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Program Planning and Evaluation Quiz one

Terms in this set (115)

Health Behavior
Behaviors that impact a person's health; activity undertaken by people for the purpose of maintaining or enhancing their health, preventing health problems, or achieving a positive body image.
examples: diet, exercise, sleep, and wearing a mask.
Health Education
"Any combination of 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, or communities"
health promotion
-Health promotion is a broader term than health education.
-It is related to health education and sometimes incorrectly used in its place.
-"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."
-"Any planned combination of educational, political, regulatory and organizational supports for actions and conditions of living conducive to the health of individuals, groups, and communities"
HEALTH EDUCATION AND HEALTH PROMOTION
-Health education is an important component of health promotion and firmly implanted in it
-"Health promotion takes into account that human behavior is not only governed by personal factors but also by structural aspects of the environment"
HEALTH PROMOTION ASSUMPTIONS
1. Health status can be changed.
2. "Health and disease are determined by dynamic interactions among biological, psychological, behavioral, and social factors"
3. "Behavior can be changed and those changes can influence health"
4. "Individual behavior, family interactions, community and workplace relationships and resources, and public policy all contribute to health and influence behavior change"
5. "Interventions can successfully teach health-promoting behaviors or attenuate risky behaviors"
6. Before health behavior is changed, the determinants of behavior, the nature of the behavior, and the motivation for the behavior must be understood
7. "Initiating and maintaining a behavior change is difficult"
8. Individual responsibility should not be viewed as victim blaming, yet the importance of health behavior to health status must be understood.
9. For health behavior change to be permanent, an individual must be motivated and ready to change.
HEALTH EDUCATION SPECIALISTS / HEALTH EDUCATORS
"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"
Program Planning
-A prearranged set of activities designed to achieve a stated set of goals and objectives
-Programs and services can be:
-Informational approaches - directed at changing knowledge or attitudes about the benefits of and opportunities for healthy lifestyles
-Behavior or social approaches - designed to teach employees the behavioral management skills necessary for successful adoption and maintenance of behavior change
-Example:
-Syringe Service Programs
-Provide more than just syringe distribution
PROGRAM TOPICS
-Chronic diseases
-Injury and violence prevention
-Mental illness/behavioral health
-Unintended pregnancy
-Oral health
-Tobacco use
-Substance abuse
-Nutrition
-Physical activity
-Obesity prevention
PROGRAM SETTINGS
-Schools
-Worksites
-Health care facilities
-Communities
-Online
EDUCATIONAL AND COMMUNITY-BASED PROGRAMS
play a key role in:
-Preventing disease and injury
-improving health
-Enhancing quality of life

-Health status and related health behaviors are determined by influences at multiple levels: personal, organizational/institutional, environmental, and policy. Because significant and dynamic interrelationships exist among these different levels of health determinants, educational and community-based programs are most likely to succeed in improving health and wellness when they address influences at all levels and in a variety of environments/settings.
CHILD AND FAMILY HEALTH PROMOTION PROGRAMS
Examples of effective health promotion activities for child and family health
•Promoting breastfeeding
•Promoting child and family nutrition
•SIDS prevention and education •Injury prevention
•Promoting physical activity
•Smoking cessation programs such as 'quit' activities and 'brief interventions'
•Promoting early literacy
WORKPLACE HEALTH PROMOTION PROGRAMS
Examples of workplace health programs and services might include:
-Classes or seminars on health topics such as fitness, nutrition, tobacco cessation, or stress management
-Weight loss programs that offer counseling and education
-Exercise classes
-Ergonomic assessments and equipment
-On-site influenza vaccines
-Employee Assistance Programs (EAPs)
-Chronic disease self-management tools
-Emails or newsletters with health information
Gardening for Health example
-What? community gardens created; garden coordinators hired; nutrition and activity programs created for youth and adult engagement
-Who? South Dakota State University partnered with communities and created wellness coalitions consisting of community members who decided where gardens should be and voice in what is included
-Where? 13 community gardens planted in 6 counties across rural South Dakota
-When? 2014-2018
-Why? gardens improve access to fruits and vegetables; increase physical activity; lower BMIs; connecting with nature has health benefits; increase social interaction; community building and engagement; reduce food insecurity
-How? Communities created action plans and budgets; wellness coalition input of what to do with food and programs that were created; external funding helped kick start the program
What is Evidence Based Public Health?
"conscientious, explicit, and judicious use of current best evidence in making decisions about the care of communities and populations in the domain of health protection, disease prevention, health maintenance and improvement (health promotion)"

-Scientific information on the programs and policies that are most likely to be effective in promoting health
-The translation of science into practice: using information from evidence-based interventions from the peer-reviewed literature within the real-world environment
-A defined, repeatable processes that lead to the evidence-base and the program
Key Characteristics of Evidence Based Public Health
-Making decisions using the best available peer-reviewed evidence (both quantitative and qualitative research)
-Using data and information systems systematically
-Applying program-planning frameworks (that often have a foundation in behavioral science theory)
-Engaging the community in assessment and decision making
-Conducting sound evaluation
-Disseminating what is learned to key stakeholders and decision makers
Evidence = Data
"THE AVAILABLE BODY OF FACTS OR INFORMATION INDICATING WHETHER A BELIEF OR PROPOSITION IS TRUE OR VALID"DECISIONS BASED ON BEST EVIDENCE AVAILABLE AT THE TIME NOT THE BEST EVIDENCE EVER POSSIBLE
Types of data (evidence) from objective to subjective
-science literature in systematic reviews
-scientific literature in one or more journal articles
-public health surveillance data
-program evaluations
-qualitative data
-community members
-other stakeholders
-media/marketing data
-word of mouth
-personal experience
Type 1 data
Defines the causes of diseases and the magnitude, severity, and preventability of risk factors and diseases. It suggests that "something should be done" about a particular disease or risk factor.
type 2 data
Describes the relative impact of specific interventions that do or do not improve health, adding "specifically, this should be done".
type 3 data
Type 3 evidence (of which we have the least) shows how and under which contextual conditions interventions were implemented and how they were received.Informing "how something should be done".
