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Skills for Health Promotion

Day One
Planning Health Promotion Programs
Evaluating Health Promotion Programs
Day Two
Influencing Policy Change and Development
Developing Health Communication Activities

The Health Communication Unit


at The Dalla Lana School of Public Health, University of Toronto
Health Sciences Building, 155 College Street, Room 500, Toronto, Ontario M5T 3M7
Telephone: (416) 978-0522 | Email: hc.unit@utoronto.ca

Skills for Health Promotion


Table of Contents
Planning Health Promotion Programs .......................................................... 3
Planning At a Glance ................................................................................................................ 5
Planning Lesson from Everyday Life ....................................................................................... 7
Sample Plan Created by the Ontario Health Program Planner ................................................ 8
Planning Health Promotion Programs Slide Show ................................................................. 33
Relationship Between Planning Types ................................................................................... 62
Programs, Strategies, Activities, Tasks (Diagram of Relationship) ....................................... 63
Type, Method, Source (Definitions and Samples) .................................................................. 64
PEEST Analysis Example Slide .............................................................................................. 65
Planning Terminology Varies .................................................................................................. 66
Components of Objectives ..................................................................................................... 67
Objectives Game Answer Key ............................................................................................... 68
Objectives Critique Exercise .................................................................................................. 76
Evidence-Informed Practice Resources Handout ................................................................... 79

Evaluating Health Promotion Programs ...................................................... 97


Evaluating At a Glance ............................................................................................................ 99
Evaluating Health Promotion Programs Slide Show ............................................................ 102
Indicator Assessment Exercise ............................................................................................. 125
Stakeholder Wheel ............................................................................................................... 133
Three Keys to Program Evaluation ...................................................................................... 134
Sources of Health Promotion Indicators .............................................................................. 135
Selecting Type of Evaluation Decision Table ....................................................................... 136
Whats Wrong with This Questionnaire Handout and Answer Key ...................................... 137

Policy Development .................................................................................... 145


Policy Development At a Glance .......................................................................................... 147
Policy Development Slide Show .......................................................................................... 149
THCUs Roadmap for Policy Development .......................................................................... 158
Comprehensive Approach to Health Promotion Slide........................................................... 159
Health Communities Framework Slide .................................................................................. 160
Policy Tobacco Case Study .................................................................................................. 161

Overview of Health Communication Campaigns ..................................... 171


Health Communication Campaigns At a Glance................................................................... 173
Health Communication Campaigns Slide Show ................................................................... 175
THCUs 12 Steps to Developing Health Communication Activities ..................................... 194
Project Breakthrough Case Study ......................................................................................... 195
Health Communication Message Review Criteria................................................................. 216

Additional Resources ................................................................................. 223


Ontario Health Program Planner Brochure .......................................................................... 225
THCU Products and Services Brochure .............................................................................. 229
Ontario Health Promotion E-Bulletin .................................................................................... 241

Planning
Health Promotion
Programs

The Six Steps to Planning a Health Promotion Program


1
Pre-Planning and Project Management

Develop a plan to manage stakeholder


participation, time, resources, data gathering and
interpretation, and decision making.
Plan to engage stakeholders, including clients
and staff, in a meaningful way.
Establish a clear timeline for creating the
workplan.
Plan how you will allocate financial, material,
and human resources.
Consider what data, including health
promotion theory, will be required to make
decisions at each step. Include adequate time in
workplan for data collection and interpretation.
Establish a clear decision-making process.

2
Conduct a Situational Assessment

Learn more about the population of interest,


trends, and issues that may affect the
implementation of your program and the wants,
needs, and assets of the community.
Types of data
Quantitative polling/survey data
Community health status indicators
Community stories/testimonials
Evaluation findings
Research findings
Cost-benefit data
"Best practices" synthesis and guidelines
Sources of data
Polling companies
Community service organizations
Community spokespersons
Journals, magazines, books
Consultants
Resource centres such as THCU
Researchers
Government departments
Private sector

3
Identify Goals, Populations of Interest,
and Objectives
Use the results of the situational assessment to
decide on goals, populations of interest, and
objectives.
Goal
A broad statement that provides overall
direction for all aspects of a program over a
long period of time
Populations of interest
The group or groups that require special
attention to achieve your goal
Objectives
Specific, measurable, attainable, realistic, and
time-limited statements about what outcomes
and processes are expected from the program
Ensure program goals, populations of interest
and objectives are aligned with strategic
directions of your organization and/or group.

Techniques & tools


Consultation with stakeholders using
individual interviews, focus groups, and/or
forums
Literature reviews
Review of past evaluation findings
Review of stakeholder mandates, agendas,
policies, and guidelines
PEEST analysis
SWOT analysis

For more
information
Workbook Page

816

1725

2637

Worksheet Page

668

6971

723

The Six Steps to Planning a Health Promotion Program


4
Identify Strategies, Activities, and
Resources

5
Develop Indicators

Use the results of the situational assessment and


available resources to select strategies and activities
that will contribute to progress toward the goals
and objectives.

Develop a list of variables that can be tracked to


assess the extent to which program objectives have
been met.

Brainstorm strategies for achieving objectives


using one or more health promotion
frameworks such as the Ottawa Charter for
Health Promotion or brainstorm activities and
look for clusters of activities that form a
strategy.
Prioritize ideas by applying situational
assessment results.
Select the best strategies then identify specific
activities for each strategy.
For existing activities, decide what to start, stop,
and continue then cluster activities into the
appropriate strategy.
Consider what financial, human and in-kind
resources are available to implement the
activities.
Decide whether some activities need to be
dropped or delayed until new resources are
found.
For more
information

For each program objective think about the


intended result.
Consider
Can the intended result be divided into
separate components?
Can the intended result be measured in some
way?
What is the appropriate time for observing a
result?
Are the sources of data required to assess this
result accessible?
Do you have the resources needed to assess
the result?

6
Review the Program Plan

Review the program plan to


clarify how each part contributes to the
objectives,
identify gaps,
ensure adequate resources are in place, and
ensure consistency with situational assessment
findings.
A logic model is a graphic depiction of the
relationship between all parts of a program (i.e.,
goals, objectives, populations, strategies,
activities and indicators). It can help with the
program review process by providing an
effective overview and communication tool.

Then
Define indicators to measure each of your
program objectives.
Perform a quality check on your proposed
indicators. Are they valid, reliable, free from
bias, and sensitive to potentially significant
changes? Modify as required.
Apply the indicators to determine extent to
which program objectives have been met.
Review indicators periodically to ensure
continued relevance for your information
needs.

Workbook Page

3848

4957

5864

Worksheet Page

746

77

87

Its a party!
Planning lessons from everyday life
How will you plan
Why are you having
the party? Who must the party? (Goal)
be consulted? How
much time do you
have to plan?
(Project
management)

What resources do
you have to put into
the party? (Inputs)

What do you have to


make or produce for
the party?
What things will
people
do/participate in at
the party? (Outputs,
Activities)

What do you think


will be different after
the party? Who? In
what way?
(Outcomes)

How will you know if


your party is a
success? (Indicators)

Nov 3, 2008
7

Sample Plan Created by the Online Health Program Planner


http://www.thcu.ca/ohpp/index.cfm
Childhood Injury Prevention Project
Step 1: Project Management
Worksheet 1.1: Understand the Context
Question

Response

Why are you going through a planning process at this


particular time?

We have just received a grant of $80,000 per year, for 4 years, from the Ministry of Health
Promotion, for doing childhood injury prevention work.

Are you modifying an existing plan or starting a new


plan?

This is a completely new plan.

What if anything, has already been decided? For


example have you decided on audience(s), issue(s),
setting(s), strategy(ies), or activities?

We know that we will be focusing specifically on childhood injury prevention. Our target age
group is 0-6. The Ministry Project Funding also dictates a focus on burns, poisoning, falls,
choking/suffocation and drowning.

What kind of content must be included in your plan?


For example, is there a template or form provided from
your potential funder?

We must meet the expectations of our health unit in terms of planning format. Thus our plan
must include a logic model. The logic model must include at least objectives, activities and
resources allocated to each activity.

Are there any other circumstances or expectations that The grant guidelines state that community stakeholders must be involved in making
may affect how you must carry out your planning
decisions about what topics to focus on. They must also be involved in helping to
process?
disseminate the messages and implement the activities that we decide to do.

What time will be available to implement the program


that you plan (including development, after planning
ends)?

We have 4 years. This must include planning and implementation time.

What financial resources (dollars) will be available to


implement the program that you plan?

$80,000 per year, for 4 years.

Are there any other circumstances or expectations that Other health units across the province are involved in planning similar efforts. We are
may affect your final program?
hoping to leverage the work and expertise of other health units, to make maximum use of
our own grant money.

English Sample Plan

May. 11 2009

page 1 of 25

Step 1: Project Management


Worksheet 1.2: Identify Stakeholder Roles and Expectations
Stakeholder Roles
Name

Interest in program/process Degree of involvement

Details of involvement

Ontario Early Years Centres

They have a mandate to protect


children while they are involved in
their programs, as well as a
mandate to assist in any way
possible, with the health and safety
of children under the age of 6.

Involved (frequently consulted or


part of the planning process)

They will be part of the newly


formed childhood injury prevention
coalition.

Emergency medical services

EMS has a mandate to support


Involved (frequently consulted or
childhood injury prevention
part of the planning process)
because childhood injuries
represent a large amount of the
work that they do. This has financial
and human cost implications.

They will be part of the newly


formed childhood injury prevention
coalition.

Children's Hospital

The hospital has a mandate to


support childhood injury prevention
because childhood injuries
represent a large amount of the
traffic that comes into emergency
rooms. This has financial and
human cost implications.

Involved (frequently consulted or


part of the planning process)

They will be part of the newly


formed childhood injury prevention
coalition. Provide input at, and
between meetings. Help with
obtaining local statistics and other
data. Help with generating contact
lists for planning advice, promotion
and implementation assistance.
Donating meeting space.

School Board

They have a mandate to protect


children while they are in school,
and a desire to do whatever they
can to help their students be as
safe as possible while under the
care of parents or other caregivers.
The School Board has children
between the ages of 4 and 6 going
to their schools.

Involved (frequently consulted or


part of the planning process)

They will be part of the newly


formed childhood injury prevention
coalition. Provide input at, and
between meetings. Help with
obtaining local statistics and other
data. Help with generating contact
lists for planning advice, promotion
and implementation assistance.
Donating meeting space.

Project Coordinator

.2 of her job is designated to lead


this project, for the next 4 years.

Core (on the planning team)

Lead the entire planning process,


implementation, and evaluation.

English Sample Plan

May. 11 2009

page 2 of 25

Name

Interest in program/process Degree of involvement

Details of involvement

Project assistant - Part Time Public


Health Nurse

.2 of her job is designated to assist


with this project, for the next 4
years.

Core (on the planning team)

Assist with managing the entire


planning process, implementation,
and evaluation.

Other health units

Many other provincial health units


have a mandate to address this
topic and this audience. Some of
them have also received
government grants to do similar
work.

Supportive (provides some form of


support)

Share all minutes. Ask for advice as


needed. As to participate on
subcommittees as is appropriate.

Appletree Childcare Centre

They want to be a leader in safe


environments for children, in the
community.

Peripheral (needs to be kept


informed)

We will keep them informed of our


ongoing planning process. If the
manager thinks there is a fit or role
for them as planning and activities
develop, she will let the project
coordinator know.

Stakeholder's Expectations
Question

Response

What overall expectations do stakeholders have in


terms of the degree of rigor and evidence that will be
incorporated into the planning process?

Medium

What overall expectations do stakeholders have in


terms of the need for new data (versus compilation of
existing data) to inform decisions throughout the
planning process?

Low

What other details are there regarding stakeholder


expectations about degree of rigor, evidence and need
for new data to inform planning decisions?

The Ministry has collected quite a bit of provincial data about childhood injury and issued a
report that serves as the background for the project. It is expected, and we are planning to
supplement that report with some local data. However, the Ministry wants most of the
money to go to implementation, rather than research.

English Sample Plan

May. 11 2009

page 3 of 25

10

Decision-Making Process
Question

Response

How will decisions be made within the core planning


group?

Another decision making process

How, specifically, will the decision-making process


work within the core planning group?

The coalition will be consulted on all major decisions. However the project coordinator
reserves the right to make the final decision. Her decisions must be approved by her health
unit manager, and supported by evidence and/or other forms of justification.

How will decisions be made outside of the core


planning group? For example, are there situations
when subcommittees will make decisions or individuals
will make decisions?

A health unit staff person will be designated as lead for every subcommittee.
Subcommittees will be discussion groups. In general, majority rules of whoever is present is
the goal. However, all major planning directions must be approved by the project
coordinator, and her manager. Thus veto of subcommittee lead is possible.

Step 1: Project Management


Worksheet 1.3: Assess Resources for Planning
Question

Response

What staff is available to participate in the planning


Two staff people and one consultant are available to participate in the planning process.
process? What is their approximate available time, and One staff person (lead, coordinator) has .2FTE for the 4 years. The other staff person (PHN
do they have any specific expertise or interests?
- to assist the lead) also has .2 FTE. The consultant will work approximately 1 day per week
(approx .2FTE equivalent) to support research and evaluation efforts related to the
program. Some of the research and evaluation work will overlap with the planning process.

Are volunteers available to aid in the planning


process? If so, how? What is their approximate
available time, and do they have any specific expertise
or interests?

At this time, there are no volunteers. All participants in the planning process are
compensated in some way, by the organization they represent, to participate in this injury
prevention work.

What partners are available to participate in the


planning process? What is their approximate available
time, and do they have any specific expertise or
interests?

Various coalition members will provide feedback that will support planning decisions. At this
point no one has stepped up offering to take on any significant role in planning other than
advice-giving. Each coalition member has agreed to attend one two-hour meeting per
month plus an additional 1.5 days per year of focused planning time.
All other health units in the province who have received government money to implement
similar childhood injury prevention strategies have agreed to work together on health
communication efforts related to this program. This is a group experienced with health

English Sample Plan

May. 11 2009

page 4 of 25

11

Question

Response
communication, but not necessarily with injury prevention. This program is a part of each of
their job descriptions - at least one day a week. Some health units have designated more
staff time to the program - up to one full FTE. Health units will contribute as much as they
can, given staff time available, to meet the collective goals of the group.

What funds are available to support the planning


process? Are these funds tagged for a specific
purpose?

50% of the budget will go to the health unit staff paid to lead and support the project (lead,
assistant, research/evaluation consultant).
Approximately $10,000 is allocated to host a community forum where community
stakeholders will be asked for various types of input to help us make planning decisions.
This event will be coordinated by the lead health unit contact, with PHN and
researcher/evaluator assistance.

What in-kind contributions are available to support the


planning process?

The room for the community forum was donated by the school board. After getting input
from the community forum participants, planning work will rest with the health unit
staff/consultant.

What kind of equipment or space is available to


support the planning process?

School board and health unit meeting rooms, computer equipment.

When can planning begin?

Apr 01 2009

When will planning end?

Aug 28 2009

What are the reasons for these deadlines and/or other Start of fiscal is April 1. This is when we will have access to the government funds, and staff
deadlines related to this planning process?
time will be available for this program. The program launch will occur in September. this is
the maximum time available for planning that will allow ample implementation of activities
during the first of four years of funding.

English Sample Plan

May. 11 2009

page 5 of 25

12

Step 1: Project Management


Worksheet 1.4: Develop Workplan for the Planning Process
Task

Lead

Time
allocated

Deadline

Budget

Other
resources

Approval
process

Gather data for


Situational
Assessment

Project
Project
researcher/evalu assistant,
ator
coalition, other
health units

4 days

Apr 14 2009

None

None

No approval
needed yet

Analyze and
Interpret data

Project
Project assistant 4 days
researcher/evalu and project lead
ator

Apr 24 2009

None

None

No approval
needed yet

Choose how to
proceed with
planning

Project
coordinator

Project assistant .5 day

Apr 27 2009

None

None

No approval
needed yet

Choose goals
and audiences

Project
coordinator

Project assistant 1 day

May 03 2009

None

Coalition
Project
meeting;
coordinator
Teleconference
with other health
units

Develop
outcome
objectives

Project
coordinator

Project assistant 2 days


and Project
researcher/evalu
ator

May 15 2009

None

None

Run by coalition
for feedback.
Project
Coordinator's
Manager must
give final 'okay'

Choose broad
program
strategies

Project
coordinator

Project
assistant,
coalition, other
health units

1 day

May 22 2009

None

None

No approval
needed yet

Brainstorm
activities

Project
coordinator

Project
assistant,
coalition, other
health units

2 days

Jun 05 2009

$200 to travel to
other health
units to discuss
options

Coalition
meeting, with
food

No approval
required yet.

Assess and

Project

Project

3 days

Jun 12 2009

$200 to travel to

Coalition

No approval

English Sample Plan

Support

May. 11 2009

page 6 of 25

13

Task

Lead

analyze activity
options

researcher/evalu assistant,
ator
coalition, other
health units

Make final
activity choices

Project
coordinator

Project
assistant,
coalition, other
health units

10

Assign
resources to
chosen
activities.

Project
coordinator

Project assistant 1
(PHN)

11

Develop Process Project assistant


Objectives for
(PHN)
Activities

12

Choose
indicators of
success

Project
Other health
researcher/evalu units
ator

13

Review and
revise overall
plan

Project
coordinator

English Sample Plan

Support

Time
allocated

Budget

Other
resources

Approval
process

other health
units to discuss
options

meeting, with
food

needed until final


activities chosen
and resources
allocated.

Jun 19 2009

None

None

No approval
needed until
resources are
assigned.

Jul 03 2009

None

None

Run by coalition
for feedback.
Project
Coordinator's
Manager must
give final 'okay'

1 day

Jul 10 2009

None

None

Project
coordinator

2 days

Jul 24 2009

None

None

Project
Coordinator's
Manager

Aug 21 2009

None

None

Run by coalition
for feedback.
Project
Coordinator's
Manager must
give final 'okay'

2 days

Project assistant 2 days


and Project
researcher/evalu
ator and other
health units

Deadline

May. 11 2009

page 7 of 25

14

Step 2: Situational Assessment


Worksheet 2.1: Develop a data gathering plan
Research Questions
Question
1

Response

What are your research questions?

WHAT IS THE SITUATION?


*What are the top causes of injury in children 0-6. Particularly in our region.
*What do local stakeholders feel are the main 0-6 injury prevention priorities?
*What is the knowledge level of child caregivers about injury risk and prevention?
*What are the attitudes of child caregivers about injury risk and prevention?
WHAT IS MAKING THE SITUATION BETTER AND WHAT IS MAKING IT WORSE?
*What are the main risk factors for childhood injuries in our region?
*What are local stakeholders in the region already doing about childhood injury prevention
(that could possibly be piggy-backed on)?
WHAT POSSIBLE ACTIONS CAN WE TAKE TO DEAL WITH THE SITUATION?
*What are other health units doing?
*What are the best or recommended practices in this area (if there are any)?

Data Gathering Plan

Type of
data

Method

Source

Additional Details

Lead

Support

Time allocated

Deadline Budget

Other
resources

Research
findings

Literature
searches and
reviews,
including
systematic
reviews

Public libraries,
Consultants,
Websites,
Resource centres
such as THCU,
Researchers

To find out knowledge and


attitudes of child caregivers about
injury risk and prevention, we are
going to get the THCU librarian to
do a literature search for us. She
uses Medline, other online
databases and searches the
internet for information. We will
retrieve relevant information from
our local library, or online, as is
possible/feasible. We will also
consult the Injury Prevention
Resource Centre to see if they
have collected any data on this

Consultant
researcher/e
valuator

Project
assistant
(PHN)

.5 day to review results of


THCU librarian literature
review1 day to retrieve
relevant documents from
the literature review1 day to
review documents
retrieved1 day to interview,
record and organize results
of researcher interview
TOTAL 3.5 DAYS

Apr 24
2009

None other
than time.

English Sample Plan

May. 11 2009

None

page 8 of 25

15

Type of
data

Method

Source

Additional Details

Lead

Support

Time allocated

Deadline Budget

Other
resources

Research/ev
aluation
consultant

Children's
hospital
coalition
member

3 days of researcher time


As needed for children's
hospital coalition member.

Apr 17
2009

None, other
than time

Access to
hospital
records and
staff to help
run the data
queries,
secured by
children's
hospital
contact.

subject. Finally, we will interview a


medical researcher at the
children's hospital who specializes
in pediatrics to see what literature
(her own, or someone else's) that
she is aware of.
2

Community
health status
indicators

Large data
sets

Community
service
organizations

We are going to get our children's


hospital contact to run data from
their records about emergency
visits and admissions related for
the age group 0-6, for the last 5
years. We will also ask them,
using postal code contact
information for the child, general
information about the incident
provided by the person who
brought the child in, and
demographic information about
the parent or person who brought
the child in (supplied upon
admission) to see whether any
obvious risk factor patterns are
evident.

Quantitative
polling/survey
data

Surveys

Community
service
organizations,
Community
spokespersons

Consultant
We are going to survey
community forum attendees about researcher/e
valuator
their experiences and feelings
about what they main 0-6
childhood injury prevention
priorities should be for this
program? We will also survey
them about injury prevention
activities that they are already
involved in. We will do this during
the forum, so we don't take up any
more of their valuable time,
outside of their forum contribution.

Project
coordinator
and PHN
assistant

4 days. 1 day to develop


and test the survey tool. 1
day to collect and enter the
data. 2 days to analyze the
data and create a report
summarizing the data

Apr 24
2009

Just
consultant
time and
the cost
associated
with the
community
forum.

Secretary to
enter the
data.
Appropriate
computer
program to
manage the
data. Both of
these things
are available
through the
health unit for
no additional
cost.

Community
health status
indicators

Literature
searches and
reviews,
including
systematic
reviews

Public libraries,
Websites,
Resource centres
such as THCU

Have THCU librarian conduct a


literature review. Search
Canadian Best Practices Portal

Project
assistant

1.5 days, split between


researcher and assistant.

Apr 24
2009

None

None

English Sample Plan

Consultant
researcher/e
valuator

May. 11 2009

page 9 of 25

16

Step 2: Situational Assessment


Worksheet 2.2: Summarize the situation

Question

Response

What is the situation? What are the trends (e.g., size,


growth), public perception, and stakeholder concerns
that describe the situation?

In Canada and other developed countries, injury is the cause of one-third of all child deaths.
Top causes of injuries in children are falls burns/scalds, poisoning, choking,
strangulation/suffocation, and drowning. This is consistent with the direction suggested at
the community forum.
A large percentage of the population feels that 'accidents' are fate and 'kids will be kids',
thus there is a need to convince the population that most injuries are predictable and
preventable.
Awareness of injury prevention measures does not always translate into behaviour.

English Sample Plan

May. 11 2009

page 10 of 25

17

Step 2: Situational Assessment


Worksheet 2.3: Analyze influences on the situation
Factor

Factor
Level of
short form influence

Direction of
influence

In top three
priorities?

Source

Directions or conclusions

Children who live with a single


part have a greater risk of injury.

Single parent

Network

It is making the
situation worse

Yes

CAPC Injury Prevention


Fact Sheet
http://www.connectionspr
ogram.ca/capccpnp/impactstatements_e
n/is_injuryprev_vf.pdf

Yes, we should be considering specific supports


for single parents that will reduce the change of
childhood injury. We may need to collect more
information on why single parent families
experience more injuries, to do this.

The health unit for the


Existing MM
neighbouring region, where many Campaign
of our residents commute to, has
already begun a chidhood injury
prevention mass media
campaign.

Organizational

It is making the
situation better

Yes

Boys are at a greater risk of


dying than girls.

Child gender

Individual

It is making the
situation worse

Don't Know

Ontario Injury Prevention


Resource Centre report
http://www.oninjuryresour
ces.ca/Publications/Comp
ass/

We may want to consider developing slightly


different messages for parents of boys and girls,
to appeal to both groups.

Childhood poverty is closely


linked with childhood injury.

Poverty

Societal
(includes
political,
economic,
environmental,
technological
considerations)

It is making the
situation worse

Don't Know

Facts on Injuries. Public


Health Agency of Canada
http://www.phacaspc.gc.ca/injurybles/index-eng.php

Yes, this indicates that specific, and tailored


efforts to work with caregivers of low income
children, should be a very important part of our
work.

English Sample Plan

May. 11 2009

Yes, we will want to build on their work and


findings, not replicate or compete in any way.

page 11 of 25

18

Force Field Analysis

Factors that
make
the

>
Existing MM Campaign (top
factor)

Societal (Media, Political, Economic,


Social, Technological Environments)

Poverty
<

the
>

Organizational environment

<

>

Networks, including friends and family


environment

<

>

Individuals

<

situation

BETTER

English Sample Plan

Factors that
make

May. 11 2009

Single parent (top factor)

situation

Child gender

WORSE

page 12 of 25

19

Step 2: Situational Assessment


Worksheet 2.4: List possible actions
Possible action

Source of idea

Additional details

Information about
effectiveness

Curriculum
development

The Canadian Best


Practices Portal for
Health Promotion and
Chronic Disease
Prevention

Risk Watch is a school-based, comprehensive injury prevention


program developed by the US National Fire Protection Association
(NFPA) and adapted for use in Canada by SmartRisk with funding from
the Ontario Fire Marshal's Public Fire Safety Council and others. The
program links teachers with community safety experts and parents. The
curriculum is divided into five age-appropriate teaching modules (PreK/Kindergarten, Grades 1-2, Grades 3-4, Grades 5-6, and Grades 7-8),
each of which addresses eight topics: motor vehicle, bike/pedestrian,
and water and ice safety, the prevention of poisoning and injuries from
falls/in playgrounds, firearms, choking/strangulation/suffocation, and
fires/burns. A ninth lesson brings together concepts in a culminating
activity. The topics cover the areas of greatest risk of unintentional
injury for children age 14 and under. [From Canadian Best Practices
Portal for Health Promotion and Chronic Disease Prevention]

According to the portal,


this has been evaluated
using: Analytic
Observational study
including: Cohort studies,
case control studies,
repeated
measures/interrupted time
series

Physician Screening

Another health unit


suggested this.

We need to research whether there is an existing, valid screening tool


that physicians could use.

None yet.

Peer support strategy


in lower income areas
where many children
live

A member of our
coalition

We have not through this through in much detail.

We do not know of any


other example of someone
trying a program like this.

Mass Media
Campaign

The neighbouring
Given our budget, we will be looking at lower budget materials if we do
region is already doing this activity - mostly print, web. Possibly radio. We hope that we will be
on. The Ministry
able to borrow or adapt materials developed by others.
Program Standards
indicate that we must
do some kind of
communication
campaign relating to
this topic area.

English Sample Plan

May. 11 2009

We do not know of any


well evaluated childhood
injury prevention mass
media campaigns. Any
information we have about
the effectiveness of other
similar efforts is anecdotal.

page 13 of 25

20

Step 2: Situational Assessment


Worksheet 2.5: Consider how to proceed

Question

Response

What are the gaps in data quality or quantity, relative to


stakeholder expectations, that may restrict your ability
to make evidence-based decisions about goals,
audiences, objectives, strategies, activities and
resources?

