Download Designing Community Nutrition Interventions: Understanding your

Elements of Successful Nutrition &
Health Promotion Programs
Today’s Purpose
• Purpose: To provide background information
on key components of health promotion
programs to be used for consideration in
program adoption.
Outline
• Introduction to the steps used in designing
community interventions
• Discuss individual steps and key
considerations
• Examine how this looks out in the community
– Case Study
Program Planning Steps
1. Initial Planning
2
2. Formative Research
3
3. Strategy Formation
1
4
4. Program Development
5. Program Implementation
6. Evaluation
Grier, S & Bryant, C. Ann Rev Public Health, 2005.
6
5
Initial Planning
• Questions
– What is the problem you are addressing?
– What is the context in which the problem exists?
• What services/programs might already exist
– Who is your target audience(s)?
• Actions
– Set Initial Goals & Objectives
– Review Literature
– Conduct Needs/Community Assessment
– Identify Funding & Resources
– Establish Community partnership/coalition
building
WHO’S YOUR TARGET AUDIENCE?
Formative Research
• Formative research helps your organization
find its audience; understand the needs and
interests of the audience; and design
programs, services, and products that address
those needs.
•What do we know?
•What don’t we know?
•What do we want to
know?
Formative Research
• Questions
– How does your target audience think and behave
as related to the problem?
• What are their values, beliefs, attitudes, behaviors?
– What can you offer and will that appeal to the
target audience?
– How can you best reach your target audience?
– What messages, strategies, materials, programs
work best with target audience?
Understanding your Target Audience
Cost vs. Benefit
Walking your Dog
Benefits
•
•
•
•
•
Health
Refreshing
Social opportunities
Better behaved dog
Access to Parks/Trails
Costs
•
•
•
•
•
Tired / Lack of Energy
Time
Weather
Safety
Access to Parks/Trails
HOW DO WE INFLUENCE THE
AUDIENCE’S COSTS & BENEFITS?
Gathering Data
Types of Formative Data
• Primary Data
– Original data that you collect and analyze
• Secondary Data
– Information that was collected by someone else, but which
you can analyze or re-analyze
• Qualitative Data
– Data presented in narrative form that generally cannot be
expressed numerically
• Quantitative Data
– Data presented in numerical terms
Methods for Collecting Data
•
•
•
•
•
Focus Groups
Key Informant Interviews
Community Forum
Group Discussions/Interviews
Surveys
Focus Groups
• A qualitative method involving a small group
of people whose discussion is carefully
planned and led by a trained moderator
– Advantages: Relative small sample, structured questions,
creative atmosphere, clarification capability
– Disadvantages: Moderately expensive and/or time
consuming, need trained moderators, can be challenging
to analyze
Key Informant Interviews
• A qualitative method of conducting indepth interviews with a small number
of individuals carefully selected for their
personal experiences and knowledge
– In-person or telephone
– Advantages: Inexpensive (telephone), easy to
administer, can cover wide region, gain in-depth
data
– Disadvantages: Expensive (in-person), interviewer
bias, trained interviewer, maybe difficult to
analyze
Community Forums
• Large group method of collecting qualitative
information from community members that is
larger and less formal than a focus group.
– Advantages: Large N, low cost, low time, audience can
participate on own terms, identify people with increased
interest
– Disadvantages: Large N, silent majority, strong leader
(argumentative), scheduling
Group Discussions/Interviews
• A qualitative method of conducting in-depth
interviews with a small group of people; less
formal than focus group
– Advantages: Small N, high response rate, efficient
and economical, stimulate others
– Disadvantages: Intimidation, fosters conformity,
group pressure may influence responses
Surveys
• A quantitative method involving systematic
data collection from a sample of individuals
selected from a target population
– Data used to generate group-level summary
– In-person, web-based, email
– Advantages: inexpensive, anonymity, large N, easy to
administer, quantitative and qualitative data
– Disadvantages: low response rate, lengthy process, no
opportunity to clarify, restrictive answers
MIXED METHODOLOGY
Audience
Phase of Formative Research
Budget
WE’VE GATHERED AND ANALYZED
THE DATA. NOW WHAT?
Strategy Formation
Strategy Development
• Translate Data into Priorities
– Refine Goals and Objectives
• Are they measurable?
– Where & how are you going to reach your target
audience?
– Identify resources, community assets
Social Ecological Model
Utilize Resources
– Research-based program:
• incorporates strategies, activities and principles that
have been shown through scientific research and
evaluation to be effective and reliable.
– Evidence-based program:
• (a) evaluation research shows that the program
produces the expected positive results;
• (b) the results can be attributed to the program itself,
rather than to other extraneous factors or events;
• (c) the evaluation is peer-reviewed by experts in the
field;
PROGRAM DEVELOPMENT
Approach vs. Framework vs. Theory
• Framework – systematic strategy used to plan
programs
• Theory – explains food choices, nutrition related
behaviors, and how they change
– Theory gives planners tools for moving beyond intuition to
design and evaluate health behavior and health promotion
interventions based on understanding of behavior.