Interventions by Level of Evidence
Accumulation of evidence from a variety of sources to gain insight into a particular topic and often combines quantitative and qualitative data. Uses multiple methods of data collection and/or analysis to determine points of commonality or disagreement.
No cherry picking
-Selecting and utilizing the studies results with the desired results
-Biases literature review, meta-analyses, conclusions, and affects policy
evidence-based public health framework
The EBPH framework guides public health professionals through a series of steps, including assessment (to identify the problem and unmet needs), determining what is known, developing and prioritizing policy options, developing an action plan, and evaluating the program or policy. The framework helps public health professionals and their partners select interventions that are well-matched to the community's needs, preferences, and organizational capacity.
the process involves:
◦identifying unmet needs
◦setting objectives
◦selecting effective interventions
◦implementing and evaluating programs and policies
EBPH Benefits
-Access to more and higher-quality information on what works
-A higher likelihood of successful programs and policies being implemented
-Greater workforce productivity
-More efficient use of public and private resources
EBPH Challenges
-Political environment
-Funding challenges
-Attitudes of leadership
-Organizational culture with strong advocates needed
-Workforce training needs and approaches
-Deficits in relevant and timely research, information systems, resources, leadership, and the required competencies
Creating a program rationale
step 1: identify appropriate background information
step 2: title the rationale
step 3: writing the content of rationale
step 4: listing references used to create rationale
program rationale: STEP 1: IDENTIFY BACKGROUND INFO
Sources of information and data to support a program rationale
-Literature - articles, books, government publications
-Know the past and current information about the topic-gain a better understanding of the concern, approaches to reducing or eliminating the health problem, and an understanding of the people for whom the program is intended
Types of information
-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 and communities— the people.
program rationale: STEP 1: IDENTIFY BACKGROUND INFO specifics
-what is the problem
-needs of priority population
-epidemiology information
-economic information
-explore organizations interests/ Goals
-evidence based data
-the people
NEEDS OF PRIORITY POPULATION (STEP 1)
Needs Assessment process of identifying, analyzing, and prioritizing the needs of a target population. carried out through a multiple-step process in which data are collected and analyzed.full needs assessments are not needed at this stage and are completed laterhowever, review of literature may generate information about a needs assessment of a similar program which can provide valuable information and data to develop the rationale.
STATUS OF PROBLEM: EPIDEMIOLOGY (STEP 1)
Epidemiology: "[t]he study of the occurrence and distribution of health-related events, states and processes in specific populations, including the study of determinants influencing such processes, and the application of this knowledge to control relevant health problems" Epidemiologic data can be analyzedEpidemiologic data sources include governmental agencies, governmental health agencies, non-governmental health agencies, and health care systems.
ECONOMIC COMPONENT OF RATIONALE (STEP 1)
Cost-benefit analysis (CBA) of a health promotion program will yield the dollar benefit received from the dollars invested in the program. Return on Investment (ROI) "measures the costs of a program (i.e., the investment) versus the financial return realized by that program" An example of ROI is a study that examined the economic impact of an investment of $10 per person per year in a proven community-based program to increase physical activity, improve nutrition, and prevent smoking and other tobacco use. The results of the study showed that the nation could save billions of dollars annually and have an ROI in one year of 0.96 to 1, 5.6 to 1 in 5 years, and 6.2 to 1 in 10-20 years "proving" the economic impact of many health promotion programs is not easyHelpful tool for calculating the financial burden of chronic diseases has been the Chronic Disease Cost Calculator Version 2
EXAMPLE OF EPI AND ECON DATA (STEP 1)
SMOKING: Approximately 17.8% of U.S. adults 18 years of age and older are cigarette smokers It has been estimated that the cost of ill effects from smoking in the United States totals approximately $300 billion per year. Almost equal amounts are spent on direct medical care ($170 billion) and productivity losses due to premature death and exposure to secondhand smoke ($156 billion) DIABETESEstimated annual costs associated with diabetes are approximately $245 billion; $176 billion from direct medical costs and $69 billion indirect costs related to disability, work loss, and premature deathNot all cases of diabetes are related to health behavior, but it is known for people with prediabetes, lifestyle changes, including a 5%-7% weight loss and at least 150 minutes of physical activity per week, can reduce the rate of onset of type 2 diabetes by 58% People with diagnosed diabetes have medical expenditures that are about 2.3 times higher than medical expenditures for people without diabetes
PROGRAM ALIGNS WITH ORGANIZATION (STEP 1)
Show how the potential outcomes of the proposed program align with what decision makers feel is importantPlanners can often get a hint of what decision makers value by reviewing the organization's mission statement, annual report, and/or budget for health-related items. Planners could also survey decision makers to determine what is important to them
EVIDENCE (STEP 1)
program planners systematically find, appraise, and use evidence as the basis for decision making when planning a health promotion program, it is referred to as evidence-based practice
THE PEOPLE (STEP 1)
The people it impacts are the most importantPromoting, maintaining, and in some cases restoring human health should be at the core of any health promotion program.
