Program Planning in Community Health PDF

Planning for Community Dental Programs Prof. Stier  Objectives 1. Define the term target population 2. Give specific examples of subjective and objective data 3. List five (5) areas where objective data is assessed 4. Give two (2) examples of geographic barriers 5. Give four (4)...

Planning for Community Dental Programs Prof. Stier  Objectives 1. Define the term target population 2. Give specific examples of subjective and objective data 3. List five (5) areas where objective data is assessed 4. Give two (2) examples of geographic barriers 5. Give four (4) examples of barriers to dental care 6. Name four (4) factors which would encourage access to care 7. Describe cultural diversity and guidelines for cross-cultural Dental Hygiene Care 8. List components of a successful survey 9. Compare and contrast questionnaire vs. interviews as used in assessment of needs. 10. Discuss the three (3) steps in the planning process and give specific examples of each. 11. Describe why program evaluation is important 12. Identify and describe the types of program evaluation 13. Define evaluation terms 14. Design a program evaluation instrument Phases in Program Planning  Assessment  Diagnosis  Planning  Implementation  Evaluation Where to Start? You are presented with a totally unfamiliar community and told to improve the oral health condition of its members… How do you begin? Assessments Assessments  Methods to gather information on factors that lead to a person’s or a community’s health status.  Assessments  Step I: Subjective Data Collection  Personal feelings/senses  Step II: Objective Data Collection  Not influenced by personal feelings Assessment Step I: Subjective Data Collection  Will orient you psychologically and physically to your environment  Examples of data collected through this method:  Is the community urban or rural?  What types of housing or hotels do you see?  What church denominations predominate?  What is the racial mix?  Are there many health food stores?  Do you see joggers?  Are there hospitals/medical facilities?  All these observations come from simple use of the senses, but are crucial first steps in assessment. Assessment Step II: Objective Data Collection  Assesses the community and issues through research  Examples of data collected through this method  Demographic Data  Geographic and Spatial Data  Political and Economic Power Structures  Economic and Social Power Groups  Statistics specifically related to Dentistry Assessment Step II: Objective Data Collection Demographic/Geographic and Spatial Data  Basic Demographic data is probably the most useful information to gather first in the collection of objective data.  Can be found in  Census records (both Federal and State)  County publications  Obtainable in local libraries  Urban planning offices  Historical Societies  Assessment Step II: Objective Data Collection Political and Economic Power Structures  This information is significant in that community participation is essential throughout the programming process.  It is therefore important to identifying powerful political groups  What groups and individuals are the key policymakers?  What are their views on health care?  Who allocates money for public programs (health and others?)  How do they spend their funds?  Legislation and Policy  Those specifically related to dentistry should be identified:  Is the water fluoridated?  What is the nature of the State Dental Practice act?  Is there restrictive legislation on auxiliaries? Assessment Step II: Objective Data Collection Economic and Special Interest Groups  These groups are all fundamental components of the community and can therefore determine the success or failure of a program.  Examples:  Church groups  Political-Change groups  A list of voluntary associations in a community becomes a useful tool for identifying major interest groups within the population as well as facts about social class and occupational distribution.  Publications with lists of community subgroups can often be located in local bookstores. Assessment Step II: Objective Data Collection Statistics Specifically Related to Dentistry:  Can be gathered once general sense of community is established  Examples:  How many practitioners are there?  What is their distribution by age and geographic location within the community?  What training institutions are available in close proximity to the area?  What percentage of providers have a solo or group practice?  What types of specialties are available, and in what numbers?  What is the current utilization rate of auxiliary personnel?  Local Dental and Dental Hygiene Associations can provide most of this data.  In addition, information relating to the issues of cost, access, and resource allocation may be available in the Dental Association data.  Assessment Access to Dental Care  Barriers to Care  Anything that limits a person’s ability to receive dentalcare  Examples:  Financial  Barriers related to minority status  The aged and the handicapped  Psychological Barriers  Geographic Barriers (includes transportation)  Legislation  Cultural Diversity How to Assess Objective Data Methods of Data Collection  Research  Surveys/Questionnaires (email, mail, phone, etc.)  Interviews  Focus Groups Assessment  Data Analysis  Will lead to diagnosis  Presentation  Show stakeholders the importance of program Diagnosis Dental Hygiene Diagnosis Diagnosis describes the PRIMARY NEED of the TARGET POPULATION as determined by performing the initial ASSESSMENT Dental Hygiene Diagnosis  May be done only evaluating the needs/vulnerability of the target population.  