HLSC 3643
Community Health
Planning and Promotion
University of Arkansas
Dr. Jones
Overview of Health
Planning Models
Purpose of Notes
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To provide students with:
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Overview of planning models
Describe common caveats
Describe research on impact
Strategies to overcome barriers of models
Objectives
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Discuss the importance of planning
relevant, practical programs for social
change
Explain types of planning models
Explain the planning process
Discuss concerns and issues
“Imagination is more
important than knowledge.”
Albert Einstein
Health Programs

Health programs are are a set of planned
and organized activities carried out over
time to accompish specific health-related
goals and objectives
Overview of Planning
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Planning for programs has various
approaches:
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“Hit the ground running” approach
“Purpose-driven” approach
“Process-oriented” approach
“Model-driven” approach
Planning Models
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PRECEDE-PROCEED (Green and Kreuter)
PATCH (CDC, 1985)
MATCH (Simons-Morton, D., SimonsMorton, B., Parcel, & Bunker, 1988)
Generalized Model for Program Planning
(McKenzie and Smeltzer, 2001)
CDCynergy (CDC, 1998)
PRECEDE - PROCEED
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9 Phases
5 Phases are diagnostic – PRECEDE
4 Phases are evaluative – PROCEED
PRECEDE
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1st Phase: Social Diagnosis
2nd Phase: Epidemiological Diagnosis
3rd Phase: Behavioral/Environmental
4th Phase: Educational/Ecological
5th Phase: Administrative/Policy
PROCEED
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6th Phase: Implementation
7th Phase: Process Evaluation
8th Phase: Impact Evaluation
9th Phase: Outcome Evaluation
PATCH
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Planned
Approach
Toward
Community
Health
PATCH
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Phase I: Mobilizing the community
Phase II: Collecting and organizing data
Phase III: Choosing priorities
Phase IV: Developing a comprehensive
intervention plan
Phase V: Evaluating PATCH
MATCH
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Multilevel
Approach
Toward
Community
Health
MATCH
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Phase 1: Goal Setting
Phase 2: Intervention Planning
Phase 3: Program Development
Phase 4: Implementation Preparations
Phase 5: Evaluation
Generalizing Model for
Program Planning
1.
2.
3.
4.
5.
6.
Assessing Needs
Identifying the Problems
Setting Goals and Objectives
Developing and Intervention
Implementing the Intervention
Evaluating the Results
CDCynergy
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Phase 1: Problem definition and description
Phase 2: Problem analysis
Phase 3: Communication program planning
Phase 4: Program and evaluation
development
Phase 5: Program implementation and
management
Phase 6: Feedback
EMPOWER
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A computer-based
planning program
Enabling methods of
planning and
organizing within
everyone’s reach.
Based on PRECEDEPROCEED
Common Components
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Most of the models have these in common:
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Asking “why” instead of “how”
Gathering data
Identifying goals/objectives
Strategy/intervention selection
Implementation
Evaluation
Follow-up/Feedback
So many models…But do they work?
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Is a model suppose to work?
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Or is it just to allow for a structured process
in organizing programs?
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What evidence is there to support the use
of a model over the other?
Does Using a Model Help?
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Advantages
Caveats
Challenges
Advantages
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Provides direction
Non-biased approach
Uncovers hidden problems
Provides evaluation measures
Ability to use theories within model
Caveats
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Takes time and resources before
implementation
Create problems for un-experienced
program planners
Difficult to determine where theories fit
May never implement program
Evaluation is never ending
Challenges
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Learning before doing
Patience
Understanding theory/model
Finding the data
Letting go
Do Planning Models Work?
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How effective are planning models if used
correctly in the success of a program or
project activity?
Research on Effect
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Some models are new and don’t have
effectiveness data.
PRECEDE-PROCEED has most use
Results…
Some Evidence!
