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HLSC 3643 Community Health Planning and Promotion. University of Arkansas Dr. Jones. Overview of Health Planning Models. Purpose of Notes. To provide students with: Overview of planning models Describe common caveats Describe research on impact Strategies to overcome barriers of models.

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purpose of notes
Purpose of Notes
  • To provide students with:
    • Overview of planning models
    • Describe common caveats
    • Describe research on impact
    • Strategies to overcome barriers of models
  • Discuss the importance of planning relevant, practical programs for social change
  • Explain types of planning models
  • Explain the planning process
  • Discuss concerns and issues
health programs
Health Programs
  • Health programs are are a set of planned and organized activities carried out over time to accompish specific health-related goals and objectives
overview of planning
Overview of Planning
  • Planning for programs has various approaches:
    • “Hit the ground running” approach
    • “Purpose-driven” approach
    • “Process-oriented” approach
    • “Model-driven” approach
planning models
Planning Models
  • PRECEDE-PROCEED (Green and Kreuter)
  • PATCH (CDC, 1985)
  • MATCH (Simons-Morton, D., Simons-Morton, B., Parcel, & Bunker, 1988)
  • Generalized Model for Program Planning (McKenzie and Smeltzer, 2001)
  • CDCynergy (CDC, 1998)
precede proceed
  • 9 Phases
  • 5 Phases are diagnostic – PRECEDE
  • 4 Phases are evaluative – PROCEED
  • 1st Phase: Social Diagnosis
  • 2nd Phase: Epidemiological Diagnosis
  • 3rd Phase: Behavioral/Environmental
  • 4th Phase: Educational/Ecological
  • 5th Phase: Administrative/Policy
  • 6th Phase: Implementation
  • 7th Phase: Process Evaluation
  • 8th Phase: Impact Evaluation
  • 9th Phase: Outcome Evaluation
  • Planned
  • Approach
  • Toward
  • Community
  • Health
  • Phase I: Mobilizing the community
  • Phase II: Collecting and organizing data
  • Phase III: Choosing priorities
  • Phase IV: Developing a comprehensive intervention plan
  • Phase V: Evaluating PATCH
  • Multilevel
  • Approach
  • Toward
  • Community
  • Health
  • Phase 1: Goal Setting
  • Phase 2: Intervention Planning
  • Phase 3: Program Development
  • Phase 4: Implementation Preparations
  • Phase 5: Evaluation
generalizing model for program planning
Generalizing Model for Program Planning
  • Assessing Needs
  • Identifying the Problems
  • Setting Goals and Objectives
  • Developing and Intervention
  • Implementing the Intervention
  • Evaluating the Results
  • Phase 1: Problem definition and description
  • Phase 2: Problem analysis
  • Phase 3: Communication program planning
  • Phase 4: Program and evaluation development
  • Phase 5: Program implementation and management
  • Phase 6: Feedback
  • A computer-based planning program
  • Enabling methods of planning and organizing within everyone’s reach.
common components
Common Components
  • Most of the models have these in common:
    • Asking “why” instead of “how”
    • Gathering data
    • Identifying goals/objectives
    • Strategy/intervention selection
    • Implementation
    • Evaluation
    • Follow-up/Feedback
so many models but do they work
So many models…But do they work?
  • Is a model suppose to work?
  • Or is it just to allow for a structured process in organizing programs?
  • What evidence is there to support the use of a model over the other?
does using a model help
Does Using a Model Help?
  • Advantages
  • Caveats
  • Challenges
  • Provides direction
  • Non-biased approach
  • Uncovers hidden problems
  • Provides evaluation measures
  • Ability to use theories within model
  • Takes time and resources before implementation
  • Create problems for un-experienced program planners
  • Difficult to determine where theories fit
  • May never implement program
  • Evaluation is never ending
  • Learning before doing
  • Patience
  • Understanding theory/model
  • Finding the data
  • Letting go
do planning models work
Do Planning Models Work?
  • How effective are planning models if used correctly in the success of a program or project activity?
research on effect
Research on Effect
  • Some models are new and don’t have effectiveness data.
  • PRECEDE-PROCEED has most use
  • Results…
some evidence
Some Evidence!
  • Reduces AIDS risk
  • Reduces weight
  • Builds coalitions/partnerships
  • Use planning models over other approaches
  • Using one or two parts of a model can still help
  • Use theories with conjunction with a planning model
case studies
Case Studies
  • For each case study, provide the following:
    • What should be the first step?
    • How would you provide the rationale?
    • Methods used to determine impact.
    • Should the program be implemented?
    • What should be the focus of evaluation efforts?
case study 1
Case Study 1
