2 Flashcards
(191 cards)
1
Q
Risk factors most associated with mortality
A
lack of physical activit, poor nutrition, tobacco and alcohol use.
2
Q
Beginning of Public Health Programs
A
1974 Canada published a policy statement: A New Perspective on the Health of Canadians. In the US the Health Information and Health Promotion Act was passed . . . leading to Healthy People - the Surgeon General’s Report on Health Promotion and Diseae pRevention.
3
Q
Health Education Definition
A
Any combination of planned learning experiences using evidence-baed practices and/or sound theories that provide the opportunity to acquire knowledge, attitudes, and skills needed to adopt and maintain healthy behavior.
4
Q
Health Promotion Definition
A
Any planned combination of educational, political, environmental, regulatory, or organizational mechanisms tha tsupport actions and conditions of living conducive to the health of individuals, groups and communities”. Also “any planned combination of educational, political, regulatory and organizational supports for actions and conditions of living conducive to the health of individuals, groups, and communities”. Also “each person has a certain degree of health that may be expressed as a place in a spectrum. From that perspective, promoting health must focus on enhancing people’s capacities for living.. That means moving them toward the health end of the spectrum, just as prevention is aimedat avoiding disease that can move people toward the opposite end of the spectrum.”Health education is an important component of health promotion
5
Q
Health Educator
A
a professionally prepared individual who serves in a variety of roles and is specifically trained to use appropriate educational strategies and methods to facilitate the development of policies, procedures, interventions, and systems conducive to the health of individuals, groups and communities.
6
Q
Health Education Specialist
A
An individual who has met, at a minimum, baccalaureatelevel required health education academic preparation qualifications, who serves in a variety of settings, and is able to use appropriate educationl strategies and methods to facilitate the development of policies, procedures, interventions, an systems conducive to the health of individuals, groups and communities.
7
Q
Role Delineation Project
A
1979 - this project yielded a generic role for the entry -level health educator - this then helped to establish the curricula - aka the seven competencies were a “Framework” for the development of competency based curricula for entry level health educators. Later, July 1997, 3 additional responsibilities were added for advanced-level health educator, including research, administration, and advancement of the profession. Te Framework was used to develop CHES.
8
Q
CUP model
A
The National Health Educator Competencies Update Project 1998, to update the competencies. Developed a 3 tiered system - entry, advanced level 1, advanced level 2.
9
Q
7 areas of responsibility
A
Four are related to program planning, implementation and evaluation. The other three could be associated with those processes . . .
10
Q
bates and Winder (1984) assumtpions of health education
A
- Health status can be changed. 2. health and disease are determined by dynamic interactions among biological, psychological, behavioral, and social factors. 3. Disease occurrence theories and principles can be understood. 4. Appropriate prevention strategies can be developed to deal with the identified health problems. 5. Behavior can be changed and those changes can influence health. 6. Individual behavior, family interactions, community and workplace relationships and resources, and public policy all contribute to health and influence behavior change. 7. Initiating and maintainig a behavior change is difficult 8. Individual responsibility should not be viewed as victim blaming, yet the importance of health behavior to health status must be understood. 9. For health behavior change to be permanet, an individual must be motivated and ready to change.
11
Q
Why is systemic planning important (Hunnicutt, 2007a)?
A
- Detailed plans can help to avoid future problems. 2. planning helps make a program transparent - good planning keeps the program stake holders informed. The planning process should not be mysterious or secretive. 4. Planning is empowering. Oncedecision makers give approval to the resulting comprehensive program plan, planners and facilitators are empowered to implenet the program. 4. Planning creates alignment - organization members will understand the “fit” to the organization.
12
Q
Generalized Model for Health Promotion Proram
A
- Assessing Needs. 2. Setting goals and objectives 3. Developing an intervention 4. implementing the intervention 5. evaluating hte results
13
Q
Priority population
A
those for whom the program is intended to serve
14
Q
Key questions for the pre-planning process
A
- Purpose of the program (how is community defined, desired health outcomes, capacity and infrastrucutre, is policy change needed). 2. Scope of the planning process (intra or inter-organizational, time frame). 3. Planning process outcomes (deliverables, written plan, program proposal, program documentation or justification). 4. Leadership and structure (what authority will planners have, how will you organize, etc.) 5. Identifying and engaging partners - how will the partners be selected, will the planning process use a top-down or bottom-up approach? 6. Identifying and securing resources (how will the budget be determined, will a written agreement outlining resonsibilities be needed, will external funding be needed, are there community resources already in place?
15
Q
Code of Ethiccs for Health Education Profession Article 1
A
Article 1 Responsibility to Public - educate, promote,maintain, and improve the health of individuals, families,a nd groups. When a conflict arises, ehealth educators consider all issues and give priority to thsoe that promote the health and well-bein of individuals and the public while respecting individal autonomy. Section 1. Health educators support the right of individuals to make informed decisions regarding their health, as long as such decisions pose no risk to the health of others. Section 2: health educators encourage actions and social policies that promote maximizing health benefits and eliminating or minimizing preventable risks and disparities for all affected parties. Section 3. Helath educators ccurately communicate the potential risks, benefits, or consequences of the services and programs they provide. Section 4. Health educators accept responsibility to act on issues that can affect the health of individuals, families, groups,a nd communities. Section 5. Health educators are truthful about their qualifications and the limitations of their education expertise and expeirence. Section 6; Health educators are ethically bound to respect, assure and protect the privacy, confidentiality, and dignity of individuals. Section 7: HE’s actively involve individuals, groups, and communities in the entire educational process to maximize the understanding and personal responsibilities of those affected. Section 8; HE’s respect and acknolwedge the rights of others to hold diverse values, attitudes, and opinions.
16
Q
Code of Ethics Article 2
A
Health educators are repsonsible for their professional behavior, for the reputation of their profession,a nd for mpromoting ethical conduct among colleagues. Section 1: HE’s maintain, improve, and expand their professional competence through continued study and education; membership, participation and leadership in professional organizations, and involvement in issues related to the health of the public. 2. HE’s model and encourage non-discriminatory standards of behavior in their interactions with others. 3. He’s encourage and accept responsible critical discourse to protect an denhance ht eprocession. 4. He’s contribute to the profession by refining existing an ddeveloping new practices, and by sharing the oucomes of their work. Section 5. He’s are aware of real and perceived professional conflicts of interest, and promote transparency of conflincts. Section 6. He’s give appropriate recognition to others for their professional contributions and achievements. Section 7: He’s openly communicate to colleagues, employers, and professional organizations when they suspect unethical practice that violates the professions’ code of ethics.
