Extensive summary of book chapters (Planning, Implementing, & Evaluating Health Promotion Programs, Mckenzie) and articles for exam 1 of the course: Interventions and Policies 1. The summary contains the following book chapters: H2, 3, 4, 6 and 7. And the following articles:
- Michie, van Stralen...
Week 1 (14)
H2: Starting the planning process (3)
Planning a health promotion program is a multistep process that begins after doing pre-planning. By
different settings/context it could be that planning not always begins the same way. Decision makers
often want “proof” (evidence) that a program is needed and will be successful. Therefore, the
planning process often begins with the planners creating a rationale to gain the support of key
people in order to obtain the necessary resources to ensure that the planning process and the
eventual implementation proceed as smoothly as possible.
The Need for Creating a Rationale to Gain the Support of Decision Makers
Most important thing of a health promotion program is SUPPORT from the highest level
(administration, board of health/directors) of the “community” for which the program is being
planned, no matter the setting of the program! These people often make the decisions to provide
resource support.
Resources: usually money, can be turned into staff, materials, supplies, facilities etc.
Support: for example, policies or involvement of key managers
Sometimes the idea for a program comes from the top-level people itself, but this doesn’t occur
frequently. In most cases, the idea has to be “sold” to the decision makers. To sell the idea to gain
support, program planners should develop a rationale for the program’s existence. Few people are
motivated by health concerns alone, so you must sell your idea. Decisions by top-level management
are based on variety of factors (finances, public image, politics). You have to develop a rationale that
shows how the new program will help to meet the organization’s goals and to carry out its mission.
Steps in Creating a Program Rationale
Figure 2.1 (inverted triangle) shows an example of a logical format to help planners create a good
rationale. This inverted triangle reflects the flow of a program rationale beginning at the top by
identifying a health problem in global terms and moving toward a more focused solution at the
bottom of the triangle. There are 4 steps to create a rationale from a program:
1) Identify appropriate background information
Find information/data that can be used to sell program development literature research (articles,
books, publications). In this way, you explore the problem, for who it is important (priority
population) etc. The types of information/data that are useful in writing a rational include those that;
Express the needs and wants of the priority population (cannot assess this with literature review)
This can be generated through a need assessment: process of identifying, analyzing and
prioritizing the needs of a priority population. Usually this process begins until decision
makers give permission for the planning to begin.
Describe the status of the health problem(s) within a given population
Analyzing epidemiological data. Epidemiology: the study of the occurrence and distribution
of health-related events, states and processes in specific populations. Epidemiologic data
gain additional significance when health problems are the result of modifiable health
behaviors and that spending money makes good economic sense (f.e. reduce smoking
through hospital costs). Economic component in a rationale is often based on cost-benefit
analysis (CBA). A common way of reporting CBA is through: return on investment (ROI) =
investment (costs of program) vs. financial return realized by program ((benefits investment
– investment) / investment). However, proving the economic impact of a program isn’t easy.
Show how the potential outcomes of the proposed program align with what the decision makers
feel is important (their goals)
Review the organization’s mission statement, annual report, survey decision makers, and/or
their budget for health items.
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, Show compatibility with the health plan of a state or the nation
Provide evidence that the proposed program will make a difference (by evidence of data)
Evidence: the body of data that can be used to make decision when planning a program.
Evidence-based practice is when program planners systematically find and use evidence as
the basis for decision making when planning a health promotion program. Objective evidence
includes systematic reviews and subjective evidence involves personal experiences.
Show how the proposed program will protect and preserve the single biggest asset of most
organizations and communities: the people
Protecting the health of employees (human resources), because fit and healthy people are
more productive, are better able to deal with stress and are absent less etc.
2) Title the rationale
Giving a title to the rationale. This can be quite simple: ‘A rationale for (program title): A program to
Enhance the Health of (name of priority population). Immediately following the title should be a
listing of who contributed to the authorship of the rationale.
3) Writing the content of the rationale
First/two paragraph(s) of the rationale should identify the health problem from a global perspective:
using information/data at most macro level available ([inter]national, regional, local). If available, it’s
good to include the economic costs of such a problem. Presenting the problem at these higher levels
show decision makers that dealing with the health problem is consistent with the concerns of others.