  • A plastic surgeon has observed many children needing reconstructive surgery due to lawnmowers. The surgeon asked for support to do a program on lawnmower safety to parents in the tri-county areas. You are the head of a foundation that supports research efforts and program in the region and your organization has a board of directors.
case study 2
Case Study 2
  • The student services director of a small urban college is concerned about the attrition of first years students. The director makes a bold move to start a program that seeks to retain students through offering incentives for second and third year students. You are a faculty member of the student services board. What would be your comments?
case study 3
Case Study 3
  • A local non-profit agency that offers assistance to the homeless is establishing a new program that will help the homeless find work. It is seeking financial support from local business to provide immediate housing for homeless people who find employment. What would be some problems and how could planning help?
  • Insert from other ppt.
social assessment guidelines
Social Assessment Guidelines
  • Engage community members as active partners in social diagnosis.
  • Identify ultimate values and subjective concerns with quality of life or conditions of living in the population.
  • Verify and clarify these subjective concerns either through existing data sources or new data from surveys or interviews.
social assessment guidelines36
Social Assessment Guidelines
  • Demonstrate how social concerns and ultimate values can serve to heighten awareness of and motivation to act on health problems.
  • Assess the capacities and assets of a community.
  • Make explicit the rationale for the selection of priority items.
  • Use the documentation and rationale from social assessment as one of the variables on which to evaluate the program.
types of social assessment
Types of Social Assessment
  • Qualitative vs. Quantitative
    • Qualitative = quality, low numbers, lots of information, open ended questions
      • Examples: interviews, focus groups, nominal group process
    • Quantitative = lots of numbers, limited information, closed ended questions.
      • Examples: surveys by telephone, mail, or self administered.
qualitative research methods
Qualitative Research Methods
  • Focus Groups
  • Nominal Groups
  • Community Forum
  • Observation
  • Depth Interviews
  • Projective Techniques
focus groups
Focus Groups
  • Group interviews where a moderator guides the interview while the group discusses the topics that are asked.
steps in focus group process
Steps in Focus Group Process
  • Step 1: Prepare for the Group
    • Select a focus group facility
    • Recruit the participants
  • Step 2: Select a Moderator
    • Create a discussion guide for moderator
  • Step 3: Conduct the Group
  • Step 4: Prepare the Focus Group Report
qualitative research methods41
Qualitative Research Methods
  • Nominal Groups
    • Using groups of five to 10 people who have knowledge of issues under consideration.
  • Community Forums
    • Identify needs of a community through public meetings
  • Observations
    • Observing target audience for visual and auditory cues which may provide understanding of issues being investigated.
qualitative research methods42
Qualitative Research Methods
  • Depth Interview
    • One-on-one interviews that probe and gain detailed answers to questions that try to uncover hidden motivations
  • Projective Techniques
    • Trying to tap respondents’ deepest feelings by having them “project” those feeling into an unstructured activity or situation.
priorities of health programs
Priorities of Health Programs
  • Which problem has the greatest impact in terms of death, disease, days lost from work rehabilitation costs, disability, etc.
  • Are certain subpopulations, such as children, mothers, ethnic minorities, refugees, indigenous populations at special risk?
  • Which problems are most susceptive to intervention?
priorities for health programs
Priorities for Health Programs
  • Which problem is not being addressed by other agencies in the community?
  • Which problem, when appropriately addressed, has the greatest potential for an attractive yield?
  • Are any of the health problems highly ranked as a regional or national priority?
epidemiological assessment diagnosis
Epidemiological Assessment/Diagnosis
  • Epidemiology—Branch of medicine dealing with a combination of knowledge and research methods concerned with the determinants and distribution of health and illness in populations.
  • The ongoing process and systematic collection, analysis, and interpretation of health data.
  • In surveillance, the following questions should be asked concerning disease, illness, and injury:
    • What: specific disease, illness, injury
    • Who: person variables: age, gender, race, etc.
    • How: causes, risk factors of disease
    • When: when did the disease occur
    • Where: where did person acquire disease
class activity

Class Activity

Develop surveillance form for a specific disease, illness or injury.