We have good data about the situation to help us identify potential audiences and topics.
We understand the trends and many of the risk factors.
We would like some more data about why low income and single parents experience
greater rates of injuries among their children. We can speculate, but would like to check for
more hard data.
Some good activity ideas have been put forward, but we need more information about the
potential effectiveness of these potential activities. In cases where we have some
effectiveness data, we would like to have a closer look at whether they are appropriate for
our community (For example, will stakeholders buy in? how much work would need to be
done to tailor the materials?)

What is your current perception about your ability to


have an impact on the situation with available time,
financial resources and mandate?

We think we can afford to do a mass media campaign, using mostly print materials if we
work together with other health units. This will save us money on development costs and
hopefully allow us to purchase materials and media time in bulk.
We think we have the resources to do one other activity. We just need to prioritize our
ideas. Ideally, this would be a more upstream activity, influencing core risk factors (e.g.
single parent living situations) rather than just raising awareness. However, we are not sure
we have the resources to do this.

What are your next steps in the planning process? Will


you proceed now, or must you revisit research
questions, project scope or resources?

We need to do more research to see whether there is research that speaks to the specific
situations that cause low income and single parent households to experience more injuries.
We also need to do more research into the effectiveness, appropriateness and resources
required to implement the potential activity ideas that have been raised.

English Sample Plan

May. 11 2009

page 14 of 25

21

Step 3: Set Goals, Audiences, and Outcome Objectives


Worksheet 3.1: Set Goals, Audiences, and Outcome Objectives
Goals
Question
1

What is your goal?

Audiences
Question
1

Which audiences will require special attention to meet


your goal?

Response
Reduce the number of childhood injuries and deaths in the region.

Response
Parents, children and childcare providers

Outcome objectives
1

To increase by 50% parents who have confidence that they can reduce the chance of their child suffering from an injury or worse by March 2010
(medium-term)

To increase by 50% parents who are aware of the rates and types of injuries among children 0-6 by March 2010 (medium-term)

To increase by 50% parents who are aware of the recommended actions or household changes needed to reduce the risk of childhood injury by
March 2010 (medium-term)

To increase by 50% parents who believe most childhood injuries are preventable, rather than 'accidents' or 'fate' by March 2010 (medium-term)

To increase by 50% parents who have implemented at least 75% of the items on the Injury Prevention in the Home Checklist by March 20011 (longterm)

English Sample Plan

May. 11 2009

page 15 of 25

22

Step 4: Choose Strategies and Activities and Assign Resources


Worksheet 4.1: Choose Strategies and Brainstorm Activities
Strategy

Activity

Create supportive environments

Peer screening and training program

Build healthy public policy


Health Communication

Campaign to raise awareness and change beliefs about the effectiveness of prevention

Self-help/mutual support
Community mobilization
Develop personal skills

curriculum development and delivery for children aged 4-6

Education/information
Strengthening health services

English Sample Plan

Have physicians screen patients with children 0-6, using standard injury risk checklist

May. 11 2009

page 16 of 25

23

Step 4: Choose Strategies and Activities and Assign Resources


Worksheet 4.2: Assess and Choose Activities
Potential
Activity

Include Strategy
in final
plan?

Information about
expected effectiveness

Information about
audience
appropriateness

Required resources

Available resources

Peer screening
and training
program

Yes

Create
supportive
environments

We have not been able to find another


program that has done this exact
thing. But there are many examples of
peer programs on other topics
(nutrition, smoking, parenting) that
have been proven effective. We
believe this is a strong indication that
this idea could be very effective if
done correctly.

There are many


neighbourhoods with clusters
of lower income families,
many with single parents. We
believe it would be relatively
easy to engage at least one of
these communities in a
strategy like this.

The resources required for


this strategy are primarily
time. A moderate budget for
printing materials and
supporting, compensating and
rewarding peer volunteers for
their efforts would be the
primary expense.

Because volunteers would be


involved with implementing
this strategy, and there are
health unit staff available who
could take on training and
monitoring of the peer
volunteers, we think this is a
very feasible strategy.

Campaign to
raise
awareness and
change beliefs
about the
effectiveness of
prevention

Yes

Health
Communication

In general, we know that health


communication campaigns can
change awareness and attitudes and
even behaviours. We don't know of a
childhood injury prevention campaign
that has been well evaluated, but we
know quite a lot about evidence-based
practices in terms of planning a
campaign (audience analysis, testing
materials in advance, etc.).

Campaigns should be tailored


to the needs of a specific
community. We would use
resources to test and tailor the
materials so that they were
appropriate for the
community.

Campaigns costs can vary


widely depending on the cost
of material development and
the types of vehicles chosen.
We know that we would be
restricted to print and web
vehicles because of our
budget.

We know that we would be


restricted to print and web
vehicles because of our
budget. We feel that we could
do a credible, effectiveness
campaign using only those
vehicles, with creativity, and
the support of neighbouring
health units.

curriculum
Yes
development
and delivery for
children aged 46

Develop
personal skills

There is a program that has been


tested, evaluated, and shown to be
effective at changing awareness and
behaviours of children 4-6.

We have examined the


materials for the program that
was tested and believe that
they can be adapted very
easily for our community.

Adaptation costs should be


minimal. Printing costs will be
the primary expense. Time
will also be required by health
unit staff to promote and
disseminate the materials to
teachers and community
members. There will also be
mailing costs.

We can allocate part of our


grant money to this budget.
We think there is health unit
staff available (in the schools
program) to lead on promotion
and dissemination.

Have
physicians
screen patients
with children 06, using
standard injury
risk checklist

Strengthening
health services

We don't know of anyone who has


done this precise thing. But we know
that physicians are a highly credible
source to most members of the
population. We suspect high success
if we can get physicians on board.

We think this is very


appropriate for our
community. The question is
whether we can get
physicians on board.

This would be a relatively low


cost activity. The main
challenge will be reaching and
engaging physicians who are
already busy with many other
things.

We have a health services


person at the health unit, with
good physician connections,
who could take on distribution
of our materials to physicians.
We will only do this activity if
we can find an existing
screening tool that has been
tested. We do not have the
resources to develop a new
one ourselves.

No

English Sample Plan

May. 11 2009

page 17 of 25

24

Step 4: Choose Strategies and Activities and Assign Resources


Worksheet 4.3: Assign Resources and Outcome Objectives
Activity

Peer screening and training program

curriculum development and delivery


for children aged 4-6

Campaign to raise awareness and


change beliefs about the effectiveness
of prevention

Strategy

Create supportive environments

Develop personal skills

Health Communication

Medium-term
objectives

2, 3, 4

2, 3, 4

2, 3, 4

Long-term
objectives

Resources

.2 FTE from health unit staff person (over


and above grant money and staff people
already allocated to the program) to
develop materials and processes. Plus
$10,000 of year one grant money for
printing materials that will be used the
following year. Another $6,000 from years
two, three and four grant money to recruit
train and otherwise support the peer
program participants. $2,000 from grant
money in years 2,3,4 to evaluate.

.2 FTE from health unit staff person (over


and above grant money and staff people
already allocated to the program) to adapt
materials and processes from the
previously developed program noted on
the Canadian Best Practices Portal. Plus
$10,000 of year one grant money for
desktopping and printing materials that will
be used the following year. Another $6,000
from years two, three and four grant
money for the health unit staff person to
promote and disseminate the curriculum
materials. $3,000 from grant money for
years 2,3,4 for evaluation of this effort.

Short-term
objectives

.25 FTE from a health unit staff person


(over and above grant money and staff
people already allocated to the program) to
develop materials.
This will be done in conjunction with other
health units to facilitate collaboration and
cost sharing.
Plus $20,000 of year one grant money for
developing and printing materials that will
be used the following year. Another
$20,000 from years two, three and four
grant money to produce the rest of the
materials and disseminate them, as per
campaign plans.
Another $5,000 in year two and $7,000 in
years three and four will be allocated to
evaluate this effort.

Outcome Objectives List


English Sample Plan

May. 11 2009

page 18 of 25

25

[1] To increase by 50% parents who have confidence that they can reduce the chance of their child suffering from an injury or worse by
March 2010 (medium-term)
[2] To increase by 50% parents who are aware of the rates and types of injuries among children 0-6 by March 2010 (medium-term)
[3] To increase by 50% parents who are aware of the recommended actions or household changes needed to reduce the risk of
childhood injury by March 2010 (medium-term)
[4] To increase by 50% parents who believe most childhood injuries are preventable, rather than 'accidents' or 'fate' by March 2010
(medium-term)
[5] To increase by 50% parents who have implemented at least 75% of the items on the Injury Prevention in the Home Checklist by
March 20011 (long-term)

Step 4: Choose Strategies and Activities and Assign Resources


Worksheet 4.4: Develop Process Objectives
Process Objective

Activity [Strategy]

To produce 4 peer training sessions for peer advisors by March 2010

Campaign to raise awareness and change beliefs about the effectiveness


of prevention [Health Communication]

To produce 300 curriculum packages for teachers of children 4-6 for


teachers by March 2009

curriculum development and delivery for children aged 4-6 [Develop


personal skills]

To produce 1 interactive website with 3 quizzes and many other materials Campaign to raise awareness and change beliefs about the effectiveness
for parents by March 2010
of prevention [Health Communication]

To produce 4 newspaper advertisements for parents by March 2010

Campaign to raise awareness and change beliefs about the effectiveness


of prevention [Health Communication]

To produce 2 radio ads for parents by March 2010

Campaign to raise awareness and change beliefs about the effectiveness


of prevention [Health Communication]

English Sample Plan

May. 11 2009

page 19 of 25

26

Step 5: Develop Indicators


Worksheet 5.1: Develop Outcome Indicators
What will you
measure?

For which of your


outcome
objectives would
you like to
develop an
indicator?

Where is the data


available?

Are there any


concerns about
the reliability of
this indicator?

Are there any


concerns about
the validity of this
indicator?

Are there any


limitations on
accessibility for
this indicator?

change in self reported


implementation of
various safety measures
(pre/post)

To increase by 50%
parents who have
implemented at least
75% of the items on the
Injury Prevention in the
Home Checklist by
March 20011 (longterm)

Annual survey
conducted by PHAC,
across Canada

No

They may tell us what


we want to hear

We can get the data


from the national survey,
for our region only, but
the sample size is on
the small side. Plus it
will cost money to
access the data.

opinion about what


percentage of childhood
injuries are preventable

To increase by 50%
parents who believe
most childhood injuries
are preventable, rather
than 'accidents' or 'fate'
by March 2010
(medium-term)

survey

No

No

Same as noted for other


surveys

responses from parents


on open ended survey
question - one question
for each of the most
common injuries

To increase by 50%
parents who are aware
of the recommended
actions or household
changes needed to
reduce the risk of
childhood injury by
March 2010 (mediumterm)

we would have to collect


this by survey

No

No

It will be expensive to
get a representative
sample of the
community. Phone
survey would probably
be the only way to do
this. Also, there may be
language barriers if we
only do an English
questionnaire. We may
have to eliminate people
who do not speak
English well, and they
may be our primary
target audience.

responses from parents


on multiple choice
survey of most common
injuries

To increase by 50%
parents who are aware
of the rates and types of
injuries among children
0-6 by March 2010
(medium-term)

survey

No

No

ditto, points raise for


other survey questions

English Sample Plan

May. 11 2009

Include in final
plan?

page 20 of 25

27

What will you


measure?

For which of your


outcome
objectives would
you like to
develop an
indicator?

Where is the data


available?

Are there any


concerns about
the reliability of
this indicator?

Are there any


concerns about
the validity of this
indicator?

Are there any


limitations on
accessibility for
this indicator?

parent confidence in
their ability to prevention
injuries

To increase by 50%
parents who have
confidence that they can
reduce the chance of
their child suffering from
an injury or worse by
March 2010 (mediumterm)

we would have to do a
survey

No

No

ditto, points raised for


other survey questions

Include in final
plan?

Step 5: Develop Indicators


Worksheet 5.2: Develop Process Indicators
What will you
measure?

Process objective
related to this
indicator

Where is the data


available?

Are there any


concerns about
the reliability of
this indicator?

Are there any


concerns about
the validity of this
indicator?

Are there any


limitations on
accessibility for
this indicator?

What percentage of the


target population
reported hearing the
radio ads

To produce 2 radio ads


for parents by March
2010

Telephone survey

No

Must ask both aided and


unaided awareness of
avoid people saying
they saw it, when they
did not

This is an expensive
undertaking, to get a
random sample

What percentage of the


target population
reported seeing the
newspaper
advertisements?

To produce 4
newspaper
advertisements for
parents by March 2010

Telephone survey

No

Must ask both aided and


unaided awareness of
avoid people saying
they saw it, when they
did not

This is an expensive
undertaking, to get a
random sample

Focus group
respondent's opinions
about the website

To produce 1 interactive
website with 3 quizzes
and many other
materials for parents by
March 2010

We must collect it

No

No, we have the money


We have to be careful
to do focus groups.
about interpretation of
results. Just because
they say they like it,
doesn't mean it is
effective, or that they will
use it. Also, focus
groups are not
generalizable to the
entire population

English Sample Plan

May. 11 2009

Include in final
plan?

page 21 of 25

28

What will you


measure?

Process objective
related to this
indicator

Where is the data


available?

Are there any


concerns about
the reliability of
this indicator?

Are there any


concerns about
the validity of this
indicator?

Are there any


limitations on
accessibility for
this indicator?

What was the cost per


unit of the curriculum
packages

To produce 300
curriculum packages for
teachers of children 4-6
for teachers by March
2009

Our own records

No

No

No

How did participants feel


about the sessions?

To produce 4 peer
training sessions for
peer advisors by March
2010

Satisfaction surveys
following the sessions

No

They may be shy or


worried about telling us
if there was something
they did not like.

Some people don't fill in


these surveys.
Especially people who
leave early.

How many people


attended the peer
training sessions

To produce 4 peer
training sessions for
peer advisors by March
2010

Our own records

No

No

No

How many training


sessions happened?

To produce 4 peer
training sessions for
peer advisors by March
2010

Our own tracking

No

No

No

Include in final
plan?

Step 6: Review the Plan


Worksheet 6.1: Review your plan
Question

Yes/No

COMPLETENESS: Is there a broad goal giving direction to the


program (worksheet 3.1)?

Yes

COMPLETENESS: Does it have audiences including individuals,


networks, organizations and/or governments (worksheet 3.1)?

Yes

COMPLETENESS: Does it include SMART (specific, measurable,


appropriate, realistic and time-limited) outcome and process objectives
(worksheets 3.1 and 4.4)?

Yes

COMPLETENESS: Does it include a few major strategies identified to


advance the outcome objectives and do these strategies reflect your
overall guiding health promotion strategy (worksheet 4.1)?

Yes

English Sample Plan

May. 11 2009

Notes and potential actions

page 22 of 25

29

Question

Yes/No

COMPLETENESS: Does it include activities that fall within clearly


defined strategies (worksheets 4.1 and 4.2)?

Yes

COMPLETENESS: Does it indicate what resources are required to


implement each activity properly (worksheet 4.3)?

Yes

COMPLETENESS: Does it include indicators for both outcome and


process objectives (worksheets 5.1 and 5.2)?

Yes

COMPLETENESS: Are all indicators accessible, reliable, and valid?

Yes

LOGIC: Will the short-term objectives contribute to your medium and


long-term outcome objectives (worksheet 3.1)?

Yes

10

LOGIC: Will the strategies contribute to meeting the goals and


objectives (worksheets 3.1 and 4.1)?

Yes

11

LOGIC: Are the activities the best ones to advance each strategy
(worksheets 4.1 and 4.2)?

Yes

12

LOGIC: Are the activities appropriate for the audience(s) (worksheets


3.1 and 4.2)?

Yes

13

LOGIC: Are there adequate resources in place to properly implement


the activities?

Yes

14

ALIGNMENT WITH SITUATIONAL ASSESSMENT: Is your plan


consistent with the key findings of the situational assessment? In
particular, does your program plan take the major influences on your
situation into account (worksheet 2.3). this check for alignment should
also include a review of any new data that arose during the planning
process.

Yes

15

ALIGNMENT WITH SITUATIONAL ASSESSMENT: Will stakeholders


be satisfied? ( worksheet 1.2)

Yes

16

PRESENTATION: Is it user-friendly and easy to follow?

Yes

17

PRESENTATION: Is it easy to follow the arrows and/or flow of logic?

Yes

18

PRESENTATION: Is there enough white space?

Yes

19

PRESENTATION: Is it presented in an order that is useful for you and


your stakeholders?

Yes

English Sample Plan

May. 11 2009

Notes and potential actions

page 23 of 25

30

Logic Model
Goal(s)

Reduce the number of childhood injuries and deaths in the region.

Audience(s)

Parents, children and childcare providers

Long-term
outcome
objectives

To increase by 50% parents who have implemented at least 75% of the items on the Injury Prevention in the Home
Checklist by March 20011 (long-term)

Medium-term
outcome
objectives

To increase by 50% parents who have confidence that they can reduce the chance of their child suffering from an injury or
worse by March 2010 (medium-term)

To increase by 50% parents who are aware of the rates and types of injuries among children 0-6 by March 2010 (mediumterm)

To increase by 50% parents who are aware of the recommended actions or household changes needed to reduce the risk of
childhood injury by March 2010 (medium-term)

To increase by 50% parents who believe most childhood injuries are preventable, rather than 'accidents' or 'fate' by March
2010 (medium-term)

Short-term (and
other) outcome
objectives
.

Strategies

Create supportive environments

Health Communication

Activities

Peer screening and training program

To produce 4 peer training sessions


for peer advisors by March 2010

Campaign to raise awareness and


change beliefs about the
effectiveness of prevention

To produce 1 interactive website with 3 quizzes and many other materials


for parents by March 2010

English Sample Plan

Develop personal skills

Process
objectives

May. 11 2009

curriculum development and delivery


for children aged 4-6

To produce 300 curriculum packages


for teachers of children 4-6 for
teachers by March 2009

page 24 of 25

31

Resources
allocated

.2 FTE from health unit staff person (over


and above grant money and staff people
already allocated to the program) to
develop materials and processes. Plus
$10,000 of year one grant money for
printing materials that will be used the
following year. Another $6,000 from
years two, three and four grant money to
recruit train and otherwise support the
peer program participants. $2,000 from
grant money in years 2,3,4 to evaluate.

English Sample Plan

.25 FTE from a health unit staff person


(over and above grant money and staff
people already allocated to the program)
to develop materials. This will be done in
conjunction with other health units to
facilitate collaboration and cost sharing.
Plus $20,000 of year one grant money for
developing and printing materials that will
be used the following year. Another
$20,000 from years two, three and four
grant money to produce the rest of the
materials and disseminate them, as per
campaign plans. Another $5,000 in year
two and $7,000 in years three and four
will be allocated to evaluate this effort.

May. 11 2009

.2 FTE from health unit staff person (over


and above grant money and staff people
already allocated to the program) to
adapt materials and processes from the
previously developed program noted on
the Canadian Best Practices Portal. Plus
$10,000 of year one grant money for
desktopping and printing materials that
will be used the following year. Another
$6,000 from years two, three and four
grant money for the health unit staff
person to promote and disseminate the
curriculum materials. $3,000 from grant
money for years 2,3,4 for evaluation of
this effort.

page 25 of 25

32

Introduction to Health
Promotion Planning

155 College Street


Room 500
Health Sciences
Building
University of Toronto
Toronto, Ontario
M5G 3M7
Tel (416) 978-0522
Fax (416) 971-1365
E-mail:
hc.unit@utoronto.ca
www.thcu.ca

What is planning?

Planning is a series of decisions,


from general strategic decisions
(e.g., identifying priorities),
to specific operational details
(e.g., program implementation) ,
based on the collection and analysis
of a wide range of information.
2

Why plan?

To get from your starting point to your


desired end point.
To help direct resources to where they will
have the greatest impact.
To ensure the development and
implementation of effective and appropriate
health promotion programming.
3

33

Levels of planning

Strategic

Program

Operational / Work / Action


4

Components of planning

Strategic Planning
Vision
Mission
Values / Beliefs / Guiding Principles
Strategies

Population(s)
Goals & Objectives
Activities

Program Planning

Details - $, timeframe, roles

Operational Planning
5

Relationship between planning types

Reason

Strategic

Program

Operational

Mission, vision,
values, strategic
direction

Program goals,
objectives,
activities

Roles, resources,
deadlines for
specific activities

Scope

3-5 years

1 per year

Day to Day

Time

Extensive, months
Extensive
(but not yearly)

Varies, but
Varies
usually weeks

Days

Dollars

Research and
consulting fees

Info gathering,
consultations,
consultants

Within regular
resources

Stakeholders

Board driven;
Consider competitors
and allies

Staff/mgmt
driven; Consider
audience

Internal org;
Consider suppliers
of goods, services

Data

Broad search

Audience
analysis, best
practices, evals

Budget and other


routine info
6

34

Check -in

Purpose
Process
Proceed?
Evaluation forms
Other logistics
Toolkit
Your evaluation and policy initiatives

Step One: Pre-planning and


project management

Develop a plan to manage:

stakeholder participation,
time,
resources,,
data gathering and interpretation, and
decision-making

35

Step One Cont

TIPS
-involve stakeholders in a meaningful way
-consider what data, including theory will be
required
i d to make
k decisions
d i i
at each
h step
-establish a clear decision-making process
from the start

10

Step Two: Conduct a situational


assessment

Learn more about the population of interest,


trends, and issues that may affect the
implementation of your program and the
wants, needs and assets of the community

11

Step Two Cont

TIPS
-use a variety of:
*types of data (e.g. Best practices,
evaluation
l i findings),
fi di
)
*sources of data (government, books,
resource centres), and
*methods (consultation, PEEST, literature
reviews) to answer your research questions
12

36

Step Three: Identify goals,


populations of interest, and
objectives

Use the results of the situational assessment


to decide on goals, populations of interest,
and objectives

13

Step Four: Identify strategies,


activities and resources

Use the results of the situational assessment


and available resources to select strategies
and activities that will contribute to progress
toward the goals and objectives

14

15

37

16

Step Four Cont

TIPS
Draft your strategies using a health promotion
framework such as the Ottawa Charter
Prioritize ideas by applying situational
assessment results, considering evidence, and
assessing resources to do the activities properly

17

18

38

Step Five: Develop Indicators

Develop a list of measurements that can be


tracked to assess the extent to which
program objectives have been met (both
process and outcome indicators)

19

Step Six: Review the Program


Plan

Review your plan for:


Completeness
Logic
L i
Alignment with the results of your situational
assessment
Overall presentation or look

20

Step Six Cont

TIPS
One of the best ways to do this is with a logic
model.
A logic model is a graphic depiction of the
relationship between all parts of a program. In
addition to helping with the program review
process, it can be a useful tool for
communicating with stakeholders.

21

39

Online Health Program Planner

www.thcu.ca/ohpp
Worksheets and advice to help you:
Plan your program in a systematic, evidenceinformed way
Create a logic model
Write complete outcome objectives
Develop a structured situational assessment plan
Organize situational assessment data
Prioritize a long list of possible activities
Reflect on your critical planning decision
23

40

The Objective
Builder Worksheet
is an example of a
table-style
worksheet (please
see webcast
b t 4 for
f
more information).
The table is
generated as you
repeat through a
series of questions.
One row = one
objective

The Freehand
side is good for
advanced users
who already
know how to
write good
objectives

Switch
Back to
Builder

Switch back and


forth as you
wish between
the builder and
the freehand
writer.

Situational Assessment

27

41

What is a situational assessment?

A snapshot of the present used to plan for


the future.

28

Why conduct a situational


assessment?

To learn more about population of interest


(i.e., who's affected by your health issue).
To anticipate trends and issues that may
affect the implementation of your program
program.
To identify community wants, needs, assets
To set priorities

29

Situational Assessment Process

1.
2.
3.
4
4.
5.
6.

Develop research questions.


Develop data gathering plan.
Collect data.
O
Organize
i and
d summarize
i data.
d t
Communicate key findings.
Consider how to proceed with planning

30

42

1. Develop Your Three Key


Questions

1. What is the situation? (consider trends,


public perception, stakeholder concerns,
etc.)
2
2.
What is making the situation better and
what is making it worse?
3. What possible actions can you take to
deal with the situation?

31

About Theory

Changing Behaviours: A Practical Framework


www.thcu.ca

Tipsheet: Summaries of Social Science


Theo ies
Theories
www.thcu.ca

Theory at a Glance
http://www.cancer.gov/PDF/481f5d53-63df41bc-bfaf-5aa48ee1da4d/TAAG3.pdf
32

2. Develop your data collection


plan

Find answers to your research questions by:


collecting various TYPES of data;
using
i a combination
bi i off METHODS;
METHODS and
d
tapping into various SOURCES.

33

43

Types of Data

Community health status indicators


Quantitative polling/survey data
Community stories/testimonials
Evaluation findings
Research findings
Cost-benefit data
"Best practices" synthesis and guidelines
Environmental scan
Stakeholder mandates, agendas, policies,
guidelines, etc.
Other

34

Methods
Consultation with stakeholders (face-to-face, using
individual interviews, focus groups, and/or forums,
etc.)
Surveys
Literature
Lit t
searches
h and
d reviews,
i
including
i l di
systematic reviews
Large data sets
Other

35

Sources of Data

Community service organizations


Polling companies
Community spokespersons
Public libraries
Consultants
Websites
Resource centres such as THCU
Researchers
Government departments
Private sector

36

44

37

Tips for developing your data


collection plan

Make sure your data collection tasks will


show the positive
Include tasks that gather meaningful input
from the audience(s)
Gather data that will help you understand
the issue broadly and deeply;
Collect enough data to develop a complete,
convincing, credible and compelling picture.
38

Tip review your data collection


plan through a PEEST lens

A PEEST analysis examines Political,


Economic, Environmental, Social and
Technological trends affecting your potential
program.
program
Ensure your data collection plan will give you
information about all elements of a PEEST
This will help you understand the situational
broadly, and deeply
39

45

40

Tip-Use Qualitative and


Quantitative Data

Talk to people to understand the true


"meaning" behind the numbers.
Numbers may tell you what is happening
happening,
but will not tell you why it's happening.

"Not everything that can be counted counts,


and not everything that counts can be
counted. Albert Einstein
41

Evidence where do I find it?

There are many definitions of evidence.


Regardless of the definition you choose, you
need evidence!
Here is a good list of sources of evidence
evidence.
http://www.thcu.ca/infoandresources/planning_r
esources_soe.cfm?ownership=ALL

Make sure your data collection plan includes


consulting at least some of these sources!
42

46

3. Collect data

Make sure the people collecting data have


the right skills
Keep good records about where the data
came from so that you can weight it
accordingly
For example consider:
Was the study published in a peer-reviewed
journal or an unpublished report? Who analyzed
the information researchers or community
members?

43

Tip

It may take some digging to find


unpublished reports, but it is worth it!
Often these reports contain useful
information about what worked and what did
not work.
They can prevent you from repeating the
mistakes of others. planning process.

44

4. Organize and summarize data for


each of your research questions

Summarize the situation


Analyze influences on the situation
List possible actions

45

47

Summarize the situation


(research question 1)

Select the most significant findings, so that


you can develop a concise summary in as
little as one paragraph, or five to six bullet
points.
points
To supplement your short summary, you
may wish to compile additional background
documents.

