Introduction to Program Planning POH705 PDF

Introduction to Program Planning POH705 School of Occupational and Public Health Toronto Metropolitan University Week 11 1 Lesson Objectives To explore the PRECEDE- PROCEED planning framework To understand how th...

Introduction to Program Planning POH705 School of Occupational and Public Health Toronto Metropolitan University Week 11 1 Lesson Objectives To explore the PRECEDE- PROCEED planning framework To understand how this framework can be used to develop a health education program Imagine, as a health educator: A problem has been identified and now you must do something to help fix the problem Applying the theories of health behaviour is one of the critical skills needed to design and deliver effective programs The PRECEDE-PROCEED framework provides a structure or _road map_ for applying theories into programs Also a tool for designing, implementing and evaluating health  The PRECEDE- PROCEED Planning Framework Just as a medical diagnosis comes before a treatment plan, PRECEDE is based on the approach that an __educational diagnosis__ (i.e., identifying the problem) should precede the intervention plan Interventions are strategically planned to meet a demonstrated _need- Also recognizes the importance of – Social determinants of health in influencing health behaviour (PROCEED) – _participation__ of the target audience in  PRECEDE PROCEED P Predisposing P Policy R Reinforcing and R Regulatory and E Enabling O Organizational C Constructs in C Constructs in E Educational E Educational and D Diagnosis and E Environmental E Evaluation D Development You do not need to memorize this. The Precede-Proceed Planning Framework Overview The framework begins at the end (__the health outcome_) and works backward to diagnose which combination of intervention strategies will result in the most effective program – I.e., Start with the problem in order to come up with a solution – Involves prioritizing targets for intervention –  Precede-Proceed Planning Framework Phase 4 Phase 3 Phase 2 Phase 1 Administrative Educational and Epidemiological, Behavioural and Social and Ecological Environmental Assessment Assessment Policy Assessment Assessment and Intervention Predisposing Alignment Genetics Factors Health Program Educatio Reinforci Behaviour n ng and Lifestyle Strategi Factors Quality es Health of Life Policy Enabling Environ- Regulation Factors ment Organization Phase 5 Phase 6 Phase 7 Phase 8 Implementation Process Impact Outcome Evaluatio Evaluation Evaluation CASE STUDY: Smoking Cessation Program for Older Canadians in Nursing Homes (Aldiabat and Navenec, 2013) Developed to guide gerontology nurses to implement smoking cessation programs in nursing homes – Problem/need: ___health risks of smoking are highest among older adults _(help nurses to develop programs- focus on health risks associated with smoking)__ Article describes how goals and objectives were developed, as well as specific activities guided by the PRECEDE- PROCEED model What is the first step in developing a program?  Precede-Proceed Planning Framework Phase 4 Phase 3 Phase 2 Phase 1 Administrative Educational and Epidemiological, Behavioural and and Social Ecological Environmental Assessment Policy Assessment Assessment Assessment and Intervention Predisposing Alignment Genetics Factors Health Program Educatio Reinforci Behaviour n ng and Lifestyle Strategi Factors Quality es Health of Life Policy Enabling Environ- Regulation Factors ment Organization Phase 5 Phase 6 Phase 7 Phase 8 Implementation Process Impact Outcome Evaluatio Evaluation Evaluation  PHASE 1: Social Assessment, Participatory Planning, and Situation Analysis ‘Application through broad participation, of multiple sources of information, both objective and subjective, designed to expand the mutual understanding of people regarding their aspirations for the common good’ At this stage, planners expand their understanding of the community via multiple __data collection__ activities – While some programs can be pre-determined based on existing health issues, they should still engage with the community to identify specific concerns Identifying community perceptions, needs and challenges How do we engage and collect this info? Planning committees Community forums Focus groups: talk to diff stakeholders , determine their readiness. Surveys Key informant interviews Secondary data analysis Example of Community-Engaged Planning Bhawra J, Buchan MC, Green B, Skinner K, Katapally TR. (2022). A guiding framework for needs assessment evaluations to embed digital tools with Indigenous communities. PLOS One. https://journals.plos.org/plosone/article?id=10. 