Unit 3 Flashcards
planning
the process of achieving a goal
where should you start planning a hpp
getting support from the top dogs, dms
why should u be careful with top dog support
they might have needs that the PP doesnt want, the pp is still ur #1 priority so be careful
resource
usually money
support
non money resource
what happens if the idea comes from the top
better for you because then you dont have to gain their support, you already have it
how do u gain support before you start
find out what dms want, make a rationale based off of that
what do most organizations value
human resources
human resources protection
many organizations have their values and goals based around this, protecting the lives of employees and organization members
prevention programs
unlikely to see a change in health status immediately, will take time
in terms of money this sucks but in terms of humans this has large value because of health. money shouldnt be the deciding factor in human resources
three things that have different goals that the organization values
employee, employer, community
leading by example
measures the organization’s commitment to employee and organizational health status and support measures
what 4 things does leading by example measure
leadership support
worksite support
economic awareness
business alignment with health
4 main steps to creating a rationale
gather evidence
title it
write the actual content
reference list/credibility part
what research should you include in your rationale
epidemilogical data (evidence based stats)
global scale relevance
whats happening in other places, be careful - might not generalize to your pp
goals, objectives, plans
budget/economic plans (CBA - ROI)
needs assessment (unlikely that it’ll be done at this point)
how it can benefit the organization
why it would benefit and make sense for the organization to invest in this program
content of rationale
economic factors epi data needs assessment global scale - get research on most macro scale whats happening elsewhere solution proposal why successful implementation plan eval design proposals
conclusion of rationale should include
references - show where and how credible your research is
conclusion - state how this is beneficial
evidence
data that is used to make decisions
evidence based
decisions that are made based on evidence, if something is evidence based it has more credibility if there was no evidence
social math
an interesting way of presenting statistics, do this so your dm’s arent bored while reading your rationale
cost benefit analysis
shows you profit in relation to expenses using a ROI - return on investment
return on investment
how much profit youre making
roi = 0
break even
roi > 0
profit
rot < 0
losing money
planning committee, when can you make one
once you have some support from key decision makers cna start a planning committee
planning committee
a collection of people that have complimentary skills that will actually plan the program that is to be implemented
what are planning committees also known as
planning team, steering committee, advisory board
what does the size of the planning committee depend on
the program and pp itself
should be small enough to reach consensus but large enough to do work
what/who should the planning commitee include (6)
- pp
- those with health risk
- variety of personalities (doers, thinkers, planners, motivators, influencers)
-key stakeholders not rep. in pp - org/sponsor
- leader
= SUCCESSFUL PLANNING COMMITTEE
what should you be aware of in a planning committee with people/leader
should be operating of the best interest of the PROGRAM not the PERSON
- be aware of politics and political personal agendas that may see people trying to act in their best interest - WRONG
what should a leader be
organized, planning, strong in achieving a goal, motivating, creative and effective
what should you do with a planning committee
- should evaluate it regularly
- add new people
- establish term limits (permanent, temporary, ad hoc?)
what is ad hoc?
ad hoc committtee?
temporary
what should you answer early in planning?
what is the dm support
are the looking to embed or institutionalize the program
is the planning committee temp, ad hoc or permanent
what resources available
how much money
what is the dms commitment
what autonomy or control does the PC have
parameters of planning
should be established early on, what parameters the program will work within
estbalish early to avoid problems and reduce risk of wasting resources
effective committee has 3 things
has an agenda
have communication between dm, planning committee and key stakeholders (PP)
organized
need
difference between now and desired level/state
true actual need
what you actually need and is required
perceived, desired need
what you want
what needs should you cater to
all of them - doesnt matter if its perceived or true
needs assessment
collecting data and analyzing it to see what needs and problems arise, determines the degree to which they’re being met, prioritize them baed on greatest risk factor and need in the community,, pp and what interventions and programs can be implmented to solve
what does a needs assessment identify
need how its being taken care of right now priority implememntation intervention to take resources/assets in community
2 goals of NA
assess needs, degree to which they’re being met (priority)
2 types of needs
service needs
service demands/desires
service need
professional approach
what the pros think the pp needs
be careful - may not be accurate
service desire/demand
what the pp thinks they need
- accurate
which is more important need or demand/desire?
both equal - have to balance and make sure both are satisifed, but again the PP is your main concern
when is not performing a NA okay?
