MIDTERM - Public Health Nutrition PDF

Intro to Public Health Nutrition: ● Nutrition = science of food and its use by the body ● Community = “unified body of individuals with common characteristics or interests who live in a particular area.” Community Nutrition (CN) - strives to improve the health and well-being of individuals and g...

Intro to Public Health Nutrition: ● Nutrition = science of food and its use by the body ● Community = “unified body of individuals with common characteristics or interests who live in a particular area.” Community Nutrition (CN) - strives to improve the health and well-being of individuals and groups within the community (micro-level approach) ● Involves nutrition education, counseling, prevention, and referrals to solve community problems ● Involves socioeconomic, political, cultural, and psychological aspects of food… Public Health Nutrition (PHN) - strives to improve the health and well-being of individuals and groups within the community via leadership at the macro level: assessments, advocacy, environmental change (builds on CN) ● Three arenas: people, policy, programs Public Health = societal efforts to promote/restore people’s health ○ 1900s: sanitation, communicable diseases ○ now: chronic diseases PHN draws on dietetics and public health (public vs private & governmental control) 10 Leading Causes of Death in the U.S. 1. Heart Disease 2. Cancer 3. Stroke 4. Lung diseases 5. Accidents 6. Diabetes 7. Pneumonia/Influenza 8. Alzheimer’s disease 9. Kidney disease 10. Septicemia Health = Absence of disease & state of physical, emotional, mental, social, and spiritual well-being Primary Prevention: Measures taken to prevent the onset of illness or injury before the disease process begins. - (EX: Vaccinations & promoting healthy lifestyles) Secondary Prevention: Actions aimed at early detection and intervention, thereby halting the progression of an illness or injury at an early stage. - (EX: Screenings like mammograms or blood pressure checks) Tertiary Prevention: Efforts to manage and mitigate complications of chronic diseases, rehabilitate those affected by disease or injury, and prevent further deterioration or complications. - (EX: physical therapy for stroke victims or diabetes management programs) Trends in the Healthcare System ● ● Increase in managed care: - HMO’s (Health Maintenance Organizations) - PPO’s (Preferred Provider Organizations) - POS’s (Point-Of-Service plans) Increased costs - Technology is $ - Aging of population - Consumer demands - Unhealthy lifestyles ● Practice of defensive medicine ● Professional Liability costs Benefits of Interprofessional Collaboration: 1. Empowers team members 2. Closes communication gaps 3. Enables comprehensive patient care 4. Reduces readmission rates 5. Promotes team mentality 6. Promotes patient-centered care The Institute of Health Care Improvement developed the triple aim framework to optimize and measure health systems performance: 1. Improved Patient Experience (Improved Patient Satisfaction) 2. Better Population Health 3. Lower Per Capita Cost Add the fourth key for the Quadruple Aim: 4. Improving work life or preventing burnout of healthcare providers Health Insurance ● Fee for service (Private) - ● Traditional individual or group Managed care (Private) - Group, usually employer-based ● Public (Medicare & Medicaid) - Low SES - Aged, blind, disabled - Are entitlement programs Medicare: (65, <65 and legally blind, or disabled, End StateRenal Disease) - Part A (Hospital and Nursing Home) - Part B (Outpatient) - Part C (Insurance companies contract with - Medicare for HMO and PPO coverage) - Part D (Drug Prescription Coverage Medicaid (state sponsored insurance with some federal support) - Medical costs for low income or disability - Varies from State to State - In Indian, we have “hoosier Healthwise” or “Healthy Indiana Plan” (HIP) ● Uninsured - Working poor, seasonal workers - Uninsurable Risks and Disease Prevention ● Risk = expected annual mortality/hazard ● Risk assessment = determining the extent of the hazard / identifying who faces the hazard Potential Future Reforms to U.S. Health Care - A movement away from treatment-based - Emphasis on health promotion and disease prevention - Effective provision and allocation of resources for preventive care, especially nutrition services. Why the need to include nutrition services in health care benefits? ● Relatively inexpensive vs. treatment ● Keep employees healthy ● Manageable and easy-to-document ● Enhances the ability to fight disease, avoid hospitalization, and expensive treatments ● Enhances patient recovery Healthy People 2030 Vision: A society in which all people can achieve their full potential for health and well-being across the lifespan. Overarching Goals = Attain healthy, thriving lives and well-being free of preventable