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Health Program Planning and Intervention

Terms in this set (81)

During the 20th century, what was a big achievement regarding health?
Many infectious diseases were controlled; chronic diseases became a greater concern.
-Average life span increased 29.7 yrs.
-United States ranked 89th (out of 225 countries) in crude death rate and 50th (out of 223 countries) in life expectancy.
When and how did the health promotion era begin?
-1974
-Lalonde Report in Canada
-Health Information & Health Promotion Act in United States
In the 20th century, four modifiable health-damaging health behaviors were identified. What were they?
-Tobacco use
-lack of physical activity
-poor eating habits
-excess alcohol consumption
Healthy People
-Defines the nation's health agenda
-Guides health policy
In regards to health education, there is a need for:
-health information to be understood by the average person
-health professionals to provide the public with the information and skills to make quality health decisions.
Describe the difference between the "common causes of death" and the "actual causes of death"
Common causes of death is what your death certificate would read, while actual causes of death is a habit or incident that lead to your death.
Example:
Common cause of death: Diseases of the heart
Actual cause of death: Tobacco
Health Education is
Planned learning experiences
''Using evidence-based practices and/or sound theories that provide the opportunity to acquire knowledge, attitudes, and skills needed to adopt and maintain healthy behaviors''
''Any planned combination of learning experiences designed to predispose, enable, and reinforce voluntary behavior conducive to health in individuals, groups, and communities''
Health Promotion is
takes into account that human behavior is not only governed by personal factors, but also the structure of the environment

