chapters 10,11,12
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Copyright © 2009 Pearson Education Inc., publishing as Pearson Benjamin Cummings
Planning, Implementing, & Evaluating
Health Promotion Programs: A Primer – James F. McKenzie, Brad L. Neiger, Rosemary Thackeray
Fifth Edition
Lecture by J. McKenzie
Implementing Health Promotion Programs
Chapters 10,11,12
Copyright © 2009 Pearson Education Inc., publishing as Pearson Benjamin Cummings
Resources
• Resources include the “human, fiscal, and technical assets available” Johnson & Breckon, 2007, p. 296) to plan, implement, & evaluate a program
• Include personnel, curriculum & other instructional resources, space, equipment, supplies, & financial resources
• Most carry a “price-tag,” but many are free or inexpensive
Copyright © 2009 Pearson Education Inc., publishing as Pearson Benjamin Cummings
Personnel
• The key resource; people needed to carry out certain tasks
• Flex time, own time, & program ownership
• Where to get personnel– Internal– External (vendors)
– Public / voluntary / free (ex. speaker’s bureaus)– Private
– Combination of internal & external
• Culturally sensitive/competent
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Curricula and Other Instructional Resources - 1
• Curriculum – a course of study
• Sources of curricula & other instructional resources– Developing your own (in-house) or having someone else
develop them; development time– Purchasing or obtaining various materials from outside
sources; cost may be a concern– Purchasing or obtaining entire “canned” (participant &
instructor’s manuals, AV, training, & marketing) from a vendor; Do they meet the needs of the priority population?
– Combination of the above
Copyright © 2009 Pearson Education Inc., publishing as Pearson Benjamin Cummings
Curricula and Other Instructional Resources - 2
• Outside sources– Public & voluntary health agencies (often
free materials)– Local– State
– Public libraries
– Purchase from a vendor– Generic materials– Personalized materials
Copyright © 2009 Pearson Education Inc., publishing as Pearson Benjamin Cummings
Curricula and Other Instructional Resources - 3
• Quality of materials – Suitability assessment of materials instrument (SAM) (Doak et al., 1996)– Components (22 items spread over 6 areas)
– Content– Literacy demand– Graphics– Layout and typography– Learning, simulation, & motivation– Cultural appropriateness
– Score– 70-100% Superior material– 40-69% adequate material– 0-39% Not suitable material
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Space
• Where will the program be held– Space owned by sponsoring organization
– Lease/rent (e.g., from schools, religious organizations)
– Free– Community rooms (e.g., business or industry)– Trade another resource for use of space– May be a clean-up charge (e.g., custodial service)
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Equipment & Supplies
• Equipment (non-consumable / non-expendable items)– Own– On loan from others
• Supplies (consumable / expendable items)– Planner provides– Participants provide
• Difference between equipment & supplies is sometimes determined by monetary value or the length of “life” of the commodity
Copyright © 2009 Pearson Education Inc., publishing as Pearson Benjamin Cummings
Financial Resources
• Often must make tough decisions about how to allocate funds• For profit or not-for-profit?• Types
– Participant fee– Profit margin?– How much? Ownership!– Sliding scale - ability to pay
– Third-party support (someone other than planning agency or participant, e.g., employer, local civic group)
– Cost sharing– Organizational sponsorship (e.g., voluntary health agency, LHD)– Grants & gifts; key terms – seed dollars, in-kind support, RFPs– Combination
• Budget
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Components of Grant Proposal
• Title (or cover) page• Abstract or executive summary• Table of contents• Introduction• Background• Description of proposed program (includes objectives, intervention,
evaluation plan, time frame)• Description of relevant institutional/agency resources• List of references• Personnel section• Budget
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Budget
• Budget – “a formal statement of the estimated revenues and expenditures” (Johnson & Breckon, 2007, p. 170)
• Financial object of the program; profit margin?