17
Q
Code of ethics article 3
A
health educators recognize the boundaries of their professional competence and are accountable for their professional activities and action.s 1. HE’s accurately represent their qualifications and the qualifications of others whom they recommend. 2. HE’s use and apply current evidence-based standards, theories, and guidelines as criteria when carrying out their professional responsibilities. 3. Hes accurately represent potential and actual service and program outcomes to employers. 4. He’s anticipate adn disclose competing committments, conflicts of interest, and endorsement of produts. 5. HE’s acknowledge and openly communicate to employers, expectations of job-related asignments that conflict with their professional ethics. 6. He’s maintain competence in their areas of professional practice. 7. He’s exercise fiduciary repsonsibility and transparency in allocating resources associated with work
18
Q
Code of ethics article IV
A
HE’s deliver health education with integrity; they respect he rights, dignity, confidentliaty an dworth of all people by adapting strategies and methods to the needs of diverse populations and communities. Article 1; HE’s are sensitive to social and cultural diversity and are in accord with the law, when planning and implementing programs. 2. He’s remain informed of the latest advances in health education thoery, research an dpractices. 3. He’s use strategies an dmethods that are grounded in and contribute to the development of professional standards, theories, guidelines, data na dexperience. 4. He’s are committed to rigorous evaluation of both program effectiveness and hte methods use to achieve results. 5. He’s promote the adoption of healthy lifestyles through informed choice rather than by coercion or intimidation. 6He’s communicatethe potential otucomes of proposed services, strategies, and pending decisions to all individuals who will be affected. 7. He’s actively collaborate and communicate with professionals of various educational backgrounds and acknowledge and respect hte sklills and contributions of such groups.
19
Q
Code of Ethics Article V
A
HE’s contribute to the health or the population and proffession through research and evaluation activities. When planning and conducting research or evaluation, He’s do so in a accordance with federal and state laws, etc. 1. He’s adhere to princniples and practices of research and evaluation that do no harm to individuals, groups, society or the environemnt. 2. He’s ensure that participation in research is voluntary and is based upon informed consent of participants. 3. he’s respect and protect hte privacy, rights and dignity of research participants, and honor commitments made to those participants 4. He’s treat all information obtained from participants as confidential unless otherwise required by law. Full disclosre needed. 5. He’s take credit, including authorship, only for work they have actually performed and give appropriate credit to the contributions of others.6He’s who serve as research or evaluation consultants maintain confideltiality of results unless permission is granted or in order to protect health and safety of others. 7. He’s report the resuls of their research and evaluation objectively, accurately, and in a timely fashion. 8 He’s openly share conflicts of interest in the research, evaluation, and disseemination proces.
20
Q
Code of ethics article VI: responsibility in profesoinal preparation
A
Those involved in teh preparation and training of He’s have an obligation to accord learners the same repsect and treatment given other groups by providing quality education thta benefits the profession and the public. 1. He’s select students rof professional preparation programs based on equal opportunity 2. He’s strive to maket he educational environment and culture conducive to the health of all involved, and free from forms of discrimination and harassment. 3. He’s involved in professional preparation and development engage in careful planning, present material that is accurate; developmentally an d culturally appropriate; provide reasonable and prompt feedback, state clear and reasonable expectations, and conduct fair assesment and prompt evaluationso f learnres. 4. He’s provide objective, comprehensive and accurate counseling to learners about career opportunitiees, development, advancement and assit learners in securing professional employemt or furhter education opportunities. 5. He’s provide adequate supervision and meaningful opportunities for the professional development of learners.
21
Q
Responsibilities and competencies for health education specialists
A
- Asses needs, assets, capacity for health education (competency 1.2 access existing information and data related to health, competency 1.6 examine factors that enhance or compromise the process of health education). Responsibility 2. Plan health education (competency 2.1 involve priority populations and other stake holders in the planning process. Responsibility V: administer and manage health education. Competency 5.2 obtain acceptance and support for programs, competency 5.3 demonstrate leadership, competency 5.5 facilitate partnerships in support of health education. Responsibility VI: serve as a health education resource person. (competency 6.1 obtain and disseminate health-related information). Responsibility VII communicate and advocate for health and health education. (competency 7.4) engage in health education advocacy.
22
Q
Leading by Example LBE
A
A validated instrument to assess leadership support for health promotion programs in work settings. Four factor scale: 1. business assignment with health promotion objectives 2 awareness of the economics of health and worker productivity 3 worksite support for health promotion 4 leadership support for health promotion (della et al 2010).
23
Q
Literature
A
The articles, books, government publications and other documetns that explain the past and current knowledge about a particular topic.
24
Q
Rationale (for a program)
A
- express the needs and wants of the priority population 2 describe the status of the health problems within a given population 3 shows how the potential outcomes of the proposed program align wtih what the decision makers feel is important 4 show compatibility with teh health plan of a state or a nation 5 provide evidence that hte proposed program will make a difference and 6 show how the proposed program will protect and preserve the single biggest asset of most organizations the people.
25
Needs asssessment
the process of identifying, analyizing, and prioritizing the needs of a priority population.
26
Epidemiological data
epidemiology is hte study of the distribution and determinants of healht-related states or events in a specifici population and the application of this stdy to control health problems.
27
Cost-benefit analysis (CBA
will yield the dollar benefit received fromt eh dollars invested in the program - return on investment. ROI = (benefits of investment - amount invested)/amount invested. It also = net savings/cost of intervention. When ROI =0, he program pays for itself. If TOI is greater than 0, then the program is producing savings that exceed the cost of the program.
