Planning, Implementing, and Evaluating Health Promotion Programs

A Primer

SeVenth edition

James F. McKenzie, Ph.d., M.P.h., M.C.h.e.S. Ball State University

Brad L. neiger, Ph.d., M.C.h.e.S. Brigham Young University

Rosemary thackeray, Ph.d., M.P.h. Brigham Young University

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Library of Congress Cataloging-in-Publication Data

McKenzie, James F. Planning, implementing, and evaluating health promotion programs: a primer/ James F. McKenzie, Brad L. Neiger, Rosemary Thackeray.—7th ed. p. ; cm. Includes bibliographical references. ISBN 978-0-13-421992-9—ISBN 0-13-421992-9 I. Neiger, Brad L. II. Thackeray, Rosemary. III. Title. [DNLM: 1. Health Promotion—United States. 2. Health Education—United States. 3. Health Planning—United States. 4. Program Evaluation—United States. WA 590] 613.0973—dc23 2015044450

ISBN-10: 0-13-421992-9 ISBN-13: 978-0-13-421992-9

1 2 3 4 5 6 7 8 9 10—V355—20 19 18 17 16

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Acknowledgments of third party content appear on pages 477–478, which constitutes an extension of this copyright page.

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This book is dedicated to seven special people—

Bonnie, Anne, Greg, Mitchell, Julia, Sherry, and Callie Rose

and to our teachers and mentors—

Marshall H. Becker (deceased), Mary K. Beyer, Noreen Clark (deceased), Enrico A. Leopardi, Brad L. Neiger, Lynne Nilson, Terry W. Parsons,

Glenn E. Richardson, Irwin M. Rosenstock (deceased), Yuzuru Takeshita, and Doug Vilnius

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Preface xiii

Acknowledgments xvii

Chapter 1 health education, health Promotion, health education Specialists, and Program Planning 1 Health Education and Health Promotion 4 Health Education Specialists 4 Assumptions of Health Promotion 9 Program Planning 10 Summary 13 Review Questions 13 Activities 13 Weblinks 14

PART I Planning a HealtH Promotion Program 15

Chapter 2 Starting the Planning Process 17 The Need for Creating a Rationale to Gain the Support

of Decision Makers 18 Steps in Creating a Program Rationale 20

Step 1: identify Appropriate Background information 20 Step 2: title the Rationale 26 Step 3: Writing the Content of the Rationale 26 Step 4: Listing the References Used to Create the Rationale 30

Planning Committee 33 Parameters for Planning 36 Summary 37 Review Questions 37 Activities 37 Weblinks 38

Chapter 3 Program Planning Models in health Promotion 41 Evidence-Based Planning Framework for Public Health 43 Mobilizing for Action Through Planning and Partnerships (MAPP) 45

Contents

v

vi Contents

MAP-IT 46 PRECEDE-PROCEED 48

the eight Phases of PReCede-PRoCeed 48

Intervention Mapping 50 Healthy Communities 51 SMART 53

the Phases of SMARt 55

Other Planning Models 57 An Application of the Generalized Model 58 Final Thoughts on Choosing a Planning Model 62 Summary 63 Review Questions 63 Activities 64 Weblinks 64

Chapter 4 Assessing needs 67 What to Expect from a Needs Assessment 70 Acquiring Needs Assessment Data 71

Sources of Primary data 71 Sources of Secondary data 82 Steps for Conducting a Literature Search 87 Using technology to Map needs Assessment data 88

Conducting a Needs Assessment 90 Step 1: determining the Purpose and Scope of the needs

Assessment 91 Step 2: Gathering data 91 Step 3: Analyzing the data 93 Step 4: identifying the Risk Factors Linked to the health Problem 96 Step 5: identifying the Program Focus 97 Step 6: Validating the Prioritized needs 98 Application of the Six-Step needs Assessment Process 98

Special Types of Health Assessments 100 health impact Assessment 100 organizational health Assessment 101

Summary 102 Review Questions 102 Activities 103 Weblinks 103

Chapter 5 Measurement, Measures, Measurement instruments, and Sampling 105 Measurement 106

the importance of Measurement in Program Planning and evaluation 107 Levels of Measurement 108 types of Measures 111

