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Design a program for a health and wellness program for a multi-culturally and economically diverse population in a community-based setting. Include these components in the program design:
�Clearly identify the components of a comprehensive health and wellness program for this type of population, with examples
�Will the program be short-term or long-term, or open-ended depending on the goals and objectives of the program?
�What instruments will you use to measure the outcomes of the program?
�Who are the key constituents (stakeholders) that will be involved in the design of this particular program?
�How will you seek funding for your program?
�Include a socio-economic and multi-cultural perspective that draws from existing national, regional or local programs
�Describe the administrative tasks, functions in the design and administration process
� Planning steps (1-15) included as outlined in Chapter 4 to incorporate the above information.
Part B: Create a health wellness program for a private corporation (workplace) that meets the stated requirements described above.
Below are the 15 planning points:
Step 1: Review the Needs Assessment
It is suggested that the planners conduct a review of the needs assessment data
and the resulting decisions that have been made up to this point. This review
will help to determine if the most appropriate recommendations for the direction
and outcome of the program have been made to meet the needs of the
target population. It is possible for the planning committee to identify additional
data that are useful to shaping the intervention, which were not undiscovered
or overlooked in the initial needs assessment process. A large amount
of data may have been collected as part of the needs assessment, but during a
review, a skillful planning committee can organize and synthesize the information
into a format that provides meaning and value, which may not have
been obvious during the initial examination of the data (Aspen Reference
Group, 2002).
Step 2: Convene an Advisory Panel or Planning Committee
As described in an earlier chapter, community members should be involved in
the entire planning process, as they are important contributors to the development
of all aspects of the program, from conducting the needs assessment to evaluating
the program (Aspen Reference Group, 2002; W. K. Kellogg Foundation, 1998).
For a number of reasons, it is necessary to involve or consult with appropriate
community members at the very beginning of the program planning process and
to include them on an advisory panel or planning committee. As with the needs
assessment process, target population and stakeholder involvement is necessary
during the planning and implementation stage. The involvement of target population
members will help to develop program ownership, which is critical for their
eventual involvement in and acceptance of the program. Target population members
can provide the planners with critical insight into the target population that
could make or break the efforts toward the desired outcome of the program. It is
important that the program be founded on the philosophical position that it is being
done with the community rather than to the community (Rainey & Lindsay, 1994).
If a coalition or advisory board was formed prior to the needs assessment,
its members may form the basis for the program planning committee. When
there is an existing committee structure, it will be important to review constituencies
that will need to be represented for the program planning part of
the process. Important contacts for inclusion on any coalition or board include
potential program providers, as well as potential program clients or potential
consumers. Representatives from a local college or university might also be considered,
as they may offer skills and possible resources to assist with program
planning and implementation. College professors might have areas of expertise
that are needed by the planning committee, or a college class might assist
in conducting some of the activities of the project as part of a course requirement.
Consider representatives that will enhance the work of the committee and
prove to be helpful to the success of the new program. When putting together
a list of potential program planning advisory board members, consider individuals
that can be described as follows:
_ Are well respected by the target audience and can provide valuable links
to the community
_ Represent the various groups within your target population and have the
ability to provide relevant input for program planning
_ Have knowledge of the target audience, members and their lifestyles,
attitudes, and resources
_ Bring to your committee a number of skills and resources that will be
useful to the program (Aspen Reference Group, 2002; Breckon, Harvey &
Lancaster, 1994)
To encourage a potential candidate to take a position on an advisory board
or committee, it is recommended that he or she be contacted personally through
a face-to-face discussion or telephone conversation. When a personal contact
is not possible, a letter or e-mail that reaches out to potential board members
may be necessary. Regardless of how the initial contact is made, the following
information may prove useful for informing the potential board member of the
fundamentals of the program being developed (Keyser et al., 1997):
_ A statement on the purpose or intent of the contact
_ The name of a key contact person, his or her title, and organization
(including a brief overview of his or her role in this project)
_ A description of the target population
_ The area of emphasis of the program and the health concern or issue to be
addressed
_ Program justification
_ A solicitation of support from the receiver
_ Ways that the potential candidate may connect with the key contact
(e Step 3: Assess and Establish a Budget for Program Planning
A budget must be considered for the planning phase of the project. Subsequently
in this chapter, program budgets will be addressed, but a budget for program
planning is important to facilitate the planning process. Because a budget for
planning is often overlooked, it is added here as a separate step. This step is
important, because resources are needed for conducting the initial research
and putting together the groundwork that is required prior to piloting and implementing
the program. Creating an advisory or planning committee, developing
the materials of the program, and preparing the necessary documents all
require staffing, time, and financial support. Program success depends on this
planning process, and cutting corners here can result in a program that fails
to meet the needs of the target population and fails to produce the program
desired outcome.