28
Values or Benefits from Health Promotion Programs
Value/benefit for community - establishing good health as norm; improved quality of life, improve economic well-being of the community, provide model for other communities. Value/benefit for individual: improved health status; reduction in health risks, improved health behavior, improved job satisfaction, lower out of pocket costs for health care; increased well-being, selg-image and self esteem. Value/benefit for employer - increased worker morale, enhanced worker performance/productivity/recruitment and retention tool; reduced absenteeism and presenteeism, reduced disability days/claims, reduced healthcare costs.
29
evidence-based practice
when program planners systematically find, appraise and use evidence as the basis for decision making when planning a health promotion program.
30
Guide to Community Preventive Services
aka The Community Guide - the most useful source for those planning health promotion programs. summarizes findings from systematic reviews that are used to answer the following questions - 1 which program and policy interventions have been proven effective 2 are there effective interventions that are right for my community and 3. what might effective interventions cost; what is the likely return on investment. Te Community Guide developed by nonfederal Task Force on Community Prevention Services - comprised of individuals appointed by director of CDC.
31
Steps for establishing a rationale
1. identify appropriate background information 2. titling the rationale 3. writing the content of the rationale 4 listing references used to create rationale
32
Social math
the practice of translating statistics and other data so they become interesting to the journalist, and meaningtul to the audience. break down the numbers so they are understandable - p 30 of the book
33
Planning committee
steering committee, advisory board, planning team - becomes one of the planner's first tasks.
34
How to choose planning group
1. make committee of individuals who represent a variety of different subgroups, be representative and give the priority population a feeling of program ownership 2. if the program deals with specific health risk, include someone with that health risk on the committee 3. committee should include willing individuals who are interested in seeing the program succeed - doers and influencers 4. committee should include an individual who has a key role within the organization sponsoring the program 5. include representatives of other stake holders not represented in the priority population (aka health care providers who need to implement the program 6. committee should be reevaluated regularly to ensure composition is good 7. if the planning committee will be in place for a long tie, new people should be added periodically. 8. be aware of the "politics"and agendas 9. make sure the committee is large enough to accomplish the work. 10. Consider subgroups.
35
Techniques to get a planning group
1. asking for volunteers 2. holding an election 3. inviting/recruiting 4. having members formally appointed 5 having an application process
36
Steps in the pre-planning process
1. purpose of the program (how is the community defined, what are the health outcomes, etc. 2. scope of the planning process (intra or interorganizational what is the time frame needed 3. planning process outcomes (deliverables - what is the written plan, program proposal, etc. 4. leadership and structure - how will planners be organized, etc. 5. Identifying and engaging partners (how will they be selected, top-down vs. bottom-up approach. 7. identifying and security resources - budget, written agreement needed (MOA memorandum of agreement), external funding, community resources, etc.
37
Before committee begins, should have answers to these questions
1. what is the decision makers philosophical perspective on health promotion programs 2. what type of commitment to the program are decision makers willing to make, are they interested in the program becoming institutionalized 3. what type of financial support are decision makers willing to provide 4. are decision makers willing to consider changing the organizational culture 5. will all individual sin the priority population have an opportunity to take advantage of the program, or will it be available to only certain subgroups 6. what type of committee will the planning comittee be? will it be a permane t or a temporary coommitee 7. what is the authority of the planning committee?
38
Generalized model -
a model used to teach basic principles of planning and evaluation emphasized in most planning models - it consists of 5 elements or steps 1. assessing needs (collecting and analyzing data to determine needs of a population) 2. setting goals and objectives (what will be accomplished) 3. developing inteventions (how goals and objectives will be achieved) 4. implementing interventions ( putting interventions into action) 5. evaluating results. (improving quality and determining effectiveness) Pre-planning is also a quasi-step.
39
PATCH
the CDC planned approach to communit y health - for use in state and local health departments and local communities - Phase 1 mobilizing the community, phase 2 collecting and obtaining data, phase 3 choosing health priorities and target groups phase 4 choosing and conducting interviews phase 5 evaluating the PATCH process and interventions. - in essence basically teh same thing as APEX-PH - Assessment protocol for excellence in public health - designed for local health departments to engage in planning and evaluation process
40
APEX-PH
Assessment protocol for excellence in public health - designed for local health departments. Phase 1 organizational capacity assessment (internal assessment of strengths), phase 2 the commuity process: Collection and analysis of community health status data, collection and analysis of community opinion data, development of an action plan with goals and objectives. Phase 3 completing the cycle (implementation plan and evaluation plan.
41
MAPP model
mobilizing for action through planning and partnerships - released in 1997 by the CDC and NACCHO. MAPP model replaces APEX-PH as a foundational approach. Phase 1 organizing for success and partnership development. phase 2 visioning;. phase 3. Four MAPP assessments, phase 4 identify strategic issues phase 5 formulate goals and strategies, phase 6 action cycle.
42
MAP-IT Model
Healthy People 2o2o (developed in 2010) developed a planning guide called MAP-IT for mobilize, assess, plan, implenet and track. 5 phases corresponding to words
43
how to select a planning model?
choose based on 1. the preferences of stakeholders, 2. how much time and funding are available for planning, 3. how many resources are available for data collection and analysis 4. the degree to wich clients are actually involved as partners in the planning process, ro the degree to which your planing efforts will be consumer oriented 5. preferences of a funding agency.
44
Three F's of program planning
Fluidity, Flexibility, and functionality. Fluidity suggests that steps in the planning process are sequential - or build on one another. Flexibility means thta planning is adapted to teh needs of stakeholders. Functionality means that an outcome of planning is improved health outcomes.
