CHES Review

What is the purpose of a needs assessment?
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What is the purpose of a needs assessment?
To gather information in order to determine what head education activities may be most appropriate given the needs and setting
Ask about the most important needs of an individual or group
What is a needs assessment?
A systematic, planned collection of information about the health knowledge, perceptions, attitudes, motivation and practices of individuals or groups and the quality of the socioeconomic they live in
A process to address the gap between what IS and what SHOULD BE
When should a needs assessment be done?
In the assessment phase to determine what needs your intervention will address
During evaluation of a health education program to monitor program impact
What does assessing capacity involve?
Identifying areas that may need to be enhanced prior to implementing a health education program in order to ensure that the program can be sustained long term
Measuring actual or potential resources that can aid int he maintenance and enhancement of health education programs
What are some examples of capacity?
Does the organization's staff have appropriate levels of knowledge, skills, and qualities? (group level)
Are there eligible participants in the population? (individual level)
Are there appropriate resources to maintain the program long term without relying on grant funding? (community level)
What are the requirements of a needs assessment?
Use of quantitative and qualitative data
Analyzing both expressed and observed needs
Engaging multiple stakeholders and a wide variety of data collection sources/methods
What are the key steps of a needs assessment?
1) Determine the purpose of the needs assessment
2) Identify available data to assess the health problem
3) Decide on the data collection approach and gather data
4) Analyze and interpret the data
5) Identify factors linked to the health problem(s)
6) Identify the focus of the program and begin the planning process
What is the first step in conducting a needs assessment?
Defining the target population ("who" is being assessed) and determining the purpose of the survey (will it be used to determine knowledge, attitudes, beliefs, behaviors, skills, and/or health status of a population?)
What are the three factors identified in a needs assessment? (Green and Kreuter)
1) Predisposing factors
2) Enabling factors
3) Reinforcing factors
What are predisposing factors?
Characteristics of a person or population that motivate behavior prior to or during the occurrence of that behavior
E.g. knowledge, beliefs, values, and attitudes
What are enabling factors?Internal and external conditions directly related to the issues that help people adopt and maintain healthy or unhealthy behaviors and lifestyles, or to embrace or reject particular environmental conditions E.g. available resources, services, laws/policies, and skill setsWhat are reinforcing factors?Attitudes that support or make it difficult to adopt healthy behaviors or foster healthy environments E.g. influence of family members, peers, teachers, employers, health providers, the media, community leaders, politicians, and other decision makersWhat is the Epidemiological Model?Focuses on determining health problems for a given target population by measuring objectively those problems that pose the greatest threat to health and quality of life What is the problem? Who has the problem? Why do those with the problem have it?What is the Public Health Model?Wants to quantify health problems through existing and epidemiological data, but tends to focus on a specific population and is valuable when there are resource limitations (Planned Approach to Community Health PATCH and Mobilizing for Action through Planning and Partnership MAPP) - identify assets and needs by utilizing community engagement to plan, conduct, and evaluate health promotion and disease prevention programsWhat is the Social Model?Seeks to identify social, economic, and political issues that can influence health Focuses on societal trends and relies on collecting data on social indicators (e.g. income, social norms, other social resources) E.g. use of Census, American Community Survey (ACS), American Housing Survey (AHS), National Health Interview Survey (NHIS)What is a focus group?A qualitative method in which individuals are invited to participate in a group interview about their perceptions, opinions, beliefs, and/or attitudes toward a specific health concern or issue Focus groups are designed to be homogenous around a characteristic of interest so that participants feel comfortable sharing information and there common frames of reference and/or experiencesWhat is a key informant interview?Participants are interviewed one or two at a time to allow for in-depth probing of the participant's views Upside: more appropriate for very sensitive topics (better change to develop rapport and create a comfortable environment) Downside: very time consuming to collect/analyze dataWhat is a nominal group process?A small group responds to questions, discusses answers, and then privately ranks the importance of health issues/concerns. The moderator ranks the answers Pros: Democratic way of making decisions (neutralizes effects of dominant people in the group) Cons: takes time, is regimentedWhat is a Delphi panel process?Used when there is no clear evidence upon which to base decisions and thus recruits experts to make decisions or recommendations Generate consensus through use of structured questionnaires, generally distributed among experts or thought leaders on a given topic Questionnaires are revised and sent back to participants (~3-5 times) to achieve consensusWhat are some examples of observational designs?Cross-sectional (one-time data collection; present or recall of past) Case-control (group comparison matching intervention participants with control participants; present or recall of past) Longitudinal (prospective and includes present and future dates)When constructing a survey or choosing existing data collection tools, it is also important to consider...The validity and reliability of the toolsWhat are validity and reliability?Validity: the degree to which the instrument measures what it is intended to measure Reliability: the degree to which the instrument yields the same results each time it is used as well as when it is used with different populationsWhat are the seven steps in analyzing survey data?1. Administer the survey: the method should fit with the objectives 2. Prepare data: code questions and answers, limit data entry errors 3. Verify data: test for accuracy or coding errors 4. Enter the data 5. Tabulate the data 6. Analyze the data 7. Record and report the data, which should include objectives, hypothesis, a description of the survey steps, and the reliability of resultsA descriptive analysis does/does not define causalityDoes not (e.g. rates, mean, median)What are the steps in analyzing assessment findings?1. Analyze the data 2. Compare them with local, state, or national data 3. Consider the social, cultural, and political environment 4. Set priorities: a. Assess the size and scope of the problem b. Determine the effectiveness of possible interventions c. Determine the appropriateness, economics, acceptability, resources, and legality of interventionsWhat are the five steps of intervention mapping?1. Create a matrix of the immediate program objectives 2. Select a theory- or evidence-based intervention with appropriate methods and strategies 