Mobley Quiz 2_ Planning and Implementing

Needs Assessment

• Collection of information on both current health status and ideal health status of a group of individuals at a site

• Formalized approach to collecting data in order to identify needs of a group of individuals

• Completed for all groups of relevant individuals

• Reflect all levels of influence in the ecoglogical health perspective

  • Intrapersonal

  • Interpersonal

  • Institutional

  • Community

  • Policy

• REsults provide foundation for work of planning health promotion program that addresses identified health problems and concerns

Four basic steps of need assessments

1. Determining the scope of assessment

2. Gathering data

3. analyzing data

4. reporting findings

1. Determining the scope of assessment

Working with the kay informants and stakeholders (advisory committoc) to determine the scope of the work and the purpose of the noods asscsamoint

Gather the data

Primary

Socondary

Retrieving only nooded data that is culturally appropriate tailored to the target

population and actting

Analyze the data

Using clear methods that people can understand

Report and share findings

Identifying options for sharing findings of needs assessment and tailoring communications to program participants, stakeholders, and staff

Results of a needs assessment can be used to

Help advocate for health resources

Develop a program or policy

Establish a baseline against which to gauge the effectiveness of the program

Needs

Conceptualized as the difference between

"what is" at the present time

"what should be under more ideal circumstances

What Is Measured In Assessing Health? Focus on the Individuals

• Physical health

• Mental health

• Social health

• Environmental health

• Spiritual health

• potentail sites: school, workplacem health care organization, community

• Capacity assessment: Thorough and accurate assessment of site to determine what resources are avallable in setting to address identified health concerns and problems

The School Health Index: A Self-Assessment and Planning Guide is used to:

Enable schools to identify strengths and weaknesses of health and safety policies and programs

Enable schools to develop an action plan for Improving student health, which can be Incorporated Into the school Improvement plan

Engage teachers, parents, students, and the community in promoting health-enhancing behaviors and better health

The School Health Index

Two activities completed by teams from a school:

• Self-assessment modules

• Planning for Improvement processes

Assesses extent a school implements the types of policies and practices recommended by the CDC for school ealth and safety programs

Primary data

New, original data that did not exist before, obtained directly form individuals at the site

Collected via surveys, interviews, focus groups, or direct observation

Can be single contact/cross sectional, multiple contact, via individuals or groups

More expensive and time consuming to collect than secondary data

Quantitative data

Statistical information, such as one would typically find in a professional journal

Includes percentages, means, or correlations

Qualitative data

Narrative, with fewer numbers

Includes Interviews, focus groupe, public hearings, and atharabeervational methode

Key informant (one-on-one) interviews

Specific sets of questions should be created ahead of time in order to create a uniform Interview format

Interviews with leaders and key informants

• Identify needs

• Prioritise needs

• Organise or mobilise the community

• Study identified needs

• Develop a plan of action

• Find resources

• Action

• Evaluate

Focus groups

Qualitative data technique in which a small group of Individuals meet to share their views and experiences on some topic

* Ideal group size - 6 to 12

Delphi technique

• Used to gather information from individuals when focus group is difficult

• May be used with a group of health experts who cannot conveniently meet in person

• Collecting data from same people multiple times; five or fewer rounds

• Generates consensus through a series of questionnaires

• Usually administered via the mall or electronic mall

Delphi technique- process

Start by asking the priority population to respond to 1 or 2 broad questions

Responses are analyzed to formulate a 2 questionnaire, which is sent out.

Responses analyzed again. A 3rd questionnaire is created and sent out to gather additional Information.

If consensus is reached, the process mayend here; If not, It may continue for another round or two.

Nominal group process

• Purpose representatives of the priority population are asked to qualify and quantify specific needs highly structured process in which a few knowledgeable

• The Process:

Groups of 5-7 people

Each person writes an answer to a single question.

Each person shares (in round robin fashion) answers with no discussion.

Answers are then clarified with discussion.