• Revenue & expenditures
• Once program is running there is a need to monitor the budget; preparing & distributing reports
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Sample Budget Sheet
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Key Terms
• Market – “the set all people who have an actual or potential interest in a product or service” (Kotler & Clark, 1987, p.108)
• Marketing – a set of processes for creating, communicating, and delivering value to customers: (American Market Association)– Social marketing – attempts to change behavior for improved
health or social outcomes– Commercial marketing – is concerned with a financial profit
• Items that can be marketed can be tangible or intangible: information, ideas, goods, services, events, or behaviors
• Exchange – trading a product for certain costs
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The Marketing Process & Health Promotion Programs
• Keys to understanding the marketing process– Understanding the priority population
– Knowing how to segment the priority population
– Having a good understanding of the diffusion theory
Copyright © 2009 Pearson Education Inc., publishing as Pearson Benjamin Cummings
The Consumer and Segmentation - 1
• All of the following should be based upon what is known about the priority population
– Type of intervention– How the intervention is offered– How much the intervention will cost– How the intervention will be promoted
• Items that must be known about those in the priority population– How they see the world– What makes them tick– How they spend their time– What is important to them
Copyright © 2009 Pearson Education Inc., publishing as Pearson Benjamin Cummings
The Consumer and Segmentation - 2
• Segmentation is a way to divide the priority population into smaller, more homogeneous or similar groups.
• Segmentation allows planers to better meet the needs of the consumer allowing for a greater chance of an exchange taking place
• Factors or variables used for segmentation: demographics, geographics, geodemographics, lifestyle/psychographics, benefits sought, and behavioral (readiness to change, knowledge, attitudes, beliefs, or behaviors)
• Most of time multiple factors are used to identify segments; no right or wrong way to segment; can be done a priori or a posteriori
Copyright © 2009 Pearson Education Inc., publishing as Pearson Benjamin Cummings
The Consumer and Segmentation - 3
• Deciding on what segments to focus; possible criteria include:– Measurable – how many people in each segment & can the factors
be measured
– Substantial – is the segment large enough & profitable enough to reach enough people to make a difference
– Accessible – can the segment be reached & services delivered?
– Differentiable – are segments different enough that they will react differently to marketing strategies
– Actionable – can products be created to attract segments?
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Example of Audience Segmentation
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Marketing and the Diffusion Theory
• The diffusion theory (Rogers, 1962) provides an explanation for the diffusion of innovations (something new) in populations; or stated a little differently, it explains the pattern of adoption of the innovations.
• Priority population– Innovators (-2 sd from mean) (2-3%)– Early adopters (-2 to -1 sd from mean) (14%)– Early majority (-1 sd to mean) (34%)– Late majority (mean to +1 sd) (34%)– Laggards (> +1 sd) (16%)
• Each group has its own set of characteristics
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Bell-shaped Curve and Adopter Categories
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S-shaped Curve and Cumulative Adoption
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A Marketing Process* - 1
• Using marketing research to determine the needs and desires– Formative research to get answers to:
– What would make it easy for the priority population to obtain the product or respond to the intervention?
– What makes it difficult for or keeps the priority population from responding to the intervention?
– What benefit does the priority population desire as a result of responding to the intervention?
– What would the priority population be willing to give up to obtain the product and accompanying benefits?
*Syre & Wilson (1990)
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A Marketing Process* - 2
• Developing a product that satisfies the needs and desires of the clients
– Know the priority population; can it be segmented
– Creating an intervention that meets the needs & values of the consumers
– Consider the benefit ladder
*Syre & Wilson (1990)
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A Marketing Process* - 3
• Developing informative & persuasive communication flows– Relates to the creative strategy & message strategy (Kotler
& Keller, 2007)
– How will the planners get the message out?
– What are the best communication channels for your clients? Media habits? What medium? Costs? Reach? Culturally appropriate?