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Reduces AIDS risk
Reduces weight
Builds coalitions/partnerships
Strategies
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Use planning models over other
approaches
Using one or two parts of a model can still
help
Use theories with conjunction with a
planning model
Case Studies
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For each case study, provide the following:
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What should be the first step?
How would you provide the rationale?
Methods used to determine impact.
Should the program be implemented?
What should be the focus of evaluation efforts?
Case Study 1
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A plastic surgeon has observed many
children needing reconstructive surgery
due to lawnmowers. The surgeon asked
for support to do a program on lawnmower
safety to parents in the tri-county areas.
You are the head of a foundation that
supports research efforts and program in
the region and your organization has a
board of directors.
Case Study 2
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The student services director of a small
urban college is concerned about the
attrition of first years students. The director
makes a bold move to start a program that
seeks to retain students through offering
incentives for second and third year
students. You are a faculty member of the
student services board. What would be
your comments?
Case Study 3
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A local non-profit agency that offers
assistance to the homeless is establishing
a new program that will help the homeless
find work. It is seeking financial support
from local business to provide immediate
housing for homeless people who find
employment. What would be some
problems and how could planning help?
Bibliography
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Insert from other ppt.
Social Assessment Guidelines
1.
2.
3.
Engage community members as active partners
in social diagnosis.
Identify ultimate values and subjective concerns
with quality of life or conditions of living in the
population.
Verify and clarify these subjective concerns either
through existing data sources or new data from
surveys or interviews.
Social Assessment Guidelines
4.
5.
6.
7.
Demonstrate how social concerns and ultimate
values can serve to heighten awareness of and
motivation to act on health problems.
Assess the capacities and assets of a
community.
Make explicit the rationale for the selection of
priority items.
Use the documentation and rationale from social
assessment as one of the variables on which to
evaluate the program.
Types of Social Assessment
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Qualitative vs. Quantitative
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Qualitative = quality, low numbers, lots of
information, open ended questions
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Examples: interviews, focus groups, nominal
group process
Quantitative = lots of numbers, limited
information, closed ended questions.
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Examples: surveys by telephone, mail, or self
administered.
Qualitative Research Methods
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Focus Groups
Nominal Groups
Community Forum
Observation
Depth Interviews
Projective Techniques
Focus Groups
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Group interviews
where a moderator
guides the interview
while the group
discusses the topics
that are asked.
Steps in Focus Group Process
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Step 1: Prepare for the Group
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Step 2: Select a Moderator
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Select a focus group facility
Recruit the participants
Create a discussion guide for
moderator
Step 3: Conduct the Group
Step 4: Prepare the Focus Group Report
Qualitative Research Methods
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Nominal Groups
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Community Forums
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Using groups of five to 10 people who have knowledge of
issues under consideration.
Identify needs of a community through public meetings
Observations
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Observing target audience for visual and auditory cues
which may provide understanding of issues being
investigated.
Qualitative Research Methods
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Depth Interview
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One-on-one interviews that probe and gain
detailed answers to questions that try to uncover
hidden motivations
Projective Techniques
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Trying to tap respondents’ deepest feelings by
having them “project” those feeling into an
unstructured activity or situation.
Priorities of Health Programs
1.
2.
3.
Which problem has the greatest impact in terms
of death, disease, days lost from work
rehabilitation costs, disability, etc.
Are certain subpopulations, such as children,
mothers, ethnic minorities, refugees, indigenous
populations at special risk?
Which problems are most susceptive to
intervention?
Priorities for Health Programs
4.
5.
6.
Which problem is not being addressed by
other agencies in the community?
Which problem, when appropriately
addressed, has the greatest potential for
an attractive yield?
Are any of the health problems highly
ranked as a regional or national priority?
Epidemiological
Assessment/Diagnosis
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Epidemiology—Branch of medicine
dealing with a combination of knowledge
and research methods concerned with the
determinants and distribution of health and
illness in populations.
Surveillance
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The ongoing process and systematic collection,
analysis, and interpretation of health data.