STEP 2: TITLE THE RATIONALE
Data has been identified and can start rationale"A Rationale for (Title of Program): A Program to Enhance the Health of (Name of Priority Population)."
STEP 3: CONTENT OF RATIONALE
Identify the health problem from a "global perspective." By global perspective we mean presenting the problem using information and data at the most macro level (whether it be international, national, regional, state, local)Showing the relationship of the health problem to the "bigger problem" at the larger perspectiveIn this step - Identify the health problem that is the focus of the rationale. This is referred to as the problem statement. The problem statement should begin with a concise explanation of the issue that needs to be addressed; why it is a problem and why it should be dealt with.
creating a program rationale STEP 3: CONTENT OF RATIONALE specifics
-problem statement
-social math
-propose a solution
-program success
SOCIAL MATH (STEP 3)
"the practice of translating statistics and other data so they become interesting to the journalist, and meaningful to the audience"Make the numbers easy to understand and clearly highlight the issueBreak the numbers down by time. Break down the numbers by place. Provide comparisons with familiar thingsProvide ironic comparisons. Localize the numbers.
PROPOSE A SOLUTION (STEP 3)
Propose a solution to the problem. the general overview of the program is often based upon the "best guess" of those creating the rationale. For example, if the purpose of a program is to improve the immunization rate of children in the community, a "best guess" of the eventual program might include interventions to increase awareness and knowledge about immunizations, and the reduction of the barriers that limit access to receiving immunizations. what can be gained from the program
PROGRAM SUCCESS (STEP 3)
Use the results of evidence-based practice to support the rationalePoint out any similarity of the priority population to others with which similar programs have been successful. "timing is right" There is no better time than now to work to solve the problem facing the priority population.
STEP 4: REFERENCES FOR RATIONALE
The final step in creating a rationale is to include a list of the references used in preparing the rationale. Having a reference list shows decision makers that you studied the available information before presenting your idea.
PLANNING COMMITTEE
Who will assist with planning the program?Who has the expertise needed to develop and implement?Who knows the needs of the population?Who is part of the population?
PLANNING MODELS
•Planning models, which are visual representations and descriptions of steps or phases in the planning process •It is the means by which structure and organization are given to the successful development and delivery of health promotion programs. •Models provide planners with direction and a framework from which to build interventions that can improve the health of individuals and communities.
THE GENERALIZED MODEL
•Provides overview of what is represented in most all other models •5 phases/steps involved in program planning•(1) assessing needs•(2) setting goals and objectives•(3) developing interventions•(4) implementing interventions•(5) evaluating results
THE GENERALIZED MODEL
•Pre-planning (not included) •Assessing needs, process of collecting and analyzing data to determine the health needs of a population and includes priority setting and population. •Setting goals and objectives identifies what will be accomplished •Developing interventions or programs are the HOW the goals and objectives will be achieved.•Implementation is the process of putting interventions into action•Evaluation focuses on both improving the quality of interventions (formative evaluation) as well as determining their effectiveness (summative evaluation)
EVIDENCE BASED PLANNING FRAMEWORK
•Not developed as a planning model but a set of seven skills focusing on evidence-based strategies•Understand the community context and concerns and population•Know the root causes for your statement issue•Evidence based solutions through scientific literature•Prioritize and action plan•Implement and evaluate
MAPP
•Mobilizing for Action through Planning and Partnerships•Developed by CDC and the National Association of County and City Health Officials (NACCHO) •Foundational approach to planning and evaluation in public health settings, particularly among local level health departments•Intended to improve health and quality of life through mobilized partnerships and taking strategic action•Six phases and Four assessments
MAP-IT
•Mobilize, Assess, Plan, Implement and Track•Introduced as a planning model to assist communities in implementing their own adaptations of Healthy People 2020•Mobilizes key individuals and organizations into a coalition that can work together to improve the health of the community
PRECEDE PROCEED
•"PRECEDE is an acronym for predisposing, reinforcing, and enabling constructs in educational/ecological diagnosis and evaluation"•"PROCEED stands for policy, regulatory, and organizational constructs in educational and environmental development"•One of the oldest and most enduring planning models used in health promotion with 8 phases•PRECEDE consists of a series of planned assessments that generate information that will be used to guide subsequent decisions•PROCEED is marked by the strategic implementation of multiple actions based on what was learned from the assessments in the initial phase
INTERVENTION MAPPING
•Designed to fill a gap in health promotion practice by translating data collected in the PRECEDE phases of PRECEDE-PROCEED into theoretically based and appropriate interventions•Assess needs using PRECEDE and then specifies who and what will change as a result of the intervention•Select intervention and describe scope and sequence of the intervention, the completed program materials, and program protocols•Determine what will be done by whom among planners or program partners.•Evaluate pop reached, strategies and methods worked as planned
HEALTHY COMMUNITIES
•Healthy Communities (or Healthy Cities) is a movement that began in the 1980•The Healthy Communities Program at the CDC has created the CHANGE (Community Health Assessment aNd Group Evaluation) tool to enable stakeholders and community team members to gather data on community strengths and assets as well as provide opportunities to create policy, systems, and environmental change through a community action plan•The movement is characterized by community ownership and empowerment and driven by the values, needs, and participation of community members with consultation from health professionals. Another characteristic of Healthy Communities is diverse partnership.
