Activity
Chapter 3
Models for Program Planning
in Health Promotion
Background
Good health promotion programs are not created by chance
Models serve as frames from which to build
Many different models
Common elements, but different labels
Must understand the Generalized Model for Program Planning
A Generalized Model for Program Planning
Background (cont.)
No perfect model
Can be used in entirety, parts, and combinations
Three Fs of program planning help with selecting the appropriate model
Fluidity - steps are sequential
Flexibility - adapt to needs of stakeholders
Functionality - useful in improving health conditions
Also, consider…
Population-based approach
Ecological framework – individuals/priority populations influenced by many different levels
PRECEDE–PROCEED
PRECEDE – “predisposing, reinforcing, and enabling constructs in educational/ecological diagnosis and evaluation” (Green & Kreuter, 2005, p. 9)
Developed in the early 1970s
PROCEED – “policy, regulatory, and organizational constructs in educational and environmental development” (Green & Kreuter, 2005, p. 9)
Developed in the 1980s
PRECEDE–PROCEED (cont.)
Best known and often used model
Theoretically grounded
Comprehensive in nature
Found in many government programs, including PATCH
PRECEDE–PROCEED (cont.)
PRECEDE
First 4 phases are assessment phases; social, epidemiological, behavioral and environmental, educational and ecological, administrative and policy and intervention alignment
PROCEED
Last 4 phases; implementation, and process, impact, and outcome evaluation
Underlying approach – …begin by identifying the desired outcome, to determine what causes it, and then design an intervention to reach the desired outcome
PRECEDE–PROCEED (cont.)
Phase 1 - Social Assessment and Situational Analysis
Phase 1 - seeks to subjectively define the quality of life (problems and priorities) of those in the priority population
Best accomplished by involving those in the priority population in self-assessment of needs and aspirations
Assessment means…
identify
describe
prioritize
Examples of social indicators of quality of life: achievement, alienation, comfort, crime, happiness, self-esteem, unemployment, and welfare
Phase 2 - Epidemiological Assessment
Phase 2 – is the step in which planners use data to identify and rank the health goals or problems that may contribute to or interact with problems identified in Phase 1
Data include vital indicators (e.g., morbidity, mortality, and disability data) as well as genetic (new addition looks at relationship between genes and health/illness), behavioral (patterns of behavior that protect or put at risk), and environmental (things outside person that can be changed to impact health) factors
Not all problems health related, then skip Phase 2
Risk factors/determinants can be prioritized with 2 X 2 matrix
Prioritization Matrix
Phase 3 - Educational & Ecological Assessment
Phase 3 – identifies and classifies factors that have potential to influence behavior or change the environment
Predisposing factors –impact motivation; e.g., knowledge, attitudes, beliefs, perceptions, and values
Enabling factors –barriers and vehicles; e.g., skills, access, availability, rules, and laws
Reinforcing factors –feedback and rewards; e.g., social benefits such as recognition, appreciation; incentives; disincentives
Priorities become focus of intervention
Phase 4 - Intervention Alignment & Administrative & Policy Assessment
The intent of intervention alignment is to match appropriate strategies and interventions with projected changes and outcomes identified in earlier phases
In administration & policy assessment, planners determine if capabilities and resources are available to develop and implement program
Close to the end of PRECEDE and moving toward PROCEED; though not a distinct break
Phase 5 - Implementation
Beginning of PROCEED
Phase 5 – with resources in hand, planners select methods and strategies of the intervention; examples education, communication, environmental change, etc.
Program begins
Phases 6, 7, & 8 - Evaluation
Process evaluation – measurements of implementation to control, assure, or improve the quality of the program
Impact evaluation – immediate observable effects of program
Outcome evaluation – long-term effects of the program
Line up with PRECEDE
Which ones are used depends on the evaluation requirements of the program
Multilevel Approach To Community Health (MATCH)
Applied when behavioral and environmental risk and protective factors for disease/injury are known and general priorities determined
Includes ecological planning - levels of influence
MATCH (cont.)
MATCH (cont.)
Phase 1 – Health Goals Section
Select goals - consider prevalence, importance, and changeability
Select priority (target) population
Identify behaviors associated with health status
Identify environmental factors (barriers and vehicles)
Phase 2 - Intervention Planning
Select intervention objectives
Identify targets of intervention (TIAs)
Select intervention approaches (ecological levels): Governments, Organizations, Communities, Individuals
MATCH (cont.)
Phase 3 – Development
Create program units or components
Create plans
Phase 4 – Implementation
Adoption
Implementation
Maintenance
Phase 5 – Evaluation
Conduct process evaluation
Measure impact
Monitor outcome
Consumer-Based Planning
Decisions based on consumer input and made with consumers in mind; include consumers throughout
Based on concepts from–
health communication – strategies to inform and influence individual and community decisions to enhance health (NCI, 2002)
social marketing – “the application of commercial marketing technologies to the analysis, planning, execution, and evaluation of programs designed to influence the voluntary behavior of target [priority] audiences in order to improve their personal welfare and that of their society” (Andreasen, 1995, p. 7)
Key Elements that Best Characterize the Practice of Social Marketing
CDCynergy
Developed initially for public health professionals at CDC with responsibilities for health communication
Developed for health communication but can be used with all health promotion planning
CDCynergy (cont.)