45
PRECEDE_PROCESS
Predisposing, reinforcing, and enabling constructs in educational/ecological diagnosis and evaluation. consists of a series of planned assessments that generate information that will be used to guide subsequent decisions. PROCEED: policy, regulatory, and organizational constructs in educational and environmental development - which is marked by the strategic implementation of multiple actions based on what was learned from the assessments in teh initial phase. PRECEDE-PROCEED is composed of eight steps. Underlying approach is to begin by identifying desired outcome, to determine what causes it, and finally to design an intervention aimed at reaching the desired outcome. Begins with the final consequences and works backward to the causes. Phase 1. Social asssessment and situational analysis - define quality of life (problems and priorities) of those in the priority population including achievement, alienation, comfort, crime, discrimination, happiness, self-esteem, employmenet, etc. Phase 2 epidemiological assessment - planners use data to identify and rank the health goals or problems that may contribute to or interact wtih problems identified in phase 1 - such as mortality, morbidity and disability data as well as genetic, behavioral, and environmental factors. Once identified, the risk factors are prioritized. Phase 3 educational and ecological assessment - identifies and classifies the various facotrs that have the potential to influence a given behavior into 3 categories - predisposing, reinforcing, and enabling. Predisposing factors include knowledge and personality traits and beliefs. Enabling factors are barriers or facilitators created by societal forces or systems which include access to healthcare etc. reinforcing factors involve the different types of feedback and rewards that those in the priority popuation receive after behavior change, which may encourage or discourage continuation of behaviors - social benefits. Phase 4 has two parts. Intervention alignment and administrative and policy assessment. Intervention alignment matches appropriate strategies and interventions with projected changes and outcomes identified in earlier phrases. Phases 5,6,7,8 make up PROCEED portion. 5 = implementation 6,7,8 process, impact, and outcome evaluation.
46
Need (in planning)
the difference between the present situation and a more desirable one. Can be an actual need (true need) or a perceived (reported need) - we identify all needs, not just true ones.
47
Needs Assessment
The process of determining needs of a priority population. Also called community analysis, community diagnosis, and coommunity assessment.
48
Reasons to do a needs assessment
1. logical place to start. 2. needs assessments help ensure appropriate use of planning reosurces 3. failure to perform a needs assessment may lead to a program focus that prevents or delays adequate attention directed to a more important health problem. 4. determine the capacity of the community to address specific needs 5. provides a focus for developing an intervention to meet th eneeds of a priority population.
49
Capacity
The individual, organizational, structures, infrastructure, politics, and systems, that can enable a community to take actio. Community Capacity is "the characteristics of communities that affect their ability to identify, mobilize, and address social and public health programs.".
50
Where might you NOT perform a needs assessment?
1. if another needs assessment has been done recently, for anotehr related program and the funding or other resources were not available. 2. program planners may be employed by an agency that deals only wtih a specific need that is alraedy known, or the agency for which they work has received categorical funds that must be used for dealing with a specific disease.
51
Peterson and Alexander (2001) suggested that needs assessment should answer the following questions
1. who is the priority population 2. what are the needs of this population 3. which subgroups with in the priority population have the greatest need 4. where are these subgroups located geographically 5. what is currently being done to resolve identified needs 6. how well have the identified needs been addressed in the past
52
Capacity Building
activities that enhance the resources of individuals, organizations, and communities to improve their effectiveness to take action.
53
2 types of data of a needs assessment
Primary data - those data you collect yourself via focus group, survey, interviews, et. that answer unique questions related to your specific needs assessment. Secondary data are those data already collected by somebody else and available for your use. Secondary data is a no contact method of collecting data.
54
Sources of primary data
1. Single-step or cross-sectional surveys (single step surveys are a means of gathering primary data from individuals or groups with a single contact, such as written questionnaires or interview. Self-report data is a subset of single-step data where people answer questions about themselves. You can also use proxy measures, significant others, or opinion leaders, or key informants. 2. Written questionnaires -MOST OFTNE USED METHOD OF COLLECTING SELF_REPORTED DATA. 3. Face to face interviews. 4. Telephone interviews 5. Electronic inerviews, 6. group interviews, 7. multistep survey 8. community form/town hall meeting 9. meetings 10 focus groups 11. nominal group process, 12 observation13. self assessments
55
How to maximize usefulness of self-reported data
1. select measures that clearly reflect program outcomes 2. select measures that have been designed to anticipate the response problems and have been validated 3. conduct a pilot study with the priority population 4. anticipate and correct any major sources of unreliability 5. employ quality control procedures to detect other sources of error 6. employ multiple methods 7. use multiple measures 8. use experimental and control groups with random assignment to control for biases in self-report.
56
Proxy/indirect measure
When the priority population cannot or does not want to respond for themselves you usea proxy or indirect measure - an outcome measure htat provides evidence that a behavior has occurred. Examples include 1. lower blood pressure for the behavior of medication taking, 3 cotinine in the blood for tobacco use, etc. usually proxy measures require more resources
57
Opinion leaders
individuals who are well respected in the community and whocan accurately represent hte views of the priority population. These leaders are 1. discriminating users of the media 2. emographically similar to the priority group 3. knowledgeable about community issues and concerns 4. early adopters of innovative behavior 5. active in persuading others to become involved in innovative behavior.
58
Key informants
strategically placed individuals hwo have the knowledge and ability to report on the needs of those within the priority population - they may/may not have formal authority but are often respected.
59
Delphi technique
a technique used in multistep surveys - a process that generates consensus through a series of questionnaires, which are usually administered via the mail or electronic mail. People are given 1-2 broad qeustions. Responses analyzed, and a second questionnaire with targeted questions are sent. Analyzed again, and a new questionnaire sent.
60
Community Forum
Town hall meeting)
61
Focus group
a form of qualitative research that are used to obtain information, feelings, opinions, perceptions, etc. usually 8-12 people. Limitation is thaat these groups aren't oftne randomly selected.
62
Nominal grou pprocess
highly structured process in which a few knowledgeable representatives of the priority population (5-7) are asked to qualify and quantify specific needs.
63
Observation
notice taken of an indiator - minimal contact method of data collection, usually done by direct observation - watching the eating patterns of kids in a lunchroom, etc. Obtrusive observation when people know they are observed, unobtrustive observation when they don't. Windshield tour or walk through is one method - usually through a neighborhood observing housing types public services, etc. Photovoice - photo novella is a form of participatory data collcection
64
Photovoice
a form of participatory data collection in which those in the priority population are provided with cameras and skills training then use the cameras to convey their own images of the community problem. Photovoice has 3 main goals 1. to enable people to record and reflect their community's strengths and concerns 2 to promote critical dialogue and ehnance knowledge about isseus through group discussions of the photographs, and 3 inform policy makers.
65
Self-assessments
HRA's health risk assessments, etc. Health assessments are the most useful in needs assessment process. HRAs most often included.