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In surveillance, the following questions should be
asked concerning disease, illness, and injury:
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What: specific disease, illness, injury
Who: person variables: age, gender, race, etc.
How: causes, risk factors of disease
When: when did the disease occur
Where: where did person acquire disease
Class Activity
Develop surveillance form for a
specific disease, illness or injury.
Fall Injury Report
Springdale Safe Communities
Location of Fall:
p Home
p Work
p Street
p Sports/Recreation
p Other (Where?_________________________________)
Age:_________
Gender:
Ethnicity:
p African-American
p Hispanic
p Other (specify:_______________________)
Severity of Fall:
p Fatal
p Hospitalized
Type of Fall:
p Same Level
p Different level
Same Level Location:
p
p
p
p
p
p
p
p
Different Level Location:
p Exterior stairs to house entrance
p Stairs to basement
p Stairs to upper floors
p Stairs to public building
p Home porch or landing
p Tree
p Horse
p Window
p Roof
p Cliff or dropoff
p Ladder
p Other (Explain_______________________)
Probable Cause of Fall:
p
p
p
p
Alcohol/Drug
Medications
Inattention
Unsafe Environment
p
p
p
p
Prevention Measure:
p
p
p
p
p
Skid strips in tub
p Skid strips on stairs
Nonskid shoes
p Handrail
Soft carpet
p Stair repairs
Sports equipment (What?____________________________________)
Other (What?_____________________________________________)
Bathtub
Living Room
Sidewalk
Sports field
p Male
p Female
p Caucasian
p Ambulatory (fracture, loss of consciousness only)
Other bathroom
p Bedroom
Basement
p Attic
Street
p Public Building
Other (Where?_________________)
p
p
p
p
Kitchen
Home yard
Private Building
Not applicable
p Stairs to attic
p Stairs in nonresidential
private building
Poor Vision
p Weather
Physical Capabilities
p Behavior
Possible Brittle Bone/Osteoporosis
Sports/Recreation Activity (What?____________)
p Nonskid rugs
p Snow/ice clearance
p Fence or other barrier
Phases 3 & 4
To Identify What Causes the Causes
Phases 3 & 4
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Assumption 1: A specific health problem
has been identified.
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Assumption 2: A common goal has already
been established for the overall program.
Behavioral & Environmental
Diagnosis Steps
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Step 1: Identify and list risk factors
Step 2: Differentiate between behavioral
and environmental factors
Step 3: Shorten the list. Which factors are
relevant to the program goal?
Behavioral & Environmental
Diagnosis Steps
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Step 4: Determine Importance.
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How prevalent is the behavior?
Does factor contribute to problem?
Behavioral & Environmental
Diagnosis Steps
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Step 5: Determine Changeability
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There is precedence elsewhere for similar
changes.
The economic costs are not prohibitive.
The proposed change is supported by public
demand.
Behavioral & Environmental
Diagnosis Steps
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Step 6: Create a matrix.
More
Important
More
Changeable
Less
Changeable
Less
Important
Behavioral & Environmental
Diagnosis Steps
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Step 7: Set Objectives
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Who?
What?
How much?
When?
Selecting Factors & Priorities
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Step 1: Identify factors explaining health
behavior.
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Step 2: Classify into Predisposing,
Reinforcing, and Enabling Factors
Factors Effecting Behavior
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Predisposing (before behavior)
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Motivate behavior related to health.
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Knowledge
Attitudes
Beliefs
Factors Effecting Behavior
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Enabling (before behavior)
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Characteristics of environment that facilitate
health behavior or attaining skills required to
perform behavior.
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Skills
Peers
Other important persons
Laws and regulations
Factors Effecting Behavior
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Reinforcing (after behavior)
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Reward or punishment following consequence of
health behavior.
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Encouragement
Reward/punishment
Other people
Selecting Factors & Priorities
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Step 3: Determine the importance of each factor
Step 4: Determine the changeability of each
factor.
