participants, staff and stakeholders to discuss results and come to consensus on what to prioritize. Maximizes opportunities to gain input and support from a wide range of individuals, groups, and organizations

Needs Assessment Report - last step p.114

Contains: -Executive summary -acknowledgements -table of contents -demographics of community -methods of data collection -main findings -Established priorities -references -apendixes

What is a need? Definition

Difference between "what is" and "what should be"

SAM p. 132

Doak, Doak, and Root (1996) developed the Suitability Assessment of Materials (SAM). Although the SAM was developed for use with print materials, it has also been used to assess videotaped and audio instructions. The SAM scores materials in six categories: content, literacy demand, graphics, layout and typography, learning stimulation, and cultural appropriateness. The SAM yields a final percentage score, which falls into one of three categories: superior, adequate, or not suitable. The SAM can be used to identify specific shortcomings that reduce the suitability of materials either in the developmental stage or in final form

Advocacy During Implementation

During implementation in each setting, program staff and stakeholders work to engage and serve participants and at the same time compete for funding and resources. Clearly, if there were unlimited resources, all health needs would be met, but given limited resources of time, materials, knowledge of what works best, and people's energy, advocacy is one tool that health promotion programs staff, stakeholders, and participants need to use in implementing programs.. Advocacy during implementation is not about a specific health promotion program.

Communication Implementation Phase

During program implementation, effectively communicating health information to program participants, stakeholders, and staff is an important part of a health promotion program.

9. Evaluate The Plan

Evaluation of the communication plan is part of the evaluation of a health promotion program (see Chapter Ten). Evaluation of a communication plan can focus on a number of issues—for example, utilization and penetration of the program communications (brochures, posters, activity materials, videos, and so on), satisfaction with the communications, or recommendations on how to improve the program materials and information. Table 8.1 provides an overview of communication plans for different sites, including their evaluation.

Balancing Fidelity and Adaptation with Evidence Based interventions

Evidence-based interventions usually have prescribed protocols to direct the implementation or use of the intervention, including a detailed set of instructions, materials, and staffing requirements. Furthermore, there is a prescribed implementation process as well as staff training and development. Developers of evidence-based health promotion interventions try to facilitate maximum fidelity to the essentials of intervention while still allowing maximal adaptation for the specific needs of a setting.

Fidelity 137

Fidelity defines the extent to which the delivery of a health intervention conforms to the curriculum, protocol, or guidelines for implementing that intervention. Intervention fidelity is rated from high to low. A high-fidelity intervention would be delivered exactly as intended by the people who created it. A low-fidelity program would be delivered quite differently than intended by the people who created it.

Budgeting and Fiscal Management

Generally, the larger or more complex the organization, the greater the likelihood that the program will use specialized financial management expertise. almost all decisions made by program directors and program staff—no matter what their role in the organization—have financial implications. well-prepared health promotion staff member should have the ability to interpret three basic financial documents: balance sheet, income statement, and cash flow statement.

Hiring Considerations

Have skills and experience that are specifically matched to program goals. If a youth development program is to be implemented, seek staff who have experience in working with young people. • Have interpersonal qualities that are desirable for the program. If the program's work is highly collaborative, seek staff who value compromise and working in teams. • Are culturally competent. Cultural competence should be a requirement for program staff. Staff diversity and cultural competence contribute to supportive and caring relationships with stakeholders and participants as well as among the staff members. These relationships are critical to participants' participation in a program and their motivation to address a health concern. • Have an interest in the organizational mission. If the organization's mission is to help eliminate health disparities, seek staff who are committed to this work.

Plain Language Presentation

Here are a few of the techniques the figure uses to present information that is visually appealing, logically organized, and comprehensible • Use ample white space. Break up dense amounts of text. Keep sentences short. • Use clear headings and bullets. Try using question-and-answer formats with straightforward answers. • Use the active voice and strong verbs. • Avoid medical jargon, and use conversational language. • Use a design that increases comprehension. Include pictures or graphics that are visually appealing to illustrate examples or important points. • Supplement written materials with audiovisual materials or conversation.

Hiring and Managing High Quality Program Staff

Hiring staff is one of the most important program leadership functions. Quality hiring decisions contribute to effective programs and positive work environments. Conversely, hiring mistakes can lead to program implementation problems and turbulent work environments.

Planning for Implementation Challenges

Implementation always brings challenges. Staff need to be flexible and able to adapt to changes.

Hook

In advocacy, something that gets people's attention and raises their awareness of an issue. Providing a hook or a sound bite allows programmers to frame a health issue in a way that increases the chance that people will discuss the issue in appropriate terms.

Advocacy Terminology Table P. 188

In order to build skills in advocacy, it is necessary to learn the terminology of advocacy. Table 7.1 lists some key advocacy terms. The terms reflect the interactions of organized political and government structures in the making and administering of public decisions for a society.

Advocacy During Evaluation

In the evaluation phase of a program, advocates use evaluation data and reports to communicate a program's effectiveness and sustain program growth and development. Without advocacy, programs disappear, even if they are effective.

communication Evaluation Phase

In the evaluation phases, effective health communication is critical to dissemination of program evaluation results and findings in order to build program sustainability.

Indicated preventive interventions

Indicated preventive interventions: The target population is high-risk individuals who have detectable signs or symptoms but have not reached the diagnostic criteria of a particular health problem. Indicated preventive interventions are found to have medium effects on health issues. An example would be a smoking cessation program for heavy smokers.

Institute of Medicine's model of preventive intervention

Institute of Medicine's model of preventive intervention. This model identifies and categorizes preventive interventions for different target populations and different health problems and concerns

Intervention Methods p.128

Instruction: teacher-based lessons Counseling: individual or group sessions, • Regulatory strategies: policy mandates, legislation, Environmental change: changes in the physical, social, or economic environment Social support: support buddy, support group, Direct interventions: screening, referral, treatment, Communication or media outreach: mass media, Advocacy: organizing at the site, coalition building, community development, social action

Communication Plan 212

It is recommended that each program have a communication plan to guide and develop information exchange between and among the program staff, stakeholders, and participants as the program is implemented.

Pretesting

Knowing which messages are most salient to the intended audience is one critical component of a successful intervention or program. Pretesting should be used in developing new materials, revising existing materials, and developing messages and concepts. Pretesting materials and messages can assist in discovering how the audience members will respond to a message, whether they will read the materials and act appropriately, and how the messages will be received.