The group selects and ranks Importance of a stated number of items.

May Include a preliminary or final vote

-Single-step (or cross-sectional) surveys can be administered via:

• Face to face-self administered or interview administered

• Telephone

• Electronic/online

• Group

Self Assessments

• Most address primary and secondary prevention issues

• Completed by individuals in the priority population

  • Use Individual reports as part of an educational program

  • Use the group reports as another source of primary needs assessment data

• Types of health assessments include:

  • Health Risk Assessments/Appraisals (HRAS)

  • Health Status Assessments (lifestyle-specific)

  • Self-screenings: BSE, TSE, ABCDES (skin cancer)

Survey questionnaires

• Most common form of gathering data for a needs assessment

4 ways to administer:

• Face to Faco surveys

  • In-depth interviews with key informants

  • Typically take the form of a conversation between the Interviewer and the respondent

  • Gather the views of the respondents in their own words

  • Disadvantages include need for a well-trained interviewer for clarity of the statements of the respondent

Mail surveys

Allow a large quantity of data to be collected in a relatively short period of time

Disadvantages

Special expertise is required to create a valid and reliable survey and to sample the population correctly

Observation

• Minimal-contact method

  • Direct (actually seeing a situation or behavior)

  • Indirect (proxy measure)

• Can be obtrusive (subject is aware of observation) or unobtrusive (subject is not aware of observation)

• Specific methods of observation:

  • Windshield tours

  • Walk-throughs

  • Photovoice (participatory data collection)

Windshield Tour or Walk-Through

Useful indicators of community health and well-being include:

• Housing types and conditions

• Recreational and commercial facilities

• Private and public-sector services

• Social and civic activities

• Identifiable neighborhoods or residential clusters

• Maintenance of buildings, grounds, and yards

Photovoice

Form of participatory data collection.

Priority population is provided with cameras and skills training (on photography, ethics, data collection, critical discussion, and policy), then use the cameras to convey their own images of the community problems and strengths

Telephone surveys

Response rates for telephone surveys may be higher than that for mail surveys for those who do not read well

Disadvantages: Time consuming, more expensive to conduct, and often result in a lower response rate (due to difficulty to interview aver the phone)

Electronic surveys

• Conducted through website or email attachment

• takes repsondenet directly to website so that questionareis can be completed online

• Con: easieness of declining survey, and hesitation of opening attachment due to possibility of receivied a computer virus

Main goals of phototype

• To enable people to record and reflect their community's strengths and concerns

• To promote critical dialogue and enhance knowledge about issues through group discussions of the photographs

• To inform policymakers

Validity

Correctly measure what you want to measure

Reliability

Consistenetly measure what you want to measure

Face validity

Based on previous questions or review of literature

Content validity

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

Questionnaire sent to panel of experts on the topic of the survey to revise it

For health needs assessment, more complex forms of validity are more appropriate such as:

Criterion-based validity or construct validity

Test-Retest reliability

• Same results will be obtained each time to the same sample of subjects (stability)

• Results of respondents' first and second surveys must be matched and are generally entered into a computer software program to calculate reliability score (-1.0 to +1.0)

• Preferred reliability is a score = 0.7 or higher

Selecting a Sample

-Three steps that are key to obtaining results that represent health-related perceptions, behaviors, and needs of the group being assessed:

1. Correctly selecting the people who will receive the questionnaire

2. Selecting a large enough sample of the entire population

3. If mailed or online survey, making sure the return rate is high enough to reduce bias (>50%)

Selecting a Sample

1. Selecting the people who will receive the questionnaire

• Representative sample

  • Can be accomplished through random selection of individuals (or as close to random as possible)

  • Randomness ensures that responses are characteristic of responses that would be obtained from entire population of people (external validity)

• Otherwise = convenience sample

2. Selecting a large enough sample that results will be representative of entire population

• Power Analysis

  • Deals with having an adequate number of Individuals to be able to generalize findings from samples to population

