Health Promotion Planning

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Health Promotion Planning

• Denise Gray

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WANTED

• SPORTS STUDIES
• 4th year class rep required
• Be available to fellow students to discuss and
  take note of any
• concerns or issues they may have (relating to the
  course). As class
• rep, you will put these views across at the next
  meeting. We welcome
• any feedback you have regarding the course, both
  negative and
• positive!
• Student/Staff meeting on Wednesday 16th April
• Room 1029 from 1-2 pm

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Intended learning outcomes

• Understand the basic principles and concepts of
  health promotion planning.
• Be able to highlight the relevance and advantages
  of systematic planning in health promotion
  practice.
• Be aware of the some of the main health promotion
  planning models, Rational Planning Model, PRECEDE
  PROCEED, Logic Models.
• Apply the planning principles to a small scale
  health promotion project.

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Dahlgren and Whiteheads Layers of Influence
Model

• Dahlgren and Whitehead's model (below) highlights
  some of the main factors determining the health
  of our regional and local populations.
• Age, sex and genetic make-up undoubtedly
  influence people's health potential, but are
  fixed. Other factors in the surrounding layers of
  the model can potentially be modified to achieve
  a positive impact on population health
• Individual lifestyle factors such as smoking
  habits, diet and physical activity have the
  potential to promote or damage health
• Interactions with friends, relatives and mutual
  support within a community can sustain people's
  health
• Wider influences on health include living and
  working conditions, food supplies, access to
  essential goods and services, and the overall
  economic, cultural and environmental conditions
  prevalent in society as a whole.

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Elephant!

• Analogy for taking whole systems approach to
  tackling health issues
• There is an old Indian proverb about three blind
  people
• describing an elephant. One holds the trunk and
  says, This is
• a snake. One holds the tail and says, No, its
  a rope. The
• third grabs a leg and says, No, youre both
  wrong. Its a tree
• trunk.
• Each person has offered their perception of the
  truth, but they have failed to describe the
  elephant. Even putting all three descriptions
  together would not make a recognisable elephant!
• (Newcastle Health City Project, 1997) cited in
  Tones Green (2004)

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Why planning?

• Well planned interventions are more likely to be
  effective.
• More poorly planned health promotion programmes
  or projects than there are good examples.
• Recent UK developments has placed greater
  emphasis on the importance of systematic health
  promotion planning
• greater economic accountability
• a target driven policy context
• evidence based practice
• healthcare reforms of the early 1990s. (Tones
  and Green 2004)

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Planning and health promotion

• Three key functions of health promotion
• strategic planning
• programme management
• quality assurance.
• Speller (1998) - An ethical obligation to clearly
  describe/document
• the assumptions, values and principles on which
  decisions about
• the adoption of one set of health promotion
  interventions over
• others.
• Health promotion is characterised by diverse and
  sometimes
• competing perspectives about the causes and
  solutions to
• health problems.
• Poorly planned projects tend also to be ones
  where diverse values
• and assumptions about how programmes should
  work are not
• surfaced.

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Dealing with complexity

• Health promotion programmes work at different
  levels e.g. individual, interpersonal,
  organisational
• HP work is often implemented on the basis of
  ideology, custom or practice as well as (or in
  spite of) existing evidence.
• Health problems - complex set of factors
  require action from not only the health sector.
• Inter-sectoral collaboration and partnership
  working.

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Jargon and terminology

• Plan - outline of all the various components and
  how they relate to each other.
• Strategy - Preferred course of action in
  achieving immediate or longer-term goals.
  Selected on the basis of evidence, theory or
  experience.
• Policy Guidelines for practice which set broad
  goals and the framework for action.
• Programme Umbrella term that includes all
  activities involved in developing and running
  project.
• Intervention - the activities or collection of
  activities that will contribute directly to the
  desired change.
• Aim a broad statement of what is intended to be
  achieved. Aims can be developed at different
  levels for example, overall programme aims,
  educational aims, policy aims.
• Objective precise and detailed statements of
  the intended outcomes that will contribute to the
  overall aim.
• Method specific approaches or techniques used.

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Planning to do what?

• Practitioners very often do not start with a
  blank sheet and often have to work on issues that
  have been determined nationally.
• Current Scottish HP priorities are - alcohol,
  tobacco, diet, physical activity and health
  inequalities.
• Systematic planning identifies goals and the most
  effective means of achieving those.
• This involves making strategic decisions about
  the most appropriate courses of action.
• Operational decisions about the deployment of
  resources and making sure all the necessary
  elements are in place.

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Deciding what to do?

