19 Oct In this project, you will conduct your own research and then create and evaluate a health promotion program that targets one of the following issues: tobacco use cessation, type 2
Listed are the assignment instructions. All information must original and timely. The date is 21 Oct.
In this project, you will conduct your own research and then create and evaluate a health promotion program that targets one of the following issues:
- tobacco use cessation,
- type 2 diabetes,
- mental health disorders,
- increased physical activity (either childhood, adult, or elderly), or
- early childhood nutrition.
After reviewing the resources in Unit VII Study Guide and conducting your own research, create and evaluate a health promotion program to address your chosen issue.
Your project must accomplish the following objectives:
- Provide detailed information on how you will use MATCH (Multilevel Approach To Community Health): a five-step planning model (selection of health and behavioral goals, intervention planning, program development, program implementation, and evaluation) introduced on page 173 of your eTextbook to create a community health intervention program.
- Provide detailed information on how you will use each of the five major steps of programming (program planning) to create a community health intervention program.
- Propose a minimum of three specific and realistic objectives for your health promotion program.
- Demonstrate critical thinking by providing detailed information on how you will use each of the six steps of evaluation to evaluate your program.
- Discuss the performance improvement approaches that are most relevant to your program.
Your project must be at least four pages in length, not counting the title or reference pages. You are required to use at least four sources, one of which may be your eTextbook, to support your project. All sources used must have citations and references in APA Style. APA formatting is otherwise not required.
HCA 3306, Community Health 1
Course Learning Outcomes for Unit VII Upon completion of this unit, students should be able to:
2. Recognize effective principles of health programming for community health on a global scale. 2.1 Indicate the steps involved in organizing a community health program. 2.2 Define the steps needed for effective evaluation of community health programs.
7. Assess methods for improving health care delivery in the United States.
7.1 Describe health care performance improvement approaches and methods Required Unit Resources Chapter 15: Systems Thinking and Leadership in Community and Public Health Unit Lesson
Centers for Disease Control and Prevention Framework for Program Evaluation In community health, much of our time and effort is invested in designing and implementing programs for community health interventions. The goal of these programs is to address pressing health issues in the community and to improve individual health and public health as a result. As community health leaders, we have a responsibility to continuously and proactively seek better health for our clients and for the community overall. But how do we know if our programs are really working? How do we know if we are achieving our desired goals and truly enhancing the health of the communities we serve? Well, that question brings up the topic of a framework for program evaluation, and the question takes us to the United States Centers for Disease Control and Prevention (CDC) in Atlanta. The CDC is truly the world’s leader in program evaluation thinking and applications. Public health organizations all over the world utilize the CDC model for evaluating its programs. It can accurately be said that Americans have shown leadership and innovation in public health evaluation. In this lesson, we will explain what program evaluation is, why it is so important, and the steps necessary for planning and conducting evaluations. We will also discuss the standards that currently exist for evaluating health care programs of all kinds. A key aspect of this lesson is the concept of stakeholders and ways to engage them in planning and program evaluation. Let’s start with a big picture view of evaluation. We spend a lot of time, effort, and money creating programs to improve the health of our communities. But is that time, effort, and money truly making a positive difference? Evaluation sets out to answer that very important question.
Evaluation There are several ways to think about evaluation of health programs. Evaluation is systematically evaluating the merit of a health program and its worth in terms of improving community health, including assessment of program operations and outcomes using a pre-established set of criteria for assessing the program. Evaluation includes determining the value of a program or activity and what it adds to community health. This is the value-added piece. Evaluation is related to research, but it is not the same thing as research. Let’s take a minute here to understand the difference. Research focuses on producing generalizable knowledge that can be used to
UNIT VII STUDY GUIDE Leadership in Public Health
HCA 3306, Community Health 2
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apply our knowledge from a sample to a larger population. It starts with research-derived questions and a paradigm stance of what we commonly term a hypothesis. Research is done in a very controlled setting, and the intention is to publish results for the professional community. Meanwhile evaluation produces knowledge that is intended for immediate use in the program. It starts with program-generated or funder-generated questions, and it takes place in an action setting that is much less controlled than the research setting. Evaluation is typically not published, but particularly interesting program evaluations are sometimes shared in the professional literature. Research sets out to prove something; whereas, evaluation sets out to improve something. That is a great and simple way to look at the difference. Evaluation is all about making a positive difference in the program under consideration. In that sense, it is similar to accreditation visits for health care facilities and academic programs. Many readers will have experienced accreditation visits to their own medical facilities and will have some understanding of this connection. Surveillance and monitoring are aspects of evaluation. Surveillance looks at disease or risk behaviors over time, while monitoring looks at changes in program outcomes over time. But evaluation does not just look at these behaviors and outcomes, it asks why these changes are taking place.