disease, disability, injury, and premature death. - Eliminate health disparities, achieve health equity, and attain health literacy to improve the health and well-being of all. - Create social, physical, and economic environments that promote attaining the full potential for health and well-being for all. - Promote healthy development, healthy behaviors, and well-being across all life stages. - Engage leadership, key constituents, and the public across multiple sectors to take action and design policies that improve the health and well-being of all. Public Policy ● Course of action chosen by public authorities to address a given problem - ● Problem = gap between reality and desired situation Policies need public and legislative support Big “P” VS. Little “p” Policy Big “P” policy ● National or state policy ● Require legislative and executive approval ● Labor and time intensive because of number of stakeholders involved ● Implementation results in greater reach at systems level Little “p” policy ● Implemented at department or agency level ● Addresses organizational practices ● Not as labor intensive to implement as Big “P” Branches of U.S. Government Executive: administers the laws ● President & Cabinet Legislative: makes the laws ● ● Senate (100 members) House of Representatives (234 members) Judicial: interprets the laws ● Court system Lobbying (Influence) Opportunities ● propose a bill ● agenda setting within Congress ● action at appropriate committee ● encourage President to sign/veto ● Note: The same ideas hold true at the state or local levels, targeting governors or mayors, etc. instead of the President Developing Effective Policy - Document needs and define the problem - Develop a “grassroots” coalition of support - Draft a policy statement; get the issue on the agenda - Seek and gain support from relevant policymakers Policy is: ● adopted ● implemented ● monitored/evaluated ● Terminated? The Process of Policymaking 1. Define Health Problems & Agenda Setting - The problem is defined and brought to the public’s and policymakers’ attention. Issues become part of the public agenda when a legislature, administrative agency, or court considers them. 2. Formulation of Alternatives - Possible solutions to the problem are devised 3. Policy Adoption - The tools or instruments are selected to achieve a given policy goal—namely, the resolution of the problem. The tools may consist of regulations, expenditures, partnerships, programs, or a combination. 4. Policy Implementation - The strategies chosen for addressing the problem using the appropriate agreed-upon tools are put into place. 5. Policy Evaluation - The impact of the policy and the tools used to implement it are evaluated. 6. Policy Termination - The policy may be terminated because of loss of support because it is not achieving its goals, or because it costs too much. How (ex: mechanism used) does the U.S. government legitimize policy in order to influence the health behavior of the general public? - Food label (Calories now in bold letters) CHANGES whether or not people will consume the food Laws and Regulations ● Laws passed tend to be vague - ● Define the broad scope of the policy Administrative bodies must interpret the law and provide detailed regulations. - “Secondary legislation” How does an Idea Becomes Law? 1. A concerned citizen, group, or organization brings an issue to the attention of a legislative representative. 2. A bill is written and submitted to the clerk, where it is numbered and printed. It must be sponsored by at least one legislative member (House, Senate, or both). 3. Bill referred to committee and subcommittee – the most significant challenge is getting out with a favorable vote. 4. Markup sessions by subcommittee and committee revise the original bill 5. The committee votes on whether to send the bill forward with a favorable vote or table it 6. Approved bills go before the full membership for debate, amendment, and vote 7. If the bill passes, it goes to the other body of legislature or Congress for the same actions 8. Finished versions of the bill will probably differ between bodies, so a conference committee will meet to resolve differences 9. Modified bill that is agreed upon is sent to the President (Governor) for action The Federal Budget Process Mandatory spending a. For entitlements – programs that require payments of benefits to anyone who is eligible b. What are examples of entitlement programs? - Social Security (affects food purchasing ability) - SNAP Program (school nutrition programs) -Medicaid/Medicare ● Discretionary spending ● Choices made in defense, energy assistance, nutrition assistance Nutrition example: WIC (women/children nutritional help) ● President’s budget is provided annually to Congress to consider ● Budget authorization – establishes programs ○ sets a ceiling on spending ○ does