66
Secondary data
Data collected by government agencies 2. data available from non-government agencies and organizations 3. data from existing records 4. data from teh literature 5. psycINFO, MEdline, ERIC (education resource information center); cumulative index to nursing and allied health literature (CINAHL) or EHXWeb - the bioethics research lab of georgetown university
67
Conducting a needs assessment
1. determining purpose and scope of needs assessment 2 gathering data. 3. analyzing the data., 4 identifying risk factors linked to health problems 5. identifying the program focus 6. validating the prioritized needs. 7
68
Needs Asessment step 1: Determining purpose and scope
what is the goal of the needs assessment? First challenge is what type of needs assessment is required - consider categorical funding.
69
Needs Assessment Step 2: Gathering Data
looking for relevant data.
70
Needs Assessment: Step 3: Analyzing the data
identifying and prioritizing the health problems. One systematic way to analyze data is to use the first few phases of PRECEDE_PROCEED model for guidance - namely 1. what is the quality of life of those in the priority population? 2. what are social conditions and perceptions shared by those in teh priority population 3. what are the social indicators (absenteeism, crime, etc), in the priority population that reflect the social conditions and perceptions 4. can the social condditions and perceptions be linked to health promotion 5. what are hte health problems associated wtih the social problems 6. which health problem is the most important to change.
71
BPR - basic priority rating
first known as the priority rating process was introduced by Hanlon 1954, in an attempt to prioritize health problems in developing countries. Current BPR MOdel = A. size of the problem on a scale of 0-10 B. seriousness of the problem on ascale of 0-20 Ceffectiveness of the possible interventions on a scale of 1-10 D. propriety, economics, acceptability, resources, and legality (PEARL - a 0 or 1). Basic Priority Rating = (A+B)C/3 x D
72
Needs Assessment Step 5; Identifying Program Focus
similar to the third phase of PRECEDE-PROCEED model - educational and ecological assessment. 1. what health promotion programs are presently available to the PP 2. are the programs being utilized 3. how effective are the programs 4. how were the needs for these programs determined 5. are the programs accessible to the priority population 6. are the needs of the PP being met?
73
Needs Assessment Step 6: Validating the Prioritized needs
validate means confirm that the need that was identified is the need that should be addressed Done by 1. rechecking the steps followed in the needs assessment to eliminate any bias 2. conducting a focus group with PP to determine reaction to the identified needs 3. getting a "second opinion" from health professionals .
74
Health Impact Assessment - HIA
a combination of procedures, methods and tools by which a policy, program or project may be judged as to its potential effects on the health of a population, and the distribution of those effects within teh population. An HIA is an approach thta can help to identify and consider the potential or actual health impacts of a proposal on a PP. Its primary output is a set of evidence-based recommendations geared to informing the decision making process. HIAs are based on 1. democracy. 2 equity 3. sustainable development and 4 ethical use of evidence. Most HIAs include 1. screening, 2 scoping (which health effects to consider 3. assessing risks and benefits 4 developin recommendations 5 reporting and 6 evaluating
75
Mission Statement
a short narrative that describes the general focus or purpose of the program.
76
Vision statement
a brief description of where the program will bein the future - may discuss future products, markets, customers location and staffing.
77
Goals
broad statements of direction written in nontechnical langauge - less specific than objectives. Goal is an expectation that 1. is much more encompassing, or global, 2 is wwritten to include all aspects or components of a program 3. provides overall direction for a program 4. is more general in nature 5. usually takes longer to complete 6 does not have a deadline 7 usually is not observed, but rather inferred because it uses words like evaluate, know, improve, and understand 8 is often not measurable in exact terms
78
Objectives
more precise and represent smaller steps than proram goals - steps that, if completed, will lead to reaching the program goals. objectives can be thought of as the bridge between needs assessment and a planned intervention. Knowing how to construct objectives for a program is an important skill
79
Levels of objectives
1. Process Objectives - daily tasks, activities, and work plans that lead to the accomplishment of all other levels of objectives. THey help shape or form a program and focus on all program inputs . . . program resources (materials, funds, space); appropriatenes of intervention activities, etc. 2. Impact objectives - comprises 3 different types of objectives - learning objectives, behavioral objectives and environmental objectives - they are called impct objectives because they describe the immediate observatble effects of the program. 3. Learning objectives - educational or learning tools needed in order to achieve the desired behavior change. They are based upon the analysis of educational and ecological assessment of PRECEDE PROCEED model. 4. Behavioral Objctives - describe the behaviors or actions in which the priority population will engage ithat will resolve the health problem and move you toward achieving your goals. 5. Environmental objectives - outline the nonbehavioral causes of a health problem taht are present in teh social, physical, psychological etc. environments. 6. Outcome objectives - the ultimate objectives of a program and are aimed at changes in health status, social benefits, risk factors, or qulities of life
80
Outcome objectives
the ultimate objectives of a program and are aimed at changes in health status, social benefits, risk factors, or quality of life.
81
Criteria for developing objectives
1. can teh objective be realized during the life of the program or during a reasonable time thereafter? 2. can the outcome realiastically be achieved 3. does the program have enough resources to obtain the objective 4. are the objectives consistent with the policies and procedures of the sponsoring agency 5. do the objectives violate any of the rights of those involved. 6. if the program is planned for a particular ethic/cultural population, do the objectives reflect the relationship between teh cultural characteristics of the priority group and the changes sought?
82
SMART GOALS
Specific, measurable, acheivable, realistic, and time phased
83
Elements of an outcome
1. the outcome to be achieved, or what will change 2. the conditions under which the outcome will be observed, 3. the criterion for deciding whether the outcome has been achieved, 4. the priority population.
84
Theory
a set of interrelated concepts, definitions and propositions that presents a systematic view of events or situations by specifying relations among variables in order to explain and predict the events o hte situations - in other words - it is ia systematic arrangement of fundalmental principles that provide a basis foe explaining certain happenings of life.
85
Model
a composite, a mixture of ideas or concepts taken from any number of theories and used together. Models draw on a number of theories to help understand a specific problem.
86
Concepts
primary elements or building blocks of a hteory. When a concept has been developed, created, or adopted for use with a specific theory, it is refered to as a construct.
