Health 366 Final

Purpose of the Program

· who is the priority population?
· how are we defining the community?
· what are the desired health outcomes?
· does the community have the capacity and infrastructure to address the problem?
· is a policy change needed?
· are environmental changes needed?

scope of the planning process

· is it intra- or inter- organizational?
· who are our partners or potential partners?
· what is the time frame for completing the project?

planning process outcomes (deliverables)

· written plan?
· program proposal?
· program documentation or justification?

leadership and structure

· what authority, if any, will the planners have?
· how will the planners be organized?
· what is expected of those who participate in the planning process?

identifying and engaging partners

· how will the partners be selected?
· how will programs be tailored to the priority population?
· will the planning process use a top-down or bottom-up approach?

identifying and securing resources

· how will the budget be determined (i.e., how much will the program cost and who will pay for it?)
· will a written agreement (i.e., MOA-memorandum of agreement) outlining responsibilities be needed?
· If a MOA is needed, what will it include?
· will external funding (i.e., grants or contracts) be needed?
· are there community resources (e.g., volunteers, building space, donations) to support the planned program?
· how will the resources be obtained?

SDOH (social determinants of health)

conditions in the environments where people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks
· education access and quality
· health care access and quality
· neighborhood and built environment
· social and community context
· economic stability

Entry Level

fewer than 5 years of experience with a baccalaureate or master's degree

advanced-1 level

5 or more years of experience with a baccalaureate or master's degree

advanced-2 level

5 or more years of experience with a doctoral degree

Epidemiological data

Gain additional significance when it can be shown that the described health problems are the result of modifiable health behaviors and that investing resources to promote health lifestyles and prevent health problems makes sense economically
· Global: World Health Organization (WHO)
· National: Center for Disease Control and Prevention (CDC)
· State: Missouri Department for Health and Senior Services
· Local: County Health Departments

Return on investment

measures the cost of a program vs. the financial return realized by that program ($10 per person is showed to save billions annually)

Cost benefit analysis

measures the cost of program based on health outcomes achieved

Cost effectiveness analysis

measures the cost of program based on health outcomes achieved

Evidence of effectiveness; The Community Guide

the website that includes the community preventive services task force's findings and the systematic reviews of public health interventions covering a variety of topics

Phase 3 of PRECEDE-PROCEED

Educational and Ecological Assessment-identifies and classifies factors that can affect behavior. Factors can be predisposing, enabling, or reinforcing

predisposing factors

needed before behavior i.e · knowledge, attitude, beliefs, perception, values

Enabling Factors

needed to engage in behavior i.e access, availability of resources, rules, laws, skills

Reinforcing Factors

received for engaging in behavior i.e. · incentives, recognition, reactions

Impact Evaluation

assesses program effectiveness in achieving its ultimate goals

Outcome Evaluation

measures program effects in the target population by assessing the progress in the outcomes or outcome objectives that the program is to achieve

Phase 7 of Precede-Proceed

Impact Evaluation-the immediate observable effects of a program. (changes in knowledge, behavior, attitude, etc.)

Phase 8 of Precede-Proceed

Outcome Evaluation-the ultimate goal of the program (weight loss, cholesterol reduction, etc.)

Phase 1 of Grant Writing Process

· Assessing needs and capacity
· Collect and analyze data to determine health needs and capacity of priority population.
· Priority setting

Phase 2 of Grant writing process

· Setting goals and objectives
· Identifies what is to be accomplished
· Written as a series of statements
· Goals are broad statements.
· Objectives are specific and measurable and outline steps to reach goals.