46

In your summary of the situation,


include insights about:

the size and growth of the situation;


the burden and impact of the program;
public perception of the problem;
stakeholder perceptions and concerns; and
the potential results of acting now, soon and
in certain ways.

47

Tip

Keep track of findings that suggest any


directions or conclusions related to planning
steps 3 and 4 where you will make
decisions about program goals
goals, objectives
objectives,
audience(s), promising strategies and
activities.

48

48

Suggested method of organizing


for forces (research question 2)

For individuals the bottom line is maintaining


a personal behaviour change.
For networks the desired impact is to create
social change through opinion leadership and
social influence.
For organizations the desired impact is to
change policies .
For society the desired impact is to change
its formal laws.
49

Analyze influences on the


situation (research question 2)

Influences may be called forces, or


sometimes a factor.
These are people, circumstances or
environments that influence the situation
situation,
either for better or worse.

50

Possible ways to analyze and sort


the influences

Is it making the situation better, or worse?


At what level of the environment does this
factor influence the situation individual,
network,, organizational,
g
, or societal?
How significant is the factor?
Can you affect change on this factor, with
your resources?
Is potential action on the factor in line with
your mandate and priorities?
51

49

List possible actions (research


question 3)

For each possible action note/summarize:


Where this idea came from;
what you know about the effectiveness;
what you know about the appropriateness
of this activity for your intended audience;
what you know about the financial and
human resources required

52

Tips

After you have sorted through your results,


address remaining gaps or questions by
returning to your data-gathering plan.
Involve others in interpreting the data.
data Work
with your stakeholders to ensure that you
are interpreting the data in a way that
resonates with their experience.

53

Roll it up into key findings

What can you not ignore?

54

50

Other analysis techniques

Organizing

Force field analysis


Affinity diagrams
PEEST
Mindmapping

Structured reflection
Six hats thinking
SWOT/SWOT clustering
PMI technique (pluss, minuss, interesting
points)

5. Present key findings

Present key findings as readable, accessible,


evidence-based answers to your research
questions what can you not ignore?
They should be convincing,
convincing compelling
correct statements that guide your planning
decisions.
These are the inputs that will guide your
planning decisions.
Try the 1, 3, 25 rule of documents.
56

6. Consider how to proceed with


planning

What gaps in data quality or quantity exist


that may restrict your ability to make
evidence-based decisions?
What is your current perception about your
ability to impact on the situation with
available resources and the parameters of
your mandate?

57

51

Build a Force Field Analysis

At what level of the environment does this


factor influence the situation?
Societal, organizational, network, individual

How
Ho is this factor
facto affecting the iss
issue?
e?
Making better/making worse

Do you think this is one of the top 3 factors


that you want to address?
Does this factor suggest any directions
related to objectives, audiences, activities,
etc.

58

Identify goals, population(s) of


interest, and objectives

59

Terminology Varies
THCU Term

Alternatives

Goal

Purpose, Mission

Outcome Objectives

Outcomes, Impacts, Effects, Results

Population of Interest

Target Group, Priority Group,


Audience, Community of Interest

Indicator

Benchmarks, Criteria for Success

Strategies

Components, Initiatives,
Interventions

Activities

Process, Implementation, Outputs

Process Objectives

Implementation Objectives

Resources

Budget, Assets, Inputs


60

52

Goals usually:
1.

are encompassing or global,

2.

include all aspects of a program,

3.

provide overall direction,

4
4.

are general in nature


nature,

5.

take a long time to complete,

6.

do not have a deadline,

7.

are not observed, but inferred because they include words like
evaluate, know, improve, and understand, and

8.

are not measurable.

From: Planning, Implementing & Evaluating Health Promotion Programs: A Primer. McKenzie et al. 2005

61

Program goal examples

The ultimate goal of CNN is to improve


student nutrition in the Haldimand and
Norfolk communities.
(positive outcome goal)
To reduce the incidence of obesity harm in
Community X
(problem reduction goal)
62

Elements of a well-written
outcome objective
Priority
Population
(who)

Target
(How much)

Outcome
(what)

Conditions
(when)

A
well-written
outcome
objective

63

53

Triple the
number of

children and
youth

involved in the
development,
Implementation and
evaluation of student
nutrition programs

By the end
of 2010

64

Examples of outcome objectives


in four elements
Target/How
much

Priority
Population/
Who

Outcome/What

Conditions/
When

Triple the
number of

children and
youth

involved in the development,


implementation and evaluation
of student nutrition programs

By the end of
2012

Double the
number of

schools in the
region

with functioning SNPs

in one year

Increase by
25% the
number of

schools in the
region

meeting MCYS nutrition


guidelines and public health
food safety guidelines

in two years

Increase to
70%

elected officials
in the region

aware of the benefits of


healthy nutrition for children
and youth and the role of the
CNN in acting on the issue

by the end of
the fiscal

Maintain

provincial
government

financial support for the CNN

for five years.


65

Objectives vary in terms of:

Process versus outcome


Time frame
Open versus close ended

66

54

Objectives vary in terms of:

Process versus outcome


Open versus closed-ended
Time frame

67

Elements of a well-written
process objective
For which
Population
(for who)

Target
(How much)

Output
(what product)

Conditions
(when)

A
well-written
process
objective

68

Examples of process objectives in


four components
How many

Output/What
Product

for Who

Conditions/
When

Create 2

Recruitment
posters inviting
participation in
an advisory
group about
nutrition

for children and youth

By the end of
2012

Create a

Business case
showing the
benefits of
student nutrition
programs for

For schools in the region

Within the
year.

69

55

Objectives vary in terms of:

Process versus outcome


Open versus closed-ended
Time frame

70

Examples of closed and open


objectives
A closed objective describes how much change you
will accomplish within what time frame.
Triple the number of children and youth involved in the
development, implementation and evaluation of student nutrition
programs by the end of 2008

An open objective does not specify the amount of


change or timeframe.
Increase the number of children and youth involved in the
development, implementation and evaluation of student nutrition
programs.

71

Objectives vary in terms of:

Process versus outcome


Open versus closed-ended
Time frame

72

56

Examples of short and long-term


objectives

Short-term usually means up to one year.


Medium-term usually means over one year to
fi e years.
five
ea s
Long-term generally means five or more
years.

73

Characteristics of good objectives


Specific
Measurable
Appropriate
Realistic with resources
available

compatible with goal,


mission/vision, other
objectives
dibl to
t key
k
credible
stakeholder groups

Time-bound
(SMART)

74

Additional THCU Resource on


Objectives

Objective Menu:
http://www.thcu.ca/infoandresources/resource_d
isplay.cfm?resourceID=54

Other objectives critique examples


http://www.thcu.ca/infoandresources/resource_d
isplay.cfm?resourceID=955

Webcasts: Comparing Goals and Objectives;


Inputs, Outputs, Outcomes; Types of
Objectives
http://www.thcu.ca
http://www.thcu.ca/videos/webcasts.htm

75

57

Resources

76

THCU on Planning

Introduction to Health Promotion Planning


Workbook French and English
Logic models workbook
Planning Situations and Solutions
Create your own planning model
Planning: At a Glance
Strategic planning to program planning and
back again (webinar proceedings)
http://www.thcu.ca/infoandresources/resource_display.cfm?res_topicID=4
77

Health Promotion Skills Essential


Resource Tour

Summary of all links mentioned during the


workshop
http://www.thcu.ca/workshops/hpskillsresou
rcetour htm
rcetour.htm

78

58

THCUs Consultation Service


Free to those working on Ontario-focused projects.
Scope varies, depending on need:

short training sessions;


brief,, one-time advice;;
review your work or product;
hands-on assistance working through our step models;
links to other sources of information and resources.

Consultation request form

http://www.thcu.ca/consultation/request_form.htm

Sample consultations

http://www.thcu.ca/consultation.htm
79

Upon Request Workshops


All of our workshops, are available upon request for
groups as small as 30 and as large as 50.
Any coalition or agency can partner with THCU to
host a workshop in their community.
We
W provide
id the
h facilitators
f ili
at no cost and
d will
ill workk
with you to help tailor, organize and promote the
event.
Service request form
http://www.thcu.ca/consultation/request_form.htm

We require at least three months' notice to plan


and deliver a workshop.
80

THCU in collaboration with partners


Health Promotion 101
This free, online course helps people familiarize themselves with essential
health promotion concepts.
http://www.ohprs.ca/hp101/main.htm

Online Proposal Writing Course


The purpose of this online course is to help both newbies and veterans
prepare a coherent and effective proposal.
http://www.thcu.ca/ohcc-thcu-proposal-writing-course/

Ontario Health Promotion Email Bulletin

Information exchange among Ontario practitioners.


Announcements and events distributed weekly.
Feature articles are distributed every second week.
The bulletins go out every Friday afternoon.
www.ohpe.ca

81

59

Evidence to support planning


decisions-collection of resources

http://www.thcu.ca/infoandresources/planni
ng_resources_soe.cfm?ownership=ALL

83

A big thank you to

Ontario Agency for Health Protection and


Promotion (OAHPP)
Cathy Duerden
Our
O workshop
k h participants
i i

84

60

Disclaimer
The Health Communication Unit and its resources and
services are funded by the Ontario Agency for Health
Protection and Promotion. The opinions and conclusions
expressed in this presentation are those of the author(s) and
no official endorsement by the OAHPP is intended or should
be inferred.

85

61

Relationship between planning types


Strategic

Program

Operational

Reason

Mission, vision,
values, strategic
direction

Program goals,
objectives,
activities

Roles, resources,
deadlines for
specific activities

Scope

3-5 years

1 per year

Day to Day

Time

Extensive, months
(but not yearly)

Varies, but
usually weeks

Days

Dollars

Research and
consulting fees

Info gathering,
consultations,
consultants

Within regular
resources

Stakeholders

Board driven;
Consider competitors
and allies

Staff/mgmt
driven; Consider
audience

Internal org;
Consider suppliers
of goods, services

Data

Broad search

Audience
analysis, best
practices, evals

Budget and other


routine info
62

63

37
64

65

Terminology
gy Varies
THCU Term

Alternatives

Goal

Purpose, Mission

Outcome Objectives

Outcomes Impacts,
Outcomes,
Impacts Effects
Effects, Results

Population of Interest

Target Group, Priority Group,


Audience, Community of Interest

Indicator

Benchmarks, Criteria for Success

Strategies

Components, Initiatives,
Interventions

Activities

Process, Implementation, Outputs

Process Objectives

Implementation Objectives

Resources

Budget, Assets, Inputs


66

Examples of outcome objectives


divided into their four components
Criterion/
How Much

Priority Population/Who

Outcome/What

Conditions/When

Triple the number of

children and youth

involved in the development,


implementation and evaluation of
student nutrition programs (SNPs)

by the end of 2008.

Double the number of

schools in the region

with functioning SNPs

in one year.

Increase by 25% the number of

schools in the region

meeting MCYS nutrition guidelines


and public health food safety
guidelines

in two years.

Increase to 70% the number of

elected officials in the region

aware of the benefits of healthy


nutrition for children and youth and
the role of the Child Nutrition
Network (CNN) in acting on the
issue

by end of the fiscal.

Maintain

provincial government

financial support for the CNN

for five years.

The Health Communication Unit www.thcu.ca Developed May 25 2007

67

OBJECTIVES GAME ANSWER KEY

Card Set A
Level of
objective

How much/
How many

For which
population/
Who

Output (what to
do or produce)
or outcome
(what change)

When

Individual
Outcome
Objective

To increase by
10% the number
of.

adults between
the age of 50 and
80.

who agree that


depression and
anxiety are highly
treatable disorders
that should be
discussed with a
doctor.

within 2
years

2000

to adults
between the age
of 50 and 80.

.educational
pamphlets sent on
the most effective
treatment options
for depression and
anxiety.

by next
January

To increase, by
20%, the
percentage of..

people who
provide informal
care (non paid
staff for
example
relatives, etc.) to
the elderly in
Ottawa.

who agree that


mental health
problems such as
anxiety and
depression are
often closely linked
to physical health
complaints.

in the next 12
months

to people who
provide informal
care (non paid
staff for
example
relatives, etc.) to
the elderly in
Ottawa.

training sessions
conducted on how
to distinguish
between physical
health complaints
and
anxiety/depression

by next
January

..physician
offices in
Niagara
Region

that give all


within the
patients a screening next 18 months
tool for depression
to take home once a
year

Set A.

Individual
Process
Objective
Set A
Network
Outcome
Objective
Set A

Network
Process
Objective
Set A

Organizational To increase, by
Outcome
10, the number
Objective
of.
Set A

1/1
68

OBJECTIVES GAME ANSWER KEY

Level of
objective

How much/
How many

For which
population/
Who

Output (what to
do or produce)
or outcome
(what change)

When

..to physician
offices in
Niagara
Region

visits made to
help implement a
depression
screening system..

by next October

To increase by 3,
the number of.

..Cabinet
members

.who feel that a


national mental
health strategy is a
priority for
Canada

in the next 18
months

..for Cabinet
members

breakfast
in the next
meeting held about two months
why a national
mental health
strategy should be a
priority for
Canada

Organizational 20
Process
Objective
Set A
Societal
Outcome
Objective
Set A
Societal
Process
Objective
Set A

2/2
69

OBJECTIVES GAME ANSWER KEY

Card Set B
Level of
objective

Direction and
Indicator

Target
Audience

Type of
outcome

Time (By.)

Individual
Outcome
Objective

To reduce by 10%
the number of .

. teens aged
14-18 in three
Windsor high
schools..

who have
unprotected sex.

.by the end of


the next school
year.

.for teens aged


14-18 in three
Windsor high
schools..

social marketing
campaign
implemented to
address the
consequences of
unprotected sex.

by the start of
the next school
year.

To increase by
10% the number
of.

.mothers of
girls aged 1014

who talk to their


daughters about
reasons for safe sex
and abstinence

by next
September

14

.for mothers of
girls aged 1014

lunch and learns


held to discuss how
to talk to their
daughters about
reasons for safe sex
and abstinence

by next June

schools in
Ontario .

.that offer the


new, research
based curriculum
package on
sexuality

by next
December

for schools in
Ontario

activity kits
produced to
supplement the
new, research
based curriculum
package on
sexuality

by next June

Set B
Individual
Process
Objective
Set B
Network
Outcome
Objective
Set B
Network
Process
Objective
Set B
Organizational To increase, to
Outcome
70%, the number
Objective
of.
Set B
Organizational 800
Process
Objective
Set B

3/3
70

OBJECTIVES GAME ANSWER KEY

Level of
objective

Direction and
Indicator

Target
Audience

Societal
Outcome
Objective

To increase, to
100%, the number
of.

communities .that offer


within three
in Ontario.
confidential
years
sexuality clinics
where birth control,
pregnancy testing
and counseling is
available for free

for underresources
communities in
Ontario

Set B

Societal
Process
Objective
Set B

Type of
outcome

Time (By.)

. grant process
within two
created to support
years.
the development of
confidential
sexuality clinics
where birth control,
pregnancy testing
and counseling is
available for free

4/4
71

OBJECTIVES GAME ANSWER KEY

Card Set C
Level of
objective

Direction and
Indicator

Target
Audience

Type of
outcome

Time (By.)

Individual
Outcome
Objective

To decrease by
25% the number
of..

.. new mothers
(to be) in
Waterloo
region.

who believe that


the advantages of
breastfeeding are
outweighed by the
disadvantages
(discomfort,
frequency of
feedings, etc.) .

by the end of
the year

for new
mothers (to be) in
Waterloo
region

community
event held to
promote the
advantages of
breastfeeding, and
provide
suggestions on
ways to minimize
the disadvantages
(discomfort,
frequency of
feedings, etc.) .

by the end of
next month

To increase, to
50%, the number
of..

.new
grandmothers.

.who encourage
the mother of their
grandchild to
breastfeed.

by June

4000

for new
grandmothers

kits sent with


information on
breastfeeding and
suggestions on how
to support their
daughters in their
breastfeeding
efforts

by January 1

..the number of ..that have quiet,


shopping malls in comfortable and

within three
years

Set C

Individual
Process
Objective
Set C

Network
Outcome
Objective
Set C
Network
Process
Objective
Set C

Organizational To increase by 50
Outcome

5/5
72

OBJECTIVES GAME ANSWER KEY

Level of
objective

Direction and
Indicator

Target
Audience

Type of
outcome

Ontario.

free breastfeeding
stations available
for new mothers

for business
owners

.. profile done on
the CBC radio
program, Ontario
today, about a
shopping mall .that
has quiet,
comfortable and
free breastfeeding
stations available
for new mothers

by the end of
the month

To increase, to
100%

.the number of
municipalities in
Ontario

that provide
funds for a free,
accessible,
breastfeeding clinic
for new mothers

in three years

for hospital
administrators

courses provided
about how to
access funds and
set up a
breastfeeding
clinic

by the end of
next year

Objective
Set C
Organizational 1
Process
Objective
Set C

Societal
Outcome
Objective
Set C
Societal
Process
Objective
Set C

Time (By.)

6/6
73

OBJECTIVES GAME ANSWER KEY

Card Set D
Level of
objective

Direction and
Indicator

Target
Audience

Type of
outcome

Time (By.)

Individual
Outcome
Objective

To reduce by 15%
the number of.

.children aged
6-18

.whose primary
after-school
activity involves
sitting in front of a
screen

by next Sept

.for children
aged 6-18

contest held to
see who can spend
the least amount of
time in front of a
screen
(tv/computer/video
games) in one
month

by next
February

To increase by
5% the number
of.

..fathers of
children aged 1014 in Haliburton
County.

who join their


child in at least 30
minutes of physical
activity per
week..

by next
September

..for fathers of
children aged 1014 in Haliburton
County.

.. weekend events
held where they
can try a series of
different kinds of
physical activities
with their
child/children

by next June

..schools

.with pop
machines

within the
next two years

schools

face-to-face
meetings held with
principals to
discuss alternatives

by next June

Set D
Individual
Process
Objective
Set D

Network
Outcome
Objective
Set D
Network
Process
Objective
Set D

Organizational To decrease by
Outcome
100 the number
Objective
of.
Set D
Organizational 10
Process
Objective

7/7
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OBJECTIVES GAME ANSWER KEY

Level of
objective

Direction and
Indicator

Target
Audience

Set D
Societal
Outcome
Objective

Time (By.)

to pop machines in
schools
To increase by 5
the number of.

..Ontario
MPs

.who feel that a


national childhood
obesity strategy
should be a top
priority for health
care system
money

by September

30

to Ontario
MPs

personally
addressed letters
sent to outline why
a national
childhood obesity
strategy should be
a top priority for
the health care
system money.

by March 1

Set D

Societal
Process
Objective

Type of
outcome

Set D

8/8
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OBJECTIVE CRITIQUE EXERCISE


As a part of the April 2007 Planning Health Promotion Programs Workshop at Wellesley Institute, participants were asked to write an
objective about a topic of their choice on an index card. We told participants that we would collect the cards, critique the anonymously
written objectives and provide the feedback to all participants. The original objectives, with feedback, are in the table below.
Objective as written by participant

What kind of objective is


this?

How could this objective be improved?

To provide affordable, nutritious, accessible


(easy to store, heat & serve) food to disabled and
senior tenants within the Community Housing
Unit on a weekly basis by December 2007.

Process objective

This well-written objective might be improved by specifying the


number of disabled and senior tenants, thus showing the full
scope of the activity.

2.

To increase the hours of care available to


residents in long-term care in Ontario from 2.5
hours to 3.5 hours per day, by December 2007.

Process objective

This is a well-written process objective, as it indicates an increase


in the available services.

3.

To increase the number of individuals that


connect with community services by attending a
health fair.

Goal

The logic in this objective seems to be:

1.

Target population is high risk prenatal.


Long-term goal is to decrease behaviours linked
to poor pregnancy outcomes (e.g. alcohol
consumption, material smoking).

A related outcome objective would speak to changes in the


behavior of the tenants.

If high-risk prenatal individuals attend a health fair, then they will


connect with community services then use the services, then
decrease risk behaviors.
If this logic is correct, the outcome and process objectives can be
clarified and separated and in the following possible ways:
1.

Clarify the terms connect and high risk prenatal.

2.

An example of a related process objective could be: To


conduct/participate in X number of health fairs by
mmm/dd/yyyy, where information about community
services is provided to women at high risk of poor
pregnancy outcomes.

3.

Outcome objectives could be developed around changes in

76

the target population. For example, increased awareness and


knowledge of services, increased use of services, or actual
behavioural changes.
4.

Create more programs that are geared towards


Addictions and Mental Health.

As written, this is fairly


general and could be
considered part of an overall
vision or mission statement,
or a goal.

To make it into an objective one should state a target date and


audience.

5.

To develop a series of workshops aimed to


inform youth of their legal rights presented by a
youth action committee that will have a high
number of active participants, with little or no
turnover.

A process objective

This process objective could be improved by adding to, or


replacing to develop with to deliver.
A number or even a range to clarify series of workshops would
help to make this objective more specific.
Adding a date would also make it more specific.

6.

To increase knowledge among HIV+ women on


services available for HIV positive women in X
region upon completion of the project.

This is the core of a outcome


objective

This objective could be improved by:


Setting a specific target: from x % to y%; and
Setting a target date.

7.

To deliver quality programming to high needs


clients.

This is a goal

This important goal could generate a number of specific process


objectives by indicating the type of programming, numbers
offered, time frame.

8.

To increase the number of seniors accessing


advanced computer & technology classes by
300%, by August 2008.

Outcome objective

This outcome objective includes the four core aspects of a good


outcome objective: target, population, indicator, date.

9.

To increase AIDS service providers (in targeted


organizations) self-reported level of comfort
with accessing and providing HIV treatment
information to a level of high or very high
by the end of the project (Oct 2008).

Outcome objective

This is a nicely written outcome objective for interventions that


might include training, network development and other support
activities.
As written, it implies 100% achievement. It could be clarified to
increase the percentage of providers reporting .to 90% or another
number.

77

It might also be improved by separating the objectives referring


to accessing and providing as the combination of the two may
be confusing.
10.

To conduct 10 Friendly to Seniors Assessments


at Toronto Hospitals by December 2007.

Process objective

This well written process objective outlines the nature, number of


services, target population, date.

11.

Environmental NGO professionals


(manger/program & project level) increase their
capacity for internally conducted evaluations of
their programs and projects by 2009.

As written, it is a goal
addressing outcomes among
the target population.

As first written, it is a goal, rather than an objective, because the


term capacity is too broad to be considered an indicator, which
is a necessary part of an objective.

Participant note: Im not into putting a %


improvement into capacity-building goals.
Perhaps the # could be:
a)

# of enviro staff who report increased


capacity

b) b) # of eval projects they complete


But these are indicators, no?

Depending on the situation, capacity might be broken down into


more focused outcomes such as increased funding, increased
skill-level at doing evaluations, etc.
Option a could be used as an indicator. Combined with the clear
date, this could form an open-ended objective.
Option b could also be used as an indicator, forming the basis of
an outcome objective.
A sample process objective could be to deliver 5 professional
training sessions focused on evaluation skill building to
environmental NGO professionals by the end of the fiscal year.

78

EVIDENCE-INFORMED PRACTICE

Resources to Increase Understanding:


Whatisevidenceinformedpractice?

Lost in Knowledge Translation: Time for a Map?


IanGraham,etal.,JournalofContinuingEducationintheHealthProfessions,Volume26No.1,
Winter2006,pp.1324.
http://www.jcehp.com/vol26/2601graham2006.pdf
This article reviews the wide variety of terms and definitions used to describe the concept of
moving knowledge into action. A framework for integrating the roles of knowledge creation and
application is suggested. Implications for health professionals are discussed.
Information Sources for Evidence-Based Public Health
OntarioPublicHealthLibrariesAssociation
http://www.ophla.ca/pdf/Information%20Sources%20for%20Evidencebased%20Public%20Health.pdf
This 4-page list links to Canadian, U.S. and International academic centres, organizations and
initiatives that focus on evidence-based public health.
Knowledge Utilization/Utilization Des Connaissances (KUUC) Database
ChaironKnowledgeTransferandInnovation,UniversityofLaval
http://kuuc.chair.ulaval.ca/english/master.php?url=recherche.php
The 'Search by Keywords' function on this database (upper right hand corner of the screen)
includes dozens of topics about knowledge transfer and innovation. Seventh from the top is a
link to resources about evidence-based decision-making.
Evidence-Based Public Health Literature Search Statement
MinistryofHealthandLongTermCare
http://www.health.gov.on.ca/english/providers/program/pubhealth/oph_standards/ophs/litss.html
#fstandard

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This webpage includes links to dozens of up-to-the-minute, dynamic literature searches


generated by pre-programmed PubMed searches. The second search focuses on published
articles about evidence-based public health.
KT Theories/Frameworks Database
ICEBeRG(ImprovedClinicalEffectivenessthroughBehaviouralResearch)
http://www.iceberg-grebeci.ohri.ca/research/kt_theories_db.html
This database contains resources about knowledge transfer conceptual models, frameworks,
theories and examples of application. ICEBeRG also maintains a list of Canadian organizations
investigating the theory, methods and practices related to knowledge translation. It is available at
http://www.iceberg-grebeci.ohri.ca/resources/enviroscan_websites.html
Interactive Domain Model (IDM) Best Practices
http://www.idmbestpractices.ca/idm.php
The IDM website explains the framework and includes resources to use the framework, case
studies, examples and a monthly reflections feature. The IDM is a best practices approach to
preventing illness and enhancing health for people working in health promotion, public health
and population health. In the IDM approach, 'best practices' vary according to the situation. The
IDM focuses on consistency between an initiatives practice and values, goals and ethics;
theories, concepts and underlying beliefs, evidence and understanding of the environment [from
website].
EPPI-Centre - The Evidence for Policy and Practice Information and Coordinating Centre
SocialScienceResearchUnitandtheInstituteofEducation;UniversityofLondon(UK)
http://eppi.ioe.ac.uk/cms/Default.aspx?tabid=89
With a mandate to carry out reviews and develop review methods, EPPI-Centre is dedicated to
making research findings accessible. The website, full of information and links covers the
following topics: what is evidence-informed policy and practice; user-driven evidence-informed
policy and practice; methods for systematic reviews; and tools for synthesis. Several databases
with primary research and reviews are also accessible through the site.
An Introduction to Evidence-Informed Public Health and A Compendium of Critical
Appraisal Tools for Public Health Practice.
NationalCollaboratingCentreforMethodsandTools(NCCMT);February2008
http://www.nccmt.ca/pubs/eiph_backgrounder.pdf

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This paper explains the 7 stages of evidence informed public health: define; search; appraise;
synthesize; adapt; implement; and evaluate. It also includes a list of tools to help you critically
appraise the available evidence.

Examples Illustrating Application:


Whatgroups,organizationsorgovernmentshaveusedevidenceinformed
decisionmakingintheirwork?