Contents vii

Desirable Characteristics of Data 111 Reliability 112 Validity 114 Bias Free 117

Measurement Instruments 117 Using an existing Measurement instrument 117 Creating a Measurement instrument 118

Sampling 121 Probability Sample 123 nonprobability Sample 126 Sample Size 127

Pilot Testing 127 Ethical Issues Associated with Measurement 129 Summary 130 Review Questions 130 Activities 131 Weblinks 131

Chapter 6 Mission Statement, Goals, and objectives 133 Mission Statement 134 Program Goals 135 Objectives 136

different Levels of objectives 136 Consideration of the time needed to Reach the outcome

of an objective 138 developing objectives 139 Questions to be Answered When developing objectives 139 elements of an objective 139

Goals and Objectives for the Nation 142 Summary 148 Review Questions 149 Activities 149 Weblinks 150

Chapter 7 theories and Models Commonly Used for health Promotion interventions 151 Types of Theories and Models 154 Behavior Change Theories 154

intrapersonal Level theories 157 interpersonal Level theories 176 Community Level theories 182

Cognitive-Behavioral Model of the Relapse Process 186 Limitations of Theory 187 Summary 188

viii Contents

Review Questions 188 Activities 189 Weblinks 190

Chapter 8 interventions 191 Types of Intervention Strategies 193

health Communication Strategies 194 health education Strategies 203 health Policy/enforcement Strategies 206 environmental Change Strategies 210 health-Related Community Service Strategies 211 Community Mobilization Strategies 212 other Strategies 215

Creating Health Promotion Interventions 225 intervention Planning 225 Adopting a health Promotion intervention 226 Adapting a health Promotion intervention 226 designing a new health Promotion intervention 228

Limtations of Interventions 233 Summary 234 Review Questions 234 Activities 235 Weblinks 236

Chapter 9 Community organizing and Community Building 237 Community Organizing Background and Assumptions 238 The Processes of Community Organizing and Community Building 241

Recognizing the issue 244 Gaining entry into the Community 244 organizing the People 245 Assessing the Community 248 determining Priorities and Setting Goals 252 Arriving at a Solution and Selecting intervention Strategies 254 Final Steps in the Community organizing and Building Processes 254

Summary 255 Review Questions 255 Activities 255 Weblinks 256

PART II imPlementing a HealtH Promotion Program 259

Chapter 10 identification and Allocation of Resources 261 Personnel 264

internal Personnel 264

Contents ix

external Personnel 265 Combination of internal and external Personnel 266 items Related to Personnel 267

Curricula and Other Instructional Resources 272 Space 275 Equipment and Supplies 276 Financial Resources 276

Participant Fee 277 third-Party Support 277 Cost Sharing 278 Cooperative Agreements 278 organization/Agency Sponsorship 278 Grants and Gifts 279 Combining Sources 282 Preparing and Monitoring a Budget 282

Summary 287 Review Questions 287 Activities 287 Weblinks 288

Chapter 11 Marketing: developing Programs that Respond to the Wants and needs of the Priority Population 291 Marketing and Social Marketing 291 The Marketing Process and Health Promotion Programs 293

exchange 293 Consumer orientation 294 Segmentation 296 Marketing Mix 301 Pretesting 310 Continuous Monitoring 312

Summary 314 Review Questions 314 Activities 315 Weblinks 316

Chapter 12 implementation: Strategies and Associated Concerns 319 Logic Models 321 Defining Implementation 322 Phases of Program Implementation 322

Phase 1: Adoption of the Program 323 Phase 2: identifying and Prioritizing the tasks to Be Completed 323 Phase 3: establishing a System of Management 326 Phase 4: Putting the Plans into Action 331 Phase 5: ending or Sustaining a Program 335

Implementation of Evidence-Based Interventions 335

x Contents

Concerns Associated with Implementation 336 Safety and Medical Concerns 336 ethical issues 338 Legal Concerns 340 Program Registration and Fee Collection 341 Procedures for Record Keeping 341 Procedural Manual and/or Participants’ Manual 341 Program Participants with disabilities 342 training for Facilitators 342 dealing with Problems 345 documenting and Reporting 345

