chapters 10,11,12

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


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


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


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



• Outside sources– Public & voluntary health agencies (often

free materials)– Local– State

– Public libraries

– Purchase from a vendor– Generic materials– Personalized materials



• 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


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)


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


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


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


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


Sample Budget Sheet


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


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


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



• 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



• 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?


Example of Audience Segmentation


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


Bell-shaped Curve and Adopter Categories


S-shaped Curve and Cumulative Adoption


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)



• 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




• 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?



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)


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)


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


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)


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


Putting Plans into Action


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


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


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


Example Informed Consent Form



• 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


Sample Medical Clearance Form



• 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



• 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



• 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

chapters 10,11,12

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