Knowledge Use in the Calgary Health Region: A Scan of Initiatives that Support Use of
Evidence in Practice
UniversityofCalgary,FacultyofMedicine;CalgaryHealthRegion;August2006
http://www.calgaryhealthregion.ca/programs/research/pdf/knowledge_utilization_scan_full_repo
rt_%20aug_28_2006.pdf
The research behind this report was conducted to develop an understanding about the current
state of knowledge utilization (KU) in Calgary Health Region, so that a broader KU strategy
could be developed. Many examples of good KU being practiced in region-wide systems,
clinical care and population health are provided. Factors that influence implementation of KU
strategies in large, integrated health systems are also discussed.
Knowledge to Action: A Knowledge Translation Casebook
CIHRInstituteofPopulationandPublicHealth;CanadianPopulationHealthInitiative;2008
http://www.cihr-irsc.gc.ca/e/documents/kt_casebook_e.pdf
This casebook summarizes 10 knowledge translation stories. Many illustrate integrated
knowledge translation which involves building knowledge translation into the research process.
CIHR has two related casebooks that illustrate both successful and less-than-successful examples
of the development and use of population and public health research evidence. They are
available at
http://secure.cihi.ca/cihiweb/dispPage.jsp?cw_page=GR_1447_E and http://www.cihrirsc.gc.ca/e/30660.html
Success Stories
SEARCHCanada
http://www.searchca.net/users/folder.asp?FolderID=2450

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SEARCH Canada helps connect public health care decision-makers with evidence so that they
apply new knowledge and make sound decisions. This web page provides links to project and
participant profiles. These examples show evidence-informed public health in action.
Building Capacity for Health Research Transfer in Western Canada: An Environmental
Scan
JudyBirdsellandKarenOmeichuk,AlbertaHeritageFoundationforMedicalResearch;2007
http://www.ahfmr.ab.ca/
This report presents the results of a scan to explore how, and through who, research transfer is
happening in Western Canada. Many organizations that have successfully facilitated the
implementation of research into practice are listed. Their innovative capacity-building features
are discussed. Recommendations for action are also included.

Resources that Build Capacity:


Whatdecisionmakingframeworksorguidescanhelpmewiththeentire
processofevidenceinformeddecisionmaking(define,search,appraise,
synthesize,adopt,implement,evaluateandincorporateevidenceinto
practice)?

The Informed Decisions Toolbox


Rundalletal.,JournalofHealthcareManagement,Volume52,Issue5,pages325342
http://www.ache.org/PUBS/JHM/Rundall%20Appendix--to%20post.pdf
This toolbox provides checklists of what to consider at each of six steps to making a wellinformed decision. The steps include: framing the question behind the decision; finding sources
of information; assessing the accuracy of information; assessing the applicability of information;
assessing the actionability of information; and determining if the information is adequate.
Program Evidence Tools
TowardsEvidenceInformedPractice(TEIP);2008
http://teip.hhrc.net/docs/tools/d._Program_Evidence_Tools/TEIP_Program_Evidence_Tools.pdf

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This toolkit provides explanation, reflective questions and worksheets for five steps to applying
evidence to program planning. These steps are: identify evidence question; develop search
strategy; collect, extract and synthesize evidence; interpret & adapt evidence; and plan to
implement and evaluate.
Cochrane Handbook for Systematic Reviews of Interventions
TheCochraneCollaboration
http://www.cochrane.org/resources/handbook/
The Cochrane Handbook contains a detailed explanation of how to conduct a review. Topics
covered include defining the review question, searching, selecting, assessing data, presenting
data, etc.
The Health Planners Toolkit
Module 3: Evidence-Based Planning
StanArdaletal.;HealthSystemsIntelligenceProject;GovernmentofOntario;2006
http://www.health.gov.on.ca/transformation/providers/information/resources/health_planner/mod
ule_3.pdf
This module includes information and tools about evidence-based planning. Topics covered
include: what is evidence; how do I find the evidence I need; how do I judge the quality of
information; how do I use information with confidence; how are things measured; ethics. Tools
are included in the Appendices.

SEARCH FOR EVIDENCE

Resources that Build Capacity:


HowdoIfindtheevidencetosupportmyplanningdecisions?

The Health Planners Toolkit


Module 3: Evidence-Based Planning
Section 2: How do I find the evidence I need?
StanArdaletal.;HealthSystemsIntelligenceProject;GovernmentofOntario;2006

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http://www.health.gov.on.ca/transformation/providers/information/resources/health_planner/mod
ule_3.pdf
This module explains five types of evidence: epidemiological data; administrative data; journals;
reports (grey literature); and expert advice. Some examples of good sources within each type of
evidence are provided. Appendix F: Evidence-Based Planning Guide supports Section Two. This
worksheet prompts the user to identify: what they want to know; what they need evidence for;
and what type of information they need. It also provides a table to organize the different types of
information found to help prepare for a thorough analysis.
Literature Searching for Evidence: Reading List
OntarioPublicHealthLibraries
http://www.ophla.ca/pdf/Literature%20Searching%20for%20Evidence%20Reading%20List.pdf
This 11-page list of journal articles and resources focuses on how to retrieve quality public
health research and evidence.
A Methodology for Searching the Grey Literature for Effectiveness Evidence Syntheses
related to Public Health
MaureenDobbins&PaulaRobeson;For:ThePublicHealthAgencyofCanada;March31,2006
http://health-evidence.ca/downloads/Dobbins2006_Grey_Literature_Project_Report.pdf
"Grey literature can often be the first and only source of effectiveness evidence on a public
health issue. While a formal publication may follow later, in many cases this evidence is never
made available to the broad public health audience." This paper defines grey literature and
presents a methodology for identifying, retrieving, and selecting unpublished reviews evaluating
the effectiveness of public health interventions. [Adapted from author's executive summary]

Evidence to Support Decision-Making:


Whataresomegoodsourcesofevidencetosupportprogramplanning?

Public Health Grey Literature Sources


OntarioPublicHealthLibrariesAssociation
http://www.ophla.ca/pdf/Public%20Health%20Grey%20Literature%20Sources.pdf
This resource provides links to Canadian and U.S. grey literature repositories; public health
organizations; academic centres; health services research and policy sources as well as other

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international organizations.
Public Health Bibliographic Databases
OntarioPublicHealthLibrariesAssociation
http://www.ophla.ca/pdf/Public%20Health%20Databases.pdf
This international list of public health databases is updated periodically by OPHLA members
Population Health Indicators: Resources
OntarioPublicHealthLibrariesAssociation
http://www.ophla.ca/pdf/Population%20Health%20Indicators.pdf
Canadian and International sources of indicators are included in this extensive 6-page list.
The Health Planners Toolkit
Module 3: Evidence-Based Planning
Appendix E: Evidence-based clinical and public health websites
StanArdaletal.;HealthSystemsIntelligenceProject;GovernmentofOntario;2006
http://www.health.gov.on.ca/transformation/providers/information/resources/health_planner/mod
ule_3.pdf
This annotated list of online resources includes sources of recommendations, guidelines,
scientific evidence, and best practices.
Public Health Reviews
EffectivePublicHealthPracticeProject(EPHPP);PHREDProgram
http://old.hamilton.ca/phcs/ephpp/ReviewsPortal.asp
This is a listing of all of the systematic review summaries and highlights for practitioners and
managers available through the EPHPP. A catalogue that contains all of the library holdings of
four PHRED health units in Ontario is also available online at http://www.phred-redsp.on.ca/
The PHRED program contributes to health promotion, health protection and the prevention of
health programs by conducting applied public health research in areas critical to effective and
efficient public health practice.
Health Evidence Canada
CanadianInstitutesofHealthResearch;CityofHamiltonPublicHealthServices
http://health-evidence.ca/

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This website houses a searchable compilation of quality research evidence for public health
decision-makers. It contains the results of a process that includes searching, screening and rating
systematic review evidence on a variety of topics.
Literature search statements for the Ontario Public Health Standards
MinistryofHealthandLongTermCare
http://www.health.gov.on.ca/english/providers/program/pubhealth/oph_standards/ophs/litss.html
#fstandard
This webpage includes links to dozens of up-to-the-minute, dynamic literature searches
generated by pre-programmed PubMed searches. Topic examples include public health
interventions to prevention chronic disease, built environments to prevention and reduce alcohol
misuse, increase public awareness of healthy child development, evidence-based public health
and public health program evaluation. Thirteen public health topic areas are covered, each with
many more specific topic searches.
Community Health Resources Database
CentersforDiseaseControlandPrevention
http://apps.nccd.cdc.gov/dach_chaps/Default/index.aspx
Browse by health topic (asthma, cancer, injury prevention, etc.), resource type (data and
statistics, evaluation, guidelines and recommendations, publications, reports, etc.) or keyword for
help with planning, implementing and evaluating community health interventions to address
chronic disease and health disparities issues.
JBI Library of Systematic Reviews and Best Practices Series Database
TheJoanneBriggsInstitute
http://www.joannabriggs.edu.au/pubs/systematic_reviews.php
This library of systematic reviews includes quantitative and qualitative health and clinical
research undertaken by the Joanna Briggs Institute and its international collaborating centres and
groups. This listing of health and clinical best practices can be sorted by title or issue. A keyword
search of the entire website is another way to find best practices and evidence related to a
specific health topic. It is available at http://www.joannabriggs.edu.au/pubs/best_practice.php
EPPI-Centre - The Evidence for Policy and Practice Information and Co-ordinating
Centre
SocialScienceResearchUnitandtheInstituteofEducation;UniversityofLondon(UK)
http://eppi.ioe.ac.uk/cms/Default.aspx?tabid=89

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With a mandate to carry out reviews and develop review methods, EPPI-Centre is dedicated to
making research findings accessible. The website, full of information and links to additional
resources includes several databases with primary research and reviews. Databases include:
database of promoting health effectiveness reviews; trials of promoting health interventions;
schemes to promote health weight among obese and overweight children in England; database of
personal development planning evaluation; database of education research and current
educational research in the United Kingdom.
SCIE Knowledge Reviews and Systematic Maps
SocialCareInstituteforExcellence
http://www.scie.org.uk/publications/knowledgereviews/index.asp
Knowledge reviews pull together knowledge from service users, research and practice. They
describe what knowledge is available, highlight the evidence that has emerged and draw practice
points from the evidence [from website]. More than 20 Knowledge Reviews are available on the
website. Topics focus on the social care needs of various populations such as disabled people,
people with mental health challenges, children and older people. Systematic mapping is a
process to map out and categorize the existing literature on a particular topic. Examples are
provided on the SCIE website. They cover topics such as depression in older people and mental
health problems among parents. the Systematic mapping examples are available at
http://www.scie.org.uk/publications/map/index.asp.
The Community Guide: What Works to Promote Health
NationalCenterforHealthMarketing,CentersforDiseaseControlandPrevention
http://www.thecommunityguide.org/index.html
The Guide presents systematic reviews that answer three questions: Which program and policy
interventions have been proven effective? Are there effective interventions that are right for my
community? What might effective interventions cost; What is the likely return on investment?
The Community Tool Box
http://ctb.ku.edu/en/promisingapproach/Databases_Best_Practices.htm
Approximately 30 links to documents, websites and databases are listed on this web page. All
focus on resources that have used evidence to develop statements, guidelines or
recommendations about 'What Works' on a variety of health promotion topics.
Evidence-Based Health Promotion
VictorianGovernmentHealthInformation
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This list of eight (8) planning resources covers: oral health; adolescent health; falls prevention;
child injury prevention; promoting healthy eating for children; body image; cardiovascular
disease and mental health. Each resource contains a critical appraisal of the available evidence
for each field. They are intended to provide an evidence base for health promotion funders,
planners and practitioners.
Resource Quickfinder: Core Public Health Functions for British Columbia
MinistryofHealthyLivingandSport,PublicHealthAgencyofBritishColumbia
http://www.phabc.org/modules.php?name=Contentcore&pa=showpage&pid=187
This list of resources, organized in a table format, links to evidence reviews, health status data
and other information related to 16 core public health programs. Programs fall into one of three
broad categories: health improvement, disease prevention or environmental health.
Shaping a Healthy America: A Decision-Making Guide
NGACenterforBestPractices
http://www.subnet.nga.org/healthyamerica/guide/impact_areas.html
Search the best practices database by specific audience and strategy for practices related to
physical activity, fruit and vegetable consumption and obesity.

APPRAISE

Resources that Build Capacity:


HowdoIjudgequalityofinformation?

The Health Planners Toolkit


Module 3: Evidence-Based Planning
Section 3: How do I judge the quality of information?
StanArdaletal.;HealthSystemsIntelligenceProject;GovernmentofOntario;2006
http://www.health.gov.on.ca/transformation/providers/information/resources/health_planner/mod
ule_3.pdf
This module explains five principles for evaluating quality of evidence: proven validity;

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quantified reliability; comparability; consultation; and explicit data audit trail. This section is
supported by Appendix A, Guidelines for Scientific Evidence. Appendix A provides a ranked list
of methods for collecting evidence, showing which methods are considered 'closer to the
objective truth'. Appendix D: Resources for Critical Appraisal is also related to this topic. It
contains an annotated list of 13 print and web resources and tools that focus on topics such as:
how to read a research paper; how to critically appraise different types of research; and signposts
to the best evidence across a broad range of evidence types and subject areas.
A Schema for Evaluating Evidence on Public Health Interventions
NationalPublicHealthPartnership,April2002
http://www.nphp.gov.au/publications/phpractice/schemaV4.pdf
The Schema is a guide for the appraisal of public health intervention evidence. It covers how to
appraise individual papers or reports, and the formulation of conclusions. In addition to
conducting reviews of evidence, it can be used: to assess proposed evaluations; as a checklist for
preparing evaluation reports; and to assess past reviews of evidence and identify research
questions based on gaps in the available evidence. This guide is filled with practical checklists
and prompts to guide users through the appraisal process. Supplementary guides about
appraising reviews, randomized controlled trials, observational studies, economic evaluations
and qualitative studies are also included.
Rapid Evidence Assessment Toolkit
GovernmentSocialResearch:CivilService(UK)
http://www.gsr.gov.uk/professional_guidance/rea_toolkit/how_to_do_an_rea/index.asp
Rapid Evidence Assessment (REA) is a tool for understanding the available evidence on a
particular issue, with a given timeline. Depending on the timeline, different review methods are
possible, ranging from a literature review (least time needed) to a review of reviews (most time
needed). The REA sits in the middle, taking 2-6 months. The REA Toolkit includes a section
called Resources for Appraising Studies. This section explains how to use the five levels of
methodological quality to weight the available evidence accordingly. Resources on appraising
quantitative studies, economic studies and qualitative studies are included at the end of the
section.
Quality Assessment Tool for Quantitative Studies
EffectivePublicHealthPracticeProject,McMasterUniversity:SchoolofNursing
http://www.myhamilton.ca/NR/rdonlyres/6B3670AC-8134-4F76-A64C9C39DBC0F768/0/QATool.pdf
This quality assessment tool is accompanied by a dictionary of terms available at
http://www.myhamilton.ca/NR/rdonlyres/F5944F3B-15A9-46E7-8AFD1CD67628E33D/0/QADictionary.pdf

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An Introduction to Evidence-Informed Public Health and A Compendium of Critical


Appraisal Tools for Public Health Practice.
NationalCollaboratingCentreforMethodsandTools
http://www.nccmt.ca/pubs/eiph_backgrounder.pdf
The paper explains the seven (7) stages of evidence informed public health: define; search;
appraise; synthesize; adapt; implement; and evaluate. It also includes a list of tools to help you
critically appraise the available evidence, for a variety of research questions.
Articles on Standards of Evidence and Evidence Grading
NationalCenterfortheDisseminationofDisabilityResearch(NCDDR)
http://www.ncddr.org/ktinfocenter/articles_pubs/standards.html
Each item on this list of articles was reviewed by NCDDR staff and assigned ratings based on
strength of evidence, readability and consumer orientation.

SYNTHESIZE

Resources that Build Capacity:


HowdoIgeneratefindingsandconclusionsfrommyevidence?

EPPI-Centre - The Evidence for Policy and Practice Information and Coordinating Centre
SocialScienceResearchUnitandtheInstituteofEducation;UniversityofLondon(UK)
http://eppi.ioe.ac.uk/cms/Default.aspx?tabid=89
With a mandate to carry out reviews and develop review methods, EPPI-Centre is dedicated to
making research findings accessible. The website includes a section on 'methods for systematic
reviews'. Within that is a substantial body of information on how to synthesize study findings,
generate conclusions and recommendations, and develop the final report. Many links to
additional readings are provided.

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ADAPT

Resources to Increase Understanding:


Whatprocessesandactionsareneededtoadaptthesynthesizedevidence,so
thatitisapplicabletomysituation/environment?

Designing Theoretically-Informed Implementation Interventions


TheImprovedClinicalEffectivenessthroughBehaviouralResearchGroup;February2006
http://www.implementationscience.com/content/1/1/4
This academic article presents some of the evidence showing that research findings are often not
integrated into practice. Thoughts about how to make research more generalizable to the 'real
world' and thus more likely to be implemented are provided. A further discussion of the
challenges are presented in a follow-up article titled "Designing theoretically-informed
implementation interventions: Fine in Theory, But Evidence of Effectiveness in Practice is
Needed". This response by Bhattacharyya et al. is available at
http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1436014

Resources that Build Capacity:


HowdoIadaptthesynthesizedevidence,sothatitisapplicableformy
situation/environment?

Tool for Assessing Applicability and Transferability of Evidence


Buffet,C.,Ciliska,D,&Thomas,H.,2007,NationalCollaboratingCentreforMethodsandTools
http://www.nccmt.ca/pubs/2007_12_AT_tool_v_nov2007_ENG.pdf
This tool is designed to assist public health managers and planners in decision-making about
program priorities for their community after the evidence has been assessed. The tool outlines a
process for assessing applicability (feasibility) and transferability (generalizability) of the
evidence to practice and policy.

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91

Will it Work Here? A Decision Makers Guide to Adopting Innovations


HealthCareInnovationsExchange
http://www.innovations.ahrq.gov/resources/guideTOC.aspx
This guide is filled with reflective questions, prompts, resources and case studies for each of four
modules. Modules include: Does the Innovation Fit? Should we do it here? Can we do it here?
How will we do it here?

IMPLEMENT

Resources to Increase Understanding:


Whatprocessesandactionsareneededtoimplementevidencebased
programming?Whatbarrierstoimplementingevidencebasedprogramming
exist?

Improving Population Health: The Uses of Systematic Reviews


MelissaSweetandRayMoynihan,MillbankMemorialFund.Producedincollaborationwiththe
CentersforDiseaseControlandPrevention(CDC);2007
http://www.milbank.org/reports/0712populationhealth/0712ImprovingPopulationHealthFinal.pdf
This report recommends that a variety of steps be taken to make systematic reviews more useful
and used. Eight cases studies summarizing the findings of systematic reviews are included for
illustration.
Building Capacity for Health Research Transfer in Western Canada: An Environmental
Scan
JudyBirdsellandKarenOmeichuk,AlbertaHeritageFoundationforMedicalResearch;2007
http://www.ahfmr.ab.ca/
This report presents the results of a scan to explore how, and through who, research transfer is
happening in Western Canada. Many organizations that have successfully facilitated the
implementation of research into practice are listed. Their innovative capacity-building features
are discussed. Recommendations for action are also included.
Guideline Implementation: Why Don't We Do It?
LeifI.Solberg,M.D;AmericanFamilyPhysician;January15,2002

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92

http://www.aafp.org/afp/20020115/editorials.html#guide
This editorial discusses why clincial guidelines are often not implemented, and what can be done
about it. A reference list is included.
Improving Research Dissemination and Uptake in the Health Sector: Beyond the Sound of
One Hand Clapping
JonathanLomas;CentreforHealthEconomicsandPolicyAnalysis:McMasterUniversity;1997
http://www.fcrss.ca/knowledge_transfer/pdf/handclapping_e.pdf
This 67-page paper presents barriers to knowledge uptake in the health sector. A variety of
approaches for improving research dissemination and uptake are proposed.
Health Research in Action: A Framework for Building Capacity to Share and Use Health
Research
SaskatchewanHealthResearchFoundation;April2007
http://www.shrf.ca/knowledge_translation
The focus of this paper is on how to increase knowledge translation capacity within
Saskatchewan. After a multi-level, broad consultation process, a framework was developed.
Roles for different types of stakeholders are discussed. Examples of success are provided.
The Health Planners Toolkit
Module 3: Evidence-Based Planning
Section 4: How do I use information with confidence?
Stan Ardal et al.; Health Systems Intelligence Project; Government of Ontario; 2006
http://www.health.gov.on.ca/transformation/providers/information/resources/health_planner/mod
ule_3.pdf
This section explains three broad measures of success in achieving good planning, even if there
are imperfections in the evidence: validity; coherence; and applicability. Eight other factors that
warrant consideration when applying data to planning are also discussed.

Resources that Build Capacity:


HowdoIensurethatevidencewillbeputintopractice?

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93

NCDDR's Dissemination Self-Inventory


NationalCenterfortheDisseminationofDisabilityResearch
http://www.ncddr.org/cgi-bin/selfinventory.cgi?location=why_an_inventory
This inventory is designed to help research disseminators make their results and reports more
useful for implementation.

Criteria for Choosing Promising Practices and Community Interventions


Section 4: How Do You Choose the Particular Practice or Intervention That's Right for
Your Community?
TheCommunityToolbox;WorkGroupforCommunityHealthandDevelopment;Universityof
Kansas
http://ctb.ku.edu/tools/en/sub_section_main_1152.htm
The 4th section of this resource includes some comments and advice about adopting and
adapting best or recommended practices. Areas discussed include: Some difficulties in finding
practices or interventions you can use; Some keys to success in replication; and Elements of
successful replications of effective programs.

The Community Health Promotion Handbook: Action Guides to Improve Community


Health
PartnershipforPrevention
http://www.prevent.org/content/view/142/173/
The handbook includes five Action Guides designed to bridge the gap between research and
practice. The Guides translate specific recommendations from The Guide to Community
Preventive Services into 'how to' guidance to help implement the recommendations. The five
Guides address diabetes management, physical activity, and tobacco-use treatment.
What Consumers and Researchers Say About Research
NationalCenterfortheDisseminationofDisabilityResearch(NCDDR)&ResearchUtilization
SupportandHelp(RUSH);2005
http://www.ncddr.org/kt/products/focus/focus12/
This technical brief summarizes the findings of two studies, conducted in 2005, that focused on
learning how to best get research information to diverse groups of end-users. A useful
supplement to this brief is: A Review of the Literature on Dissemination and Knowledge

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94

Utilization. Also published by RUSH, this older (1996), but useful literature review provides an
overview of definition and models. A detailed explanation of the four dimensions that affect
knowledge utilization are presented: source of the message; content; dissemination medium; and
the intended users. It is available at
http://www.researchutilization.org/matrix/resources/review/.
Implementation Tools
NationalInstituteforHealthandClinicalExcellence(NICE)
http://www.nice.org.uk/usingguidance/implementationtools/implementation_tools.jsp
NICE provides national guidance on promoting good health and preventing and treating ill
health. Guidance documents cover topics such as cancer, infectious diseases and other public
health issues. To support the guidance documents, NICE maintains a list of implementation
tools. Some are generic and some relate to specific NICE guidance documents.

Improving Population Health: The Uses of Systematic Reviews


MelissaSweetandRayMoynihan
MillbankMemorialFund.ProducedincollaborationwiththeCentersforDiseaseControland
Prevention(CDC);2007
http://www.milbank.org/reports/0712populationhealth/0712ImprovingPopulationHealthFinal.pdf
This report recommends that a variety of steps be taken to make systematic reviews more useful
and used. Eight cases studies summarizing the findings of systematic reviews are included for
illustration.
RE-AIM Planning Tool
WorkgrouptoEvaluateandEnhancetheReachandDisseminationofHealthPromotion
Interventions
http://www.re-aim.org/Documents/RE-AIM%20PLANNING%20TOOL.pdf
This checklist raises questions about intervention implementation. It is intended to guide
decisions about intervention changes required.

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95

EVALUATE

Examples Illustrating Application:


Whatgroups,organizationsorgovernmentshaveevaluatedhowevidenceis
usedinpracticeandwhatconditionshelporhindertheuseofevidence?

The Steps Program in Action: Success Stories on Community Initiatives to Prevent


Chronic Diseases
CentersforDiseaseControlandPrevention;2008
http://www.cdc.gov/healthycommunitiesprogram/evaluation-innovation/pdf/StepsInAction.pdf
The booklet provides a snapshot of the Steps-funded communities evaluations in schools,
worksites, communities and health care settings. The Steps-funded project helped communities
implement public health interventions that are based on scientific evidence and have been
successful at changing peoples behaviors.
The Nature of Evidence Resources and Knowledge Translation for Health Promotion
Practitioners.
RebeccaArmstrongetal.HealthPromotionInternationalAdvanceAccess.June27,2007.
http://heapro.oxfordjournals.org/cgi/reprint/dam017v1
This paper presents the findings from an evaluation to explore how practitioners viewed and used
a series of evidence-based health promotion resources. Findings show that the resources are
unlikely to change practice without a practitioner engagement strategy. Implications are
discussed.

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96

Evaluating
Health Promotion
Programs

The Ten Steps to Evaluating a Health Promotion Program


1
Clarify Your Program
Ensure that your program has clearly defined goal(s) populations of interest, outcome objectives, activities
and outputs, and indicators of success.
Review vision and mission to which the program is intended to contribute. Clarify goal(s) that
summarize the positive outcomes you intend to achieve. They need not be measurable.
Understand the intended audience so that you can make decisions about the most appropriate
evaluation methods. Be aware of their demographics: where they live; the best way to reach and
communicate with them; and unique subgroups.
Define outcome objectives. They should include:
An indicator what you are trying to have an impact on
A target how much you are trying to impact the indicator
A population who are you trying to have an impact on
A date when you expect to achieve your objective
Define activities (i.e., things that you will do and produce) within a detailed workplan. Activities are
associated with implementation/process objectives not outcome objectives.
Ensure that activities are clearly linked to outcome objectives. A logic model will demonstrate links
and discover gaps in logic.

2
Engage Stakeholders
Define your stakeholders, understand their
interests and expectations, and engage them in a
review of objectives so that you can define
evaluation questions.

3
Assess Resources for Evaluation
Clarify staff, time, money, and other resources
available for evaluation in order to inform
evaluation design.
Identify resources available for the evaluation.

Make a list of people and/or organizations that


would be interested in the evaluation, including
program participants.
Identify stakeholder interests and expectations.
Specifically
what they want to know about the program,
and
their expectations regarding the type and
nature of the evaluation.

Consider
funds;
staff and volunteer time, interest, and
evaluation skills;
timeline;
equipment and tools; and
support of partner organizations.
Ensure that timeline for evaluation is aligned
with timeline for program implementation.

Prioritize stakeholder evaluation questions and


expectations.
Define final evaluation questions.

Develop indicator(s) for each outcome objective that will tell you if you achieved it. Indicators may
be based on things such as standards set by professional organizations, data about a control group
that did not participate, norms established through previous evaluations, morbidity or mortality
rates, and participant opinions.
Make an estimate based on what would not be acceptable in situations where you need an indicator
but do not know what kind of effect would be reasonable to expect.
For more
information

Develop indicators of success for implementation objectives (e.g., numbers of things distributed,
number of people contacted, resources expended).

