Chapters 10,11,12

1. Chapters 10,11,12 Implementing Health Promotion Programs Lecture by J. McKenzie

2. Resources • Resources include the “human, fiscal, and technical assets available” Johnson & Breckon, 2007, p. 296) to plan, implement, & evaluate a program • Include personnel, curriculum & other instructional resources, space, equipment, supplies, & financial resources • Most carry a “price-tag,” but many are free or inexpensive

3. Personnel • The key resource; people needed to carry out certain tasks • Flex time, own time, & program ownership • Where to get personnel • Internal • External (vendors) • Public / voluntary / free (ex. speaker’s bureaus) • Private • Combination of internal & external • Culturally sensitive/competent

4. Curricula and Other Instructional Resources - 1 • Curriculum – a course of study • Sources of curricula & other instructional resources • Developing your own (in-house) or having someone else develop them; development time • Purchasing or obtaining various materials from outside sources; cost may be a concern • Purchasing or obtaining entire “canned” (participant & instructor’s manuals, AV, training, & marketing) from a vendor; Do they meet the needs of the priority population? • Combination of the above

5. Curricula and Other Instructional Resources - 2 • Outside sources • Public & voluntary health agencies (often free materials) • Local • State • Public libraries • Purchase from a vendor • Generic materials • Personalized materials

6. Curricula and Other Instructional Resources - 3 • Quality of materials – Suitability assessment of materials instrument (SAM) (Doak et al., 1996) • Components (22 items spread over 6 areas) • Content • Literacy demand • Graphics • Layout and typography • Learning, simulation, & motivation • Cultural appropriateness • Score • 70-100% Superior material • 40-69% adequate material • 0-39% Not suitable material

7. Space • Where will the program be held • Space owned by sponsoring organization • Lease/rent (e.g., from schools, religious organizations) • Free • Community rooms (e.g., business or industry) • Trade another resource for use of space • May be a clean-up charge (e.g., custodial service)

8. Equipment & Supplies • Equipment (non-consumable / non-expendable items) • Own • On loan from others • Supplies (consumable / expendable items) • Planner provides • Participants provide • Difference between equipment & supplies is sometimes determined by monetary value or the length of “life” of the commodity

9. Financial Resources • Often must make tough decisions about how to allocate funds • For profit or not-for-profit? • Types • Participant fee • Profit margin? • How much? Ownership! • Sliding scale - ability to pay • Third-party support (someone other than planning agency or participant, e.g., employer, local civic group) • Cost sharing • Organizational sponsorship (e.g., voluntary health agency, LHD) • Grants & gifts; key terms – seed dollars, in-kind support, RFPs • Combination • Budget

10. Components of Grant Proposal • Title (or cover) page • Abstract or executive summary • Table of contents • Introduction • Background • Description of proposed program (includes objectives, intervention, evaluation plan, time frame) • Description of relevant institutional/agency resources • List of references • Personnel section • Budget

11. Budget • Budget – “a formal statement of the estimated revenues and expenditures” (Johnson & Breckon, 2007, p. 170) • Financial object of the program; profit margin? • Revenue & expenditures • Once program is running there is a need to monitor the budget; preparing & distributing reports

12. Sample Budget Sheet

13. Key Terms • Market – “the set all people who have an actual or potential interest in a product or service” (Kotler & Clark, 1987, p.108) • Marketing – a set of processes for creating, communicating, and delivering value to customers: (American Market Association) • Social marketing – attempts to change behavior for improved health or social outcomes • Commercial marketing – is concerned with a financial profit • Items that can be marketed can be tangible or intangible: information, ideas, goods, services, events, or behaviors • Exchange – trading a product for certain costs

14. The Marketing Process & Health Promotion Programs • Keys to understanding the marketing process • Understanding the priority population • Knowing how to segment the priority population • Having a good understanding of the diffusion theory

15. The Consumer and Segmentation - 1 • All of the following should be based upon what is known about the priority population • Type of intervention • How the intervention is offered • How much the intervention will cost • How the intervention will be promoted • Items that must be known about those in the priority population • How they see the world • What makes them tick • How they spend their time • What is important to them

16. The Consumer and Segmentation - 2 • Segmentation is a way to divide the priority population into smaller, more homogeneous or similar groups. • Segmentation allows planers to better meet the needs of the consumer allowing for a greater chance of an exchange taking place • Factors or variables used for segmentation: demographics, geographics, geodemographics, lifestyle/psychographics, benefits sought, and behavioral (readiness to change, knowledge, attitudes, beliefs, or behaviors) • Most of time multiple factors are used to identify segments; no right or wrong way to segment; can be done a priori or a posteriori

17. The Consumer and Segmentation - 3 • Deciding on what segments to focus; possible criteria include: • Measurable – how many people in each segment & can the factors be measured • Substantial – is the segment large enough & profitable enough to reach enough people to make a difference • Accessible – can the segment be reached & services delivered? • Differentiable – are segments different enough that they will react differently to marketing strategies • Actionable – can products be created to attract segments?