not provide money Budget appropriation – provides money for programs ○ may be for a single year, specified period of years (multi-year appropriations), or an indefinite number of years (no-year appropriations) ■ Continuing resolutions may be needed during vote ● What is a continuing resolution? - continuation of funds Strategies for Influencing the Political Process ● Political Action Committees (PACs) ● “political arm” of interest group ● ● Lobbying = Marketing ● ● raises money to support candidates whose views are favorably aligned with the group’s missions and goals provide technical information to policymakers to help pass legislation Building coalitions (networks and other alliances) ● join with smaller groups to influence political system Examples of agencies for information and partnerships ● ● Federal ● ______: Food and Nutrition Services (USDA) ● _____: FDA, NIH, CDC Professional ● ● SNEB, AND, or APHA Voluntary health agencies ● ACS, AHA ● Companies ● Non-profits ● AARP, United Way Community Assessment (Aka Asset Mapping) ● ● Measurement = assigning numbers to concepts (add to this) Assessment = 1. measuring the way things are (baseline) 2. determining should be 3. calculating the difference Assess Why? ● determine level of care needed ● respond to a crisis, demand, or opportunity ● **MUST have baseline to determine effectiveness Assess What? 1. Define target population ● 2. 3. Describe target population ● demographics: ● Age ● Sex ● SES ● Ethnicity ● Education What are the perceived health needs? ● 4. 5. Who is the community? how will you know? What is the health and nutritional status? ● statistics: IMR, LBW, causes of death and disability… ● check with community agencies ● survey nutrition-related habits, dietary intakes, food supply… (NNMRR system) What resources are available to meet needs? ● Men, Minutes, Money, Materials Assessing Nutritional Status ● ● Before data collection ● Review the purpose, goals, and objectives ● Develop a set of questions ● Select a method to obtain answers Methods of data collection Food Diary/Record, 24-hour recall, FFQ’s, Dietary History Anthropometric Measurements: EX: measures height, weight, BMI Biochemical (laboratory): EX: taste acuity to test for zinc status Composition (of the body): EX: skinfold thickness, lean body mass vs body fat Dietary Assessment: EX: recording food consumption, 24 hr recall, weighing food ● Selecting a Method ● Issues to consider: - ● Program objectives ● Study population ● Financial issues ● Implementation requirements ● Analysis requirements ● Actual data collection issues Practical issues Scientific issues Sensitivity vs. specificity Sensitivity - is a test's ability to accurately identify individuals or situations with a specific trait or condition, prioritizing reducing false negatives and identifying all true situations, especially when genuine opportunities may be missed. Specificity - A test's specificity measures its ability to exclude individuals or cases without the desired characteristic, minimizing false positives and identifying cases with the desired condition, ensuring specificity to prevent unnecessary interventions or treatments. Validity vs. reliability Validity - is the accuracy and appropriateness of a measurement in capturing the intended construct or concept, such as a questionnaire measuring depression but actually measuring anxiety, indicating its validity. Reliability - is the consistency and stability of a measurement or test over time and across different conditions, ensuring the same measurement yields similar results if administered repeatedly or by different individuals, as in a reliable weight scale. - Cultural issues Steps in Community Assessment 1. Define the problem 2. Set the parameters 3. ● Define “community” ● Determine the purpose of assessment ● Define target population ● Set goals and objectives ● Specify the type of data needed Collect data ● Individual lifestyle factors ● Living, working and social conditions ● Community conditions ● Background conditions 4. Analyze and interpret the data 5. Share the findings 6. Set priorities 7. Choose a plan of action Decision-making Tools ● Brainstorming: spontaneous idea generation ● Nominal group: all relevant personnel work to consensus ● Focus group: ‘unaffected’ group opinions are extracted ● Roundtable: discussion among stakeholders ● Consensus building: diverse groups work toward goal ● Flowchart: tool to analyze and sequence processes/problems Cooperative Extension Service Began as an agricultural outreach mandated by President Lincoln Serves all residents of the U.S. - “Cooperative” = Working together with others (mutually beneficial) - “Extension” = Sharing useful information and knowledge with people. The Program Plan 1. Problem/needs statement ● Literature review ● Community needs assessment 2. Goals and objectives 