Workbook Page

1722

278

31

Worksheet Page

235

29

32

99

The Ten Steps to Evaluating a Health Promotion Program


4
Select the type of evaluation
Select the best type of evaluation for your program
at this time. Choices include formative, process,
summative (short-term), summative (long-term),
and a combination.
In order to decide, clarify the time the program
has been in operation, stage (e.g., development,
winding down), and type of evaluation already
done.
Determine the best type by applying the
following guidelines:
When a program is starting up, formative and
some process evaluations are realistic.
Evaluations in the initial phases are most useful
for quality improvement and efficiency.
When program leaders are learning how to
effectively implement the program, formative
and process evaluations are most helpful and
realistic. Summative evaluations for measuring
short-term and intermediate-term outcomes are
possible. Even in this stage it is important to
measure processes to determine why outcomes
may not be reached.
Once the program has been established, it is
possible to conduct summative evaluations to
assess the short and long-term impact of the
program.
For more
information

5
Determine Appropriate Methods of Measurement and Procedures
Identify the most plausible kinds of evaluation methods as well as how the data will be collected.
Consider stakeholder expectations, success indicators, available resources, and the type of evaluation
to determine the most plausible evaluation methods. Evaluation studies may be qualitative or
quantitative. Some of the choices include
a literature review,
survey of experts,
interviews,
management audits,
record keeping, and
pre/post health status measures.
Determine how and how often data will be collected. This decision should include whether to
include a comparison group, whether random assignment is needed, and how many times data
should be collected. This decision should be based on:
whether you must show comparative impact on people who have not been exposed to the program
(analytical data),
the best way and time to communicate with participants/recipients,
ways to limit the burden on study participants,
success indicators, and
kinds of studies chosen.

6
Develop Workplan, Budget and Timeline
for Evaluation
Identify specific tasks, roles, resource allocations,
and deadlines for the evaluation.
When creating the project plan dont forget to
allow enough time for design, tool
development, pilot testing, report writing, and
dissemination of results.
Minimize costs by combining material testing
with summative pre-testing and using students
and volunteers.
Outsource when objectivity is needed; staff
lacks the skills, time or interest; and resources
are available.

Choose, adapt, or develop the evaluation data collection tool. Questions to be included in the tool
should be dictated by
success indicators,
time and resources available, and
type of evaluation study
Choose a sample size and a sample recruitment method. The size of the sample should be based on
size of total target population,
budget,
desired level of confidence in results, and
need to analyze information about subgroups.

Workbook Page

3348

4956

635

Worksheet Page

5761

5761

668

100

The Ten Steps to Evaluating a Health Promotion Program


7
Collect Data
Pilot test tools and procedures and then collect
data.
Develop data collection standards and
procedures for people involved in data
collection.
Ensure that people collecting the information
are trained in the appropriate data collection
procedures.
Closely monitor data as it comes in to ensure
that procedures and tools are correct.

8
Process the Data and Analyze the Results
Prepare and then analyze the data.
Put data in a format that can be summarized
and interpreted.
Cluster qualitative data to determine how often
an idea appears in the data set.
Double-check at least 10% of the data,
especially odd comments or "out of range"
numbers to minimize errors.
Enlist the support of a data analysis expert
whenever possible.

Computerize data collection where appropriate


to make later analysis easier.

9
Interpret and Disseminate Results
After interpretation, share results with all
stakeholders in formats that are tailored to their
specific interest in the evaluation.
Anchor all interpretation to the original
evaluation questions.
Keep your audience(s) in mind when preparing
the report. Consider their specific interest in the
evaluation.
Include the limitations of the evaluation in the
final report.

10
Take Action
Make changes to improve the program based on
the evaluation results.
Involve stakeholders to determine what
program adjustments are warranted.
Create a list of recommended actions that
address the outcomes of your evaluation.
Prioritize those changes that are most important
and feasible to implement.
Set up an action plan to implement the
recommended changes.

Compare and contrast evaluation results of


similar programs and if applicable the results of
different parts of the evaluation.
To illustrate results, use simple visuals whenever
possible.
Create shorter and/or otherwise tailored
versions of the final report for different
stakeholders, depending on how they plan to
use the information.

For more
information
Workbook Page

6972

736

7784

856

Worksheet Page

101

Introduction to
Evaluating Health
Promotion Programs

155 College Street


Room 400
The Banting Institute
University of Toronto
Toronto, Ontario
M5T 3M7
Tel (416) 978-0522
Fax (416) 971-1365
E-mail:
hc.unit@utoronto.ca
www.thcu.ca

Five-minute OUTCOME evaluation


course

In pairs, carefully observe one another.


Turn your backs to each other, changing
three things about your personal
appearance
appearance.
Now, face each other, and in turn, try to
identify the three changes in the other
person.
Discuss..
2

Definitions

Program Evaluation The systematic


gathering, analysis and reporting of
information to assist in decision-making.
decision making
Ontario Ministry of Health, Public Health Branch (1996)

102

Steps in evaluation process

Step 1: Clarify your program


Step 2: Engage stakeholders
Step 3: Assess resources for evaluation
Step 4: Select the type of evaluation
Step 5: Determine methods of measurement and
procedures
Step 6: Develop workplan, budget and timeline
Step 7: Collect data
Step 8: Process the data and analyze the results
Step 9: Interpret and disseminate results
Step 10: Take action

Step One: Clarify your program

Ensure that your program has clearly defined


goals, populations of interest, outcome
objectives, activities, outputs and indicators.

Recall the Elements of a wellwritten outcome objective


Priority
Population
(who)

How much

Outcome
(what)

Conditions
(when)

A
well-written
outcome
objective

103

Step Two: Engage stakeholders

Define your stakeholders, understand their


interests and expectations, and engage them
in a review of objectives
This will help you define you evaluation
questions

Who are our stakeholders?

Understanding stakeholder
interests

What do they want to know from the


evaluation?
How do they expect the evaluation to be
conducted?
d t d?
Usually need to prioritize stakeholder
interests due to budget limitations

104

Understanding the reason for


evaluation

In step two we aim to develop our


evaluation questions.
We do this by:
Defining
D fi i our stakeholders
t k h ld
Engaging them in an appropriate way
Learning about their interests and expectations
Our work in step two sets the tone for stakeholder
relationships that will carry through the rest of the
evaluation

Engaging stakeholders
involve stakeholders from the beginning
only expect involvement in things they are
interested in
communicate the benefits of their involvement
be clear about how decisions will be made avoid
raising unrealistic expectations
do not burden with unnecessary tasks or timelines
share information in tailored formats
celebrate successes with stakeholders

11

Benefits of participatory evaluation


helps to ensure appropriate evaluation methods (e.g.,
reading level, cultural appropriateness)
helps ensure evaluation questions are grounded in the
perceptions and experiences of the program participants
helps facilitate the process of empowerment (i.e., giving
people greater control over decisions affecting their health)
helps to overcome participant resistance to evaluation
helps to foster participant understanding

12

105

Step Three: Assess resources for


evaluation
Clarify staff time, money and other resources
available for evaluation.
The will inform your evaluation design decisions
Consider:

Funds
Staff and volunteer time and interests
Timeline
Equipment and tools
Support of partners

Step Four: Select the Type of


Evaluation

Select the best type of evaluation for your


program at this time.
Choices include formative, process and
summative
There are different terms/interpretations/types
types of summative evaluation including:

Outcome evaluation
Impact evaluation
Cost-benefit evaluation
Cost-effectiveness

106

Step Five: Determine appropriate


methods of measurement and
procedures

Identify the most plausible kinds of


evaluation methods as well as how the data
will be collected

Methods: Qualitative or quantitative


How and How often?
Choose, adapt or develop evaluation tool
Choose a sample and recruitment method

Step Six: Develop workplan,


budget and timeline

Identify specific tasks, roles, resource


allocations and deadlines for the evaluation

Step 7: Collect the Data


TIPS

Train, train, train!


Easy formats
Support and encourage data collectors
Check information recorded
Audio tape in-depth interviews and focus
groups
Computerize as much as possible

107

Step 8: Process the Data


Quantitative Data
Quantitative information is easier to analyze when it
has been entered as a number. In other words all
response categories should be assigned a number
y
software ((EXCEL,, SPSS))
Use data analysis
Verify 10% of the data entry to eliminate errors.
Most errors are systematic
What if you dont have data analysis software?

Step 8: Analyze the Data


- Quantitative Data

For most surveys or tracking methods simple


descriptive statistics (frequencies, means,
ranges, etc.) are all that is needed.
M
More complex
l analysis
l i may be
b required
i d
when comparisons are needed between
subgroups of the population or to test
changes over time.

Step Nine: Interpret and


Disseminate the results

After interpretation, share results with all


stakeholders in formats that are tailored to
their specific interest in the evaluation

108

Step Ten: Take action

Make changes to improve the program based


on the evaluation results
How are you going to use the results of your
evaluation plan?

Indicators

Matching Indicators to Objectives

To increase the number of employees in X


workplace eating nutritionally balanced
meals by 25% by June 2009.
Indicators
# of healthy and lower nutritional value choices
offered
# of healthy and lower nutritional value choices
purchased (e.g. pop)

109

Debrief of Activity:
More about Indicators

Units of measurement used to assess the


extent to which objectives have been met.
Building
g block for a comprehensive
p
evaluation plan.
Must be valid, reliable, and accessible.

25

For each indicator identify:

What you will measure


Where the data is available
Any concerns about:
Validity
Reliability
Accessibility

26

What will you measure?

percentage of people who agree


that(outcome)
Number sent (process)
Participant
P i i
comments (process)
(
)
Etc.

110

Where is the data available?

Outcome indicator examples:


Community health survey
Collect it ourselves
Media monitoring service

Process indicator examples:


Program secretary budget files
Physician office records
Workshop registration forms
28

Validity

Can you generalize the results beyond your


sample (external validity)?
I.e., is your sample like the rest of the world?

Is it a true indicator of what you wanted to


measure (internal validity)?
E.g. If they say they like it it doesnt mean it
is useful

29

Reliability

Will it give consistent, accurate


measurement over time?
If you ask the same question at different times,
will they respond in the same way?
Are you using the right scale?
Does everyone understand the question in the
same way? Is there too much room for
interpreting the question?
Can emotions or other circumstances change the
respondents answers from day to day?
30

111

Are there any limitations on


accessibility for this indicator?

Examples:

There is a limited sample from our region


There is a fee
Physicians are difficult to reach
There are few people who have permission (or
skills) to access the data

31

Sources of Health
Promotion Indicators
Health Canada website (search indicators)
www.hc-sc.gc.ca
U.S Healthy People 2010 Local Health Indicators
www.healthypeople.gov/LHI
g
Canadian Council on Social Development
www.ccsd.ca
Federation of Canadian Municipalities quality of life
reporting system www.fcm.ca

More Sources of Health


Promotion Indicators
Indicators that Count: Measuring Population Health at the
Community Level
http://www.ncbi.nlm.nih.gov/pubmed/10686755
Indicators of Quality of Life in Canada: A Citizens Prototype
http://www.cprn.org/doc.cfm?doc=91
APHEO http://www.apheo.ca/
Health Evidence Network
http://www.euro.who.int/HEN/Syntheses/20030820_1
What is the evidence on effectiveness of empowerment to
improve health?
http://www.euro.who.int/Document/E88086.pdf

112

Evidence to support planning


decisions-collection of resources

http://www.thcu.ca/infoandresources/planni
ng_resources_soe.cfm?ownership=ALL
This
Thi is
i in
i your handout
h d
package.
k

34

Select Type of Evaluation

Step Four: Select the Type of


Evaluation

Select the best type of evaluation for your


program at this time.
Choices include formative, process and
summative

113

Types of evaluation

Formative
Process
Summative

Formative evaluation

Assesses process of developing a program


Helps to ensure that programs are developed
i accordance
in
d
with
i h stakeholder
k h ld needs
d
Identifies how/why key decisions were made

Process evaluation

Assesses the procedures and tasks involved


in implementing a program (whats
happening?)
Sometimes known as program tracking or
monitoring

114

Components of
process evaluation

# and type of people reached by program


Quantity and type of activity/service
provided
Description of how services are provided
Quality of services provided (participant
satisfaction)

Summative evaluation

Attempts to determine value of program


Includes measures of short and long term
outcomes
Includes
I l d process considerations.
id
i

Summative Evaluation: There are


many terms/types/interpretations

For example, all of the following may be a


part of summative evaluation

Changes in attitudes, knowledge, behaviour


Changes in morbidity or mortality rates
Number of people participating or served
Cost-benefit analysis
Cost-effectiveness analysis
Changes in policies
Outcome assessments
Impact assessments

115

Selecting Evaluation Type


Handout/guided example
1. When will you be doing the evaluation?
2. Why are you conducting the evaluation?
3. What questions do your stakeholders want
answered?
4. Who is available to conduct the evaluation?
5. How do you expect to conduct the evaluation?
6. How much resources do you have? (time,
expertise, funds)
7. What evaluation have you already conducted?

1. When will you be doing the


evaluation?

a. Prior to or early in intervention


b. Middle of intervention
c. As intervention is winding down

2. Why are you conducting the


evaluation?

a. To ensure the intervention is consistent


with the needs and wants of the people
involved
b. To ensure that the intervention is being
implemented according to plans and best
practices (are we doing things right?)
c. To assess the extent to which the
intervention achieved its purposes and
objectives (are we doing the right things?)

116

3. What questions do your


stakeholders want answered?

a. Who is the best audience for this


intervention?
b. How many people are we reaching? Are
they satisfied?
c. Did we achieve what we set out to do? Did
the benefits justify the costs?

4. Who is available to conduct the


evaluation?

a./b. Program participants, stakeholders, and


interventionists
c. E
Experienced
i
d and
d expert evaluators
l
and
d
researchers, in addition to program
participants, stakeholders, and
interventionists

5. How do you expect to conduct


the evaluation?

a. Needs assessments, pre-testing of


materials and procedures
b. Program logs, diaries
c. Pre
P and
d post surveys

117

6. What resources do you have?


(time, expertise, funds)

a. Moderate
b. Minimal
c. Substantial

7. What evaluation have you


already conducted?

a. None
b. Formative
c. Formative and process

Step Five: Determine appropriate


methods of measurement and
procedures

Identify the most plausible kinds of


evaluation methods as well as how the data
will be collected

Methods: Qualitative or quantitative


How and How often?
Choose, adapt or develop evaluation tool
Choose a sample and recruitment method

118

Methods
Qualitative or Quantitative?
Consider:

Stakeholder expectations
Success indicators
Available
l bl resources
Type of evaluation

Examples:

Survey of experts
Interviews
Record-keeping
Pre/post health status measures

Quantitative vs
Qualitative Evaluation

Not everything that can be counted


counts, and not everything that counts
can be counted.
Albert Einstein
53

Change three things

Simple
0X0
But designs can be more elaborate

54

119

How and how often?

How many times will you collect data?


Include a comparison group?
Use random assignment?

55

How and How Often?

0X00
Second observation, time series, to see whether
effects are lasting

0 X 0 0 vs 0 0 0
Control group not exposed to an intervention
silver standard

R 0 X 0 0 vs R 0 0 0
Random assignment addition a control trial
the gold standard
56

To decide how and how often,


consider:

Do you need to show comparative impact on


people who have not been exposed?
What is the best way and time to
communicate with participants/recipients?
How can you limit the burden on study
participants?
What are your success indicators?

57

120

Choose a sample and a


recruitment method

How many will be included?


How will the people be selected?
Random or convenience sample?
How to decide?
Size of entire population
Budget
How confident do you need to be with the
results
Do you need to look at subgroups?

Evaluation tool

Design is important
But the heart of it is whether you have a
good tool, that measures the right things.
Choose,
Ch
adapt
d
or develop
d
l
Consider:
Success indicators
Time and resources
Type of evaluation study
59

Whats Wrong With This


Questionnaire?

At your table, review the questionnaire and


discuss whether you feel there are flaws in
the questions.
Make notes about your conclusions
You have 15 minutes

121

Types of Errors to Look For

Leading questions (therefore bias).


Incorrect order (creating resistance or bias).
Intrusive questions that may generate
hostility.
Lingo and complicated words/phrases.
Double-barrel questions
Changing response categories (order or the
terms).

Whats Wrong With This


Questionnaire?

Compare your results with the answer key in


your package
Raise any outstanding questions, or other
comments

Resources

122

Resources

Essential Skills Resource Tour


http://www.thcu.ca/workshops/hpskillsresourc
etour.htm
THCUs Resource Database (Evaluation
Section)
http://www.thcu.ca/infoandresources/resource
_display.cfm?res_topicID=5

THCU Evaluation Podcast

Evaluating Health Promotion Programs


Workbook in French and English
Conducting Survey Research Workbook
Conducting Focus Groups Workbook
Tips for Running Focus Groups with Youth
Continuous Quality Improvement Slideshow
Evaluation At a Glance
http://www.thcu.ca/infoandresources/resource
_display.cfm?res_topicID=5

Glossaries
WHO Health Promotion Glossary
http://www.who.int/hpr/support.material.shtml

NCI Health Comm Glossary


http://www.cancer.gov/pinkbook/page14
p //
g /p
/p g

Atlantic Centre of Excellence for Womens Health


EVAL glossary
http://www.acewh.dal.ca/eng/reports/EVAL.pdf

Canadian Evaluation Society List of Glossaries


http://www.evaluationcanada.ca/site.cgi?s=1&ss=1&nu
m=00676

123

A big thank you to

Ontario Agency for Health Protection and


Promotion
Our colleagues
Our
O workshop
k h participants
i i

Disclaimer
The Health Communication Unit and its resources and
services are funded by the Ontario Agency for Health
Protection and Promotion. The opinions and conclusions
expressed in this presentation are those of the author(s) and
no official endorsement by the Agency for Health Protection
and Promotion is intended or should be inferred.

124

IndicatorAssessmentExercise

Considereachpossibleindicator:

Isitvalid?YES/NO
Isitatrueindicatorofwhatyouwanttomeasure?

Canyougeneralizeyourresultstotherestoftheworld?

Isitreliable?YES/NO
Willitgiveconsistent,accuratemeasurementovertime?

Isitaccessible?YES/NO
Wherewillyougettheinformation?

Willitbedifficulttogettheinformation?

125

PossibleIndicator AnswerKey
OutcomeObjective:Thatatleastone16+memberofeveryfamily,inthisNorthernFirstNations
community,participateintheprocessofharvesting,preparing,preservingorstoringtraditionalfoods
(tolatereatintheirownhousehold)byDecember2011.
1.

Numberofadult
communitymembers,of
thosewhoparticipateina
communitywidedoorto
doorsurvey,whoclaim
thatthattheyknowhow
toharvest,prepare,
preserveorstoreatleast
oneofthetraditional
foodslistedinthesurvey
question.

Isitvalid?
Itmeasuresperceivedknowledge,ratherthanreportedbehaviourwhichtheobjectivefocuseson.However,this
maybeokay,ifyouareatthestageofassessingpossibleprecursorstobehaviour.

Whetheryoucangeneralizesurveyrespondentstothewholecommunitydependsonresponserate,and
characteristicsofrespondents,andhowtheycomparetocharacteristicsofthewholecommunity.

Isitreliable?
Thereisapossibilitythatascommunityknowledgeaboutwhatisrequiredtoharvest,prepare,preserve,store
traditionalfoodsincreases(perhapsasaresultofcommunityprogramming),thatconfidencemayactually
decrease.Sothismaynotbeareliablemeasure.Itmaybebettertoalternatively(orinadditionto),measure
reportedparticipationinharvesting,preparing,etc.

Isitaccessible?
InasmallNortherncommunity,adoortodoorsurveyconductedbyatrustedcommunitymembermaybeacost
effectivewaytogetahighresponserate.Ascommunitysizeincreases,andifsurveyorsarestrangers,thismay
notbethecase.

126


2.

Numberof
programs/outings/field
tripswhereolderyouth
(1618)participatein
traditionalharvesting,as
reportedbyschoolsand
communityyouthgroups
inaprogramlog.

Isitvalid?
ThisisPARTofagoodindicatorofwhatwewanttomeasureforPARTofthepopulation(notthoseolderthan
18).Itdoesnotcapturethewholepopulation,anditdoesnotreflectactualparticipantnumbers,ordegreeof
participantinvolvementintheprogram.Itmaybeoneofaseriesofrelatedindicators.

Theresultscanbegeneralizedtothecommunityonlyinsofarasevaluatorsareabletocalculatethepercentage
oftotalyouth(1618)thatthenumbersrepresent

Isitreliable?
Itmayprovideconsistent,accuratemeasurementovertimeifthosewhoaresupposedtocompletetheprogram
logsaregivenamplereminders,coachingasnecessary,timetocompletethetask(paidtime,orsomeother
incentive),andfeeltheprogram/sareimportant.Asidefromthesereportingissues,itshouldbeareliable
indicator,solongasacleardefinitionisprovidedforouting/fieldtrip/program.

Isitaccessible?
Itisaccessibleifthereisbudgettoprovidethesupportnotedaboveunderreliability(coaching,incentives,time,
etc.)

127

OutcomeObjective:Thatsomekindof(atleastone)traditionalfoodisavailable everyday toall


communitymembersthroughdaycares,schools,homesandeventsbyDecember2011.
3.

Percentageofdaycare
directorsthatclaimtobe
offeringatleastone
traditionalfood(froma
listprovidedtothem)to
thechildrenintheir
daycare,eachday,when
contactedforabrief
telephonesurvey.

Isitvalid?
Yes,itisagoodmeasureofprogresstowardtheobjective.Itisgeneralizabletotherestofthecommunityifa
representativesampleofdaycaresparticipateinthesurvey

Isitreliable?

Aslongasthedefinitionofatraditionalfoodisclearlydefined(viaalistofpossibilities),andeveryone
understandswhateachtraditionalfoodis,thenthisshouldbeareliablemeasure.

Isitaccessible?
Accessibilityprobablydependsonthelengthofthesurvey.Adaycaredirectorhasverylittletimefortalkingon
thephone.Ifthesurveyistrulyveryshortonetothreesimplequestions,itisprobablyaccessible.

Accessibilityalsodependsontheevaluatorsaccesstocurrentandcompleteinformationaboutcommunity
daycares.Ifthereisnotanexistinglist,extraresourcesrequiredtocreateagoodlistmaycreateabarrierto
accessibility.

128


4.

Numberofcommunity
membersover18,of
thoserespondingtoa
communitywideinternet
survey,whoclaimtobe
eatingtraditionalfoods
once,twice,ormoretimes
aweek.

Isitvalid?
Eatingbehaviourisnotagoodmeasureofaccessibility,thefocusofthisobjective.Ifratesofeatingarehigh,one
presumesaccessibility.Butifeatingratesarelow,noconclusionscanbedrawnaboutaccessibilitytheremay
beotherreasonswhypeoplearenoteatingtraditionalfoodsthathavenothingtodowithaccessibility.The
indicatorshouldfocusonperceivedavailability,invarioussettings.

Also,itdoesnotmeasurethebehaviouroftheentirepopulation(thoughforethicalandmanypracticalreasons
itcanbemoredifficulttoaccesscommunitymembersunder18)

Isitreliable?
Yes,aslongaseveryoneunderstandsthedefinitionoftraditionalfoods.

Isitaccessible?
Itdependsoncommunityaccessto,andskilllevelcompletingonlinesurveys.

Incentives,reminders,andperceivedimportanceoftheissue,aswellaslengthoftheentiresurvey(time/energy
investmentrequired)mayalsoaffectresponseratesandoverallcosttocollectandanalyzedata.

129

ProcessObjective:Toadvocate toFirstNationgovernmentsforcommunitylevelpoliciestoallow
adultcommunitymembersemployedbythemunicipality,timeofffromworkfortimeofftohunt,
harvestandsharetraditionalfoodknowledge.
5.

Theamountoftimeand
moneyusedtoadvocate
forthispolicyasrecorded
inprogramlogs.

Isitvalid?
Costisagoodprocessmeasure

Inpolicydevelopment,itisverydifficulttogeneralizetheamountoftimeandmoneyrequiredforadvocacy.
Muchdependsonhowmuchconvincingisneeded.

Isitreliable?
Reliabilitywilldependonsupportsprovidedtothepeoplewhomustrecordtheinformation.Forexample,they
wouldneedenoughtime,incentive/encouragement,reminders,andaccountabilitytodoagoodjob.
Theymustalsofeelthetaskifuseful(i.e.itwillbeanalyzed/compiledforagoodpurpose).

Isitaccessible?
Itdependsonthelevelofdetailtherecordersareexpectedtorecord.Themoredetail,themoreinaccessible.

6.

Theamountofsupportive Isitvalid?
mediacoveragerelatingto Amountofresultingcoverageisagoodindicatorofhowtheprocessisgoing.However,itcanbedifficulttodraw
thispolicy.
conclusionsaboutwhethertypeandamountofcoverageareduetotheeffortsofyourorganizationspecifically.
Otherorganizations,otherpoliticalforces,journalistswithcertainbiasescanallaffectthetypeandamountof
coverage.

Isitreliable?
Yes,counting(numberandwordcount)mediacoveragedoesprovideaconsistent,accuratemeasureovertime.

Isitaccessible?
Abroadscanofmanymediavehiclesandchannelscoveringalargegeographicareaisbestdonebyamedia
trackingagency.Thecostisvariabledependingongeographicareaandnumberofchannelsscanned.Inasmall
community,withveryspecificlocalmediachoices,thisjobmaybedoneinhouse.However,eveninsituations
wherelocalstaffsarescanningoneortwolocalchannels,timeisrequiredtodoitproperlyandconsistently.
6

130


7.

NumberofNorthern
communitiesthatadopta
policyasreportedby
municipalitiesinresponse
toanonline
questionnaire.

Isitvalid?
Thisisagoodindicatorofsuccess.However,itisanoutcomeindicatorthanaprocessindicator.

Isitreliable?
Aslongasthedefinitionofasuccessfulpolicyisclearlyunderstood,thisshouldgiveaconsistent,accurate
measurementovertimeaboutsuccessofpolicybuildingefforts.

Apossiblethreattoreliabilityissendingthequestionnairerequesttoapersonwhorankstoohighortoolowin
theorganization.Thismayresultinincorrectanswers,orlowresponserates.

*NoteThisindicatordoesnotprovidethewholestory.Itisalsoimportanttomeasureimplementationofthe
policies.Relatedindicatorsaboutawarenessandunderstandingofthepolicyamongvariousstakeholders,and
actualuse/implementationofthepolicyarealsoimportant.

Isitaccessible?
Anonlinequestionnaireformunicipalitiesmaybeaccessible,aslongasacontactlistforthebestpersonto
answerthequestionsisavailable.

Process:Tomake25presentationstocommunitymembersofallagesaboutdiabetesandthevalueof
traditionalfoodsinpreventionandtreatment.
8.

Numberofpeoplein
attendanceateach
communitypresentation
asrecordedbymeeting
organizers.

Isitvalid?
Yes,thisisagoodindicatorofwhatyouwanttomeasure

Generalizationisnotapplicablehere.Attendanceatpresentationsmaybeinfluencedbymanylocalfactors

Isitreliable?
Thisshouldgiveconsistent,reliablemeasureovertime,aslongasthereissomeoneateacheventproperly
countingattendees.