Spiritual Health

Least studied dimension of health. Been ignored in needs assessments because of difficulty of assessing the concept. Includes: sense of purpose, religion, satisfaction, prejudice levels

Appropriations

Legislation that designates or appropriates funding to a program

Authorizations

Legislation that sets policies or programs

Lobbying

Lobbying occurs when an attempt is made to influence legislation. The tax status of an employer determines whether employees may lobby and to what extent employees may engage in specific activities.

Long Term Outcomes

Long-Term Outcomes depicts the ultimate extension of the program's impact. If the activities are effective and the planners achieve both the short-term and the intermediate outcomes, the logic model specifies that the related long-term results that could be reasonably expected

MADD Advocacy

MADD used a media advocacy campaign to educate the public about the dangers of drunk driving. This advocacy raised public consciousness about the threat of drunk driving and spurred lawmakers to initiate more legislation to curb this danger. MADD's media advocacy has been recognized as the impetus that inspired action that decreased fatalities resulting from drunk driving (Dejong, 1996).

Problems with Secondary Sources

Make sure data is current, unbiased, valid, easy to access, correct target population, etc. Use multiple sources when possible.

Chapter 5

Making Decisions to Create and Support A Program

Selecting Health Promotion Materials

Many developed by the government but still important to pilot test with the population

March of Dimes Advocacy 185

March of Dimes have applied their efforts not just toward soliciting donations for research but also toward advocacy for more funding for research in their chosen areas. Today's March of Dimes works in the areas of research, education, community services, and advocacy (March of Dimes, n.d.).

Measurability

Measurability is the major difference between goals and objectives.

Nutrition Advocates

Nutrition advocates have been responsible for a fair amount of legislation designed to protect and strengthen the healthful food supply in the United States. These advocacy efforts led to sweeping reforms in federal policy such as Public Law (P.L.) 101-535, commonly known as the Nutrition Labeling and Education Act of 1990, which mandates nutrition labels on packaged foods. This law represented a major victory for dietitians and consumers who had heavily advocated for the addition of this educational tool.

Promoting Needs Assessment p.98

Often 1st public acknowledgement that something is being done. Publicity creates awareness of the needs assessment and enhances the chance that individuals and groups who've been asked to participate will respond. Increases visibility of the organizations that form the advisory committee

Action Plans Definition p.154 -155

One of the most critical steps in the health promotion planning process is the creation of practical and specific action plans. These practical documents are based on the program's goals, objectives, and interventions. It provides a summary of how the program needs to progress. The plan links the specific activities that will be undertaken with the outcomes desired. Once developed, the action plan helps staff members track progress, adapt to changes, and document accountability as the program unfolds. planned, it can also serve as a key document in process evaluation—ongoing review of the process by which the program is implemented and of the impact that the process has on the outcomes.

Health Advocacy

"the processes by which the actions of individuals or groups attempt to bring about social and/or organizational change on behalf of a particular health goal, program, interest, or population" Engagement in advocacy has long been suggested as a professional responsibility of health professionals

Mental Health assessment of Population

# with mental disorders, # receive care, # institutionalized. However, due to lack of insurance coverage for these services, numbers will be lower than actual.

Writing Objectives (6 Tips) p.125

(1) are measurable, relevant, and achievable; (2) drive action and suggest a set of steps that will help to achieve the goals within a specific time frame; (3) include a range of measures directed toward achieving program goals; (4) are established at the outset of the program in order to make evaluation possible; (5) support short-term as well as long-term plans; and (6) are based on sound scientific evidence

Education entertainment

(a form of health communication in which educational content and information is intentionally incorporated into an entertainment format) is another powerful way to engage an audience, and studies have demonstrated that exposure to health information and behaviors through entertainment media can have strong effects (National Cancer Institute, 2001

Benefits of interactive data collection

- allows collectors to clarify both their own questions and respondents answers -allows specific words used by the population to describe health issues to be collected for later use in surveys of larger groups.

Program Goals p.113 Ranking method 2 p.113-114

-Based on priorities set the advisory board -Directed toward reducing a particular health problem -PEARL model to determine which interventions to pursue. Score each area. 1=yes, 0=no Scores are MULTIPLIED so a zero on any answer removes it from the priorities no matter how important it is. -Propriety: does problem fall within organizational mission -Economic Feasibility: Does it make economic sense to address it? Will there be economic problems if NOT addressed? Acceptability: Will target population accept on intervention to address problem Resources: Are resources available to address the problem? Legality Do current laws allow the problem to be addressed?

Feasibility Factors p.112

-how hard will it be to correct -are resources available? -How effective are current solutions? -potential acceptance of solutions at the site diagram on p.113

Steps to Survey Success p.104

1. Correctly select the sample 2. Power Analysis : Selecting a large enough sample that the results will be representative of the population 3. Make sure the return rate is high enough to reach adequate sample size. Try for better than 50%

Four Steps of Needs Assessment details p.98-99

1. Determine the scope of the assessment 2.Gather data 3. analyze data 4. report findings

Reporting and Sharing the Findings (Last Step) p. 108

1. Identify any factors that are linked to the health problem 2. Identify the focus for the program 3.Validate the need for the program 4.Tailor communications to program participants, staff, and stakeholders

2 Tips for writing final report p.115

1. Start with a plan 2. Keep it simple 3. Respect adult learning styles

Communication Plan 9 Steps p.212-218

1. Understand the problem 2. Define communication objectives 3. Learn about the intended audience 4. Select communication channels and activities 5. Develop Partnerships 6. Conduct market research to refine your message and materials 7. Implement communication plan 8.Review tasks and timeline 9. Evaluate the plan

Developing the Health Promotion Policy p.141

1. generate support from organization leaders and stakeholders 2. Organize a cooperative process for policy and development 3. Develop policy content 4. Prepare for implementation 5. Implement the policy 6. Support stakeholders 7. Evaluate the policy

6 Tips to Balance Fidelity and Adaptation of interventions 137-138

1. identify and understand the theory behind an intervention 2.Assess fidelity and adaptation concerns for a site or setting. 3. Involve the individuals who developed the intervention 4. Involve the stakeholders 5. Employ an analysis of core components of the intervention 6. Develop an overall implementation plan based on these inputs

Who does advocacy target?

People with power to make change. For example, by owners, stockholders, chief executive officers, boards of directors, superintendents, program directors, foundation staff members, government workers, and politicians such as local, state, and federal legislators.

Electioneering

Persuasion of voters in a political campaign

2 Types of Data

Primary Data & Secondary Data

NAAL Literacy Level Proficient

Proficient means that the person has the skills necessary to perform more complex and challenging health literacy activities

Program Objectives

Program objectives are the specific steps (or subgoals) that need to be achieved in order to attain the goal. They are specific and measurable targets with a timeline that identifies by when the objective will be attained.