Phase 3 of Grant writing process

· Developing interventions
· Creating activities and strategies by which goals and objectives can be reached

Phase 4 of Grant writing process

· Implementing interventions
· Putting interventions into action

Phase 5 of Grant writing process

· Evaluating results
· Focuses on both improving the interventions (formative evaluation) and determining the intervention's effectiveness (summative evaluation)

Single Step Surveys

· a means of gathering data in which collectors obtain the data from individuals or groups with a single contact
· self report, proxy measures, from significant others, opinion leader, or key informants
· face-to-face interviews, telephone interviews, electronic surveys, group interviews, written surveys

Multi-Step Surveys

· those collecting the data contact respondents who will provide the data on more than one occasion
· Delphi Technique: a process that generates a consensus through a series of questionnaires, which are usually administered online or through the mail (five or fewer rounds)

Basic Priority Rating (BPR) Model

prioritizes needs assessment data and requires planners to rate four different components of the identified needs and insert ratings into a formula to determine a priority rating

Focus Groups

a form of qualitative research that uses exploratory processes to obtain information about attitudes, feelings, perceptions, insights, beliefs, misconceptions, opinions, and receptivity of the priority population

nominal group process/technique

a highly structured process in which a few knowledgeable representatives (5 to 7) are asked to qualify and quantify specific needs

Categorical Funds

those that are earmarked or dedicated to support programs aimed at a specific health problem or determinant (i.e., risk factor)

Capacity

the individual, organizational, and community resources that enable a community to take action

capacity building

activities that enhance the resources of individuals, organizations, and committees to improve their effectiveness in taking action

Bias

a preference that inhibits impartiality; distorted data
· steps to minimize bias
· unobtrusive observations
· data is collected in a confidential way (respondent's identity can be determined but not released)
· data is collected anonymously (no way of identifying respondent)

internal consistency

the intercorrelations among individual items on the scale, meaning whether scale items measure the same domain
· Cronbach's Alpha or Kuder-Richardson

Rater Reliability

focuses on the consistency in observing or rating a series of items

Inter-rater-

consistency among/between using two or more raters

Intra-rater

· consistency when using a single rater
· Cohen's kappa, correlation coefficients, or spearman rank order

Vision Statement

· Brief description of where program will be in the future; typically, in 3 to 5 years.
· States how priority population will be healthier and more fulfilled in 3 to 5 years

Mission Statement

· a short narrative that describes the purpose and focus of the program
· describes the current focus of a program and may reflect the philosophy behind it
· also helps guide planners in the development of program goals and objectives

Goals

· broad statements that describe the expected outcomes of the program
· Less specific than objectives and serve as a long-term expectation for a program and a foundation for developing program objectives
· Typically include verbs such as evaluate, know, improve, increase, promote, protect, minimize, prevent, reduce, and understand

process objectives

· daily tasks, activities, and work plans that lead to accomplishing all other levels of objectives

Impact objectives

immediate observable effects of a program; foundation for impact evaluation; include learning, behavioral, and environmental objectives

Outcome objectives

end-stage objectives of a program; aimed at changes in health status, social benefits, or quality of life.

Elements of an objective

· Priority population, or WHO will change
· Outcome, or WHAT will change
· Place, or WHERE the change will occur
· Time frame or WHEN the change will occur
· Target, or HOW MUCH change will occur

Healthy People 2030

· Launched in August 2020
· Comprised of core (355), developmental, and research objectives
· Important components
· Leading health indicators (LHIs)
· Overall health and well-being measures (OHMs)

Continuum theories

· identify variables that influence actions and combine them into an equation to predict action

Stage Theories

· have an ordered set of categories into which people are classified and identify factors that could induce movement from one category to the next

Constructs

concept used with a specific theory

Reinforcement

· Behavior frequency is determined by reinforcements; reinforcement has a strengthening effect on behaviors.

positive reinforcement

adding a reward

negative reinforcement

removing a negative reinforcer

Logic Model Components

inputs, activities, outputs, outcomes

Inputs

resources used to plan, implement, and evaluate a program (i.e. partnerships, equipment, and supplies)

Activities

interventions or strategies used to bring change

Outputs

direct results of the activities of the activities (products, services, and new infrastructure)

Outcomes

The intended results

Short-term outcome

changes in awareness, attitudes, knowledge, skills

Mid-Term Outcome

· changes in behavior or environment

Long-term outcome

risk reduction, change in health status, ↑ Quality of Life

Adopt

· Adopt an existing intervention that is supported by evidence showing that the intervention was effective when used elsewhere

Adapt

· Adapt an existing intervention that is supported by evidence showing it was effective elsewhere but the circumstances or setting in which it was used were different from the proposed setting

