Study Group - Implementation Flashcards
What is involved in implementation of health programs?
- Coordinating logistics to train volunteers & staff
- Monitoring progress
- Delivering program
- Evaluating effectiveness & sustainability of program
What should HES do first when preparing to implement health program? Why?
Project or Work Plan b/c a well developed work plan ensures fidelity of implementation
What is a project or work plan?
- Detailed road map for how program goals will be achieved
- Should be aligned with logic model or strategic plan for program
- Used to identify needed services so HES can acquire them
What needs to be included in a strong work plan?
- Goals
- Objectives
- Activities
- Timelines
- Evaluation measures
- Roles & responsibilities involved in implementing specific aspects of plan
- Intervention mapping
Steps of intervention mapping
- Assessment of problem
- Prioritizing determinants of IM
- Program Design
- Program construction
- Program implementation
- Program evaluation
What is a part of IM ‘assessment of problem’?
- Logic model
- Ecological model domains
What is included in IM ‘prioritizing determinants of IM’?
Ranking priorities based on changeability & level of impact
What is included in IM ‘program design’?
- Use theory to assist in method selection & strategies
- Ensure theories compliment one another & are accurately interpreted/applied
What is included in IM ‘program construction’? How can HES ensure to have high fidelity?
- Program development
- Detailed methods & strategies = high fidelity
What is part of IM ‘program implementation’?
Training of staff
What needs to be considered and used in IM ‘program evaluation’?
- Use logic model as guide
- Test for rigor
What are the types of resources needed for implementation of work plan?
- Personnel
- Curriculum & Instructional
- Space
- Equipment
- Financial
What is an MOU/MOA?
Document that captures and outlines agreement and principles of that agreement between 2 parties
MOU
Memorandum of Understanding
MOA
Memorandum of Agreement
What obligations/requirements must HES follow when implementing health programs?
- Guidelines & legal standards for their organization & organization providing funding
- State & local laws, rules, regulations
- Funding announcements or solicitations
- Award notices
- Guidance documents
- Any restrictions of how funds can be used
Paperwork Reduction Act (1995)
Helps reduce paperwork burden & maximize information collection
Rehabilitation Act (section 508)
Federal agencies must make websites, electronic material, & other information technology accessible to people with disabilities
Plain Writing Act (2010)
Federal agencies must use “clear communication that public can understand & use”
What is fidelity?
Degree of correspondence between program as intended & program is actually implemented in designated order
What should not happen when adapting programs?
Substantial modification or elimination of core program elements
What should training staff & volunteers consist of/include?
- Program objectives
- Intended outcomes
- Logic model
- Core elements (program content & steps)
- Instruction of their role
- Offer guidance & opportunities to practice their roles
What should be used when training program staff & volunteers?
Training manual (AKA Program procedural manual)
What is a training manual used for?
Used to communicate step-by-step plans for program
What is included in a training manual/program procedural manual?
Provides background info, ideas for facilitation, & parameters of program (supports program fidelity & implementation)
What needs to be considered when providing training?
- Best way to provide instruction based on intended audience
- Funds & expertise levels of those providing training
- Cost, content, & required instructional expertise
- methods to use during training
What are some methods that can be used when providing training?
- On the job training
- One-on-one training
- In person group work
- Distance learning techniques
What does an action plan for program implementation identify/help HES with?
- Used to describe how goals & objectives will be achieved
- Identifies needed resources
- How responsibilities will be assigned
Who should be involved in developing action plan for program implementation?
Members of intended audience (both those who can hinder & help implementation of program)
How does intervention mapping focus on dissemination?
Developing implementation plan to achieve supporting adoption, implementation, & maintenance of programs
What are the GENERAL phases of program implementation?
- Adopt program
- Identify & prioritize tasks to complete
- Establish management system
- Put plans into action
- End or sustain program/intervention
What are the components of EFFECTIVE public health programs?
- Use innovation to develop evidence base
- Use limited number of high priority, evidence-based interventions
- Use effective program management
- Use partnerships & coalitions
- Communicate accurate & timely information
- Obtain resources & support
Program implementation challenges
- Lack of funding to implement program as designed (fidelity)
- Common settings have primary missions other than prevention
- Implementing new programs requires training staff & administration in effective delivery
- Kinds of data systems needed to target & monitor prevention programs does not currently exist
- Participation in & completion of prevention programs is usually voluntary
- Some organizations have more capacity to handle implementation than others
What needs to be done PRIOR to implementation of health program?