Needs Assessment Results

Provide foundation for planning a health promotion program that addresses identified needs, helps allocate funds, and provides baseline data

Types of Information to Be Collected (Data) p.97

Quantitative Data: statistical info, numbers, measurable, defined. Not sufficient alone to provide insights needed to determine health problems Qualitative Data: more narrative with fewer numbers. Includes perceptions and misperceptions of community members. Methods include 1 on 1 interviews, focus groups, public hearings, observation. They inform each other , compliment each other to help staff derive conclusions and establish goals for community interventions

Face Validity p.103

Questions are based on previous questions or a review of the literature (weakest form of validity to use)

Concept testing Questions to Ask Audience p.223

Questions need to help determine: • Comprehension of the behavioral recommendation or call to action • The ability of the message or materials to attract attention • The intended audience's ability to recognize the message as relevant • Cultural appropriateness for the intended audience • Believability • Credibility • Persuasiveness • Usefulness • General attractiveness • Acceptability

Ranking Priorities Method 1

Rank each priority by feasibility and importance to determine which ones to focus on

Evidence Based

Relevant scientific evidence that has undergone comprehensive review and rigorous analysis to formulate practice guidelines, performance measures, review criteria, and technology assessments for telehealth applications

RTIPs P.133

Research-Tested Intervention Programs (RTIPs), was developed and is maintained by the National Cancer Institute. evaluates the effectiveness of broad intervention categories through systematic research reviews. RTIPs is a database of actual programs and products that individuals, groups, and organizations can access and use

Tools for Assessing Capacity (School Health Index) p.96

Schools: school health index (nat ctr for chronic disease prevention and health promotion at CDC in partnership w parents, admin, staff, health experts, and NPO. "Assesses the extent to which a school implements they types of policies reccomended by CDC research based guidelines for school health & safety policies and programs" Purpose: 1. enables schools to identify +&- of health & safety programs/policy 2.enables schools develop action plan improve student health which can be incorporated into school improvement plan 3.Engages teachers, parents, students and community in promoting health enhancing behaviors

Using Secondary Data p.106 - 107 Examples P.108

Searching 2nd data is necessary for all Health Promotion programs. Gives big picture and overview of how to proceed Benefits: 1. Cheaper than 1st 2. Publicly available and accessible electronically 3. *Usually* yield more accurate results than 1st. Large scale. 4. 2nd sources help define the population and structuring sample 5. Sometimes make 1st data unnecessary Internal sources can be used for 2nd data (payroll, attendance records, student grades, clinic records, etc) External Sources: main provider is government (fed, state, local), voluntary health associations, private foundations, national and international institutions, prof. associations and institutions.

Selective preventive strategies

Selective preventive strategies are approaches in which specific groups are targeted because they share a significant risk factor and interventions are designed to reduce that risk. An example of a selective preventive strategy is providing visits by a public health nurse to a young, unmarried, and economically disadvantaged pregnant woman to promote behaviors during and after pregnancy that will be healthy for both the woman and her child.

Short-Term Outcomes

Short-Term Outcomes column lists the things that we expect will happen as an immediate result of each of the planned activities.

Why Pretest?

Some may say that pretesting takes too much time and money. But it's just the opposite: if the materials or messages are not pretested, valuable time and financial resources will be wasted on materials or messages that do not resonate with the target audience. Taking some extra time can actually save time and money in the end. Because most health promotion implementers are not a part of the target audience, it is essential to pretest messages and materials to ensure that they will meet communication objectives when they are received by people in the intended audience who may have very different issues and concerns from members of the program staff.

Media advocacy

Strategic use of news media and, when appropriate, paid advertising to support community organizing to advance a public policy initiative

Alliances and Partnerships for Advocacy

Successful advocacy efforts do not happen in isolation; they are the result of coordinated, collaborative efforts by individuals and organizations working to achieve common goals. Effective partnerships rely on the strengths each individual or organization brings to the group. One partner may have more financial resources; another may have an established network that can be easily mobilized. One may have more clout and thus be able to bring attention to the cause..

Reliability

The ability of an evaluation instrument (a survey) to produce the same results each time it is administered

3. Learn about the intended audience

The audience may already be defined by the location of the health promotion program, or there may be several audiences. The goal in this step is to learn as much as possible about the individuals who make up the target audience in order to tailor the program most effectively. Audience segmentation and formative research can help in this process.

Pretesting Steps p.221

The basic iterative steps in pretesting are 1. Review existing materials. 2. Develop and test message concepts. 3. Decide what materials to develop. 4. Develop messages and materials. 5. Pretest messages and materials. 6. Revise the materials, then produce and distribute them

Availability

The content (whether targeted message or other information) is delivered or placed where the audience can access it. Placement varies depending on audience, message complexity, and purpose ranginf from interpersonal and social networks to billboards and mass transit signage to prime time tv ads

Reach

The content gets to or id available to the largest possible number of people in the target population

Timeliness

The content is provided or available when the audience is most receptive to, or in need of, the specific information

Consistency

The content remains internally consistent over time and also is consistent with information from other sources (the latter is a problem when other widely available content is not accurate or reliable.

Repetition

The delivery of/access to the content is continued or repeated over time, both to reinforce the impact with a given audience and to reach new generations

Cultural Competence

The design, implementation, and evaluation process that accounts for the special issues for select population groups (for example, ethnic, racial, and linguistic) and also educational levels and disability

4. Develop Messages and Materials

The following guidelines will help ensure that program materials are understood, accepted, and used by the intended audience • Ensure that the message is accurate. Make sure that the information provided is factual. It is always good to have the materials reviewed by experts on the topic. • Be consistent. Consistency is critical to a program's success and, ultimately, to its identity Make sure that the messages in all materials are consistent not only with the communication strategy but also with one another. • Be clear. Keep the message simple and clear. Do not use a lot of technical terms. Make sure that the intended audience's tasks are clear and understandable. • Make sure that materials are relevant. Talk about the program's benefits. The formative or consumer research will provide insight into what the intended audience values. • Ensure that materials are credible. Again, use formative research to guide the decision about whom to use as a spokesperson. • Create appealing materials. Ensure that materials are appealing and eye-catching, so they grab the attention of the intended audience.

formative research

The goal of formative research is to describe the intended audience: who they are, what is important to them, what influences their behavior, and what would enable them to engage in the desired behavior. Formative research can also be used to determine how ready the intended audience is to change; what social or cultural factors may affect the program; when and where the audience can best be reached; what communication channels are preferred by the audience; and what learning styles, language, and tone the intended audience prefers

Low Literacy Older Adults

The high prevalence of low health literacy in older adults is of particular concern because they are the most likely to have chronic conditions such as diabetes, cardiovascular disease, or cancer. Approximately 80 percent of Americans aged 65+ in 2005 have at least one chronic condition, and 50 percent have at least two.