18. Example of Audience Segmentation

19. Marketing and the Diffusion Theory • The diffusion theory (Rogers, 1962) provides an explanation for the diffusion of innovations (something new) in populations; or stated a little differently, it explains the pattern of adoption of the innovations. • Priority population • Innovators (-2 sd from mean) (2-3%) • Early adopters (-2 to -1 sd from mean) (14%) • Early majority (-1 sd to mean) (34%) • Late majority (mean to +1 sd) (34%) • Laggards (> +1 sd) (16%) • Each group has its own set of characteristics

20. Bell-shaped Curve and Adopter Categories

21. S-shaped Curve and Cumulative Adoption

22. A Marketing Process* - 1 • Using marketing research to determine the needs and desires • Formative research to get answers to: • What would make it easy for the priority population to obtain the product or respond to the intervention? • What makes it difficult for or keeps the priority population from responding to the intervention? • What benefit does the priority population desire as a result of responding to the intervention? • What would the priority population be willing to give up to obtain the product and accompanying benefits? *Syre & Wilson (1990)

23. A Marketing Process* - 2 • Developing a product that satisfies the needs and desires of the clients • Know the priority population; can it be segmented • Creating an intervention that meets the needs & values of the consumers • Consider the benefit ladder *Syre & Wilson (1990)

24. A Marketing Process* - 3 • Developing informative & persuasive communication flows • Relates to the creative strategy & message strategy (Kotler & Keller, 2007) • How will the planners get the message out? • What are the best communication channels for your clients? Media habits? What medium? Costs? Reach? Culturally appropriate? *Syre & Wilson (1990)

25. Example Program Titles • Heart at Work (worksite program of AHA) • Freedom From Smoking (cessation program of American Lung Association) • StayWell (Control Data) • Active for Life (activity program of the American Cancer Society) • Live Well - Be Well (worksite program of Quaker Oats) • Live for Life (Johnson & Johnson)

26. Defining Implementation • “the act of converting planning, goals, and objectives into action through administrative structure, management activities, policies, procedures, and regulations, and organizational actions of new programs” (Timmreck, 1997, p. 328) • Setting up, managing, and executing a project (Keyser et al., 1997) • Program diffusion - adoption, implementation, sustainability (Bartholomew et al., 2006)

27. Implementation • Planners need to be flexible when implementing a program • Phases of implementation • Adoption of the program - a part of marketing • Identifying & prioritizing the tasks to be completed • Establishing a system of management • Putting the plans into action • Ending or sustaining a program

28. Critical Path Method (CPM) or PERT/CPM B I Items on critical path cannot be delayed without delaying the program; time is important estimates are made for earliest & latest start & finish times for each activity A C G H J M K L D E F A. Start planning B. Develop rationale C. Needs assessment D. Create instrument E. Select sample F. Collect & analyze data G. Create goals/objectives H. Create intervention I. Pilot test J. Implement program K. Identify & allocate resources L. Marketing M. Evaluate (process, impact, & outcome)

29. Phase 4 - Putting Plans into Action • Major ways of putting plans into action (Parkinson & colleagues, 1982) • Inverted triangle represents number of people involved • Pilot testing – trying the program out with a small group from the priority population to identify any problems • Phased-in – limiting the number of people who are exposed then gradually increasing the numbers; by offerings, by location, by ability, by number • Total program – all in priority population exposed at same time

30. Putting Plans into Action

31. First Day of Implementation • Also referred to as: program launch, program rollout, or program kick off • Decide on a first day; consider launching to coincide with other already occurring event (e.g., weight loss program & New Year’s resolution) • Kick off in style • Seek news coverage, if appropriate • Consider a news hook; e.g., day in history • Special event; use of celebrities

32. Phase 5 - Ending or Sustaining a Program • How long to run a program • Ending? • Goals & objectives met? • Resources available? • Need to re-focus? • Sustaining? • Work to institutionalize • Advocating for the program • Partnering with others • Revisiting & revising the rationale

33. Concerns Associated with Implementation - 1 • Safety & Medical Concerns • Most programs are to improve health, thus do not put participants in danger • Informed consent • Explain nature of program • Inform participants of risk & discomfort • Explain expected benefits • Inform of alternative programs • Indicate that they are free to discontinue participation at any time • Allow participants to ask questions

34. Example Informed Consent Form

35. Concerns Associated with Implementation - 2 • Safety & Medical Concerns (continued) • Informed consent (waiver of liability or release of liability) do not protect planners from being sued • Medical clearance signed by a physician • Ensure safety & health • Program location; appropriate security • Building codes met & facilities free from any hazards • Qualified instructors • Plan in case of emergency

36. Sample Medical Clearance Form

37. Concerns Associated with Implementation - 3 • Ethical Issues • Where competing values are at play & judgment must be made on what is the most appropriate course of action • Code of Ethics for the Health Education Profession to guide the work of health educators; highest standards • The Belmont Report: Ethical Principles & Guidelines for the Protection of Human Subject Research • Respect for persons • Beneficence – maximizing benefits & minimizing harm • Justice – fairness

38. Concerns Associated with Implementation - 4 • Legal concerns • Negligence – failing to act in a prudent (reasonable) manner • Omission • Commission • Reducing liability – key to avoiding liability • Aware of legal liabilities • Qualified instructors • Good judgment • Informed consent • Medical clearance • Limit work to expertise • Safe environment • Insurance

39. Concerns Associated with Implementation - 5 • Program Registration & Fee Collection – need a system • Procedures for Recordkeeping – HIPAA; anonymity/ confidentiality • Procedure and/or participants manuals – 1) make sure all understand, 2) standardize, avoid Type III error, 3)ideas for facilitation, 4) provide additional background information, & 5) provide additional resources • Training of facilitators – if it is not possible to hire qualified instructors, may need to train • Dealing with problems – try to anticipate • Reporting & documenting – for 1) accountability, 2) public relations, 3) motivation of participants, 4) recruitment of new participants