Fall Injury Report

  • Springdale Safe Communities
  • Location of Fall: p Home p Work p Street p Sports/Recreation
  • p Other (Where?_________________________________)
  • Age:_________ Gender:p Male p Female
  • Ethnicity: p African-American p Hispanic p Caucasian
  • p Other (specify:_______________________)
  • Severity of Fall:p Fatal p Hospitalized p Ambulatory (fracture, loss of consciousness only)
  • Type of Fall: p Same Level p Different level
  • Same Level Location:p Bathtub p Other bathroom p Bedroom p Kitchen
  • p Living Room p Basement p Attic p Home yard p Sidewalk p Street p Public Building p Private Building p Sports field p Other (Where?_________________) p Not applicable
  • Different Level Location:p Exterior stairs to house entrance p Stairs to upper floors p Stairs to attic p Stairs to basement p Stairs to public building p Stairs in nonresidential private building
  • p Home porch or landing p Window p Roof p Tree p Cliff or dropoff p Ladder
  • p Horse p Other (Explain_______________________)
  • Probable Cause of Fall:p Alcohol/Drug p Poor Vision p Weather
  • p Medications p Physical Capabilities p Behavior p Inattention p Possible Brittle Bone/Osteoporosis
    • p Unsafe Environment p Sports/Recreation Activity (What?____________)
  • Prevention Measure: p Skid strips in tub p Skid strips on stairs p Nonskid rugs p Nonskid shoes p Handrail p Snow/ice clearance p Soft carpet p Stair repairs p Fence or other barrier p Sports equipment (What?____________________________________)
  • p Other (What?_____________________________________________)
phases 3 4

