phlt 410 exam 2 (developing the implementation plan)

ethics: the golden rule

"Do unto others as you would have them do unto you." Most public health organizations, but particularly those run by charitable organizations, put "caring" for individuals and their rights and feelings at the top of their core values.

SWOTE: final strategy analysis ethics

How can the program/organization be fair and conduct the intervention in the most ethical manner possible? --What are the bases of these decisions? What needs to be changed, if anything, in order to prioritize human rights, gender equity, or other ethical issues over short-term programmatic gains?

logic model outcomes immediate outcome measures

assessed through surveys Mass media immediate outcome measure (Next-day recall of message, Awareness of issue, Change in attitude or motivation to try something)

logic model outcomes intermediate outcome measures

changes in indvl behaviors due to: enactment of policies, uptake of technology, strategies by organizations

Kellogg logic model sequence of components purpose

define planned work and intended results

Logic Model: Activities Outreach and education activities

health fairs, speaking engagements, trade shows, or grocery store or drugstore promotional activities

Logic Model: Activities training workshops

healthcare providers, teachers, coaches, or clergy to use media effectively

Logic Model Outcomes

immediate, intermediate, and long-term outcomes --> results in change in knowledge, beliefs, intentions, behavior

logic model outcomes long-term vs impact

long-term refers more to individuals (an individual quits smoking and his life is extended) Impact refers to population (the death rate from tobacco goes down)

Logic Model: Activities mass media spots

paid advertising, public service announcements, entertainment education events (plays, television program scripts, radio soap operas), blogs, etc.

go back to slides 57-60

problem stmt, goal, objectives, inputs, partners, outputs, short term outcomes, intermediate outcomes, long term outcomes

Logic model: Resources

tangible (money, paid staff/ volunteer hours, facilities, equipment) less tangible (expertise, involvement of collaborators at the local/state/ntl/global level)

ethics: Deontological (duty-based) principles

"Stick to the principles, and the outcomes will take care of themselves." ex- A public health program that requires participants to demonstrate economic or nutritional need; uses rules — and not privilege (or bribery)—to distribute resources

ethics: other rights and privileges from the DOI

"We hold these truths to be self-evident, that all men are created equal, that they are endowed by their Creator with certain unalienable" rights, that among these are Life, Liberty and the pursuit of Happiness." Just how far an individual's right to liberty in the pursuit of happiness extends is subject to debate

ethics: utalitarianism

"the greatest good for the greatest number of people" or "the end justifies the means" ex: quarantine and travel restrictions for infectious outbreaks. the rights of a few are restricted to protect the health of the many

summary implementation plan key points

- background and justification, including SWOTE analysis - intended audiences - communication objectives by audience - messages - settings and channels for conveying your messages - activities (media, materials, other methods) - available partners and resources - tasks and timeline - budget

Kellogg logic model sequence of components

-planned work (resources/inputs, activities) -intended results (outputs --> outcomes and impact)

Logic Model: Impact

Generally measured in terms of population-level health or socioeconomic improvements Reflected in reductions in: Mortality rates and Prevalence of disease

What happened to the cdc optimal nutrition project?

The optimal nutrition project was never fully implemented due to insufficient funds and a scientific disagreement concerning promotion of multivitamins—and not just folic acid alone Example of an internal "weakness" in a program, in addition to the external "threat."

kellogg defn of logic model

a picture of how your organization does its work—the theory and assumptions underlying the program

Logic Model: Activities Patient/Individual decision aids

computer animations, brochures, decision software, pencil and paper flipbooks, kits, or worksheets.

What happened to the cdc optimal nutrition project? threats

issue/product -A seemingly "apple pie" issue such as preventing birth defects is caught up in two politically sensitive areas: Unplanned, and often, premarital sexual activity & Elective termination of pregnancies that are diagnosed with neural tube defects. -It was imperative that the collaborating partners found ways to discuss the issues without suggesting that either of these activities were recommended -Obstetricians had been advising patients to begin taking folic acid when they confirmed pregnancy. Changing this message around was more difficult than promoting a new behavior. organizational -National health communication campaigns dependent on partnerships are difficult to navigate. Implementation is completely dependent upon partners. - Healthcare providers have less time during their patient visits to discuss many important health issues, including folic acid.

logic model outcomes long-term

may be identical to impact permanent changes in health behavior, statutes and laws, or changes in environmental quality

logic model visual (process)

(your planned work) 1. resources/inputs 2. activities (your intended results) 3. outputs 4. outcomes 5. impact

implementation plan: budget

- If you want a good result, you will need to trade off time for money--Do you have more time or money? - Out-of-pocket expenses drive up costs (ex- video and sound production, printing services, and paid placement, etc) - personnel salaries for anyone with expertise that you cannot acquire for "free" (Consultants/Experts can be extremely expensive)