3. Intervention plan 4. Management system 5. Funding sources 6. Implement the program 7. Evaluation plan Developing Goals and Objectives (Obj must be measurable and Action oriented) ● ● Goal = broad statement of desired end ● provide focus/direction for work ● Focuses on how a situation will be changed due to a successful project, not what a project will do. Objective = specific measurable description of outcome or activity needed to reach a goal ● impact (behavioral) obj. = statement of expected behavior after intervention ● outcome obj. = statement of result of behavior change ● process obj. = statement of actions, methods, strategies to produce behavior or outcome objective SMART objectives are: ● Specific - What kind of, or which problem is to be addressed? ● Measurable - How much, how many, and how well the problem/need will be resolved. ● Attainable/Achievable - Can the objective be accomplished in the proposed time frame with the available resources and support? ● Relevant - Does the objective address the goal? Will the objective have an impact on the goal? ● Time-bound - Does the objective propose a timeline for when the objective will be met? Ex: Reduce obesity rates for children and adolescents. SAmple objective: By 2024, the prevalence of obesity will be reduced to 5%. Writing Objectives ● ● Match the objective with the outcome desired ● psychomotor ● cognitive ● Affective A is for AUDIENCE ● ● B is for BEHAVIOR ● ● under what circumstances? D is for DEGREE/DATA ● ● what should occur? C is for CONDITIONS ● ● who is acting? Target audience how much/how often…? E is for EVALUATION ● how to measure? Nutritional Epidemiology ● study of nutritional determinants of disease in human populations ● identify and study associations between diet and disease in defined populations Epidemiology - “the study of the distribution and determinants of health-related states and events in specified populations and the application of this study to control of health problems” ● ● Originally used to investigate, control, and prevent epidemics of infectious disease Has expanded to include control and prevention of all health problems Incidence - the proportion of group initially free of a disease that develops the disease over a period of time” (new cases of disease) Prevalence - the proportion of a group possessing a disease at a specific time” (existing cases of disease) Diet exposure - foods, food groups, nutrients, or patterns that contribute to a particular health or disease outcome Relative Risk = Rate of condition among exposed divided by rate of condition among unexposed ● “Measure of how much a particular risk factor influences the risk of a specified outcome”- to identify differences in disease rates between exposed and unexposed groups Dietary assessment methods Strengths and Weaknesses Dietary Types 1. Observation Methods Method 1: Trained observer watches people eat, estimates and records the amounts of food served, eaten, and wasted - Method 2: Plate waste method, involves weighing plate served and left over and subtracting leftover from served Do not rely on respondents’ memory Low burden on respondent High researcher burden (labor intensive) 2. Self Report TYPES 1. Diet Record (Does not rely on memory) ● ● ● Prospective tool Asks individuals to record everything he/she eats for a specified number of days Can provide detailed intake data 2. 24-hour dietary recall (RELIES ON MEMORY) ● ● ● ● Labor intensive and requires high cooperation from respondent Recording may lead to respondent altering diet Requires respondent to be literate Retrospective method ● ● ● ● ● Individual recalls and provide details about all foods and beverages consumed over past 24 hours Portion size guides may be provided to help with estimation Gold standard diet assessment method Low respondent burden, doesn’t alter usual diet Frequent overreporting and underreporting 3. FFQ’s 1. Retrospective method 2. Provides estimate of usual intake over a period of time (e.g., 1 week, 6 months, 1 year) 3. Asks about frequency of consuming items from a list of foods, and how much of the items was consumed 4. Moderate respondent burden 5. Depends on respondents’ ability to describe diet 6. For self-administered, respondent must be literate 3. Biomarkers (Doesn’t Rely on memory) ● ● ● ● Tool to verify food intake from self-report (a gold standard method) External indicators that reflect food intake by measuring metabolites in urine and serum Includes Doubly labeled water, currently most widely accepted biomarker (but also very expensive) Not all biochemical indicators can be used as markers of nutrient intake Study designs in nutritional epidemiology - Ecological studies - compares different groups of people E. Cross-sectional - A study that occurs early in an investigation; this type of study helps to discover what factors