Next step is identifying the health problem that is the focus of the rationale = problem statement.
Begins with a concise explanation of the issue that needs to be addressed. Includes why it should be
dealt with and (if available) supporting data for the problem (needs assessment/related literature).
By presenting the problem statement you can use the technique of social math: practice of
translating statistics and other data so they become interesting to the journalist, and meaningful to
the audience (make it dramatic).
The next step is proposing a solution to the problem, which includes the name and purposed of the
proposed health promotion program, and a general overview of what the program may include
(“best guess, because often there is no permission yet). Align the potential values and benefits of the
program with what is important to the decision makers.
Finally, state why this program will be successful by using the results of evidence-based practice to
support the rationale. It is also helpful to point out the similarity of the priority population to others
with which similar programs have been successful. Moreover, using the argument that the “timing is
right” for the program can be useful (so that there is no better time than now to solve the problem).
4) Listing the references used to create the rationale
A reference list shows decision makers that you studied available information before presenting your idea.
Planning Committee
The amount of people involved in the planning process is determined by the resources and
circumstances of a particular situation. A very helpful method to develop a clearer and more
comprehensive planning approach is to establish a committee. First you have to identify who is
willing to be a member of the planning committee (advisory board/planning team). This committee
often consists of interested and well-respected individuals.
Partnering: the association of two more entities (individuals, groups, organizations) working together
on a project of common interest. Advantages of partnering are: sharing the costs, bring more
stakeholder to the “table”, working with others that have the same value, more capacities, different
perspectives. A partner must be interested in meeting the needs of the priority population (1), must
see the unmet need of a priority population as a problem (2), must have unused resources that could
help solve a problem (3) and could benefit from being your partner (4).
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, There is no ideal size for a planning committee. The following guidelines should be helpful in setting
up a committee:
1) The committee should have representation from all segments of the priority population.
2) If the program deals with a specific health risk/problem it is important that someone with that
risk/problem is being included on the committee
3) The committee should include willing individuals who are interested in seeing the program
succeed (doers and influencers).
4) The committee should include an individual who has a key role within the organization sponsoring the
program
5) The committee should include representatives of other stakeholders not represented in the priority
population
6) The committee membership should be re-evaluated regularly
7) New individuals should be added periodically to generate new ideas
8) Be aware of the “politics” that are always present in an organization/ priority population. There
are always some who bring their own agendas to committee work
9) Committee must be large enough to accomplish the work, but small enough to be able to make
decisions and reach consensus. Subcommittees can handle specific tasks if needed.
10) Sometimes multiple layers of planning committees are needed. If the priority population is highly
dispersed geographically, these various subgroups ay need their ow local planning committee
There are 5 different techniques used to choose committee members:
1) Asking for volunteers by word of mouth, newsletter, needs assessment
2) Holding an election, throughout the community or by subdivisions of the community
3) Inviting/recruiting people to serve
4) Having members formally appointed by a governing group or individual
5) Having an application process then selecting those with most desirable characteristics
Thereafter, a leader has to be chosen. It is not always good to choose a planner/specialist. It is
preferable to have someone other as a leader, because it helps to spread out the workload of the
committee and it allows the planners to remain objective about the program.
The planning committee needs to be well organized and well run to be effective. The committee
should meet regularly, have a formal agenda. Makeup of a solid planning committee is:
Representatives of all segments of priority population + Doers + Influencers + Representative of
sponsoring agency + Other stakeholder + Good leadership
Parameters for Planning
Planning parameters within which they will work must be identified after support of the decision
makers and forming of the planning committee. After planning parameters have been defined, the
committee should understand how the decision makers view the program, and should know what
type and number of resources and amount of support to expect. Identifying the parameters early will
save the planning committee a great deal of effort and energy throughout the planning process.
Committee members should answer different questions so that they will not involve too deeply in
the planning process. Questions are for example:
(1) What is the decision makers’ philosophical perspective on health promotion programs (values/ benefits)?
(2) What type of commitment are decision makers willing to make to the program
(institutionalization of the program or pilot program)?
(3) What type of financial support are decision makers willing to provide?
(4) Are decision makers willing to change the organizational culture so that there is a culture of
health?
(5) Will all individuals in 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 committee be (permanent/temporary)?
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