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GCH411_Lec2 - GCH 411 Health Program Planning Health...

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Unformatted text preview: GCH 411 Health Program Planning Health Planning Models Health PRECEDE-PROCEED Francisco Semião, MS, MPH Department of Global and Community Health College of Health and Human Services Planning Models: Background Information Information Models serve as frames from which Models to build; Provide structure & organization for the planning process process Many different models Common elements, but different Common labels labels Background Information (con’t.) (con No perfect model Can be used in entirety, parts, & combinations Three Fs of program planning help with Three selecting the appropriate model selecting Fluidity - steps are sequential Flexibility - adapt to needs of stakeholders Functionality - useful in improving health Functionality conditions conditions Categories Practitioner driven Consumer-based What is PRECEDE/PROCEED? What PRECEDE/PROCEED is a communityoriented, participatory model for creating oriented, successful community health promotion interventions. interventions. PRECEDE has five phases: PRECEDE Phase 1: Social diagnosis Phase 2: Epidemiological diagnosis Phase 3: Behavioral and environmental Phase diagnosis diagnosis Phase 4: Educational and organizational Phase diagnosis diagnosis Phase 5: Administrative and policy Phase diagnosis diagnosis PROCEED has four phases: PROCEED Phase 6: Implementation Phase 7: Process evaluation Phase 8: Impact evaluation Phase 9: Outcome evaluation Assumptions behind PRECEDE/PROCEED: PRECEDE/PROCEED: Since behavior change is by and large Since voluntary, health promotion (and, by extension, the promotion of other community benefits) is more likely to be effective if it’s participatory. more Health and other issues must be looked at in Health the context of the community. the Health and other issues are essentially qualityof-life issues. Health is itself a constellation of factors that Health add up to a healthy life for individuals and communities. communities. Why use PRECEDE/PROCEED? PRECEDE/PROCEED? A llogic model provides a procedural structure for ogic constructing an intervention. constructing A logic model provides a framework for critical analysis. analysis. PRECEDE/PROCEED is participatory, thus assuring PRECEDE/PROCEED community involvement. community Community involvement leads to community buy-in. PRECEDE/PROCEED incorporates a multi-level PRECEDE/PROCEED evaluation, which means you have the chance to constantly monitor and adjust your evaluation. constantly The model allows leeway to adapt the content and The methods of the intervention to your particular needs and circumstances. How do you use PRECEDE/PROCEED? PRECEDE/PROCEED? In Phase 1, social diagnosis, you ask the In community what it wants and needs to improve its quality of life. improve In Phase 2, epidemiological diagnosis, In you identify the health or other issues that most clearly influence the outcome the community seeks. the In these two phases, you create the In objectives for your intervention. objectives How do you use PRECEDE/PROCEED? (cont.) PRECEDE/PROCEED? In Phase 3, behavioral and environmental diagnosis, In you identify the behaviors and lifestyles and/or environmental factors that must be changed to affect the health or other issues identified in Phase 2, and determine which of them are most likely to be changeable. changeable. In Phase 4, educational and organizational diagnosis, In you identify the predisposing, enabling, and reinforcing factors that act as supports for or barriers to changing the behaviors and environmental factors you identified in Phase 3. in In these two phases, you plan the intervention. How do you use PRECEDE/PROCEED? (cont.) PRECEDE/PROCEED? In Phase 5, administrative and policy In diagnosis, you identify (and adjust where necessary) the internal administrative issues and internal and external policy issues that can affect the successful conduct of the intervention. conduct Those administrative and policy concerns Those include generating the funding and other resources for the intervention. resources How do you use PRECEDE/PROCEED? (cont.) PRECEDE/PROCEED? In Phase 6, implementation, you carry out the In intervention. intervention. In Phase 7, process evaluation, you evaluate the In process of the intervention – i.e., you determine whether the intervention is proceeding according to plan, and adjust accordingly. plan, In Phase 8, impact evaluation, you evaluate whether In the intervention