in a group of people are associated with a particular outcome (such as a disease), allowing further research to take place. A. Randomized Control Trial - Individuals with known characteristics relevant to a research study are carefully chosen to participate in the study; these individuals are assigned either to a control group (without an intervention) or an experimental group (with an intervention) without the researcher controlling the selection. D. Cohort study - Observational study that looks for relationships between exposure to certain factors and the development of (disease) outcomes among groups of people initially free of the outcome, either looking forward or looking at the past. B. Case-control study - Individuals who experience the outcome of interest are paired with individuals who are similar but do not experience the outcome of interest. These pairs are then compared to try to find characteristics that explain the differing outcomes. C. Correlational study- Observational study that examines factors of a population at a given point in time Ecological or correlational studies - Compare frequency of events (or disease rates) in different populations with the per capita consumption of certain dietary factors (e.g., total fat) - Can be used as first step in exploring relationship between an exposure (e.g., diet) and disease because of reliance on data routinely collected by government agencies for surveillance Controlled trials - Human experiment in which people are assigned to receive 1 out of 2 or more treatments - Treatments could be drug, dietary prescription or health intervention (e.g., weight loss, smoking cessation program( - Goal is to replicate the real-life situation so that results are as close as possible to what would happen if treatment were used in real life - ● Randomized controlled trial ○ ● Tend to be very expensive Persons meeting eligibility requirements are randomly assigned to an experimental or control group Non-randomized controlled trial ○ Persons are assigned to an experimental or control group using a method that is not random What is the goal of nutrition education? Nutrition education - is the process of teaching the science of nutrition to an individual or group. How do we accomplish behavior change? - Knowledge Attitude Behavior Barriers to communication (Source, Message, Channel, Receiver) ● ● ● ● ● ● Prior expectations; different starting points (prior knowledge/experience) Inaccurate inferences Differing perceptions of words Conflicting information Noise ● physical ● Emotional Forgetfulness ● ● ● ● ● ● Information overload Haste in prepping message Ignoring nonverbal cues Close-mindedness; intolerance Poor listening habits Learning philosophy: “Ways of Knowing” Ways of Knowing Received knowers - Knowers who depend on listening and external authority for knowledge. ● ● ● Rote-mode learning (doing over) learn from experts information is right or wrong Subjective knowers - Knowers who depend entirely on internal resources for valuing and knowing ● ● ● ● Experiential learning knowledge is personal and private Feelings are important Often reject “expert” authority Procedural knowers (lawyers & scientists) - Knowers who obtain knowledge by applying objective, logical, rational procedures ● ● ● ● need to see evidence reason and common sense valued highly knowledge is impersonal experts only as good as their arguments Constructed knowers - Knowers who construct their own meaning. Knowledge is contextual; subjective and objective ways of knowing are integrated ● ● ● complex, balanced approach knowledge is constructed value and integrate expert advice, feelings, personal experience, reason Improving Communication as Senders ● ● ● ● ● ● Know the audience Adjust message to their prior knowledge, experience, readiness, literacy Adjust to their way of knowing Establish expertise Provide hands on experience Personalize message ● ● ● Test: formative evaluation Proofread!! Get someone else to proofread! ● “Spellcheck,” but don’t rely on spellcheck “The demonstrators were attached by vicious policy dogs…” National nutrition policy ● ● ● ● A set of nationwide guidelines that specify how the nutritional needs of the population will be met Does the U.S., have a national nutrition policy? YES - programs set up (WIC) (SNAP) Yes, U.S. national nutrition policy manifests through ○ Food assistance programs ○ National nutrition and health objectives ○ Regulations to safeguard the food supply and ensure safe handling of food ○ Dietary guidance systems ○ Monitoring and surveillance programs ○ Food labeling legislation U.S. national nutrition policy is comprised of 3 elements ● ● ● National nutrition monitoring and surveillance Nutrient intake standards Dietary guidance systems Why monitor nations health and nutritional status? ● Nations monitor health and nutrition