Evidence Based Chronic Disease Prevention Module Six: Developing An Action Plan For The Program Or Policy

1. Evidence Based ChronicDisease Prevention Module Six: Developing An Action Plan For The Program Or Policy Presented by: Edie Sternberg, MPH, CHES

2. Module Six Evidence Based Chronic Disease Prevention 2 Why An Action Plan? Objectives Explore the various program planning models that may provide useful strategies. Understand the importance of solid action planning and setting realistic and measurable objectives

3. Module Six Evidence Based Chronic Disease Prevention 3 Remember the Elements of Strategic Planning Vision, mission, values Environmental assessment Strategic issues & goals Outcomes and outcome measures Objectives and strategies Evaluation and results

4. Module Six Evidence Based Chronic Disease Prevention 4 A Simple Planning Cycle

5. Module Six Evidence Based Chronic Disease Prevention 5 Considerations Earlier modules Am I doing the right things? This phase and the next modules (Module Seven � logic model, and Module Eight � Program Evaluation), primarily concerned with: Am I doing things right? A logic model is a dynamic roadmap for the planning, implementation and evaluation phases of the program.

6. Module Six Evidence Based Chronic Disease Prevention 6

7. Module Six Evidence Based Chronic Disease Prevention 7 Criteria for a Good Action Plan Complete List all the action steps or changes Clear Who will do what by when? Current What resources are needed? Anticipate emerging opportunities and threats

8. Module Six Evidence Based Chronic Disease Prevention 8 Program Planning Models Process begins with needs assessment and option development and reviewing existing evidence Our version covered in modules 1-5 Goal setting is key Goal Long-term desired change in the status of a priority health need Objective Short-term, measurable, specific activity

9. Module Six Evidence Based Chronic Disease Prevention 9 Program Planning Sound objectives are Performance, behavior, or action oriented; Precise in their language (do not use general or vague verbs); Measurable; Results oriented with stated outcomes; Clear in their description of content and performance; Tied to specific timetables for completion.

10. Module Six Evidence Based Chronic Disease Prevention 10 Program Planning Example of a sound goal To reduce the occurrence and impact of preventable diseases and conditions Example of a sound objective Reduce the rate of lower extremity amputation among people age 18 and older in IL with diabetes from 5.4 per 1000 in 1998 to 4.0 per thousand in 2010. Objectives are achievements, not activities The what, not the how

11. Module Six Evidence Based Chronic Disease Prevention 11 Program Planning Consider �intermediate�/realistic objectives If we promise too much in outcomes, we are destined to fail What are intermediate objectives for the diabetes example? Number of MDs receiving diabetes care guidelines Number of diabetics requesting a foot examination Number of diabetics referred for follow-up foot care

12. Module Six Evidence Based Chronic Disease Prevention 12 Program Planning Examples of intermediate objectives Knowledge Decrease the percentage of persons with diabetes aged 65 and older reporting that they have never heard of the importance of regular foot examination by a physician from 30% in 2000 to 10% in 2005. Attitudes Decrease the percentage of persons with diabetes aged 65 and older reporting they feel unprepared to perform daily foot care from 40% in 2000 to 20% in 2005.

13. Module Six Evidence Based Chronic Disease Prevention 13 Determine Strategies for Accomplishing Objectives Develop a set of strategies within 5 levels Individual (individual knowledge, attitudes) Interpersonal (family, friends, peers) Community (social networks, norms, media) Organizational (agencies, worksites) Governmental (laws, regulations)

14. Module Six Evidence Based Chronic Disease Prevention 14 Interventions at Various Levels

15. Module Six Evidence Based Chronic Disease Prevention 15 Interventions at Various Levels

16. Module Six Evidence Based Chronic Disease Prevention 16 Action Strategies For each strategy/intervention list Data needed/sources Objective Program resources needed Stakeholder input needed Time permitting Specific tasks with responsible party Time table for specific tasks Return to these next meeting during evaluation discussion This type of activity can be done with your staff members Process should lead you back to the literature or other sources on effectiveness

17. Module Six Evidence Based Chronic Disease Prevention 17 Other Considerations Role of piloting Can be useful when risk is high or resources are phased in over time Some attempt at evaluation before full-blown effort is implemented Difficulties in evaluation? Consideration of piloting should be part of planning process Often involves qualitative methods

18. Module Six Evidence Based Chronic Disease Prevention 18 Other Considerations Need for community involvement From IPLAN model Who is involved may change, but process well-defined Community defines both process and focus areas, facilitates community �buy-in�

19. Module Six Evidence Based Chronic Disease Prevention 19 Need for Agency/Coalition Involvement Can bring expertise, credibility, resources Is more acceptable to local communities/creates advocates Increases likelihood of sustainability Can create �burn-out� among key leaders Will take more time Requires attention to communication/feedback

20. Module Six Evidence Based Chronic Disease Prevention 20 Other Considerations Develop at least a working knowledge of behavioral science theories AND Employ a well-trained health educator Each will likely have his/her own biases and preference about planning and theoretical frameworks

21. Module Six Evidence Based Chronic Disease Prevention 21 Behavioral Science Theories Examples Health Belief Model Stage of Change Theory PRECEED/PROCEED Social-cognitive Theory

22. Module Six Evidence Based Chronic Disease Prevention 22 Behavioral Science Theories Health Belief Model Purpose: To explain and predict preventive health behavior. Focuses on relationship of health behavior practices and utilization of health services. Originated in 1952. Components: Perceived barriers, perceived benefits, perceived susceptibility, and perceived seriousness. Cues to action (added later to original theory). Applications to health education: Provide incentive to take action. Provide clear course of action to acceptable cost. Enhance feeling of competency to take action.

23. Module Six Evidence Based Chronic Disease Prevention 23 Behavioral Science Theories Precede/Proceed Purpose: Precede -> framework for systematic development/evaluation of health education programs Proceed -> to promote the plan or policy, regulate the environment, and organize the resources required by the plan or policy Overall - >to direct initial attention to outcomes rather than inputs, which forces planning from the outcome point of view

24. Module Six Evidence Based Chronic Disease Prevention 24 Behavioral Science Theories Precede/Proceed Components: Precede -> 5 phases (social diagnosis, epidemiological diagnosis, behavioral and environmental diagnosis, education and organizational diagnosis, and administrative and policy diagnosis). Proceed -> 4 phases (implementation, process evaluation, impact evaluation, and outcome evaluation). http://www.ihpr.ubc.ca/precede.html

25. Module Six Evidence Based Chronic Disease Prevention 25 Other Considerations Turn to ready-made resources e.g., Community Tool Box http://ctb.lsi.ukans.edu/

26. Module Six Evidence Based Chronic Disease Prevention 26 Other Considerations Health Policy Coach http://www.healthpolicycoach.org Overview of Health and Behavior Theories http://www.hsc.usf.edu/%7Ekmbrown/Research.htm http://www.hsc.usf.edu/%7Ekmbrown/hlth_beh_models.htm http://ext.msstate.edu/fee/healthed/selfcare/

27. Module Six Evidence Based Chronic Disease Prevention 27 Action Strategies Six small groups work to develop action strategies at each level Action strategies for all levels is ideal Use evidence to target appropriate strategies This action planning often leads to other applied research questions/interventions