1371/journal.pone.0279282 In community-based research projects, _needs assessments _ are one of the first steps to identify community priorities - aka Don’t memorize, but think critically about what should be asked. Need to understand Digital access Example: Needs Assessment with Ile- X Covid-19 was focused on Because it was the most Time-sensitive issue. Example: Needs Assessment with Ile- X Understanding community via data collection activities Focus groups, key informant interviews Identifying community perception, needs and desires Relevance, timing of issues Considering community capacity, strengths, resources, readiness to change Who can lead efforts to address the problem? Youth led Existing funds, infrastructure Problem  readiness to change  Precede-Proceed Planning Framework Phase 4 Phase 3 Phase 2 Phase 1 Administrative Educational and Epidemiological, Behavioural Social and Ecological Assessment Policy and Environmental Assessment Assessment and Assessment Intervention Once we have Predisposing Alignment Factors Genetics awareness of who it is we are looking to design Health Program this program for, we can be more specific if we Educatio Reinforci Behaviour know the context n ng and Lifestyle Strategi Factors Quality es Health of Life Policy Enabling Environ- Regulation Factors ment Organization Phase 5 Phase 6 Phase 7 Phase 8 Implementation Process Impact Outcome Evaluatio Evaluation Evaluation  PHASE 2: Epidemiological, Behavioural and Environmental Assessment Epidemiological Assessment Identifies the health priorities/issues that the program will focus on – Priorities may differ even within a community, so it’s important to define __subgroup___________ Determines which factors (behavioural and environmental) influence the identified health priorities Why is this important?  PHASE 2: Epidemiological, Behavioural and Environmental Assessment Most factors classified as behavioral or environmental Look at secondary data sources – _stats can, population health assessments, hospital records, previous studies (information that has already need collected)___ _______________________________________  PHASE 2: Epidemiological, Behavioural and Environmental Assessment Behavioral Determinants of a health problem can be understood on 3 levels: E.g. smoking cessation Proximal? ___attitude (interest), motivation, ability to participate. __ Intermediate? __peers and family that have baring on health behaviour. Peer pressure and social support + or -_ Distal?  PHASE 2: Epidemiological, Behavioural and Environmental Assessment Environmental Determinants Social and physical factors that go beyond behavioral control that can be modified to support the behavior to influence the health outcome. – can be modified! Usually require other strategies in addition to health education to modify these determinants in a program Health behaviours and programs do not function in isolation from these  PHASE 2: Epidemiological, Behavioural and Environmental Assessment Decisions need to be guided by the community and supported by the health data Prioritize factors by __importance_ and __changeability_ What does this mean? Design a program that has the potential for change. Scope on improving awareness of harms of smoking. Understand what is  PHASE 2: Epidemiological, Behavioural and Environmental Assessment Direct program resources to those factors that are the most important AND modifiable – __attitudes, knowledge, access to resources (more at organizational level), ect.._____ THEORIES? – Social cognitive theory – Organization change theories CASE STUDY: PHASE 1 and 2 Information Gathering What type of information gathering activities should gerontology nursing staff be doing at this stage to assess the community? Recall: We need to involve the community, assess their needs, identify capacity and readiness to change __perception of smokers (asking pppl who don’t smoke how they feel about smoking wont be useful. )_ _risk factors_, institutional policies and CASE STUDY: PHASE 1 and 2 Information Gathering WHO do we involve in this process? Nursing home residents who smoke, _staff__, other residents to understand other concerns (i.e., second-hand smoke) HOW do we engage/involve them? Individual sessions _focus groups__ Questionnaires Organization forums Nursing home __records and reports__ Previous literature, etc.  