Fiscal Management Definition

The maintaining of sound records and procedures in order to safeguard and maximize a program's money assets, and resources, which protects the program's sustainability and allows it to operate with economy effectiveness, and efficiency.

1. Understand the problem p.212

The needs assessment discussed in Chapter Four is the foundation for the communication plan. It provides a clear picture of the health problem or concern, the program's stakeholders and participants, and the program's priorities

Performance Evaluation

The primary method that effective leaders use to manage for staff success is performance evaluation. Workplace performance evaluation is often thought to mean year-end reviews that determine raises, bonuses, or even job cuts. While annual reviews play a role in performance evaluation, the best leaders evaluate their staff on a continual basis. Such ongoing evaluation starts with staff goals that are formulated in partnership with supervisors and that meet staff, program, and organizational needs. These goals provide the blueprint for staff work, are discussed in regularly scheduled meetings with the primary supervisor, and are adjusted as necessary on the basis of changes at the staff, program, or organizational level.

Understandability

The reading or language level and format (including multi-media) are appropriate for the specific audience.

The National Adult Literacy Survey (NALS)

The scope of the health literacy problem is far reaching. The National Adult Literacy Survey (NALS) found that approximately 90 million adults, half of the U.S. population, lack the literacy skills necessary to effectively use the U.S. health system. Health literacy issues can affect people of all backgrounds, but it is particularly burdensome for those with low literacy to try to read and understand health-related information. Most health information is written at or above the tenth-grade reading level, yet the average reading level of people in the United States is eighth grade, and 20 percent of the population reads at or below the fifth-grade level The NALS also discovered that 50 percent of African Americans and Hispanics read at or below the fifth-grade level.

Reliability (Communication)

The source of the content is credible and the content itself is kept up to date

Tobacco Advocacy 186

The strides made in legislation to control tobacco use can be credited largely to the advocacy of researchers, activists, health practitioners, and nonprofit organizations. Long-term efforts to educate and heighten awareness about the harmful effects of tobacco have resulted in increased legislative activity in the area of tobacco control.

8. Review Tasks and Timeline p. 218

The timeline of the communication plan specifies what needs to be accomplished when. Detailing the tasks enables the work to be assigned and kept on schedule and allows resources to be allocated for each task. The timeline should be reviewed and adjusted as the program progresses. The communication plan timeline can be incorporated into the Gantt chart for the entire program (see Chapter Six).

Factors Contribute to Health Literacy

They include social and individual factors such as cultural and conceptual knowledge and listening, speaking, arithmetical, writing, and reading skills (Nielsen-Bohlman, Panzer, & Kindig, 2004). Studies have shown that individuals with inadequate health literacy report less knowledge about their medical conditions and treatment, worse health status, less understanding and use of preventive services, and a higher rate of hospitalization than those with marginal or adequate health literacy

6. Conduct Market Research

This step includes conducting market research and pretesting in order to determine the activities for each intended audience, messages for each market, and materials to be developed. The next section will go into greater detail on how to develop and test messages and materials.

4. Select Communication Channels and Activities p.215

To reach your program's intended audience, consider the settings, times, places, and states of mind in which they may be receptive to and able to act on the program's key message (National Cancer Institute, 2001). Then identify the channels (routes of message delivery) through which the program's message will be delivered and the activities that can be used to deliver it.

Treatment interventions p.130

Treatment interventions are approaches that target those who have high symptom levels or a diagnosable illness or disorder. These interventions apply to those individuals' diagnosed illnesses and disorders. The interventions (treatment) usually take place in clinical settings.

Treatment interventions

Treatment interventions are approaches that target those who have high symptom levels or a diagnosable illness or disorder. These interventions apply to those individuals' diagnosed illnesses and disorders. The interventions (treatment) usually take place in clinical settings. Table 5.1 presents different types of interventions

501 (c)(3) Organizations

U.S. tax code exempts certain types of organizations from federal taxation of income. All of these organization types appear in Section 501 (c)(3) of the Internal Revenue Code. Organizations must apply for tax-exempt status; if they receive this status, they are often referred to as 501(c)(3) organizations. Organizations receiving tax-exempt status are primarily schools, colleges, universities, religious organizations, and charitable organizations

Universal preventive interventions

Universal preventive interventions: The target population is the general public or a population that has not been identified on the basis of individual risk. In other words, these interventions are designed for everyone. Universal preventive interventions are found to have mild to strong influences on different health concerns among different populations. Examples of this type of intervention include mass media campaigns via public service announcements on TV and social skills instruction provided to all K-12 students.

Universal STRATEGIES

Universal preventive strategies are approaches designed to address risk factors in an entire population without attempting to distinguish who is at elevated risk. Examples include programs that address risk factors in broadly defined population groups

Response Bias

When the people who take the surveys have responses that are inconsistent with those who did not respond to the survey. The more the beliefs differ, the greater the bias.

Balance

Where appropriate, content presents the benefits and risks of potential actions or recognizes different and valid perspectives on the issue.

Standard Operating Procedures

Without clear, concise, culturally appropriate, and sensitive procedures, programs fail. Program procedures are written and shared in a document called standard operating procedures. As a program develops and grows so do the standard operating procedures.

Working with a creative team

Working with a Creative Team. In developing a concept, the opportunity to work with a creative team may arise. A creative team is a group of graphic artists and multimedia professionals (for example, videographers or filmmakers). • Develop a good working relationship with the team, and determine the point person. • Explain to the team the health communication strategy, including who the intended audience is and what they value. • Talk about pretesting and how all concepts and materials must be pretested. Explain that you will assist with arranging access to the intended audience for pretesting. • Ensure that the creative team understands the importance of developing culturally appropriate concepts and materials (National Cancer Institute, 2001).

Focus Groups - Primary Data

a qualitative data collection technique in which a small group of individuals meet to share their views and experiences on some topic 6-12 people, 60-90 min Keep homogeneous groups- diversity bad for honesty Number of focus groups depends on how diverse the population group is. Want to represent most people.

