Health and Wellness Programming: Design and Administration

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4 C H A P T E R

Program Planning: The Big Picture

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Key Terms: planning committee, program ownership, program desired outcome, potential program provider, potential consumer, evidence-based or science-based

The coalition feels good about their needs assessment. What an in- teresting process it was, and they discovered much that they did not know. Clearly, however, respirator y-related health problems are on the rise, and cigarette smoking is by far the major contributor. Now, they have to decide what to do.

Health professionals have always planned programs to achieve desirable ends, such as to impact health status and improve the quality of life. Over the years, planning has become more systematized and, as a result, potentially more ef- fective. The planning models developed to assist in this process include Precede–Proceed, PATCH, Model for Health Education Planning (MHEP), and Comprehensive Health Education Model (CHEM) (McKenzie & Smeltzer, 2001). Although the models differ, there does appear to be some consistency in the literature regarding recommendations for going about the program plan- ning process. Suggested steps for program planning and general planning principles will be reviewed in this chapter. The planner may conduct the plan- ning activities in an order that differs from the one presented here, or a num- ber of the described activities of program planning may be conducted simultaneously. The size and past experiences of the planning committee may influence the steps for planning, along with the size and scope of the program being planned and implemented.

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70 Chapter 4: Program Planning: The Big Picture

Program Planning Steps

Step 1: Review the Needs Assessment It is suggested that the planners conduct a review of the needs assessment data and the resulting decisions that have been made up to this point. This review will help to determine if the most appropriate recommendations for the di- rection and outcome of the program have been made to meet the needs of the target population. It is possible for the planning committee to identify addi- tional data that are useful to shaping the intervention, which were not undis- covered or overlooked in the initial needs assessment process. A large amount of data may have been collected as part of the needs assessment, but during a review, a skillful planning committee can organize and synthesize the infor- mation into a format that provides meaning and value, which may not have been obvious during the initial examination of the data (Aspen Reference Group, 2002).

Box 4.1 Action steps to establish or strengthen a coordinated school health program.

At the school level At the district level

Source: Fetro, J. V. (1998). Implementing coordinated school health programs in local schools. In Marx, E. & Wooley, S. F. (eds.), Health is academic: A guide to coordinated school health programs (p. 21). New York: Teachers College Press.

Establish school-based leadership. Identify key players. Establish a healthy school team and select a coordinator. Get support from other school-site staff. Establish a common language. Set up a safety net. Map existing school-based and community-based resources. Identify student, family, and staff needs. Identify programmatic needs. Develop an implementation and coordination plan. Identify existing and potential sources of funding.

Secure district-level leadership. Establish a broad-based advisor y committee. Identify supports and challenges in the broader school community. Develop supportive board policies. Train district and community advocates to sell the program.

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Program Planning Steps 71

Step 2: Convene an Advisory Panel or Planning Committee As described in an earlier chapter, community members should be involved in the entire planning process, as they are important contributors to the development of all aspects of the program, from conducting the needs assessment to evaluat- ing the program (Aspen Reference Group, 2002; W. K. Kellogg Foundation, 1998). For a number of reasons, it is necessary to involve or consult with appropriate community members at the very beginning of the program planning process and to include them on an advisory panel or planning committee. As with the needs assessment process, target population and stakeholder involvement is necessary during the planning and implementation stage. The involvement of target popu- lation members will help to develop program ownership, which is critical for their eventual involvement in and acceptance of the program. Target population mem- bers can provide the planners with critical insight into the target population that could make or break the efforts toward the desired outcome of the program. It is important that the program be founded on the philosophical position that it is being done with the community rather than to the community (Rainey & Lindsay, 1994).