Step 5: Create a matrix to find factors that have a
high importance and high changeability.
Step 6: Write measurable learning objectives.
Development of Health Education
Learning Objective Components
1.
WHO (priority group)
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2.
WHAT
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3.
Specific group on whom objective will focus on.
What is the target group expected to do?
Should contain action verb.
HOW MUCH
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How much is to be achieved by priority group?
Development of Health Education
Learning Objective Components
4.
WHERE
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5.
What are the specific geographic boundaries of
program effort?
WHEN
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What amount of time has been allowed for
achieving the objective?
Objective Example
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Program Goal:
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By the year 2000, as a result of the Safe
Communities Program, reduce fatal injuries
among those aged 15 to 24 caused by motor
vehicle crashes in Springdale to no more than 17
per 1,000,000 population. (The current level is
33 per 100,000.)
Phases 5 & 6
Administrative Diagnosis
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Step 1: Resources needed
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Time
Staff
Money
Step 2: Assessment of Available
Resources
Administrative Diagnosis
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Step 3: Assessment of Barriers to
Implementation
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Staff Commitment and Attitudes
Conflict of Goals
Rate of Change
Familiarity
Complexity
Space
Community Barriers
Policy Diagnosis
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Step 1: Assessment of Policies,
Regulations, and Organization
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Loyalty
Consistency
Flexibility
Administrative/Professional Discretion
Policy Diagnosis
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Step 2: Assessment of Political Forces
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Level of Analysis
Win-Lose Approach
Systems Approach
Exchange Theory
Power Equalization Approach
Power Educative Approach
Conflict Approach
Advocacy and Educating the Electorate
Empowerment Education and Community Development
Components of a Proposal
1.
2.
3.
4.
5.
Introduction
Program goals and objectives
Detail of program strategies and activities
Evaluation of program
Program timeline
Components of a Proposal
Budget
Staff and personnel experience
Boilerplate material:
6.
7.
8.
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9.
Non-profit status
Board of directors
Committee members
Organization information
Letters of support
Finding Funding for Project
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Two Main Sources
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Government – produce request for funding
(RFP’s) for proposals specific to a disease or
prevention activity.
Finding Funding for Project
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Foundations –
(examples, Wal-Mart,
CommunityCare
Foundation) – Usually
accept proposals on
ongoing basis. Most
often very specific
guidelines and special
interests areas for
funding (education, arts,
community, etc.)
Project Description
1.
2.
3.
List major activities.
Estimate time for
activities.
How activity is
spread out over time.
Project Timelines: Gantt Chart
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List of activities with
the time needed to
complete each
program component.
Project Timelines: Gantt Chart
Budget Items
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Personnel
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Director
Staff
Administrative
Assistance
Consultants
Hourly
Equipment
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Facilities Cost
Travel (Domestic International)
Materials and Supplies
Communications
(phone, fax, etc.)
Indirect Costs
Activity: Grants
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Research and find a grant (with submission
guidelines) opportunity related to your area
of interest from:
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Governmental Source
Foundation
Bring to class for discussion
Health Communications
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Definition - Intention to inform, influence,
and motivate individuals and
organization to take action toward
health.
Health Communications
Health Communications can:
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Increase awareness
Demonstrate skills
Demonstrate a demand for health services
Remind or reinforce knowledge
Health Communications
Health Communications can’t:
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Compensate for lack of health care
Produce behavior change
Be equally effective with all messages
Social Marketing Theory
Definition: Applies concept of traditional
marketing to the "sale" of promotion of healthy
behaviors.
Elements include:
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Market plan,
Carefully designed message,
Employment of mass media,
Consensus building, and
Appropriate packaging.
Social Marketing Theory
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Stresses the importance of understanding
the target audience and designing
strategies based on their wants and
needs rather than what good health
practice directs that they should do.
