HLSC 3643 Community Health Planning and Promotion

1. HLSC 3643 Community Health Planning and Promotion University of Arkansas Dr. Jones

2. Overview of Health Planning Models

3. Purpose of Notes • To provide students with: • Overview of planning models • Describe common caveats • Describe research on impact • Strategies to overcome barriers of models

4. Objectives • Discuss the importance of planning relevant, practical programs for social change • Explain types of planning models • Explain the planning process • Discuss concerns and issues

5. “Imagination is more important than knowledge.” Albert Einstein

6. 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

7. Overview of Planning • Planning for programs has various approaches: • “Hit the ground running” approach • “Purpose-driven” approach • “Process-oriented” approach • “Model-driven” approach

8. 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)

9. PRECEDE - PROCEED • 9 Phases • 5 Phases are diagnostic – PRECEDE • 4 Phases are evaluative – PROCEED

10. PRECEDE • 1st Phase: Social Diagnosis • 2nd Phase: Epidemiological Diagnosis • 3rd Phase: Behavioral/Environmental • 4th Phase: Educational/Ecological • 5th Phase: Administrative/Policy

11. PROCEED • 6th Phase: Implementation • 7th Phase: Process Evaluation • 8th Phase: Impact Evaluation • 9th Phase: Outcome Evaluation

13. PATCH • Planned • Approach • Toward • Community • Health

14. PATCH • 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

15. MATCH • Multilevel • Approach • Toward • Community • Health

16. MATCH • Phase 1: Goal Setting • Phase 2: Intervention Planning • Phase 3: Program Development • Phase 4: Implementation Preparations • Phase 5: Evaluation

17. Generalizing Model for Program Planning • Assessing Needs • Identifying the Problems • Setting Goals and Objectives • Developing and Intervention • Implementing the Intervention • Evaluating the Results

18. CDCynergy • 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

19. EMPOWER • A computer-based planning program • Enabling methods of planning and organizing within everyone’s reach. • Based on PRECEDE-PROCEED

20. 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

21. 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?

22. Does Using a Model Help? • Advantages • Caveats • Challenges

23. Advantages • Provides direction • Non-biased approach • Uncovers hidden problems • Provides evaluation measures • Ability to use theories within model

24. Caveats • 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

25. Challenges • Learning before doing • Patience • Understanding theory/model • Finding the data • Letting go

26. Do Planning Models Work? • How effective are planning models if used correctly in the success of a program or project activity?

27. Research on Effect • Some models are new and don’t have effectiveness data. • PRECEDE-PROCEED has most use • Results…

28. Some Evidence! • Reduces AIDS risk • Reduces weight • Builds coalitions/partnerships

29. Strategies • 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

30. 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?

31. 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.

32. 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?

33. 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?

34. Bibliography • Insert from other ppt.

35. 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.

36. 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.

37. 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.

38. Qualitative Research Methods • Focus Groups • Nominal Groups • Community Forum • Observation • Depth Interviews • Projective Techniques

39. Focus Groups • Group interviews where a moderator guides the interview while the group discusses the topics that are asked.

40. 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

41. 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.

42. 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.

43. 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?

44. 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?

45. 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.

46. Surveillance • 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

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

48. 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?_____________________________________________)

49. Phases 3 & 4 To Identify What Causes the Causes

50. 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.