Lecture 1: Systematic program planning
1a: Systematic program planning: conceptual overview
- In this course we will not talk about particular contemporary social issues. Rather this course
focusses on overall principles and theories and examples of how to apply insights into intervention
development, implementation and evaluation. To a range of social issues. So the content should be
relevant to us as emerging academic professionals.
- Issues to do with the health and wellbeing of young people, the wellbeing and health of people
migrating to our part of the world. How we can make sure that our environments are healthy and
pleasant to live in. Or for instance how we can ensure that currently with measures and interventions
and policies we contribute to stopping and preventing the spread of corona.
Health and wellbeing
- In this course we also consider health and wellbeing to be
two sides of the same coin. So the idea behind the course is
that health and wellbeing, health and the social conditions
and quality of life are very closely related.
- So that means that we consider health interventions, and health policy interventions of course have
an effect on health. But also through improving health, improving the social conditions and the
quality of life of people. When people are not healthy their quality of life will be diminished, so
improve their health by health related policies, then their quality of life will improve as well.
- Similarly, if people’s social conditions and quality of life are not optimal, their health will also suffer.
People in unfortunate, disadvantaged social conditions typically also experience health
disadvantages. So we consider that any social policy or social service intervention that is more
broadly towards suggesting broader social issues like unemployment, social isolation, participation in
social activities will also have a beneficial effect for people’s health in a more specific sense. So health
and wellbeing are closely related.
Intervention and policy
- Another couple things to clarify is the terms intervention and policy. Those are common language
terms and take on different meanings depending on how people use those terms.
- Intervention= any sort of activity to intervene in a situation, to change a situation. So an
intervention in people’s health: to prevent illness; to increase participation in society; to decrease
loneliness. It can be any sort of act and activity to address those issues.
- Typically with interventions we think of programs (= a series of planned actions; something
intentional and dedicated; for instance we can develop a program to ensure that younger people in
neighborhoods are in contact with older people to reduce the loneliness of older people and perhaps
it provides some practical support); project (= a time-limited set of action; so a program may run for
a year, just to see whether or not people appreciate this, whether or not people want to participate,
whether we can continue to find the funds to run it); service (= a dedicated organization that
provides programs and projects that provide services if you will; health care organizations, general
practitioners; for example an organization that has developed a program to bring younger people in
contact with older people and that organization sees that program as a service it provides).
- So interventions are typically relatively concrete. They can also be at much higher levels. So
interventions might also include policies.
- Policies= high-level overall plans. Typically developed by governments or some government body.
For instance by the university. Executive board might come up with a policy that guides the actions of
anyone in the organization.
- So there is different ways of looking at how interventions and policies relate. And both are valid. It’s
,just to be aware that the relationship can be sort of explained in certain ways.
- So interventions can be considered specific ways to achieve policy goals. So the policies are the high
levels directions, and the interventions are the concrete actions, programs, projects and services.
- Interventions or policies can also be considered as a specific subtype of interventions. You can see
that an intervention is any type of action, and a policy might be a particular way to achieve an overall
goal. So you might want to promote the health and wellbeing of elderly people. And the policy might
be that all sorts of home care organizations need to put in place some sort of program for older
people with younger people.
- Both ways of relating policies and interventions to each other are valid. It’s just to be clear how you
see the relationship whenever you talk about it.
In detail: sexual health
- Let’s look a bit more in detail why one would need something like systematic program planning.
- This is an example of a contemporary and social issue that is at the intersection of youth studies and
public health. The sexual health of young people in the world and in the Netherlands in particular. So
sexual health is particular concerned for young people who are generally otherwise very healthy. And
you can see surveillance date from the national institution of health and the environment in the
Netherlands. And you see an infographic that plots the number of STI consultations in the past years.
Most recent date 2019. What we can see is that in 2019 150.000 people consulted public sexual
health services. We don’t have date for the number of GP consultations. But it won’t be that much
lower than 2018. We can estimate that about half a million people were consulted in relation to STI’s
in one year alone. That illustrates the extent of sexual health as an issue for people. Young people
<25 yo are particularly affected by STI’s and they have the largest share of chlamydia infections. And
chlamydia is by far the most transmitted infection. Estimates are that there’s at least well over
60.000 diagnoses a year, which may be an underestimate. In particular young people <25yo are
infected. They count for more than half of the infections. And it is the highest among <20yo’s, and
then gradually the infection rate declines. Other groups with increased risks include: men who have
sex with men, less related to age. Sexual health is an important area of public health.
How to decide on a response?
- How does one decide on how to promote a particular health issue. How to address particular health
as a social issue. Well, in short, there are 3 answers to that.
- 1) The first way on deciding on a response is based on the expertise & experience of professionals.
So in health and social policy, there is extensive training. Many professionals with lots of experience
on a daily basis make decisions on how they go about. And they use their expertise and their
experience. This can be a way of going about but we also know that building approaches drawing on
only ones expertise and experience in developing approaches to address health and social issues is
less effective than also using theory and evidence. So one step up from only using ones own
experience and expertise is to go with:
- 2) Best practice approaches: shared information, shared knowledge within and amongst
professionals as to what might work. Which might be based on theory and shared experiences across
for instance a sector. Another way and considered one further step up is:
- 3) Evidence-based approach: likely the best to of approaching intervention and program
development is to draw on this. Approaches that have been evaluated in robust research and we
know that interventions work.