- categorical funding
when one was just completed
no resources/money - stupid!!!!
what do you expect from an NA
needs degree theyre being met priority list assets and resources available suggested methods of intervention
what will an NA answer
what is going on in the community what are the risks and issues and needs what degree are they being met what interventions are promising what is being used in the commnunity right now to address them where are subgroups what are their needs where are they located geographically what can be done what is most pressing
community building
using the assets of the community to mobilize
strength based - what the community already has and can be used
how do you get NA data
primary sources
secondary sources
primary sources
actually conducted info from the PP themselves
pros of primary sources
- tailored to pp - fits well
- relevant
- will address needs accurately
PARTICIPATORY DEMOCRACY AND JUSTICE = FACILITATES BUY IN from the PP
what will a good planner do??? in light of what???
use 2ndary data in light of its limitations
cons of primary data
costly
time
hard to get sometimes
resource intensive
secondary sources
data already collected, not from PP
pros of secondary data
easy to locate, free, fast access
cons of secondary data
may not fit pp
may not be relevant is it accurate?
barriers to obtaining re: confidentiality issues
types of primary data sources
- single step surveys/cross sectional surveys/point in time surveys
- multistep surveys [delphi technique]
- meetings
- town hall meetings/community forum
- focus groups
- nominal groups
- observations
- self assessments
different types of single step surveys
written electronic face to face telephone group interviews
- proxy measure
- signficant others
- key informatants
- opinion leaders
what are the 4 types of observations
- direct (intrusive, unintrusive)
- indirect (proxy measure)
- walkthrough/windshield
- photovoice/videovoice
2 types of self assessments
HRAs - health risk assessments
HSAs - health status assessments
2ndary data sources (4)
govt
non govt agencies
data already collected from existing records
databases/internet (literature)
Mapping
putting needs on a map - mapping them geographically
what tool is used to map NA data
GIS - geographical information system
self report
the pp tells you about themselves, need to be careful for bias and info that may not be true, mostly has pretty good validity though
proxy measure
way of seeing if the behaviour actually occurred if the PP doesnt want to give you info self-disclosure
significant others
the pp doesnt have to tell you about their needs themselves, people very close to them can do that for them - aka - significant others, lovers, friends, family - can accurately report on what people need
key informatants
people in the community that have been strategically placed to report on needs - may be biases
opinion leaders
well respected individuals in the community that report on needs and can tell planning committes what they need or want in the community, are pretty represenative and people will take what they say with merit
- usually early adopters/influencers
written surveys
most often used can reach easily can reach many quick to administer time effective not that expensive unless targeting many
cons: low response, can facilitate response increase by making it pretty, puttin ID number and folowing up, incentives, no clarification if needed
face to face
better because can have clarification can probe more time costly - travel time can have visual cues can produce bias/influence answers participatory for the PP - good training required for consistency of question asking and taking responses
probing
a technique used by interviewers to get more indepth answer
telephone surveys
more wireless only households random digit dialing - doesnt work, random selection (cell phones, answering machines, may not have same area code) - no visual cues, quick, need trianing, can have bias, probing, can clarify, time effective
group interviewers
good - can get many info form many people at once
bias is possible
can probe - have same adv. as face to face interviewers, short time
electronic interviews
can hire companies to do part of the work for you - eg coming up with questionnaires - payment depends on service and length of time the service was used
- easy
- people familiar with technique
- technology - not eveyone comofrbale
- privacy
- canr each many people
- good control
- no clarification
- can design it as you wish
- more increasing use of technology in life
multistep surveys
delphi technique, gather info on more than occasion
- send out questionnaire, broad questions get answer, conduct another survey based on those answers - can go for 5 or fewer rounds
community forum/town hall meeting
led by a skilled moderator, people fromt he pp come together to discuss issues that they may have - has to be controlled by a moderator and follow a agenda - be careful of silent minority of vocal minority
meetings
meetings of a couple of people from the pp
- if small group may not be entirely representative of the PP - have to take in the whole PP into account and how they may have different needs and desires than the small group interviewed and meeting discussed
focus groups
came out of group therapy
a group of 8-12 people come together that dont know each other and were chosen based on a characteristic to discuss a certain topic
- need moderator as well - as topics get more controversial, need better worded questions and more skilled
- need to discuss, record and evaluate for later purposes - may be videotaped
nominal groups
groups of 5-7 people that come together, put down responses and THEN discuss the issues to ensure that there is no bias and that responses were already recorded prior to hearing what everyone else thinks - your true feelings and needs are put forward
- once discussed, focus is on prioritizing and ranking issues by IMPORTANCE
direct observations
can be intrusive - people know that youre observing them and their behaviour,this may lead to social desirability bias, hawthorne effect
can be unintrusive - people don’t know that youre observing them - is this ethical?