is having the intended impact on the behavioral and environmental factors it’’s aimed at, and s behavioral adjust accordingly. adjust In Phase 9, outcome evaluation, you evaluate whether In the intervention’’s effects are in turn producing the s the outcome(s) the community identified in Phase 1, and adjust accordingly. adjust Phase 1 - Social Assessment Phase Assessment means… Identify Describe Prioritize Phase 1 - seeks to subjectively define Phase the QOL (problems & priorities) of priority population population Self-assessment of needs & aspiration Phase 2 - Epidemiological Phase Assessment Epidemiology - study of the distribution & Epidemiology determinants of disease determinants What are the health problems associated What with the desired QOL? with Not all problems health related; If Phase Not 2 not applicable, skip and move on to Phase 3. Phase Phase 2: Epidemiological Phase Assessment Epidemiological Data: Mortality Morbidity Disability Fertility Incidence rates Prevalence rates Phase 2: Epidemiological Phase Assessment Creating Priorities: Which problem has the greatest impact in Which terms of death, disease, days lost from work, rehabilitation costs, disability, family disorganization, and costs to communities and agencies for damage repair or loss and cost recovery? cost Phase 2: Epidemiological Phase Assessment Creating priorities (continued) Which problems are most changeable? Which problem has the greater potential for Which an attractive yield in improved health status, economic savings and other benefits? economic Phase 2: Epidemiological Phase Assessment Creating priorities Are certain sub-populations such as Are teenagers, tourists, elderly, immigrants, at risk? risk? Which problem is not being addressed by Which other agencies in the community? Is there a need being neglected? Are any of the problems highly ranked as a Are regional or national priority? regional Phase 3: Behavioral Phase Diagnosis Focuses on behavioral and nonbehavioral causes (personal and behavioral environmental factors) which seem to be linked to health problems defined in Phase 2 Phase Behavior of Interest May Behavior be… Behavior of the people whose health is in Behavior question, OR question, Behavior of those who control resources Behavior or rewards or Community Leaders Legislators Parents Teachers Health Professionals Environmental or NonEnvironmental Behavioral Factors Genetic Predisposition Age Gender Existing Disease Workplace Adequacy of Health Care Facilities Environmental Factors Environmental Include Determinants outside the person that can Determinants be modified to support behavior, health, or quality of life. or Physical Social Economic Phase 3: Behavioral & Phase Environmental Diagnosis Health and environmental factors Health identified are the risk factors or risk conditions that the intervention will be tailored to affect. tailored Phase 3: Behavioral & Phase Environmental Diagnosis Each factor is rated in terms of its Each importance to the health problem to And rated in terms of its changeability And changeability Decision Matrix Decision More Important Less Important More Changeable Less Changeable High Priority for Program Focus Low Priority Except to Demonstrate Change for Political Purposes No Program Priority for Innovative Program; Evaluation Crucial Phase 3: Behavioral & Phase Environmental Diagnosis If planners fail at this stage to become If rigorous in identifying and ranking these factors and how they influence the outcomes sought, the whole planning process will collapse under its own weight. weight. Phase 3: Behavioral & Phase Environmental Diagnosis Once target behaviors and conditions are Once identified, behavioral objectives are written written Specificity is vital Phase 3: Behavioral & Phase Environmental Diagnosis How many will know, believe, or be able How to do what by when? to How much of what resource will be How available to whom by when? available Phase 4: Educational & Phase Organizational Diagnosis Identifies causal factors that must be Identifies changed to initiate and sustain the process of behavioral and environmental change identified in Phase 3 change Phase 3 - Behavioral & Phase Environmental Assessment Behavior of priority population Determining & prioritizing behavioral & Determining environmental risk factors or conditions linked to the health problem to Environmental factors - determinants outside Environmental an individual, that can be modified to support behavior, health, or QOL behavior, Once identified, must be prioritized Review of PRECEDE Review Model Predisposing Factors