87
Construct
when a concepti s used in reference to a specific theory
88
Variable
specify how a construct is to be measured in a psecific situation
89
Measurement
The process of applying numerical or narrative data from an instrument or other data-yielding tools to objects, events, or people. The data generated by measurements is classified into quantitative and qualitative
90
Quantitative measures
numerical data collected to understand individuals' knowledge, understanding, perceptions and behavior - mortality rates, BMIs, prevalence of cigarette smokingetc.
1. measures level of occurrence, asks how often, how many, studies actions, is objective, provides proof, is definitive, measures levels of actions and trends, describes
91
Qualitative measures
data collected with the use of narrative and observational approaches to understand individuals knowledge, perceptions, attitudes and behaviors. uusually represented as words that are organized into codes or themes - notes generated from observational studies, transcripts from focus groups, etc.
1. provides depth of understanding, asks why, studies motivations, is subjective, enables discovery, is exploratory, allows insights into behavior and trends, interprets
92
Levels of measurement
1. nominal - lowest levle in measurement hierarchy and use names, or labels to categorize people, places or things - female/male, etc. 2. ordinal level measures allow planners to put data into categories that are mutually exclusive and exhuasitve, but also permit them to rank-order the categories. The distance between categories cannot be measured. ex: very satisfied, satisifed, not satisfied, etc. 3. Interval level measures - allow planners to put data into categories that are mutually exclusive and exhaustive and rank-orders the categories. The widths of differences between categories must all be the same. What is the temperature today - differences between 93 and 94 degrees = 85 and 86 degrees Another example is IQ testing. 4. Ratio level measures - the highest level in the measurement hierarchy, enables planners to do everything with data that can be done with the other three levels of measures, however those tasks are accomplished using a scale with an absolute zero. What was your score on the test. HOw many minutes do you exercise aerobically, etc.
93
Psychometric qualities
the reliability, validity, and fairness of a measure
94
Reliability in measurement
an empirical estimate of the extent to which an instrument produces the same result measure or score applied once or two or more times. Reliability coefficients are highest if no error exists (r=1.0) and lowest when there is only error or no association between two measures (r = 0).
95
Internal consistency in measurement
one of the most commonly used methods of estimating reliability - inter correlations among the individual items on the instrument, that is, whether intems on the istrument are measuring the same research domain. Scored between 0 and1, with socres greater than .7 typically classified as acceptable and scores of .8 classified as good. Scores of .9 or greater are excellent - but can also indicate there is redundancy in the instrument (too many questions asking the same thing).
96
Test-retest reliability in measurement
stability reliability - used to generate evidence of stability overa period. To establish this type of reliability the same instrument is u sed to measure the same group of people under similar, or the same conditions, at two different points in time. .7 or greater is generaly acceptible, .8 is ideal
97
Rater reliability
focuses on the consistency between individuals hwo are observing or rating the same items or when one individual is observing or rating a series of items. If two or more raters are involved, it is referred to as inter-rate reliability. If only one individual is observing or rating a series of events, it is referred to as intra-rater reliability. Example of inter-rater: If 10 cars are observed by the raters and they agree 8 out of 10 times on whether the drivers are wearing their safety belts, the inter-rater reliability would be 80%. INtra-rater reliability woudl be the degree to which one rater agrees with himself or herself over time.
98
Parallel forms reliability
Equivalent forms or alternate-forms reliability, focus on whether different forms of the same measurement instrument when measuring the same subjects will provide similar results. - means, standard deviations,a nd inter-item correlations.
99
Validity
whether a measurement is correctly measuring the concepts under investigation. Using a valid instrument increases the chance that planners/evaluators are measuring what htey want to measure, thus ruling out other possible explanations for the results.
100
Face validity
the lowest level of validity - a measure is said to have face validity, on teh face, it appears to measure what it is supposed to measure. - example when a planner asks a group of colleagues to look over a series of questions to see whether they seem reasonable to include on a questionnaire about the risk for heart disease
101
Content validity
the assessment of the corespondence between the items composing the instrument and the content domain from which the items were selected - all the essential elements of a research doamin are included in the instrument. Usually established by a jury or panel of experts to review the instrument.
102
Criterion-related validity
the exten tto hwich data generated from a measurement instrument are correlated with dta generated from a measure of hte phenomenon being studied, usually an individuals behavior or performance. Criterion-related validity is dividied into 2 subgroups - predictive validity and concurrent validity
103
Predictive validity
if the measurement used wll be correlated with another measurement of the same phenomenon at anotehr time - the use of standardized testing predicting college success
104
Concurrent validity
a new instrument and an established valid instrument htat measure hte same characteritics are administered to the same subjects and the results of the new instrument are compared to the results of the valid instrument.
105
Construct validity
the degree to which a measure correlates with other measures it is hteoretically expected to correlate with (construct validity tests the theoretical framework within which the instrument is expected to perform.
106
Convergent validity
the exten to which two measues whihc purport to be measuring the same topic correlate
107
Discriminant validity aka divergent validity
requires that the construct should not correlate with dissimilar variables.
108
Sensitivity and specificity
Sensitivity - the ability of the test to identify correctly those who actually have the disease. Specificity - the ability of the test to identify only non-diseased individuals who actually do not have the disease.
109
Fairness
the question of whether a measure is appropriate for the individuals of various ethic groups with different backgrounds, gender, education levels, etc.
110
Culture
the patterened ways of thoughts and behavior that characterize a social group, which are learned through socialization processes and persist over time.
111
Bias free
biased data are those data that have been distorted because of the way they have been collected.
112
Measurement instrument
the item used to measure hte variables of interest
113
instrumentation
collective term that describes all measurement instruments used.
114
Using existing measurements
1. identifying measurement instruments - consider hte national center for health statistics, or CDC WONDER.
2. getting your hands on the instrument
3. is it the right instrument - is there significant evidence of hte psychometric qualities of the instrument, has it been used in similar partiicpants to yours, etc.