If a coalition or advisory board was formed prior to the needs assessment, its members may form the basis for the program planning committee. When there is an existing committee structure, it will be important to review con- stituencies that will need to be represented for the program planning part of the process. Important contacts for inclusion on any coalition or board include potential program providers, as well as potential program clients or potential consumers. Representatives from a local college or university might also be con- sidered, as they may offer skills and possible resources to assist with program planning and implementation. College professors might have areas of exper- tise that are needed by the planning committee, or a college class might assist in conducting some of the activities of the project as part of a course require- ment. Consider representatives that will enhance the work of the committee and prove to be helpful to the success of the new program. When putting together a list of potential program planning advisory board members, consider indi- viduals that can be described as follows: � Are well respected by the target audience and can provide valuable links

to the community

� Represent the various groups within your target population and have the ability to provide relevant input for program planning

� Have knowledge of the target audience, members and their lifestyles, attitudes, and resources

� Bring to your committee a number of skills and resources that will be useful to the program (Aspen Reference Group, 2002; Breckon, Harvey & Lancaster, 1994)

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To encourage a potential candidate to take a position on an advisory board or committee, it is recommended that he or she be contacted personally through a face-to-face discussion or telephone conversation. When a personal contact is not possible, a letter or e-mail that reaches out to potential board members may be necessary. Regardless of how the initial contact is made, the following information may prove useful for informing the potential board member of the fundamentals of the program being developed (Keyser et al., 1997): � A statement on the purpose or intent of the contact

� The name of a key contact person, his or her title, and organization (including a brief overview of his or her role in this project)

� A description of the target population

� The area of emphasis of the program and the health concern or issue to be addressed

� Program justification

� A solicitation of support from the receiver

� Ways that the potential candidate may connect with the key contact (e-mail address and cell and office phone numbers)

Step 3: Assess and Establish a Budget for Program Planning A budget must be considered for the planning phase of the project. Subsequently in this chapter, program budgets will be addressed, but a budget for program planning is important to facilitate the planning process. Because a budget for planning is often overlooked, it is added here as a separate step. This step is important, because resources are needed for conducting the initial research and putting together the groundwork that is required prior to piloting and im- plementing the program. Creating an advisory or planning committee, devel- oping the materials of the program, and preparing the necessary documents all require staffing, time, and financial support. Program success depends on this planning process, and cutting corners here can result in a program that fails to meet the needs of the target population and fails to produce the program desired outcome.

Step 4: Write and Review a Mission Statement The mission statement is a narrative statement describing the focus of the program, which often includes the program intent and philosophy (McKenzie & Smeltzer, 2001). Developing a mission statement is a critical step in creating a strong foundation for the development of program goals and objectives and is a pro- gram activity that must be accomplished very early in the planning process. A mission statement may have been written as part of the needs assessment process, so it is important to review any existing mission statements before proceeding.

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Step 5: Write and Review Program Goals and Program Objectives The program goals evolve from the mission statement, and the objectives evolve from the goal or goals. Once the mission statement is in place, the task of de- veloping the outcome or goal of the project, along with the specific objectives, needs to occur (NACCHO, n.d.). Objectives outline in measurable terms the desired changes that should occur in the target population as a result of the in- tervention and provide the basis of evaluation for the program (McKenzie & Smeltzer, 2001). Suggestions for developing a mission statement, program goals, and objectives are provided in an earlier chapter. If goals and objectives were developed as part of a needs assessment process, they will need to be re- viewed and possibly adjusted.

Step 6: Select a Theory or Theories on Which to Base Your Program One or more theories or specific constructs from the pro- fessional literature is needed to guide the planners in de- veloping or selecting the intervention required to meet program goals and objectives (Glanz & Rimer, 1997). Successful health education programs are grounded in a theoretical foundation that is reflective of the current re- search and understandings of the profession. Chapter 6 reviews some of the most commonly used theories in health education and health promotion.

Step 7: Review Other Programs to Generate Program Strategy Alternatives Those involved in the program planning process need to identify potential strategies that address the goals and objectives that have been identified (NACCHO, n.d.). To ensure success for the intervention, it is important to base the new program on other successful programs. A wide review of the pro- fessional literature and other professional documents, paying attention to programs and strategies that have been deemed successful through some type of evaluation, will help to generate a list of potential strategies and activities. Many foundations and professional associations or organizations offer lists of evidence-based or science-based programs that should be examined for po- tential use in the project. In the manual Getting to Outcomes: Methods and Tools for Planning, Evaluation, and Accountability, Fetterman (2000) provides a list of criteria for determining if a program is evidence-based and it includes the following: � The degree to which the program is based upon a well-defined theory or

model

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Checkpoint 4.1 What are some of the most commonly used theories and models for describing health behavior?