Summary 346 Review Questions 346 Activities 347 Weblinks 348

PART III evaluating a HealtH Promotion Program 349

Chapter 13 evaluation: An overview 351 Basic Terminology 352 Purpose of Evaluation 354 Framework for Program Evaluation 356 Practical Problems or Barriers in Conducting an Evaluation 358 Evaluation in the Program Planning Stages 360 Ethical Considerations 360 Who Will Conduct the Evaluation? 361 Evaluation Results 362 Summary 362 Review Questions 363 Activities 363 Weblinks 363

Chapter 14 evaluation Approaches and designs 365 Formative Evaluation 366

Pretesting 373 Pilot testing 373

Summative Evaluation 374 Selecting an Evaluation Design 375 Experimental, Control, and Comparison Groups 376 Evaluation Designs 378 Internal Validity 381 External Validity 382

Contents xi

Summary 383 Review Questions 383 Activities 384 Weblinks 384

Chapter 15 data Analysis and Reporting 387 Data Management 388 Data Analysis 389

Univariate data Analyses 390 Bivariate data Analyses 391 Multivariate data Analyses 392 Applications of data Analyses 393

Interpreting the Data 394 Evaluation Reporting 396

designing the Written Report 397 Presenting data 397 how and When to Present the Report 398

Increasing Utilization of the Results 399 Summary 400 Review Questions 400 Activities 400 Weblinks 401

Appendix A Code of ethics for the health education Profession 403

Appendix B health education Specialist Practice Analysis (heSPA 2015)– Responsibilities, Competencies and Sub-competencies 409

Glossary 419

References 433

Name Index 459

Subject Index 465

Text Credits 477

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this book is written for students who are enrolled in a professional course in health promotion program planning. It is designed to help them understand and develop the skills necessary to carry out program planning regardless of the setting. The book is unique among the health promotion planning textbooks on the market in that it provides readers with both theoretical and practical information. A straightforward, step-by-step format is used to make concepts clear and the full process of health promotion planning understandable. This book provides, under a single cover, material on all three areas of program development: planning, implementing, and evaluating.

Learning Aids

Each chapter includes chapter objectives, a list of key terms, presentation of content, chapter summary, review questions, activities, and Weblinks. In addition, many of the key concepts are further explained with information presented in boxes, figures, and tables. There are also two appendixes: Code of Ethics for the Health Education Profession and Health Education Specialist Practice Analysis 2015—Responsibilities, Competencies, and Sub-competencies; an extensive list of references; and a Glossary.

Chapter Objectives

The chapter objectives identify the content and skills that should be mastered after read- ing the chapter, answering the review questions, completing the activities, and using the Weblinks. Most of the objectives are written using the cognitive and psychomotor (behavior) educational domains. For most effective use of the objectives, we suggest that they be reviewed before reading the chapter. This will help readers focus on the major points in each chapter and facilitate answering the questions and completing the activi- ties at the end.

Key Terms

Key terms are introduced in each chapter and are important to the understanding of the content. The terms are presented in a list at the beginning of each chapter and are printed in boldface at the appropriate points within the chapter. In addition, all the key terms are presented in the Glossary. Again, as with the chapter objectives, we suggest that readers skim

PrefaCe

xiii

xiv Preface

the key terms list before reading the chapter. Then, as the chapter is read, particular attention should be paid to the definition of each term.

Presentation of Content

Although each chapter could be expanded—in some cases, entire books have been written on topics we have covered in a chapter or less—we believe that each chapter contains the necessary information to help students understand and develop many of the skills required to be successful health promotion planners, implementers, and evaluators.

Responsibilities and Competencies Boxes

Within the first few pages of all except the first chapter, readers will find a box that contains the responsibilities and competencies for health education specialists that are applicable to the content of the chapter. The responsibilities and competencies presented in each chapter are the result of the most recent practice analysis—the Health Education Specialist Practice Analysis 2015 (HESPA 2015), which is published in A Competency-Based Framework for Health Education Specialists—2015 (NCHEC & SOPHE, 2015). These boxes will help readers under- stand how the chapter content applies to the responsibilities and competencies required of health education specialists. In addition, these boxes should help guide candidates as they prepare to take either the Certified Health Education Specialist (CHES) or Master Certified Health Education Specialist (MCHES) exam. A complete listing of the Responsibilities, Competencies, and Sub-competencies are presented in Appendix B.