Mental Health

ability to deal constructively with reality, adapt to change, cope with adversity

Where Do People Get Their Health Information? NAAL

adults with below basic or basic health literacy were less likely than adults with higher health literacy to get information about health issues from written sources (newspapers, magazines, books, brochures, or the Internet) and more likely than adults with higher health literacy to get a lot of information about health issues from radio and television. Written brochures or pamphlets are often not the best way to provide people with health information, particularly those who are more likely to have low health literacy.

Advocacy during Planning

advocacy is about being a champion of a specific health concern and fighting to have it addressed. The money, time, materials, and people that support the needs assessment and program design come from the efforts of these champions.

Content Validity p.103

based on how well the questionnaire items reflect all of the content areas one is attempting to measure

Evidence Based Interventions p.132

can be conceptualized as the delivery of optimal care through integration of current best scientific evidence, clinical expertise and experience, and preferences of individuals, families, organizations, and communities. A defining characteristic of evidence-based interventions is their use of health theory (Table 3.10) in both developing the intervention content (activities, curriculum, tasks) and evaluation (measures, outcomes). 2 Key Sources developed by the government: NREPP & RTIPs

Group channels

can reach more of the intended audience while still retaining many of the positive aspects of interpersonal channels. Group channels include neighborhood groups, workplaces, churches, or clubs. The activities associated with these channels are classroom instructions, large and small group discussions, recreational and sporting events, and public meetings. As with communicating through interpersonal channels, working with groups requires significant levels of effort and can be time-consuming and expensive

Key Informant (one on one interview) - Primary Data

certain individuals possess unique and important info that can provide insights into health issues at a site Uniform interview format: specific questions created ahead of time. Must pilot test. Example p.100 Be aware: opinions and bias will be presented as facts

School Health Index Two Activities

completed by teams from school 1. 8 self-assessment modules (evaluates what's already been done and current strengths and weaknesses) 2. Plan for improvement

Accuracy

content is valid without errors of fact, interpretation or judgement

Social Health

education, poverty, crime rates

Legislative advocacy

essentially, advocating for or against bills, ordinances, and laws.

Environmental Health

external conditions that healthy growth and development

The 2003 National Assessment of Adult Literacy (NAAL)

included the first-ever national assessment of health literacy of adults in the United States, based on this definition of health literacy: "the ability to use printed and written information associated with a broad range of goals at home, in the workplace, and in the community (including healthcare settings)" Results were reported in terms of four literacy levels: below basic, basic, intermediate, and proficient.

Health theories and models

influence questions asked and info sought in the N.A.

Interventions for Target Populations

interventions need to match the specific needs of the target population

Community channels

involve working with community groups to conduct activities such as meetings, conferences, and other events to disseminate the program's message. Community channels can reach a large intended audience, may be familiar to the audience, may have influence with the audience, and can offer shared experiences. Community channels can also be time-consuming to establish. Another negative aspect is the possibility of losing control of the message if it has to be adapted to fit organizational needs. .).

Community Needs assessment

needs of individuals living in a specific geographic area

Sampling Bias p.105

occurs when sample selected in a manner that results in people being left out that have unique characteristics (race, health beliefs or behaviors, socioeconomic status) Results will be uncharacteristic of population

Sample Smoke Free Workplace policy

p. 140

Dimensions of Health

p.94 Physical Health, Mental Health, Social Health, Environmental Health, Spiritual Health

Data Collection

plays a pivotal role in assessing the quality of life of the population and establishing priorities for health promotion programs.

1st Phase of developing a health promotion program

program planning

Intermediate Outcome.

refers to results that may not be seen after a single activity but can be measured or verified at some future point.

Fiscal Year

refers to the dates of the funding year. Some grants or contracts begin on January 1 and end on December 31, so the funding cycle follows the calendar year . Other funding, particularly that associated with schools or universities, begins on July 1 and ends on June 30. Still other funds may have a start date based on the day the award was made—March 1, October 1, or any other month in the year. It can be challenging for managers to handle grants with different fiscal years.

Capacity assessment areas to be explored

relationships that support health, opportunities to promote personal health for everyone at the site, support systems for and barriers to implementation of the program.

cash flow statement.

shows how an organization's operations have affected its cash position.

income statement

shows the financial performance of an organization over a specified time period—typically a year.

balance sheet

shows what an organization owns and how it is financed.

SMART Goals p.125-127

specific, measurable, achievable, realistic, and time-bound.

Inputs p.160

the first column (Inputs), the major resources from the state public health department, along with its partners, are represented. These resources could include funding and staff from the health department's office

Grassroots Lobbying

the public is encouraged to approach legislators about a piece of legislation—for example, when members of an organization contact members of the public through a call to action that urges them to ask a government official to vote in a certain manner (Vernick, 1999).

Social Math

to help people to conceptualize problems in real terms, although it does have a somewhat sensational element. For example, instead of saying that 400,000 people will die of tobacco-related disorders each year, the fact sheet on the APHA Web site states that this is the equivalent of losing the population of a number of towns. Use a list of the populations of nearby towns to formulate a local example.

Action Objectives (or behavioral)

used to identify needed changes in the actions or behaviors of the target population. This type of objective is appropriate for impact evaluation or summative evaluation.

Outcome objectives

used to identify the long-term accomplishments of a health promotion program. Example: % of binge drinkers will decrease 10% after completion of program

Delphi Technique - primary data p.101

1. open ended questions sent to group of professionals. They respond and responses are put into a list. 2. The combined list send back to professionals for them to respond to, correct, clarify 3. Process can end here, or the new compiled list can be sent back to them for rating and ranking

DEVELOPING AND PRETESTING CONCEPTS, MESSAGES, AND MATERIALS

(See step 6 above) In communicating with the program participants, it is essential to know how the audience members view their health and what they are being asked to do (or not do). One way to understand different audiences and create programs, materials, and messages that resonate with them is to develop and pretest concepts, messages, and materials to see which ones have the most meaning for them and motivate them to take action.