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� The degree to which the population serviced received sufficient interventions

� The quality and appropriateness of the data collection and data analysis procedures used

� The degree to which there is strong evidence of a cause and effect relationship

The use of science-based programs is encouraged but not always possible. There also exists in the literature programs that have demonstrated effective- ness but do not meet the science-based criteria. Practice-based programs or “best practices from the field” can be found in the professional literature in profes- sional journals, through foundations and government organizations, and on Web sites (Fetterman, 2000). A search of best practices may provide the plan- ners with strategies or intervention suggestions that can be adopted to meet the needs of the program or intervention being developed.

Once a literature review for successful programs has been conducted, follow- up telephone calls to staff associated with those programs may assist in provid- ing additional details and insight that is not apparent in the available literature. A conversation with the appropriate staff member or director could provide the planners with feedback on a number of issues, such as the location and need for resources, overcoming implementation barriers, and evaluation strategies.

Step 8: Assess and Establish the Budget for Program Implementation Review the financial arrangements for the program by looking at the money pro- vided by the main funding source and any funding from another party or or- ganization. Assess the allocated budget and its parameters to determine if it is sufficient to perform the tasks and activities of the program. Identify the re- sources for program implementation—those that already exist and those to be developed or purchased—and determine if they will be sufficient to achieve the program goals. The budget should include allocation for staffing, program sup- plies and materials, facilities and space, marketing resources, and other oper- ational expenses (Breckon, Harvey & Lancaster, 1994).

For a more detailed examination of potential budget items and consider- ations, the following questions for the planners from the Community Tool Box located at http://ctb.lsi.ukans.edu/ are provided (Rabinowitz, 2003): � What are the activities that will do the most to advance your cause and

mission that you can carry out with the resources you have?

� How many staff positions will it take to run the activities and do it well?

� How much money will go to staffing (salary, consultant fees, fringe benefits) and from what sources will staff members be compensated?

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� What else will be needed to run the program and its activities (space, supplies, equipment, phone and other utilities, insurance, travel, indirect costs, etc.)?

While attempting to identify the necessary personnel to be involved in the project, planners should consider hiring from the target population (Aspen Reference Group, 2002; W. K. Kellogg Foundation, 1998). Staffing with mem- bers of the community helps to increase program acceptance and provides valuable insight into the community and its members. For many programs, hav- ing sufficient funding is a primary concern. An investigation into the possibil- ity of donated or shared resources with other community programs, such as building space or large equipment items, might help to address some funding limitations. Finding low-cost or donated program materials, such as curricu- lum and other educational items, may be possible through voluntary health agencies or government offices.

Grants and financial gifts from foundations, government agencies, com- munity groups, and businesses is another way to increase funding for a program (McKenzie & Smeltzer, 2001). Opportunities for seeking soft money, such as grants, will require an investigation into the potential funding sources that exist and an examination of the types of projects or programs that are funded by those sources. Interviewing staff members from similar programs, contact- ing government offices for potential funding, and working with a local college or university and its research office are a few suggestions for getting started in the pursuit of soft money.

Step 9: Estimate Time Often, a timetable of the specific tasks and activities of the program is devel- oped to assist those involved in the process by informing them of when the ac- tivities are to take place and who is responsible for each activity. Planners often develop timelines that reflect the implementation and evaluation process. Including the entire planning process on the timetable can be most helpful (McKenzie & Smeltzer, 2001). Planners need to develop a timeline that flows logically, is realistic, and will assist in achieving the goal by the program dead- line. In order to prepare a timeline many planners use a Gantt timeline and chart out the project activities on a day-to-day, week-to-week, or month-to-month basis. A wealth of information on this charting method exists in the professional literature and on the Web.