Precede-Proceed Planning Framework Phase 4 Phase 3 Phase 2 Phase 1 Administrative Educational and Epidemiological, Behavioural and Social and Ecological Environmental Assessment Assessment Policy Assessment Assessment and Intervention Predisposing Alignment Genetics Factors Health Program Educatio Reinforci Behaviour n ng and Lifestyle Strategi Factors Quality es Health of Life Policy Enabling Environ- Regulation Factors ment Organization Phase 5 Phase 6 Phase 7 Phase 8 Implementation Process Impact Outcome Evaluatio Evaluation Evaluation  PHASE 3: Education and Ecological Assessment This stage identifies the precursors and reinforcing factors that must be present – These are needed to _initiate_ and __sustain__ the change process – Collectively influence the likelihood that behavioral and environmental change will occur Classified as: – Predisposing, Reinforcing, Enabling factors= need to be labelled to Predisposing factors – antecedents (i.e., precursors) to a behavior that provide rationale or motivation for that behavior- existing knowledge on topic (anything that might pre-dispose u to behaviour )= INDIVIDUAL LEVEL FACTORS E.g., a person’s knowledge, attitude, beliefs, skills, confidence Reinforcing factors – factors that following a behavior, (behaviour is already in effect) provide continued _reward_ or __incentive_ for repetition of that behavior = REWARDING E.g., social support, peer influence, social norms Enabling factors - antecedents to behavioral or environmental change that allow a motivation or environmental policy to be realized (provide with If attempting to reduce rates of blood-borne infections among injection drug users (IDUs) in your community, which of the following factors would you prioritize based on its importance and changeability? Predisposing factors  Increase knowledge among IDUs about dangers of sharing needles Enabling factors  Provide a safe injection site as a supporting resource  Increase awareness of the issuefactors. Reinforcing and improve attitudes among the community What theories are relevant for Phase 3 – Education and Ecological Assessment? Individual-level – Most appropriate for addressing ___predisposing factors__– help to identify messages and how to communicate with individuals i.e. phone calls, face-to-face, mass media, social media? = Interpersonal-level – Appropriate for _reinforcing factors __– suggest use of indirect communication channels through friends, family and methods such as peer support groups- influence family, friends and peer support groups. Community and organizational change theories – ____enabling factors __– suggest environmental  Goal of the Program What is a goal? Broad general statements that describe what the program plans to accomplish – Provide direction and focus – Define the scope – Foundation for objectives Essential to provide direction and focus. Overarching statements. Where as objectives are more specific  SMART Objectives S– SPECIFIC M– MEASURABLE A– ACHIEVABLE R– REALISTIC T– TIME-SENSITIVE Anchor to what are reference point is. Coming up with a measurable target (achievable object) We want to have a duration to assess these objectives. Relies on expertise on topic.  2 Types of Objectives Process objectives Focus on activities to be completed in a certain time period Outcome objectives Define the expected results; answer WHO, WHAT, WHERE, WHEN Short-term – expected immediately/occur soon after program implementation, i.e., within a year () Intermediate – follow short-term objectives  GOAL: Improve the academic achievement of registered POH705 2024 students at TMU Doesn’t say by how much. Identifies academic achieve and timeline SMART, Short-Term SMART, Short-Term Process Objective Outcome Objective 85% of all registered The percentage of POH705 POH705 will attend at students who meet or exceed least 8 of the scheduled the historical class average will 10 classes in Fall 2024 increase by 10% by the end of Measurable objective, has to do the With activity of coming to class. Fall 2024 school term Some correlation with people who attend and Better grade  CASE STUDY: PHASE 3 Recall the smoking cessation program in Canadian nursing homes. What are you trying to find out? 1) Contributing factors (to smoking rates) what influences smoking rates 2) Encouraging factors (to enable or discourage smoking) 3) Barriers vs. facilitators (what will help/discourage smoking) How will you find the answers?  