Must determine what DENTAL HYGIENE INTERVENTION would alleviate risk/disability/death.  Inter-disciplinary approach to overall health may be addressed during this phase if outside the normal parameters of dental hygiene practice.  Target Population  A term used to represent a certain segment of the population.  A group of individuals with similarities of some sort whether it be age, race, educational background, life situation, and/or health condition.  The group shares a common factor that puts them at risk Population at Risk Population with Greatest Risk Health Disparities  What is a health disparity?  Difference in health status or outcome among different populations  May be related to race/ethnicity, age, sex, income, language spoken, education, etc. Oral Health Disparities  What are oral health disparities?  Differences in oral health based on similar factors  May be higher incidence/prevalence of caries/periodontitis; higher rates of oral cancer, etc.  Examples:  Non-Hispanic blacks, Hispanics, Alaska Natives, and American Indians have poorest oral health in U.S.  Adults between 35-44 with less than a high school education experience caries and periodontitis three time more than those with at least some college education  Blacks with oral pharyngeal cancer have a lower 5-year survival rate than whites (36% vs. 61%) Planning Planning  Once the problem is identified, a plan can be put in place to address it  Goals and objectives will be established  These will reduce or provide a solution to the problem  Appropriate steps to achieve these goals and objectives will be identified *Community engagement is crucial Planning Process  Step I: Establish Priorities  Step II: Development of Program Goals & Objectives  Step III: Development of Solutions Planning Step I: Establish Priorities Each community is unique and while the general process is the same, specifics will be very different from community to community.  What is the magnitude of the problem? (does it cause death/disability?)  How many people are affected? (person, community or whole country)  What types of resources are available? (Human resources, money, facilities, technology)  What has already been done in the community?  What are the prevailing attitudes (and perceived needs)toward the problem?  What groups are expressing the most interest in the problem?  Are there legal constraints? Planning Step II: Development of Program Goals & Objectives  Program Goals  Broad statements on the overall purpose of a program to meet a defined problem.  Program Objectives  More specific and describes in a measurable way, the desired end result of a program activity  Should be realistic and based on research  SMART objectives  Outcome Objectives  Provides a means by which to quantitatively measure the outcome of the specific objective. SMART Objectives  Specific: “Who” or “What” is involved  Measurable: How much change is expected  Achievable: Should be attainable  Realistic: Should relate to the program  Time-phased: Should have a time-frame Example:  Goal: Students taking Preventive Dentistry and Public Health will pass the course  Objective: 90% of the students taking Preventive Dentistry and Public Health will pass the midterm and final exams by the end of the semester Healthy People 2030  Healthy People  Provides science-based 10-year national objectives  Encourages collaborations across communities and sectors  Empower individuals toward making informed health decisions  Measures the impact of prevention activities Healthy People 2030 Cont’d  Oral health section has 17 objectives (some with subparts)  Oral health is also a topic under “Leading Health Indicators”  Leading Health Indicators are high priority items  12 topics, 26 indicators  For topic of oral health, indicator is “children, adolescents, and adults who have visited the dentist in the past year” Planning Process Step III: Development of Solutions  The final step in the planning process is to develop a set of solutions for goals and objectives  Questions to be answered: 1. WHAT is going to be done? 2. WHO will be doing it/WHO will receive the intervention? 3. WHEN will it be done? 4. HOW will the intervention occur? Planning Resources & Constraints  Resource Identification (aka Inputs)  Selection of resources for an activity such as personnel, community partners, equipment and supplies, facilities and financial resources must be determined with consideration of what would be most effective, adequate, efficient and appropriate for the tasks to be accomplished.  Identifying Constraints  Remember when planning, careful consideration should be made to the type of resources available as well as to the program constraints.  Logic Model Outputs Outcomes -- Impact Inputs Activities Participation Short Medium Long These are the Activities Participatio These are These These are resources you’ll are what n is just immediate are changes need for the you do who is changes in change in program to with the participatin the s in conditions actually occur. It’s resource g in the situation, action. based on very inclusive. s needed activities. or the newly (inputs). They learning/ adopted should knowledge actions. correlate to changes. the activities. Assumptions External Factors These are simply what you These are anything that think about the could impact your community/target program’s success. population, that makes you think they need help.  