indirect observations
proxy measure - measure if the behaviour actually occurred
windshield/walkthrough
actually walk through the neighborhood, see what changes need to be done, what community health needs
photovoice
document needs via a photo, catalogue them and inform policy makers of what needs to be done and change
self assessments
the pp can self-assess themselves for health risks but the reliability and validity of these are variable, a bit more realiable when computed but can self-calculate risk as well
health risk assessment
how likely you are to die from it, the risk youre at
health status assessment
your overall health status at the present moment
what makes primary data so useful?
facilitates participatory democracy and justice, faciliating buy in and program ownership for PP stakeholders
stakeholder
anyone that has an interest in the program or battling the issue at stake
what are the steps in conducting an NA?
Id purpose of the NA gather data analyze data assess the community risk factors - prioirtize/set goals/set program focus review
STEP 1 - ID PROGRAM FOCUS
what youre going to analzye what needs what implementation what is the purpose of this ... participatory democacy determine how many problems you want to focus on (depends on resource and financial status of your initiative)
gather data
primary or secondary data same level as program use both qualitative and quantitative data evidence based use models and grassroots participation
analyze data
make sure you take in cultural differences - cultural competence
- may be the hardest step becuase you might not be able to see effects and trends clearly
- prioritize based on BPR 2.0 MODEL
bpr 1.0
basic priority rating model
- revised bc focused too clearly on communicable diseases - BPR 2.0
BPR 2.0
- size
- seriousness
- effectiveness of program
- PEARL
PEARL
propriety economics accessibility resources legality
0-1 = if 0 ~ falls to bottom of priority list
4) ID RISK FACTORS
- identify the risk factors that poses a risk and if changes can lessen the risk
5) DETERMINE THE PROGRAM FOCUS
reinforcing, enabling and predisposing factors that need to change - which to focus on
6) REVIEW
make sure that the need you identifyied is the actual need that has the most priority otherwse you just wasted a shit ton of resources and you are stupid and need to start over
Health impact Assessment
done on top of NA , decided by DMs if needed
measures the potential impact of the intervention on the population/risk
steps of a HIA
screening scoping assess risks and benefits make reccomendations report evaluate
what are the 4 values that a HIA is based on
equity sustainability democracy ethics SEED
Interventions
the actual services and strategies/activities implemented to the PP - what is between the pretreatment and post treatment
what are the two things that an intervention MUST be
efficient
effective
what does the size of the intervention depend on
- resources
multiplicity
the amount of activies/strats THE MORE THE BETTER
dose
the number of units delivered in the intervention THE MORE THE BETTER
levels of influence
who does it affect (interpersonal, intrapersonal, community) **THE MORE THE BETTER*
intervention strategy
general action plan for the intervention to take place through, they are not mutually exclusive, can overlap and have elements of the others and work in conjunction - the more the better *multiplicity is key
* it is rarely sufficient to only use 1 or 1 type of strategy
what are strategies for interventions used for
communicating change, creating awareness, motivating, increasing demand, building social norms
health communication strategy
the use of communication channels to influence people and create awareness of a program
most often used
determined by what channel it can go through to the people
highest penetration rate
cost effective
less threatening (eg: rxns)
rarely sufficient alone
traditional communication model
reciever is passive, message is passed top down from sender
multidirectional communication model
can go many ways - can go bottom up, horizontal (consumer shared)
how do you ensure a communication health strategy is effective
if it is consumer based - you have to understand the PP wants and desires and motivations to be effective
communication channels (5)
intrapersonal interpersonal community groups mass media social media
intrapersonal communication channel
individual based strategy most often used, time and costly tailored to person > personalization > targeting (groups) enhanced via technology person specific coaching is an example
interpersonal
same elements as intrapersonal but more people (small group)
community groups
can communciate via groups already established in the community
mass media
use media channels to communicate (eg: news, billboards)