Establishing priorities at a Site

- How large is discrepancy between site and state or country? -How many individuals are affected by the problem? -Which problem has greatest impact on disability or mortality? -What are leading perceived health problems of the stakeholders? MORE on Pg. 112

Developing Effective Policies and Procedures - Schools p. 145

-Be flexible and creative -Assess and respect the needs of families -Provide resources for families -Establish a family feedback loop -Give clear and consistent messages about health -Create a welcoming, culturally competent school

Analyzing Results p.109

-Descriptive data to provide baseline assessment for comparisons, writing grants, program planning, etc -Helps to compare site statistics to those of the state or nation -Hire a statistician to determine what types of in-depth data are available GIS - Geographical Information System p.111 - helps visualize health data

Advocacy Methods p.196

-Talking Points -Newspaper Editorial Pages -Letters, E-Mails, Phone Calls -PSAs -Press Conferences -Blogs -Meetings with Legislators

Building Relationships With Media

-Use the 4Ps when meeting -Thank them for good stories -Offer to help edit for accuracy -Make lists of good health reporters and make friends with them -Be aware and conscious of their deadlines

Budget Challenges

1. First, what if there's not enough money in the budget? Sometimes this happens despite careful planning. If a resource shortfall is identified during the planning phase, the program staff can search for funding or resources that will cover the additional expenses. Overspending without prior approval from the funder might result in fewer resources for the next phase of the program. Even worse, overspending might jeopardize the program's continued or future funding, the project manager's position as a program leader, or the ability of the agency to successfully seek future support from this funder. 2. Second, what if money is left over? This is a good problem to have, and it can happen for several reasons. Sometimes an expense item ends up costing less than anticipated or personnel costs are reduced through in-kind contributions of staff time from other sources. Careful monitoring of the budget on at least a monthly basis should help staff members to identify places where savings are occurring in plenty of time to make wise decisions about what to do with the extra money.

Expenses - 4 Expense Categories

1. Personnel : compensation paid to staff 2. Supplies: Items needed to implement the program 3. Services: specific skills, talent, and expertise that must be hired for short periods of time. Kitchen staff, translators, etc. 4. Travel, Training, and dissemination of results: Travel and professional development costs.

1. Review Existing Materials

1. Review Existing Materials Developing materials can be costly and time-consuming, so it is best to begin by reviewing all the materials that are currently available. There are many places to look for existing materials, including local and state health departments, professional and voluntary health associations, and federal agencies such as the Centers for Disease Prevention and Control and the National Institutes of Health. Materials produced by federal agencies are in the public domain and are free for anyone to use. To determine the relevance of materials, ask the following questions: • Are the materials appropriate for the intended audience? Are they culturally appropriate? • Are the messages consistent with the health communication plan? • Will the materials meet the communication objectives?

5 Key Advocacy Questions

1. What action—one that is feasible—will actually solve the health problem? What action needs to happen? Is it a new law, regulation, funding, service, or research initiative? The action needs to be compelling in order to get people interested in working for it. It also needs to be small enough that the program can achieve at least part of the action within a year or two, to keep people interested. Whatever the action, state it clearly and succinctly. Often such a statement is thought of as a program action (or behavioral) objective (discussed in Chapter Five) which directs and shapes a program's advocacy. It would be titled the advocacy action objective. 2. Who needs to take action? Who actually has the authority to make the change? For example, can a mayor, city council, or state or federal agency or legislature effect the desired change? Who needs to be wooed because they can influence those with authority? For example, can members of the media or specific citizen groups help advance the cause? 3. What does your audience need to hear? What advocacy message will move all those people to make the change? An effective advocacy message has two parts: an appeal on the merits ("This bill is important because . . . ") and an appeal to self-interest ("Hundreds of voters want to know how you'll vote on . . . "). 4. Whom does your audience need to hear the message from? What messengers can be recruited, and who will be most persuasive? An advocacy campaign needs a mix of messengers—people who can speak from personal experience, people with recognized authority, and others who might have some special pull with the people you are trying to reach. 5. What actions will you use to make your point? What will people be asked to do to deliver the message? The options are many: people can be asked to lobby officials politely or protest in front of their offices, get an article in the newspaper, or attend a town meeting. Generally, the best actions to advocate are those that require the least effort and confrontation but still get the job done.

Attributes of Effective Health Communication

Listed below and on p.206

Letter To The Editor

A letter written by an individual citizen to a newspaper editor as a means of sharing his or her opinion and inspiring others to take positive action on an issue of concern. Political leaders and other policymakers rely on editorials in newspapers and blogs to gauge the views of their constituents. The philanthropic actions of community health organizations are often inspired by issues facing the community that were initially brought to the public's attention through letters to the editor. Also see Op-Ed

Ordinance

A statute or regulation, usually enacted by a city government

Validity

A survey that correctly measures what you want it to measure. The higher the validity, the more complex the assessment.

Audience segmentation

Audience segmentation is the division of priority populations into subgroups that share similar qualities or characteristics (Thackeray & Brown, 2005). Populations can be divided into segments according to multiple factors, including geography, demographics, psychographic traits (for example, attitudes, beliefs, self-efficacy), behaviors, and readiness to change The goal is to segment the intended population on characteristics that are relevant to the health behavior to be changed and to organize the program's efforts around these groups of similar individuals

Program Material Criteria

Availability. The availability of the material, in terms of quantity and time frame, should be considered in the planning stage. Reading level. The reading level of a piece of writing indicates how easy it is to read by assigning it a school grade level. The reading level often determines whether the intervention material is acceptable for the intended participants. Low reading literacy in the American general population has become a challenge in developing health promotion materials. Production quality and suitability. To address the overall suitability of materials use SAM

5. Develop Partnerships p.217

Employing other organizations as partners is a useful and cost-effective method to broaden the reach of a program. Maibach, Van Duyn, & Bloodgood, (2006) explain that partners can serve as a "powerful and sustainable distribution channel." The foundation of the partnership approach is the value of collaboration between organizations that share common interests and reach diverse audiences in order to achieve outcomes that neither could achieve alone (Hasnain-Wynia, Margolina, & Bazzoli, 2001). Many organizations work with partners or intermediaries in order to reach their intended audience. In addition, partnerships can • Provide more credibility for a program's message because the partner organization might be considered a trusted source for the intended audience. • Increase the number of messages the program can share with the intended audience. • Provide additional resources. • Expand support for an organization's high-priority activities (National Cancer Institute, 2001).

Goals Vs Objectives

Goals provide an overview of the desired outcomes at the end of the program, while objectives provide specific and clear steps (tasks) that need to be achieved in order to attain the goal (or goals) of the program. Each goal may have several tasks (objectives) that need to be completed in order to achieve it. Different types of objective statements are used, depending on the needs of the program.

Health promotion and positive development STRATEGIES

Health promotion and positive development strategies target an entire population with the goal of enhancing strengths in order to reduce the risk of later problem outcomes or to increase prospects for positive development. Examples include programs that focus on building personal and social skills through teacher, parent, and youth training and development of individualized action plans to improve fitness levels after receiving the results of a fitness screening test.

