NRSG 780 - HEALTH PROMOTION AND

POPULATION HEALTH
Module 8: Pro gram Planning Essentials and Models
OVERVIEW
The purpose of this module is to provide an overview of the core functions of public
health and the public health system, to examine the key elements of effectiveness-
based program planning and to introduce population-based program planning models.
O BJECTIVES
At the conclusion of this module, the learner will be able to:
 Explain the core functions of public health
 Describe key components of the public health system
 Distinguish the essential components of effectiveness-based program planning
 Utilize program planning models to develop effective interventions
R EQUIRED R EADINGS
 Office of Disease Prevention and Health Promotion (DHHS). (2014). Program
Planning: MAP-IT: A Guide to Using Healthy People 2020 in Your
Community.
 W.K. Kellogg Foundation. (2004). Logic Model Development Guide, Chapter 1
(pp. 1-14).
 Centers for Disease Control and Prevention (CDC). (2014). The Public Health
System and the 10 Essential Public Health Services.
R ECOMMENDED R EADINGS
 PRECEDE/PROCEED Section 2. (2014). In Community Tool Box (UK): Learn a
Skill.
D IRECTIONS
Read the module content and activities. Then complete the assignment for the module
CORE FUNCTIONS AND THE PUBLIC HEALTH
SYSTEM
D EFINITION OF P UBLIC H EALTH :
“What we as a society do collectively to assure the conditions in which people
can be healthy”
Institute of Medicine Report “The Future of Public Health,” 1988
E XERCISE
Watch this video to learn more about public health’s role in improving the health status
of the United States to in one generation.
Consider the following questions: (click on the question to see the answer)
  Do you think that this video is effective?
 What is missing in this video?
5
P - A P UBLIC H EALTH A PPROACH
Five key elements in a public health approach to addressing population health issues:
1. Populations
Target for intervention: the country as a whole; a specific state, county, city,
neighborhood or specific group such as people at risk or with a particular
disease
2. Prevention
Prevention Levels
o Primary
o Secondary
o Tertiary
Prevention Strategies
High-risk: focuses on identifying the relatively small number of individuals who
are at high risk in order to reduce their risk factor(s) and subsequent
development of disease
Population-based: focuses on changing behavior in large numbers of people,
most of whom have low or no risk at present, in order to prevent the
development of risk factors and disease
3. Partnerships
o Activities undertaken within the formal structure of government
o Associated efforts of private and voluntary organizations and individuals
4. Priorities
Resources are limited, therefore priorities must be established
5. Public Health Workforce
o A competent public health and personal health care workforce requires:
 Providing education and training for personnel
 Licensing professionals and certifying facilities including regular
verification and inspection follow-ups
 Continuing quality improvement and life-long learning within all
licensure/certification programs
 Partnering with professional training programs to assure community-
relevant learning experiences
 Assuring continuing education in management and leadership for
administrators and executives
P UBLIC H EALTH O BLIGATIONS OF G OVERNMENT
1. Prevent epidemics and the spread of disease
2. Protect against environmental hazards
3. Prevent injuries
 4. Promote and encourage healthy behaviors
5. Respond to disasters and assist communities in recovery
6. Assure the quality and accessibility of health services
C ORE F UNCTIONS OF G OVERNMENT IN P UBLIC H EALTH
 Assessment—identification of problems
 Policy Development—mobilization of necessary efforts and resources
 Assurance—vital conditions are in place so that crucial services can be received

Assessment
1. Monitor health status to identify community health problems
2. Diagnose and investigate health problems and health hazards in the community
Policy Development
3. Inform, educate and empower people about health issues
4. Mobilize community partnerships to identify and solve health problems
5. Develop policies and plans that support individual and community health efforts
Assurance
6. Enforce laws and regulations that protect health and ensure safety
7. Link people to needed personal health services and assure the provision of
health care when otherwise unavailable
8. Assure a competent public health and personal health care workforce
9. Evaluate effectiveness, accessibility and quality of personal and population-
based health services
Assessment—Policy Development--Assurance
10. Research for new insights and innovative solutions to health problems
T HE P UBLIC H EALTH S YSTEM
  THE SYSTEM BACKBONE: Governmental Public Health Infrastructure
 Community
 Health care delivery system
 Employers and Business
 The Media
 Academia (public health and health sciences)
Partnerships are expanding in public health and the system is growing more complex as
we tackle new problems.