- Gain program/intervention buy-in from priority population
- Identify individuals/organizations responsible for intervention delivery
- Use implementation plan or project management plan to develop detailed list and relationships of all program activities, components, & tasks
- Pilot testing & phase in
- Mass communication to share info & support program objectives & implementation
- Consider how to end or sustain program
How can HES create environment conducive to learning?
- Get management or stakeholder support
- Identify resources to support implementation
- Obtain buy-in from implementation staff
- Meet learner’s needs
- Target audience
- Healthy & positive physical environment (trust & respect, physical aspects in classroom)
How does HES determine baseline data?
Review available quantitative & qualitative data from secondary data (national, state, & local resources)
Why is determining baseline data important?
- Provides beginning measure for evaluating changes in behavior, practices, & skills associated with program goals
- Helps in assessment of knowledge, beliefs, attitudes, values of intended audience
- Helps in assessing capabilities & skills related to outcomes
How is marketing plan used by HES?
Identifies audience(s), message(s), & intended communication methods
What should health program marking plan be aligned with?
Program goals & objectives
Targeted messages
Segmenting/dividing audience into smaller SUBGROUPS with similar characteristics
Tailored Messages
- Specific SUBPOPULATION focusing on their needs & personal (primary) data
- culturally appropriate, relevant, & applicable
How can HES reach larger audience via tailored messages?
Computer tailoring
What are the 4 principles of Marketing? What are they in program planning/implementation?
- Product - target of intervention
- Place - location of program
- Price - monetary & other costs associated with program
- Promotion - sum of all avenues used to communicate messages about the program
Potential program implementation issues
- Staffing & training
- Intervention content
- Program delivery
- Intervention participants
What does “Behavior is multifaceted” mean?
Multiple strategies are often needed to change behavior
How can HES develop health programs that will be potentially successful in motivating priority population to change their behavior?
Consider strategies at various levels of ecological model
RE-AIM
Reach Effectiveness Adoption Implementation Maintenance
What is RE-AIM used for?
Help with intervention delivery
IM ADAPT meaning? How is it helpful for HES?
Intervention Mapping to Adapt
- helpful in adapting evidence-based interventions
What are IM ADAPT steps?
- Needs Assessment
- Set objectives
- Select methods
- Design program
- Plan implementation
- Create evaluation plan
What are the different types of media for HES to consider?
- Paid media
- Earned media
- Social media
- Digital media
Gantt Chart
Visual representation of all tasks needed to be completed before, during, & after program
What does Gantt Chart allow HES to do?
Plan tasks needed to successfully deliver program & monitor progress of all tasks
Program Evaluation & Review Technique (PERT)
Visually shows relationships between tasks and allows HES to track progress
Critical Path Method (CPM)
- Graphically shows timelines & relationships to tasks
- Ability to show components that are most important in adhering to timeline
Fishbone Diagram
Represent sequential events & major factors that produce given outcome
- AKA Cause & effect diagrams *
Control Charts
Shows average & whether variable is within acceptable parameters
Histograms
Simple bar graph showing frequency of value for one variable
Scatter Diagrams
Bar graph to identify major source of problem
Flowcharts
Sequence of activities from start to outcome
What does meeting with stakeholders regularly allow for?
- Monitoring progress
- Receive feedback
- Report progress (who gets the reports? What is preferred method?)
What can be used to help track whether activities are producing desired outcomes & if outputs lead to expected short-term outfomes?
Logic model
How can keeping track of outcomes & indicators related to program objectives help HES?
- Assess preliminary data regarding program successes, unintended outcomes, & opportunity to refine as needed
- Preliminary analysis captures descriptive data important to stakeholders, funders, & program staff
- Better understanding why intervention succeeded or failed to achieve expected results
When modifying action plan, what does HES need to know?
- Who to involve
- Know when & from who approvals are needed
- When modifications may be needed through evaluation of process & monitoring fidelity of implementation
What should HES focus on when adapting a program?
Maintaining fidelity of ORIGINAL intervention
What does program adaptation allow HES to do?