Chapter 6 Implementation

Implementation Tools, Program Staff, and Budgets

Communication Planning Phase

In the planning phases, needs assessment reports and ways of sharing program decisions about mission, goals, objectives, interventions, policies, and procedures shape people's perceptions of a program before it even starts.

7. Implement The Communication Plan p.217

In this step, communication activities are integrated into the overall implementation of the health promotion program. At this time, it is important to ensure that all materials and communications that program stakeholders and participants receive are consistent with their health literacy. Likewise, it is important that all channels of communication be accessible, supported, and utilized. For example, if cell phone technology such as text messaging is to be used, all program participants need to have a cell phone or access to a cell phone and know how to receive and send text messages.

Indicated preventive

Indicated preventive strategies are approaches aimed at individuals who have significant symptoms of a disorder but do not meet diagnostic criteria. An example of an indicated preventive strategy is a home-based and school-based intervention that focuses on disruptive boys in kindergarten. •

NAAL Literacy Level Intermediate 53%

Intermediate means that the person has the skills necessary to perform moderately challenging health literacy activities Findings indicated that the majority of adults (53 percent) had intermediate health literacy, meaning that they could do things like determine the healthy weight range for a person of a specific height on a body mass index chart or determine the times when it would be correct for a person to take a prescribed medication after reading the label.

Planning Program Interventions 127

Interventions must facilitate attainment of each goal and objective. Should be culturally appropriate and based on theories and models. Identifying the interventions explains how you intend to achieve the objective

Common Implementation Challenges

Lack of attention to details is hampering execution of the program. Attention to the details at the start of a program's operation is necessary and important. The realities of actual program operations are more difficult than program planners anticipated. Rarely do programs function as planned, at least initially. Staff and stakeholders do not follow the action plan or Gantt chart as closely as they should. Staff and stakeholders often need to make decisions as the program is developing, particularly in response to participants' needs. Conflicts occur. Conflict and struggles are natural parts of program implementation. Each staff member and stakeholder will have his or her own work style, priorities, and level of commitment. Unanticipated staff turnover leaves vacancies in positions that are critical to accomplishing the plan. Hiring, training, and retaining staff is an integral part of program implementation Crisis occurs in the organization or community, and the program has to be put on hold. Despite the best planning, events sometimes require staff or participants to focus their efforts in another area for short or long periods of time. The timeline is unrealistic. This also happens. The process of moving from an action plan to a Gantt chart timeline helps identify whether this might be the case as all the necessary activities are placed on one calendar. . Staff members are unhappy with their job. Unhappy staff members typically do not perform to their capabilities and contribute to turbulent work environments. Staff members are challenged by working in teams. Working in teams has become a common approach to implementing health promotion programs.

Example of Good Partnership

Many effective public health advocacy campaigns are collaborations between national, state, and local partners. A good example of such a campaign began in 1991 when public health practitioners were encouraged to advocate for policy change as part of the National Cancer Institute's American Stop Smoking Intervention Study for Cancer Prevention (ASSIST) (National Cancer Institute, 2005). ASSIST was a demonstration project designed to bring public and private partners together to advocate for policies to prevent tobacco use and for tobacco control policies. On the national level, ASSIST was a joint effort of the National Cancer Institute (NCI) and the American Cancer Society (ACS). Both organizations had a common goal: to prevent cancer. NCI contracted with seventeen state health departments (SHDs) to hire staff and fund interventions, including advocating for policies that had shown promise in reducing and preventing tobacco use. ACS committed resources (time, dollars, and staff) to ASSIST at national, state, and local levels.

Needs Assessment Limitations

Money, time, personnel, political restraints

Population Health measured by:

Morbidity, Mortality, office visits to doctors, hospitalizations

Survey Questionnaires - primary data p.102-103

Most common form of gathering data for needs assessment. - written question surveys. 4 Ways to Administer: mail, telephone, f2f, electronic Anonymous surveys get better responses Must be valid and reliable

Very long-term outcome p.161

Most health promotion programs are designed to achieve a very long-term outcome that is health- or disease-related. very long-term outcomes that are envisioned are the program's goals.

Outcomes

Moving from what is planned to what is hoped will happen, we arrive at the three Outcomes columns on the right side of the logic model.

5. Pretest Messages and Materials

Much like pretesting concepts, it is necessary to pretest draft materials with the intended audience. Some people believe they can skip this step because they have tested the concept and have had professionals review the health content, so to expedite the process, they go from draft material to final production with no review or input from the intended audience. This is a big mistake because one never knows what detail in a finished piece might be problematic to the target audience. In the long run, this round of pretesting will save valuable time and money. Many health education professionals can recall a close call when they were about to skip this step but decided at the last minute to test with the intended audience and found out that they would have had a major flaw in the final material had they not tested the draft first. Testing draft materials is not a step to skip.

NREPP

National Registry of Evidence-Based Programs and Practices (NREPP), which was developed and is maintained by the Substance Abuse and Mental Health Services Administration (SAMHSA) in the U.S. Department of Health and Human Services. searchable database of interventions for the prevention and treatment of mental and substance use disorders (Figure 5.1). NREPP uses a voluntary, self-nominating system in which intervention developers elect to participate. There will always be some interventions that are not submitted to NREPP, and not all that are submitted are reviewed. Nevertheless, new intervention summaries are continually being added to the site. The registry is expected to grow to a large number of interventions over time.

Legalities of Health Advocacy and Restrictions

No restrictions: A piece is not written either for or against the ordinance; instead, the piece advocates for healthy and safe practices. There are no restrictions on this type of advocacy behavior. 501(C)(3): Banned from electioneering. Electioneering is defined as any attempt to persuade voters in a political campaign. Employees can only spend a certain percentage of time lobbying. This regulation covers all houses of worship in America. Thus the law is clear that tax-exempt institutions cannot engage in electioneering; however, their ability to legally participate in lobbying is a little less clear. Government Employees : Government employees must be exceedingly careful about advocacy work because of the need for employees of the government to avoid any appearance of bias.

Public Service Announcement PSA

Noncommercial advertisements broadcast on radio or television in the public interest. PSAs are intended to modify public attitudes by raising awareness about specific issues. The most common topics of PSAs are health and safety. A typical PSA is part of a public awareness campaign to inform or educate the public about an issue such as smoking or compulsive gambling.

Transitioning to Program Implementation - Six Stages

Not overnight, sometimes takes years 1. Exploration and adoption- achieve acceptance and support 2.Program installation - structural supports necessary for the program 3. Initial Implementation- operating a program for the first time with the target population 4. Full Operation -occurs when a program is operating with full staffing complements and full client loads, and all of the realities of doing business are impinging on the newly implemented program. 5. Innovation - happens over time as staff, stakeholders, and participants learn what works with a target population in a particular setting. 6. Sustainability is about long-term program operation. Skilled practitioners and other well-trained staff leave and must be replaced with other skilled practitioners and well-trained staff.