SMART
Social Marketing Assessment and Response ToolOrient program interventions to the preferences of consumers throughout the entire planning process
CHOOSING A MODEL
Three Fs of program planning: fluidity, flexibility, and functionality•Fluidity suggests that steps in the planning process are sequential, or that they build on one another. •Flexibility means that planning is adapted to the needs of stakeholders. Due to various circumstances, planning is usually modified as the process unfolds.•Functionality means that the outcome of planning is improved health conditions, not the production of a program plan itself.
CREATING A MODEL
Review all the models presented Identifying what you think are the common components of the modelsWhy include each component Draw a diagram of your model
OUR CLASS PROCESS
•Pre Planning•Problem to be Addressed•Program Rationale•Key Stakeholders or Involved Members•Needs Assessment•Mission Statement and Goals•Selecting an Intervention/Program•Implementing the Program•Evaluating the Program
what is a need?
circumstances in which something is necessary, or that require some course of action; necessity (noun). require (something) because it is essential or very important (verb).
What is a Needs Assessment
•A systematic procedure for determining the nature and extent of problems experienced by a specific population that affect their health either directly or indirectly•The process of identifying, analyzing, and prioritizing the needs of a priority population.
•A systematic way to gather information about a problem or issue.
•A process for identifying what already exists and what is missing in programs, gaps in services, or curriculum.
•The process used to justify a program and identify resources needed for the program.
Why are Needs Assessments Important?
•Community insight: what are the health concerns and why are they happening AND community engagement •Ensures that what you do, the plan or program you build, is designed and carried out in an appropriate and efficient way
•Focuses what you are doing: interventions, priority populations, funding/resources. Helps ensure that scarce resources are allocated where they can give maximum health benefit. Without determining and prioritizing needs, resources can be wasted on unsubstantiated programming.
•Tells you what you can be measuring•Can determine the capacity of a community to address specific needs. Community capacity is the "characteristics of communities that affect their ability to identify, mobilize, and address social and public health problems" and "Assessing community capacity helps you think about existing community strengths that can be mobilized to address social, economic, and environmental conditions affecting health inequities.
identifying Resources Needed through the Needs Assessment
•Personnel resources—Who will work on the project? What will their roles be? Will there be committees and subcommittees set up?
•Financial resources—What are the funding sources? Consider needs for planning, implementation, and evaluation. Where will limited funding best be spent?•Physical resources—Where will the program take place? Will the physical facilities and geographic location meet the needs of the audience/targeted population?
Reasons Information is Gathered in Needs Assessment
•Consider the specific interests of the target population•Identify or gather more information about a problem that has been identified or previously documented. •Provide a specific focus for program planning. •Assure that the program plans and materials used are relevant.•Determine if the need is for programming or other noneducational interventions. •Consider the resource needs of the program to assure that the plans can be carried out. •Identify specific skills and competencies needed for the targeted population to change behavior. •Identify strategies that will affect attendance and participation of the audience or target population.
(some) Questions that can be answered through Needs Assessment
•Who makes up the priority population?•What are the needs of the priority population? •Why do these needs exist?•What factors create or determine the need?•Which subgroups within the priority population have the greatest need? •Where are these subgroups located geographically?•What resources are available to address the needs?•What is currently being done to resolve identified needs?•How well have the identified needs been addressed in the past?
Performing Needs Assessment
•The type of needs assessments performed will depend on the type of program/unit of instruction being planned. •Some are time consuming and costly. •For example: 1. Large-scale assessments of community healthcare needs. 2. Use of data about the target population that already exists to decrease time and funds for large-scale assessments. •Some are as simple as a short questionnaire. •For example: 1. Survey of a college class to determine the needs of students in a course. 2. Ask participants what is important to them and what will make a positive experience for them. 3. Ask target group what they would like to see changed or implemented.
Sources of Data in a Needs Assessment
•1. Primary data—•data directly collected from the population of concern (e.g., interviews, focus group, survey, nominal group process, observation)—has the advantage of being specific to the target group.•2. Secondary data—•data already collected by someone else or an agency (e.g., data from government agencies, review of the literature, statistics from existing records)—has the advantage of being available but may not be completely applicable to the population.
Ways to enhance self report data
•1. Select measures that clearly reflect program outcomes. •2. Select measures that have been designed to anticipate the response problems and that have been validated. •3. Conduct a pilot study with the priority population.•4. Anticipate and correct any major sources of unreliability. •5. Employ quality-control procedures to detect other sources of error. •6. Employ multiple methods. •7. Use multiple measures. •8. Use experimental and control groups with random assignment to control for biases in self-report.