Create common ground between delivery of intervention & characteristics of group using program/intervention
Steps of Program Adaptation
- Assess community
- Understand possible interventions
- Select intervention
- Consult with experts
- Consult with stakeholders
- Decide on needed adaptations
- Adapt original program
- Train staff
- Test adapted materials
- Implement adapted program
- Evaluate adapted program
What can be used to measure fidelity?
- Activity logs
- Document reviews
- Observations
- Reports
- Surveys
- Gantt charts
- Logic models
- Interviews
What is multiplicity?
of activities (can be at different levels)
What is dose?
program units delivered via program activities
- How many program components were delivered as part of intervention?
How is dose tracked?
Process evaluation & program monitoring
Core functions of human resource management
PADS
- Planning
- Acquisition
- Development
- Sanctions
How should curriculum & instructional resources, space, or equipment & supplies be monitored?
Based on volume, frequency of use, & relationship to program/project plan
How can HES ensure resources are used properly?
Project plans & Project management principles
What does financial management do within human resource management?
- Development & use of system processes that ensure fiscal accountability
- Approach to accounting operations
- Reporting & regular reviews or audits
What can be used to collect data on sustainability elements/domains?
- Surveys
- Interviews
- Focus groups
- Program documents
What types of data should be collected on sustainability of program/intervention?
- Leadership/political support
- Funding stability
- Collaboration/partnerships
- Organizational capacity
- Program evaluation
- Program adoption
- Communication
- Strategic planning/vision
What guides should be created to aid in stability of program/intervention throughout program/program monitoring?
- Implementation guide
- Train-the-trainer model
- Document lesion
When should intervention/program sustainability be considered?
From the beginning or program planning
Accountability
- Being answerable for actions taken
- Successful/failure of program
Responsibility
Being charged with ensuring that things are done within specific parameters
Types of Accountability
- Efficiency
- Fiscal
- Legal
- Coverage
- Service delivery
- Impact
Phases of Implementation
- Encourage target population to take interest in program
- Conducting resource & task inventory
- Program planning
- Putting plans into action
- Using evaluation to decide whether to terminate or continue program
Steps for Initiating Plan of Action
- Community Organization
- Pretesting
- Diversity training
- Effective leadership
What is community organization?
Consultations & cooperation with respected individuals & organizations in community
Why is pretesting done/performed?
To acquire information about prevalent attitudes & health-related behaviors
What is diversity training?
Adjusting health communication message to various constituents in the community
Effective leadership
Strong sense of organization & discipline within health education program
Steps of Community Organizing Process
- Recognize the issue
- Entering community
- Establishing priorities & goals
- Selecting strategies for problem solving
- Implementing the plan
- Evaluating progress
- Maintaining achievements
How can HES recognize the issue/problem within a community?
- Needs assessment
- Evaluation of primary & secondary data
How can HES establish goals & priorities via community organizing process?
Utilize SMART technique for establishing goals & objectives
How can HES select best strategy for problem solving via Community Organizing Process?
Establish tailored messages
What are ways HES can implement the program?
- Phase-in
- Total implementation
How can evaluation of program be completed via community organizing process?
Using established indicators
How can HES ensure maintaining achievements identified in community organizing process?
Continuing or discontinuing elements of program based on evaluation
What are things HES need to use/consider when providing training for implementation using social cognitive theory?
- Address more than 1 element of reciprocal determinism
- Engineer environment
- Address individual skill building
- Clarify values
- Understand need to provide great deal of practice
- Practice repetition
- Observational learning
- Verbal persuasion
- Learning in increments
- Provide skill training to foster mastery in behavior
- Capitalize previous experience
- Provide models of similar situations
- Use testimonials
- Foster self awareness of physical & emotional responses
- Use all venues to regulate & foster self control
- Encourage use of journaling
Training Strategies implementing Transtheoretical Model
- Increase awareness
- Make risks personal
- Emphasize self-efficacy
- Aid in development of definitive plans
- Establish short term goals
- Give specific resources
- Give feedback & positive reinforcement
- Aid in problem solving
- Give opportunities for social support
10 Aid in establishing coping strategies - Provide reminders of benefits
- Describe pros & cons of change for individual (consequences & rewards)
- Establish self awareness of behaviors that are problematic
- Utilize empathy/family interventions
Health Belief Model
- Likelihood of action determined by perceived gains in something they value
- Independent influence on behavior based on PERCEIVED THREAT & EXPECTED GAINS
severity + susceptibility = threat
benefits - barriers = adopting behavior
What are cues to action?