Social Marketing Theory
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8 major components
i.
ii.
iii.
iv.
v.
vi.
consumer orientation
exchange theory
audience analysis and segmentation
formative research
channel analysis
marketing mix
1.
2.
3.
4.
product
price
place
promotion
vii. process tracking
viii. marketing management
What is media advocacy?

The strategic use of media as a resource
for advancing a social or public policy
initiative.

How can a media opportunity best
advance policy goals and shift the
debate from individuals to the collective
decisions of policies and norms?
Steps in Media Advocacy
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Media Advocacy
Set Public Agenda
Public Advocacy
Influence legislation
Set Policy
How is media advocacy different from
health education?
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Political vs. Behavioral science
Individual as advocate vs. Individual as audience
Advance healthy public policy vs. Develop health
messages
Decentralized and opportunistic vs. Problem and
approach
Changes in environment vs. Changes in individual
Uses news and paid ads vs. Public service bulletins
Target is person power vs. Person with problem
Power gap vs. Information gap
Media Advocacy Strategies
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Cultivating relationships
Research (monitoring)
Creative epidemiology
Creating news
Link with other news
Use paid advertising
Media Advocacy Strategies
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Issue framing (access, content)
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Access
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Controversy
Milestone
Anniversary
Irony
Celebrity
Breakthrough
Localize
Personalize
Injustice
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Content
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Translate individual problem to
social issue
Assign primary responsibility
Present solution
Make practical/policy appeal
Develop pictures and images
Tailor to audience
Media Advocacy Strategies
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Gain access to media
Use paid advertising
Limitations
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Lack of guidelines
Complex skills
Time requirements
Movement away from behavior
Controversial and confrontive
Media Advocacy Planning
GOTME
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Goals
Objectives
Target
Message
Evaluation
Earned Media
Utilizing print, broadcast, and interactive media
to elevate the level of public awareness. Not
posters brochures, or other print materials.
Core Principles
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Messages
Target
Testing
Follow-up
Earned Media: Messaging
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Relevant-news
Appropriate
Concise (10-15 seconds)
Memorable
Actionable
Earned Media: Target
Focus to get most for money
Maximize efficiency
Reach those who need message
Example: Drinking and driving
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Under-age drinkers
21-34 year olds
Hard core drinkers and repeat offenders
Earned Media:
No Free Media-Earned!
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Focus on issue
Local relevance
Timeliness-today!!
Problem-solution
Call to action—call to advocacy
Earned Media: Hooks that Work
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Crisis-you have a solution
Controversy
Innovation/creation (visual)
Research/Studies
Note: does not need to be all original
Earned Media: Tactics/Strategies
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Proclamation
Community event
Press conference (few)
Ribbon-cutting/ground breaking
Speaking engagements
Earned Media: Vehicles
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Media advisories
Calendar of events
Press release
Letter to the editor
PSA
Op-Eds
Talk radio
News media
Intenet/new media
(used by most of
reporters)
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Cable television
Community-bulletin boards
Earned Media: Partners in Programs
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Research
Training
Branding
Development
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Marketing
Media
Tracking
Reporting
Earned Media: Successful Programs
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Remain focused
Effective materials and messages
Generate awareness
Foster strategic alliances
Provide ease of action
Sustain effort
Phases 7-9
Evaluation
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Evaluation is: the comparison of an object of
interest against a standard of acceptability
Types of Standards:
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Arbitrary
Scientific
Historical
Normative
Compromise
Phases 7-9
Evaluation

Types of Evaluation Design
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Historical Record-Keeping (easy)
Periodic Inventory
Comparative
Controlled-Comparative
Controlled Experimental
Evaluative Research (more rigorous)
Types of Evaluation
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Formative
Process (Phases 5 and 6)
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Impact (Phases 3 and 4)
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Behavior
Environment
P, R, and E Factors
Outcome (Phases 1 and 2)
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Program
Implementation
Health
Quality of life
Cost Effectiveness
Cost Benefit