Strategies to Gather Information in Needs Assessment for Primary Data
1. Surveys
2. Questionnaires
3. Interviews
4. Focus groups
5. Community forums or town meetings
6. Nominal group process (consensus conference)
7. Observations
Surveys and Questionnaires
•Who should answer these questions??•The priority/target population •Community opinion leaders, and key informants. Opinion leaders are individuals who are well respected in a community and who can accurately represent the views of the priority population. These leaders are: 1. Discriminating users of the media 2. Demographically similar to the priority group 3. Knowledgeable about community issues and concerns 4. Early adopters of innovative behavior •Family members and friends. Collecting data from the significant others of a group of heart disease patients is a good example. Program planners might find it difficult to persuade heart disease patients themselves to share information about their outlook on life and living with heart disease. A survey of spouses or other family members might help elicit this information so that the program planners could best meet the needs of the heart disease patients. •Key informants are individuals with unique knowledge about a particular topic. Such as going through the disease or health experience themselves.
Survey
This needs assessment survey was designed to gather information for an osteoporosis education and prevention program for mothers and daughters. This was designed to be part of a wellness program held in a pharmacy.
Questionnaire
This questionnaire is an example of one that could be given to participants preparing for an exercise program to help the rehabilitation team assist the clients with their exercise plans. A sample number of responses to each question is included to help you begin to think about how one might use the results for a group program. Consider that there are 8 people in the group.
Interviews
•Face to Face Interviews - one on one in person; need to train interviewer so does not vary in questioning; has the advantage of gaining more complete data from respondents; builds rapport; can be time consuming
•Telephone Interviews - easy method at moderate cost; difficult to reach wireless only homes; try to gain access to a targeted directory; training interviewers to be consistent with questions
•Electronic Interviews - reduced response time, cost of materials, ease of data collection, flexibility in the design and format of the questionnaire, control over the administration such as distribution to the recipients all at the same time on the same day, and recipient familiarity with the format and technology
•Group Interviews - data can be collected from several people at once in a short time; members can influence others responses or one who dominates conversation
Interviews
•May be with an individual or a group. •May be the first step in gathering data to be followed by using the information to develop another means of assessment.•May supplement other forms of data to verify information collected in other ways. •Useful in obtaining data from individuals who do not express themselves well on a written survey. •Can gather information important in identifying and solving problems—for example: Does an individual recognize that a problem exists? How does the individual perceive the problem? Does the individual have any ideas for improvements or solutions? What does the individual like the most and the least about a situation or program? What is going well and not so well? What is important to the individual? What are his or her interests, goals, and hopes for the program in the future?

-This interview was designed to gather information from teachers about their perceptions of health literacy in the 3rd grade and to determine what might work in their school. Their responses will provide information about possibilities and to decide what other needs assessment strategies might be helpful in planning the program.
Community Forums or Town Meetings
•The community forum, also sometimes referred to as a town hall meeting, approach brings together people from the priority population to discuss what they see as their group's problems/ needs. •It is not uncommon for a community forum to be organized by a group representing the priority population, in conjunction with the program planners. Such groups include labor, civic, religious, or service organizations, or groups such as the Parent Teacher Association.
Focus Groups
•Qualitative research that grew out of group therapy. •Focus groups bring together a relatively small group of people who are asked to respond to new ideas or to solicit their views on an issue or service. •Focus groups are used to obtain information about the feelings, opinions, perceptions, insights, beliefs, misconceptions, attitudes, and receptivity of a group of people concerning an idea or issue.
•At the time of the invitation, they receive general information about the session but are not given any specifics. This precaution helps ensure that responses will be spontaneous yet accurate.
•Although focus groups have been shown to be an effective way of gathering data, they do have one major limitation. Participants in the groups are usually not selected through a random-sampling process. They are generally selected because they possess certain attributes (e.g., individuals of low income, city dwellers, parents of disabled children, or chief executive officers of major corporations).
•The results of the focus group are not generalizable

-Needs assessment focus group to gather information from parents who have children with diabetes. The purpose is to learn about the experiences they have had with the healthcare system as they take care of their children.
Focus Groups
1. Identify approximately 8-12 invited people who have information or a point of view about the issue.
•2. Several focus groups are often conducted with different participants using the same questions.
•3. Those invited should represent the target population. •4. Sometimes an incentive will encourage participation.
•5. Questions are prepared ahead of time and a facilitator is identified to lead the group.
•6. The facilitator asks each question and solicits responses from the participants and sometimes asks the participants to prioritize the responses.
•7. Care is taken during the session so that:
• One person does not dominate the group.
• Everyone has a chance to give input. • The facilitator does not lead the group in the direction of a certain viewpoint.
• Judgments are not made during the session.
•8. The session is recorded and/or videotaped.
•9. The session is transcribed and the responses analyzed. • Issues and themes delineated.
• Potential solutions described.
• Services needed identified.
Nominal Group Technique
A structured process to gain consensus from a group of stakeholders who have the information needed to be knowledgeable participants. They are invited participants and are representatives of the priority population.A summary of the process •1. Five to seven people are invited to the group (several groups may be meeting concurrently). •2. They are asked to respond to a question in writing without discussing. •3. They then share responses using a round-robin method. •4. Each idea is exactly recorded (whiteboard or large sticky notes). •5. These are made visible for all to see during the session. •6. Responses are discussed among everyone and clarified. •7. The participants are asked to rank order the responses privately. Votes are tallied to determine what is rated the highest by the group. The highest rated ideas are the ones most favored or important to the group.