Intervention

· the planned actions that are designed to prevent disease or injury or promote health in the priority population

Dose

the number of program units delivered

Multiplicity

refers to the number of components or activities that make up an intervention

Curriculum

a planned set of lessons or courses designed to lead to competence in an area of study

Treatment

an intervention

Intervention Strategies

· Health communication
· Health education
· Health policy/enforcement
· Environmental change
· Health-related community service
· Health advocacy and community mobilization

Communication Channels

· Intrapersonal
· Interpersonal
· Organizational and community
· Mass media
· Social media

P.O.S.T

People, Objectives, Strategy, technology

People

What are they ready for?
What technology do they use? Why?

objectives

Why do you want to pursue the groundswell?
What do you want to happen (i.e., a change in attitudes, knowledge, and/or behavior)?

Strategy

How do you want relationships to change (e.g., customers to carry your messages; customers to become engaged)?
How will you use the marketing mix (i.e., product, price, place, promotion)?

Technology

What technology to use?
What technology will you use, given what you are trying to accomplish?

Health Literacy

capacity to obtain, process, and understand basic health information and services to make appropriate health decisions

Health Numeracy

the degree to which individuals have the capacity to access, process, interpret, communicate, and act on numerical, quantitative, graphical, biostatistical, and probabilistic health information needed to make effective health decisions

General Principles of Learning

1. Aim at multiple senses
2. Get learners actively involved
3. Eliminate distractions
4. Is the learner ready to learn?
5. Present relevant information for the learner
6. Use repetition
7. Learning encountered is pleasant
8. Material to be learned starts with what is known and proceeds to the unknown
9. Application of concepts
10. Paced appropriately for the learner

Health Policy and Enforcement Strategies

· Include executive orders, laws, ordinances, judicial decisions, policies, regulations, rules, and position statements

Phases of Policy Making

agenda setting, policy formulation, policy adoption, policy implementation, policy assessment, policy modification

Agenda Setting

what is the health problem

Policy Formulation

wording is often difficult; simply language

Policy Adoption

by authoritative body

policy implementation

Needs to show good judgement and respect

Policy assesment

is it solving the health problem?

policy modification

should it be maintained, modified or eliminated

Environmental Change Strategies

economic, service, social, cultural, psychological, political

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

Social Marketing Principles

· to design programs that facilitate voluntary behavior change for improved personal or societal well-being

Market

the set of all people who have an actual or potential interest in a product or service

Marketing Mix (4 P's of Marketing)

Product, Price, Place, Promotion

Segmentation

a way to divide the priority population into smaller, more homogeneous, or similar groups. Its goal is to create groups of people who share similar characteristics or qualities who will respond similarly to the intervention

Five steps in segmentation

· Review formative research to identify behaviors that influence whether people experience morbidity or mortality associated with a health topic.
· Decide what the program's focus will be.
· Review data and literature to identify factors that influence whether people participate in the identified behavior.
· Group people who share similar characteristics.
· Choose the segment(s) to focus on.

Criteria of segments

· Measurable—can important characteristics be measured?
· Substantial—can enough people in the segment be reached?
· Accessible—can segment be reached?
· Differentiable—are segments unique enough to respond to a different strategy?
· Actionable—can programs be developed that will attract and serve segments?

Consumer-based

· those based on a priority population's wants, needs, desires, and preferences

Consumer oriented

· all marketing-related program decisions are based on what planners know about the priority population and their preferences; information gather via formative research
· Core product

Core Product

· Benefits associated with using a product or service are called core products or the bundle of benefits · i.e. The core products for increasing physical activity is cardiovascular health improvement, weight management/loss, stress relief/improved mental health, increase in self-esteem/empowerment, less infectious disease, and saving money on healthcare

Engage Facilitator skills

· An understanding and passion for wellness education and prevention,
· Strong presentation/communication skills,
· Leadership and interpersonal skills for engaging a broad group of stakeholders, and
· Baseline knowledge about the four main topic areas addressed in Engage
· Alcohol and other drug use,
· Issues of bias and discrimination,
· Interpersonal violence, and
· Mental well-being and suicide prevention