''Any planned combination of educational, political, environmental, regulatory, or organizational mechanisms that support actions and conditions of living conducive to the health of individuals, groups, and communities'' (Joint Committee, 2012).
''Any planned combination of educational, political, regulatory, or organizational supports for actions and conditions of living conducive to the health of individuals, groups, and communities''
Health Educator
''A professionally prepared individual who serves in a variety of roles and is specifically trained to use appropriate educational strategies and methods to facilitate the development of policies, procedures, interventions, and systems conducive to the health of individuals, groups, and communities''
Health Education Specialist
''An individual who has met, at a minimum, baccalaureate-level required health education academic preparation qualifications, who serves in a variety of settings, and is able to use appropriate educational strategies and methods to facilitate the development of policies, procedures, interventions, and systems conducive to the health of individuals, groups, and communities''
Settings of a health educator
*Schools
---K-12, colleges, and universities
*Community health agencies
---Governmental and nongovernmental
*Worksites
---Business, industry, and other work settings
*Health care settings
---Clinics, hospitals, and managed care organizations
Primary Prevention
Preventative measures that forestall the onset of illness or injury during the pre-pathogenesis process
Example: Vaccinations
Secondary Prevention
Preventative measures that lead to early diagnosis and prompt treatment of a disease, illness, or injury to limit disability, impairment, or dependency and prevent more severe pathogenesis.
Tertiary Prevention
Preventative measures aimed at rehabilitation following significant pathogenesis
Limits of prevention
Biological
-Life expectancy
Technology
-infectous diseases
Ethical
-Laws for Common Good
-Taxes on Tobacco
-Biomedical and research
Economic
-5% of health care $ spent on prevention
When did the Role Delineation Project begin?
1979; began to define the role of the entry-level health educator
When did the seven ''Areas of Responsibility'' generic to all entry-level health educators regardless of the setting were delineated.
1985
When did the Competencies Update Project (CUP) re-verified the entry level and verified the advanced level.
1998-2004
A Competency-Based Framework for Health Education Specialist came out in...
2010
CUP Model
--Responsibilities, competencies, and sub-competencies identified for entry level, advanced level 1, and advanced level 2
--Responsibilities have remained fairly consistent over the past 20 years.
Framework used by NCHEC, NCATE, & SABPAC
1. Provides a guide for all colleges and universities to use when designing and revising their curricula (SEBPAC).
2. Used by the National Commission for Health Education Credentialing, Inc. (NCHEC) to develop the core criteria for certifying individuals as health education specialists through national certification exams:
--Certified Health Education Specialists (CHES)
--Master Certified Health Education Specialist (MCHES) -NEW in 2010.
3. Used by program accrediting and approval bodies to review college and university academic programs (NACATE).
Some of the Assumptions of Health Promotion
--Health status can be changed.
--Health & disease are dynamic.
--Disease theories & principles can be understood.
--Appropriate prevention strategies can be developed.
--Behavior can be changed & those changes can impact health.
--Many things contribute to health & influence behavior change.
--Initiating & maintaining a behavior change is difficult.
--Individual responsibility should not be viewed as victim blaming.
--For behavior change to be permanent, the person must be motivated & ready to change.
Systematic planning is important for the following four reasons
1. Planning forces planners to think through details in advance.
2. Planning helps to make a program transparent.
--Good planning keeps the program stakeholders (any person or organization with a vested interest in a program) informed.
3. Planning is empowering.
--Once decision makers (those who have the authority to approve a plan) give approval to the resulting comprehensive program plan, planners and facilitators are empowered to implement the program, encouraging ownership of the program.
4. Planning creates alignment.
--All organization members have a better understanding of where they ''fit'' in the organization and the importance that the plan carries.
Planning a health promotion program
-multistep process
-''To plan is to engage in a process or a procedure to develop a method of achieving an end''
Why would you need to create a rationale
*Gain support of decision makers
--You need to have a sound rationale before making an appeal to the decision makers.
--There is no formula for writing the rationale...suggested starting points.
--A logical format for a rationale is presented as the inverted triangle; triangle is symbolic of the design going from global terms to a focused solution.
Decision makers
those who provide and allocate the necessary resources and support
--Resources - money that can be turned into staff, supplies, etc.
--Support - e.g., policies, value, decision making
Why is it important to gain support of decision makers
--Sometimes, the idea for a program comes from the top.
----> This makes it easier to get support.
--Often it comes from someone other than one who is a part of the top level of the community (i.e., an employee, parent, health educator, or member of the population).
--->They will need help selling the idea to those at the top.
--Most planners will need to create a rationale (written proposal) to sell the program.
How do you measure decision makers' support for health promotion
-Leading by Example (LBE) Instrument
Leading by Example Instrument
-A valid instrument to assess leadership support for health promotion programs in work settings
-Four Factor Scale
1. Business assignment with health promotion objectives
2. Awareness of the economics of health and worker productivity
3. Worksite support for health promotion
4. Leadership support for health promotion
Steps in creating a program rationale
1. Identifying appropriate background information
2. Titling the rationale
3. Writing the content of the rationale
4. Listing the references used to create the rationale
Types of information and data that are useful in writing a rationale
--Express the needs and wants of the priority population
--Describe the status of the health problem(s) within a given population
--Show how the potential outcomes of the proposed program align with what the decision makers feel is important
--Show compatibility with the health plan of a state or the nation
--Provide evidence that the proposed program will make a difference
--Show how the proposed program will protect and preserve the single biggest asset of most organizations—the people
Cost-Benefit analysis (CBA)
Benefit received from the dollars invested in the program
Return on Investment (ROI)
Measures the costs of a program versus the financial return realized by that program
An example of a good title to a rationale would look like
''A Rationale for ___________ : A Program to Enhance the Health of ___________ .''
Content section of the rationale should include
--Identifying the health problem
--Propose a solution
--State why the program would be successful
When writing the content of the rationale, identify the health problem...
--from a global perspective
--->Show the relationship of the local health problem to the bigger problem.
--identify the health problem that is the focus of the rationale
--->This is called a problem statement.
--->The statement should also include why it is a problem and why it should be dealt with.
--->Use social math to help highlight economic impact.
The final step in creating a rationale is
Reference list
--Having a reference list shows decision makers that you studied the available information before presenting your idea.
--Be consistent with formatting references.
--Examples use APA format.
Guidelines for creating a planning committee
1. composed of individuals who represent a variety of subgroups within the priority population.
2. If the program that is being planned deals with a specific health risk or problem, it would be important that someone with that health risk (e.g., smoker) or problem (e.g., diabetes) be included on the planning committee.
3. individuals willing to serve who are interested in seeing the program succeed
4. someone who has a key role in the organization sponsoring the program.
5. representatives of other stakeholders (any person or organization with a vested interest in a program) not represented in the priority population.
6. Regularly evaluate membership to ensure fulfillment of goals and objectives.
7. individuals should be added periodically to generate new ideas and enthusiasm.
8. Be aware of ''politics''.
9. Make sure the committee is large enough to accomplish work, but small enough to be able to make decisions and reach consensus.
10. In some situations there might be a need for multiple layers of planning committees.
Make up of a solid planning/steering committee
--representitves of all segments of priority population
--doers
--influencers
--represetatives of sponsoring agency
--other stakeholders
good leadership
Generalized planning model
Pre-planning comes before
PATCH
" Planned Approach to Community Health"
a preferred planning model used in partnership with state and local health departments and communities
Steps of PATCH
1. Mobilizing community
2. Collecting and Organizing Data
3. Choosing health priorities
4. Developing a comprehensive intervention plan
5. Evaluating PATCH
APEX-PH
"Assessment Protocol for Excellence in Public Health"