direct mass media influence
target people to change directly
indirect mass media influence
make changes in the environment to influence and change behaviour
social media
channel that is gaining prominencie, can control easily upload, reach many people, good for promotion
what is at the heart of social media
networking and relationships
how do you evaluate social media
POST
PEOPLE
OBJECTIVES
STRATEGIES
TECHNOLOGY
Health LIteracy
being able to understand and read literature and items to inform and influence good decision making for attaining an optimal level of health and wellness
4 levels of health literacy
below basic
basic
intermediate
proficient
what level of reading is effective for writing
reading @ 6th grade level is good
Document Literacy
being able to fill out documents/applications
prose literacy
being able to read prose
quantitative literacy
using numbers and using that for literacy
health numeracy
reading and interpreting biostats, statistics, proabilities, numbers, etc for influencing and acting on it for good health
health education strategies
using education and learning to communicate a program or intervention - eg: health classes
not mutually exclusive - very close to health comm strats
planned learning experiences in an educational setting, providing knowledge to elicit for healthy behavioural change
what do you need to know in order for health edu strats to work
how the pp learns
curriculum
the knowledge thats being presented, leading to a level of proficiency in it
scope t
the breadth and depth of what youre learning
sequence
order in which u learn the units of study
lessons
what you learn in 1 sitting
lesson plan
written outline of 1 lesson - intro, body, conc
10 principles of learning
- motivation
- relevance
- unknown to know
- learner has to be engaged and active in learning
- attention
- dsitraction
- senses
0 application - pace
5 principles of adult learning
- adult needs to know why learning
- build on previous knowledge
- active
- motivated
- culturally relevant
5 stages of learning
- attention
- present stimulus
- engage
- feedback
- retention and transference
health policy strategies
implement a law to change PP behaviours a way of forcing change good method as a last resort may be controversial ~ taking away freedoms as decisions made my authority but counterargument is that it is for the better health of the overall community and greater good based on incentives can affect built environments
what do you need to ensure for a policy
its well written
followed by everyone
affects everyone, everyone has same commitment and desire to follow it
6 phases of policy implementation
agenda setting formulate approval implement assess modify
environmental change strategies
evoke a change in environment to evoke changes in behaviours - eg: smoking bylaws
get people to change by removing barriers and making the healthy choice the easy choice (ottawa charter of health_
- can be closely realted with policy change strats
health related community service strats
- put things like flu clinics, free check ups in and around the community
- has merit because closely associated with health care professional
- services tests and health care in the community
reduce barriers to obtaining it
cons - ethical obligations
community movbilization strats
- community org/building
- community advocacy
community advocacy
enabling pp to influence policies in their community to account for change for the collective good on behalf of a health goal
7 methods of community advocacy
- electioneering
- direct lobbying
- turning grass roots to direct lobbying
- internet
- media advocacy - newspapers
- media adovacy - resource person
- influence voting
3 tiered method - good, better, best
good - do it yourself
better - do it yourself + influence others
best - all the above plus for a long period of time
behaviour modification activities
modifying behaviour
- pick something to monitor
- monitor it, analyze, pick a plan of action, change
health status evaluation
can help kick start beh modification
organizational culture activities
organizations can have their own culture - their personality, can have activities based on that
what is and what isnt important to the company/organization
cultural audit
evaluation of values and norms of a organization, see if they support the HPP
social activities
- buddy system
- contests
- contracts (with contingencies)
- social events (fill a void)
- social networking (relationships)
incentives and discentives
rewards or consequences for a behaviour
can work well and motivate
can be financial or nonfinancial
how do you figure out what incentives to use
ask in a na
put many incentives in pp - mass appeal
what should incentives be/do
should be consistent with health
of value
big deal
linked to beahviour and overall outcome desired
