Introduction to Health Promotion Planning

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Introduction to Health Promotion Planning
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Ancient Chinese proverb

• If we do not change our direction, we are likely
  to end up where we are headed.

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Introductions

• Facilitators
• The LiveMeeting Technology
• Webinar Courtesy
• Participants on the call
• Check-in re size of display on screen can
  everyone see the slides?
• Anyone not yet online?

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Agenda

• Introduction to THCUs recommended approach to
  planning health promotion activities
• Strong focus on increasing your awareness of the
  resources and supports available to you, as you
  work through your planning process.

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What is planning?

• Planning is a series of decisions,
• from general strategic decisions
• (e.g., identifying priorities),
• to specific operational details
• (e.g., program implementation) ,
• based on the collection and analysis
• of a wide range of information.

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Why plan?

• To get from your starting point to your desired
  end point.
• To help direct resources to where they will have
  the greatest impact.
• To ensure the development and implementation of
  effective and appropriate health promotion
  programming.

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Levels of planning
Strategic

• Program

Operational / Work / Action
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Components of planning

• Vision
• Mission
• Values / Beliefs / Guiding Principles
• Strategies
• Population(s)
• Goals Objectives
• Activities
• Details - , timeframe, roles

Strategic Planning
Program Planning
Operational Planning
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Step 1

• Pre-planning and Project Management

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Five elements to manage

• Participation
• Time
• Money/resources
• Data
• Decision-making

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1. Identify stakeholder roles and expectations

• CORE - on the planning team
• INVOVLED - frequently consulted or part of
  planning process
• SUPPORTIVE- providing some form of support
• PERIPHERAL - needs to be kept informed

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Levels of Stakeholders
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2. Determine planning start and end dates
develop workplan

• Participatory planning takes longer.
• Participatory ideals may conflict with political
  and cost issues.

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3. Assess resources for planning

• Includes funds, staff, time equipment and space.
• Includes in-kind contributions from partners.
• Opportunity costs.
• Must consider short-term expense vs. long-term
  pay-off.

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4. Determine complexity of data gathering and
analysis process

• Set general guidelines for
• how much data will be collected
• how much if any original research will be
  conducted
• the balance between qualitative and quantitative
• the type of rigour and evidence that will be
  incorporated into the planning process

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Answering two questions can help you set
guidelines.

• What overall expectations do stakeholder have in
  terms of the degree of rigour and evidence that
  will be incorporated into the planning process?
• What overall expectations do stakeholders have in
  terms of the need for new data (versus
  compilation of existing data) to inform decisions
  throughout the planning process?

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• Experience is a good teacher,
• but the fees are high!
• -Heine

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5. Choose decision making processes

• Establish a clear decision-making process for the
  core-planning group early on. Will the group run
  on consensus, or majority vote? Or something
  else?
• Outline any other decision-making processes that
  will be used. For example, for subcommittees,
  certain individuals, certain circumstances, etc.
• Revisit the decision-making process regularly

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Step 2

• Situational Assessment

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What is a situational assessment?

• A snapshot of the present used to plan for the
  future.

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Situational Assessment Process

• Develop research questions.
• Develop data gathering plan.
• Collect data.
• Organize and summarize data.
• Present key findings as readable, accessible,
  evidence-based answers to your research questions
  what can you not ignore? They should be
  convincing, compelling correct statements that
  guide your planning decisions.

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Why conduct a situational assessment?

• To learn more about population of interest (i.e.,
  who's affected by your health issue).
• To anticipate trends and issues that may affect
  the implementation of your program.
• To identify community wants, needs, assets
• To set priorities

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1. Develop Your Three Key Questions

• 1. What is the situation? (consider trends,
  public perception, stakeholder concerns, etc.)
• 2. What is making the situation better and what
  is making it worse?
• 3. What possible actions can you take to deal
  with the situation?