What Type of Programs Can Be Evaluated? Just about any type of program can be evaluated:
• direct health interventions, • community mobilization programs and services, • surveillance systems, • monitoring systems, • health policy initiatives, • disease outbreak investigations, • clinical laboratory testing, • communication and education campaigns, • programs to create infrastructure, • community health education programs, • community-wide or focused screening programs, and • administrative effectiveness.
These are just a few examples. Truly any community health program needs evaluation and should be evaluated.
When Should We Evaluate? Evaluation has a role at all phases in the program planning and delivery process, from conception to completion of the program. We can assess a developing program to see if it is headed in the right direction. We can assess a stable, mature health program to see how well it is meeting its objectives and community needs, and we can evaluate a program after it has ended. Some health programs are not ongoing and exist for a definite specified time period (3–5 years being common), and then they are terminated. Evaluation can help us to decide if time-limited health programs actually worked and whether they should be repeated or not.
Why Do We Evaluate Programs? Evaluation helps us to gain insight into our programs and their operations, and it looks at their direction and their effectiveness. It helps us to understand what works and what does not work. We can improve practices for better health impact through evaluation. Evaluation is all about modifying current practices so that they work better and achieve more. Evaluation measures progress toward stated objectives and goals. Sometimes, evaluation helps us document for our funders that their money is well spent, and that can lead to expansion and increased funding. It can help us to demonstrate accountability.
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UNIT x STUDY GUIDE Title
CDC Steps in Community Health Program Evaluation The CDC has developed a six-step process for program evaluation, which has become the clear standard for evaluating health care programs of all kinds:
• engage stakeholders, • describe the program, • focus the evaluation design, • gather credible evidence, • justify conclusion, and • ensure use and share lessons learned (CDC, n.d.).
This approach emerged over time because evaluation is only valuable if the findings are actually used to make a positive difference. Early involvement of stakeholders is crucial here because there must be a market for the product of the evaluation. Stakeholders help us to ask the most important and most relevant questions so that the results of the evaluation will actually be meaningful and utilized. There is nothing worse than conducting an extensive evaluation process and seeing the resulting document go onto a shelf where it is never utilized. The CDC has tried very hard over the years to not let that happen. A real key is finding out who cares about the success of the program, the stakeholders, and very importantly, we let those stakeholders help us to define the success of the program. Stakeholders are crucial here. Do they think about the program in the same way that we do as evaluators? Often, evaluators learn from the stakeholders that certain things are more important.
Four Standards for Effective Evaluation So what standards will evaluators utilize as they move through the CDC model? Four standards have consistently been most helpful, and they should be considered in every evaluation (CDC, n.d.).
• Utility refers to who actually needs the information from the evaluation and what they will do with it. Clearly, the evaluation should be conducted in a way that meets stakeholder and funder needs and generates information that is helpful. A key question under utility is whether or not the evaluation provides relevant and useful information in a timely manner.
• Feasibility refers to how much money and time can we realistically put into the evaluation process. There may be a lot of things that we would like to include in the evaluation, but there are real-world time and budget constraints. We need to pick the things that are most important and can realistically be evaluated. A key question under feasibility is whether or not the planned evaluation steps are realistic given the time resources and expertise of the evaluators at hand.
• Propriety refers to how we need to take steps to conduct the evaluation ethically and in upmost respect for the privacy of medical information that will be included in the evaluation. The Health Insurance Portability and Accountability Act provides important guidance here, and we must carefully follow its guidelines. A key question is whether or not the evaluation protects the rights of individuals and protects the welfare of clients.
• Accuracy refers to how we need to design our evaluation in such a way that the information obtained is accurate and reliable for decision-making. A key question is whether or not the evaluation provides findings that are valid, given the needs of those who will utilize the results.
Hopefully, this lesson has provided some insights into the process of evaluating community health programs. The process is important. It has been fine-tuned over the years under CDC leadership as evaluators have learned more and more about what works well and what does not. The completed evaluation is shared with all stakeholders, and, if appropriate, it is shared with local media. Much is riding on the results of the evaluation process. The continuation of the program definitely depends upon evaluation results. Continued funding is often at risk, and opportunities to replicate the program in other communities often hinge upon evaluation results for a particular program. So a good bit of time and thought goes into the design of the evaluation.
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Also, the evaluators must be objective in their assessments, which is so important. The best evaluations are done by community health experts from outside the community and by people who have no vested interest in the program. Objectivity is best in that scenario.