how can you make an incentive effective
- figre out outcome
- link beh to outcome
- figure out incentive
- link outcome with incentive
- assess
planning approaches (2)
high risk micro
popn based macro
there are instances where a major or mass amount of people with a low risk of a disease or health risk can lead to a greater incidence than a smaller population of people with high risk
there are different instances in life to use a popn based approach or micro based approach, one will never obliterate the other completely
High Risk Micro Approach
people with a high risk of disease are targeted to recieve the intervention
pros of micro high risk
- tailored to person with high risk
- individual based with high risk = good sense of resources
- affecting person you know needs it
- benefits > risk
- motivation for both client and practicioner are both high
motivates behaviour change
cons for micro high risk approach
medicalization for prevention - dont know youre at trisk till youre told
attaining ideals is hard if not impossible
hard to monitor risks unless you start early or have previous ailments
not behaviourally appropriate - goes against norms
- results are temporary - neeed to shift to other preventative measures too
when should you use a micro approach
when you need to decrease incidence in a small number of individuals with a HIGH risk
when is micro not effective
when you need to change the health status of many people with a low or moderate risk
macro population approac
when many people are at a low or moderate risk for the factor
pros of macro population approach
hits many people
attempts to change social norms - works with them to establish something that is culturally and socially acceptable, unlike micro approach
attempts to change behaviours of many
attempts to find root cause and eliminate it
benefits good for popn, low for indivudlas
changing exposure has good qual and quan effects on people and subsequent generations
cons of macro
lack of motivation
risky - sometimes benefits not outweight the cost (eg: fake fat)
when should you use macro
when the only way is to get through the population
need to affect many people
need to affect many with the least possible adverse side effects (eg: smoking bylaws)
creating a HP intervention
there is no best model, every PP is different but multiplicity is good
6 criteria for a GOOD intervention
- addresses needs/risk factors
- solves needs/goals
- engages the community
- does good impact on community
- allows comm to get involved
-follows standards of practice - easy to evaluate
uses resources
what should an intervention be
efficient and effective
efficient
uses resources well
effective
actually meets goal
settings approach
tailoring your intervention to your pp
best practice intervention
recommended, shows evidence of working where it was previously implemented
best experience
no critical peer review but evaluation shows promise
best process
shows that planning is good - may work
4 types of interventions
- evidence based
- effective
- promising
- emerging
tailoring
making the intervention cater specifically to your pp and their wants/desires, makes them want to pay attention to it more
cultural sensitivity
making sure that the intervention caters to the different cultural spectrum in the pp
mutliplicity
having multiple strategies in the inverntion
- the more the better - more channels, more likely to influence the population, more response and exposure
adapting interventions
- can adapt evidence based interventions to your own pp - be careful though, doesnt always work, needs constant revisions
6 steps of adapting
assess select prepare pilot test implement revise
3 intervention intentions
learning
behaviour
environmental
motivational interviewing and coaching
behaviour cahnge individual approaches
health promotion
the act of people enabling control over and increasing their health
there are many components to health
we each satisfy them in different and the same ways
individual approach to health
has large value because it can help those that are in high risk and need help and as well as those that are at a low risk but want to improve their overall level of vitality and health/living
beneficial to all on an individual sclae
when meeting with a health coach
advice and well meant advice may be taken the wrong way, met with blame, frustration and blank stares, unproductive persuasion
- how we speak to clients is just as important as what we say to them because the motivation is all in the qualitity of interaction and relationship
client relations is just as important as client impact
friendsly advice is not endorsed, may lead to frsutration and blame
you dont give input as a coach but you guide the client to finding the own answers that are within
coaching