• Decisions about how to go about addressing the
  health
• problem of interest will depend on a range of
  factors
• Available evidence of effective interventions.
• Funding available.
• Expertise health promotion practitioner.
• The objectives
• The characteristics of the target group or
  context. Some approaches will be more acceptable
  or appropriate than others.
• Collective views about the cause of the health
  problem in the first place!
• Compromise may be necessary, but that should not
  mean that inappropriate methods are used!

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Four key questions should inform the planning
process

• Where are we now?
• Where do we want to go?
• How will we get there?
• How will we know when we have got there?

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Planning stages

• Major steps in planning, sustaining and
  evaluating a health promotion project
• Identify the issues or health problems in the
  community
• Prioritise the issues or health problems to
  identify the one that the project will address
• Identify risk factors and set the goal for the
  project
• Determine contributing factors and state
  objectives for the project
• Determine what the strategies will be
• Develop the action plan for the project. DO IT!
• Sustain the project or keep the project (or some
  parts of it) going
• Evaluate the project

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General planning stages

• Identifying needs and priorities
• Setting aims and objectives
• Identifying appropriate methods for achieving
  objectives
• Identifying resources
• Plan evaluation methods
• Setting an action plan
• Action, or implementation of the plan and the
  evaluation.

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Needs and priorities

• Four types of health social need (Bradshaw
  1972)
• Normative
• Felt
• Expressed
• Comparative
• Needs may be defined already
• national epidemiological data.
• Local community profiles and local agencies
  reports.
• May need additional investigation.

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Health needs

• Health needs can be professionally or lay defined
• Focus on positive health or disease states
• Various determinants, either environmental or
  behavioural.

Tones and Green 2004
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Health needs

• Priority is based on various factors
• Extent and severity of the problem
• Urgency of a problem
• Number of people affected
• Power and influence of those affected
• Possibility of achieving change/improvement
• Level of concern, support or commitment from
  major stakeholders
• Feasibility of taking action in the current
  context based on assessment of capacity within
  the organisation
• Consistency with the ethics and values of those
  involved

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General planning stages

• Identifying needs and priorities
• Setting aims and objectives
• Identifying appropriate methods for achieving
  objectives
• Identifying resources
• Plan evaluation methods
• Setting an action plan
• Action, or implementation of the plan and the
  evaluation.

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Aims and objectives

• Aims are the broad goals associated with
  improving health in a particular area
• reducing the amount of alcohol-related ill
  health.
• Objectives -
• S - Specific
• M - Measurable
• A Achievable
• R - Realistic
• T Time bound
• Objectives should be stated in such a way that
  they identify the changes that you wish to see by
  the end of your intervention.
• Measurable, realistic and at the same time,
  sufficiently challenging that something has been
  achieved that would not have otherwise been the
  case.

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Health Promotion Objectives

• Objectives can refer to educational, behavioural,
  policy, process or environmental outcomes.
• Educational objectives can relate to changes in
  three categories
• increased levels of knowledge
• changes in attitudes and beliefs
• the gaining of new skills
• Behavioural change objectives relate to changes
  in lifestyles and increased uptake of services

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Health Promotion Objectives

• Environmental objectives concerning changing the
  environment to make it more healthy, e.g.,
  providing health food cooperatives in local
  communities to increase the availability of fresh
  fruit and vegetables.
• Policy objectives concerning changing changes in
  policy, e.g. implementing drug free policies in
  the workplace.
• Process objectives related to increased
  participation and collaboration - e.g. within a
  community.

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Health Promotion ObjectivesThe good, the bad,
the ugly!

• Examples
• To improve the health of the people of x area.
• To address health inequalities in y area.
• To reduce smoking prevalence in z area.
• To increase the proportion of smokers living in
  area x seeking advice about smoking cessation
  with the smoking advice service by the end of
  October 2007, from 1/5th of known smokers to
  3/5ths of known smokers.

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General planning stages

• Identifying needs and priorities
• Setting aims and objectives
• Identifying appropriate methods for achieving
  objectives
• Identifying resources
• Plan evaluation methods
• Setting an action plan
• Action, or implementation of the plan and the
  evaluation.

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Different risk factorsdifferent focus
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Different risk factorsdifferent focus
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General planning stages

• Identifying needs and priorities
• Setting aims and objectives
• Identifying appropriate methods for achieving
  objectives
• Identifying resources
• Plan evaluation methods
• Setting an action plan
• Action, or implementation of the plan and the
  evaluation.