Step 10: Select Strategies and Activities At this point, planners need to consider which intervention strategies and ac- tivities can best help to achieve the program goals. Again, a review of the lit- erature for effective intervention details is an important step to consider. Several

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potential strategies should be identified for each objective. The selection of the strategies and activities of the intervention is a process that takes some time and investigation to successfully accommodate the target population and meet the program objectives.

Those involved in strategy selection must attempt to identify potential barriers to the implementation of each strategy identified (NACCHO, n.d.). Reviewing the needs assessment information may identify some barriers, as will a look at the professional literature. Talking with others who may have used the strategy in similar situations can also reveal potential barriers to using the strategy. The existence of implementation barriers does not rule out the use of a strategy, but the barriers must become part of the discussion of whether to incorporate a particular strategy into the program.

The program planning group should investigate, outline, and discuss the details of all strategies being considered for inclusion in the program before mak- ing final selections, based upon a mutually agreed upon set of criteria. During this process, the group should consider program strategies that accomplish the following: � Fit with the resources and needs of the community

� Consider the beliefs, values, and practices of the community

� Reflect field testing (have shown success in the field)

� Dispel health misconceptions (Aspen Reference Group, 2002)

� May be related to other strategies under consideration

� Support the theoretical framework of the program (NACCHO, n.d.)

In the literature on successful or similar programs, there may appear ref- erences to curricula or canned interventions that can be purchased for use with the program being developed. There are a number of national curricula or health programs that have been shown to be effective and are worth consider- ation for adoption. According to Lohrmann and Wooley, effective health edu- cation curricula should include the following eight characteristics: � Are research-based and theory-driven

� Include basic, accurate information that is developmentally appropriate

� Use interactive, experiential activities that actively engage students

� Provide students an opportunity to model and practice relevant social skills

� Address social or media influences on behavior

� Strengthen individual values and group norms that support health- enhancing behaviors

� Are of sufficient duration to allow students to gain the needed knowledge and skills

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� Include teacher training that enhances effectiveness (1998, p. 44)

The MAPP process suggests that, at this point in the program planning process, a report be drafted by the planning committee (NACCHO, n.d.). The report should synthesize and outline the program planning decisions. The re- port then becomes a written reference point for the program planning committee during the program adoption and implementation processes. It can also be shared with advisory councils, boards of directors, and the community at large.

Step 11: Plan Evaluation By this point in the process, the development of an evaluation plan should have been initiated. Evaluation should be designed as a continuous process so that even the planning process itself is evaluated (Aspen Reference Group, 2002). It is im- portant to select evaluation methods and questions that will facilitate process, im- pact, and outcome evaluation. What data need to be collected and when are they collected are critical considerations for a comprehensive evaluation. Evaluation instruments and record-keeping methods must be developed so that the neces- sary data are available for the evaluators (Aspen Reference Group, 2002). The plan- ner or planners may not have the expertise and resources to conduct all phases of the evaluation, and an outside or external evaluator may need to be consulted (Rainey & Lindsay, 1994). If an external evaluator is needed for the project, it is suggested that the evaluator be brought in during the planning phase to develop the evaluation plan as early as possible in the process.

Step 12: Determine and Establish Cooperative Agreements and Linkages with Other Appropriate Community Agencies A successful program has at its wheel a planner who knows the importance of politics and the necessity of working with the key decision-makers and other community agencies at the local level. A review of the current pro- gramming that is being offered to the target population must be conducted. Do similar programs exist for this group? Will the program meet needs not cur- rently being met or addressed? Determine how the new program will differ, strengthen, or enhance what already exists and if avenues for collaboration are present (Fetterman, 2000; Rainey & Lindsay, 1994). Collaborative relationships for intervention development and delivery may take many forms, including an advisory committee, a consortium, a network, or a task force. The goal of this relationship must be explored, as the outcome could be that of sharing infor- mation, coordinating services for the target population, or working to advocate for a policy or environmental change.

The following questions may help in determining if there are political barriers to the program, and may help develop the potential for cooperative relationships:

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� What agencies and organizations are already involved with this health concern and might perceive your program as a threat?

� What can be done to gain the support and endorsement of those agencies?