CASE STUDY: PHASE 3 Predisposing Factors? Attitudes, knowledge, beliefs, personal preferences, skills, etc. of elderly smokers and other staff Reinforcing Factors? Contextual factors: organizational, social, psychological, economic and cultural factors Enabling Factors? Motivation of smokers, environmental factors that encourage or discourage smoking: accessibility of resources, availability of cigarettes, ‘No Smoking’  CASE STUDY: PHASE 3 What could be the goals and objectives of the program? Increase of ppl who quit smoking. Specific objective: decrease # of cigarettes by 50% within the next 8 months – is it specific is it measurable? To help older Canadian people living in nursing homes to quit smoking  Within five years of initiating the program, self reporting by older Canadian people who smoke and live in nursing home settings will indicate that 50% have completely quit smoking, 25% think they will quit smoking next year, 25% no longer smoke inside their rooms but in designed smoking rooms inside the nursing home. Yes it is a smart objective Is this statement “SMART”?  To prepare one small, private, equipped room inside the nursing home setting to be used as a clinic in which the advanced- practice gerontology nurses and related specialists provide counseling and other treatments that are culturally meaningful to the clients being served. This has to do with an activity, the act of providing counselling and treatments is a process. Framed more oriented toward activities which makes it a process Is this an outcome or process objective? No, doesn’t state when they intend to do this or who is the target population. Needs to be more specific! No target, no specific parameters or timeline to achieve this process  Precede-Proceed Planning Framework Phase 4 Phase 3 Phase 2 Phase 1 Administrative Educational and Epidemiological, Behavioural and Social and Ecological Environmental Assessment Assessment Policy Assessment Assessment and Predisposing Intervention Factors Genetics Alignment Health Program Educatio Reinforci Behaviour n ng and Lifestyle Strategi Factors Quality es Health of Life Policy Enabling Environ- Regulation Factors ment Organization Phase 5 Phase 6 Phase 7 Phase 8 Implementation Process Impact Outcome Evaluatio Evaluation Evaluation  PHASE 4: Administrative and Policy Assessment After identifying priorities and goals, the program planner will select and align the programs components The priority is the determinants of change previously identified – Identify _admin__ – Identify organizational barriers and facilitators – Identify _policies _ that are needed for program implementation  PHASE 4: Administrative and Policy Assessment 2 levels of alignment between assessment of determinants and selection of interventions __MACRO LEVEL__: Interventions affecting enabling factors for environmental change which in turn supports the desired health= HIGH LEVEL behaviour/outcome  PHASE 4: Administrative and Policy Assessment __MICRO LEVEL __: Interventions directly aimed at predisposing, reinforcing and enabling factors- Program activites, interaction with target population and peer group that can be part of predisposing, reinforcing and enabling behaviour Includes individual, peers, family and  CASE STUDY: PHASE 4 What kind of human and material resources would be needed for the smoking cessation program? Nurses may want to assess the types and number of personnel. E.g., Behavioural and addiction nurse specialist, smoking cessation consultants Material resources and supplies E.g., pamphlets, lecture room, medical supplies Needs depend on program activites. Potential barriers affecting program  CASE STUDY: PHASE 4 Assess availability of human and material resources and make plans to PROCEED with the program Identify the barriers for implementing smoking cessation program Implement the model (PROCEED phase 5)  Precede-Proceed Planning Framework Phase 4 Phase 3 Phase 2 Phase 1 Administrative Educational and Epidemiological, Behavioural and Social and Ecological Environmental Assessment Assessment Policy Assessment Assessment and Intervention Predisposing Alignment Genetics Factors Health Program Educatio Reinforci Behaviour n ng and Lifestyle Strategi Factors Quality es Health of Life Policy Enabling Environ- Regulation Factors ment Organization Phase 5 Phase 6 Phase 7 Phase 8 Implementation Process Impact Outcome Evaluatio Evaluation Evaluation PHASE 5-8: Implementation and Evaluation The program is ready for implementation Data collections plans must be in place for evaluation purposes – to assess if it worked? – Process evaluation – evaluation of how the program was implemented according the protocol (closly accoated with implementation phases ) – Impact evaluation - assess __change _ in predisposing, reinforcing and enabling factors as well as in behavioral and environmental factors – Outcome evaluation – determine the effect of the program on health and quality of life  PHASE 5-8: Implementation and Evaluation Needs assessment Talk to community Set goals and objectives “process” Evaluation Activites riskreduction.strategicfire.org/monitor-evaluate-modify-the-plan/monitoring-the  CASE STUDY: PHASE 5 - 8 Smoking Cessation Program