Isitaccessible?
Thisisalowcost,easytogatherindicator.
7

131


9.

Numberofcommunity
memberswhoknowtwo
reasonswhytraditionalfood
preventsandtreatsdiabetesas
reportedontheendof
presentationevaluation.

10. Numberofquestionsand
commentsfromparticipants
duringthesession.

Isitvalid?
Thisisagoodindicatorofsuccess,butitisanoutcomeindicator(knowledge).

KnowledgeresultsatonesessioncanonlybegeneralizedtoanothersessionIFparticipantcharacteristicsat
eacheventaresimilarandifcontentandmethodsofpresentationarevirtuallyidentical

Isitreliable?
Ifmeasuredinthesameway,andresultsarecoded/interpretedinthesamewayeachtime,thisshould
provideaconsistent,accuratemeasureofknowledgeofparticipants,postevent,overtime.

Isitaccessible?
Thisisalowcost,easytocollectindicator.Problemscanariseifpeopleleaveearly,anddontcompletethe
evaluationformsattheendofthesession.Itisimportanttoemphasizetheimportanceoftheevaluation
andgivepeopleadequatetimebeforetheendofthepresentation,tocompletethesurvey.
Isitvalid?
Thisisagoodindicatorofqualityandengagement.

ResultsatonesessioncanonlybegeneralizedtoanothersessionIFparticipantcharacteristicsateach
eventaresimilarandifcontentandmethodsofpresentationarevirtuallyidentical

Isitreliable?
Ifdefinitionsofquestionsandcommentsareclearlydefined,andaclearprocessforcountingthemis
agreedupon(e.g.apersondesignatedtocountthemduringthesession),thisshouldbereliable.

Isitaccessible?
Ifcountingrequiresanextrastaffpersondedicatedtothetask,thismaynotbeanaccessibleindicator.Ifa
morecasualcountingsystem(estimatesbyfacilitator)isused,itislessreliable,butmoreaccessible.

132

Who are our stakeholders?

133

134

SourcesofHealthPromotionIndicators

HealthCanadawebsite(searchindicators)www.hcsc.gc.ca

U.SHealthyPeople2010LocalHealthIndicatorswww.healthypeople.gov/LHI

CanadianCouncilonSocialDevelopmentwww.ccsd.ca

FederationofCanadianMunicipalitiesqualityoflifereportingsystemwww.fcm.ca

IndicatorsthatCount:MeasuringPopulationHealthattheCommunityLevel
http://www.ncbi.nlm.nih.gov/pubmed/10686755

IndicatorsofQualityofLifeinCanada:ACitizensPrototype
http://www.cprn.org/doc.cfm?doc=91

APHEOhttp://www.apheo.ca/

HealthEvidenceNetwork

http://www.euro.who.int/HEN/Syntheses/20030820_1

Whatistheevidenceoneffectivenessofempowermenttoimprovehealth?
http://www.euro.who.int/Document/E88086.pdf

135

Decision Table for Step 4:


Selecting Evaluation Type
Focus
Question

Option a.

Option b.

Option c.

1.

When will you be


doing the
evaluation?

Prior to or early in
intervention

Middle of
intervention

As intervention is
winding down or
completed

2.

Why are you


conducting the
evaluation?

To ensure the
intervention is
consistent with the
needs and wants of
the people
involved

To ensure that the


intervention is
being implemented
according to plans
and best practices
(are we doing
things right?)

To assess the extent to


which the intervention
achieved its purposes and
objectives?
(are we doing the right
things?)

3.

What questions do
your stakeholders
want answered?

Who is the best


audience for this
intervention?

How many people


are we reaching?
Are they satisfied?

Did we achieve what we


set out to do?
Did the benefits justify
the costs?

4.

Who is available to
conduct the
evaluation?

Program
participants,
stakeholders, and
interventionists

Program
participants,
stakeholders, and
interventionists

Experienced and expert


evaluators and
researchers, in addition to
program participants,
stakeholders, and
interventionists

5.

How do you expect


to conduct the
evaluation?

Needs Assessments
Pre-testing of
materials and
procedures

Program logs,
diaries

Pre and post surveys

6.

How much
resources do you
have? (time,
expertise, funds)

Moderate

Minimal

Substantial

7.

What evaluation
have you already
conducted?

None

Formative

Formative and process

Formative
evaluation

Process
evaluation

Summative
evaluation

THEN YOUR
SITUATION IS A GOOD
MATCH WITH

136

Whats Wrong With This Questionnaire?

This hypothetical questionnaire is to be conducted with the general population in an area


of a city that has a high percentage of lower income households.
The purpose of the survey is to evaluate the effectiveness of a media campaign, which
includes radio, television, and print PSAs.
The PSAs profiled existing physical activity programs in a specific geographical area.
They portrayed the programs as fun, relaxed, and informal, and contained the message
that the programs listed were free or inexpensive.
The program was developed in response to an evaluation of existing physical activity
programs which revealed that the average household income of participants was
significantly higher that the average for the community.
The objectives of the campaign are:
1.

To increase awareness of free or low-cost physical activity programs in the


community.

2.

To increase the use of existing physical activity programs that are free or low-cost
by families and individuals with an annual household income or $25,000.00 or
less.
This questionnaire contains several common errors. Please review the
questionnaire and note the errors. We will discuss the errors together.

137

Questionnaire to Critique
Hello, my name is (INSERT YOUR NAME). I am calling to ask a few questions about
advertising that has recently been conducted promoting low-cost and free physical
activity programs in your community. Can I interview you now?
IF YES, CONTINUE
IF NO, THANK AND TERMINATE
Q.1

What is your annual household income?


$___________.00

Q.2

Do you feel that the physical activity programs in your community are too
expensive for you to participate in?
YES
NO

Q.3

Recently, the local Public Health Unit ran a series of PSAs promoting existing
physical activity programming in your community. The PSAs ran across all
media types and were in low to moderate rotation for the past month. The content
was upbeat, including a catchy sound tract, and focused on free and low-costs
activities. Do you recall seeing or hearing any PSAs of this nature?
YES
NO

Q.4

1
2

Are you currently a member of a gym or fitness club, or do you participate in any
regular physical activity program?
YES
NO

Q.5

1
2

1
2

Please tell me what regular physical activity you participate in.


__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________

138

Q.6

What was the media source that carried the PSA that you saw or heard?
RADIO
TV
WEEKLY NEWSPAPER
DAILY NEWSPAPER

Q.7

1
2
3
4

How would you rate the quality of the PSA(s) that you saw or heard? How much
did you like them?
Excellent
Good
Fair
Poor
Terrible

Q.8

Would you say that the PSA that you saw increased your likelihood to participate
in local physical activity programming?
YES
NO

Q.9

Did the media coverage that you saw or heard increase your awareness of free or
low-income fitness and recreation opportunities in your community?
YES
NO

Q.10

1
2

1
2

Please tell me your name and address so we can send you some more information
about fitness and recreation opportunities in your community.
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________

139

Answer Key
Introduction
A.

This introduction gives away too much information about the subject. Awareness
questions will be biased by the introduction.

B.

An introduction should:

include the name of the organization conducting the survey, to ensure the validity
to the respondent (in some special cases a blind survey is required, and the
name will not be given)
let the respondent know how long the interview will take
let the respondent know that their responses will be confidential and anonymous

Here is an example of a better Introduction:


Hello, my name is (INSERT NAME), and Im calling from the local Public Health
Department. We are conducting a survey about the fitness and recreational sport
opportunities in our community, and would appreciate your participation. The interview
will take approximately five minutes. We are contacting approximately 200 people in the
community, and I assure you that your name will not be associated with your answers.
Would you like to take part in an interview now?
Q.1

Q. 2

A.

This question should never start a questionnaire. Personal information


such as income, should always be kept until the end of the interview when
the respondent feels more comfortable, and has a good understanding of
the survey.

B.

The use of precoded income categories allow the respondent to simply


pick a category as opposed to stating their income.

A.

The respondent may be unfamiliar with the term physical activity


programming. It would be better to use simple, clear language such as,
fitness and recreation opportunities, or sports and fitness activities.

B.

As in question one, any question dealing with money, or other personal


issues, should be kept for later in the interview.

140

Q.3

This is an aided awareness question. This means that you are telling the
respondent exactly what PSA you are interested in, then asking whether or not
they has seen or heard it. It is better to start with an unaided awareness
question such as, Have you recently seen, read, or heard anything about fitness
and recreation programs in your community? You want the question to be
focused on your subject of interest, but not stating the exact PSA. Following up
with an aided awareness question will give you a good idea if the awareness.
The term PSA may not be known. Use a term such as advertising, or anything
in the media.

Q.4

This is a double barrel question. It is asking two different questions and giving
one response category. If this information is needed, it should be broken into two
questions as follows:
Q.4

Are you currently a member if a gym or fitness club?


YES
NO

Q.5

1
2

Do you participate in any regular physical fitness program?


YES
NO

1
2

Q.5

This question requires a skip pattern. If the respondent answers No in question


four, meaning that they do not participate in any regular physical activity, then
they should not be asked question five.

Q.6

A.

This question relates directly to question three and should follow right
after it. Breaking up related questions is confusing for respondents, and
interviewers!

B.

The term media source and PSA may not be understood by respondents.
A simple way around these terms is:
Q.6

Where did you read, see, or hear this information?

141

Q.7

Q.8

Q.9

A.

This is double barrel question. Rating the quality of something is not the
same as asking someone whether or not they liked it. A respondent may
feel that they PSA is of high quality, but not like it, or vice versa. This
should be broken into two questions, if they are both necessary.

B.

The method of recording the response is different on this question from


the other questions. This will make the data processing more difficult.

A.

This question may be confusing for respondents. The terms increase


your likelihood is not common language.

B.

The information that this question is asking for could be better obtained by
the records of the programs themselves. Asking people if they are likely
to do something can be valid, but wherever possible, record the action in
a more objective, direct manner.

A.

These questions are leading. In some cases, respondents will say yes to a
question simply because the dont want to appear uninformed. Openended questions can get at the same information, without leading the
respondent. For example:
What do you recall about the information that you read, saw, or heard?

B.

It would be more logical if this question were located closer to the other
questions about the PSAs.

142

Q.10 A.

B.

The revised introduction tells the respondent that the information they give
is confidential. Asking for personal information after ensuring
confidentiality needs to be explained clearly, and the respondent reassured
that their name will not be associated with their responses.
A question like this can generate hostility. If you need to ask respondents
for personal contact information, the best way to do so is to state why you
are asking, and then give them the option to provide the information.

Here is a better way to ask this question:


Q.10

Would you be interested in receiving a list of local free and low-cost


fitness and recreation opportunities?
IF YES, CONTINUE
IF NO, SKIP TO GOODBYE

Q.11

Where would you like the information sent?


____________________________________________________________
____________________________________________________________
____________________________________________________________
____________________________________________________________
____________________________________________________________

143

Policy
Development

The Eight Steps to Developing a Health Promotion Policy


1
Describe the Problem

2
Assess Readiness for Policy
Development

3
Develop Goals, Objectives, &
Policy Options

4
Identify Decision Makers &
Influencers

Obtain a detailed understanding of the


specific problem. This will be a
foundation for developing clear goals,
assessing options, & building support for
the policy among decision makers.

Determine whether to proceed. This


decision should be based on whether your
community is ready for a specific policy &
your organization is ready to lead or
support the process.

Decide which decision makers will be the


focus of your support-building efforts.
Choosing the wrong people can waste
resources & may even jeopardize future
strategies if you approach people at the
wrong level, or wrong time.

Understand the problem:

Assess readiness:

Causes What is the origin or cause of


the problem? What has contributed to
its development?

Community Who will be supportive


or unsupportive? Why? What is public
opinion? What reasons to oppose this
policy will be put forward? Are there
educational & awareness programs in
your community that focus on your
problem? How successful have they
been? Has the problem been a recent
focus in the media?

Define clear goals & objectives for the


policy change & generate a list of policy
options that you want decision makers to
consider. Putting forward more than one
option shows stakeholders that you are
flexible & willing to negotiate. Assessing
numerous options prepares you to explain
why there are certain ones that you will
not support.

Impact What is the extent & cost of


the problem in your community? What
would happen if it was NOT dealt
with?
Perception Who else thinks it is a
problem? Who thinks it is not?
Possible Solutions What has been
done to try & resolve the problem, in
your community & others? What are
potential policy & non-policy
solutions? What are the costs &
benefits of various solutions?
Search for information to find answers:
Types of data quantitative opinion,
community health status survey,
community stories, evaluation &
research findings, cost-benefit, "best
practices" synthesis & guidelines,
organizational mandates, historical
approaches

Organizational Is the policy &


development process a fit with your
mandate? How much time/resources do
you have to support it? Who can you
support the process?
Shape your answers into a Force Field
Analysis a snapshot of the forces that
will drive or restrain the process. The
snapshot may be different for different
policy options.
You may use other strategies before
beginning policy development (e.g.,
focus on data collection, education, &
persuasion or find additional resources).
If you start when public opinion is
negative or resources are inadequate you
may fail & reduce your credibility.
"Lead" may not be the best role for
you. If the community is ready but you
are not you can support policy
development in other ways.

For more
information

Sources journals, magazines, books;


consultants, private sector; resource
centres; government departments; local
health units; non-governmental
organizations & strategies, polling
companies, researchers, community
spokespersons

Workbook Page
Worksheet Page

714
745

1526
767

Develop one or two goals These are


broad statements summarizing the
ultimate direction or desired
achievement of your policy.
Develop your objectives These are
brief statements specifying the desired
impact or effects of a policy. Objectives
should be specific, measurable,
acceptable, realistic & time limited.
Generate a list of policy options to
address the issue These are choices
regarding the types of policies that can
be put in place to address health issues.
Assess all policy options to determine
fit with goals & objectives Choose a
shortlist from the ones that fit after
considering community &
organizational readiness for each
option. This shortlist comprises the
options that will be presented to
decision makers.

2734
78

Ask city clerks or other government


officials who would be best to approach
& how to approach them. Dont
assume that you already know the best
person.
Consider starting with someone lower
on the hierarchy rather than heading
straight for the top.
Start with more sympathetic &
supportive individuals rather than
pouring your energy into the "toughest
nut."
Find out as much as you can about how
your decision makers make decisions.
For example, consider whether they are
most driven by
media coverage,
their own strong beliefs & values,
the needs of their clients or
constituency, &/or
other influential people or groups.
Brainstorm a list of influential
individuals and groups. Then organize
them according to the order in which
you think they should be approached.

358
79

147

The Eight Steps to Developing a Health Promotion Policy


5
Build Support for the Policy

6
Write &/or Revise the Policy

7
Implement the Policy

8
Evaluate & Monitor the Policy

Choose channels & vehicles through which


to try to persuade decision makers to
proceed with policy development &
develop the messages that are put forth
using these methods. This step can win or
lose battles.

Define the specific logistical & legal details


about a policy. The precise wording of a
policy often dictates whether or not it is
passed.

Ensure that all pre-requisites are in place


for policy implementation & then
implement the policy. Many policies have
been retracted upon realizing that
implementation is impractical, too costly,
too controversial or progress toward the
ultimate goal cannot be demonstrated.

Develop & manage a system for evaluating


the long-term effectiveness, feasibility, &
support for a policy. Early identification of
problems & timely policy amendments
may help avoid full retraction of a policy
when implementation presents challenges.
A thorough evaluation will also help to
demonstrate accountability to stakeholders
& reduce implementation costs.

Choose one or more of the following to


help advance your agenda:
Low profile quiet negotiation, meet
civil servants, share information,
non-public briefs
Medium profile continued
negotiation, meet civil servants, public
briefs, committee meetings, alliances
with others, letters to newspapers
High profile public criticism, PR &
ad campaigns, release information,
letter writing, demonstrations
Focus messages on
the links between the policy & a
compelling issue,
simple descriptions of solutions, &
signs in the community that change
is warranted & desired (e.g., public
opinion, media coverage).
Prepare to counter arguments such as
too costly,
increased regulations restrict
individual freedoms, &
there is an non-policy solution.
Scan the community continually for
opportunities to get your message out.

Include all of the following in your


policy:
the purpose of the policy, goals, and
objectives;
a description of the regulations and
sanctions;
procedures for non-compliance;
a plan for promoting and
disseminating the policy; and
a plan for monitoring and evaluating
the policy.
Gather other policy examples to assist
with the writing process.
Prepare to revise as many times as
necessary. "Seeing it in writing" will
often re-ignite opposing forces.
Consult stakeholders throughout the
writing & revision process. People
responsible for funding, implementing,
& otherwise acting upon the policy
should be included. Community
consultations are often a part of this
process.
Consult with a legal professional about
the policy.

Ensure the following conditions are met


before embarking on policy
implementation:
The policy meets stated goals and
objectives.
Objectives are measurable.
Approval of key decision makers and
stakeholders has been obtained.
An accurate estimate of the resources
needed to implement your policy has
been developed.
The timeline is realistic and
appropriate.
The policy specifies who is
responsible for what.
Consult with people responsible for
funding, implementing, & otherwise
acting upon the policy as
implementation is considered.
Ensure that the policy implementation
plan includes:
good communication
an enforcement plan
signage.

Seek answers to the following questions:


Is the situation better than it was
before the policy was implemented?
If the policy was not as effective as
anticipated, why not?
Are people who were involved in the
policy process happy with the results?
Do the people affected have a
favourable view of the policy? If not,
what can be done to address their
concerns?
Are there foreseeable developments
that may affect the policy?
Use indicators such as the following to
help answer these questions:
behaviours or health status of
community members,
number of infractions,
mass media coverage of the policy, &
resources allocated to implementing
the policy.

Review every policy draft to ensure that


the policy goals & objectives will are
met.

Frequently adapt messages as public


opinion, media, & decision-maker
landscapes change.
For more
information

Be strategic in every vehicle, messenger


& word choice.

Workbook Page
Worksheet Page

3952
8085

538
86

5962

63-66

148

Developing Health
Promotion Policies
University of Toronto
Health Sciences Building
155 College Street,
Room 500
Toronto, ON M5T 3M7
Tel (416) 978-0522
Fax (416) 971-2443
E-mail:
hc.unit@utoronto.ca
www.thcu.ca

Comprehensive approach to health


promotion

THCU / N.Dubois
149

Why take a policy approach? (1)


Awareness & educational programs may be shortlived when designated funds are no longer
available, but policies, once implemented are much
harder and slower to change more sustainable.
sustainable
Because they are harder to change, they can often
withstand changes in politicians / decision makers.

Improving the
Health of Canadians
Canadian Institute for
Health Information
377 Dalhousie Street,
Suite 200
Ottawa,, Ontario K1N
9N8
Telephone: (613) 2417860
Fax: (613) 241-8120
www.cihi.ca
ISBN 1-55392-363-4

Impact of policy (1)

A 10% increase in the price of cigarettes


decreases consumption
about 4% among adults,
and up to 14% among youth.

Health Canada

THCU / N.Dubois
150

Aspects of a good policy

economically feasible
politically acceptable
socially acceptable
administratively and technologically
possible

Four types of policies

Legislation seat belt laws


Fiscal measures discount gym membership
for employees
Taxation
T
i tax credits
di for
f money spent to
make factories environmentally friendly
Organizational change change flex-hours
policies to accommodate working parents
with a variety of childcare arrangements

The roadmap
to policy
development

THCU / N.Dubois
151

Step One: Describe the problem

Cause of the problem


Impact of the problem
Perception of the problem
Possible solutions

Step Two: Assess Readiness for


Policy Development

The purpose of this step is to determine


whether or not to proceed with a specific
policy development strategy. This decision
should be based on whether:
Your community is ready
Your organization is ready

It may be that more education is necessary


(internally and/or externally)

Assessing readiness

Community

Who is supportive or unsupportive?


What is public opinion?
Who would care/be affected, in what way?
Has their been education/awareness/media
attention already about the issue?

Organization
Does it fit with your mandate?
How much time/resources do you have/
Who else can support you?

THCU / N.Dubois
152

Step Three:
Develop Goals, Objectives, Policy Options

The purpose of this step is to:


Define clear goals and objectives for the policy
development initiative
Generate a list of policy options that you want
the decision-maker/s to consider

Step Four: Identify Decisionmakers and Influencers

The purpose of this step is to decide which


decision-makers will be the focus of your
support-building efforts
Might be one person, could be a group of
people, could be a hierarchal series of people
Who tends to influence their decisions?

Step Five: Build Support for a


Policy

The purpose of this step is:


To choose communication channels and vehicles
through which you will try to persuade decisionmakers to proceed with policy development
To develop the content, or messages, that are
put forth using those communication methods.

THCU / N.Dubois
153

Communication vehicles vary in


level of profile
Low Profile

Medium Profile

High Profile

Largely phone or face-to-face

Largely mass media;


presentations;print

Quiet negotiation
Meet civil servants
Share information
Non-public briefs

Public criticism
P.R. and ad
campaigns
Work opposition
Release
information
Letter writing
Demonstrating at
rallies

Meet civil servants


Public briefs
Feed supporters
info
Appear at committees
MPP visitations
Alliances
Letters to
newspapers
Letters to MPPs

Step Six: Write and/or Revise the


Policy

This step is the policy-writing phase and


involves defining the specific logistical and
often legal details about a policy.

How to do this step

All policies should include the following:


Rationale, goals, objectives
Definitions
How the policy is implemented (regulations,
(regulations
sanctions, procedures for dealing with failure to
comply)
Communication, signage and dissemination
plans, and
A plan for monitoring and evaluating the policy.

THCU / N.Dubois
154

Step Seven: Implement the Policy

The purpose of this step is to ensure all prerequisites are in place for policy
implementation, and then implement the
policy.
policy

Step Eight: Evaluate & Monitor

The purpose of this step is to develop and


manage an ongoing system for evaluating
the long-term effectiveness, feasibility and
support for a policy
policy.

Resources

THCU / N.Dubois
155

THCU on Policy

Developing Health Promotion Policies


Workbook
Making the Case (for health promotion)
Presentation
Media Advocacy Workbook
Policy Development At a Glance
Larry Grand Webcast: Developing Alcohol
Policy at Queens
http://www.thcu.ca/infoandresources/policy_resources.htm

Non-THCU

National Collaborating Centre for Healthy


Public Policy
http://www.ncchpp.ca/513/The+Centre.htm

A big thank you to

Ontario Agency for Health Protection and


Promotion
THCU Colleagues
Our
O workshop
k h participants
i i

THCU / N.Dubois
156

Disclaimer
The Health Communication Unit and its resources and
services are funded by the Ontario Agency for Health
Protection and Promotion. The opinions and conclusions
expressed in this paper are those of the author(s) and no
official endorsement by the OAHPP is intended or should be
inferred.

THCU / N.Dubois
157

Roadmap for Policy Development

158

Comprehensive approach to health


promotion

159

160

5/28/2010

Exploring Policy Options to


Reduce Second-hand
Smoke Exposure in Multiunit Dwellings
Laurie Nagge, Public Health
Nurse, Region of Waterloo Public
Health

Working Committee
5 tenants (advisory capacity)
Staff:
Public Health
Waterloo Region Housing
Region
R i off W
Waterloo
t l C
Community
it
Housing Incorporated (ROWCHInc.)
Legal Services
Communications
Process has been a joint Initiative of
Public Health & Planning, Housing and
Community Services

Timelines
Tenant complaints, April 2008
Report to Community Services Committee
(CSC) recommending tenant survey June
24, 2008
Tenant survey, October 2008
Advisory group created January 2009
Memo to Council (survey results), Mar. 3,
2009
Community forums/online survey, Apr. 2009
Final report/recommendations to CSC, Oct.
6, 2009. Approved.
Council approval, Oct. 14, 2009

161

5/28/2010

Step #1 - Describe the


Problem
Causes second-hand smoke, higher

incidence of smoking, age of building stock

Impact community housing residents

vulnerable populations (children, seniors)


higher incidence of exposure
chronic
h i conditions
diti
Perception health concern vs. violation of
rights
Possible solutions no action total ban
Types of data opinion, experiences of
other jurisdictions
Sources survey, focus groups, resource
centres, polling data, other housing providers

Waterloo Region Housing (WRH) and


Region of Waterloo Community Housing
Inc. (ROWCHI)
2,723 housing units
2591 WRH, 132
ROWCHI
Family
y 1207 units
31% receive
assistance
12% work &
receive partial
assistance
57% work

Non-elderly
singles 307
units
48% receive
assistance
52% work
Seniors 1077
units
9% receive
assistance
91% pension
income

Types of Data
Literature review
2nd National Conference on
Second-hand Smoke in Multi-unit
Dwellings (MUDs) (January 2009)
Consultations with resource
centres, other jurisdictions,
academics
Tenant surveys
Community forums, online survey

162

5/28/2010

Other Useful Resources


Internal research and evaluation
support
Use of work plans and subsub
committees
Member of Canadian smoke-free
housing listserv

Step #2 Assess Readiness


for Policy Development
Tenant Survey:
Cover letter offered translation
services
Three-week
Three week response time prepre
stamped return envelope
Reminders posted in Housing
buildings
967 returned surveys; 36%
response rate

Tenant Consultation cont'd


Six community forums
Online survey
Two questions:
1. How many
buildings should
be smoke
smoke-free?
free?
No buildings
Some buildings
(complexes or
rows for town
homes)
All buildings

2. How much outdoor


space should be
smoke-free? (If no
smoking allowed
indoors)
Outdoor smoking
anywhere
Outdoor smoking at a
distance
Outdoor smoking on
some properties (town
homes)
Outdoor smoking in
designated smoking
areas only

163

5/28/2010

Step #3
Develop Goals, Objectives,
and Policy Options

Guiding Principles for Policy


Decision-making
Effectiveness achieve desired
outcomes
Efficiency
Effi i
minimize
i i i resources ($)
Adequacy - satisfy the needs,
values, or opportunities that gave rise
to the problem
Dunn, W.N. (2004). Public policy analysis: An introduction. Upper Saddle River, New Jersey:
Pearson Education Inc.

Guiding Principles for Policy


Decision-making
Equity fairly or justly distributes
effects and/or efforts
Responsiveness - satisfies the
needs,
d preferences,
f
or values
l
off
particular groups
Appropriateness - believability of
the policies objectives and
assumptions
Dunn, W.N. (2004). Public policy analysis: An introduction. Upper Saddle River, New Jersey:
Pearson Education Inc.

164

5/28/2010

Policy Decision Making


Tenant input (survey, forums,
online survey)
Health protection
Legal
Feasibility
Cost/benefit
Enforcement
Dunn, W.N. (2004). Public policy analysis: An introduction. Upper Saddle River, New Jersey:
Pearson Education Inc.