� Should a coalition of interested groups be formed to address the health concern? (Rainey & Lindsay, 1994)

Step 13: Write Component-Specific Behavior and Learning Objectives Once the activities and strategies of the project have been identified, and possi- bly purchased or developed, it may be time to reevaluate the objectives. This reevaluation is useful to determine if the existing objectives are still adequate for meeting the program goal or goals. An intervention often contains a num- ber of different components or actions that target different behaviors or envi- ronmental factors. Each component must include objectives that are specific to each targeted action or behavior. For example, if a program focuses on physical activity, diet, and exercise, then a set of objectives must be developed for each of the three sets of behaviors. One set of objectives must be targeted toward phys- ical activity, one toward diet, and one toward exercise. At this step in the plan- ning process, additional learning objectives may need to be written to reflect the full scope of the intervention and all that it is developed to impact.

Step 14: Pilot-Test the Intervention Prior to a full program implementation, it is suggested that a pilot test of the intervention be conducted. A pilot test, with a small group that represents the target population, is helpful to identify potential flaws or problems with the in- tervention. The information that results from this step could result in correc- tions that could save valuable resources and time later on. Common problems that may be uncovered during a pilot test generally deal with potential flaws in the actual design or delivery of the intervention. A process evaluation of the pilot test that examines the intervention program, strategies, materials, and im- plementation could result in information that necessitates adjustments to the implementation (McKenzie, Pinger & Kotecki, 2002). Some questions to ask during the process evaluation of the pilot test to determine if you need to fine- tune the implementation are as follows: � Were program materials pretested?

� Is the message appropriate for the target audience in terms of language, values, and educational levels?

� Is the message appropriate to meet the stated objectives?

� Is the program appropriate to meet the stated objectives? (Rainey & Lindsay, 1994)

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� Was the intervention implemented as planned?

� Was the person conducting the intervention well received?

Step 15: Implement the Program This step involves carrying out the activities that make up the intervention, while attempting to meet objectives and, ultimately, the program goal. Implementation can be conducted after the pilot test results are analyzed and any resulting adjustments are made to the intervention (McKenzie, Pinger & Kotecki, 2002). Once the program is revised, it is suggested that the program be phased in rather than completely implemented. McKenzie and Smeltzer (2001) offer four approaches to phasing in a program:

1. By different program offerings

2. By placing an initial limit on the number of participants

3. By choice or location within the target population community

4. By participant ability or skill level (start with beginner-level programming)

Fetro (1998) identifies several factors or program characteristics that con- tribute to the successful implementation of a coordinated school health program. These characteristics, if present, assist the planner of a community or health promotion program in conducting a successful implementation as well. These characteristics include a clear underlying purpose with potential outcomes; a perceived value in addressing identified needs; adaptability; replicability; con- sistency with the institution’s mission and vision; ease of implementation; cred- ibility with staff and the community; a capacity for broadening the knowledge base of the target population; and the potential for the program to enhance, sup- plement, or support existing programs (Fetro, 1998).

Jose and Dee decided to split their programming planning efforts by creating two new committees. One will focus on community program- ming inter ventions, and the other will work with the coordinated school health program to focus on school-age youth. The coalition will con- tinue to exist but will meet less frequently. Some coalition members have become members of the new planning committees. The planning committees have broken into smaller work groups to establish bud- gets, write mission statements, define goals and objectives, and re- search inter vention ideas.

Social Marketing, Program Planning, and Implementation Social marketing entails using marketing principles to influence the behavior of groups for the benefit of society (Goldman, 2003). Social marketing princi- ples can assist us in developing and implementing programs that are focused,

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relevant to our target populations, and, thus, more apt to be successful. As you will notice as you read this chapter, we have already discussed some concepts that are included in social marketing. However, by reviewing social marketing principles, you will learn how to make connections between program devel- opment and implementation.

Several of the most important concepts of social marketing will be discussed here. You are encouraged to consult the references at the end of the chapter on your own for more detailed discussions of these concepts. These concepts are exchange, evolving behavior, marketing mix, positioning strategy, and market segmentation (Goldman, 2003; Smith, 2000; Andreasen, 1995).