Observations
•Observation can provide information about the people and the environment. Observers must be trained in the process so that data collected is reliable. •1. Direct observation—observing the situation, behavior, or people directly.• For example: Observing how children with asthma use their inhaler during physical activities. • Observing bike riders for use of helmets and other behaviors that keep them safe. • Observing the types of food that children choose in the school cafeteria. •2. Indirect observation—observing the results or outcomes of a behavior or by asking others.•For example: Asking parents about the behaviors of their child with asthma. • Observing the results of flossing and brushing teeth during a dental checkup. • Asking adult children about the adherence to medication of an elder parent.

•Windshield tours or walk-through•the person(s) doing the observation "walks or drives slowly through a neighborhood, ideally on different days of the week and at different times of the day, 'on the lookout' for a whole variety of potentially useful indicators of community health and well-being"•Potentially useful indicators may include: "(A) Housing types and conditions, (B) Recreational and commercial facilities, (C) Private and public sector services, (D) Social and civic activities, (E) Identifiable neighborhoods or residential clusters, (F) Conditions of roads and distances most travel, (G) Maintenance of buildings, grounds and yards" •Photovoice •participatory data collection (i.e., those in the priority population participate in the data collection) in which those in the priority population are provided with cameras and skills training (on photography, ethics, data collection, critical discussion, and policy), then use the cameras to convey their own images of the community problems and strengths •"Photovoice has 3 main goals: (1) to enable people to record and reflect their community's strengths and concerns; (2) to promote critical dialogue and enhance knowledge about issues through group discussions of the photographs; and (3) to inform policy makers"
Self-Assessments
•"A majority of these approaches address primary prevention issues, such as the assessment of risk factors and protective factors in one's lifestyle pattern, and the secondary prevention process of the early detection of disease symptoms"•Self-assessments are done by gathering data directly from the target group that gives the program planner information about the group's risk factors and health behaviors. •Self-assessments may be used to help participants evaluate what is important to them and what they would like to change. Self-evaluations can be done in a questionnaire or individual interview. •Health risk appraisals can be used as a self-assessment as a means to motivate people—done through a questionnaire. •1. Questions might be about health behavior, personal or family health history, demographics, and physical data. 2. The results generate individual and group reports. 3. Planners can use the individual reports or group reports depending on the program plan.
Multiple Needs Assessments for One Program
A variety of needs assessment strategies were used to develop an asthma pilot project to address the educational needs of Latino families. A sampling of data used to develop this program is included. This project was funded by HRSA Bureau of Health Professions with support from the Institute on Urban Health Research, Northeastern University. This example is used to show the range of needs assessment strategies that were used for one program.
Primary data
data directly collected from the population of concern (e.g., interviews, focus group, survey, nominal group process, observation)—has the advantage of being specific to the target group.
Secondary data
data already collected by someone else or an agency (e.g., data from government agencies, review of the literature, statistics from existing records)—has the advantage of being available but may not be completely applicable to the population.
Strategies to Gather Information in Needs Assessment for Secondary Data
1. Data Collected by Government Agencies 2.Data from Non-Government Agencies and Organizations 3. Data from Existing Records4. Data from the Literature
Data from Government Agencies
Some data collection is mandated by law (e.g., census, births, deaths, notifiable diseases)•Some data collection is voluntarily (e.g., usage rates for safety belts)•The data is available for free access by contacting the agency that collects the data, or by finding them on the Internet, or in a library that serves as a depository.
Data from Non-Governmental Agencies and Organizations
•Data collected from...health care systems, voluntary health agencies, business, civic, and commerce groups. •Most of the national voluntary health agencies produce yearly "facts and figures" booklets that include a variety of epidemiological data. •Many local agencies (e.g., local health department), health care facilities (e.g., non-profit hospitals) and organizations (e.g., United Way) often have data they have collected for their own use.
Data from Existing Records
•Often collected as a part of normal operations of an organization. •May be an efficient way to obtain the necessary information for a needs assessment (or an evaluation) without the need for additional data collection. •The advantages include low cost, minimum staff needed, and ease in randomization. The disadvantages include difficulty in gaining access to the necessary records and the possible lack of availability of all the information needed for a needs assessment or program evaluation.
Data from the Literature
•Planners might also be able to identify the needs of a priority population by reviewing any available current literature about that priority population. •An example would be a planner who is developing a health promotion program for individuals infected by the human immunodeficiency virus (HIV). Because of the seriousness of this disease and the number of people who have studied and written about it, there is a good chance that present literature could reflect the need of a certain priority population.
Conducting Needs Assessments
Needs assessment may be the most critical step in the planning process and should not be taken lightly.
Conducting Needs Assessments
1. Determining the Purpose and Scope
•What is the goal of the needs assessment? What does the planning committee hope to gain from the needs assessment? How extensive will the needs assessment be? What kind of resources will be available to conduct the needs assessment? •Important to know what data is already available and whether community health improvement or assessment plans have recently been conducted•Determine how involved the community well be in the assessments
Conducting Needs Assessments
2. Gathering Data
•data that are most applicable to the planning situation and that will do the best job of helping planners to identify the actual needs of the priority pop•Determine what local and national data already exists that fulfill knowledge needed (primary data) and fill in the gaps with secondary data•For example, if secondary data show that there is a need for cancer education programming, but does not specifically identify the type of cancer or segment the priority population by useful demographic characteristics (e.g., age or sex), then efforts should be made to collect such data. •For example, it may be that all the secondary data are quantitative data such as how frequently a service is used, and thus it might be very useful to collect primary data that are qualitative in nature such as detailed explanations of why a service was not used.