What happened to the cdc optimal nutrition project? Ethics

- Women who had babies born with spina bifida and anencephaly (These women might feel guilty learning there was something that might have prevented this) - The women who were currently pregnant and hadn't taken folic acid prior to conception (Might be worried about their pregnancy) - Fetuses with severe NTD often expire in utero & Some are born in a condition that is not viable for more than a few hours or days (abortion issue) - While physicians may advise parents to terminate such a pregnancy prior to delivery, the CDC was silent on this issue. (The goal of the campaign was to prevent neural tube defects, not to prevent the birth of the babies who have those defects) - Many children who have spina bifida receive sufficient surgery and therapy that they can overcome their disabilities and live fulfilling lives. (Again, the campaign did not want to suggest that these children weren't wanted or loved.)

implementation plan cycle

--> identification of the dissemination and communication activities --> identification of communication objectives --> identification of target groups --> determination of the info to be provided (the message) -->

Ethical Considerations

-Avoid doing harm through the actions of trying to help -Doing utmost to better health of the intended population -Have respect for the freedom of every person and community

SWOTE: final strategy analysis

-Best done with partners and stakeholders -Comparing strengths and opportunities against the weaknesses and threats, make a "go/no-go" decision -Need to think about the SWOTE in terms of when and how it might affect the process described in the logical framework

What happened to the cdc optimal nutrition project? weaknesses

-The message that all women should consume folic acid daily if capable of becoming pregnant posed many challenges in terms of attracting the attention of the target audience and convincing them to change behavior. -considered an additional expense, or time burden -Many foods that contained some folate, such as orange juice or leafy greens, were thought to be adequate dietary sources for folic acid -At the outset (1996 or so), fortified foods, such as bread, contained too little folic acid to provide the correct dose if a normal serving were consumed. -limited funding -Federal authorities, such as the USDA, FDA, and CDC, could not agree on the correct level of fortification in order to protect all women and prevent any potential harm -African American women, in particular, were less susceptible to NTDs and more susceptible to B12 deficiency -changing policy is a slow process - The CDC and all other federal agencies or organizations that receive federal funding are prohibited from lobbying Congress. -Seeking more federal resources for the program, especially funding, was difficult

What happened to the cdc optimal nutrition project? strengths

-issue or product (birth defects/neural tube defects was a tragic event that any org would support eradicating; strong scientific data supporting folic acid to prevent; folic was readily available as an inexpensive supplement; multivitamin consumption is a simple behavior and easy to discuss) -organizational (numerous scientists, physicians, and program managers who were committed to the issue; evaluation data available that indicated the need to focus on women's beliefs about the benefits and barriers of consuming enough folic acid; cdc had capacity and financial resources to do the audience research; cdc funding available to translate research findings into draft and final health messages)

key planning tools to manage an intervention

-logic model -SWOTE -operational plan (w timeline, budget, and assignment of responsibility)

Swote - Two ways to consider weaknesses

1. Gaps within the organization includes a lack of: knowledge, skills, experience, or material resources 2. Weaknesses of the actual intervention: delayed or limited availability, costs to produce (if more than the market price to sell), distribution hurdles, or the service is unattractive to consumers in some way (ex- having to promote a stool blood test or colonoscopy for colon cancer screening) - Weaknesses may also be less tangible, such as: a lack of leader commitment to the intervention; a non-existent or poor reputation;Insufficient funding; a rushed timeline

PRODUCTION AND DISSEMINATION FACTORS - criteria

1. Preventability How many people toss the photocopied brochure in the trash limited reading or without reading it? Best method to reaching multiple audiences with higher-quality media is to work with partners and share the expenses 2. Expandability (Scalability) mass media are used to expand the scope of an intervention; work with partners and share the expenses 3. Sustainability Can the program be sustained over time? worked into a longer-term schedule of public relations, partner counseling, or other ways of carrying the message beyond the time and place 4. Cost-effectiveness Public health interventions tend to have very limited budgets, certainly compared to competing commercial campaigns So little money is spent on sustaining health communication interventions that it is almost pointless to assess their cost effectiveness

Swote - Two ways to consider strengths

1. Strengths as the attributes within the organization (personnel capabilities, experiences, material resources, organizational commitment, time allotted, and budget) 2. Strengths as the attributes of the intervention/communication campaign (positioning of a product or service, its cost, and its attractiveness or reputation)

Reading a Logic Model

1. resources/inputs- certain resources are needed to operate your program 2. activities- if you have access to them, then you can use them to accomplish your planned activities 3. outputs- if you accomplish your activities, then you will hopefully deliver the amt of product/service that you intended 4. outcomes- if you accomplish your activities to the extent you intended, then your participants will benefit in certain ways 5. impact- if these benefits to participants are achieved, then certain changes in orgs, communities, or systems might be expected to occur

ethics defn

A system of moral principles. They affect how people make decisions and lead their lives. It is concerned with what is good for individuals and society and is also described as moral philosophy.