client centeresd behavioural cognitive change approach that has theoritical underpinnings
3 theories of CALC
TRA TPB SCT
client resistance may be a product of
quality of interaction adnw what youre saying
motivational interviewing
- used in addiction counselling
miller and rollnick
individual, client centered behavioural change approach that focuses on a way of being with people - if you focus too much on the tools, you lose sight of the central approach
- faciliate behavour cahnge by resolving ambivalence
ambivalence
conflict in not knowing which behaviour change route to take - biggest obstacle
7 key points of motivational interviewing
- the answers are within the client
- passive, quiet, directive approach
- clients role is to find the answers, practicioners just guides
- primary obstacle is ambivalence
- resistance is just feedback, overestimate of clients readiness to change
- persuasion is not effecitve
respect clients right to choose - relationship as equals
4 guiding pricinples of MI
R - resist righting reflex - NO ADVICE/PERSUASION/COERCION
U - understand client’s internal motivations - listen with genuine curiositiy
L - listen! (1 mouth, 2 ears)
E - evoke transformation - michaelangelo approach - saw the marble, saw david
Coactive Life Coaching
many behaviour models, this is what irwin uses
- based on theories (SCT/TRA/TPB)
- main goal, help people help themselves
- intrapersonal channel
- uses underpinnings of MI
coactive
relationship between the coach and client is that of equals
4 cornerstones of CALC
- NCRW
- answers from within
- aim to motivate to change
- holistic approach
client assumptions
- clients have the answers
- nothing is wrong with the clients
- answers are there but there are barriers
coach’s role
help the client find the answers not by giving advice but by using questions that are open ended and based on anything because holistic approach to life impacts helath
listen to inuition, resist righting reflex
DROP ASSUMPTIONS, REPLACE WITH CURIOSITY
3 types of coaching
fulfillment
balance
process
Fulfillment Coaching
help the client get fulfilment in life overall
thoery - SCT
balance coaching
get many different perspectives
theory - TRA/TPB
process coaching
help the cient open up to see where they are in life and how to gain control of their life and where they are in this moment
why is coaching/talking effective
humans value talking about our selves, releases stress and self-disclosure helps us really understand ourselves and connect
social connection motivates us
fulfillment coaching
expectations, expectancies, values, self efficacy, acknowledgements and reinforemcenet
- uncovering goals, championing - SCT, showing clients what they’re capable of
process coaching
explains voluntary behaviour and intentions - look at all different perspectives of life just not social and subjective norms or lack of percieved behaviour control - if you see many perspectives then you can see different paths of actions TRA/TPB
process coachin
no theoretical base - just look at where the client is in their life and regain control of their life by exploring it
CALC AND OBESITY STUDY
study conducted at UWO that shows that CALC could be an effective behavioural change intervention that could help obese people lose weight - has much potential although more time should have been let for the study as well as more people so more evidence could be gathered to further see effects of CALC on obesity and weight loss
- changes in waist circumference, HRQOL, healthy eating, self esteem, confidence ability, DPA
- no change in BMI and self-efficacy (again research shows this could help - need longer study)
- participants had buy in $20 per 7 sessions
could talk about anything with coach on the phone
- this opened up their lives and have support which increased confidence and perspectives in clients leading to results that were mentioned above
CALC AND SMOKING CESSATION STUDY
study done at UWO showing that CALC has potential for helping smoking cessation
- clients barriers - control, identity
- triggers - stress, social situations
- through MI and coaching saw different perspectives relating to quitting and stopping cigarettes from controlling their lives
- yielded mixed results - coaching brings MI principles into action
- increased trends in self-efficacy, control over cigarettes, decrease in # of cigarettes, self esteem
- 1 mo follow up - increased awareness of dependency, control, barriers
3 mo follow up - empowerment, control, possibility for change
6 mo follow up - shift in overall perspectives
- coaching helped find a substitute for cigarettes and was fundamental in gaining insights
need more people trained and knowledgeable about coaching - more people - more time, more control - more effective results that are generalizable