Step 4: Write and Review a Mission Statement
The mission statement is a narrative statement describing the focus of the program,
which often includes the program intent and philosophy (McKenzie & Smeltzer,
2001). Developing a mission statement is a critical step in creating a strong
foundation for the development of program goals and objectives and is a program
activity that must be accomplished very early in the planning process. A
mission statement may have been written as part of the needs assessment process,
so it is important to review any existing mission statements before proceeding.
72 Chapter 4: Program Planning: The Big Picture
Step 5: Write and Review Program Goals and Program
Objectives
The program goals evolve from the mission statement, and the objectives evolve
from the goal or goals. Once the mission statement is in place, the task of developing
the outcome or goal of the project, along with the specific objectives,
needs to occur (NACCHO, n.d.). Objectives outline in measurable terms the
desired changes that should occur in the target population as a result of the intervention
and provide the basis of evaluation for the program (McKenzie &
Smeltzer, 2001). Suggestions for developing a mission statement, program
goals, and objectives are provided in an earlier chapter. If goals and objectives
were developed as part of a needs assessment process, they will need to be reviewed
and possibly adjusted.
Step 6: Select a Theory or Theories on Which to Base Your
Program
One or more theories or specific constructs from the professional
literature is needed to guide the planners in developing
or selecting the intervention required to meet
program goals and objectives (Glanz & Rimer, 1997).
Successful health education programs are grounded in a
theoretical foundation that is reflective of the current research
and understandings of the profession. Chapter 6 reviews some of the most
commonly used theories in health education and health promotion.-mail address and cell and office phone numbers)
Step 7: Review Other Programs to Generate Program Strategy
Alternatives
Those involved in the program planning process need to identify potential
strategies that address the goals and objectives that have been identified
(NACCHO, n.d.). To ensure success for the intervention, it is important to
base the new program on other successful programs. A wide review of the professional
literature and other professional documents, paying attention to
programs and strategies that have been deemed successful through some type
of evaluation, will help to generate a list of potential strategies and activities.
Many foundations and professional associations or organizations offer lists of
evidence-based or science-based programs that should be examined for potential
use in the project. In the manual Getting to Outcomes: Methods and Tools
for Planning, Evaluation, and Accountability, Fetterman (2000) provides a list
of criteria for determining if a program is evidence-based and it includes the
following:
_ The degree to which the program is based upon a well-defined theory or
model
Program Planning Steps 73
Checkpoint 4.1
What are some of the most
commonly used theories and
models for describing health
behavior?
_ The degree to which the population serviced received sufficient
interventions
_ The quality and appropriateness of the data collection and data analysis
procedures used
_ The degree to which there is strong evidence of a cause and effect
relationship
The use of science-based programs is encouraged but not always possible.
There also exists in the literature programs that have demonstrated effectiveness
but do not meet the science-based criteria. Practice-based programs or �best
practices from the field� can be found in the professional literature in professional
journals, through foundations and government organizations, and on
Web sites (Fetterman, 2000). A search of best practices may provide the planners
with strategies or intervention suggestions that can be adopted to meet the
needs of the program or intervention being developed.
Once a literature review for successful programs has been conducted, followup
telephone calls to staff associated with those programs may assist in providing
additional details and insight that is not apparent in the available literature.
A conversation with the appropriate staff member or director could provide the
planners with feedback on a number of issues, such as the location and need
for resources, overcoming implementation barriers, and evaluation strategies.
Step 8: Assess and Establish the Budget for Program
Implementation
Review the financial arrangements for the program by looking at the money provided
by the main funding source and any funding from another party or organization.
Assess the allocated budget and its parameters to determine if it is
sufficient to perform the tasks and activities of the program. Identify the resources
for program implementation�those that already exist and those to be
developed or purchased�and determine if they will be sufficient to achieve the
program goals. The budget should include allocation for staffing, program supplies
and materials, facilities and space, marketing resources, and other operational
expenses (Breckon, Harvey & Lancaster, 1994).
For a more detailed examination of potential budget items and considerations,
the following questions for the planners from the Community Tool Box
located at https://ctb.lsi.ukans.edu/ are provided (Rabinowitz, 2003):
_ What are the activities that will do the most to advance your cause and
mission that you can carry out with the resources you have?
_ How many staff positions will it take to run the activities and do it well?
_ How much money will go to staffing (salary, consultant fees, fringe
benefits) and from what sources will staff members be compensated?
74 Chapter 4: Program Planning: The Big Picture
_ What else will be needed to run the program and its activities (space,
supplies, equipment, phone and other utilities, insurance, travel, indirect
costs, etc.)?