Exchange The concept of two or more entities exchanging something is considered to be the central idea of social marketing (Smith, 2000). It answers the question, I’ll consider doing this for you, but what is in it for me? For example, what does the parent get out of properly using a child car seat? What does the 60-year- old get from quitting smoking, or the fully employed parent from physical ac- tivity? The implications for the program planner and facilitator or teacher are that the behavior you are asking individuals to engage in and the benefits of engaging in it must be clearly communicated to the target group and perceived by them as beneficial. A study by Hawkins and colleagues (2002) on the mean- ings of sexual activity for rural youth found that the term sexual activity did not have one consistent definition among these youth. The first steps in setting up an exchange with this group would be to determine exactly what behaviors you are trying to get the group to adopt and clearly communicate what those be- haviors are in terms and language that are clear to the target group. You would then have to figure out what they would get in exchange for engaging in the recommended behaviors or, in other words, what your program will be pro- moting about the recommended behaviors.

Evolving Behavior Behavior and the reasons for (or against) engaging in a behavior evolve. Thus, an intervention must evolve and adjust. For the program planner, this means con- ducting a process evaluation and acting on the results. It also means that needs assessments must be periodically updated. O’Donnell and colleagues (2002) found that the percentage of both male and female urban minority youth who reported ever having engaged in sexual intercourse increased from the fall to the spring of seventh grade. This may have implications for your program.

Marketing Mix Perhaps better known as the four Ps—product, price, place, and promotion— the proper marketing mix can be crucial to the success of a program. All four elements must be analyzed and considered during program development to as-

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certain the best mix for the target population. All elements are employed but not necessarily to the same degree (Goldman, 2003).

Product Product, in this case, refers to the behavior that you are trying to have the tar- get population adopt. Goldman (2003, p. 95) suggests a series of questions to be asked about the product (behavior) you are offering to the target population. They are summarized as follows: � What is the core product?

� What benefits of the product, valued by the program participant or student, should be offered (e.g., feeling better about oneself, experiencing fewer symptoms, gaining increased social acceptance, or generating cost savings)?

� What is the tangible product (program or intervention)? How is it packaged? What are its features? What is its style? What is its quality level?

� How can value be added to the tangible product to make it more attractive?

� What else do participants or students receive after participation?

The program planner must complete a thorough needs assessment and must thoroughly involve the target population during both the needs assessment and program planning stages in order to address the product questions.

Price Goldman defines the concept of price as “financial, temporal, emotional, and energy cost” (2003, p. 94). Smith (2000) reminds us to consider the social cost of engaging in the behavior being promoted. The needs assessment should in- clude strategies to identify the target group’s perceived barriers to engaging in the behavior; although, sometimes these are difficult to identify up front (Goldman, 2003). The program planners can focus intervention strategies on removing or lessening the costs (real or perceived) to the target population.

Place The concept of place includes the places or channels used to deliver the program, which are designed to encourage the target population to adopt the product (behavior). The program planner must assess prefer- able and appropriate physical locations (ensuring com- fort and safety), communication delivery channels, program delivery channels, and facilitator and teacher characteristics while developing the program. Where are people willing to go or definitely unwilling to go? Where do the individu-

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Checkpoint 4.2 What might be some of the costs to a traditional college-age student for abstaining from experimenta- tion with marijuana?

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als go on a regular basis, and can delivering occur there? Are there nontradi- tional channels that could be considered? (Goldman, 2003).

Promotion What are you going to say about the behavior and through what channels will you say it? These questions represent the concept of promotion. It is impera- tive for program planners to be culturally literate with regard to the target pop- ulation, to include target population members on planning committees, and to assess and pilot channels of delivery. Channels used to attract participants may include advertising, public relations activities, direct marketing, counseling, games, personal communications, and consumer promotions.