Policy Decision Making


Did not know the policy outcome
ahead of time
Selected top three policy options
(based on tenant input) for analysis
and debate
Working towards a policy NOT a
by-law
Key presenting recommended
policy "options" not final
decisions

Step #4 Identify Decision


Makers
Understand the political process
Regional Council's history on smokefree legislation

Medical Officer of Health


Commissioner and Director of
Housing
Community Service Committee
members (Board of Health)
Regional Council members

165

5/28/2010

Influencers
Delegations:
Brian King, MPH., PhD.
Candidate, Roswell Park Cancer
Institute
Jim Bergman, Smoke-free Law
Project, Smoke-free Michigan
Tenant representatives

Step #5 Build Support for the


Policy
Low profile tenant sent letter to
Council; Public Health, Housing, Legal
staff and tenants identified policy options
Medium profile CSC reports to
propose survey and
d recommend
d policy
li
High profile:
Media question and answer
Key messages counter arguments
CSC reports are released to the
media

Step #6 - Write and/or


Revise the Policy
Effective April 1, 2010, all new leases signed
with Waterloo Region Housing (WRH) in all
buildings and properties be 100 per cent
smoke-free and restrict smoking outdoors to a
distance of five meters or more away from any
windows, entrances or exits to the
building/unit;
The Board of Region of Waterloo Community
Housing Incorporated and other Community
Housing Providers be asked to consider
implementing similar restrictions regarding
smoking;

166

5/28/2010

Policy Outcomes
Public Health investigate, develop and
implement cessation support for tenants
and those on the waiting list;
Public Health and Waterloo Region
Housing staff work together to provide
individualized support or other special
arrangements to any tenants
experiencing health conditions or other
challenges that might complicate their
ability to comply with the policy;

Policy Outcomes
Staff report back on the implementation
process and results in October 2010;
This policy would not apply to existing
tenants unless
l
they
h move to a new uniti
and that staff be authorized to exercise
flexibility to deal with hardship cases in
the event of a transfer.

Lease Language
"The Tenant, all other occupants of the
Leased Premises, the Tenant's Guests
and business invitees shall not smoke
or hold lit tobacco or similar product in
th L
the
Leased
dP
Premises,
i
iincluding
l di th
the
balcony, patio or other areas specifically
included in this Lease. Smoking is only
permitted outdoors at a distance of not
less than five metres away from
windows, entrances or exits to the
Residential Complex."

167

5/28/2010

Step #7 Implement the


Policy
Implementation workgroup/work plan
Policy and Procedure document
Policy statement
Lease signing procedures
Inclusion/exclusion (e.g., medicinal
marijuana, traditional use of tobacco)
Enforcement protocol
Staff responsibilities/training
Monitoring
Reference documents

Step #8 - Evaluate and


Monitor

Formulate research questions


Logic model
Annual pre/post survey to all residents
Air quality testing
Complaint tracking
Tracking steps taken as per
enforcement protocol
Media coverage
Costs to implement
Legal precedents - monitor

Challenges
Only able to implement policy with new
leases, grandfathering existing tenants
Complex, emerging issue
Few examples from community housing
Low response at community forums and
online
Political process can only make
recommendations but this is also a
good thing!

168

5/28/2010

Keys to Success
Partnership between Housing and Public
Health
Tenant involvement
U of T Student Policy placement
Legal consultation
Tenant survey and consultation data
Regional Council has history of progressive
smoke-free policies
Plan to provide cessation services
Recommendation "to provide individualized
support or other special arrangements"

Contact Information
Laurie Nagge, RN, MHS
Public Health Nurse
Region of Waterloo Public Health
150 Main Street,
Street 3rd floor
Cambridge, Ontario
Canada
N1R 6P9
Phone: 519-883-2008 ext. 3439
E-mail: nlaurie@region.waterloo.on.ca

169

Overview of Health
Communication
Campaigns

The Twelve Steps to Developing a Health Communication Campaign

1
Project Management

Develop plan to manage


stakeholder participation, time,
money, other resources, data
gathering and interpretation,
and decision-making
throughout the planning
process.
Plan to meaningfully engage
stakeholders.
Establish a clear decisionmaking process.
Establish a timeline for
creating the workplan.
Establish a timberline for the
campaign.
Plan how you will allocate
financial, material, and
human resources.

For more
information

2
Health Promotion Strategy

Establish and/or confirm a


complete health promotion
strategy.
Consider measurable
objectives at all four levels
(individuals, networks,
organizations, and
communities/societies) and
ensure they are realistic, clear,
specific, a strategic priority,
measurable, attainable, and
time-limited.
Ensure your project team is
aware and supportive of your
health promotion strategy.
Use logic models as well as
narratives to review and
describe the strategy.

Consider what data will be


required to make decisions at
each step. Include adequate
time in workplan for data
collection and interpretation.

3
Audience Analysis

4
Communication Inventory

5
Outcome Objectives

Collect the demographic,


behavioral and psychographic
characteristics of your chosen
audience(s) and create an
audience profile.

Make a list of the existing


communication resources in
your community and
organization including
alliances and good relationships.

Identify the bottom-line changes you


hope to accomplish with the
campaign.

Where possible, segment your


audience.

Assess the strengths, weaknesses


and possibilities of getting your
message delivered through these
resources.

Use existing and new


qualitative and quantitative
data.
Use a combination of less and
more expensive means.
Ensure that multiple data
sources confirm your audience
conclusions.
Ensure you have a complete
and compelling understanding
of your audience.

Modify existing inventories


and directories, e.g., media
lists from partner
organizations.
When listing your resources,
consider a mix of
communication strategies,
including media,
interpersonal, and events.

6
Channels and Vehicles

Chose vehicles that will carry


your message(s).

Consider all four levels


(individuals, networks,
organizations, and
communities/societies).

Choose the best channels and


vehicles for the situation based
on reach, cost, and
effectiveness,( i.e., fit to
situation, audience, and
objectives).

Limit yourself to two to three


objectives per level.

Use a mix of short- and longlived channels and vehicles.

Describe a change rather than


an action step.

Consider a mix of
communication strategies,
including media, interpersonal
and events.

Ensure objectives are SMART:


specific;measurable;attainable;
realistic;time-limited.
Ensure objectives address a
strategic priority.
Ensure objectives are aligned
with overall strategy (Step
Two)

Workbook Page

11

15

21

27

29

31

Worksheet Page

80

85

86

87

89

90

Web Resources

Sample Step One Worksheets


Stakeholder Wheel

Menu of objectives

Audience profiles
Focus Groups Workbook

Step 5-6-7 Worksheet

Step 5-6-7 Worksheet

173

7
Combining and
Sequencing

8
Message Development

9
Identity Development

10
Production

Combine and sequence channels


and vehicles across timeline.

Determine what you will say


to your intended audience(s) to
reach your objectives, and how
you will say it.

Create an identity that will


clearly communicate your image
and your intended relationship
with your audience.

Develop specs for each desired


product, select and contract with
suppliers, and manage
production process.

Use examples from a wide


variety of sources to help
determine your preferences.

Aim to produce the best


materials within budget and
on time.

Produce materials that "carry


the identity" name, position
statement, logo, and images, as
required.

Manage reviews and sign-offs


very carefully.

Hold a big event first or build


to a grand finale.
Include activities with both
high and low visibility.
Mix the shelf life.
Be aware of special events and
holidays, friend or foe.
Try to fit activities with the
season.
Build in existing events but be
ready for the unexpected.
Balance your timing so that
you get repetition but avoid
message fatigue.
Apply the rule: 3 messages, 3
times, 3 different ways.

Ensure each message includes:


A What; A So What; A
Now What (A clear indication
of what the message is about;
reasons the audience should
care; clear next steps for the
audience.).
This is a key part of creating
the specs of any
communication product to
guide production.
Build upon information and
decisions in steps 17,
particularly Audience Analysis
and Objectives.

11
Implementation

Implement campaign.

12
Evaluation

Gather, interpret, and act upon


qualitative and quantitative
information throughout the 11
steps.
Throughout all steps, pay
attention to clearly identifying
stakeholder expectations,
finding resources for the
evaluation, and being sure
your efforts are evaluable.

Pre-test all material with


intended audience.

Manage your identity, by


ensuring all connections with
your audience (e.g., print,
verbal, online) are consistent
with your identity.

To generate ideas, review


materials from a variety of
sources and assess what you
like and dont like.

Link with large issues that are


capturing the public agenda.
Opportunities to integrate

activities are important.


For more
information

That is, a single activity can


be designed and delivered to
have impact at all 4 levels.

Workbook Page

43

45

51

55

59

61

Worksheet Page

91

92

93

94

98

99

Web Resources

Step 5-6-7 Worksheet

Message Review Tool

174

Overview of Health
Communication
Campaigns
Provincial Workshop
155 College Street
Room 500
Health Sciences
Building
University of Toronto
Toronto, Ontario
M5T 3M7
Tel (416) 978-0522
Fax (416) 971-1365
E-mail:
hc.unit@utoronto.ca
www.thcu.ca

Definition of health
communication
The process of promoting health by disseminating

messages through mass media, interpersonal


channels and events.

Mayy include diverse activities such as clinicianpatient interactions, classes, self-help groups,
mailings, hotlines, mass media campaigns, events.
Efforts can be directed toward individuals,
networks, small groups, organizations, communities
or entire nations.

THCUs definition of health


communication

Where good health promotion


and good communication
practice meet.
From Rootman and Hershfield, Health Communication
Research: Broadening the Scope. Health Communication.
6(1), 69-72. (1996)

175

Check -in

Purpose
Process
Proceed?
Evaluation forms
Other logistics
Toolkit
Your evaluation and policy initiatives

Types of health communication

Persuasive or Behavioural Communications


(which may employ social marketing
strategies)
Risk Communication
Media Advocacy
Entertainment Education
Interactive Health Communication
Communication for Social Change
5

176

http://www.phac-aspc.gc.ca/fluwatch/0910/w18_10/index-eng.php

http://abc.go.com/shows/greysanatomy/medical-case-file

177

http://ww2.heartandstroke.
ca/hs_bp2.asp?media=bp

http://www.thcu.ca/videos.htm

Comprehensive health
communication campaigns (1)
goal-oriented attempts to inform, persuade or
motivate behaviour change;
ideally aimed at the individual, network,
g
and community/societal
y/
levels;;
organizational
aimed at a relatively large, well-defined audience
(i.e.,they are not interpersonal persuasion);
provide non-commercial benefits to the individual
and/or society;

178

Comprehensive health
communication campaigns (2)
occur during a given time period, which may range
from a few weeks to many years;
are most effective when they include a combination
of media, interpersonal and community events;
a d,
and,
involve an organized set of communication
activities.
Based on Everett M. Rogers, and J. Douglas Storey,
Communication Campaigns, in Charles R. Berger and Steven H.
Chaffee (eds.), Handbook of Communication Science, Sage:
Newbury Park, CA, (1988).

Case Study
Implementing THCUs Twelve Step Health Communication Model:
Case Study #4

Project Breakthrough:
A Campaign to Reduce Stigma Attached to
Mental Illnesses from the Canadian
Psychiatric Research Foundation
August, 2006

http://www.thcu.ca/infoandresources/publications/hccasestudy4.cprf.v1.03.pdf

179

Mental Illness in Canada

Prevalence one in five Canadians directly affected


Cost to economy estimated at over $16 billion/yr.
Stigma no one wants to talk about it or act
gy
No national strategy
Understanding minimal and awareness low,
misconceptions rife
Funding alarmingly low

Those with mental illness remain disadvantaged by


a lack of research funding, are deprived of basic
compassion, understanding and community resolve
to assist them with their devastating illness.

Background cont
The Canadian Psychiatric Research Foundation
(CPRF) founded in 1980 to raise and distribute
funds for psychiatric research in Canadian
universities and teaching hospitals.
CPRF is volunteer driven
driven, with a staff of three
three,
Governed by a volunteer Board of Directors and a
Professional Advisory Board of senior Canadian
researchers
Staff of three and several volunteer expert
committees to help with education, fundraising,
marketing, communications, public relations and
administration.

Step One Project Management

Time Management
All planning, design, pre-testing done in 3months

Money and other resources


No money
Ad agency secured (over coffee) to do all work
pro-bono, with BOD
Various media channels donated media
time/space

180

Step One
Project Management cont

Stakeholder participation
Voluntary BOD comprised of senior business and
community leaders and researchers informed the
process

Decision-making process
CPRF BOD reserved the right to approve or veto
everything, however one board member
designated to work closely with agency

Data gathering and interpretation


Pro-bono pre-campaign survey added to
omnibus survey to inform creative development

Step 2 Revisit Health Promotion


Strategy
Three components to this project
Communication campaign
Fundraising campaign
Political support initiative

Comm campaign proposed to heighten interest in


the plight of the mentally ill.
Hoped that this increased interest would provide a
window of opportunity to boost fundraising for
research.

Step 3 Audience Analysis &


Segmentation
Decision to focus on general public aged 25+
Choice based on experience

Campaign informed by CPRF volunteers and staff


who have encountered various forms of stigma.
Eg
E.g.
Employees scared to reveal illness to mgmt
Parents referring to childs suicide as accident
Mental health organizations being denied office space

Pre-testing for attitudes and awareness Thomson


Lightstone added questions to an omnibus survey
(pro-bono)

181

Step 4 An Inventory of
Communication Resources

Ad agency Arnold Worldwide agreed to do


the work of development and securing
time/space pro-bono
No budget
g at all
Time of one BOD member available to lead

Step 5
Set Communication Objectives

Individual
To decrease the stigma associated with mental
illness in the general public over age 25 years.

Network
T
To increase
i
the
th number
b off students
t d t iin medical
di l
school who are involved in psychiatry research

Societal
To increase government support for increasing
financial resources in the healthcare system for
the mentally ill

Step 6 Select Channels &


Vehicle

Multi-media campaign that included print,


radio, and TV ads. Other printed materials
included brochures and press kits. Many
public relations activities were also used.
used
Please see table on page 6 of case study for
details.

182

Step 7 Sequencing of Activities

Campaign launched during Mental Illness


Awareness Week
Since media airtime and space were
donated CPRF could not follow a fixed
donated,
timelines.
Ads appeared when time and space were
available.

Step 8 Developing the Message

Now What
Acknowledge that, like any serious affliction,
people with mental illness cant get better by
themselves
Donate to help fund research

So What (why should I care)


Uncontrolled/untreated mental illness comes at a
great cost to the economy and society
Give the prevalence, you or someone you know
may now or in the future be affected

Step 8 Develop the Message


cont

What (what else)


Mental illness it at epidemic proportions
1 in 8 Canadians will be hospitalized for mental
illness at some point in their lives
Many mental illnesses respond well to medical
intervention
Etc. (see case study)

183

Step 9 Project Identity

The logo of the CPRF appeared on all


campaign resources.

Step 10 Develop Materials

A creative brief was developed. Points


included the intention to:
Challenge existing perceptions
g
Get media coverage
Garner pro-bono support

Tone was intended to be informed,


provocative, challenging, unpatronizing and
emphathetic
Different sizes/lengths were created to
accommodate different media availabilitise

Step 11 Implement the


Campaign

Pro bono placement of all components


Public relations strategy timed to ad
placements
Initial
I i i l surge which
hi h tapered
d
CPRF provided speakers for interviews and
articles

184

Step 12 Evaluation and Results

Formative
Pre-campaign pro bono omnibus survey

Process
S
Some positive
i i and
d negative
i public
bli feedback
f db k to
ads
Many requests by other organizations to use ads

Summative
Pro-bono focus testing donated by Kaleidovision

Final
Decision
Use
Lose
Adapt

185

Criterion 1: The message must get


and maintain attention
added Aug 26/02

If you dont capture and maintain attention,


you cannot be effective!
Diff
Different techniques
h i
will
ill capture different
diff
audiences messages must always be
tested.

Ways to capture attention


To make ads

Attractive
Interesting
Entertaining
Stimulating

Use high quality


creative (text, graphics,
visuals)

Consider using

Parody
Suspense
Word play
Sensuality
Emotionally involving
scenes
Humour
Vivid visuals
Striking statements
Lively language
Fascinating facts
Memorable slogans

Criterion 2: Put strongest points


at beginning of message

Position most critical information early in the


message.
A
Audiences
di
who
h lose
l
interest
i
or become
b
distracted will still process key points.

186

Criterion 3: The message must


be clear

Can the audience identify the main message


points?
Now
N
Wh
Whatt
So What
What

Elements that can help or hinder


clarity

language and reading level;


pace/speed;
amount of content;
statistics;
background (text, graphics, music, etc.); and
repetition.

Criterion 4: The action you are


requesting is reasonably easy (1)
Sometimes behaviour takes too much effort and
sacrifice.
This can be overcome with easy and appealing
b b steps.
baby
Per Wittes EPPM, likely to increase self-efficacy

From Atkin, C. Theory and Principles of Media Health Campaigns. In Rice, R. & Atkin, C.
(Ed.). Public Communication Campaigns. 3rd Ed. 2001.

187

Criterion 4: The action you are


requesting is reasonably easy (2)

Be aware that target behaviours can be


arranged along a continuum according to:

degree of time,
effort,
money,
psychological, and
social costs.

Criterion 5: Make effective use of


incentives
Changing behaviour is more than just asking
Must be a reason why they should care (So What)
Different kinds of incentives:

Physical
Economic
E
i
Psychological
Moral-Legal
Social.

For or against/Why or why not


Severity and Susceptibility (Kim Witte, EPPM)

Criterion 6: Provide good evidence


for threats and benefits (1)

You must provide credible evidence that


threats and benefits are real and likely.
Th
They must also
l be
b convinced
i
d that
h the
h
behaviour you recommend will actually
alleviate the threat discussed (I.e. Response
Efficacy)

188

Criterion 7: The messenger must


be a credible source
The messenger is the model appearing in message
who delivers information, demonstrates behavior,
or provides a testimonial.
Th
The source messenger is
i helpful
h l f l in:
i
attracting attention,
personalizing by modeling actions and
consequences, and
making message memorable.

Above information presented by Dr. Chuck Atkin at 2000 Special Topics, THCU
workshop).

Typical categories of messengers

Celebrity (famous athlete or entertainer)


Public official (government leader or agency director)
Expert specialist (doctor or researcher)
Organization leader (hospital administrator or executive),
Professional performer (standard spokesperson,
attractive model, or character actor)
Ordinary real person (blue-collar man or a middle-class
woman)
Specially experienced person (victim, survivor, or
successful role model)
Unique character (animated, anthropomorphic, or
costumed).
Above information presented by Dr. Chuck Atkin at 2000 Special
Topics, THCU workshop).

Criterion 8: Messages must be


believable

Messages must be realistic.


They should not make extreme claims or use
extreme examples.
Avoid highly dramatic episodes.
episodes
Do not provide misleading information
The audience must believe the information is
accurate.

189

Criterion 9: Use an appropriate


tone
Light

Heavy

Humorous

Angry

Whimsical

Outrage

Ironic

Injustice

Cheery

Dramatic

Criterion 10: Use an appropriate


appeal

Rational
Emotional

Criterion 11: Do not harm the


audience

Message may unintentionally reach


audiences it wasnt intended for.
Therefore
Therefore, developers must consider the
views of anyone who might encounter the
message.
This is mainly a problem for negative
messages that use threats or fear appeals.

190

Criterion 12: Display identity


throughout
A campaign identity includes

a mission,
vision,
a positioning statement/copy platform,
a slogan,
name,
images,
logo.

Identity defines, distinguishes, and synergizes.

Challenges

The Golden Rule states it is hard to have


cheap, quick and high quality products
H
How then
h can we reasonably
bl cut down
d
on
time and costs pressures in order to preserve
quality?

The Task -

1. How to work with time most effectively so


you do not need to pay through the nose
or sacrifice on quality?
2 H
2.
How to save on expenses without
ih
really
ll
sacrificing desired quality?
- Share your ideas & experiences regarding
lessons learned (the good, the bad and the
ugly) on these 2 challenges

191

Resources

THCU on Health Communication


Map of all health communication resources
http://www.thcu.ca/infoandresources/health_comm_map.cf
m

Health communication campaigns toolkit


http://www thcu ca/infoandresources/resource dis
http://www.thcu.ca/infoandresources/resource_dis
play.cfm?resourceID=1008
Health communication message review criteria
http://www.thcu.ca/infoandresources/resource_dis
play.cfm?resourceID=56
Interactive online campaign planner
http://www.thcu.ca/infoandresources/ohc/myworkb
ook/login/login.asp

THCU on Health Communication


Cont

Use of social media in health promotion


Guest facilitator Craig Lefebvre
http://www.thcu.ca/videos/new_media_webinar.
htm

Webcast: Identify your audience


http://www.thcu.ca/videos/webcasts.htm

192

A big thank you to

Ontario Agency for Health Protection and


Promotion
Cathy Duerden
Our
O workshop
k h participants
i i

Disclaimer
The Health Communication Unit and its resources and
services are funded by the Ontario Agency for Health
Protection and Promotion. The opinions and conclusions
expressed in this presentation are those of the author(s) and
no official endorsement by the Agency for Health Protection
and Promotion is intended or should be inferred.

193

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215

Health Communication Message Review Criteria


Health Rere
Truly persuasive health communication messages are difficult to create, regardless of the change you are
trying to elicit in your audiences. When you are seeking a behavioural shift, the challenge is even greater.
McGuires hierarchy1 is one theory that helps explain how and why messages fail or succeed. McGuire
posits that before taking action audiences must:

tune into the message,


attend to it,
maintain interest in it,
understand it,
think about it,
develop related skills,
agree with the position in the message (attitude change),
store the message in memory,
pull the message from memory when relevant, and
decide to act on the information (intention).

McGuire goes on to say that successfully accomplishing each of these steps depends on numerous input
communication variables, such as:

characteristics of the message source (e.g. attractiveness, credibility),


design of the message (e.g. organization, style),
channel characteristics (e.g. directness),
characteristics of the person who receives the message (e.g. mood, education),
etc.

There is some research on how each input variable impacts on each step. For example, we know that the
right messenger can attract attention, help change attitudes and affect memorability. This message review
tool focuses on various input communication variables and what we know about their ability to impact on
one or more of the steps leading to behaviour change.
This is not an exact or fully developed science. What increases success of reaching one step, may decrease
success at another step. For example, fast paced, flashy messages may grab attention, but hinder
understanding. In addition, different audiences usually require very different messages, even when working
toward similar goals.
Following is a list of the minimum criteria that must be met in order to develop a persuasive message. We
recommend that the list be used in conjunction with audience analysis, message pre-testing and campaign
evaluation.

McGuire, W.J. Input and Output Variables Currently Promising for Constructing Persuasive Communications. In Rice, R. & Atkin,
C. (Ed.). Public Communication Campaigns. 3rd Ed. 2001.

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Health Communication Message Review Criteria


Health Rere

1. The message will get and maintain the attention of the audience.
If you dont capture and maintain the attention of the audience throughout the message, you dont have a
chance of achieving your objectives. The more audience members can be engaged to actually think about
the message (including imagined or actual rehearsal of the recommended behavior), the more likely they are
to experience appropriate changes in knowledge, attitudes, and behavior2, 3.
To make ads attractive, interesting, entertaining, and stimulating always apply high quality creative and
mechanical execution (text, graphics, visuals) and consider using consider using parody, suspense, word
play, sensuality, emotionally involving scenes, humour, vivid visuals, striking statements, lively language,
fascinating facts, and/or memorable slogans.

2. The strongest points are given at the beginning of the message.


The information that is most critical for convincing your audience to adopt the recommended behaviour
should be positioned early in the message. That way, audiences who lose interest or become otherwise
distracted will still have the opportunity to process some key points.

3. The message is clear.


The message should be clear to the audience. In other words, it should be easy for them to point out the
actions you are asking them to take (Now What), the incentives or reasons for taking those actions (So What)
as well as the evidence for the incentives and any background information or definitions (What). Elements
that can help or hinder clarity include:

language (vocabulary, lingo) and reading level,


pace/speed,
amount of content (avoid trying to cram in too much),
background (text, graphics, music, etc.), and
repetition.

Statistics should be used with caution in messages. Most people overestimate the risk of things like car and
airplane accidents, but underestimate things like strokes and heart attacks. People also tend to underestimate
the cumulative probability that an event will occur (e.g., the odds of wrecking a car by the time you are 18 if
you drive under the influence several times per year), even if they correctly understand the odds that the
event will occur on any one occasion.

Maibach, E. & Flora, J. (1993). Symbolic modeling and cognitive rehearsal. Communication Research, 20, 517-545.
Petty, R., Baker, S., & Gleicher, F. (1991). Attitudes and drug abuse prevention: Implications of the Elaboration Likelihood Model
of Persuasion. In L. Donohew, H. E. Sypher, & W. J. Bukoski (Eds.), Persuasive communication and drug abuse prevention.
Hillsdale, NJ: Lawrence Erlbaum.
3

217

Health Communication Message Review Criteria


Health Rere
In general4:

Expressing cumulative probabilities can be an effective means of enhancing the perceived relevance of a
risk.
Although risk analogies can be useful (i.e., explaining a poorly understood risk by comparing it to
another more commonly understood risk), such comparisons must be done carefully. The two risks
compared should have certain qualities in common, otherwise audience members are likely to reject both
the risk comparison and the message.
Qualitative expressions of risk (e.g.,many") should also be used with caution as they may be understood
in vastly different ways by different people.
Messages that attempt to convey risk information should, when possible, use both quantitative and
qualitative expressions to increase audience comprehension.

4. The action you are asking the audience to take is reasonably easy.
Sometimes a behaviour is not acceptable to the audience because it takes too much effort and sacrifice. This
can be overcome by presenting easier behaviours that have fewer barriers and are more easy and appealing5.
The key is to be aware that target behaviours can be arranged along a continuum according to degree of time,
effort, money, psychological and social costs. For example, abstinence has not been a very effective strategy
for alcohol, tobacco and drugs. Instead, you might promote modestly demanding behaviours such as signing
a pledge card or abstaining just during a drug-free week. There are also other responses that might be
targeted, such as awareness, knowledge, beliefs, values and attitudes; that will lead to the focal behaviour6.
Having role models demonstrate the behaviour can increase audience confidence that the behaviour is easy to
perform and providing solutions to barriers that have been expressed by the audience can also help make the
behaviour easier for audiences. Not all barriers can be addressed this way, however. In many cases the
actual physical or social environment must be modified to make a behaviour reasonably easy to accomplish.

5. The message uses incentives effectively7.


Creating a persuasive health communication message involves more than simply asking the audience to do
what you want. You must explain to them why they should be interested in changing their behaviour.
Incentives for changing behaviour can be physical, economic, psychological, moral-legal, or social, and they
can be either for or against a behaviour (i.e. why or why not adopt recommended action?).

Holtgrave, D. R., Tinsley, B. J., & Kay, L. S. (1995). Encouraging risk reduction: A decision-making approach to message design.
In E. Maibach & R. Parrott (Eds.), Designing Health Messages: Approaches from Communication Theory and Public Health
Practice. Thousand Oaks, CA: Sage.
5
For more information on the importance of making the behaviour reasonably easy for audiences, please see Everett Rogers,
Diffusion of Innovations, 3rd ed. (New York: Free Press, 1983) and/or Understanding and Using Fear Appeals for Tobacco Control,
The Health Communication Unit/Program Training and Consultation Centre, February 2000,
http://www.thcu.ca/infoandresources/Step%208%20Health%20Communication%20Message%20Development.htm
6
Based on content from Atkin, C. Theory and Principles of Media Health Campaigns. In Rice, R. & Atkin, C. (Ed.). Public
Communication Campaigns. 3rd Ed. 2001.
7
Information based on content presented by Dr. Charles Atkin at 2000 Special Topics, THCU workshop.