Phases 3 & 4

To Identify What Causes the Causes

phases 3 450
Phases 3 & 4
  • Assumption 1: A specific health problem has been identified.
  • Assumption 2: A common goal has already been established for the overall program.
behavioral environmental diagnosis steps
Behavioral & Environmental Diagnosis Steps
  • Step 1: Identify and list risk factors
  • Step 2: Differentiate between behavioral and environmental factors
  • Step 3: Shorten the list. Which factors are relevant to the program goal?
behavioral environmental diagnosis steps52
Behavioral & Environmental Diagnosis Steps
  • Step 4: Determine Importance.
    • How prevalent is the behavior?
    • Does factor contribute to problem?
behavioral environmental diagnosis steps53
Behavioral & Environmental Diagnosis Steps
  • Step 5: Determine Changeability
    • There is precedence elsewhere for similar changes.
    • The economic costs are not prohibitive.
    • The proposed change is supported by public demand.
behavioral environmental diagnosis steps55
Behavioral & Environmental Diagnosis Steps
  • Step 7: Set Objectives
    • Who?
    • What?
    • How much?
    • When?
selecting factors priorities
Selecting Factors & Priorities
  • Step 1: Identify factors explaining health behavior.
  • Step 2: Classify into Predisposing, Reinforcing, and Enabling Factors
factors effecting behavior
Factors Effecting Behavior
  • Predisposing (before behavior)
    • Motivate behavior related to health.
      • Knowledge
      • Attitudes
      • Beliefs
factors effecting behavior58
Factors Effecting Behavior
  • Enabling (before behavior)
    • Characteristics of environment that facilitate health behavior or attaining skills required to perform behavior.
      • Skills
      • Peers
      • Other important persons
      • Laws and regulations
factors effecting behavior59
Factors Effecting Behavior
  • Reinforcing (after behavior)
    • Reward or punishment following consequence of health behavior.
      • Encouragement
      • Reward/punishment
      • Other people
selecting factors priorities60
Selecting Factors & Priorities
  • Step 3: Determine the importance of each factor
  • Step 4: Determine the changeability of each factor.
  • Step 5: Create a matrix to find factors that have a high importance and high changeability.
  • Step 6: Write measurable learning objectives.
development of health education learning objective components
Development of Health Education Learning Objective Components
  • WHO (priority group)
    • Specific group on whom objective will focus on.
  • WHAT
    • What is the target group expected to do?
    • Should contain action verb.
    • How much is to be achieved by priority group?
development of health education learning objective components62
Development of Health Education Learning Objective Components
    • What are the specific geographic boundaries of program effort?
  • WHEN
    • What amount of time has been allowed for achieving the objective?
objective example
Objective Example
  • Program Goal:
    • By the year 2000, as a result of the Safe Communities Program, reduce fatal injuries among those aged 15 to 24 caused by motor vehicle crashes in Springdale to no more than 17 per 1,000,000 population. (The current level is 33 per 100,000.)
administrative diagnosis
Administrative Diagnosis
  • Step 1: Resources needed
    • Time
    • Staff
    • Money
  • Step 2: Assessment of Available Resources
administrative diagnosis66
Administrative Diagnosis
  • Step 3: Assessment of Barriers to Implementation
    • Staff Commitment and Attitudes
    • Conflict of Goals
    • Rate of Change
    • Familiarity
    • Complexity
    • Space
    • Community Barriers
policy diagnosis
Policy Diagnosis
  • Step 1: Assessment of Policies, Regulations, and Organization
    • Loyalty
    • Consistency
    • Flexibility
    • Administrative/Professional Discretion
policy diagnosis68
Policy Diagnosis
  • Step 2: Assessment of Political Forces
    • Level of Analysis
    • Win-Lose Approach
    • Systems Approach
    • Exchange Theory
    • Power Equalization Approach
    • Power Educative Approach
    • Conflict Approach
    • Advocacy and Educating the Electorate
    • Empowerment Education and Community Development
components of a proposal
Components of a Proposal
  • Introduction
  • Program goals and objectives
  • Detail of program strategies and activities
  • Evaluation of program
  • Program timeline
components of a proposal70
Components of a Proposal
  • Budget
  • Staff and personnel experience
  • Boilerplate material:
    • Non-profit status
    • Board of directors
    • Committee members
    • Organization information
  • Letters of support
finding funding for project
Finding Funding for Project
  • Two Main Sources
    • Government – produce request for funding (RFP’s) for proposals specific to a disease or prevention activity.
finding funding for project72
Foundations – (examples, Wal-Mart, CommunityCare Foundation) – Usually accept proposals on ongoing basis. Most often very specific guidelines and special interests areas for funding (education, arts, community, etc.)Finding Funding for Project
project description
List major activities.

Estimate time for activities.

How activity is spread out over time.

Project Description
budget items



Administrative Assistance




Facilities Cost

Travel (Domestic -International)

Materials and Supplies

Communications (phone, fax, etc.)

Indirect Costs

Budget Items
activity grants
Activity: Grants
  • Research and find a grant (with submission guidelines) opportunity related to your area of interest from:
    • Governmental Source
    • Foundation
  • Bring to class for discussion
health communications
Health Communications
  • Definition - Intention to inform, influence, and motivate individuals and organization to take action toward health.
health communications79
Health Communications
  • Health Communications can:
    • Increase awareness
    • Demonstrate skills
    • Demonstrate a demand for health services
    • Remind or reinforce knowledge
health communications80
Health Communications
  • Health Communications can’t:
    • Compensate for lack of health care
    • Produce behavior change
    • Be equally effective with all messages
social marketing theory
Social Marketing Theory
  • Definition: Applies concept of traditional marketing to the "sale" of promotion of healthy behaviors.
  • Elements include:
    • Market plan,
    • Carefully designed message,
    • Employment of mass media,
    • Consensus building, and
    • Appropriate packaging.
social marketing theory82
Social Marketing Theory
  • Stresses the importance of understanding the target audience and designing strategies based on their wants and needs rather than what good health practice directs that they should do.
social marketing theory83
Social Marketing Theory
  • 8 major components
    • consumer orientation
    • exchange theory
    • audience analysis and segmentation
    • formative research
    • channel analysis
    • marketing mix
      • product
      • price
      • place
      • promotion
    • process tracking
    • marketing management
what is media advocacy
What is media advocacy?
  • The strategic use of media as a resource for advancing a social or public policy initiative.
  • How can a media opportunity best advance policy goals and shift the debate from individuals to the collective decisions of policies and norms?
steps in media advocacy
Steps in Media Advocacy
  • Media Advocacy
  • Set Public Agenda
  • Public Advocacy
  • Influence legislation
  • Set Policy
how is media advocacy different from health education
How is media advocacy different from health education?
  • Political vs. Behavioral science
  • Individual as advocate vs. Individual as audience
  • Advance healthy public policy vs. Develop health messages
  • Decentralized and opportunistic vs. Problem and approach
  • Changes in environment vs. Changes in individual
  • Uses news and paid ads vs. Public service bulletins
  • Target is person power vs. Person with problem
  • Power gap vs. Information gap
media advocacy strategies
Media Advocacy Strategies
  • Cultivating relationships
  • Research (monitoring)
  • Creative epidemiology
  • Creating news
  • Link with other news
  • Use paid advertising
media advocacy strategies88
Issue framing (access, content)












