Implementing Health
Promotion Programs
Implementing Health Promotion Programs
• Community Organizing and Community Building
• Identification and Allocation of Resources
• Marketing: Making sure programs Respond to
Wants and Needs of Consumers
• Implementation: Strategies and Associated
Concerns
Community Organizing and
Community Building
• Community defined
– Membership – a sense of identity and
belonging
– Common symbols systems – similar language
– Shared values and norms
– Mutual influence – influence each others
– Shared needs and commitment to meeting
them
– Share emotional connection – common
history, experiences, and mutual support
Community Organizing and
Community Building
• Community Organizing
– A shift from individuals to broader community
involving citizen participation, grass-roots
participation, community participation, macro practice,
community based, community empowerment, and
community partnerships
– Defined: a process through which communities are
helped to identify common problems or goals,
mobilize resources, and in other ways develop and
implement strategies for reaching their goals they
have collectively set (Minkler, 1997, p. 5)
Terms Associated with Community Organizing
• Citizen Participation
– The bottom-up, grass-roots mobilization of
citizens fro the purpose of undertaking
activities to improve the condition of
something in the community
• Community Capacity
– Community characteristics affecting its ability
to identify, mobilize, and address problems
Terms Associated with Community Organizing
• Community Development
– A process designed to create conditions of
economic and social progress for the whole
community with its active participation and the
fullest possible reliance on the community’s
initiative (United Nations, 1955, p. 6)
• Community participation
– A process of involving people in the
institutions or decisions that affect their lives
Terms Associated with Community Organizing
• Empowered Community
– One in which individuals and organizations apply their
skills and resources in collective efforts to meet their
respective needs
• Grass-Roots Participation
– Bottom-up efforts of people taking collective actions
on their own behalf, and their involve the use of a
sophisticated blend of confrontation and cooperation
in order to achieve their ends
• Macro Practice
– The methods of professional change that deal with
issues beyond the individual, family, and small group
level.
Steps in Community Organizing and Building
1. Recognizing the issue: recognizes that an issue exists in the
community and that something needs to be done about it
2. Gaining entry into the community
3. Organizing people
4. Obtaining the support of the community members to deal
with the concern
5. Assessing the community
Steps in Community Organizing and Building
6 Determining the priorities and setting goals
7 Arriving at a solution and selecting intervention strategies
8 Implementing the plan
9 Evaluating the outcomes of the plan of action
10 Maintaining the outcomes in the community
11 Looping back
Planned Approach to Community Health
A Five Phases of PACH Model for
Community Organization Process
1
Mobilizing the
community
5
Evaluating
PATCH
Source: Kreuter et al. (1985)
2
Collecting and
organizing data
3
Choosing health
priorities
4
Developing a
comprehensive
intervention plan
Identification and Allocation of
Resources
• Resource defined: Including all the people
and things needed to carry out the desired
program
– Personnel, internal resources, external
resources, combined resources, space,
equipment and supplies, financial resources,
participant fee, third-party support, cost
sharing, organizational sponsorship, grants
and gifts
The Components of a Grant Proposal
• Title (or cover) page: concise and explicit
• Abstract: short and concise
• Introduction: begin with a capsule
statement, be comprehensible to the
informed layperson, including problem,
significance of the program, and purpose
of the program.
• Background: Previous work and the
related literature
The Components of a Grant Proposal
• Description of proposed program: include the
objectives, description of intervention, evaluation
plan, and time frame
• Description of relevant institutional/agency
resources: identify the resources the proposer’s
organization will bring to the project
• List of references
• Personnel section
• Budget: include budget needs for personnel,
equipment, materials, and supplies, travel,
services, other needed items, and indirect costs
Marketing: Making sure Programs Respond
to Wants and Needs of Consumers
• Market defined: the set of all people who have an actual
or potential interest in the product or service
• Marketing: the planned attempt to influence the
characteristics of voluntary exchange transactions –
exchanges of costs and benefits by buyers and seller or
providers and consumers.
• Apply to health promotion: Suggesting that planners
would like to exchange costs and benefits with those in
the priority population.
– i.e., planners would like to exchange the benefits of participation
in health promotion programs (the objectives or outcomes of the
programs they panned), such as “a longer healthier life, looking
and feeling better, and having fewer but healthier children for the
costs of the program, which may come from the participants.