Positioning Strategy The program planner needs to understand, from the target population’s per- spective, what the competition is. What is competing with the adoption of the recommended behavior? What is done instead? The competition may include other behaviors (or not engaging in particular behaviors). There may also be attitudes, beliefs, and enabling factors associated with not engaging in the rec- ommended behavior. This suggests that the program planner must not only ex- amine the perceived benefits and barriers of the recommended behavior, but also those of the competing actions. This way the recommended behavior can be positioned in comparison to the competing behaviors.

Market Segmentation As described by Forthofer and Bryant (2000, p. 36) market segmentation in- volves “dividing a population into distinct segments based on characteristics that influence their responsiveness to marketing interventions.” In health ed- ucation and health promotion, market segments might be based on such fac- tors as stage from the Stages of Change Model (described in Chapter 6), attitude toward the behavior, level of self-efficacy, or frequency of engagement in the be- havior. Dividing the target population into distinct segments has several ben- efits, including the identification of subgroups that can realistically be reached with available resources, and the ability to develop a program that is a good fit for each segment, rather than a general fit for the whole target population.

The social marketing recommendations that fol- low have been adapted from steps outlined by Andreasen (1995): � Be thorough in your needs assessment. Be sure to identify competing actions and opportunities.

� Get help with developing your social marketing strategies if you feel “lost.” Hire a consultant, utilize the faculty at local

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Checkpoint 4.3 What sort of market segmenta- tion do we use in comprehensive school health education?

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colleges and universities, or recruit a marketing specialist to your advisory group.

� Address your target population’s perceived barriers to the four Ps. They are not always the same as the “real” barriers that may have been identified in your needs assessment.

� Continually reassess the four Ps as your program or curriculum evolves.

� Engage in process evaluation and make adjustments based on the results.

� It is okay to start small. Try social marketing principles in small steps and see what happens.

Jose has selected a public awareness campaign as one of the pieces of his inter vention addressing cigarette smoking. He knows that he must create and communicate messages that will resonate with the adults in the community. He decides to consider a social marketing approach.

Jose went back to his needs assessment data and took a look at the factors contributing to cigarette smoking to see if they differed by age, income, ethnic or cultural group, and gender. He found some in- teresting differences. He decided that he needed to get a little more information about what might motivate some of these groups to ex- change cigarette smoking for something else. He cajoled his super vi- sor into funding refreshments so that he could run a few focus groups. He found the motivators to be being able to play with the grandchildren for those older than 55 years; not having to stand outside in the cold in the winter for those from ages 30 to 55 years; and saving money for those younger than 30. He plans to base his messages around these motivators. He also determined that worksites are the best places to deliver smoking cessation programs. He will have to work on tr ying to get employers to allow flextime or slightly longer lunches so that em- ployees can attend during work hours.

Summary Recommendations for program planning, along with general principles for guiding program planning, were reviewed. Fifteen steps for successful planning and implementation were discussed. Those 15 steps consisted of conducting a review of the needs assessment, convening an advisory panel, budgeting for pro- gram planning, writing the mission statement, writing the goals and objec- tives, selecting appropriate theories, reviewing other programs, establishing a budget for implementation, establishing a timeline, selecting strategies and

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activities, planning the evaluation, establishing cooperative agreements, writ- ing component-specific behavior and learning objectives, pilot-testing the in- tervention, and implementing the program.

1. What should be considered when selecting strategies for inclusion in a program?

2. What are the broad steps involved in planning a health education or health promotion program?

3. What is a pilot test, and why should it be conducted?

4. Think about adult cigarette smoking behavior. What can your program give adults in exchange for quitting smoking?

5. Conduct some research and make a list of the perceived benefits of smoking for adults, and a list of the attitudes, beliefs, and enabling factors that compete with quitting. How do you think you will position not smoking?

6. Conduct some research and make a list of the perceived benefits of smoking for adolescents and a list of the attitudes, beliefs, and enabling factors that compete with quitting. How would your positioning of not smoking differ for adolescents and adults?

7. What are some nontraditional channels of delivery that could be used for smoking adults in your community or in a worksite in your community?

1. Write a one-page paper describing what might be different when planning a program for a community-based program as opposed to a school-based program.

2. Locate a description of a health promotion program. Review the program based on the criteria outlined in step seven. Would you adopt all or some of the components of this program? Why or why not?