Reference Centers for Disease Control and Prevention. (n.d.). A framework for program evaluation. U.S. Department of
Health and Human Services. https://www.cdc.gov/eval/framework/index.htm Suggested Unit Resources In order to access the following resource, click the link below. The following web page will help you understand the Racial and Ethnic Approaches to Community Health (REACH) program. The article will cover the impact of the program across REACH communities. Centers for Disease Control and Prevention. (2020). REACH program impact. U.S. Department of Health and
Human Services. https://www.cdc.gov/nccdphp/dnpao/state-local- programs/reach/program_impact/index.htm
- Course Learning Outcomes for Unit VII
- Required Unit Resources
- Unit Lesson
- Centers for Disease Control and Prevention Framework for Program Evaluation
- What Type of Programs Can Be Evaluated?
- When Should We Evaluate?
- Why Do We Evaluate Programs?
- CDC Steps in Community Health Program Evaluation
- Four Standards for Effective Evaluation
- Suggested Unit Resources
MATCH (Multilevel Approach To Community Health)pg 173
A five‐step planning model (selection of health and behavioral goals, intervention planning, program development, program implementation, and evaluation) that facilitates program planning and also helps planners to integrate behavioral theories into interventions.
Two important concepts underlying MATCH are that it incorporates the ecological model and that it explicitly integrates theory with planning.
MATCH is a planning model that, like the other models discussed in this chapter, facilitates program planning. In addition, it helps planners to integrate behavioral theories into interventions, as discussed in Chapter 8. The MATCH model incorporates findings from needs assessments, literature reviews, theory, and logic into successful programs. Two important concepts underlying MATCH are that it incorporates an ecological model (discussed in Chapter 6) and that it explicitly integrates theory with planning. Thus, the model includes all the levels of the ecological model; that is, the intrapersonal, interpersonal, organizational, community, physical environment, and public policy factors that affect health. And all these levels are considered when designing a health promotion intervention.
The selection of an appropriate theory for intervention development is also critical, as theory holds three important functions in the MATCH model. First, theory helps program planners to conceptualize a problem. Said another way, theory helps a program planner to understand why a behavior is either occurring or not occurring. For example, consider how a planner might use the health belief model in addressing the problem of low adherence to taking prescribed medications among older community members recently diagnosed with heart disease. According to the health belief model, patients are less likely to take their medications when they do not perceive forgetting their medication as harmful (perceived severity), they do not perceive themselves to be at risk for having another heart attack (perceived susceptibility), they see no benefit in taking the medications (perceived benefits), they cannot afford to take their medications every day (perceived barriers), their doctor did not fully discuss the importance of taking the medication (cues to action), and/or they lack confidence in their ability to remember to take their medication every day (self‐efficacy). (Readers who have questions about the terminology in this description are encouraged to look ahead to the full description of the health belief model in Chapter 8.)
The second function theory has in the MATCH planning model is to help program planners identify variables of interest. This function goes hand in hand with the first function; now, however, program planners must decide which theory variables they will target for intervention. Continuing the previous example of using the health belief model, a program planner may decide to target cues to action, perceived barriers, and perceived benefits in an outpatient health promotion program delivered by nurses and health educators.
The final function of theory in the MATCH model is to assist program planners in identifying intervention strategies and methods. A number of educational, policy, and environmental methods, such as goal setting, modeling, positive reinforcement, and step‐by‐step instruction, can be operationalized into strategies that target specific theory variables. For specific strategy suggestions, readers are encouraged to seek further information regarding the theory chosen for an intervention in the work of Simons‐Morton, McLeroy, and Wendel (2012).
The MATCH model consists of five steps, each with substeps, as outlined in Table 7.3. These steps and substeps are meant to give program planners a sort of formula or recipe for program implementation, an approach that makes the MATCH model unique among the other planning models (see Figure 7.2).
Table 7.3 Essential Steps and Substeps of the MATCH Model
Step 1: Selection of health and behavioral goals
Step 1.1: Select at‐risk target population
Step 1.2: Select health status goals
Step 1.3: Identify health behavior goals
Step 1.4: Identify environmental goals
Step 2: Intervention planning
Step 2.1: Select intervention objectives
Step 2.2: Identify targets for the intervention
Step 2.3: Select the intervention channel approach, theory, strategy, and methods
Step 3: Program development
Step 3.1: Create program components
Step 3.2: Develop intervention
Step 3.3: Develop protocol, curriculum, manual, or guide
Step 4: Program implementation
Step 4.1: Facilitate adoption, implementation, and maintenance
Step 4.2: Implementation and maintenance
Step 4.3: Dissemination and translation
Step 5: Evaluation
Step 5.1: Conduct process evaluation
Step 5.2: Measure evaluation
Step 5.3: Monitor outcomes
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