Public health systems are commonly defined as “all public, private, and voluntary
entities that contribute to the delivery of essential public health services within a
jurisdiction.” This concept ensures that all entities’ contributions to the health and well-
being of the community or state are recognized in assessing the provision of public
health services.
The public health system includes:
 Public health agencies at state and local levels
 Healthcare provider
 Public safety agencies
 Human service and charity organizations
 Education and youth development organizations
 Recreation and arts-related organizations
 Economic and philanthropic organizations
 Environmental agencies and organizations
EFFECTIVENESS-BASED PROGRAM PLANNING
Beginning in the 1980s and continuing to today, program planning and implementation
has been driven by performance accountability. This stems from the fact that many
public health and human service programs are funded by tax dollars. Performance
accountability has also been embraced by many private sector organizations such as
foundations, non-profits and the United Way. Government and private sector funding
sources want to know if the programs they support work and if they do not, funds can be
redirected.
Effectiveness-based Program Planning has two foci:
Effectiveness: measurable changes occurring in organizations, communities or
systems as a result of receiving services
Program: prearranged set of activities designed to achieve defined goals and
objectives
P ROGRAM P LANNING : S TEPWISE P ROCESS
Program planning is a stepwise process that includes several critical elements.
1. Determine Need
Review quantitative data (morbidity and mortality reports, survey data,
information from available utilization databases such as Medicare and
Medicaid, insurers, health care agencies, assessing existing resources)
Review qualitative data (information from key stakeholders, focus groups,
public forums)
2. Establish a framework for action-Goals and Objectives
Goals
Characteristics of goals:
o Goals provide a sense of programmatic direction
o Goals are not necessarily achievable
o Goals should fit within the mission of the organization that offers the
program*
  * This is very important to consider since most programs are not
funded at a level that allows programs to be freestanding.
Examples of Goals

o Attain high quality, longer lives free of preventable disease, disability,

injury, and premature death
o Achieve health equity, eliminate disparities, and improve the health of all
groups
o Create social and physical environments that promote good health for all
o Promote quality of life, healthy development and healthy behaviors across
all life stages
Objectives
Outcome Objectives identify results (ends) to be achieved by program, such
as reduction in incidence and prevalence of the problem in the target population
Process Objectives identify manner (means) in which results will be achieved,
identify milestone necessary to achieve outcome objectives, such as offering
weekly screening, referral and follow-up programs for a year that will reach
5000 individuals
Characteristics of Objectives:
o Objectives should be written in clear, unambiguous terms (behavioral
language)
o Objectives should Identify expected results
o Objectives should identify measurable results
o Objectives should identify time frame within which results will be achieved
o Objective should identify achievable results based on technology,
knowledge and resources
o Objectives should identifies parties responsible for results
Example of an Outcome Objective:

Mental Health and Mental Disorders

By 2020, increase the proportion of persons with co-occurring
substance abuse and mental disorders who receive treatment for both
disorders by 10% from 3.0% to 3.3%.
Baseline: 3.0 percent of persons with co-occurring substance abuse
and mental disorders received treatment for both disorders in 2008
Target: 3.3 percent
Target-Setting Method: 10 percent improvement
 Data Source: National Survey on Drug Use and Health (NSDUH),
SAMHSA
Activities
Specific tasks that must be completed to achieve process objectives
Common Activities:
o Health communications
o Media advocacy
o Policy actions
o Initiatives at work, school, health care settings
Characteristics of Potential Activities:
oEffectiveness—evidence that when properly applied, activity can
contribute to attaining the objective
o Reach—potential for activity to reach a large portion of the target
population
o Acceptability—extent to which the target population, general public and
relevant agencies finds the activity socially and culturally acceptable
o Cost—extent to which the activity is economically feasible
o Public support—extent to which the activity has potential for engendering
positive public opinion, support for the initiative or public health and
prevention in general
3. Develop Evaluation Plan during program planning

o Types of Evaluation:
o Formative/Process—ongoing evaluation to determine if the program is
doing what it set out to do (focus on process objectives)
o Summative/Outcome—evaluation at conclusion of program to assess
accomplishments (focus on outcome objectives)
PROGRAM PLANNING MODELS
A wide range of evidence-based program planning models are available to assist you in
developing frameworks for community-based population health programs. Using
program planning models typically speeds the planning process and assists in
identifying essential elements for program success.
This module will highlight three models:
1. MAP-IT, the model for implementing Healthy People 2020
2. Logic models
3. PRECEDE/PROCEED developed by Drs. Larry Green and Marshall Kreuter
There are many others that may assist you including the Communities That Care Model
that specifically focused on preventing youth from problem behaviors, the Community
Readiness Model that is issue specific and the Healthy Cities/ Healthy Communities
Model, a citizen driven framework used extensively in international settings.
MAP-IT: A FRAMEWORK FOR PLANNING AND EVALUATING PUBLIC
HEALTH INTERVENTIONS IN A COMMUNITY