Phase 1: Organizational Capacity Assessment (internal assessment of strengths)

Phase 2: Community Process; Collect & analyze community health status data. Develop an action plan with goals & objectives

--Phase 3: Completing the Cycle (Implementation & Evaluation Plans)
MAPP
Mobilizing for Action through Planning and Partnerships
--Replaced APEX-PH in 2000
MAP-IT
Mobilize, Assess, Plan, Implement, and Track (5 phases)
--Introduced to assist communities in implementing their own adaptations of Healthy People 2020.
Value of generalized planning model
--It streamlines the planning process (a common framework).
--It contains the building blocks for all other models.
--It is linear, yet fluid.
--It aligns with the grant writing process.
Factors that contribute to choosing a planning model
1. Preferences of stakeholders
2. Time and funding
3. Resources for data collection and analysis (or lack of)
4. Involvement of partners
5. Preferences of a funding agency
6. Ecological framework
Three F's of program planning
--Fluidity - steps are sequential
--Flexibility - adapt to needs of stakeholders
--Functionality - useful in improving health conditions
PRECEDE
"predisposing, reinforcing, and enabling constructs in educational/ecological diagnosis & evaluation"
--First 4 phases are assessment phases; (social, epidemiological, behavioral & environmental, educational & ecological, administrative & policy and intervention alignment)
PROCEED
"policy, regulatory, and organizational constructs in educational & environmental development"
-Last 4 phases; implementation, and process, impact, & outcome evaluation
Underlying approach to PRECEDE-PROCEED
...begin by identifying the desired outcome, determine what causes it, & then design an intervention to reach the desired outcome
Explain the relationship among good health behavior, health education, and health promotion
Health education is an important component of health promotion, "without health education, health promotion would be a manipulative social engineering enterprise." Health behavior are the behaviors in which impact a person's health. So good health behavior can be directly linked with proper health education and health promotion practices.
Explain the difference between health education and health promotion
Health promotion is a broader term than health education.
Explain how a person becomes Certified Health Education Specialist or a Master Certified Health Education Specialist
--A bachelor's, master's or doctoral degree from an accredited institution of higher education; AND one of the following:
•An official transcript (including course titles) that clearly shows a major in health education, e.g., Health Education, Community Health Education, Public Health Education, School Health Education, etc. Degree/major must explicitly be in a discipline of "Health Education." OR
•An official transcript that reflects at least 25 semester hours or 37 quarter hours of course work (with a grade "c" or better) with specific preparation addressing the Seven Areas of Responsibility and Competency for Health Educators
Explain how the Compentency-Based Framework for Health Education Specialist is used by colleges and universities, NCHEC, NCATE, SABPAC
The framework is used by program accrediting and approval bodies to review colleges and university academic programs in health educaiton. NCATE uses the framework to review and accredit teacher prep programs in health educaitn at institutions of higher education. SABPAC *(NOW CEPH)* uses the framework to review and approve undergraduate community health education programs via self-study or external reviewers
Identify the assumptions upon which health education is based
--Health status can be changed.
--Health & disease are dynamic.
--Disease theories & principles can be understood.
--Appropriate prevention strategies can be developed.
--Behavior can be changed & those changes can impact health.
--Many things contribute to health & influence behavior change.
--Initiating & maintaining a behavior change is difficult.
--Individual responsibility should not be viewed as victim blaming.
--For behavior change to be permanent, the person must be motivated & ready to change.
Define the term "pre-planning"
allows a core group of people to gather answers to key questions that are critical to the planning process before the actual planning process begins
Explain the role Healthy People played in the relationship between the American People and health
Healthy People was the first set of goals and objectives for American's health. It is a specific set of health related objectives targeting American's that should be met within the ten year span. It was made for the general public.
How is health education define by the Joint Committee on Terminology
any combination of planned learning experiences using evidence-based practices and/or sound theories that provide the opprotunity to acquire knowledge, attitudes, and skills needed to adopt and maintain healthy behavior
What is the National Health Educator Compentencies Update Project
reverify the entry-level health educator responsibilities, competencies, and subcompetencies and to verify the advanced-level competencies and subcompetencies
What is the Health Educator Job Analysis- 2010
"to validate the contemporary practice of entry and advanced-lecel health education specialists"
What are the Parameters for planning?
-Committee members must identify the planning parameters within which they will work.
-There are seven questions to which committee members should have answers before they become too deeply involved in the planning process.
1. What is the decision makers' philosophical perspective on health promotion programs?
2. What type of commitment to the program are decision makers willing to make? Are they interested in the program becoming institutionalized?
3. What type of financial support are decision makers willing to provide?
4. Are decision makers willing to consider changing the organizational culture?
5. Will all individuals in the priority population have an opportunity to take advantage of the program, or will it be available to only certain subgroups?
6. What type of committee will the planning committee be? Will it be a permanent or a temporary (ad hoc) committee?
7. What is the authority of the planning committee?
What is social math? Give examples
"the practice of translating statistics and other data so they become interesting to the journalist, and meaningful to the audience"
-Break numbers down by time
-break down numbers by place
-provide comparisons with familiar things
-provide ironic comparisons
-localize numbers
What are the steps of writing a rationale?
1. Identify appropriate background information
2. Titling the rationale
3. writing the content
4. listing references
Four phases of PRECEDE
1. Social Assessment
2. Epidemiological Assessment
3. Educational and ecological assessment
4. Administrative and policy assessment and intervention alignment
Four phases of PROCEED
5. Implementation
6. Process Evaluation
7. Impact Evaluation
8. Outcome evaluation
Name other planning models
-SMART
-SWOT
-CHANGE tool
-Health communication model
-Intervention Mapping
-Healthy Plan-It
Phase 1 of PRECEDE
Social assessment
-seeks to subjectively define the QOL (problems & priorities) of those in the priority population
Phase 2 of PRECEDE
Epidemiological Assessment
-planners use data to identify & rank the health goals/problems contributing to or interacting with problems identified in Phase 1.