Internal symptoms or external events/reminders from credible sources that encourage behavior (part of health belief model)
How does level of self-efficacy aid/hinder behavior change?
People won’t try new behavior if they are not confident they can succeed
What are the constructs of Social Cognitive Theory (SCT)?
- Knowledge
- Outcome expectations
- Goal formation
- Perceived self-efficacy
- Socio-economic factors
What are the types of knowledge considered with SCT?
Content & Procedural knowledge
Content knowledge
Understanding advantages & drawbacks of health behavior
Procedural knowledge
Understanding how to engage in given health behavior
Perceived Self-Efficacy is _______________.
- Perception based
- Task specific
- Context specific
- skill oriented
- Resilient self-efficacy
How can an individual increase self-efficacy? What does each one mean?
- Physiological state - moods/emotions affect physiology which in turn influences self-efficacy
- Verbal persuasion - occurs after hearing others comments about behavior
- Vicarious experience - participating in behavior after watching others do it
- Enactive attainment - engaging in behavior & interpreting results
What are the 5 stages of Change according to transtheoretical model (TTM)? What occurs in each of the steps?
- Precontemplation - No intention of taking action in next 6+ months
- Contemplation - Thinking about pros/cons of behavior change
- Preparation - Intend to adopt behavior in next month
- Action - Modifications of lifestyle behavior change has occurred in last 6 months
- Maintenance - Sustaining behavior for 6+ months
Theory of Reasoned Action (TRA)
Suggests personal beliefs about health behaviors & social influences equally & independently shape a person’s intent to act
What are the constructs of TRA?
- BELIEFS + EVALUATION = ATTITUDE towards behavior
- Subjective norm
- Behavioral intent
How to measure behavioral intent via TRA?
- Target
- Action
- Time
- Context
Theory of Planned Behavior (TPB)
- similar to TRA (addition of perceived behavioral control
What is perceived behavioral control according to TPB?
- Extent individual/group perceives they have control over the outcome
- Strength or influence of external factors affects adoption of health-protective behavior
ARCS motivational model
Compilation of guidelines from many motivational theories
What are the causes of motivation according to ARCS motivational model?
Extrinsic or Intrinisic
What does ARCS motivational model provide learners?
Ability to acquire new knowledge & skills with enough time & effort
What are the motivational categories of ARCS motivational model? What falls under each stage?
- Attention - Capture learner’s interest & maintain their attention
- Relevance - Know learner’s needs & provide opportunities to match activities to motives
- Confidence - build positive expectations & provide methods for successful mastery of knowledge & skill
- Satisfaction - Provide reinforcement to learners’ success & encourage use of new knowledge & skills
Bloom’s Taxonomy
- Helps classify learning objectives that are developed
- Focuses on concept that instruction needs to possess higher-ordered objectives felt to be intellectually demanding
- Helps determine spectrum of training needs
- Considers whether training needs require simple, complicated, or complex learning
Classifications of Bloom’s Taxonomy
- Knowledge
- Comprehension
- Application
- Analysis
- Synthesis
- Evaluation
Tasks of Bloom’s Taxonomy
- Remember
- Understand
- Apply
- Analyze
- Evaluation
- Create
Methods for Health Education Program Implementation
- Pilot testing
- Phase-in
- Total implementation
Maslow’s Hierarchy of Needs (from most important first)
- Physiological needs (air, food, water)
- Safety needs (security, employment, health)
- Love & belonging (friendship, family, intimacy)
- Esteem (respect, self-esteem, status)
- Self-actualization (desire to become most that you can be)
- must receive needs from previous level to look for next level needs *
Steps to ensure implementation is consistent
- Build support for the plan
- Develop plan for implementation
- Train those guiding implementation
- Carry out pilot programs
- Assess each step of implementation
- Promote the plan
How can Physiological state affect self-efficacy? How to improve to increase self-efficacy?
Emotions affect physiology
- Use of can vs can’t
- Reduce anxiety/stress
- Focus on positive things
- ## Control moods naturally
How can we help others’ improve their self-efficacy?
Instruct, correct, encourage, & support
