Models for Program Planning in Health Promotion

1. Models for Program Planning in Health Promotion Chapter 2

2. Planning Models: Background Information • Models serve as frames from which to build; Provide structure & organization for the planning process • Many different models • Common elements, but different labels A Generalized Model for Program Planning

3. Background Information (con’t.) • No perfect model • Can be used in entirety, parts, & 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 • Categories • Practitioner driven • Consumer-based

4. PRECEDE - PROCEED • PRECEDE - predisposing, reinforcing, and enabling constructs in education / ecological diagnosis & evaluation • PROCEED - policy, regulatory, and organizational constructs in educational & environmental development

5. PRECEDE - PROCEED • Larry Green & Marshall Kreuter • PRECEDE created in early 1970s • PROCEED created in the 1980s • Best known & often used model • Theoretically grounded • Comprehensive in nature • Found in many government programs

6. Phase 1 - Social Assessment • Assessment means… • Identify • Describe • Prioritize • Phase 1 - seeks to subjectively define the QOL (problems & priorities) of priority population • Self-assessment of needs & aspirations

7. Phase 2 - Epidemiological Assessment • Epidemiology - study of the distribution & determinants of disease • What are the health problems associated with the desired QOL? • Not all problems health related; If Phase 2 not applicable, skip and move on to Phase 3.

8. Phase 3 - Behavioral & Environmental Assessment • Behavior of priority population • Determining & prioritizing behavioral & environmental risk factors or conditions linked to the health problem • Environmental factors - determinants outside an individual, that can be modified to support behavior, health, or QOL • Once identified, must be prioritized

9. Phase 4 - Educational & Ecological Assessment • Identifies & classifies factors that have potential to influence behavior or change the environment • Predisposing factors - antecedent; impact motivation; e.g., knowledge, attitudes , beliefs, values • Enabling factors - antecedent; barriers & vehicles; e.g., access, availability • Reinforcing factors - subsequent; feedback & rewards; e.g., incentives, disincentives • Priorities become focus of intervention

10. Phase 5 - Administrative & Policy Assessment • Determine if capabilities & resources are available to develop & implement program • Close to the end of PRECEDE & moving toward PROCEED

11. Phase 6 - Implementation • Beginning of PROCEED • Selection of methods and strategies of the intervention, for example, education &/or other resources • Program begins

12. Phases 7, 8, & 9 - 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

13. MATCH • Multilevel Approach to Community Health • Developed in late 1980s • Used by U.S. Government • Applied when behavioral & environmental risk & protective factors for disease / injury are known & general priorities determined • Includes ecological planning - levels of influence

14. Phase 1 - Goals Selection • Select goals - consider prevalence, importance, & changeability • Select priority (target) population • Identify behaviors associated with health status • Identify environmental factors (barriers & vehicles)

15. Phase 2 - Intervention Planning • In this phase intervention objectives are matched with intervention targets & intervention actions • Identify targets of intervention actions (TIAs); consider levels of influence

16. Simons-Morton et al., (1995) Governments Organizations Communities Individuals McLeroy et al., (1988) Intrapersonal Interpersonal Institutional Community Public policy Ecological Approach

17. Phase 2 - Intervention Planning • In this phase intervention objectives are matched with intervention targets & intervention actions • Identify targets of intervention actions (TIAs); consider levels of influence • Select intervention objectives (what will change?) • Intervention actions (activities / strategies) (how to change?)

18. Remaining Phases of MATCH • 3 - Program Development (create program units or components) • 4 - Implementation (adoption, implementation, maintenance) • 5 - Evaluation (process, impact, & outcome)

19. Consumer-Based Planning • Decisions based on consumer input & made with consumers in mind; include consumers throughout • Based on concepts from • health communication - strategies to inform & influence individual & community decisions to enhance health (NCI, 2002) • social marketing - planning process designed to influence the voluntary behavior of a specific audience segment to achieve a social rather than financial objective

20. Consumer-Based Planning Models • CDCynergy, or Cynergy for short, “is a job aid or tool to help educators systematically conceptualize, plan, implement, and evaluate interventions within a public health context” (G. Cole, 2002) • SMART - Social Marketing Assessment and Response Tool

21. About CDCynergy • Developed by the Office of Communication at the CDC in 1997 • First issued in 1998 • Developed initially for public health professionals at CDC with responsibilities for health education • Developed for health communication but…

22. About CDCynergy (con’t.) • Because of widespread interest, CDC has made it available to others • CDCynergy 2001 is disseminated through SOPHE • To date $2.6 million has been spent to develop it • Wide-spread use will bring standardization • Models, examples, resources, consultants, & information on a single CD-ROM • Links to templates to create plans

23. CDCynergy P 3: Plan Intervention (Is communication dominant or supportive?) P 5: Plan Evaluation Navigation controls: Contains 52 steps divided among the phases P 1: Describe Problem (identify & define) P 2: Analyze Problem (causes, goals, intervention strategies P 6: Implement Plan P 4: Develop Intervention • 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

24. The future of CDCynergy • Plans to make CDCynergy web-based • Several versions & more to come • http://www.cdc.gov/communication/cdcynergy.htm

25. Social Marketing Assessment & Response Tool (SMART)(Neiger, 1998) 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 [4Ps, competitors, & partners] P 4: Channel Analysis [interpersonal, small group, organizational, community, mass media] P 5: Developing Interventions, Materials, & Pretesting Implementation Evaluation

26. Other Planning Models • A systematic Approach to Health Promotion (Healthy People 2010) • Components: goals, objectives, determinants of health, & health status • Mobilizing for Action Through Planning & Partnerships (MAPP) (NACCHO) • Components: Organizing, Visioning, Assessments, Identify Strategies Issues, Formulate Goals & Strategies, Action Cycle

27. Other Planning Models (con’t.) • Assessment Protocol for Excellence in Public Health (APEX-PH) (NACCHO) [PACE-EH] • Components: Organizational capacity; Community Process, Completing the Cycle • Strengths, Weaknesses, Opportunities, Threats (SWOT) Analysis S W O T

28. Other Planning Models (con’t.) • The Health Communication Model (NCI) • Healthy Plan-IT (CDC) • Components: Priority Setting, Establishing Goals, Outcome Objectives, Strategy, Evaluation, & Budget • Healthy Communities (Healthy Cities) (USDHHS) • Components: Mobilize, Assess, Plan for Action, Implement, Track Progress & Outcomes

29. Models for Program Planning in Health Promotion Chapter 2 - The End