Logic Model Outputs Outcomes -- Impact Inputs Activities Participation Short Medium Long -Time available for program to -Restore -Children in -Less untreated existing -Better -Lower occur cavities the cavities among children home incidence of community care cavities -Administer -Money for supplies/donations habits among fluoride -Parents of from suppliers/funding from establis children treatments the children government hed being treated -Teach children among -Materials for preventative and and/or parents -Volunteer children restorative treatments (i.e. gloves, proper dental fluoride varnish, filling material homecare providers etc.) techniques -Staff at the schools -Equipment to set up a clinic (i.e. chairs, suction, instruments, etc.) or availability of an existing clinic -Forms/charts (for patient information and permission slips) Assumptions External Factors -Parents/children have a desire to have -Funding available from state cavities fixed -Donations made from supply companies -Parents/children want to prevent more decay from occurring -Attitudes of volunteers when treating children -There is a need for financial assistance in receiving treatment -Attitudes/behavior of children during treatment -Volunteers are properly trained/have experience in treating children Implementation Implementation  This step includes the process of putting the plan into action and monitoring the plan’s activities, personnel, equipment, resources, and supplies  This step should include feedback from personnel and participants as well as ongoing evaluation and mechanisms Implementation  Implementation, like planning, involves individuals, agencies, and the community working together  The strategy should answer the following questions :  WHY: the effect of the objective to be achieved.  WHAT: the activities required to achieve the objective.  WHO: the individuals responsible for each activity.  WHEN: the chronologic sequence of activities.  HOW: the materials, methods, media, methods, and techniques to be used.  HOW MUCH: a cost estimate of materials and time. Implementation Pilot Testing  For ease in addressing these questions, many community oral health programs begin on a small scale  Using a smaller population with the intent to expand later is called pilot testing.  This implementation strategy allows for an opportunity to test the program’s effectiveness  Provides ease in control and monitoring of the program activities.  Provides useful information and enables decisions to be made about the future of the program  Example: fluoride mouth rinse programs. *Piloting is a form of implementation and evaluation. Evaluation Program Evaluation  Evaluating programs is a critical step in public health initiatives.  By evaluating both the process and the outcomes of a program, the benefits and effectiveness can be understood. Program Evaluation  Evaluation is necessary for program planners to know the following:  If intended efforts are effective  The social implications caused as a result  Cost/benefit analysis Program Evaluation Overarching Purposes:  Contribution to the provision of quality services to people in need  Means to developing “good practice”  Make the best use of scarce resources  Provide feedback to staff and participants  Shape future policy development and programs Program Evaluation  The results [OUTCOMES] of the interventions are measured against the program objectives.  The evaluation answers whether the program was successful in reducing or eliminating the identified need or problem as originally defined in diagnosis Program Evaluation Questions that may be answered through evaluation:  Did the program accomplish what it was designed to do?  Did the program work better than other similar programs?  Did the program reduce health cost?  Could the program be improved?  Should the program continue?  Does the program merit continued funding?  Should the program be expanded? Program Evaluation Timing Two types of evaluation that occur at different times:  FORMATIVE EVALUATION  During the implementation process  SUMMATIVE EVALUATION  After the intervention has already occurred Formative Evaluations  Help point out problems and identify opportunities to make improvements during program  Examples: DMFT scores being collected at various points throughout program (long-term programs)  Similar to the dental hygiene process of care in:  Evaluating instrumentation technique  Deposit removal Summative Evaluations  The results of the program are compared with the goals and objectives and are used to determine the impact of the program on the community’s health.  Example: Follow-up questions several months after program is completed regarding knowledge of oral health  Similar to the dental hygiene process of care in:  Re-evaluating probing depths of an individual patient after treatment of SRP  Program Evaluation Focus  Examines why a program succeeds or fails.  Identifies positive or negative effects  Determines if goals appropriate for the audience  The most important focus for most evaluations is on improvement of processes, implementation, efficiency, or anything that makes a program more organized and cost- effective  Program Evaluation  A combination of quantitative and qualitative methods can be used to specify and measure identifiable objectives can be used during evaluation  (measurements--process of using a specific method to evaluated something)  Qualitative methods are helpful when long-term changes are expected.  