--Data include vital indicators (e.g., morbidity, mortality, & disability data) + genetic (relationship between genes & 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
Phase 3 of PRECEDE
Educational and Ecological Assessment
-Identifies & classifies factors that can influence behavior or change the environment

-Predisposing factors - impact motivation; e.g., knowledge, attitudes, beliefs, perceptions, & values

-Reinforcing factors - feedback & rewards; e.g., social benefits such as recognition, appreciation; incentives; disincentives (includes family, peers, teachers, self, others who control rewards & incentives)

-Enabling factors - skills, access, availability, rules, & laws
Phase 4 of PRECEDE
Intervention Alignment & Administration & Policy Assessment
-Intervention alignment matches strategies & interventions with projected changes & outcomes identified earlier.
-In administration & policy assessment, determine if capabilities & resources are available to develop & implement a program.
Phase 5 of PROCEED
Implementation
-With available resources, planners select methods & strategies of the intervention (examples: education, communication, environmental change, etc.)

-Program begins
Phase 6, 7, 8 of PROCEED
Based on objectives written during the assessment process
-Process
-Impact
-Outcome
*Lines up with PRECEDE phases
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
What are the benefits of MAPP?
-Create a healthier community & better QOL
-Increase the visibility of PH in the community
-Anticipate & manage change
-Create a stronger PH infrastructure
-Engage the community & create community ownership for PH issues
Phases of MAP-It
1. Mobilize
--Mobilize key individuals & organizations into a coalition to improve the health of the community; similar to pre-planning
2. Assess (ID of needs & resources)
--= to a needs assessment of state & local data to set priorities
3. Plan
--Develop goals & objectives, measures, baselines, and targets
4. Implement
--Develop work plan (action steps, time line & communic. plan)
5. Track
--= to evaluation
SMART
Social Marketing Assessment & Response Tool.
"The "heart" of SMART is Phases 2 - 4; usually performed simultaneously"
**pg 59
SWOT
*Strengths
--What the organization does well, resources, personnel, & partnership
*Weaknesses
--Poor reputation, codes, regulations, policy, or management restrictions
*Opportunities
--Unfulfilled consumer needs, loosening or removal of barriers, a new funding stream, or a newly organized coalition
*Threats
--Consumer trends, organizational competition, or private industry
How can the CHANGE tool be used?
--get a picture of the policy, systems, and environmental change strategies in place throughout the community
--develop a community action plan for improving policies, systems, and the environment to support healthy lifestyles; and
--assist with prioritizing community needs and allocating available resources
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