While attempting to identify the necessary personnel to be involved in the
project, planners should consider hiring from the target population (Aspen
Reference Group, 2002; W. K. Kellogg Foundation, 1998). Staffing with members
of the community helps to increase program acceptance and provides
valuable insight into the community and its members. For many programs, having
sufficient funding is a primary concern. An investigation into the possibility
of donated or shared resources with other community programs, such as
building space or large equipment items, might help to address some funding
limitations. Finding low-cost or donated program materials, such as curriculum
and other educational items, may be possible through voluntary health
agencies or government offices.
Grants and financial gifts from foundations, government agencies, community
groups, and businesses is another way to increase funding for a program
(McKenzie & Smeltzer, 2001). Opportunities for seeking soft money, such as
grants, will require an investigation into the potential funding sources that
exist and an examination of the types of projects or programs that are funded
by those sources. Interviewing staff members from similar programs, contacting
government offices for potential funding, and working with a local college
or university and its research office are a few suggestions for getting started in
the pursuit of soft money.
Step 9: Estimate Time
Often, a timetable of the specific tasks and activities of the program is developed
to assist those involved in the process by informing them of when the activities
are to take place and who is responsible for each activity. Planners often
develop timelines that reflect the implementation and evaluation process.
Including the entire planning process on the timetable can be most helpful
(McKenzie & Smeltzer, 2001). Planners need to develop a timeline that flows
logically, is realistic, and will assist in achieving the goal by the program deadline.
In order to prepare a timeline many planners use a Gantt timeline and chart
out the project activities on a day-to-day, week-to-week, or month-to-month
basis. A wealth of information on this charting method exists in the professional
literature and on the Web.
Step 10: Select Strategies and Activities
At this point, planners need to consider which intervention strategies and activities
can best help to achieve the program goals. Again, a review of the literature
for effective intervention details is an important step to consider. Several
Program Planning Steps 75
potential strategies should be identified for each objective. The selection of the
strategies and activities of the intervention is a process that takes some time and
investigation to successfully accommodate the target population and meet the
program objectives.
Those involved in strategy selection must attempt to identify potential
barriers to the implementation of each strategy identified (NACCHO, n.d.).
Reviewing the needs assessment information may identify some barriers, as will
a look at the professional literature. Talking with others who may have used
the strategy in similar situations can also reveal potential barriers to using the
strategy. The existence of implementation barriers does not rule out the use of
a strategy, but the barriers must become part of the discussion of whether to
incorporate a particular strategy into the program.
The program planning group should investigate, outline, and discuss the
details of all strategies being considered for inclusion in the program before making
final selections, based upon a mutually agreed upon set of criteria. During
this process, the group should consider program strategies that accomplish the
following:
_ Fit with the resources and needs of the community
_ Consider the beliefs, values, and practices of the community
_ Reflect field testing (have shown success in the field)
_ Dispel health misconceptions (Aspen Reference Group, 2002)
_ May be related to other strategies under consideration
_ Support the theoretical framework of the program (NACCHO, n.d.)
In the literature on successful or similar programs, there may appear references
to curricula or canned interventions that can be purchased for use with
the program being developed. There are a number of national curricula or
health programs that have been shown to be effective and are worth consideration
for adoption. According to Lohrmann and Wooley, effective health education
curricula should include the following eight characteristics:
_ Are research-based and theory-driven
_ Include basic, accurate information that is developmentally appropriate
_ Use interactive, experiential activities that actively engage students
_ Provide students an opportunity to model and practice relevant social
skills
_ Address social or media influences on behavior
_ Strengthen individual values and group norms that support healthenhancing
behaviors
_ Are of sufficient duration to allow students to gain the needed knowledge
and skills
76 Chapter 4: Program Planning: The Big Picture
_ Include teacher training that enhances effectiveness (1998, p. 44)
The MAPP process suggests that, at this point in the program planning
process, a report be drafted by the planning committee (NACCHO, n.d.). The
report should synthesize and outline the program planning decisions. The report
then becomes a written reference point for the program planning committee
during the program adoption and implementation processes. It can also be
shared with advisory councils, boards of directors, and the community at large.
Step 11: Plan Evaluation
By this point in the process, the development of an evaluation plan should have
been initiated. Evaluation should be designed as a continuous process so that even
the planning process itself is evaluated (Aspen Reference Group, 2002). It is important
to select evaluation methods and questions that will facilitate process, impact,
and outcome evaluation. What data need to be collected and when are they
collected are critical considerations for a comprehensive evaluation. Evaluation
instruments and record-keeping methods must be developed so that the necessary
data are available for the evaluators (Aspen Reference Group, 2002). The planner
or planners may not have the expertise and resources to conduct all phases
of the evaluation, and an outside or external evaluator may need to be consulted
(Rainey & Lindsay, 1994). If an external evaluator is needed for the project, it is
suggested that the evaluator be brought in during the planning phase to develop
the evaluation plan as early as possible in the process.