Example: Knowledge regarding oral health  Quantitative methods may provide information on immediate results  Example: Reduction in prevalence of caries after program Program Evaluation  Clinical Evaluation Methods:  Basic Screenings  Epidemiological Examinations  Nonclinical Evaluation Methods:  Questionnaires  Telephone Interviews  Surveys  Focus Groups  Observation Program Evaluation Framework  Six steps in public health program evaluation 1. Engage the stakeholders 2. Evaluator describes the program 3. Focus the evaluation design 4. Gather credible evidence 5. Justify conclusions 6. Ensure use and share lessons learned  Engage Stakeholders  Persons or organizations having an investment in what will be learned and what will be done:  Those involved in program operations  Those served or affected by the program  Primary users of the evaluation  Examples: Policy makers, funding agents, special interest groups, community representatives  Participation is essential to the evaluation process  Increase the relevance of credibility of the results Describe the Program  Convey the mission and objectives of the program being evaluated:  Statement of need  Expected effects  Activities  Resources  Stage of development  Context  Logic Model Focus the evaluation design  The evaluation must assess the issues of greatest concern to Stakeholders while using time and resources efficiently:  Purpose  Users  Questions  Methods  Agreements Gather Credible Evidence  The information collected should convey a well-rounded picture of the program that is credible:  Indicators (universal indices)  Sources  Quality (state of the art technology)  Logistics (where the study/intervention was conducted can gain credence). Justify Conclusions  To justify conclusions, certain questions must be answered that determine value/success of program  What will be evaluated?  What aspects of the program will be considered when judging a programs performance?  What standards will be reached for the program to be considered successful?  What evidence will be used to indicate how the program has performed? Ensure use and share lessons learned  Deliberate action is taken to make sure evaluation process and findings are used and disseminated:  Design  Preparation  Feedback  Follow-up  Dissemination  Additional uses Program Evaluation Designs  Commonly used evaluation designs:  Post-program Only  Pre-program and Post-program  Pre-program and Post-program with a Comparison Group  Pre-program and Post-program with a Control Group Post-Program Only  Outcomes are assessed after the program is completed.  Least useful design because it is difficult to assess the amount of change that occurs.  No baseline measurement taken before program to compare with outcomes at the end.  This design is useful only when it is more important to ensure that participants reach a specific desire outcome than it is to know the degree of change. Pre-program and Post-program  Enables an assessment of the amount of change.  Baseline measurements taken prior to the program are compared with measurements taken at the program’s conclusion.  Improvement over the post-program only design, but still may not offer complete confidence.  Does not account for the changes in the target group that are not related to the program Pre-program and Post-program with a Comparison Group  The assessment of a group similar to the target group but who did not receive the program.  Both target and comparison groups are assessed prior to the program and at the conclusion of the program.  Comparison group must be similar as possible to the target group, demographically. Pre-program and Post- program with a Control Group  Greatest support for claims that the program was responsible for the outcomes.  People are randomly assigned form the same overall target population to either group.  Random assignment allows each person an equal chance of being selected for either group  Control group is as close as possible to the comparison group  Data Collection Methods  Many advantages and disadvantages to the different ways of collecting data.  Best to use various techniques, since each method has its weakness.  Surveys fit the needs for descriptive data.  Experiments fit the need for testing hypotheses. Data Collection Methods  Self-Administered Surveys ( pen & pencil)  Telephone surveys  Face-to-face surveys  Archival Trend Data  Observation  Record Review  Focus Groups  Unstructured Interview/ Narratives  Open-ended Questions on a Written Survey  Participant Observation  Archival Research Management Information Systems  Help organize the data necessary to manage a program and make decisions.  Evaluators should develop tracking forms that are simple and user friendly.  Information from forms is entered into a data base to track a programs production, such as numbers per provider or children served at a school.  Information must be tabulated, summarized and displayed graphically to make it comprehendible Documentation  No evaluation is worthwhile if the information is not reported back to the stakeholders.  The program planner and the staff involved are accountable to program participants, decision makers, funding agencies, Stakeholders, community leaders, and other interested parties.  Personnel need to generate user-friendly reports with outcomes displayed graphically, including a comparison between outcomes and initial objectives. Summary  This lecture outlines the process of program planning in community health  Various methods of data collection should be utilized in any one program  Community engagement is a vital in the program’s success  Strong evaluation methods will ultimately determine the success and longevity of the program