3. Design and organize the intervention 4. Specify the implementation plans 5. Generate the program evaluation plansWhat are some potential barriers to health education?Health literacy and numeracy Competing priorities or lack of interest Lack of skilled and/or committee people Lack of funds and resources Lack of leadership Unsupportive environment Transportation or geographic challenges Lack of time Weak partnershipsWhat are some potential facilitators of health education?Strong partnerships Sustaining structure/coordination Evidence that the health education/promotion program works Adaptability to needs Good communication Funds and resources Low response burdenWhat is the difference between a theory and a model?A theory is a set of interrelated constructs, definitions, and statements that present a systematic view of events or situations by specifying the relationships among variables, with the SOLE purpose of explaining and predicting the events or situations A model is a system that often draws upon several theories to better understand a health problem in a specific setting or contextWhat is the precede/proceed model?A community-oriented, participatory model aimed at developing successful community health education and promotion programs and interventionsWhat are the five phases of the precede model?1. Social diagnosis 2. Epidemiological diagnosis 3. Behavioral and environmental diagnosis 4. Educational and organizational diagnosis 5. Administrative and policy diagnosisWhat are the four phases of the proceed model?6. Implementation 7. Process evaluation 8. Impact evaluation 9. Outcome evaluationWhat does PRECEDE stand for?Predisposing, reinforcing, and enabling constructs in educational/environmental diagnosis and evaluationWhat are predisposing factors? Enabling factors? Reinforcing factors?Predisposing: knowledge, attitudes, beliefs, values that may motivate or be responsible for a given behavior and may impact readiness to change Enabling: include those influence that enable and individual to act on a specific behavior, such as resources, services, supportive policies Reinforcing: influences that encourage repeated behaviors or incentive continued practice of the behavior, such as social support, rewards, praise, or symptom reliefPhase 1: Social diagnosisMultiple sources of data collection that focus on better understanding the perceived needs of a community (i.e. focus groups, key informant interviews, surveys, and participant observation)Phase 2: Epidemiological diagnosisTypically involves secondary health outcome data or data that describes a health problem and potential causes of the health problem These data are often used to develop program goals and objectivesPhase 3: Behavioral and environmental diagnosisThis includes data on internal and external factors that influence behavior and the environment Often these data may come from literature reviews or theories that can be used to explain behaviorPhase 4: Educational and organizational diagnosisThis includes data on individual-, interpersonal-, or community-level theories that can identify and describe the key determinants of health behaviors These areas are typically classified as predisposing, reinforcing, or enabling factorsPhase 5: Administrative and policy diagnosisThis involves a diagnosis of strategies and data from the administrative and policy-level sources It includes data collected from previous steps, including availability of resources and organizational policies that may impact program implementationWhat does PROCEED stand for?Policy, regulatory, and organizational constructs in education and environmental development These steps focus on program implementation and evaluationPhase 6: ImplementationThis phase involves processes for implementing and evaluating the health education programPhase 7: Process evaluationThis focuses on program fidelity or the extent to which a program is being implemented as it was designed and plannedPhase 8: Impact evaluationThis examines changes in predisposing, enabling, and reinforcing factors and the influence of a program on the desired behavioral and environmental changesPhase 9: Outcome evaluationThis final phase examines whether the program has affected the desired health problemWhat does program planning involve?Identifying the needs, priorities, potential root causes of health problems, facilitators and barriers to achieving its objectives and overall goals of the programStrategy v. intervention v. programStrategy: the general approach to preventing an overall health problem (multiple strategies may be used to address the health issue) Intervention: a set of activities or strategies to prevent a specific health problem and address the factors that contribute to the problem Program: a group of strategies or interventions to address a health problemWhat is a logic model?A flowchart that provides an organized way of understanding the key elements of a program Include: resources, inputs, activities, outputs, objectives, and short-, intermediate-, and long-term outcomes Also helpful in identifying factors that may be outside of the health educators' and program staffs' control Especially helpful in identifying causal links among the program key elementsWhat are stakeholders?Individuals or groups from a specific community or agency that share a common goal, values, or identity They often represent the "who" and "what" of your interventionGoals v. objectivesGoals are broad statements about the long-term expectations or results of a health ed program/intervention Objectives are statements that describe the achievable results and specify the who what when where why howWhat are SMART objectives?Specific: includes the "who," "what," and "where" Measurable: "how much" change is expected Achievable: is it feasible to accomplish the desired results? Realistic: considers the resources, personnel, costs, and time frame Time sensitive: represents "when" the activities will be completedWhat is the difference between process and outcome objectives?Process: used to monitor program implementation and provide data on how well the program is doing at reaching its target audience and intended activities Outcome: used to monitor how well a program is doing at achieving the desired results of the programShort-term v. intermediate-term v. long-term outcome objectivesShort term: changes in attitudes, knowledge, and skills Intermediate: changes in behavior, norms, and policy Long term: changes in a specific health problemVision statement v. mission statementVision statement: short phrase that represents the aspirations of your program; describes the long-term and broad goals of your program Mission statement: short, describing the overall outcomes of your program/intervention and making a brand statement about the program's key goalsWhat is Bloom's Taxonomy?Bloom's Taxonomy is often used when writing learning objectives for ed or training purposes; divides thinking skills into higher and lower order sets Focuses on the cognitive (knowledge) domainWhat are the levels of Bloom's Taxonomy?1. Knowledge level -- information directly from the text 2. Comprehension level -- giving the meaning of terms, idioms, language, making inferences etc. 3. Application level -- applying knowledge from a text to a new passage or situation 4. Analysis level -- examining parts of a passage to sort, categorize, make connections etc. 5. Synthesis level -- to make generalizations or to take information and develop a strategy 6. Evaluation level -- to judge veracity, fact or opinion or bias