*Syre & Wilson (1990)
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Example Program Titles
• Heart at Work (worksite program of AHA)
• Freedom From Smoking (cessation program of American Lung Association)
• StayWell (Control Data)
• Active for Life (activity program of the American Cancer Society)
• Live Well - Be Well (worksite program of Quaker Oats)
• Live for Life (Johnson & Johnson)
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Defining Implementation
• “the act of converting planning, goals, and objectives into action through administrative structure, management activities, policies, procedures, and regulations, and organizational actions of new programs” (Timmreck, 1997, p. 328)
• Setting up, managing, and executing a project (Keyser et al., 1997)
• Program diffusion - adoption, implementation, sustainability (Bartholomew et al., 2006)
Copyright © 2009 Pearson Education Inc., publishing as Pearson Benjamin Cummings
Implementation
• Planners need to be flexible when implementing a program
• Phases of implementation1. Adoption of the program - a part of marketing2. Identifying & prioritizing the tasks to be completed3. Establishing a system of management4. Putting the plans into action5. Ending or sustaining a program
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Critical Path Method (CPM) or PERT/CPM
A C G
D E F
H J M
I
K L
B Items on critical path cannot be delayed without delaying the program; time is important estimates are made for earliest & latest start & finish times for each activity
A. Start planningB. Develop rationaleC. Needs assessmentD. Create instrumentE. Select sampleF. Collect & analyze dataG. Create goals/objectives
H. Create interventionI. Pilot testJ. Implement programK. Identify & allocate resourcesL. MarketingM. Evaluate (process, impact, & outcome)
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Phase 4 - Putting Plans into Action
• Major ways of putting plans into action (Parkinson & colleagues, 1982)– Inverted triangle represents number of people involved
– Pilot testing – trying the program out with a small group from the priority population to identify any problems
– Phased-in – limiting the number of people who are exposed then gradually increasing the numbers; by offerings, by location, by ability, by number
– Total program – all in priority population exposed at same time
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Putting Plans into Action
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First Day of Implementation
• Also referred to as: program launch, program rollout, or program kick off
• Decide on a first day; consider launching to coincide with other already occurring event (e.g., weight loss program & New Year’s resolution)
• Kick off in style
• Seek news coverage, if appropriate
• Consider a news hook; e.g., day in history
• Special event; use of celebrities
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Phase 5 - Ending or Sustaining a Program
• How long to run a program
• Ending?– Goals & objectives met?– Resources available?– Need to re-focus?
• Sustaining?– Work to institutionalize– Advocating for the program– Partnering with others– Revisiting & revising the rationale
Copyright © 2009 Pearson Education Inc., publishing as Pearson Benjamin Cummings
Concerns Associated with Implementation - 1
• Safety & Medical Concerns– Most programs are to improve health, thus do not put
participants in danger
– Informed consent– Explain nature of program– Inform participants of risk & discomfort– Explain expected benefits– Inform of alternative programs– Indicate that they are free to discontinue participation at any
time– Allow participants to ask questions
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Example Informed Consent Form
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Concerns Associated with Implementation - 2
• Safety & Medical Concerns (continued)– Informed consent (waiver of liability or release of liability) do not
protect planners from being sued
– Medical clearance signed by a physician
– Ensure safety & health– Program location; appropriate security– Building codes met & facilities free from any hazards– Qualified instructors– Plan in case of emergency
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Sample Medical Clearance Form
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Concerns Associated with Implementation - 3
• Ethical Issues– Where competing values are at play & judgment must be made
on what is the most appropriate course of action
– Code of Ethics for the Health Education Profession to guide the work of health educators; highest standards
– The Belmont Report: Ethical Principles & Guidelines for the Protection of Human Subject Research
– Respect for persons– Beneficence – maximizing benefits & minimizing harm– Justice – fairness
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Concerns Associated with Implementation - 4
• Legal concerns – Negligence – failing to act in a prudent (reasonable) manner
– Omission– Commission
– Reducing liability – key to avoiding liability – Aware of legal liabilities– Qualified instructors– Good judgment– Informed consent– Medical clearance– Limit work to expertise– Safe environment– Insurance
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Concerns Associated with Implementation - 5
• Program Registration & Fee Collection – need a system• Procedures for Recordkeeping – HIPAA; anonymity/
confidentiality • Procedure and/or participants manuals – 1) make sure all
understand, 2) standardize, avoid Type III error, 3)ideas for facilitation, 4) provide additional background information, & 5) provide additional resources
• Training of facilitators – if it is not possible to hire qualified instructors, may need to train
• Dealing with problems – try to anticipate• Reporting & documenting – for 1) accountability, 2) public
relations, 3) motivation of participants, 4) recruitment of new participants
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