PHASE 5: Implementation Identify the interventions based on policy and administrative diagnoses Specific interventions per-level What kind of intervention? Individual level: Smoke cessation counseling – Based on Stages of Change, can decide which intervention is most necessary, i.e., education for awareness, nicotine-patches if at relapse stage, etc. Community level: Prevent second-hand smoke and relapses  Applied Example #1: Diabetes Management Aimed to identify health management strategies for chronic disease (diabetes mellitus) in an urban community based on the PRECEDE- PROCEED model Chronic disease health management strategies have the potential to improve patients’ diabetes knowledge, lower blood glucose levels, improve self- efficacy and self- Kan, W., Yang, R., & Tang, M. (2021). Application research of chronic disease health management in an urban management, and community based on the PRECEDE-PROCEED model in the long-term management of diabetes mellitus. American  Applied Example: Diabetes Management Outcome measures  FPG (fasting glucose levels), 2hPG (post-load plasma glucose) and HbAlc (glucose monitoring) levels in the PRECEDE-PROCEDE group _were lower_ than those in the routine group at six months after the management Clinical manifestations, complication prevention, hypoglycemic intervention, diet and exercise awareness rate in the PRECEDE- Kan, W., Yang, R., & Tang, M. (2021). Application research of chronic disease health management in an urban community based on the PROCEDE PRECEDE-PROCEED the long-term ___were model ingroup management of diabetes mellitus. American journal of translational research, 13(7), 8142–8149.  Applied Example #2: Physical Activity Intervention Aim: To pilot an intervention promoting physical activity and reducing sedentary behavior among female healthcare workers based on the PRECEDE-PROCEED model Healthcare and social assistance workers are at higher risk for obesity and often lack access to workplace health Fetherman, D. L., & Cebrick-Grossman, J. (2023). Use of the PRECEDE–PROCEED Model to Pilot an Occupational Physical Activity Intervention: Tailored Through a Community Partnership. AAOHN Journal, 71(8), 367–374.  Applied Example: Physical Activity Intervention Participants achieved the recommended minimum of 7,000 steps per day after the 12- week intervention. Sedentary time decreased, alongside improvements in health-related psychosocial measures. The PRECEDE- PROCEED model proved to be an effective framework for tailoring and evaluating the community-based Fetherman, D. L., & Cebrick-Grossman, J. (2023). Use of the PRECEDE–PROCEED Model to Pilot an Occupational Physical Activity Intervention: Tailored Through a Community Partnership. AAOHN Journal, 71(8), 367–374.  Applied Example: Creating an Inclusive Environment Aim: To create an inclusive environment for people with physical disabilities at a shopping center in Montreal Effectiveness was measured by assessing changes in accessibility and inclusivity through participant surveys, impact evaluations, Ahmed, S., Swaine, B., Milot, M., Gaudet, C., Poldma, T., Bartlett, G., Mazer, B., Le Dorze, G., Barbic, S., Rodriguez, A. M., Lefebvre, H., Archambault, P., Kairy, D., Fung, J., Labbé, D., Lamontagne, A., & Kehayia, E. (2017). Creating an inclusive mall environment with the PRECEDE-PROCEED model: a living lab case study. Disability and Rehabilitation, 39(21), 2198–2206. https://doi.org/10.1080/09638288.2016.1219401  Applied Example #3: Creating an Inclusive Environment The project effectively showcased how the PRECEDE-PROCEED model guided the development of interventions that directly addressed barriers to inclusivity in a mall environment. By involving community stakeholders throughout the planning and implementation phases, the model ensured that interventions were tailored to the specific needs of individuals with disabilities, Ahmed, S., Swaine, B., Milot, M., Gaudet, C., Poldma, T., Bartlett, G., Mazer, B., Le Dorze, G., Barbic, S., Rodriguez, A. M., Lefebvre, H., Archambault, P., Kairy, D., Fung, J., Labbé, D., Lamontagne, A., & Kehayia, E. (2017). Creating an inclusive mall environment with the PRECEDE-PROCEED model: a living lab case study. Disability and Rehabilitation, 39(21), 2198–2206. https://doi.org/10.1080/09638288.2016.1219401  Canadian Best Practices Portal Resources for planning and evaluating programs https://cbpp-pcpe.phac-aspc.gc.ca/inter ventions/search-interventions/ https://cbpp-pcpe.phac-aspc.gc.ca/inter ventions/  Only 2 classes left! Introduction to Program Evaluation (in-person) Communication Tools (posting recording early) Final Exam: December 4 See D2L announcements for