Developing effective policy and procedures

Policies are the backbone of a health promotion program Effective Policies: Clearly state the health values and priorities of the organization and are tailored to the unique requirements and needs of the setting and stakeholders Procedures: Are drawn from the policies and address program logistics and day to day operating details such as recruitment, retention, and precognition of program participants.

Mass Media campaigns

are a tried-and-true approach that has been used to spotlight many health promotion topics (National Cancer Institute, 2001). Mass media channels include but are not limited to newspapers, magazines, newsletters, radio, and television (Glanz, Rimer, & Lewis, 2002). These channels offer many opportunities for dissemination of a program's message

Interactive media

are communication technologies that can be used to reach multiple audiences. These technologies extend both the reach and depth of mass media (Glanz, Rimer, & Lewis, 2002). They include interactive CD-ROMs, webinars, online courses, electronic bulletin boards, newsgroups, chat rooms, blogs, e-mail, text messages, Listservs, podcasts, online videos and social networking sites (for example, Facebook and Twitter). The types of channels in this category are constantly changing and evolving VERB example in graphic

Meeting with Legislators

Preparation: Preparation for meetings with legislators should be as thorough as preparation for a job interview Prepare a set of talking points to inform your conversation. Prioritization: talking points should be prioritized. Change the order of the discussion of the talking points depending on the elected official. The prioritization of talking points in a meeting may be informed by viewing the voting record of the elected official. Punctuality: First, be punctual. Arrive early and check in with the assistant. Use this punctuality principle during the meeting. Stay on task; don't overstay your welcome; and be certain to use time to your advantage in advancing your goal. If you are asking for increased funding for school health programs, don't waste time complaining about the potholes in the roads. Politeness: An air of politeness should underlie all proceedings of the day. Citizens do pay the salaries of elected officials, but that does not mean that employees should be treated rudely. Don't react in a rude manner if the official does not respond in the desired manner.

Plain Language p.210

Presenting information in plain language (or plain English) is an integral component of improving health literacy. Plain language has many definitions, but it is fundamentally defined as communication that the audience can understand the first time they read or hear it. Written material in plain language means that the members of an audience can • Find what they need • Understand what they find • Use what they find to meet their needs the essence of plain language is a focus on the audience, clarity, and comprehension. Using clear and concrete words in a straightforward manner is the best way to organize information, particularly health content.

Using Pretesting To Its Fullest

Pretesting is one way to ensure that the intended audience will understand the materials developed and act on their message. the intended audience to accomplish the following: • Assess comprehensibility—Does the intended audience understand the message? • Identify strong and weak points—What parts of the materials are doing their job best—for example, attract attention, inform, or motivate to act? What parts are not doing their job? • Determine personal relevance—Does the intended audience identify with the materials? • Gauge confusing, sensitive, or controversial elements—Does the treatment of particular topics make the intended audience uncomfortable?

Monitoring the Budget p.174

Program resources and expenses can be monitored with simple spreadsheet software such as Microsoft Excel or Apple's Numbers. It is very important to monitor the budget on a regular basis in order to make sure that expenses and income are within the projected range The program director is responsible for making sure that the allocated funds are spent by the end of the time periods designated by the funder.

Needs Assessment Program Sites

Rather than geography N.A. can be conducted in schools, workplaces, health care organizations, or communities.

Resources

Some health promotion programs have fixed incomes. They are funded at a certain level to implement a set of activities over a given period of time. In the case of multiple-year funding, annual reports that show how the resources for one year have been used may be required before funds are released for the next year. Careful spending of resources according to the approved categories and within the approved limits makes this kind of fiscal management relatively easy. In contrast, some health promotion program budgets are based on variable factors, such as the number of people who enroll, the number of clients who complete a series of program activities, matching funds, revenue from services, fundraising, or in-kind contributions from other sources.

Local Advocacy

Some policy advocacy results in changes at state and local levels. Tip O'Neill, former Speaker of the U.S. House of Representatives, has been credited with stating, "All politics is local." That is also true for many types of health policy, as one can see in the wide variance, for example, in ordinances that restrict the purchase of guns in municipalities, designate speed limits in states, direct alcohol sales, and ensure swimming pool safety.

Basic Elements of Effective Policy 142-143

Statement of Purpose -Background -Goals Definitions, Expectations and Prohibitions Implementation Approaches -dissemination strategies - Benefits and assurances -Consequences and appeals

Interpersonal channels

are more likely to be trusted and put the message into a personal context. These channels include physicians and other health professionals, friends, family, and counselors. Examples of activities or methods for delivering the message within interpersonal channels are one-on-one counseling, telephone hotlines, informal discussions, and personal coaching and instruction. Interpersonal channels are the most effective for teaching and can be very influential, but they can also be time-consuming and expensive to use and can have a limited reach.

To Determine if NREPP or RTIPPs are appropriate for you: p.136

The array of settings in which the intervention might be based should be considered when deciding which evidence-based interventions would be most appropriate to address specific goals. Coverage across the range of populations or settings involved in a health concern. Many of the most prevalent and significant risks and issues pertaining to specific health problems can now be identified through published empirical data, but significant gaps in coverage still remain, both in terms of information and appropriate interventions. Knowledge of what populations interventions will be effective for—and under what conditions. For each intervention that works, you need to know as much as possible about the population within which benefits accrue. You need to know in what settings an intervention works. Role of race, ethnicity, and culture. Factors of race, ethnicity, and culture—for example, norms, beliefs, and values derived from their respective cultures—influence the target population and program site. An effective intervention must be compatible with relevant norms, beliefs, and values or must incorporate the ability to understand, respect, and work with differences. Staff creativity, experience, and clinical expertise. Evidence-based interventions have explicit protocols described in intervention manuals that may provide essential principles and guidelines but still allow considerable flexibility and use of staff's creativity, experience, and clinical expertise in the effort to achieve desired intervention outcomes.

Secondary Data

already exists. collected by someone else for different purpose. may or may not be from the population being assessed. Example: Healthy People Data, vital records, census data, and journals. Potential Problems: data may not exist for some settings, data may be old, data not correctly collected

Mental Illness

alterations in thinking, mood or behavior that impair relationships with others and environment Not opposite from physical health but exist along continuum of impairment 20% mentally ill