Introduction to Program Planning POH705 Week 11 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...

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 To inform us (as health educators) how to - Plan an efficient 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 Loading… effective programs The PRECEDE-PROCEED framework provides a structure or ________ road map for applying theories into programs L list to to Follow put into use Also a tool for designing, implementing and evaluating health education/promotion programs  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) come up with a should precede the intervention plan - diagnosiswhasato Interventions are strategically planned to meet a solve demonstrated _______ need Also recognizes the importance of – Social determinants of health in influencing health behaviour (PROCEED) – ______________ Participation of the target audience in defining the problem, goals, and solutions  PRECEDE PROCEED P Predisposing P Policy R Reinforcing and R Regulatory and E Enabling O Organizational C Constructs in Loading… 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 groups ?? have age-imeline need tery clear - I target – Involves prioritizing targets for intervention _ – Identifying measurable objectives  Precede-Proceed Planning Framework Phase 4 Phase 3 Phase 2 Phase 1 Administrative and Educational Epidemiological, Behavioural and Social Policy Assessment and Environmental Assessment Assessmen and Intervention Ecological t Alignment Assessment Predisposing Genetics Factors Health Program Education Reinforcing Behaviour Strategies Factors and Lifestyle Quality Health of Life Policy Enabling Environ- Regulation Factors ment Organization Phase 5 Phase 6 Phase 7 Phase 8 Implementatio Process Impact Outcome n Evaluation Evaluatio Evaluatio  n n CASE STUDY: Smoking Cessation Program for Older Canadians in Nursing Homes Thosewhewl older Developed to(Aldiabat guide gerontology> and Navenec, - 2013)to implement adults nurses smoking cessation programs in nursing homes – Problem/need: _________________________________ Health risks of smoking are highest among oldeelts Article describes how goals and objectives were developed, as well as specific activities guided by the PRECEDE-PROCEED model Built on health behaviour theories including – ____________________ Health Belief Model (individual level theory) – ____________________ Social learning (Community level) theory What is the first step in developing a program?  Precede-Proceed Planning Framework Phase 4 Phase 3 Phase 2 Phase 1 Administrative and Educational Epidemiological, Behavioural and Policy Assessment Social and Environmental Assessment and Intervention Ecological Assessment Alignment Assessment Predisposing Genetics Factors Health Program Education Reinforcing Behaviour Strategies Factors and Lifestyle Quality Health of Life Policy Enabling Environ- Regulation Factors ment Organization Phase 5 Phase 6 Phase 7 Phase 8 Implementatio Process Impact Outcome n Evaluation Evaluatio Evaluatio  n n 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’ Loading… 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 Considering community _________, capacity strengths, __________, resources readiness to change Biggest ~ important ↓ focus to on the Strengths barrier Identify key stakeholders Like what they doing are well in  How do we engage and collect this info? Planning committees Community forums (talking to not just resident but w/family as well) Focus groups 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 LTheir area of focus Example: Needs Assessment with Ile-X  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 Identify stakeholders Advisory Council, educators, youth  Precede-Proceed Planning Framework Phase 4 Phase 3 Phase 2 Phase 1 Administrative and Educational Social Epidemiological, Behavioural and Policy Assessment and Assessmen Environmental Assessment and Intervention Ecological t Alignment Assessment Predisposing Genetics Factors Health Program Education Reinforcing Behaviour Strategies Factors and Lifestyle Quality Health of Life Policy Enabling Environ- Regulation Factors ment Organization Phase 5 Phase 6 Phase 7 Phase 8 Implementatio Process Impact Outcome n Evaluation Evaluatio Evaluatio  n n PHASE 2: Epidemiological, Behavioural and Environmental Epidemiological Assessment Assessment Identifies the health priorities/issues that the program will focus on -identify the context – Priorities may differ even within a community, so it’s important to define _____________ subgroups Determines which factors (behavioural and environmental) influence the identified health priorities Why is this important? Translates priorities into measurable objectives for the - - program being developed  program being developed PHASE 2: Epidemiological, Behavioural and Environmental Assessment Most factors classified as behavioral or environmental Look at secondary data sources (info thatalreadycollected – ______________________________________ Stats Can pop health assessments hospital , , _______________________________________ records, previous studies May need to collect primary data L you go and collect L screenings PHASE 2: Epidemiological, Behavioural and BehavioralEnvironmental Determinants of a Assessment health problem can be understood on 3 levels: E.g. smoking cessation Proximal? (Attitude _________________________________________ Motivation , ability to participate (accessibility) Intermediate? (peer family societal , , factors/ _________________________________________ Peer Pressure Social support , Distal? Coutering _________________________________________ laws/regulations for which venues sell Cigarettes can  - PHASE 2: Epidemiological, Behavioural and Environmental Environmental Determinants Assessment Social and physical factors that go beyond behavioral control that can be modified to support the behavior to influence the health outcome. 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 environmental factors  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 _______________ changability L Potential for scope to change What does this mean?  PHASE 2: Epidemiological, Behavioural and Environmental Assessment Direct program resources to those factors that are the most important AND modifiable – __________________________________________ eg attitudes knowledge access. , , for resources et , 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 _______________, Risk Factors institutional policies and structure, characteristics of smokers, morbidity and mortality, genetic predispositions, etc. 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 & reports Previous literature, etc.  