- Different ways of going about. And there is an important role to play for each of these different
sources of guidance on intervention responses.
- Evidence-based practice= move towards this, it underlines the importance of drawing on 1clinical
experience (there will not always be practice or evidence based experience available), but also
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patient’s experience/preference (patients have a good understanding, or clients have a good
understanding of the issues they face and also have a good understanding of what types of
approaches might be acceptable and usable for them and which ones might not); and 3research
evidence. Combine these three for optimal intervention design approach.
- Issues to also take into account when deciding on which intervention to develop is sometimes you
can come up with very good or even ideal approaches to address an issue, but there may be 1local
resources or constraints (for example: contact tracing is a critically important aspect of containing
corona, but some public health services face resource constraints in terms of finances but also
human resources, and they cannot deliver up to the level that they would want); 2political and social
concerns (an important issue on deciding on a response; for instance early in the corona pandemic
people were very concerned about schools, so the decision was made to close schools for a particular
period of time, even though there may have been evidence that young people might play no role in
the pandemic, but social concerns played an important role; also with corona virus testing and
contact tracing, political concerns are very important, because the government want to fight corona
as much as they can, and contain in control the epidemic as much as they can); 3collaborative
planning process (over the past decades there has been an increasing recognition of the importance
of including various stakeholders into intervention and policy design).
Importance of planning
- ‘Good health promotion programs are not created by chance; they are the product of coordinated
effort and are usually based on a systematic planning model or approach’ (McKenzie et al, 2017;
p41).
- The interventions/policies that work are the ones that has been thought trough well. And putting
thought into things, bringing people on board to systematical development, requires some form of
planning process. So the importance of planning has to do with the fact that it may increase the
efficacy of interventions and policies.
The Power of Planning
- There are different reasons why planning might be important for the success of interventions and
policies that we develop. David Hunnicutt has summarized a couple of reasons why planning may be
related to effectiveness, why it might be important: 1planning forces you to think through the details
in advance (when you think through the details in advance, the more likely you are to come up with
an approach that will work); 2planning makes your program transparent (once you have a good idea
and can share that idea with others, there is a possibility to critically reflect on the approach that
you’re developing and to change it when necessary); 3planning is empowering (it provides people
involved in the planning process with the skills and the confidence that they might need to actually
develop and deliver the intervention or policy that they are developing); 4planning creates alignment
(it’s important to involve many different stakeholders in the planning process, and through that
involvement some form of alignment between those stakeholders is achieved, or some sort of
consensus or agreement has to be achieved in order to develop an intervention or policy).
Planning approaches
- We’ll focus on five approaches in this lecture: 1Logic model; 2Theory of Change; 3PRECEDE-PROCEED
model; 4Intervention Mapping Protocol; 5McKenzie’s Generalized Model.
Logic model/log frame/logic frame
- The logic model, here depicted in the form of a table. In the
guest lecture you will see a logic model in a flow gram/diagram.
The idea behind the matrix and the flow chart is pretty similar.
- Logic model: considered the first attempt to clarify the link between programs and outcomes. And
, the idea is that it really sort of focusses on the program referred to as activities. As well as the inputs,
for instance the human resources required to actually deliver those activities. And how those
program activities might be linked to outcomes. Making a distinction between intermediate
outcomes (for instance people’s health behavior, like young people not taking up smoking) and the
ultimate impacts (for instance seeing a reduction in long cancer and heart diseases in society).
- The logic frame also requires one to think about factors/conditions that might be necessary for
activities. To link to, to actually result in outcomes. For instance activities might be smoke prevention
programs in school for young people. And the critical enabler would be that schools should be willing
to actually provide those programs, which is not necessary an obvious given. All these various tasks
that schools have to engage with. Including the regular curriculum but also other health promotion
activities.
- So that’s the idea of logic program. I need skills and resources to develop for instance this smoking
prevention program. I need the collaboration with schools. And if we deliver a program, than
hopefully we will reduce the number of young people starting to smoke. And then we will see a
reduction in heart diseases and lung cancer related to smoking in the population.
- It’s very much a descriptive, visual representation. It’s a list of components and what is needed to
achieve.
Theory of Change
- Related to the logic model, but more recent. Going back to the 1990’s.
- Theory of Change: a logic model+, it’s more explanatory
rather than just listing the program components and the
outcomes. It actually explains the pathways of change. So
how do we want to achieve outcomes.
- Thinking about the lung disease/hearth cancer example:
prevent young people from starting smoking but there may
be different ways to achieve that. So there are various
decisions that one can make as to the approach. Assuming that preventing smoking in young people
is a worthwhile target, we can then start thinking about how we want to achieve that.
- The terms ‘logic model’ and ‘theory of change’ are used interchangibly. In the Intervention Mapping
Approach, the logic models have a clear favour of theory of change. They also use the flowchart. How
are outcomes achieved through intermediate outcomes and thow these are achieved through
interventions and progam activities. - High-level depiction of complex processes of change.
Explanatory: pathway of change, critical thinking.
PRECEDE-PROCEED model
- PRECEDE: Predisposing, Reinforcing and Enabling Constructs in Educational Diagnosis and
Evaluation.
PROCEED: Policy, Regulatory, and Organizational Constructs in Educational and Environmental
Development.
- Overarching specification of a
systematic approach to health
promotion and social policy
intervention and program
development.
- Top of the graph; process
related to development of
interventions in the bottom you