• Approach – describes the best way to teach
information to your target audience
Frameworks
• Logic Model
• Social Ecological Model
• Social Marketing - Systematic planning process
used to promote personal and societal welfare
– Know your target audience (formative research)
– Four P’s of marketing
• Behavior change theories are often embedded
within frameworks
Types of Theory
• Explanatory
– Explanatory theory describes the reasons why a problem exists.
– It guides the search for factors that contribute to a problem and
can be changed.
• Behavior Change
– Change theory guides the development of health interventions.
– It spells out concepts that can be translated into program
messages and strategies, and offers a basis for program
evaluation.
– Change theory helps program planners to be explicit about their
assumptions for why a program will work.
Behavior Change Theories
Social Learning Theory
• Most useful for understanding what drives behavior
& how we can influence behavior change
• Attempts to bridge the intention-behavior gap
• Reciprocal determinism – personal, behavioral, and
environmental factors work together to influence
behavior
• Outcome expectancies and self efficacy are driving
forces
Social Learning Theory Constructs
• Personal factors (thoughts and feelings)
– Outcome expectations vs. expectancies
– Self-efficacy
• Behavioral factors (knowledge and skills)
– Factual and procedural knowledge
– Cognitive and behavioral skills
– Self regulation
• Environmental factors
– Imposed vs. selected vs. created environments
– Observational learning and guided mastery
Behavior Change Theories
Stages of Change
• Describes processes people go through in
order for behavior change to occur
• Stages categorize people according to
readiness to act
• Decisional balance and self efficacy important
to move people through stages
• Activities must match the stage
Stages of Change
• Precontemplation – unaware, uninterested, uninformed
– Provide information, increase awareness
• Contemplation – considering a change in near future (6 mo)
– Motivational activities
• Preparation – ready to change in immediate future (1 mo)
– Action-oriented activities
• Action – started new behavior
– Action-oriented activities
• Maintenance – new behavior has become part of lifestyle
– Support, encouragement, reward
• Relapse – most likely to occur during action and maintenance
– use it as a learning experience
Explanatory Theory
Health Belief Model
• Most useful for designing motivational component
of education program
• Constructs
– Perceived Threat of Condition
• Severity and susceptibility
– Perceived Barriers and Benefits
• Barriers can be physical or psychological
• Benefits>barriers = action
– Self Efficacy
• Lack of self efficacy is a barrier
– Cues to Action
• External or internal
• Influence perceived threat
For more information on theories refer to the
National Cancer Institute’s Theory at a Glance.
http://www.cancer.gov/PDF/481f5d53-63df41bc-bfaf-5aa48ee1da4d/TAAG3.pdf
Approach
Experiential Learning
• Allows people to learn by doing
• Learner centered
• Role of educator is to:
– Observe
– Ask questions
– Provide feedback and support
• Role of learner is to:
– Do
– Reflect
– Apply
Experiential Learning
5. Apply
1. Experience
2. Share
4. Generalize
3. Process
Adult Learning Approach
•
Describes the best way to teach new information
to adults
Four A’s
•
–
–
–
–
Anchor: Introduce material and ground the topic to the
learner’s lives
Add: Provide the new information
Apply: Have the learners do something realistic with the
information (activity)
Away: Help learns see how they can use new
information in the future
Summary
• Frameworks, Theories and Approaches are
often used in combination
• One is not better than the other. It is
dependent on the goals and objectives.
Program Content
• Narrow the focus!
• 2 outcome objectives per 45 minutes
• No more than 3 outcome objectives per
presentation
• Reputable resources
• Age appropriate
Are the sources reputable?
• Current information
– Rule of thumb: literature should have been published or
updated in the last 5 years
•
•
•
•
Published scientific journal articles
Published professional journal articles
Textbooks
Fact sheets from other state Extension programs or
government agencies
• Websites: government (.gov), university (.edu)
• News paper articles, consumer journals/magazines,
.com and .net websites are NOT reputable sources
Is the program appropriate for the
audience?
What to consider:
• Age
• Reading level
–
–
–
–
Know your audience
Aim for 5th – 8th grade reading level
Use layman’s terms and short sentences
Check with Flesh-Kincaid reading level in Microsoft Word®
• Language
– If working with a diverse group, offer materials in the
appropriate languages
• What the audience wants (formative research)
Is the program appropriate for
preschool learners?
• Use food-based activities
• Use developmentally appropriate learning
activities and play
• Focus on behaviors
• Encourage self-regulation
• Involve parents and families
Is the program appropriate for middle
childhood and teen learners?
• Focus on behaviors children can control
• Address motivations that are meaningful and
important to the children
• Incorporate self-assessment
• Use activities (food based if possible)
• Use content appropriate for cognitive
development
• Address social norms and peer influence
• Encourage self-regulation
Is the program appropriate for adult
learners?