status - to decide how to allocate scarce resources - to enhance the quality of life - to improve productivity ● Nutrition monitoring includes: - Nutrition screening - System for identifying individuals for nutrition/public health intervention, often at community level - Nutrition assessment - Measurement of indicators of dietary status to identify possible occurrence, nature, and extent of impaired nutrition status - Nutrition monitoring - Assessment of dietary or nutrition status at intermittent times with aim of detecting changes in diet or nutrition status of a population - Nutrition surveillance - Continuous assessment of nutrition status for purpose of detecting changes in trends so that corrective measures can be taken Types of data Primary data: relate directly to the population served; often collected by the acting agency itself ● focus groups, local surveys Secondary data: relate to already existing data in either published or unpublished form ● NNMRR data National Nutrition Monitoring and Related Research Program (NNMRRP) Goals ● ● ● Collect, analyze, and disseminate data… Establish baseline data and uniform standards Provide data to evaluate proposed policy changes National nutrition monitoring program, Federally mandated collection and analysis of data on: ○ national food - supply ● U.S. Food Supply Series ● Quantities available per capita of: ● ○ food ○ kcals available ○ nutrients USDA ○ food composition ● USDA Nutrient Data Base ● National Nutrient Data Bank ○ food and nutrient consumption ● Nationwide Food Consumption Survey (NFCS) ● Continuing Survey of Food Intakes by Individuals (CSFII) ● USDA ● 5 A Day for Better Health ● NCI… ○ ● Behavioral Risk Factor Surveillance System (BRFSS) ○ annually since 1984 by CDC to examine trends over time ○ States can use to address urgent/emerging health issues ○ ● Consumer knowledge, attitudes, behaviors ■ Physical activity behavior ■ Dietary behaviors ■ Tobacco and alcohol use ■ Health seeking behaviors, e.g., mammograms, pap smears ■ Food frequencies for dietary fat, fruit, and vegetable consumption Nutritional/health status National Health and Nutrition Examination Survey (NHANES) ○ Representative sample of civilian non-institutionalized population ages 2 months and older ○ Dietary intake (one 24-hour recall) ○ Body composition ○ Biochemical analyses of blood and urine ○ Bone density ○ Dietary and health behaviors ○ Collects data at household, family, and individual level Uses of NMRRP Data ● ● ● ● ● ● Assessment of dietary intake Monitoring and Surveillance Regulation Food programs and Guidance Scientific Research Historical trends Intervention - Health promotion activity aimed at changing behavior of a population - Nutrition intervention is targeted at nutrition-related problem Sometimes used interchangeably with the term “program” The Transtheoretical Model [TTM] (Stages of Change) ● ● ● Describes stages through which a person progresses over time to make behavior change Assumes ● Behavior change involves different steps or stages ● There are common stages of change across various health behaviors ● More effective to tailor an intervention to stage of change a person is in vs. not taking stage into account Precontemplation ● no awareness of needed change EX: Are you interested in trying to eat more vegetables? (Pre-contemplation) ● Contemplation ● thinking about change EX: Are you thinking about eating more vegetables soon? (Contemplation) ● Preparation ● ready to change EX: Are you ready to plan how you will eat more vegetables? (Preparation) ● Action ● make changes EX: Are you in the process of trying to eat more vegetables? (Action) ● Maintenance ● maintaining changes EX: Are you trying to continue eat vegetables? (Maintenance) Social-Cognitive Theory (SCT) ● ● Model for understanding how behavior, personal factors, and environment interact constantly Change in one area will affect the others (reciprocal determinism) Health Belief Model ● ● ● ● 3 components for adopting a new health behavior: ● the perception of a threat to health ● expectation of certain outcomes related to a behavior – benefits ● Self-efficacy – the belief that one can make a behavior change to produce outcomes Health Belief Model factors: ● perceived susceptibility (vulnerability to disease) ● perceived severity (seriousness of disease) Locus of control ● Internal (perceived Benefits) ● External (perceived Barriers) ● Cues to action Self-efficacy ● confident in their ability to successfully perform an action Motivational Interviewing (Client-centered intervention - individual counseling) 4 Principles: Resist: the urge to confront the client about the need for behavior change - (EX: Don’t say something like you shouldn’t be eating that it’s not good for you.) Understand: eliciting and understanding the client’s own motivations - (EX: Try to use the information there telling you to get an understanding of what the client needs and is looking for.) Listen: listening with empathy - (EX: Listen without making the client feel judged, and repeat back what they said to you to ensure you understand.) Empower: empowering the client, encouraging hope and optimism. - (EX: help them realize that they are the ones who control what they do, so they need to reinforce what is being told to them to help make changes in their own lifestyles.) Designing Intervention Programs 1. Determine level of prevention ● 1º, 2º, 3º 2. 