Conducting Needs Assessments
3. Analyzing the Data
•1. What is the quality of life of those in the priority population? •2. What are social conditions and perceptions shared by those in the priority population? •3. What are the social indicators (e.g., absenteeism, crime, discrimination, performance, welfare, etc.) in the priority population that reflect the social conditions and perceptions? •4. Can the social conditions and perceptions be linked to health promotion? If so, how? •5. What are the health problems associated with the social problems? •6. Which health problem is most important to change?
Conducting Needs Assessments
4. Identifying Risk Factors Linked to Health Problem
•Epidemiologic Assessment•Identify the determinants of health of the health problem•Identify and prioritize the behavioral and environmental factors that, if changed, could lessen the health problem in the priority population.•Environment is multidimensional and can include economic environment (e.g., affordability, incentives, disincentives); service environment (e.g., access to health care, equity in health care, barriers to health care); social environment (e.g., social support, peer pressure); psychological environment (e.g., emotional learning environment); and the political environment (e.g., health policy).
Conducting Needs Assessments
5. Identifying the Program Focus
•Identify those predisposing, enabling, and reinforcing factors that seem to have a direct impact on the risk factors.•Determine the status of existing health promotion programs•1. What health promotion programs are presently available to the priority population? •2. Are the programs being utilized? If not, why not? •3. How effective are the programs? Are they meeting their stated goals and objectives? •4. How were the needs for these programs determined? •5. Are the programs accessible to the priority population? Where are they located? When are they offered? Are there any qualifying criteria that people must meet to enroll? Can the priority population get to the program? Can the priority population afford the programs? •6. Are the needs of the priority population being met? If not, why not?
Conducting Needs Assessments
6. Validating the Prioritized Needs
•Validate means to confirm that the need that was identified is the need that should be addressed. Validation amounts to "double checking," or making sure that an identified need is the actual need. •Any means available can be used, such as (1) rechecking the steps followed in the needs assessment to eliminate any bias, (2) conducting a focus group with some individuals from the priority population to determine their reaction to the identified need (if a focus group was not used earlier to gather the data), and (3) getting a "second opinion" from other health professionals.
Measurement
Process of applying numerical or narrative data from an instrument (e.g., a questionnaire) or other data-yielding tools to objects, events, or people. Planners need to identify what instrument or tool will be used to collect dataExample: data collected on height and weight from a group of people then translated to body mass index (BMI) values, they can classify participants as either underweight (usually a BMI of < 18.50), normal (18.50-24.99), overweight (25-29.99) or obese (> 30).
Quantitative Measures:
"are numerical data collected to understand individuals' knowledge, understanding, perceptions, and behavior"Examples: mortality rates for diabetes over the last five years, BMIs of participants in a weight loss program, the prevalence of cigarette smoking among adolescents, the ratings on a patient satisfaction survey, and the pretest and posttest scores on a HIV knowledge test.
Qualitative Measures:
"data collected with the use of narrative and observational approaches to understand individuals' knowledge, perceptions, attitudes and behaviors"Often include words that are organized by codes and themes.Examples: notes generated from observational studies, transcripts from focus groups, and taped recordings of in-depth interviews with key informants.
Nominal
Use names or labels to categorize people, places, or things They do not represent any particular value or order.
Ordinal
Data into categories but allow rank-order to the categories. The different categories represent relatively more or less of something. However, the distance between categories cannot be measured.
Interval
Data into categories that are mutually exclusive and exhaustive, and rank-orders the categories, and are continuous. The widths or differences between categories must all be the same which allows for the distance between the categories to be measured with no absolute zero value.
Interval and Ratio sometimes grouped together as Numerical Data
Ratio
Data with a scale using absolute zero. An absolute zero "point means that the thing being measured actually vanishes when the scale reads zero"
Interval and Ratio sometimes grouped together as Numerical Data
characteristics of data
The results of a needs assessment or program evaluation are only as good as the data that are collected and analyzed. If a questionnaire is filled with ambiguous questions and the respondents are not sure how to answer, it is highly unlikely that the data will reflect the true knowledge, attitudes, and so on, of those responding. It is of vital the data they collected are... reliable, valid, and unbiased. (these are the tool's psychometric qualities)
Reliability
an empirical estimate of the extent to which an instrument produces the same result, applied once or two more times
validity
whether an instrument correctly measures what it is intended to measure
bias
Data that do not accurately reflect the true level of a measure because of errors in the measurement process including how data were collected or due to error in the selection of the study participants, in the study's design, or in the intervention phase which includes how participants were exposed to the treatment
-when participants do not feel comfortable answering a sensitive question, when participants act differently because they know they are being watched, when certain characteristics of the interviewer influence a response, when participants answer questions in a particular way regardless of the questions being asked, or when a biased sample has been selected from the priority population.
Creating Measurement Instruments
Only when planners are unable to use or adapt another instrument for their use should they undertake the process of developing their own
-Wording Questions - Avoid leading questions ( most people do this... what do you do?)Ask about one thing at a time (not do you brush and floss your teeth - but separate) Avoid jargon or words people may not know (if use a word - define it like aerobic means doing activities for 30 minutes)Be specific (don't be general or things that can be interpreted more than one way
-esponse Options -Planners must determine the format for response options and the response options will generate the needed data.