218

Health Communication Message Review Criteria


Health Rere
For example, in the social dimension, for incentives might include acceptance, coolness, physical
attractiveness, being considered normal, being liked, acting for the greater good, increased power, respect,
and friendship. Against incentives might include rejection, embarrassment, appearing unappealing, being
socially deviant, becoming isolated, being considered selfish, being considered weak, or losing trust of
others.
There are numerous ways in which to maximize the effectiveness of incentives:

Incentives will be most effective if the audience thinks they are extremely negative or extremely positive
and very likely to happen to them. If you cannot find an incentive that the audience thinks is extremely
positive or negative and very likely, use one that is not as severe/positive, but very likely. Emotional
appeals intensify motivation by highlighting severity.
Most campaigns focus on negatively attacking the unhealthy behaviour, however frequent emphasis on
negative outcomes may desensitize viewers. A more flexible, softer tactic can be to discount the
perceived benefits of the unhealthy practice, such as by asserting that smoking does not really impress
peers. In general, use both positive and negatives incentives.
Try to use more than one incentive per message.
Use multiple appeals across a series of messages.
Use new appeals for familiar subjects.
Make sure that all incentives build on the existing values of the audience [Does the audience care about
the incentive you are using? Is it relevant to them? Is it applicable to their situation and needs? (Rather
than just your priorities and needs!)]

Thorough audience analysis and message pre-testing can help to ensure that incentives are being used
effectively.

6. Good evidence for threats and benefits is provided.


Message designers must provide credible evidence that threats (associated with not doing the behaviour) and
benefits (of doing the behaviour) are real and likely. Audiences must also be convinced that the behaviour
recommended will actually alleviate the threat discussed. This can be challenging since different types of
evidence works with different audiences. For example audiences that are already interested in the topic
respond to expert quotes, documentation and statistics, and audiences that are not involved are more likely to
respond to dramatized case examples and testimonials.

7. The messenger is seen as a credible source of information8.


The messenger is the model appearing in the message who delivers information, demonstrates behavior, or
provides a testimonial. The messenger is helpful in attracting attention, personalizing abstract concepts by
modeling actions and consequences, bolstering belief formation due to source credibility, and facilitating
retention due to memorability.

Information based on content presented by Dr. Charles Atkin at 2000 Special Topics, THCU workshop.

219

Health Communication Message Review Criteria


Health Rere
Messengers can be a/an:

celebrity (famous athlete or entertainer),


public official (government leader or agency director),
expert specialist (doctor or researcher),
organization leader (hospital administrator or executive),
professional performer (standard spokesperson, attractive model, or character actor),
ordinary real person (blue-collar man or a middle-class woman),
specially experienced person (victim, survivor, or successful role model), or
unique character (animated, anthropomorphic, or costumed).

No one messenger is always superior. For example, a doctor may communicate trust and expertise in one
campaign, and be perceived as boring in another. In selecting the appropriate messenger, the crucial factor is
which component of influence model needs a boost. For example:

peer modeling of the recommended behaviors and/or demonstrations of experience with the (negative
or positive) consequences of an action is one of the most effective means of enhancing viewers'
skills, confidence to use those skills, perceptions of consequences, and motivations9;
celebrities help draw attention to a dull topic;
experts enhance response efficacy,;
victims convey the severity of harmful outcomes; and
victims who share similar characteristics of the audience should augment susceptibility claims.

In general messenger credibility is enhanced by:

power,
perceived expertise,
perceived honesty,
attractiveness, and
being similar to the target audience.

8. Messages are believable.


Messages must be realistic. This means they should:

not make extreme claims or use extreme examples;


avoid highly dramatic episodes; and
provide accurate information (i.e. not misleading information).

Bandura, A. (1997). Self-Efficacy: The Exercise of Control. NY: W. H. Freeman.

220

Health Communication Message Review Criteria


Health Rere

9. The message uses an appropriate tone for the audience.


A messages tone may be light, heavy, humorous, angry, whimsical, ironic, cheery, dramatic, etc. In general
a serious tone is safest if it is not too boring or bland. Regardless of tone avoid preaching or dictating and
always test humour before using it!

10. The message uses an appeal that is appropriate for the audience.
Rational appeals work with audiences that are already interested in your topic (Atkin 2001) and emotional
appeals work better with audiences that are not already interested in your topic. If you frighten the audience,
be sure to give them a relatively easy way to alleviate the threat. If you make your audience anxious,
without a way to reduce the anxiety they will block out the message or do the behaviour you dont want
them to do, even more often.

11. The message will not harm or be offensive to people who see it. This includes
avoiding victim blaming.
It can be difficult to control who is exposed to your message it may unintentionally reach audiences it
wasnt intended for. Therefore, ethically, developers must consider the views of anyone who might
encounter the message. This is mainly a problem for negative messages that use threats or fear appeals. In
all cases, designers should adopt the motto first do no harm10. It is also important to remember that
complicated behaviours like smoking, eating, exercising and drinking are not always simple personal
choices. Be sensitive to the role of an individuals environment. Help them to overcome their environment
and dont assume it is their fault and all their responsibility.

12. Identity is displayed throughout.


A campaign identity includes a name, a positioning statement or copy platform, a logo, a slogan, and
possibly other images. Identity distinguishes, defines and synergizes. Identity amplifies the impact of a
campaign in a number of ways11:

First, it helps people to remember the key campaign messages because they can connect discrete
messages with each other and with the "bigger picture" of the campaign.
Second, it stimulates more conversation and comment, an outcome that is particularly important for
behavior change campaigns.
Third, in time, the unifying features themselves could come to represent the messages and the image of
the campaign, leading people to immediately recall the key campaign messages every time the symbol is
presented.

The slogan should prominently and concisely capture the main idea For example, Take Your Butt Outside;
5-a-day, every-day; How young do they have to be before we care?
10

Based on content from Atkin, C. Theory and Principles of Media Health Campaigns. In Rice, R. & Atkin, C. (Ed.). Public
Communication Campaigns. 3rd Ed. 2001.
11
Youth Anti-Drug Media Campaign Communication Strategy Statement
http://www.mediacampaign.org/publications/strat_statement/basis.html

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Health Communication Message Review Tool

Excell Very
-ent
Good
1.

The message will get and maintain the attention of the audience.

2.

The strongest points are given at the beginning of the message.

3.

The message is clear (i.e. it should be easy for the audience to


point out the actions you are asking them to take Now What, the
incentives or reasons for taking those actions as well as the
evidence for the incentives and any background information or
definitions).

4.

The action you are asking the audience to take is reasonably easy.

5.

The message uses incentives effectively (more than one type of


incentive is used, the audience cares about the incentives presented
and the audience thinks the incentives are serious and likely).

6.

Good evidence for threats and benefits is provided.

7.

The messenger is seen as a credible source of information.

8.

Messages are believable.

9.

The message uses an appropriate tone for the audience (for


example, funny, cheery, serious, dramatic).

Fair

Fail

10. The message uses an appeal that is appropriate for the audience
(i.e. rational or emotional). If fear appeals are used, the audience
is provided with an easy solution).
11. The message will not harm or be offensive to people who see it.
This includes avoiding victim blaming.
12. Identity is displayed throughout.

FINAL RECOMMENDATION
Use
Lose
Adapt
Comments ___________________________________________________________________________

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Additional
Resources

New from THCU and NCCMT...


The Online Health Program Planner (OHPP)
The OHPP is a tool that will guide you through part or all of THCUs 6-step planning process and help
you make evidence-informed planning decisions. This fully integrated learning system includes stepspecific support menus on every page.

Evidence-informed planning with ease.


Interactive. Flexible. Intuitive.

Visit the website at www.thcu.ca/ohpp

at the Dalla Lana School of Public Health


University of Toronto

225

What kind of planning


From start to finish, I need
help planning my program
in a systematic, evidencebased way.

Explore THCUs 6-step


program planning model.
The OHPP includes a
workbook, worksheets,
evidence to support
decision-making, practical
tips and recommended
resources for each step.

I am interested in a
painless way to write
complete outcome
objectives.

A few clicks in our


Objective Builder
menus and youve got a
complete outcome
objective.
Tailor the objective or
write your own with the
Freehand Writer/Editor.

I want to create a
logic model.

Goals, audiences,
objectives, activities,
resources and
indicators.
Enter your decisions.
Produce the logic
model.
Its easier than ever.

I need a structured plan


to collect situational
assessment data.

From comprehensive
drop-down menus, choose
the right combination of
data types, methods and
sources to answer your
research questions.
Assign task responsibilities, timelines and
resources.
There you have it
your data collection
plan.
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support do you need?


Im looking for a way to
organize my situational
assessment data.

I want to reflect on and


review some critical
planning decisions.

What factors influence the


situation? At what level of
the environment? Is the
impact positive or
negative?

Is my plan complete,
logical, aligned with the
results of my situational
assessment, and
presented in a visually
appealing way?

Organize your findings


into a table or Force
Field Analysis diagram
to inform your
planning decisions.

Use the Plan Review


checklist to reflect on
critical decisions.

I need to prioritize a long


list of possible
activities.

What do you know


about eectiveness,
appropriateness, and
resources required
to implement your
activity?
Clarify, sort, rank,
choose.

And more!

Work on some or all of


your plans. Use one worksheet, or all worksheets.
Start now. Return later.
Print your plan. Change it
as it develops.
For beginners, managers,
teachers and seasoned
practitioners.
A one-stop planning shop.

227

About Us
The development of the Online Health Program Planner (OHPP) is closely aligned with the mandates of the two
organizations that contributed to its inception and growth: The Health Communication Unit (THCU) at the Dalla
Lana School of Public Health, University of Toronto and the National Collaborating Centre for Methods and Tools
(NCCMT).

The Health Communication Unit


The Health Communication Unit (www.thcu.ca) at the University of Toronto provides support to thousands
of health practitioners every year. Through THCUs online spaces and face-to-face interaction, community
practitioners are able to ask for and receive tools that are simple yet powerful, concrete and visual.

Contact Us

Specific Contacts:

The Health Communication Unit


at The Dalla Lana School of Public Health, University of Toronto
Health Sciences Building, 155 College Street, Room 500
Toronto, Ontario M5T 3M7
Telephone: (416) 978-0522
Fax: (416) 971-1365
Email: hc.unit@utoronto.ca
Website: www.thcu.ca

Jodi Thesenvitz
Resource Development Consultant
Email: j.thesenvitz@utoronto.ca
Larry Hershfield
Manager, THCU
Email: hershfield.larry@utoronto.ca

The National Collaborating Centre for Methods and Tools


The National Collaborating Centre for Methods and Tools (www.nccmt.ca) is one of six centres that make up
the National Collaborating Centres for Public Health. The NCCMT focuses on improving access to and use of
evidence-informed methods and tools for knowledge translation in public health. Ultimately, the NCCMT aims to
enhance evidence-informed public health practice and policy in Canada by providing access to innovative, high
quality, up-to-date methods and tools for public health practitioners involved in policy and program decisionmaking as well as practice.

Contact Us

Specific Contact:

National Collaborating Centre for Methods and Tools


McMaster University
1685 Main Street West, Suite 302
Hamilton, ON L8S 1G5
Phone: (905) 525-9140, ext. 20450
Fax: (905) 529-4184
Email: nccmt@mcmaster.ca
Website: www.nccmt.ca or www.ccnmo.ca

Dr. Donna Ciliska


Scientific Director
McMaster University
Email: nccmt@mcmaster.ca

Potential Partners
THCU and NCCMT are committed to working with other organizations with a mandate to increase the capacity
of public health practitioners to make evidence-informed program planning decisions. Over time, we hope
to find ways to integrate the work of others within the OHPP. For example, we have begun plans to create
a bridge between the Canadian Best Practices Portal for Health Promotion and Chronic Disease Prevention
(http://cbpp-pcpe.phac-aspc.gc.ca) and the OHPP to allow users to incorporate best practice search results
into their situational assessment and activity selection process. Due to the sophistication of the online planner,
many other types of integration with and tailoring for other organizations are possible. Potential partners should
contact Larry Hershfield, manager of THCU, for more information.
228

THCU Products
and Services
Training, consultation and resources for health promotion
practitioners in Ontario. Free of charge.

http://www.thcu.ca
Information and Services on Health Communication,
Program Planning, Evaluation, Policy Change and Sustainability.

Larry Hershfield

hershfield.larry@utoronto.ca (manager)

Jodi Thesenvitz

j.thesenvitz@utoronto.ca (consultant)

Nancy Dubois

n.dubois@utoronto.ca (consultant)

Robb MacDonald r.macdonald@thcu.ca (consultant)

University of Toronto, Health Sciences Building, 155 College Street, Room 500
Toronto, Ontario M5T 3M7 Telephone 416.978.0522 Facsimile 416.971.1365
229

About Us
What is The Health Communication Unit (THCU)?
The Health Communication Unit at the Centre for Health Promotion, University of Toronto, is funded
by the Ontario Agency of Health Protection and Promotion. Begun in 1993, it was developed to provide
training and support in health communication. Between 1997 and 2000, its mandate was expanded to
include health promotion planning, evaluation, policy change, and sustainability.

What is THCUs goal?


THCU aims to increase the capacity of individuals and organizations in the field of community and
public health to plan, deliver, and evaluate health promotion programs within a comprehensive and
population-based approach.

What services are available?


THCU provides
quality resource materials,
provincial and regional workshops and webinars, and
tailored consultations.

What products and services do you offer in French?


Some of THCUs resources are available in French. These can be found on our website at www.thcu.ca.
Each year, we have a budget to provide some consultations and training in French. Although we cannot
currently offer all of our products and services in French, we are exploring ways to increase our capacity
to serve the Francophone community. While we explore these options, we hope that bilingual health
promotion practitioners in Ontario will make use of our resources and services, then promote, use and/or
adapt them in their Francophone communities.

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230

Examples of Resources
Our resources are all available, free of charge, online at www.thcu.ca
At a Glance-The Eight Steps to Developing a Health Promotion Policy
This two-page handout summarizes THCUs eight-step process. Related worksheets and tools to
help you complete each step are noted, along with tips for efficient, effective completion of each step.
This is a great overview and checklist for both newbies and seasoned practitioners.

Changing Behaviours: A Practical Framework


This resource describes and provides examples for the eight conditions required to change personal
health behaviours.

Health Communication Message Review Criteria


This review tool lists the minimum criteria for developing a persuasive message.

Health Promotion 101


Health Promotion 101 is an on-line, self-directed course designed by the Ontario Health Promotion
Resource System for health promotion practitioners as well as those interested in learning more
about the field of health promotion. Nine modules address the key aspects of health promotion
theory and practice, including definitions and concepts, models of health, theories of behaviour,
organization and community change, and health promotion values and strategies. Students will
become familiar with essential health promotion concepts, and, in so doing, increase their capacity to
promote healthy changes in individuals, organizations, and communities.

Literature Search Results in Support of Consultations


When needed, we contract a wonderful librarian named Barbara Scott to do literature searches on
various topics that our clients ask us about. The requests from the last couple of years are posted on
our website.

Logic Models Workbook


This workbook equips participants with the knowledge and skills needed to develop logic models for
their health promotion programs.

Making the Case at a Glance


This two-page handout summarizes key information from THCUs two-day workshop, Making the
Case. Revised in the fall of 2006, the new model is organized around a small number of key practical
decisions such as who will make the case, rather than a series of steps to follow.

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231

Overview of Developing Health Communication Campaigns Tool Kit


This tool kit accompanies THCUs Overview of Developing Health Communication Campaigns
workshop, gathering the slideshow, and handouts in one convenient location for use during the event.

Overview of Health Communication Campaigns Workbook


This workbook explains our 12 steps and provides worksheets to aid you in applying the steps.

Online Interactive Campaign Planner


This online application will guide you through steps 5 to 7 and will allow you to create, save, and
print a full text and/or attractive visual summary of your campaign, which can then be shared and
modified at any time, from any computer!

Planning Case Studies


Implementing THCUs Six Step Health Promotion Planning Model is a series of case studies where
the planning of actual health promotion programs is described using our six-step process.

Strengthening Personal Presentations Workbook


This workbook focuses on five core skills for making an effective presentation--one that provides the
audience with the information they seek in a stimulating manner.

The Update: Special issue on risk communication


This issue of THCU's newsletter provides an overview of risk communication along with
information on planning risk communication efforts, developing messages, and evaluating. It also
contains articles from Ontario experts, describing their lessons-learned from local experiences.

Got great programs, services, resources, research? Dont forget to write your
OHPE bulletin article! This successful partnership between The Health Communication Unit
and Health Nexus is read by about 20,000. Publishing a feature article in the bulletin is a great
way to disseminate information about your work directly to the health promotion community.
Email features@ohpe.ca with your article idea or visit www.ohpe.ca for further details.

4
232

Regional Workshop Service


What are regional workshops?
Each year, THCU holds approximately 40 workshops across Ontario. We just need to know who would like
to host one. Its first come, first served, and we work with groups as small as 30 and as large as 50.
We encourage hosts to promote outside their organization to community partners and others in their region.
We offer short webinars, half-day, one-day and two-day workshops on the following topics
Audience analysis
Conducting focus groups
Conducting surveys
Developing health communication campaigns
How tos in health communication production
Interactive health communication
Introduction to evaluating health promotion programs
Introduction to policy change
Making the case
Managing the communication campaign development process
Media advocacy
Media relations
Message development
Program planning
Strengthening personal presentations
Sustainability
Using large group data sets

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233

Who can be involved?


Any coalition or agency can be a partner in a regional workshop. That means acting as hosts and
promoters of the event, as well as identifying and arranging local input and content.
Travel and material costs are negotiated on an individual basis. We provide the facilitators at no cost.

How do we get started?


If you are interested in being a partner for a regional event, please fill out the Service Request form
online at www.thcu.ca .
Please note that we cannot guarantee service with less than three months notice.

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234

Consultation Service
THCU provides free consultations, for people in Ontario who are
working in the area of health promotion, on the following topics:
evaluation of health promotion programs,
health communication,
health promotion program planning,
policy development, and
sustainability.

Consultations may involve


brief, one-time advice;
feedback on your work (reviewing the quality and potential for effectiveness);
hands-on assistance for groups working through our defined step models; and/or
information and resources.

Will a consultation meet my needs?


Consultations can be carried out in English or French by THCU associates or guest consultants
from our network of planners, advocates, communicators, and evaluators. They may be conducted via
telephone, electronic media, in person at a mutually agreed upon location, or using a combination of all
three methods.
They range from short one-time contacts to a number of longer sessions (half-day or more); time and
travel limitations may exist.

How do I arrange a consultation?


To arrange a consultation, just complete and submit a Service Request form, available online at
www.thcu.ca. Please note that we cannot guarantee service with less than six weeks notice. It may take
longer to arrange a consultation in French.

7
235

Examples of Consultations
Guided Process on Annual Program Plan
Challenge
Help an interdisciplinary Chronic Disease Prevention team with their annual program planning process.

Service received
Three face-to-face planning meetings with entire team a tailored application of THCUs program
planning step model.

THCU resources/tools provided and/or discussed


THCUs Program Planning Workbook
Evidence-based filters for suggested activities or projects
Joint guidelines for assigning tasks
Joint budget guidelines
Stakeholder wheel

Actions taken as a result of the consultation


More joint team projects, instead of those undertaken by individual team members, or topic area projects,
with an overall team focus on obesity prevention and workplace health.

Lessons learned
Although THCUs tools and processes are useful on their own, tough questions about justifying the
rationale for various programs are sometimes received better when coming from an external source, such
as a THCU consultant, compared to colleagues and managers.

Barriers to taking advice or using the tools


There were different types of practitioners working together, e.g., nutritionist, public health nurses, health
promoters, etc. Working with such a diverse group was sometimes a challenge. The team was also initially
concerned that an outside facilitator would bring in his/her own agenda; however, this did not happen.

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236

Guided Process on Evaluation Plan for Health Communication Campaign


Challenge
Help Parent Action on Drugs (PAD) develop an evaluation plan for a communication campaign on
youth marijuana prevention targeted to youth in Ontario. The primary audience was secondary school
students in Ontario between ages of 15 and 18 (or Grades 10, 11, 12) who are using marijuana regularly,
and who may be using it problematically. The secondary audience was students in the same grades
who are not currently using or who are using marijuana experimentally. The campaign, involving events,
teacher training, peer education and other components, was already underway.

Service received
Clients had one two-hour face-to-face session with a THCU consultant and project team, which
focused on determining the best way to use available evaluation resources: formative, process or outcome
evaluation.

THCU resources/tools provided and/or discussed


Several of the worksheets from the Introduction to Evaluating Health Promotion Programs workbook.

Actions taken as a result of the consultation


PAD decided to use their resources toward a process evaluation, which would inform changes to be
made to the second year of the campaign. They developed a request for proposal to further develop and
carry out the process evaluation.

Lessons learned
PAD learned to prioritize and narrow the scope of their evaluation. PAD also gained enough
information to feel that, given another similar project, they could proceed on their own. If exploring new
territory, however, PAD might ask for another consultation.

Barriers to taking advice or using the tools


PAD encountered some challenges applying the evaluation model and tools the THCU consultant
recommended. They would have liked more hand-holding.

9
237

Feedback on Evaluation Work Plan


Challenge
Provide feedback on the Physical Activity Resource Centres (PARC) Walk This Way evaluation plan
and give them other approaches and options to consider.

Service received
THCU provided feedback and suggestions on PARCs evaluation plan via email and telephone.

Actions taken as a result of the consultation


PARC incorporated as much feedback as possible into the evaluation plan for that year. They tabled the
rest of the information for future planning.

Lessons learned
The consultation process and turn-around took longer than PARC expected. In the future, PARC will
request a consultation further in advance.

Information about Focus Groups


Challenge
Provide information about focus groups to Ontario Womens Health Network (OWHN). Specifically,
OWHN wanted information about using focus groups not only as a method to gather information, but
as a capacity-building tool.

Service received
THCU performed a literature search and sent OWHN a compilation of the information found.

Actions taken as a result of the consultation


OWHN used the information from the literature search as background information to help build their
case for using focus groups. In the end OWHN felt that they were better informed.

Lessons learned
OWHN found THCUs service timely, thorough, and valuable. OWHN also felt that THCU has access
to information that would be difficult for OWHN to attain on their own.

Barriers to taking advice or using the tools


Multiple competing demands on OWHNs available resources.

10
238

Feedback on Website
Challenge
Review and provide input for the Go Outside the Box campaign website, intended for community
partners, their staff and the population at large.

Service received
Advice on website changes to consider, sent by THCU consultant,via email and telephone.

THCU resources/tools provided and/or discussed


A member of the Go Outside the Box community partnership had previously attended THCUs
Planning Effective Health Campaigns workshop and used the tools handed out in that session.

Actions taken as a result of the consultation


The Go Outside the Box community partnership member made changes to the website. For example,
the campaign description was expanded and the site was linked with other partnership websites.

Lessons learned
Time is at a premium. Having a consultation is valuable and easier than the Go Outside the Box
committee member thought it would be. Information was shared with the partnership members.

Barriers to taking advice or using the tools


The Go Outside the Box committees first choice would have been to have a face-to-face meeting. Due
to time constraints, this was not possible; however, they were still able to incorporate the suggested
changes.

We do not implement processes, analyze data, or create resources or reports for our clients.
However, we offer training on our evaluation, planning, policy, health communication, and
sustainability models. We also conduct guided process consultations where we help clients
apply our models to a particular situation and we are able to comment on drafts and processes.
Sometimes clients do not realize that we are able to connect with them multiple times about a
particular project to ensure implementation questions are answered.

11
239

Other Key Facts


The Health Communication Unit (THCU) is mandated to provide support to health promotion
practitioners and organizations in the areas of health communication, planning, evaluation, policy
development, and sustainability.
Each year, we deliver approximately 40 workshops, hold approximately 75 face-to-face guided-process
consultations, and provide advice and information about 100 times per year, reaching over 3,300 clients.
We maintain a website at www.thcu.ca, with over 100,000 visits per year and co-publish the weekly
Ontario Health Promotion Email Bulletin and its searchable archive at www.ohpe.ca.
We have 13 workbooks in print and dozens of other tools and handouts in circulation, most available on
our website and some available in French.
THCU is a leading user of new technologies in its sector: registrations, service requests, and needs
assessments are collected online. Our internal database allows for quick entry and production of reports
for clients and funders. We are using quick web publishing tools for community building (www.thcu.ca/
Workplace/vc/index.cfm) and have an interactive, online health communication workbook (www.thcu.
ca/infoandresources.htm).
THCU is dedicated to Continuous Quality Improvement. We regularly conduct time of service
and follow-up evaluations, which are shared with participants and stakeholders and drive continual
improvements in how we develop, promote, administer, deliver, and evaluate our services. All evaluations
system-wide and THCUs own reveal high satisfaction with services and materials.
THCU is at the Dalla Lana School of Public Health, University of Toronto. We have a core group of parttime consultants supplemented by guest consultants as needs and opportunities arise.
A number of our consultants teach highly regarded university courses in health promotion and coordination.
We have excellent collegial relationships with health communication scholars across the world.

12
240

ONTARIO HEALTH
PROMOTION E-BULLETIN
Now Accepting
Feature Articles for
the September 2010 March 2011 issues of
the Ontario Health
Promotion Email
Bulletin

Reach up to 20,000 health promotion


professionals!
The Ontario Health Promotion Email Bulletin (OHPE) is a weekly
newsletter for people interested in health promotion. It is produced by
Health Nexus Sant and The Health Communication Unit (THCU)
and provides information on workshops, conferences, job postings,
projects, issues, and resources.
We currently have over 5000 readers across Ontario and beyond. Many
of these readers have told us that they regularly pass our bulletin on to
at least four additional colleagues who do not subscribe. This brings our
readership to close to 20,000.

Look forward to Fridays


The events, announcements, and jobs are distributed by email on
Friday. A feature and related resources are included at least every
second week.

Join us
You can join us by subscribing at http://www.ohpe.ca or by emailing
info@ohpe.ca.

Contribute a feature article


Got great programs, services, resources, research? Publishing a feature
article in the bulletin is a great way to disseminate information
about your work directly to the health promotion community. Email
features@ohpe.ca with your article idea or visit www.ohpe.ca for
further details.

241

Send us your news and commentary


Letters to the editor and contributions to our News from the Field
column are welcome at any time. Events, announcements, and job
postings must be sent by noon Thursday for inclusion in the next
days issue.
Complete submission guidelines are available at http://www.ohpe.ca/.

Access Past Issues


All past issues are stored in our online, searchable database. You can
search our database by key word and also browse by complete issues or
by individual entries for events, announcements, job postings, feature
articles or resources.

Contact Us
If you have any questions about the OHPE Bulletin, we invite you to
browse our website (http://www.ohpe.ca). You can also contact us by
email at info@ohpe.ca
THCU and Health Nexus Sant are members of the Ontario Health
Promotion Resource System. OHPE is funded by the Ministry
of Health Promotion. Content of the OHPE is provided as an
information-sharing service. Inclusion of information and resources in
the OHPE Bulletin does not represent endorsement by Health Nexus
Sant, THCU, or the Ministry.

242