•
•
•
•
•
•
•
•
•
Provide specific information pertinent to their lives
Create a safe learning environment
Develop respectful relationships: power-with
Empower your learners, let them choose topics
Engage learners with activities and facilitated
discussion
Teach skills
Build on past experiences
Sequence tasks from simple to complex while
building the strength of new skills
Always end with conclusions
Implementation
Promote your program
• Does the program come with promotional
materials?
• Promotional materials should be designed and
tested specifically for your target audience
• Media: newspaper adds, flyers, newsletters,
magazines, television, radio, word-of-mouth
• Placement: place adds where your target
audience will see them
Present programs as they were
designed!
• Respect the rationale, research, time and
effort that went into designing the program
and evaluations
• Altering a program:
– Will change the content
– Will change the outcomes
– Evaluations may no longer be valid
• Al a cart presentation are designed and
evaluated piecemeal, series programs are
designed and evaluated as a full series
EVALUATION
Evaluation Basics
• Evaluation should be considered early; prior to
program development
• Purpose: to determine the extent to which a
program or intervention is effective, i.e., to
determine if it is successful or how well it
meets its objectives
• It should be conducted throughout program
development.
Types of Evaluation
• Formative
– Strengthen or improve the program being evaluated
• Needs Assessment, Implementation & Process
• Summative
– Examine the effects or outcomes of the program
• Outcome, Impact & Cost-Benefit Analysis
Characteristics of Good Evaluation
• It is objective.
– Self-assessments and subjective judgments of those responsible for a
program have low credibility.
• It is replicable.
– Someone else should be able to re-do your evaluation and get the
same results.
• It is methodologically strong.
– Confidence in the evaluation's findings; evaluation is able to resist
criticism and attack.
• Its results are generalizable.
– The results should apply to the broad range of individuals, and
situations to which the program is aimed.
What can be evaluated?
•
•
•
•
Demographics
Knowledge
Attitudes
Behavior
– Change
– Intentions
– Predictors
Ecological Model of Predictors of Childhood
Overweight
Davison KK, Birch LL. Obes Rev. Aug 2001;2(3):159-171.
Applying Evaluation Methods
• Program/Curriculum – multiple sessions
– Behavior change, knowledge, attitudes
• Presentation – one-shot
– Knowledge, attitudes, intent to change behavior
• Written Materials – newsletter, fact sheet, etc.
– Knowledge, attitudes
Logic Model
CASE STUDY:
WHAT DOES THIS LOOK LIKE IN THE
REAL WORLD
Agency X
• Agency X is a statewide initiative aimed at
reducing overweight and obesity rates and
related chronic diseases.
• A partnership among foundations, health
care organizations, non-profit organizations
and state and local public health agencies.
• Current Objective: Develop and Implement a
statewide Social Marketing campaign
• Current Organizational Budget: ~ $16 million
INITIAL PLANNING
Examining State Health Data
Disparities: Obesity
Prevalence of obesity* by race and ethnicity, Colorado Adults, 2007 BRFSS
* Body Mass Index > 30
Disparities: Fruit & Veg
Prevalence of consuming 5 or more servings of fruits and vegetables per race
and ethnicity, Colorado Adults, 2007 BRFSS
Disparities: Physical Inactivity
Prevalence of physical inactivity by race and ethnicity,
Colorado Adults, 2007 BRFSS
Income Disparities: Obesity
Prevalence of obesity* by income, Colorado Adults, 2007 BRFSS
* Body Mass Index > 30
Income Disparities: Fruit & Veg
Prevalence of consuming 5 or more servings of fruits and vegetables
by income, Colorado Adults, 2007 BRFSS
Income Disparities: Physical Inactivity
Prevalence of Physical Inactivity by Income, Colorado Adults, 2007 BRFSS
WHO ARE YOUR TARGET
AUDIENCES?
Hispanics
Audiences with Limited Resources
HOW DO WE LEARN MORE ABOUT
THESE AUDIENCES?
Focus Groups
Focus Group Results
• Expanded target audience to include women
• Resulted in strategy formation & message
– Limit emphasis on individual behaviors
– Promote social support and networks
– Make it fun
– Reach those who are ‘tweeners’
– The Power of All of Us!
– Developed storyboards for Ad campaign
Ad / Storyboard Example
Will this resonate with the
target audience?
• Will this reach who they want it to reach?
• Is the scenario representative of the target
audience?
• Are the foods culturally appropriate?
• What emotions are they appealing to?
• Will stakeholders support it?
DON’T ASSUME ANYTHING!
The only way to answer these
questions is to:
Ask the Target Audience!
WHAT ARE THE GOALS/OBJECTIVES
OF THIS AD?
What can you evaluate?
• Reach
– Individuals/Communities
– Demographics
• Recall
– Is message on target? How does it relate to goal?
– Likes/Dislikes
• Awareness building
• No change to knowledge or behavior
• Maybe attitude depending on goal
REVIEW PROTOCOL
QUESTIONS