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About Theory

• Changing Behaviours A Practical Framework
• www.thcu.ca
• Tipsheet Summaries of Social Science Theories
• www.thcu.ca
• Theory at a Glance
• http//www.cancer.gov/PDF/481f5d53-63df-41bc-bfaf-
  5aa48ee1da4d/TAAG3.pdf

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2. Develop your data collection plan
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Your data should

• show the positive (strengths and issues, rather
  than needs or deficits)
• be the result of ongoing, meaningful input from
  the intended audience(s)
• look broadly and deeply at health issues and
• be complete, convincing, credible and compelling.

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Find answers to your research questions by

• collecting various TYPES of data
• using a combination of METHODS and
• tapping into various SOURCES.

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Types of Data

• Community health status indicators
• Quantitative polling/survey data
• Community stories/testimonials
• Evaluation findings
• Research findings
• Cost-benefit data
• "Best practices" synthesis and guidelines
• Environmental scan
• Stakeholder mandates, agendas, policies,
  guidelines, etc.
• Other

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Methods

• Consultation with stakeholders (face-to-face,
  using individual interviews, focus groups, and/or
  forums, etc.)
• Surveys
• Literature searches and reviews, including
  systematic reviews
• Large data sets
• Other

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Sources of Data

• Community service organizations
• Polling companies
• Community spokespersons
• Public libraries
• Consultants
• Websites
• Resource centres such as THCU
• Researchers
• Government departments
• Private sector
• Other

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PEEST

• A PEEST analysis examines Political, Economic,
  Environmental, Social and Technological trends
  affecting your potential program.

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Evidence to support planning decisions-collection
of resources

• http//www.thcu.ca/infoandresources/planning_resou
  rces_soe.cfm?ownershipALL

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3. Collect data
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Use Qualitative and Quantitative Data

• Talk to people to understand the true "meaning"
  behind the numbers.
• Numbers may tell you what is happening, but will
  not tell you why it's happening.
• "Not everything that can be counted counts, and
  not everything that counts can be counted.
  Albert Einstein

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You can observe a lot just by watching.Yogi
Berra
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4. Organize and summarize data for each of your
research questions

• What is the situation? (consider trends, public
  perception, stakeholder concerns, etc.)
• What is making the situation better and what is
  making it worse?
• What possible actions can you take to deal with
  the situation?

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Suggested method of organizing for forces
(research question 2)

• For individuals the bottom line is maintaining a
  personal behaviour change.
• For networks the desired impact is to create
  social change through opinion leadership and
  social influence.
• For organizations the desired impact is to change
  policies .
• For society the desired impact is to change its
  formal laws.

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Force Field Analysis
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6. SWOT Analysis

• Systematic approach to organizing the
• Strengths
• Weaknesses
• Opportunities
• Threats
• around your topic / issue /responses to it.

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Cluster of SWOT Results
From Kevin P. Kearns, Comparative Advantage to
Damage Control Clarifying Strategic Issues Using
SWOT Analysis. Nonprofit Management and
Leadership 3 No. 1 (Fall 1992).
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5. Present key findings

• Present key findings as readable, accessible,
  evidence-based answers to your research questions
  what can you not ignore? They should be
  convincing, compelling correct statements that
  guide your planning decisions.

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Step Three

• Identify goals, population(s) of interest, and
  objectives

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Terminology Varies
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Step Three Process

• Choose goals
• Choose populations of interest
• Create outcome objectives

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A goal is usually

• general in nature
• provides overall direction for a program
• is written to include all parts of a program
• takes a long time to complete
• does not have a deadline
• is not measurable in exact terms because it often
  includes subjective words like evaluate, know,
  improve, and understand

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Program goal examples

• The ultimate goal of CNN is to improve student
  nutrition in the Haldimand and Norfolk
  communities.
• (positive outcome goal)
• To reduce the incidence of obesity harm in
  Community X
• (problem reduction goal)

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Populations of Interest (Audiences)

• Primary population
• Secondary populations (who influence the primary
  population)

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Create Outcome Objectives

• An outcome objective is a brief statement
  specifying the desired changes in an audience
  caused by a health promotion program. Depending
  on the accepted terms of your organization,
  changes may also be called results, impacts, or
  effects.