Diffusion Theory (Rogers, 1962)
The theory provides an explanation of the diffusion of
innovations (something new) in populations, stated in another
way, it provides an explanation for the pattern of adoption of
the innovations
If one thinks of a health promotion program as an innovation,
the theory describes a pattern the priority population will follow
in adopting the program. The pattern of adoption can be
represented by the normal bell-shaped curve. The theory
provides an explanation of the diffusion of innovations
(something new) in populations, stated in another way, it
provides an explanation for the pattern of adoption of the
innovations
Innovators Early
adopters
<3%
14%
-2sd
-1sd
Late
majority
34%
Mean
Number adopting
-3sd
Early
majority
34%
Time
+1sd
Laggards
16%
+2sd
+3sd
Diffusion Theory
• Innovators: 2%-3% of the priority population would probably become
involved in the program just because they had heard about it and
wanted to be first
• Early adopters: -1 SD, 14%. Very interested in the innovation, but
they are not the first to sign up.
• Early majority and late majority: fall between minus 1 sd and the
mean, and between eh mean and plus 1 sd. 34%. Those in the
earlier majority may be interested in the health promotion program,
but they will need external motivation to become involved. Those the
early majority will deliberate for some tie before making a decision. It
will take more work to get the late majority involved, because they
are skeptical and will not adopt an innovation until most people in
the social system have done so.
• Laggards: 16%. Greater than plus 1 sd. Not very interested in
innovation and would be the last to become involved in the health
promotion programs, if at all.
The Marketing Process and Health
Promotion Programs
• Five distinct functions of the marketing process as they
related to the health care field (Syre and Wilson, 1990).
– Using marketing research to determine the needs and
desires of the present and prospective clients from the
priority population
– Developing a product that satisfies the needs and desires
for the clients
– Developing informative and persuasive communication
flows between those offering the program and the clients
– Ensuring that the product is provided in the appropriate
form, at the right time and place, and at the best price
– Keeping the clients satisfied and loyal after the exchange
has taken place
Implementation: Strategies and
Associated Concerns
• Implementation defined: the act of
converting planning, goals, and objectives
into action through administrative
structure, management activities, policies,
procedures, and regulations, and
organizational action of new program
(Timmreck, 1997, p. 328).
Phases of Program Implementation
• Phase 1: Adoption of the Program: greater care
must go into the marketing process to ensure
that a relevant product (i.e., the health promotion
program) is planned so that those in the priority
population will want to participate in it.
• Phase 2: Identifying and Prioritizing the Tasks to
be completed. Many of these tasks are often
referred to as program logistics, defined as the
procurement, maintenance, and transportation
of materials, facilities, and personnel
A Task Development Time Line
Year 1
Develop program
rationale
Conduct needs
assessment
Develop goals
And objectives
Create intervention
Conduct formative
evaluation
Assemble necessary
resources
Market program
Pilot test program
Refine program
Phase 1 intervention
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A Task Development Time Line (cont.)
Year 2
Phase 2 intervention
Phase 3 intervention
Phase 4 intervention
Total
implementation
Collect and analyze
data
Prepare evaluation
report
Distribute report
Continue with
follow-up for
long-term evaluation
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Phases of Program Implementation
• Phase 3: Establishing a System of Management:
Turn attention to how the program will be
managed. Defined as the process of achieving
results through controlling human, financial, and
technical resources (Breckon, 1997, p. 313)
• Phase 4: Putting the Plan into Action. Many
ways: by using a piloting process; by phasing it
in, in small segments, and by initiating the total
program all at once. They are better explained
by using an inverted triangle (see next slide).
Disadvantages
Advantages
- More people involved
- Evaluation more meaningful
With larger group
Total Program
- Easier to copy with workload
- Gradual investment
Phase-in
- Opportunity to test program
- Close control of program
Pilot
- Big commitment
- No chance to
test program
Fewer people involved
- Very few involved
- Not meeting all needs
- Hard to generalize
about results
Phases of Program Implementation
• Phase 5: Ending or Sustaining a Program:
determine how long to run a program.
– End, if the objective is reached.
– Continue, if the goal and objective is not met
Concerns Associated with
Implementation
• Legal Concerns: Liability.
– Make sure to adequate assess the risk (physical, mental)
– Informed consent
– Confidentiality
•
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•
•
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Medical Concerns: need medical clearance
Program Safety
Moral and Ethical Concerns
Procedural Manual and/or Participants’ Manual
Training for Facilitators
Dealing with Problems
Reporting and Documenting
SUMMARY
• Five phases planners follow in
implementing a program
– Adoption of the program
– Identifying the prioritizing the tasks to be
completed
– Establishing a system of management
– Putting the plan into action
– Ending or sustaining a program
SUMMARY
• There are matters that need to be
considered and planned for prior to and
during implementation