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Identifying resources

• Resources include funding, skills, expertise and
  material such as leaflets.
• Funding for larger scale projects usually
  requires the production of a budget which is a
  statement of expected costs.
• Staff costs - salary, superannuation, training
  and staff development.
• Capital costs rent, power, IT (hardware, software
  licences) rental of community halls etc., travel
  and subsistence.
• Budget control systems to monitor the amount of
  money spent.

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General planning stages

• Identifying needs and priorities
• Setting aims and objectives
• Identifying appropriate methods for achieving
  objectives
• Identifying resources
• Plan evaluation methods
• Setting an action plan
• Action, or implementation of the plan and the
  evaluation.

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Evaluation

• Evaluation must relate to the objectives that
  have been set at the outset!!
• E.g. If you have set out to increase the numbers
  of people that are using a smoking cessation
  service you would want to know
• how many people were using the service at the
  start of the project and how many were using it
  at the end.
• changes in patterns of use over time.
• More on evaluation later!

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General planning stages

• Identifying needs and priorities
• Setting aims and objectives
• Identifying appropriate methods for achieving
  objectives
• Identifying resources
• Plan evaluation methods
• Setting an action plan
• Action, or implementation of the plan and the
  evaluation.

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Detailing the plan

• Detailed plan identifies
• Tasks
• Individuals responsible for each task
• Resources
• Timescale and means of evaluation
• Interim indicators to show if you are proceeding
  as planned.

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General planning stages

• Identifying needs and priorities
• Setting aims and objectives
• Identifying appropriate methods for achieving
  objectives
• Identifying resources
• Plan evaluation methods
• Setting an action plan
• Action, or implementation of the plan and the
  evaluation.

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Implementation of the plan

• Its useful to keep a diary or log of any events
  or changes and feed this information into your
  evaluation.
• _________________________________________
• Stages of planning
• A framework can be used to plan a variety of
  interventions.
• In practice, the planning process may begin at
  different stages with experience and findings
  feeding in at different stages.

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Exercise

• You are involved in setting up a working group to
  develop a local health promotion initiative to
  encourage more older people in your community to
  become physically active in the community in
  which you live. The community is a inner city
  urban area, which has been identified as one with
  high levels of deprivation and poverty.
• Who would you want to be involved in this working
  group?
• What broad aims/goals would be appropriate?
• What would appropriate objectives be to meet the
  overall aim?

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McCarthy's model for rational health planning
Options
Identification of need
Decisions on policy
Available resources
Evaluation
Implementation
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Precede Proceed planning model
(Green and Kreuter, 1991).

• Naidoo and Wills p 361-363 for detailed
  description

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Logic models

• Helps to construct a picture of what you are
  trying achieve showing the links between intended
  inputs, activities, outputs and outcomes.
• A framework for integrating planning, delivery
  and evaluation!
• Its not reality but the best prediction of what
  needs to happen to get to your outcomes
• Part of a wider planning and performance cycle
• Scottish Executive used LMs to guide and develop
  their Keep Well programme

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LOGIC MODEL PLANNER
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Advantages of planning

• Making explicit the anticipated causal mechanisms
  underpinning any desired changes, i.e.
• how those involved think the programme they are
  planning is going to work. What assumptions do
  they have?
• Identifying all the necessary conditions for
  change.
• what needs to be in place to allow things to work
  as planned? e.g. A council group willing to
  back a harm reduction programme in a community
  that needs a needle exchange programme to
  operate.
• Making sure the various components of the
  intervention are in the right place at the right
  time.
• E.g. Having appropriately trained teachers for a
  national school based sex education programme.

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Advantages of planning

• Ensuring all the conditions are in place to
  maximise effectiveness
• that sufficiently large numbers of people in a
  community believe the problem is big enough to
  warrant action e.g.
• providing a local shelter for teenagers to
  socialise in to try to reduce the incidence of
  vandalism or anti social behaviour amongst a
  group who perceive themselves to have nothing to
  do.
• Planning can also be a way of getting various
  stakeholders together.
• Planning models can help to make the various
  values, rationale and assumptions explicit that
  are inherent in the decision making process.
• Planning can expose situations where the rational
  decision would be to pursue one course of action,
  and/or political pressures another.

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References

• Naidoo and Wills. 2000 Health Promotion
  Foundations for Practice. Balliere Tindall
  London Chapters 17 18
• Green, J. and South, J. 2006 Evaluation Open
  University Press, Maidenhead
• Tones, K. Green, J. 2004. Health Promotion
  Planning and Strategies. Sage Publications
  London Chapters 4 5
• Reach 2010 Logic Model http//www.pubmedcentral.ni
  h.gov/articlerender.fcgi?artid1500948
• Keep Well Programme
• http//www.healthscotland.com/prevention-2010-bac
  kground.aspx