• To determine necessary size of random sample, it is important to understand how much sampling error one is willing to accept, size of the population, and how much variation there is in the population with respect to the outcome variables being survey

3.High return rate to reduce bias (>50%)

• Other bias issues that should be considered:

• Sampling bias: Final survey responses are uncharacteristic of the population

• Response bias: When people who respond to the survey are different in their health beliefs or behaviors from those who do not respond to the survey

Secondary Data

• Collected by someone else for another purpose

• Sources of secondary information are government, voluntary health associations, private foundations, national and international institutions, professional associations, and universities

• Examples include: Healthy People information, national data sets, vital records, census data, and peer-reviewed journals

Reasons for using secondary data:

• Cheaper to collect than primary data

• National, state, and local health data are publicly available and accessible electronically

• Yields more accurate data than those obtained through primary research

• Representative

• Larger numbers

• Youth Risk Behavior Survey

Worksites or organizations often collect information of their daily operations

• Attendance rates

• Performance scores

• Number of sick and vacation days

• Production statistics

• Sales figures

• Expenses

Problems with secondary data

• Quality

• May not contain what you need or from exact target population

• May be outdated

• May need permission to use or pay a fee to use

• Analysis may be more complicated

Analyzing results

• Depends on purpose of needs assessment

• Should provide a baseline assessment from which to do comparisons, write grants, plan programs, etc

• Should Include descriptive statistics for comparison purposes using tables or graphs

Writing a final report

Start with a plan

• Written and oral reports can be developed

Keep it simple

• Needs assessment reports do not need to be elaborate

• Keep Information clear simpia, and brief

• Use charts, graphs or figures to explain data when possible

Final report

• Excoute summary

• Acknowledgementa

• Table of contents

• Domographics of community

• Methods of data collection

• Main findinga

• Extablished prioritics

• References and appendixes

Disseminating options

• Printing the entire report: Preparing special reports or brochures for particular groups of individuals and stakeholders

Posting report on web

• Informing people about the report through

  • email

  • public meetings

  • board and staff meetings

  • newspaper reports

  • radio and television interviews by advisory board members and staff

  • press releases and news conferences

What do we do during pre-planning?

• Decide about involvement of key stakeholders

• Determine who should be sitting at the table.

• Pre-planning increases participation and maximizes resources.

Guidelines for project management: partcipation

- Identify key stakeholders

- Consider roles and the process for participation

- Focus on the process

Work with people, not for them

Involve clients in project design

Use participatory evaluation strategies and techniques from participatory research

Trust = Mutual Respect, Mutual Benefit, Shares Power, Reflection, Shared Knowledge

Resource system concept

• Resource system: program developers & possible funders

• Intermediate user system: potential program adopters and implementers

• End-user system: priority population, managers, and/or leaders from community organizations

• Planning committees are dynamic. You may need to continually review who is or should be a part of the committee.

5 elements to manage during preplanning and planning

• Meaningful participation of stakeholders

• Time

• Money and other resources

• Data-gathering and interpretation

• Decision-making

When all elements are managed well, project outcomes may exceed expectations and problems are less likely to occur.

What happens with poor management?

Stakeholders: Decisions may be overruled, delayed, or challenged.

Time: Lost opportunities, decreased impact, stressful relationships

Resources: Unanticipated costs, project discontinuation

Data: Misleading or incomplete databases; poor data methods

Guidelines for project management: Time

• Time required for each step varies.

• The participatory nature means each step may take longer than other kinds of planning.

• The desired participation level may contrast with other considerations. Compromise.

Guidelines for project management: resources

• Create an inventory of available resources

  • Allocated budgets

  • Expertise

  • Contributions from volunteers and partners

  • Opportunities that may be missed

• Time

Managing effective work groups

• Active, two-way communication

• Communication distributed among group members,

  • not to and from group members and the leader

• Distribution of leadership and responsibility for group function

  • generating goals & agenda

• Goals are fluid and reflect both individual and group needs

• Group cohesion advanced through:

  • problem-solving competence, inclusion, affection, acceptance, support, and trust

Vision

What things would "look like" in the future if you were completely successful.