3. 4. 5. 6. 7. Determine if individual, group, or system intervention Determine goals, then outcome objectives, then behavioral objectives Evaluate stage of readiness of target group Write process objectives, develop procedures, and develop content Create a timeline Develop training program Surveillance & Monitoring vs. Program Evaluation ● ● ● Surveillance - tracks disease or risk behaviors Monitoring - tracks changes in program outcomes over time Evaluation- seeks to understand specifically why these changes occur Monitoring/survellance implies an ongoing process ● ● ● NNMRR Act: ongoing nutrition surveillance surveys Evaluation implies finality ● “the measurable determination of the value or degree of success in achieving specific objectives” WHY Evaluate? ● Improve your program ● Methods, effectiveness, content, & correct weaknesses ● Justify your program ● Document your program When to conduct evaluation? A = Conception D= Completion A) Planning a new program B) Assessing a developing a program C) Assessing a stable program D) Assessing a program after it ended Types of Evaluation: Formative Evaluation = process of testing certain elements of a program before it is fully implemented - EX: When the cook tastes the soup Summative Evaluation = research at the end to determine program effectiveness - EX: When the guests taste the soup What to Evaluate? Outcome: measuring a program’s effectiveness in changing one or more aspects of nutritional or health status. Impact: for whom was the intervention most / least effective? Process: how a program is implemented Structure: evaluation of personnel and environmental factors related to program delivery Efficiency Evaluation: cost benefit analysis & cost effectiveness Who Conducts Evaluation? Internal: program staff & other agency staff External: outside consultant Formative Evaluation tools: ● ● ● ● ● ● focus groups test with small samples expert review client review check for readability… do a “dry run” Summative Evaluation Tools: ● post test surveys (compare to assessment “pretests” ● interviews ● monitor community health outcomes Summative evaluation activities should match your program goals and objectives Framework for program evaluation ● ● ● ● ● ● Step 1: Engage stakeholders. Step 2: Describe the program. Step 3: Focus the evaluation design. Step 4: Gather credible evidence. Step 5: Justify conclusions. Step 6: Ensure use and share lessons learned. Building blocks for grant writing ● ● ● Generate ideas - Noting a legislative initiative - Reading implications for research from published studies - Observing societal trends or needs in the community - Brainstorming with colleagues - Reviewing statistical data - Review grant funders call for proposals Describe goals - Address goals that can be achieved with combined resources from the organization and grant sponsor - Refer to Healthy People 2030 goals and objectives to describe alignment with proposal goals - Consider using a community-based participatory research (CBPR) approach - Write clearly defined, specific goals Identify funding sources - Generating an idea in response to a grant sponsor/funder’s request - Finding a grant sponsor/funder to fund the grant seeker’s idea - Network with colleagues to learn about upcoming funding opportunities - Contact granting agencies about upcoming RFPs - Contact local businesses to seek small grants - Decide whether to compete for a grant Sources: ● ● ● ● ● Federal government: - Catalog of Federal Domestic Assistance Foundations Corporations Ag commodity boards Etc. (local businesses) ● ● Identify potential collaborators - May come from within the organization seeking the grant or from outside organizations - Collaboration can greatly improve a proposed project - Network with colleagues - Correspond with individuals working on similar projects Build the proposal Components of a proposal - Letter of intent – preproposal (brief) sent prior to full proposal - Transmittal letter – indicates your reason for submitting proposal - Title page – follow recommended format - Abstract – summary that outlines proposed project, best written after the full proposal has been drafted (Summarizes methodology, why you want it, and how much you need) Components of the grant proposal narrative - Needs statement – problem statement and literature review - Goals and objectives – describe what the grant seeker plans to achieve - Participants – description of characteristics - Methods – describes in detail the procedures for achieving objectives - Evaluation plan- how outcomes from the project will be evaluation (formative, summative, impact evaluation) - Measurements – to measure outcomes of program or intervention (e.g., diet recalls, weight & height) - Data analysis – how collected and analyzed - Dissemination – how interested audiences will get information about outcomes - Timeline and activity chart – manageable steps - Capability – establishes credibility of grant seeker ● Develop the budget - Budget – describes expected project cost, shows grant seeker’s planning/management expertise ● Budget categories ● Direct costs ● Indirect costs (Ex: administrative costs) ● Cost sharing – grant seeking organization agrees to pay certain costs ● Budget narrative – explain or justify all expenditures - Appendixes – materials that directly support the proposal - Direct costs: - ● salaries, fringe benefits ● supplies ● contractual services ● equipment ● (travel to conferences) ● (publication costs) Indirect costs: - Overhead changed by sponsoring institution (support services, rent, utilities) Direct and Indirect = Total Budget Cost ● Assemble the final product and submit to funder Assembling the final product ● Proofread for errors ● Correct formatting ● Get feedback from colleagues Review of the grant proposal ● Confirmation that grant has been received ● Feedback ● Grant funded or explanation why not funded Types of Grants Planning - Support planning, developing, designing, and establishing the means for performing research or accomplishing other approved objectives Demonstration - Establish or demonstrate the feasibility of a theory or an approach Research - To support investigation or experimentation aimed at the discovery and interpretation of facts Service - Cost of organizing, establishing, providing, or expanding the delivery of health or other essential services to a specified community or area Training - Support costs of training students, personnel, or prospective employees in research, or in the techniques or practices pertinent to the delivery of health services in the particular area of concern Top Reasons Why Proposals Fail - Poor writing!!! - Guidelines were not followed - Missed deadline - Lack of quality plan or errors in budget - Project didn’t match funding agency priorities What is Marketing? Marketing - is the process by which individuals and groups get what they need and want by creating and exchanging products and values with others (process of finding and keeping customers) - Fit products / services / programs with needs - Find a problem: “sell” your solution Develop a Marketing Plan ● Determine needs and wants of target population Older people = more need for Dietitians - Heart disease - Cancer -Osteoporosis (weak bones) ● ● ● ● Specify benefits of product or service Conduct a situational analysis Develop marketing strategy Develop budget and timetable Situational Analysis ● Research the: ● Market ● Environment ● Competition ANALYZE YOUR SWOT Example Strengths Internal positive attributes of the program that can facilitate activities Having a workforce that is experienced Weaknesses Internal attributes of the program that may hinder the achievement of its activities and goals. Outdated Technology Opportunities External factors that may facilitate your program’s activities. Identifying an untapped market (potential for new business) Threats External factors that may hinder program activities Competitors or Economic decline Segment your market by: ● Geography ● Demographics ● Psychographics (life style, personality) ● Behavior The Marketing Mix ● Product What we’re offering people: ● Service ● Behavior ● Commodity (tangible goods) ● Place: Channels, Coverage, Locations, Inventory, Transport ● Price ● ● tangible costs - parking ($), flyers (expenses to make) ● Intangible costs - time, interaction with people (makes people happy - mental health), exercise class ($), helping others Promotion ● advertising - social media, ads, radio ● sales promotion ● personal selling ● publicity Common Pitfalls in Marketing ● No $ - is allocated for marketing (can hinder promotions) ● Target audience - is not carefully defined or reached ● Actual newspaper ad: “Illiterate? Write today for free help.” In newspaper - literally for someone who can’t read (so not going to work) Social Marketing: Increase the acceptability of a social idea or practice among a specific target population Types of behavior change: ● Cognitive ● Action ● Behavior ● Value Commercial Marketing: refers to the process of promoting and selling products or services to businesses or consumers with the goal of generating profit.