4. final steps before proceeding - making sure you have permission when not in public domain
115
Sampling
sthe need to select participants from whom data will be collected - a small sample of participants. Universe - Population - Survey population - Sample
116
Random selection
increases the likelihood you get a representative sample of the survey population
117
probability sample
when random selection is used to create a sample
118
simple random sample
have a list or "sampling frame" of all sampling units in the survey population. Then assign numbers - then randomly select numbers.
119
systematic sample
takes every Nth person of the sample
120
Stratified random sample
used if it is important that certain groups are reflected in the sample - you have have a survey population of 100 partiicpants, and in that 100 there are only 8 of one group. If you were to select 10 from the group, it's a good chance that you wouldn't have anyone from the 8. Stratifid random sample prevents this
121
Strata
divide the survey population into subgroups
122
proportional stratified random sample
does the sample mirror in proportion the survey population
123
nonproportional stratified random sample
want equal representation from different strata within the survey population.
124
Nonprobability samples
all individuals in the survey population do not have equal chance of being selected. May be selected for: convenience, volunteer, direct contact, homogeneous, judgmental or typical of strata, quota.
125
pilot testing
set of procedures used by planners/evaluators to try out the program on a small group of participants prior to actual implementation.
126
preliminary review
conducted when those responsible for the data collection process ask colleagues, not people from the priority population,to review the data collection instrument.
127
Pre-pilots
aka mini pilots - are used by planners/evaluators with 5-6 members of the priority population to assess the quality of materials, instruments, and data collection techniques.
128
Pilot test
actual implementation of the instrument
129
field study
final pilot test, combining all materials previously tested separately into a complete prgram.
130
Intervention, aka treatment
planned activities to achieve an outcome - a theory-based strategy or experience to which those in the priority population will be exposed or in which they will take part. Intervention describes all the activities that occur between the two measurement points.
131
Multiplicity (intervention)
the number of components or activities that make up the intervention, greater hte multiplicity, greater hte outcome
132
Dose (intervention)
number of program units delivered. For example, if the intervention for a skin cancer program would consist of multiple activities (multiplicity) and those activities would include an educational class for the public, distribution of brochures to those at high risk, and ratio and television public service announcemnets. The dose questions wouldbe: how many times would the class be offered? How many brochrues distributed, etc. greater the dose, better the outcome
133
Strategy
general plna of action for affecting a health problem - a strategy may encompass several activities including
1. health ocmmunication strategies
2. health education strategies
3. helath policy/enforcement strategies
4. environmental change strategies
5. health related community service strategies
6. community mobilization strategies
7. other strategies
134
Health communication strategies
the study and use of communication strategies to inform and influence individual and community decisions that affect health. - health communication alone is rarely sufficient to change behavior and reduce the risk of disease. But have the highest penetration rate - the ability to reach highest numbers of PP. Much more cost effective an dless threatening than most other types of strategies.
135
Communication channel
the route through which a message is disseminated to the PP - select appropriate channels, intrapersonal (one to one communication), intrapersonal (small group), organizationl and community an dmass media. The intrapersonal reaches the fewest people, etc.
136
Health education strategies
inform people. - provide the oppportunity for the PP to gain in-depth knowledge about a particular health topic.
137
Scope
breadth and depth of material presented
138
sequence
order in which the material is presented
139
Health policy/enforcement strategies
executive orders laws, ordinances, judicial decisions, policies, regulations, rules an dposition statements. - exist for the protection of the community and of individual rights.
140
environmental change strategies
provide opportunities, support an dcues to help people develop healthier behaviors. - inadeqaute access to food, safety issues, et.c often environmetal change strategies do not require action on the part of the PP.
141
Health related community service strategies
service,s tests, treatments, or care to improve the health of those in the PP - health risk assessment form, low cost flu shots, etc.
142
Community mobilization strategies
help communities identify and take action on shared concerns using participatory decision making - empowermnet. 1. community organization and building and 2 community advocacy
143
Community organization and community building
the process by which community groups are helped to identify common problems or goals, mobilize resources, and in other ways develop and implement strategies for reaching goals they ahve collectively set.
144
Community advocacy
a proces in which the people of the community become involved in the institutions and decisions that will have an impact on their lives.
145
Behavior modification activities
intrapresonal level intervention - a systematic procedure for changing a specific behavior - log behavior, etc.
146
organizational culture activities
closely aligned with environmental change - strategies are activities that affect organizational culture. Culture audit - helps identify cultural health values, cultural health norms cultural touch points, peer support opportunities. etc.
147
Incentives and disincentives
carrots and sticks to improve health behaviors in worksite settings.
148
Logic model
systematic and visual way to present and share your understanding of the relationships among the resources you have to operate your program, the activities you plan, and the changes or results you hope to achieve. Simply put, a logic model is a roadmap. They increase likelihood of success because they
1. communicate the purpose of the program and expected results
2. describe the actions expected to lead tot he desired results
3. become a reference point for everyone involved in th eprogram
4. improve program staff expertise in planning, implementation adn evaluation
5. involve stakeholders, enhancing the likelihood of resource commitment.
6. incorporate findings from other research and demonstration projects .
7. identify potential obstacles to program operation so that staff can address them early on
149
Inputs (logic model)
resources tha tare used to plan, implement, and evaluate a program. They often include HR, partnerships, funding sources, equipment, supplies, materials, and community resources.
150
Outputs (logic model)
activities or interventions in a program - often include products like curricula, trainings, services, infrastructure, etc.
151
Outcomes (logic model)
intended results and are broken into short-term mid-term, or long-term outcomes.
152
Implementation
carry out of a program
153
Phases of implementation
1. adoption of the program
2. identifying and prioritizing tasks to be completed. often use GANTT charts or PERT charts (program evaluation and review technique) that include a diagram and a timetable. Can also use a critical path method which is similar to PERT - presents a graphical view of hte project and predicts time needed to complete project. CPMs focus on time by showing which tasks are critical to maintaining the planning schedule and which are not.
3. establishing a system of management - craft effective and efficient programs - PADS - planning, acquisition, development and sanction
4. Putting plans into action - by using 1. a piloting process, 2. by phasing htem in, in small segments, and 3. by initiating entire program at once.
5. Ending or sustaining a program - can work to institutionalize the program, seek feedback from program participants, advocating for the program, partnering with other organizations, revisiting and reviewing the rationale for hte program.