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Elements of a well-written outcome objective
Outcome (what)
Priority Population (who)
Conditions (when)
Target (How much)
A well-written outcome objective
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Triple the number of
children and youth
involved in the development, Implementation
and evaluation of student nutrition programs
By the end of 2010
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Examples of outcome objectives in four elements
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Plan long term, develop actions for the short
term
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Objectives can be set at four levels of change
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Identify individuals, networks, organizations
and/or communities that

• must change because they have significant bearing
  on the situation (something that should be done)
• are amenable to change something that could be
  done and
• are aligned with the mandates, expectations and
  interests of the key stakeholders (something your
  organization would be expected to do).

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Additional THCU Resource on Objectives

• Objective Menu
• http//www.thcu.ca/infoandresources/resource_displ
  ay.cfm?resourceID54
• Other objectives critique examples
• http//www.thcu.ca/infoandresources/resource_displ
  ay.cfm?resourceID955
• Webcasts Comparing Goals and Objectives Inputs,
  Outputs, Outcomes Types of Objectives
  http//www.thcu.ca/videos/webcasts.htm

http//www.thcu.ca
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Step 4

• Identify Strategies, Activities, and Resources

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Step Four Process

• Choose strategies and activities
• Allocate resources
• Create process objectives

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Strategies and Activities

• STRATEGY broad type of intervention or approach
  to change (e.g., community mobilization).
• ACTIVITY a specific action to be taken within a
  certain time period (e.g., organizing a community
  forum as part of the community mobilization
  process)
• Each strategy will likely have many activities
  some activities are a part of more than one (even
  all) strategy.

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Relationship between programs, activities,
strategies and tasks
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Activities

• Workshops
• Counseling
• Product development
• Curriculum design
• Training
• Field days
• Conferences

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Assign resources

• Resources include money, expertise, time, space,
  equipment and so on.
• Resources can be provided through funded budgets,
  donated funds or revenue, and/or goods and
  services provided in-kind.

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Elements of a well-written process objective
Output (what product)
For which Population (for who)
Conditions (when)
Target (How much)
A well-written process objective
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Examples of process objectives in four components
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How to choose strategies

• Generate a possible list of strategies
• One way to do this is to create a list for each
  of your outcome objectives.
• Another method is to start by listing activities
  for each of the outcome objectives, then
  clustering the activities into strategies.
• Either way, focus on this question
• What do you need to do to reach your goal and
  outcome objectives that is consistent with your
  health promotion philosophy?

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Prioritize

• Use specific criteria to prioritize the options.
  For example, consider whether the strategy
• has significant bearing or potential to have an
  impact on the situation (something that should be
  done)
• is amenable/likely to occur given your available
  resources, expertise, etc.(could be done) and
• is aligned with your mandate and stakeholder
  interests (something your organization would be
  expected to do).

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How to choose activities

• Prioritize existing and new according to 
• what you know about the effectiveness of this
  activity
• What you know about the appropriateness of this
  activity for your intended audience
• what you know about the financial and human
  resources required and
• what resources you have available.

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How to assign resources

• Allocate what is available to specific
  activities.
• Examine the gaps between what is needed and what
  you have.
• Explore ways of obtaining the required resources
  from other organizations, alternative funding
  sources, etc.
• Consider which activities you will keep and which
  parts will be on hold until new resources are
  found.

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Write process objectives

• The number of products and services you can
  realistically deliver is closely tied to your
  available resources. If necessary, reduce the
  number of services provided, or increase the
  required budget to cover the desired level of
  service.