Likert ScalesMake sure answer options match well with questionResponse options should be mutually exclusive and exhaustive
-Presentation - 1.A cover page. The cover page should include the title of the survey, indicate the survey sponsor, and contain an image that reflects the survey topic. 2.A survey title. The title should tell the reader what the survey is about. For example: "Live for Life Weight Loss Class Evaluation" 3.A purpose statement. This tells the respondent the reason for the survey. Do not be too specific so as to bias participant responses. For example, "The purpose of this survey is to learn about your experience with the Live for Life classes" is better than "The purpose of this survey is to find out about how often you eat fruit and vegetables and how often you exercise." 4.A statement about confidentiality of answers. This means that nobody will know what they put as answers and their responses will not be linked to them as a person. 5.Instructions for how they should fill out the survey. For example, "For each question, mark the one box that best reflects your opinion." These instructions may also appear throughout the survey before a set of questions. In that case, they are called "transition statements." For example, "The next group of questions asks about your opinion on the Live for Life curriculum. Mark whether you agree or disagree with each statement." 6.Instructions for what they are to do with the survey once they are completed. For example, "When you are finished with the survey, please place it in the box at the front of the room." The visual appearance
Sampling
Nonprobability - all individuals in the survey population do not have an equal chance or probability of being selected to participate. Participants can be included on the basis of convenience (because they have volunteered, are available, or can be easily contacted) or because they possess a certain characteristic. Probability - random selection is used, each person in the survey population has an equal chance or probability of being selected.
Mission Statements
Sometimes referred to as a program overview or program aim, a mission statement is a short narrative that describes the purpose and focus of the program. Mission statement provides a description of the current efforts of a program but may also reflect the philosophy behind it. Formalizes the reason for an organization's existence by providing a long-term sense of direction and continuity Establishes broad and relatively permanent parameters within which goals are developed and specific programs designed Includes a target population and a statement of the agency's vision for what ideally might be achieved in collaboration between the agency and the target population
Relates to what is important to the organization and what it wants to accomplish.Contains information about the overall direction and purpose of the program or organization.Expression of the values and philosophy of the organization or program.Broad enough to be adaptable over time yet has a focus.Should set the stage for developing program plans.Serve as motivations for planners and participants
Function of Mission Statements
A good mission statement is lofty, inspiring, concise and understandableThe mission statement should be the most enduring part of the organizationBrief description of the organization's purpose, describes:The target populationWhat the organization can do with/for the target populationMission statement is somewhat general and long-term or permanentShould outlast staffShould outlast specific programsProvides continuity when other aspects/characteristics of the organization change
Mission Statements Constraints
Too many people want to incorporate own agendas into the statementMission statements become too long and unfocused to be meaningfulThe statement is not clear so it is left open to different interpretationsA meaningless mission is soon forgottenAbsence of a mission statement or a poorly developed one leaves people and programs without direction
Examples of Mission Statements
Educational Institution: recognized as a leader in preparing health educators to make a difference in urban communitiesBe a model for incorporating urban experiential learning into the curriculum for health educatorsTo promote collaborations with urban communities so there us a mutually beneficial relationship between the academic institution and the community
Program Goals
Goals are broad statements that describe the expected outcomes of the program. "Goals set the fundamental, long-range direction" VS "Objectives break the goal down into smaller parts that provide specific, measurable actions by which the goal can be accomplished" Goals are expectations that: provide overall direction for the program, are more general in nature, do not have a specific deadline, usually take longer to complete, and are often not measured in exact terms. Should include two components: who will be affected, and what will change as a result of the program. Goals typically include verbs such as evaluate, know, improve, increase, promote, protect, minimize, prevent, reduce, and understand
Broad statements of directionGeneral statements of learning outcomes or program directionsGeneral knowledge, skills, or attitudes that the learner/participant will have after the instruction takes placeProvides guidance for the establishment of objectivesProvides guidance for directing the planning activities and strategies in the program plan
Writing Goals
One goal per program Must be consistent with the organization's mission Provide a framework for the objectives and direction for the program State expected/desired outcomes Do not need to be measurable or specify time frame Sometimes set by funding source Frequently specified in grant request for applications/proposals
Barriers in Goal Development
You may not have the physical or financial resources to achieve the goalsTime constraints may result in some participants not achieving all the goals of a programParticipants may not have developed the attitudes and values needed for accomplishing the goals of a program
How/Where are Goals Derived?
From Needs Assessments...Statistics indicating risk for specific health problemsStatistics indicating increased incidence of specific diseasesGoals and directions that are desired by the participantsFrom healthcare Team...All health professionals involved with patient careThe patient an family membersMission statements of the facility or organizationGuidelines for standard of careCommunity NeedsDirect ObservationReview of records or incidentsProblems identified
Needs Assessments can Lead to Goal Development
Needs assessments can be done first and will indicate the goals to be developedTo implement health education programs to meet the needs of the communityTo implement a new health professional program'To develop programs for staff recertification or for continuing education
Examples of Program Goals
The elderly participants will be able to function independentlyTo graduate competent health educatorsTo develop a program for cardiac risk factor modification for people in the communityTo educate participants in developing heart healthy mealsTo increase the number of participants using the fitness centerParticipants will be able to manage their own asthmaTo improve healthy choices in the school cafeteriaParticipants will value a healthy lifestyle
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