154
Evluation needs to . . .
1. address and improve quality, 2. determine effectiveness
155
Evaluation definition
A process of determining the valu eo r worth of a health promotion program or any of of its components based on predetermined criteria or standards of acceptability identified by stakeholders
156
Standards of acceptability
the minimum levels of performance, effectiveness, or benefits used to judge value.
157
Two categories of evaluation
1. Formative evaluation - quality assessment and program improvement 2. summative evaluation - determines effectiveness.
158
Formative evaluatoin
quality assessment and program improvement. Process begins when programs are developed, continues through implementation phase and ends when program is conlcuded. The purpose is to improve overall quality of a program or any of its compoentns before it is too late.
159
Process evaluation
closely related to formative evaluation. Assesses the implementation process in general, tracks and measures what wet well and what went poorly and how thse factors contributed to the success or failure of the program.
160
Summative evaluation
to assess the effectiveness of the intervention and the extent to which awareness, attitudes, knowledge, behavior, the environment or health status changed as a result of a particular program. Requires the measurement and establishment ofa baseline value (the starting point) as well as measurement of the same health indicator after the program is introduced.
161
Impact and outcome evaluations
closely associated with summative evaluation. While summative is more generally an umbrella term associated with effectiveness, impact evaluation tends to focus on intermediary measures such as behavior change or changes in knowledge, attitudes and awareness. Whereas outcome evaluation tends to measure the degree to which end points such as diseases or injuries actually decreased.
162
Why do we want programs evaluated?
determine achievement of objectives related to improved health status, improve program implementation, provide accountability to funders and community, increase community support for initiatives, to contribute tot eh scientific base for community public health interventions, to inform policy decisions
163
Steps in an evaluation
1. engaging stakeholders - ensure their perspectives are understood. 2. describe the program - mission goals, etc. 3. focusing on evaluation design making sure the interests of stakeholders are addresssed. 4. gathering credible evidence 5. justifying conclusions - comparison of the evidence against the stancards of acceptability 6. ensuring use and sharing lessons learned. dissemination fo the evaluation results. Framework also uses four standards of evaluations - 1. utility standards, feasibility standards, propriety standards, and accuracy standards
164
Utility standards
ensure that informatio needs of evaluation users are satisfied
165
Feasibility standards
ensure that the evaluation si viable and pragmatic - realistic and affordable
166
propriety standards
ensure that the evaluation is ethical
167
Accuracy standards
ensure the evaluation produces findings that are considered correct.
168
Baseline data
data reflecting initial views or data
169
Elements of formative evaluation - Justifcation and evidence
assurance that programs are supported by key stakeholdrs and evidence based
170
Elements of formative evaluation - capacity
careful examination of competency of those woh are desgining and implementing a program
171
Elements of formative evaluation - resources
adequate internal or external fudning and or assistance from partner organizations
172
Elements of formative evaluation - cost-identification analysis
compare interventions available for a program - which one is the least expensive.
173
Elements of formative evaluation - inclusion
right parnters are involved in the program
174
Elements of formative evaluation - accountability
each partner organization performs work as previously arranged
175
Elements of formative evaluation - adjustment
most critical element - process whereby planners make necessary changes to the program or its implementation based on feedback.
176
Elements of formative evaluation - recruitment, reach, response
promoting a program and ensuring the people in the priority population are aware of the program, can engage in teh program, and participate i nthe program.
177
Elements of formative evaluation - interaction and satisfaction
the degree to which practitioners effectively work and communicate with program participants and how satisfied participants are with the program in general or with specific compoents.
178
Elements of formative evaluation - dose
how many products, services or other program components wer delivered to the priority population.
179
Elements of formative evaluation - context
presence of any confounding factors
180
Pretesting
1. testing components of a program with teh priority population prior to the implementation 2. collecting baseline data prior to program implementation that will be compared wtih posttest data to measure the effectiveness of the data.
181
Procedures used in formative evaluation
Focus groups, surveys, in-depth interviews, informal interviews, key informant interviews, direct observation, expert panel reviews, quality circles, protocol checklist, gantt chart, program and evaluation forms.
182
Confounding variables in summative evaluation
community-wide programs often have great dificulty identifying with any precision the degree to which the programs themseles had an impact when the priority population was exposed to so many influences at the same time.
183
Steps in identifying summative evaluations
1. identify resources and determine what is expected from the program and what can be observed 2. define the problem - determine what is to be evaluated 3. make a decision about evaluation design, whether to use the qualitative or quantitative methods of data collection or both.
184
qualitative methods used in evaluation
case studies, content analysis, delphi techniques, ethnographic studies, films, photographs and videotape recording, focus group interviewing, historical analysis, indepth interviewing, nominal group process (a highly structured process in which a few knowledgeable representatives fo the priority population are asked to qualify and quantify specific needs)., participant observer studies, quality circle, unobtrusive techniques -such as review of archival data, study of physical traces.
185
Measurement in evaluation
the process of applying numerical or narrative data from an instrument
186
Pretest and posttest
measurements before program begins and after ends.
187
Experimental design
greatest control voer the various factors that may influence the results - it involves random assignment to expreimental and control groups with measurement of both groups. Produces th emost effective and interpretable and defensible evidence of effectiveness.
188
quasi-experimental design
results in an interpretable and supportive evidence of program effectiveness, but usually cannot control fro all factors that affect the validity of the results. No random assignment to hte groups, comparisons are made on experimental and comparison groups.
189
Nonexperimental design
without the use of a comparison group, has little control over hte factors that affect the validity of the results.
190
Internal validity
the degree to which change thatwas measured can be attirubted to the program and allows evaluators to speakw tih more confidence that ht eprogram itself made a difference. Factors include: history, maturation, testing, instrumentation, statistical regression, selection, mortality, diffusion or imitation of treatments, ocmpensatory equalization of treatments, compesnatory rivalry, resentful demoralization of respondents receiving less desirable treatments.
191
External validity
the exnte to which the program can be expected to produce similar effects in other populations aka generalizability. Reactive effects can threaten external validity including oscial desirability, expectancy effect, hawthorne effect, and placebo effect.