Step 12: Determine and Establish Cooperative Agreements
and Linkages with Other Appropriate Community Agencies
A successful program has at its wheel a planner who knows the importance
of politics and the necessity of working with the key decision-makers and
other community agencies at the local level. A review of the current programming
that is being offered to the target population must be conducted.
Do similar programs exist for this group? Will the program meet needs not currently
being met or addressed? Determine how the new program will differ,
strengthen, or enhance what already exists and if avenues for collaboration are
present (Fetterman, 2000; Rainey & Lindsay, 1994). Collaborative relationships
for intervention development and delivery may take many forms, including an
advisory committee, a consortium, a network, or a task force. The goal of this
relationship must be explored, as the outcome could be that of sharing information,
coordinating services for the target population, or working to advocate
for a policy or environmental change.
The following questions may help in determining if there are political
barriers to the program, and may help develop the potential for cooperative
relationships:
Program Planning Steps 77
_ What agencies and organizations are already involved with this health
concern and might perceive your program as a threat?
_ What can be done to gain the support and endorsement of those agencies?
_ Should a coalition of interested groups be formed to address the health
concern? (Rainey & Lindsay, 1994)
Step 13: Write Component-Specific Behavior and Learning
Objectives
Once the activities and strategies of the project have been identified, and possibly
purchased or developed, it may be time to reevaluate the objectives. This
reevaluation is useful to determine if the existing objectives are still adequate
for meeting the program goal or goals. An intervention often contains a number
of different components or actions that target different behaviors or environmental
factors. Each component must include objectives that are specific to
each targeted action or behavior. For example, if a program focuses on physical
activity, diet, and exercise, then a set of objectives must be developed for each
of the three sets of behaviors. One set of objectives must be targeted toward physical
activity, one toward diet, and one toward exercise. At this step in the planning
process, additional learning objectives may need to be written to reflect the
full scope of the intervention and all that it is developed to impact.
Step 14: Pilot-Test the Intervention
Prior to a full program implementation, it is suggested that a pilot test of the
intervention be conducted. A pilot test, with a small group that represents the
target population, is helpful to identify potential flaws or problems with the intervention.
The information that results from this step could result in corrections
that could save valuable resources and time later on. Common problems
that may be uncovered during a pilot test generally deal with potential flaws in
the actual design or delivery of the intervention. A process evaluation of the
pilot test that examines the intervention program, strategies, materials, and implementation
could result in information that necessitates adjustments to the
implementation (McKenzie, Pinger & Kotecki, 2002). Some questions to ask
during the process evaluation of the pilot test to determine if you need to finetune
the implementation are as follows:
_ Were program materials pretested?
_ Is the message appropriate for the target audience in terms of language,
values, and educational levels?
_ Is the message appropriate to meet the stated objectives?
_ Is the program appropriate to meet the stated objectives? (Rainey &
Lindsay, 1994)
78 Chapter 4: Program Planning: The Big Picture
_ Was the intervention implemented as planned?
_ Was the person conducting the intervention well received?
Step 15: Implement the Program
This step involves carrying out the activities that make up the intervention,
while attempting to meet objectives and, ultimately, the program goal.
Implementation can be conducted after the pilot test results are analyzed and
any resulting adjustments are made to the intervention (McKenzie, Pinger &
Kotecki, 2002). Once the program is revised, it is suggested that the program
be phased in rather than completely implemented. McKenzie and Smeltzer
(2001) offer four approaches to phasing in a program:
1. By different program offerings
2. By placing an initial limit on the number of participants
3. By choice or location within the target population community
4. By participant ability or skill level (start with beginner-level programming)
Fetro (1998) identifies several factors or program characteristics that contribute
to the successful implementation of a coordinated school health program.
These characteristics, if present, assist the planner of a community or health
promotion program in conducting a successful implementation as well. These
characteristics include a clear underlying purpose with potential outcomes; a
perceived value in addressing identified needs; adaptability; replicability; consistency
with the institution�s mission and vision; ease of implementation; credibility
with staff and the community; a capacity for broadening the knowledge
base of the target population; and the potential for the program to enhance, supplement,
or support existing programs (Fetro, 1998).
Jose and Dee decided to split their programming planning efforts by
creating two new committees. One will focus on community programming
interventions, and the other will work with the coordinated school
health program to focus on school-age youth. The coalition will continue
to exist but will meet less frequently. Some coalition members
have become members of the new planning committees. The planning
committees have broken into smaller work groups to establish budgets,
write mission statements, define goals and objectives, and research
intervention ideas.
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