• Individuals and families will lead optimally healthy and happy

• A world free of lung disease

Mission:

What your program currently does.

Program overview or aim.

• EWP's mission is to promote healthy and productive individuals and families.

• To save lives by improving lung health and preventing disease

Goals:

Broad statements written in non-technical language.

Use action words but are not measureable.

overall direction

explain general intents of program

less specific than objectives: longer term w/o speciifc deadline, not observed

• Increase regular exercise among staff and their family members

• Reduce lung cancer death

• Attain strong air pollution health standards

• Improve Quallity of Life for COPD and asthma patients

• Out adult and youth smoking rates

Objectives:

Break the goal down into smaller parts that provide specific, measurable actions by which the goal can be accomplished.

provide an organized pathway to meet higher goals

operational and measurable

Describe specific things your program will accomplish (in context of the audience/population)

Include quantitative or qualitativa degree, amount, or level of achievement or change.

Should be specific and measurable and include at least 5

components:

*Who? Target audience

What? Target Behavior

When? Time frame

How measured? If avaliable, technique used to take measurements/report

Level/amount to achieve? Program impact/goal for target behavior

Mission statement

• will have what you do and how you do it.

Example-Peaceful Paths (Domestic Abuse Network:

We promote relationships free of violence and control by providing a safe place to receive Intervention, advocacy, and education services waing prevention strategies and community partnerships.

Process objectives

measureable activites carried out by team memebrs of program

• Will do to obtain outcome objectives

• Action or steps taken

• teach, counsel, educate, document, serve, etc.

Ex. Each community nutritionist will conduct two nutrition lectures per week over the course of a 3month prg

Impact and outcome objectives

Measureable changes as a result of a program/intervention and/or changes in health outcome

• short, medium, long term objectives

• result in: health improvements, quality of life, cost benefit

By the year 2020, reduce iron deficiency to less than 5 percent among low-income children under 2 years.

By the end of the lesson, increase accuracy of identifying a whole grain food to at least 75% of students.

Specific

what exactly will you do? Who will be Involved? What strategies will you use? What's the outcome?

Measurable-

how will you know If you succeeded? Can you measure the

change?

Achievable-

Can you achlieve the objective in the proposed time frame and with available resources?

Relevant

are the data collected relevant? Will it lead to desired results?

Time frame-

when will the objective be accomplished? What is the stated deadline?

Don’t Use These for Objectives!

• Know

• Understand

• Appreciate

• Grasp the significance of

• Enjoy

• Learn

• Become familiar with

• Become aware of

• Believe

• Have faith in

• Value

• Acquire

Implementation Fidelity

Was the intervention delivered as designed?

Type III Error

• Saying the program was effective, but for the wrong reason

• Finding the desired answer to the wrong question.

• Related to implementation fidelity.

Evidence-based Practice

• Strategy

• Example: diabetes support group because social

support is importa

Evidence-based Intervention

An entire intervention

Core Component or Essential Elements

Active ingredients assumed to be responsible for

achieving the intended outcomes

Adaption

change made to an evidence-based approach,

including additions, deletions, modifications, and

reordering.

• Purposeful actions taken prior or during implementation to improve fit with

local context.

• Field adaptation vs. planned adaptation

Fidelity

No changes to the intervention.

• Intervention delivered as planned.

Lack of fidelity

Strategies or actions that change the program during implementation due to

barriers or challenges.

Steps in planning and implementing

1. Assess community

2. Understand the intervention

3. Select intervention

4. Consult with experts

5. Consult with stakeholders

6. Decide what needs adaptation

7. Adapt the original program

8. Train staff

9. Test the adapted materials

10.Implement

11.Evaluate