Health Care and Promotion Fund Project Expo 2006: Beginning with dissemination in mind: Characteristics of successful health promotion programs Dr. Charles C. Chan Co-Chair Promotion Sub-committee Health Care and Promotion Fund Committee Health, Welfare and Food Bureau 22 nd May, 2006

The purpose of the HCPF - to foster and support efforts in health promotion and disease prevention.

The HCPF provides financial support to: 1.Health promotion projects by non-profit organizations that help people adopt healthier lifestyles by enhancing awareness, changing behavior or creating an environment that supports good health practices; 2.Research related to health promotion and preventive care. Research projects provide an information base for health promotion interventions that enhance good health and the prevention and early detection of disease and disability. (No HCPF research grants have been awarded since 2002.)

Two perennial questions bothering potential applicants to HCPF 1.Non-research projects : Why do we still have to collect evidence of changes in awareness, behavior and environment that support good health practice? 2.Dissemination : Why would another NPO want to do what we are doing?

Decision makers in health care are increasingly interested in using high quality scientific evidence to support clinical and health policy choices……. Reliable evidence is essential to improve health care quality and to support efficient use of limited resources. Journal of American Medical Association 2003; 290:

The HCPF is obliged to identify the vital characteristics of interventions that enables an intervention to: 1.reach large number of people, and especially those who can most benefit; 2.be widely adopted by different and representative stakeholders and settings; 3.be consistently implemented by staff members and / or community volunteers with moderate level of training and supervision; 4.produce replicable and long-lasting effects (and minimal or no negative impacts) at reasonable cost.

To facilitate further improvement of the quality of project applications, future projects will be encouraged to adopt: 1.multilevel approaches, 2.increasing focus on social contextual factors, and 3.infrastructures built for sustaining and disseminating prevention programs known to be effective in Hong Kong.

Core Questions & Corresponding Strategies for Proposal Preparation Utilizing the RE-AIM framework (Glasgow et al, 2003; 2004) as a planning approach to enhance translation and dissemination, a list of core questions and corresponding strategies were developed, which may be useful to our community stakeholders in proposal preparation.

Reach (Individual Level) The absolute number, proportion, and representativeness of individuals who are willing to participate in a given initiative, intervention, or program. Core QuestionsCorresponding Strategies 1. What percentage of the target population would come in contact with your program? Use a multiple channel, multi- stage plan of recruitment of target population. 2. Do you have a plan (by stage) to reaching the most needy? Funding elements may include those addressing reduction of participation barriers.

Efficacy / Effectiveness (Individual Level) The impact of an intervention on important outcomes, including potential negative effects, quality of life, and economic outcomes. Core QuestionsCorresponding Strategies 1. How effective will the intervention likely to affect key targeted outcomes? Consider examples of tiered care approaches or intervention tailoring methods. 2. Do you expect any unintended adverse consequences? Funding elements may include adverse outcome evaluation and cost-benefit analysis.

Adoption (Setting or Organizational Level) The absolute number, proportion, and representativeness of settings and intervention agents (people who deliver the program) who are willing to initiate a program. Core QuestionsCorresponding Strategies 1. What percentage of the targeted settings and organizations (including high- risk or underserved population) will agree to take on this program? In the case of multi-site applicants, it is important to build-up profiles of settings known to have contact with the target population as potential adoption settings. 2. What kind of motivation package(s) likely to increase the fit between your program and targeted organizational goals and capacity? Funding elements may include cost of adoption, i.e., staff willingness, service re- prioritization (or customization of intervention) and staff-community network capacity enhancement.

Implementation (Setting or Organizational Level) At the setting level, implementation refers to the intervention agents' fidelity to the various elements of an intervention's protocol, including consistency of delivery as intended and the time and cost of the intervention. Core QuestionsCorresponding Strategies 1. What proportion of staff (at different levels) and community partners (including lay persons) within a setting and / or a community will agree to program delivery? Consider alternatives of delivery agents (staff, lay persons, or combinations of staff-lay partnerships, etc.) and process (full or partial automation of the program) with training and supportive supervision of lay partners. 2. What is needed to increase the likelihood that various components will be delivered as intended? Funding elements may include mechanisms of providing feedback and recognition for adherence to implementation.

Maintenance (Individual or Setting Level) The extent to which a program or policy becomes institutionalized or part of the routine organizational practices and policies. Within the RE-AIM framework, maintenance also applies at the individual level. At the individual level, maintenance has been defined as the long-term effects of a program on outcomes after 6 or more months after the most recent intervention contact. Core QuestionsCorresponding Strategies 1. What are the characteristics of persons and settings showing maintenance of the intended program impact? Taking into consideration the status of existing community efforts, including natural environment and natural helpers in the maintenance of the desired behavioral changes. 2. What kind of motivation package(s) is likely to help building the infrastructures needed to sustain further dissemination of the program? Exploration of multiple funding sources to support follow-up assessments on characteristics of successes at both the individual and setting levels.

The HCPFC is exploring ways in which the spirit of health promotion will take root in the communities of Hong Kong by considering: 1.Its role as a regional clearinghouse of successful health promotion programs. 2.Systematic effort in linking successful community practices with university research teams, and that of isolated initiatives from the private sector. 3.Measures to enhance stakeholders efforts in transforming their current capacities into facilitating resources and infrastructures necessary for longer-term implementation of effective programs.

Reference 1.Glasgow, R.E., Lichtenstein, E., Marcus, A.C. (2003). Why don’t we see more translation of health promotion resarech to practice? Rethinking the efficacy-to-effectiveness transition. American Journal of Public Health, 93, 8, Glasgow, R.E., Klesges, L.M., Dzewaltowski, D., Bull, S.S., Estabrooks, P. (2004). The future of health behavior change research: What is needed to improve translation of research into health promotion practice? Annuals of Behavioral Medicine, 27, Solomon, S., Kington, R. (2002). National efforts to promote behavior-change research: Views from the Office of Behavioral and Social Sciences Research. Health Education Research, 17, Tunis, S.R., Stryer, D.B., Clancy, C.M. (2003). Practical clinical trials: Increasing the value of clinical research for decision making in clinical and health policy. Journal of the American Medical Association, 290, effective programs.