Precede-Proceed Planning Framework Phase 4 Phase 3 Phase 2 Phase 1 Administrative and Educational and Epidemiological, Behavioural and Social Policy Assessment Ecological Environmental Assessment Assessmen and Intervention Assessment t Alignment Predisposing Genetics Factors Health Program Loading… Education Reinforcing Behaviour Strategies Factors and Lifestyle Quality Health of Life Policy Enabling Environ- Regulation Factors ment Organization Phase 5 Phase 6 Phase 7 Phase 8 Implementatio Process Impact Outcome n Evaluation Evaluatio Evaluatio  n n 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 Objectives are formulated based on priorities Predisposing factors – antecedents (i.e., precursors) to a behavior that provide rationale or motivation for that behavior E.g., a person’s knowledge, attitude, beliefs, skills, confidence Reinforcing factors – factors that following a behavior, provide continued ________ reward or ________ for repetition of incentive that behavior 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 E.g., program services and resources, development of new skills 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? Increase knowledge among IDUs about dangers of sharing needles Predisposing factors Provide a safe injection site as a supporting resource Enablinor Increase awareness of the issue and improve attitudes among the community leaders, health-care providers and other influential people to offer more peer support Reinforcing Factor 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 reinforcing factors – Appropriate for ______________– suggest use of indirect communication channels through friends, family and methods such as peer support groups Community and organizational change theories – ______________– Enabling fac for suggest environmental change - i.e,. organizations’ delivery of services, policies, laws, and regulations  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  SMART Objectives S – SPECIFIC M – MEASURABLE A – ACHIEVABLE R – REALISTIC T – TIME-SENSITIVE  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 Long-term – ultimate expected impact of a program  GOAL: Improve the academic achievement of registered POH705 2024 students at TMU Goal ussmart vs. Objective SMART, Short-Term SMART, Short-Term Process Objective Outcome Objective 85% of all registered The percentage of POH705 students who POH705 will attend at meet or exceed the historical class least 8 of the scheduled average will increase by 10% by the end 10 classes in Fall 2024 of the Fall 2024 school term  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) 2) Encouraging factors (to enable or discourage smoking) 3) Barriers vs. facilitators (what will help/discourage smoking) How will you find the answers? ___________________ Literature review __________________________________________________ Prioritize infolfactors based on what is __________________________________________________ morel less important and more/less susceptible to change  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’ signs, etc  CASE STUDY: PHASE 3 What could be the goals and objectives of the program? 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. Is this statement “SMART”? yes 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. to da -havingrivity a - Is this an outcome or process objective? Is it SMART? No NO percentage no targetno timeline  Precede-Proceed Planning Framework Phase 4 Phase 3 Phase 2 Phase 1 Administrative and Educational Epidemiological, Behavioural and Social Policy Assessment and Environmental Assessment Assessmen and Intervention Ecological t Assessment Alignment Predisposing Genetics Factors Health Program Education Reinforcing Behaviour Strategies Factors and Lifestyle Quality Health of Life Policy Enabling Environ- Regulation Factors ment Organization Phase 5 Phase 6 Phase 7 Phase 8 Implementatio Process Impact Outcome n Evaluation Evaluatio Evaluatio  n n 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 ___________ resources – 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 _____________: Interventions affecting enabling factors for environmental change which in turn supports the desired health behaviour/outcome – E.g., administrative issues, organizational structure, culture, resources, policy and regulatory issues  PHASE 4: Administrative and Policy Assessment ___________: Macro level Interventions directly aimed at predisposing, reinforcing and enabling factors Includes individual, peers, family and others who can influence the desired change – E.g., media, counselling, advocacy, etc.  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 Potential barriers affecting program success? Potential facilitators?  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 and Educational Epidemiological, Behavioural and Social Policy Assessment and Environmental Assessment Assessmen and Intervention Ecological t Alignment Assessment Predisposing Genetics Factors Health Program Education Reinforcing Behaviour Strategies Factors and Lifestyle Quality Health of Life Policy Enabling Environ- Regulation Factors ment Organization Phase 5 Phase 6 Phase 7 Phase 8 Implementatio Process Impact Outcome n Evaluation Evaluatio Evaluatio  n n PHASE 5-8: Implementation and Evaluation The program is ready for implementation Data collections plans must be in place for evaluation purpose – Process evaluation – evaluation of how the program was implemented according the protocol – 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 indicators. PHASE 5-8: Implementation and Evaluation https://riskreduction.strategicfire.org/monitor-evaluate-modify-the-plan/monitoring-the-plan/  CASE STUDY: PHASE 5 - 8 Smoking Cessation Program PHASE 5: Implementation Identify the interventions based on policy and administrative diagnoses 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 PHASE 6-8: Process, Impact and Outcome Evaluation 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-management, and improve the quality of life. Kan, W., Yang, R., & Tang, M. (2021). Application research of chronic disease health management in an urban community based on the PRECEDE- PROCEED model in the long-term management of diabetes mellitus. American journal of translational research, 13(7), 8142–8149.  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-PROCEDE group ___________ were higherthan those in the routine group at six months after the management. Kan, W., Yang, R., & Tang, M. (2021). Application research of chronic disease health management in an urban community based on the PRECEDE-PROCEED model in the long- term 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 promotion resources. 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. https://doi.org/10.1177/21650799231180793  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 occupational health intervention. 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. https://doi.org/10.1177/21650799231180793  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, and community feedback. 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 #2: 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, significantly enhancing social inclusion. 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/interventions/search-interventions/ https://cbpp-pcpe.phac-aspc.gc.ca/interventions/  Only 2 classes left! Introduction to Program Evaluation (in-person) Communication Tools (posting recording early) Final Exam: December 4 See D2L announcements for details.