SWOTE threats

Factors that could delay or prevent achieving your program objectives and may include: Political instability; Environmental catastrophe; Activity linked to risky funding, or dependent on personalities

What happened to the cdc optimal nutrition project? opportunities

Issue or Product -The private sector quickly got the message and began fortifying foods or putting labels on foods that highlighted folic acid levels. -Healthcare providers were already educating their patients about better health and pregnancy outcomes. Folic acid supplements and information were relatively inexpensive and easy to provide. -Taking vitamins had become "trendy" as part of a fitness-, sports-, appearance-, or health-related lifestyle. organizational -several long-established and highly reputable organizations involved in the fight against birth defects -They were very willing to contribute to the campaign by providing research, data, access to target populations, and mechanisms for distribution and dissemination. -They also were able to discuss the issue with their congressional representatives in their home states as well as provide and sponsor congressional briefings on the issue. -Campaign partners agreed to disseminate messages and materials through their own channels and at their own cost

Logic Model: Activities

Mass media spots, Patient/Individual decision aids, Training workshops, Outreach and education activities

implementation plan: timeline

Most larger-scale communication programs take one year to plan and produce - Conducting formative research, developing and testing materials, and readying everything for dissemination - Most people need time to progress through readiness stages - Months to year of exposure before preliminary evaluation

SWOTE opportunities

Opportunities are positive factors related to time and place include: A favorable political climate; Funding; Technology development and innovation; Seasonal, entertainment, and style trends; Big events that draw a lot of attention; Celebrity endorsements

implementation plan: budget direct costs

Part of the budget that contributes directly to a program's outputs - Personnel costs (salary, fringe) - Out-of-pocket/non-personnel costs (equipment, supplies, travel, patient care costs, etc)

implementation plan: defining partner roles

Partners usually are: -Eager to participate (for resources and standing, while making small investment of their own resources) -Tricky to work each stakeholder's objectives into a unified plan to support program needs -Best programs include several key organizations, transferring resources to smaller entities, building level of sustainability -Most strategic way to plan an intervention: Allow organizations to contribute based on strengths

SWOTE: final strategy analysis strengths and weaknesses

These items are most likely to affect the program's "inputs." -Is the program based on the organizational strengths and those of the intervention? -- If not, how can these strengths featured more prominently in the intervention? How can the program fix each weakness? -Do the strengths and weaknesses of the partners balance each other out?--This can be a critical question when deciding on partner arrangements. -Is the proposed program too far away from the core business of the organization? -- (If the mission of the university is to educate students, may you conduct a health communication campaign in the community?) - Do you need to rethink the program before too much is invested?

SWOTE: final strategy analysis Opportunities and threats

These tend to affect achievement of outputs as planned, or outcomes - How can the program exploit each opportunity? -- What must be changed in order to exploit an opportunity? What does it maximize: achievement of outputs or outcomes? Do you need to build additional alliances to take advantage of an opportunity? -How can the program defend against each threat? -- How realistic are the threats, and how great a risk do they pose? At what point do you need to account for the threats: between inputs and outputs or between outputs and outcomes? - Do you need to make additional alliances to defend against these threats?

implementation plan: budget in-kind contributions

Time, space, use of equipment, and other in-house resources Not factored into the direct or indirect costs of the budget Some donors expect to see a match of their investment through direct financial, in-kind resources or additional donations

SWOTE analysis

Tool to assess Strengths, Weaknesses, Opportunities, and Threats, "E" added for ethical assessment -Strengths and Weaknesses: refer to conditions that are within your control - Opportunities and Threats: are outside of your control -Ethical considerations: may reside inside your organization; Assess if program could harm, limit rights, or not deliver as promised best conducted w partners/stakeholders

implementation plan: budget total budget

Total Budget is the sum of direct and indirect costs, including in-kind contributions and additional donations Annual budget and budget for total time period In addition to spreadsheet, often need a budget narrative

implementation plan: budget indirect costs

What it costs an agency to exist, but not tied directly to creating the program's outputs (Office space and utilities, environmental management, depreciation on equipment, housekeeping, building improvements, compliance) Usually calculated as a percentage of direct costs

summary implementation plan

Your plan guides the program and is shown to potential collaborators/donors, but does not go into details. Should include key points

SWOT analysis

[helpful] [hurtful] [internal] S W [external] O T

Logic Model: Outputs

measure whether activities were delivered as planned for mass media ("page views", downloads), patients (# health facilities, practices, providers have agreed to use decision aids), outreach (# public appearances, engagements, health fairs)