Reinforcing Factors Phase 4 Educational & Phase Ecological Assessment Assessment Enabling Factors Predisposing Factors Predisposing Knowledge Attitudes Values Beliefs Perceived Needs and Abilities Enabling Factors Enabling Environmental and Personal Resources that impact: Accessibility, Availability and Affordability Programs & Services Skills Money & Time Facilities Laws Reinforcing Reinforcing Positive or Negative Feedback From: Peers Family Health Care Workers Law Enforcement The Media Others Phase 4: Educational & Phase Ecological Assessment After identifying the three types of After influencing factors, assess their relative importance and changeability importance Then related learning and Then organizational objectives can be written, and state so that health promotion programs can focus where they will do the most good in facilitating development of or changes in behavior and environment and Phase 4: Educational & Phase Ecological Assessment Theory is applied in this Phase Predisposing Individual Factors Predisposing Individual Theories Individual Enabling Factors – Interpersonal Level Enabling Theories Theories Reinforcing Factors – Community Level Reinforcing and Systems Theories and Phase 5: Administrative and Phase Policy Diagnosis Health Programs Health Education Policy Regulation Organization Predisposing Factors Reinforcing Factors Enabling Factors Phase 5: Administrative and Phase Policy Diagnosis Focuses on administrative and Focuses organizational concerns which must be addressed prior to program implementation implementation Includes assessment of resources, Includes budget development and allocation, development of implementation timetable, organization and coordination with others with Phase 5: Administrative Phase and Policy Diagnosis Administrative Diagnosis Analysis of policies, resources and Analysis circumstances prevailing organizational situations that could hinder or facilitate the development of the health program Policy Diagnosis Policy Assesses the compatibility of your Assesses program goals/objectives with those of the organization and its administration the Phase 5: Administrative and Phase Policy Diagnosis Work in this phase is specific to the Work context of the program and the sponsoring organization(s) and requires political savvy as much as theoretical or empirical knowledge empirical Informed by theories, particularly Informed community-level theories community-level Phase 5: Administrative Phase and Policy Diagnosis Assess limitations and constraints Select the best combination of methods Select and strategies and Development of organizational and Development resource objectives follows resource Reducing Drunk and Reducing Drugged Driving by New Drivers in Northern Virginia What did you include in What your intervention design? Which Predisposing, Enabling and Which Reinforcing Factors did you choose to change? Why? change? What are your impact objectives? PROCEED Model PROCEED Implementation and Evaluation Phase 6: Phase Implementation The act of converting program objectives The into actions through policy changes, regulation and organization (Green & Kreuter, 1991, p.432). Kreuter, Phase 4 - Educational & Ecological Assessment Assessment Identifies & classifies factors that have Identifies potential to influence behavior or change the environment environment Predisposing factors - antecedent; impact Predisposing motivation; e.g., knowledge, attitudes , beliefs, values values Enabling factors - antecedent; barriers & Enabling vehicles; e.g., access, availability Reinforcing factors - subsequent; feedback & Reinforcing rewards; e.g., incentives, disincentives rewards; Priorities become focus of intervention Phase 5 - Administrative & Phase Policy Assessment Determine if capabilities & resources are Determine available to develop & implement program program Close to the end of PRECEDE & moving Close toward PROCEED toward Phase 6 - Implementation Phase Beginning of PROCEED Selection of methods and strategies of Selection the intervention, for example, education &/or other resources &/or Program begins Phases 7, 8, & 9 - Evaluation Phases Process evaluation - measurements of Process implementation to control, assure, or improve the quality of the program improve Impact evaluation - immediate Impact observable effects of program observable Outcome evaluation -long-term effects of Outcome the program the Line up with PRECEDE Any Questions? Any Feedback always welcomed Phone: 202-994-8303 Email: [email protected] Email: [email protected] ...
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