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Step 5

• Develop Indicators

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Indicators help answer the questions

• How will you know the strategy has been
  implemented?
• How will you know the objective has been
  achieved?
• How will you measure progress toward your desired
  outcome?
• How will you know what is different after your
  program?

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More about Indicators

• Units of measurement used to assess the extent to
  which objectives have been met.
• Building block for a comprehensive evaluation
  plan.
• Must be reliable, valid and accessible.

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For each indicator identify

• What you will measure
• e.g percentage of people who agree that(outcome)
• Number sent (process)
• Participant comments (process)
• Where the data is available
• Any limitations on accessibility
• Any concerns about reliability
• Any concerns about validity

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Where is the data available?

• Outcome indicator examples
• Community health survey
• Collect it ourselves
• Media monitoring service
• Process indicator examples
• Program secretary budget files
• Physician office records
• Workshop registration forms

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Step 6

• Review the Program Plan

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Step 6 is about reviewing your plan for

•  Completeness
• Logic
• Alignment with the results of your situational
  assessment
• Overall presentation or look

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Resources
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Online Health Program Planner

• http//www.thcu.ca/ohpp/

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Table Format
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THCU on Planning

• Introduction to Health Promotion Planning
  Workbook French and English
• Logic models workbook
• Planning Situations and Solutions
• Create your own planning model
• Planning At a Glance
• Strategic planning to program planning and back
  again (webinar proceedings)
• http//www.thcu.ca/infoandresources/resource_displ
  ay.cfm?res_topicID4

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Health Promotion Skills Essential Resource Tour

• Summary of all links mentioned during the
  workshop
• http//www.thcu.ca/workshops/hpskillsresourcetour.
  htm

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Planning resources Not ours, but also good!

• Innonet
• On-line assistance step-by-step with your
  planning http//www.innonet.org/
• Tools of Change
• Canadian planning support http//www.toolsofchange
  .com/English/firstsplit.asp
• Community Tool Box
• Planning community health promotion
  http//ctb.ku.edu/

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THCUs Consultation Service

• Free to those working on Ontario-focused
  projects.
• Scope varies, depending on need
• short training sessions
• brief, one-time advice
• review your work or product
• hands-on assistance working through our step
  models
• links to other sources of information and
  resources.
• Consultation request form http//www.thcu.ca/consu
  ltation/request_form.htm
• Sample consultations http//www.thcu.ca/consultati
  on.htm

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Upon Request Workshops

• All of our workshops, are available upon request
  for groups as small as 30 and as large as 50.
• Any coalition or agency can partner with THCU to
  host a workshop in their community.
• We provide the facilitators at no cost and will
  work with you to help tailor, organize and
  promote the event.
• Service request form http//www.thcu.ca/consultati
  on/request_form.htm
• We require at least three months' notice to plan
  and deliver a workshop.

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Brought to you by THCU.

• Case Study Series
• Planning, evaluation, health communication
• What Were Reading
• Recommended and summarized resources
• Literature search results
• Completed to support our client consultations
• All available at http//www.thcu.ca/infoandresourc
  es.htm
• THCUs Online Learning Community
• Questions generated from our clients, answers
  generated by THCU and colleagues
  http//www.thcu.ca/blogs/lc/

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More by THCU

• Guide to French Language Resources
  http//www.thcu.ca/index_f.htm
• Changing Behaviours A Practical Framework
  http//www.thcu.ca/infoandresources/resource_displ
  ay.cfm?resourceID58
• Overview of Sustainability Workbook
  http//www.thcu.ca/infoandresources/resource_displ
  ay.cfm?resourceID784

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THCU in collaboration with OHPRS

• Health Promotion 101
• This free, online course helps people familiarize
  themselves with essential health promotion
  concepts.
• http//www.ohprs.ca/hp101/main.htm
• Online Proposal Writing Course
• The purpose of this online course is to help both
  newbies and veterans prepare a coherent and
  effective proposal.
• http//www.thcu.ca/ohcc-thcu-proposal-w
  riting-course/
• Ontario Health Promotion Email Bulletin
• Information exchange among Ontario practitioners.
• Announcements and events distributed weekly.
• Feature articles are distributed every second
  week.
• The bulletins go out every Friday afternoon.
• www.ohpe.ca