Translate individual problem to social issue

Assign primary responsibility

Present solution

Make practical/policy appeal

Develop pictures and images

Tailor to audience

Media Advocacy Strategies
media advocacy strategies89
Media Advocacy Strategies
  • Gain access to media
  • Use paid advertising
  • Lack of guidelines
  • Complex skills
  • Time requirements
  • Movement away from behavior
  • Controversial and confrontive
media advocacy planning
Media Advocacy Planning
    • Goals
    • Objectives
    • Target
    • Message
    • Evaluation
earned media
Earned Media
  • Utilizing print, broadcast, and interactive media to elevate the level of public awareness. Not posters brochures, or other print materials.
  • Core Principles
    • Messages
    • Target
    • Testing
    • Follow-up
earned media messaging
Earned Media: Messaging
  • Relevant-news
  • Appropriate
  • Concise (10-15 seconds)
  • Memorable
  • Actionable
earned media target
Earned Media: Target
  • Focus to get most for money
  • Maximize efficiency
  • Reach those who need message
  • Example: Drinking and driving
    • Under-age drinkers
    • 21-34 year olds
    • Hard core drinkers and repeat offenders
earned media no free media earned
Earned Media: No Free Media-Earned!
  • Focus on issue
  • Local relevance
  • Timeliness-today!!
  • Problem-solution
  • Call to action—call to advocacy
earned media hooks that work
Earned Media: Hooks that Work
  • Crisis-you have a solution
  • Controversy
  • Innovation/creation (visual)
  • Research/Studies
  • Note: does not need to be all original
earned media tactics strategies
Earned Media: Tactics/Strategies
  • Proclamation
  • Community event
  • Press conference (few)
  • Ribbon-cutting/ground breaking
  • Speaking engagements
earned media vehicles
Media advisories

Calendar of events

Press release

Letter to the editor



Talk radio

News media

Intenet/new media (used by most of reporters)

Cable television

Community-bulletin boards

Earned Media: Vehicles
earned media partners in programs








Earned Media: Partners in Programs
earned media successful programs
Earned Media: Successful Programs
  • Remain focused
  • Effective materials and messages
  • Generate awareness
  • Foster strategic alliances
  • Provide ease of action
  • Sustain effort
phases 7 9 evaluation
Phases 7-9Evaluation
  • Evaluation is: the comparison of an object of interest against a standard of acceptability
  • Types of Standards:
    • Arbitrary
    • Scientific
    • Historical
    • Normative
    • Compromise
phases 7 9 evaluation102
Phases 7-9 Evaluation
  • Types of Evaluation Design
    • Historical Record-Keeping (easy)
    • Periodic Inventory
    • Comparative
    • Controlled-Comparative
    • Controlled Experimental
    • Evaluative Research (more rigorous)
types of evaluation
Types of Evaluation
  • Formative
  • Process (Phases 5 and 6)
    • Program
    • Implementation
  • Impact (Phases 3 and 4)
    • Behavior
    • Environment
    • P, R, and E Factors
  • Outcome (Phases 1 and 2)
    • Health
    • Quality of life
  • Cost Effectiveness
  • Cost Benefit