P 1: Describe Problem (identify & define)
P 2: Analyze Problem (causes, goals, intervention strategies)
P 3: Plan Intervention (Is communication dominant or supportive?)
P 4: Develop Intervention
P 5: Plan Evaluation
P 6: Implement Plan
Navigation controls: Contains 52 steps divided among the phases
CDCynergy (cont.)
Other links
Lite
Glossary
Index
CDC Web
Help
My Plan
Active
buttons [change
with phase &
step] (examples,
resources,&
consultant)
Non-changing
buttons (tools
for research &
media library)
There is also a supplemental resources CD for CDCynergy 3.0
Social Marketing Assessment & Response Tool
SMART, created by Neiger & Thackeray (1998), is a social marketing planning framework
A careful review of the model provides an excellent overview of social marketing
SMART has seven phases
The heart of the model is composed of Phases 2, 3 , & 4; usually performed simultaneously
SMART (cont.)
P 1: Preliminary
Planning [problem, name in terms of
behavior, develop goals, project costs]
P 2:
Consumer Analysis [segment
priority population
& determine needs,
wants, & preferences]; also
secondary & tertiary audiences
P 3: Market
Analysis of [4Ps (place, price,
product, promotion)
competitors,
& partners]
P 4: Channel
Analysis [interpersonal,
small group,
organizational,
community,
mass media]
P 5: Developing Interventions, Materials, & Pretesting
P 6: Implementation
P 7: Evaluation
Other Planning Models
A systematic Approach to Health Promotion (Healthy People 2010; Healthy People 2020)
Components
Goals
Objectives
Determinants of health
Health status
Other Planning Models (cont.)
Mobilizing for Action through Planning & Partnerships (MAPP)
Relatively new; created by NACCHO for use by local public health agencies
Phases
Organizing for Success and Partnership Development
Visioning
Four MAPP Assessments (arrows around phases: next slide)
Identify Strategic Issues
Formulate Goals and Strategies
The Action Cycle ( Implement and Evaluate)
MAPP (cont.)
Four MAPP Assessments
Community Themes and Strengths Assessment: issues residents feel are important: "What is important to our community?" "How is quality of life perceived in our community?“ "What assets do we have that can be used to improve community health?“
Local Public Health System Assessment: focuses on all of the organizations and entities that contribute to the public's health. "What are the components, activities, competencies and capacities of our local public health system?" "How are the Essential Services being provided to our community?"
Four MAPP Assessments (cont.)
Community Health Status Assessment: identifies priority community health and quality of life issues. Questions answered here include, "How healthy are our residents?“ "What does the health status of our community look like?“
Forces of Change Assessment: identifying forces such as legislation, technology that affect the context in which the community and its public health system operate. Answers the questions, "What is occurring or might occur that affects the health of our community or the local public health system?“ "What specific threats or opportunities are generated by these occurrences?"
Other Planning Models (cont.)
Assessment Protocol for Excellence in Public Health (APEX-PH) (NACCHO) [PACE-EH]
Components
Organizational capacity
Community Process
Completing the Cycle
SWOT (Strengths, Weaknesses, Opportunities, Threats) Analysis
| O | T |
| S |
| W |
Other Planning Models (cont.)
SWOT analysis helps minimize planning time
Helps identify problems, set/clarify goals and creates a plan
Requires the examination of strengths (assessment of resources, what it does well or differently, expertise of personnel, partnerships)
Examines weaknesses
Opportunities include unmet consumer needs, removal of administrative or legislative barriers, new funding, a coalition
Other Planning Models (cont.)
Threats involve shift in consumer trends, promotion of harmful products or services in the community
Strengths and weaknesses pertains to organization’s internal weakness; opportunities and threats relate to the external environment
Other Planning Models (cont.)
Healthy Communities (Healthy Cities) (USDHHS)
Components:
Mobilize
Assess
Plan for Action
Implement
Track Progress and Outcomes
The Communication Model (NCI, 2002)
Other Planning Models (cont.)
Healthy Plan-IT (CDC)
Components
Priority Setting
Establishing Goals
Outcome Objectives
Strategy
Evaluation
Budget
Other Planning Models (cont.)
Intervention Mapping
Relatively new– 1998
Based upon the importance of planning programs that are based on theory and evidence
Draws on both the PRECEDE–PROCEED and MATCH models
Steps – 1) Needs assessment, 2) Matrices of Change Objectives, 3) Theory-based methods and practical strategies, 4) Program, 5) Adoption and Implementation, and 6) Evaluation Planning
Still Other Planning Models
Comprehensive Health Education Model (Sullivan, 1973)
Model for Health Education Planning (Ross & Mico, 1980)
Model for Health Education Planning & Resource Development (Bates & Winder, 1984)
Planned Approach to Community Health (CDC, no date)
Generic Health/Fitness Delivery System (Patton et al., 1986)
The Planning, Program Development, and Evaluation Model (Timmreck, 2003)
Class Activity
Identify possible risk factors for your assigned topic/issue and prioritize them using the 2 X 2 prioritization matrix.
Conduct a SWOT analysis on your issue and identify your group and community’ strengths, weaknesses and resources.