MAP-IT has five steps:

1. Mobilize individuals and organizations that care about the health of your
community into a coalition.
2. Assess the areas of greatest need in your community, and the strengths and
resources that you can tap into to address those areas.
3. Plan your approach: start with a vision of where you want to be as a
community; add strategies and action steps to help achieve that vision.
4. Implement your plan using concrete action steps that can be monitored and will
make a difference.
5. Track your progress over time.
How do you use MAP-IT?
1. Mobilize
o Consider what you want coalition partners to do and how the coalition
might be organized
o Brainstorm potential partners
o Recruit coalition members
o Create a vision for the coalition
2. Assess
o Collect locally available data about resources and needs
o Collect information from public and archival sources.
o Determine what issues are most important to community residents and
key stakeholders
o Identify community assets, including people, skills, capacity and capacity
building, space, organizations and institutions, knowledge, funds, etc.
o Based on data and community priorities, prioritize needs by consensus
o Establish baseline data
3. Plan
o Choose the issue(s) the initiative will work on
o Set clear objectives
o For each objective, develop an action plan that includes:
 A strategy and tactics
 A timeline with reasonable time targets for each phase of the
strategy
 The responsible parties and their roles and tasks
  Indicators and/or other measures of progress
4. Implement
o Identify an individual or organization to serve as the coordinating point for
the implementation of the initiative.
o Make sure that everyone involved knows what’s going on and what
everyone else is doing
o Use the media and other channels to inform the community about the
work of the initiative
5. Track
o Start your evaluation and monitoring at the very beginning of your
initiative, if possible
o Set up a system for gathering data
o Consider:
 Data Quality
 Limitations of self-reported data
 Data validity and reliability
 Data availability
o Organize and analyze data on a regular basis, so that you can make
appropriate adjustments in your work as time goes on
o Share progress and successes with the community
MAP-IT: ADDITIONAL R ESOURCES
 Healthy People 2020, a collaboration between several different organizations
with the mission of setting objectives for the health of the nation. They provide
the MAP-IT framework for Implementation, as well as many other useful
pages, including:
 Organizing a Coalition: Provides a list of important questions to consider before
organizing a coalition, in a printable format that allows you to fill out answers to
the questions and/or distribute them to a planning group.
 Potential Partners: A checklist that will help you think of all possibilities for
potential partners for your effort.
 Prioritizing Issues: An exercise that will assist you in determining which issues
it is most important for your effort to undertake.
 Community Assets: A checklist to assist you in determining community assets
that are available.
 Measuring Progress: Helpful formulas for quantitatively measuring your
progress.

L OGIC M ODEL
Basically a logic model is a systematic and visual way to present and share your
understanding of the relationships among the resources you have to operate your
program, the activities you plan, and the changes or results you hope to achieve.

When read from left to right, logic models describe program basics over time from
planning through results. Reading a logic model means following the chain of reasoning
or “If…then…” statements which connect the program’s parts. The figure below shows
how the basic logic model is read.

The purpose of a logic model is to provide stakeholders with a road map describing the
sequence of related events connecting the need for the planned program with the
program’s desired results. Mapping a proposed program helps you visualize and
understand how human and financial investments can contribute to achieving your
intended program goals and can lead to program improvements.
PRECEDE/PROCEED MODEL
PRECEDE/PROCEED: A community-oriented participatory model for creating
successful community health promotion interventions. It was among the first and is
an internationally recognized program planning model for public health.
PRECEDE/PROCEED is designed to prioritize behavioral and environmental
objectives
 Identify risk factors
 Differentiate between behavioral and environmental risk factors
 Focus on the factors most likely to achieve program objectives
 Determine the importance of risk factors
 Determine the potential for changeability
 Identify what is most important and most changeable
 Set objectives--who, what, how much, when
PRECEDE-PROCEED: 9 Phases
Five Diagnostic Phases:
1. Social Assessment
2. Epidemiologic Assessment
3. Behavioral and Environmental Assessment
4. Educational and Organizational/Educational Assessment
5. Administrative and Policy Diagnosis
Four Implementation and Evaluation Phases:
6. Implementation
7. Process Evaluation
8. Impact Evaluation
9. Outcome Evaluation
A DDITIONAL P LANNING M ODELS

The Community Tool box is a global resource for free information on essential skills for
building healthy communities. It offers more than 7,000 pages of practical guidance in
creating change and improvement.
The Community Tool Box offers practical resources for your work:
 How-to Guidance – Table of Contents
 Toolkits
 Troubleshooting guide
 Evidence-based practices – promising approaches
Check out the Community Tool Box at http://ctb.ku.edu/en