Models for Program Planning in Health Promotion HSC 489

Presentation Overview The Purpose of Theories and Models Various Models How Grants Fit In

The Purpose of a Model “Models? I hate models!” “Not another model!” “Rats!” “What’s a model?”

Theory versus Models A theory is… A model is… “a tool to help health educators better understand what influences health”--Hochbaum et. al, 1992 explains how/why life happens developed over time A model is… represents theory framework for investigation/design Examples: PATCH PRECEDE/PROCEED

Precede-Proceed Model PRECEDE: Predisposing, Reinforcing & Enabling constructs in Educational/Ecological Diagnosis & Evaluation PROCEED: Policy, Regulatory & Organizational Constructs in Educational and Environmental Development Green & Kreuter

PRECEDE/PROCEED Model Phase 5 Administrative & policy assessment Phase 4 Educational & ecological assessment Phase 3 Behavioral & environmental assessment Phase 2 “Epi” assessment Phase 1 Social assessment Health Promotion Health Education Policy Predisposing Factors Behavior Quality of Life Reinforcing Factors Health Environ-ment Enabling Factors Phase 6 Implementation Phase 9 Outcome Evaluation Phase 8 Impact Evaluation Phase 7 Process Evaluation

Phase 1: Social Assessment Define the quality of life (problems & priorities) of the target population Involve members of population in a self-study of their needs Social indicators: absenteeism, alienation, crime, discrimination, happiness, riots, self-esteem, welfare, unemployment

Phase 2: Epi. Assessment Use data to ID and rank health goals or problems that identified in P1. Data: disabilities, fertility, fitness, morbidity/mortality, physiological risk factors (incidence, prevalence, etc) Add notes from book.

Phase 3: Behavioral & Environmental Assessment Determining & Prioritizing Behavioral and Env. Risk Factors linked to P2 health problems Behavioral: compliance, coping, prevention activities, self-care Environmental: economic, services, society (access, affordability)

Prioritization Matrix Importance + Importance - High Priority for program focus Low priority Priority for innovative program No program Changeable + Changeable -

Phase 4: Educational & Ecological Assessment IDs and classifies factors that have the potential to influence a behavior Predisposing: knowledge and traits Reinforcing: Rewarding/feedback Enabling: barriers created by societal forces

Phase 5: Administrative & Policy Assessment Determine if the resources are available to develop and implement the program Establish Goals and Objectives Precede ends

Phase 6: Implementation Select models and strategies of the intervention Implementation begins Proceed begins

Phase 7: Process Evaluation Based on Goals & Objectives of P5 Measurements gathered during implementation To control, assure, or improve program quality Add measurements from pg 273

Phase 8: Impact Evaluation The immediate observable effects of a program Leads to the intended outcomes of a program Intermediate outcomes

Phase 9: Outcome Evaluation An ultimate goal or product of a program Generally measured by morbidity or mortality, vital measures, symptoms, signs

MATCH Multilevel Approach to Community Health (MATCH) Intervention activities should be aimed at a variety of objectives and individuals

MATCH, when is it used? When behavioral and environmental risk and protective factors are known When general priorities for action have been determined Focuses on program development

Phases of MATCH 1: Goal Selection – select health-status goals, priority populations, select health behavior goals, and environmental factors/goals 2: Intervention Planning – match intervention objectives with intervention targets and intervention actions

TIAs: Targets of the Intervention Actions Individuals that exert influence or control over the personal or environmental conditions related to the health & behavior goals Levels of TIAs: individual, interpersonal, organizational, societal, and governmental.

Phases of MATCH 3: Program Development – create program units or components, select or develop curricula, develop session plans, create or acquire materials 4: Implementation Preparations – facilitate adoption, implementation and maintenance; select and train implementors (educators)

Phases of MATCH 5: Evaluation – Conduct process evaluation, measure impact and monitor outcomes

PATCH Planned Approach to Community Health (PATCH) Developed by CDC in the mid 1980s With the Community definition of… Can be used in a variety of health ed and health promotion situations 5 Steps

PATCH Steps Mobilizing the Community Collecting and organizing data Choosing health priorities and target groups Choosing and conducting interventions Conducting Evaluations 1st three can be considered facets of a needs assessment, but only serve as a very general reminder of what should be done.

PATCH suggested elements Community support and participation Data collection and analysis Objectives and standards to help plan and evaluation Adoption of multiple strategies in multiple situations Sustained monitoring and evaluation Local and national support Six elements critical to successful planning and action in community based public health programs.

APEXPH and MAPP Assessment Protocol for Excellence in Public Health (APEXPH) and Mobilizing for Action through Planning and Partnership (MAPP) APEXPH – a tool for local health departments for all components of program planning MAPP – enhanced APEXPH, more structured framework for assessment and program planning.

APEXPH Organizational Capacity Assessment Community Process Completing the Cycle

MAPP Four Assessments Community themes and strengths assessment Local public health system assessment Community health status assessment Forces of change assessment Prioritize strategic issues Goals & Objectives Action Cycle – planning, implement, evaluate

Health Communication Any type of human communication concerned with health The art and technique of informing, influencing, and motivating audiences about important health issues Includes health education, social marketing, and mass communication

Social Marketing A program planning process designed to influence the voluntary behavior of a specific audience segment to achieve a social rather than a financial objective Positions consumers at the core of all activity Not complicated, just time-consuming and costly

Social Marketing – key elements Audience centered program development Promotion of voluntary behavior change Audience segmentation and profiling Formative research to develop & test programs Range of product development based on audience research (AR)

Social Marketing – key elements Product distribution based on AR Program promotion through channels identified in AR Process evaluation Outcome evaluation Audience & community involvement in the planning process (i.e, focus groups)

CDCynergy Most comprehensive and theoretically based health communication model CD-ROM tool Six Phases Creation of a Social Marketing Plan

Phases of CDCynergy Problem Definition & Description Problem Analysis Communication Program Planning Program & Evaluation Development Program Implementation & Management Feedback

How Grants Fit In? A statement of the obvious Programs Money Models Funding Resources Plans