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Check-in reflection

• What are the most important learnings/messages
  you will take away from todays workshop?
• Reflection what activities and resources will
  you commit to learning more about planning?
• Evaluation forms

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Blog/THCUs Online Learning Community

• Where we can continue todays learning
• http//www.thcu.ca/blogs/lc/

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A big thank you to

• Ontario Ministry of Health Promotion
• Cathy Duerden
• Our workshop participants

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Disclaimer

• The Health Communication Unit and its resources
  and services are funded by the Ontario Ministry
  of Health Promotion. The opinions and conclusions
  expressed in this presentation are those of the
  author(s) and no official endorsement by the
  Ministry of Health Promotion is intended or
  should be inferred.

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Objectives vary in terms of

• Process versus outcome
• Time frame
• Open versus close ended

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Objectives vary in terms of

• Process versus outcome
• Open versus closed-ended
• Time frame

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Objectives vary in terms of

• Process versus outcome
• Open versus closed-ended
• Time frame

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Examples of closed and open objectives

• A closed objective describes how much change you
  will accomplish within what time frame.
• Triple the number of children and youth involved
  in the development, implementation and evaluation
  of student nutrition programs by the end of 2008
• An open objective does not specify the amount of
  change or timeframe.
• Increase the number of children and youth
  involved in the development, implementation and
  evaluation of student nutrition programs .

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Objectives vary in terms of

• Process versus outcome
• Open versus closed-ended
• Time frame

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Examples of short and long-term objectives

• Short-term usually means up to one year.
• Medium-term usually means over one year to five
  years.
• Long-term generally means five or more years.

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Characteristics of good objectives

• Specific
• Measurable
• Appropriate
• Realistic with resources available
• Time-bound
• (SMART)

• compatible with goal, mission/vision, other
  objectives
• credible to key stakeholder groups

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Relationship between planning types
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Theory

• Systematically organized knowledge... devised
  to analyze, predict or otherwise explain the
  nature or behaviour of a specified set of
  phenomena that could be used as the basis for
  action.
• Van Ryn and Heany (1992)
• "A strategy for handling data in research,
  providing modes of conceptualization for
  describing and planning.
• Glaser and Strauss (1967)

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Examples of Theories

• stages of change
• health belief model
• social learning theory
• diffusion of innovation
• socio-environmental theories
• community mobilization theories (e.g., Rothman's
  typology social planning, locality development
  and social action)
• advocacy and political change theories (e.g.,
  Saul Alinsky)

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Tips for Using Theory

• view as guidelines, not "absolutes
• view separate theories as complementary, not
  mutually exclusive
• NEVER apply a theory without a thorough
  understanding of your population of interest
• theories should not be used as short cuts
• base criteria for 'success' on changes in your
  community, rather than successful application of
  theory

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Differences between goals and outcome objectives
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Reliability

• Will it give consistent, accurate measurement
  over time?
• If you ask the same question at different times,
  will they respond in the same way?
• Are you using the right scale?
• Does everyone understand the question in the same
  way? Is there too much room for interpreting the
  question?
• Can emotions or other circumstances change the
  respondents answers from day to day?

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Validity

• Can you generalize the results beyond your sample
  (external validity)?
• I.e., is your sample like the rest of the
  world?
• Is it a true indicator of what you wanted to
  measure (internal validity)?
• E.g. If they say they like it it doesnt mean
  it is useful

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Are there any limitations on accessibility for
this indicator?

• Examples
• There is a limited sample from our region
• There is a fee
• Physicians are difficult to reach
• There are few people who have permission (or
  skills) to access the data

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