3. Locate and examine a request for proposal (RFP) from an agency or foundation to determine the types of health education projects that may be funded with soft money. Review the types of information needed to complete the proposal process.

E X E R C I S E S

Q U E S T I O N S

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4. Identify a health promotion program in the professional literature. Generate a list of possible budget items, and attempt to identify a low- cost way to cover some of the necessary expenses.

5. You want to make sure that you have enough money in your budget to pilot-test your program before full implementation. Write a memo to your supervisor explaining why it is important to pilot-test your program.

Andreasen, A. A. (1995). Marketing social change. San Francisco: Jossey-Bass.

Aspen Reference Group (2002). Community health education and promotion: A guide to program design and evaluation (2nd ed.). Gaithersburg, MD: Aspen.

Breckon, D. J., Harvey, J. R. & Lancaster, R. B. (1994). Community health educa- tion settings, roles, and skills for the 21st century (3rd ed.). Gaithersburg, MD: Aspen.

Fetterman, D. (2000). Getting to outcomes: Methods and tools for planning, evalua- tion, and accountability (Volume 1). Retrieved April 10, 2003, from http://www.stanford.edu/~davidf/empowermentevaluation.html.

Fetro, J. V. (1998). Implementing coordinated school health programs in local schools. In Marx, E. & Wooley, S. F. (eds.), Health is academic: A guide to coordi- nated school health programs (p. 21). New York: Teachers College Press.

Forthofer, M. S. & Bryant, C. A. (2000). Using audience-segmentation tech- niques to tailor health behavior change strategies. American Journal of Health Behavior, 24(1), 36–43.

Glanz, K. & Rimer, B. K. (1997). Theory at a glance: A guide for health promotion practice. Washington, DC: US Department of Health and Human Services; US Public Health Service; National Institutes of Health.

Goldman, K. D. (2003). Social marketing concepts. In Bensley, R. J. & Brookins- Fisher, J. (eds.), Community health education methods (pp. 83–105). Sudbury, MA: Jones and Bartlett.

Hawkins, M. J., Davis, M., Eady, C., Rausch, S., Donnelly, J. & Young, M. (2002). Meanings of abstinence and sexual activity for rural youth. American Journal of Health Behavior, 33(3), 140–145.

Keyser, B. B., Morrow, M. J., Doyle, K., Ogletree, R. & Parsons, N. P. (1997). Practicing the application of health education skills and competencies. Sudbury, MA: Jones and Bartlett.

Lohrmann, D. K. & Wooley, S. F. (1998). Comprehensive school health educa- tion. In Marx, E. & Wooley, S. F. (eds.), Health is academic: A guide to coordinated school health programs (pp. 41–66). New York: Teachers College Press.

McKenzie, J. F., Pinger, R. R. & Kotecki, J. E. (2002). An introduction to commu- nity health (4th ed.). Sudbury, MA: Jones and Bartlett.

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McKenzie, J. F. & Smeltzer, J. L. (2001). Planning, implementing, and evaluating health promotion programs: A primer (3rd ed.). Needham Heights, MA: Allyn & Bacon.

National Association of County and City Health Officials [NACCHO] (n.d.). Mobilizing for action through planning and partnerships. Retrieved July 15, 2003, from http://mapp.naccho.org/MAPPModel.asp.

O’Donnell, L., et al. (2002). Early sexual initiation and subsequent sex-related risks among urban minority youth: The reach for health study. Family Planning Perspectives, 33(6), 268–275.

Rabinowitz, P. (2003). Planning and writing an annual budget. In Community tool box (Part L, Chapter 43). Retrieved April 11, 2003, from http://ctb.lsi.ukans.edu/.

Rainey, J. & Lindsay, G. (1994). 101 questions for community health promotion- program planning. Journal of Health Education, 25(5), 309–312.

Smith, W. A. (2000). Social marketing: An evolving definition. American Journal of Health Behavior, 24(1), 11–17.

W. K. Kellogg Foundation (1998). Evaluation handbook. Battle Creek, MI: Kellogg Foundation

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