Health Planning

1
Health Planning Evaluation
2

• Community assessment the first step in process of
  planning interventions to protect promote
  health of communities
• Next steps are
• Interpretation of data
• Formulate diagnoses

3

• Most community health nursing textbooks include
  approaches to data interpretation nursing
  diagnoses
• Example Table 18-5 in Allender Spradley

4

• In reality, this process is not linear
• Other models capture the process much more fully
• e.g. Healthy Communities Process
• Developed by BC Ministry of Health

5

• Community as Partner Model (Vollman, Anderson
  McFarlane, 2004)

6

• These models are not linear
• Process can be entered at any point
• Does not necessarily go in just one direction

7
Data Organization

• Can be a complex task
• Having a conceptual model to guide the process is
  extremely helpful
• Important to sort organize data as you go

8

• Initially sorted using the categories of the
  model used to guide the assessment process
• May end up moving some data or combining it with
  data from another category

9
Data Analysis

• Qualitative data entered into statistical/epidemio
  logical programs
• Quantitative data analyzed using appropriate
  methodologies

10

• Commence data analysis as soon as data is
  collected organized
• Identify gaps, inconsistencies
• Return to data collection

11

• Norwood (2003) refers to this as the Iterative
  Nature of the Problem Identification Phase

12
Community Diagnosis

• Several approaches to the writing of community
  diagnoses
• e.g.Vollman, Anderson McFarlane (2004)
• Complete community diagnosis has 4 components

13

• Statement of the problem or strength (issue)
• Identification of the aggregate/population/communi
  ty affected (focus)
• Identification of the factors that are causally
  linked to the problem or strength (etiology)
• Identification of the evidence that supports the
  diagnosis (manifestation)

14

• All 4 elements are important because they also
  form the basis for
• Program planning
• Evaluation of the intervention(s)
• Example from Vollman, Anderson McFarlane (2004)

15

• Risk of low birth weight (issue)
• among pregnant teens living in downtown area
  (focus)
• related to
• a) inadequate income (etiology)
• as manifested by (manifestations)
• Insecure housing
• Use of food bank
• Unemployment rates in this group

16

• Risk of low birth weight (issue)
• among pregnant teens living in downtown area
  (focus)
• related to
• b) tobacco use (etiology)
• as manifested by (manifestations)
• Smoking rates among pregnant teens

17

• Community diagnoses can also identify a community
  strength
• Example (Vollman, Anderson McFarlane, 2004)

18

• Optimal solid waste disposal system (issue)
• in the west end of the community (focus)
• as a result of effective management of the
  community recycling system (etiology)
• as evidenced by 98 participation in recycling
  program 25 reduction in volume of waste
  delivered to the citys landfill site
  (manifestations)

19
Determining Priorities

• No easy process to determine priorities
• Ideally, after diagnoses have been formulated,
  should be a community consultation process
• Allows community members to rank priorities
• Even then, unlikely that consensus would be
  achieved

20

• Factors that can help determine priorities
• Magnitude of concern expressed by community
• Number of people potentially/actually affected
• Severity/urgency of the problem
• Capacity of existing resources to deal with the
  problem

21

• Potential for success in solving the problem
• Need for additional education training
• Extent of additional resources needed to respond
  to the problem

22

• One commonly used approach is also categorize
  problems as
• Immediate
• Short term
• Long term
• Even these rankings might be only a rough guide

23

• Some problems which may not be all that serious
  may also be easily resolved in the short term

24
Problem Analysis

• Once priorities established, each issue or
  problem selected for intervention can be further
  analyzed
• Assists in establishment of objective
  strategies
• Example of one approach

25
(No Transcript)
26
(No Transcript)
27
Planning Interventions at the Macro-Level

• Several models can be used to guide planning for
  interventions
• Community-as-Partner Model B.C. Ministry of
  Health model include this phase
• Helpful to be more explicit about detailing how
  the over-all process will look and who will be
  involved

28

• Examples on overheads

29
Planning Interventions at the Micro-Level

• One level of planning involves establishing
• Goals (based on issue contained in community
  diagnosis)
• Target population (based on focus contained in
  community diagnosis)

30

• Objectives (based on etiology contained in
  community diagnosis
• Indicators of success (based on manifestations
  contained in community diagnosis)

31

• Another level of planning involved analysis of a
  range of strategies that might be useful in the
  intervention phase
• Many health professionals make the mistake of not
  analysing interventions as carefully as previous
  steps in the process

32

• Above all, know your detractors
• Know why they dont support you
• Might provide valuable insights into some of the
  barriers to successful implementation

33

• Two types of analysis useful
• 1. SWOT (often used in strategic planning)
• Strengths
• Weaknesses
• Opportunities
• Threats

34

• 2. Force-Field Analysis
• Identify support for a specific problem solution
• These are the driving forces
• Identify Barriers to a solution
• These are the restraining forces

35

• Identify possible consequences
• Are they driving or restraining forces?
• Dont forget the negative ones
• Maximize supports minimize restraining forces
• Weight driving restraining factors
• High, medium or low

36

• Tally weighted factors for both driving
  restraining forces
• Choose or reject the problem solution

37
Implementing the Intervention(s)
38
Evaluating the Intervention(s)

• 3 types of evaluation
• Formative (process)
• Impact (summative)
• Outcome

39

• Formative evaluation
• Assesses the program implementation as soon as it
  begins
• Enables improvements in the plan during the
  implementation phase

40

• Typical information sought
• Is the program reaching the target group
• Are the participants satisfied with the program
• Are all of the components of the program being
  implemented
• Is the quality of all components of the program
  satisfactory
• What barriers are being encountered
• Any unmet needs or issues

41

• Impact evaluation
• Assesses the immediate effects of the program on
  
• Knowledge
• Attitudes
• Skills
• Perceptions
• Beliefs
• Access to resources
• Social support

42

• Outcome evaluation
• Assesses population level impact of the program
• Measures changes in incidence prevalence of
  risk factors

43

• Community participation
• Participation of community members often
  expressed as a value held by those involved in
  community based programs
• Actual community participation can range from
  tokenism to full community control

44

• 8 steps of citizen participation
• Manipulation
• Therapy
• Informing
• Consultation
• Placation
• Partnership
• Delegated power
• Citizen control

45

• Class discussion of
• Readings
• Assignment