Chapter Summary

At the end of each chapter, readers will find a one- or two-paragraph review of the major con- cepts covered in the chapter.

Review Questions

The questions at the end of each chapter provide readers with some feedback regarding their mastery of the content. These questions also reinforce the objectives and key terms presented in each chapter.

Activities

Each chapter includes several activities that allow students to use their new knowledge and skills. The activities are presented in several different formats for the sake of variety and to ap- peal to the different learning styles of students. It should be noted that, depending on the ones selected for completion, the activities in one chapter can build on those in a previous chapter and lead to the final product of a completely developed health promotion program plan.

Weblinks

The final portion of each chapter consists of a list of updated links on the World Wide Web. These links encourage students to explore a number of different Websites that are available to support planning, implementing, and evaluating programs.

Preface xv

new to this edition

In revising this textbook, we incorporated as many suggestions from reviewers, colleagues, and former students as possible. In addition to updating material throughout the text, the follow- ing points reflect the major changes in this new edition:

? Chapter 1 has been updated to include information about the revised areas of responsibility, competencies, and subcompetencies based on the Health Education Specialist Practice Analysis (HESPA 2015) (NCHEC & SOPHE, 2015), and the implications of HESPA 2015 for the Health Education Profession.

? Chapter 2 has been expanded to include additional information on sources of evidence to support a program rationale, additional information on determining the financial burden of ill health, a new example of a written program rationale, and information on the importance of partnering with others when creating a program.

? Chapter 3 has been restructured to place more emphasis on the prominent planning models used in health promotion. The chapter also now includes the Evidence- Based Planning Framework in Public Health, the CHANGE tool used to plan healthy community initiatives, and more evidence-based examples of how planning models are used in practice.

? Chapter 4 has new information on the importance of needs assessment in the accredita- tion of health departments and the IRS requirement for not-for-profit hospitals, new information on using technology while conducting a needs assessment, and a new section on organizational health assessments.

? Chapter 5 includes new information on wording questions for different levels of measurement, how to present data in charts and graphs, how to write questions and response items for data collection instruments, and guidelines for the layout and visual presentation of data collection instruments.

? Chapter 6 now includes a new section on short-term, intermediate, and long-term objectives, and a new SMART objective checklist.

? Chapter 7 includes additional information on the expansion of the socio-ecological approach, additional information on the constructs of the social cognitive theory, the inclusion of the diffusion of innovations theory which was previously found in Chapter 11, and a new section on the limitations of theory.

? Chapter 8 features new information on motivational interviewing, new content on the built environment, new content on behavioral economics, information on the Affordable Care Act and its impact on incentives, and new content on the limitations of interventions.

? Chapter 9 includes new information on the renaming of community organizing strategies and updated figures on community organizing and community building typology and on mapping community capacity.

? Chapter 10 now includes expanded information on using volunteers as a program resource, and program funding by governmental agencies.

? Chapter 11 has been reworked and now has several new boxes and tables that include a social marketing planning sheet, factors to consider when selecting pre-testing methods, a 4Ps marketing mix example, types of questions to ask for formative research, and examples of segmentation.

xvi Preface

? Chapter 12 content includes expanded information on logic models, new content on professional development including a template for a professional development plan, new content on monitoring implementation, and new content on the implementation of an evidence-based intervention.

? Chapter 13 now includes updated information on CDC’s Framework for Program Evaluation and new information on CDC’s characteristics of a good evaluator. In addition, new information has been added to support the importance of evaluation and the use of evaluation standards.

? Chapter 14 includes updated terminology and context for internal and external validity, and updated context for experimental, quasi-experimental, and non-experimental evaluation designs.

? Chapter 15 includes updated information for data management, data cleaning, and the transition to data analysis. In addition, new information is presented to show the relationship between levels of measurement and the selection of statistical tests including parametric and non-parametric tests.

? All chapters include more practical planning examples and, where appropriate, new application boxes have been added to chapters.

? A new appendix has been added that contains all of the Responsibilities, Competencies, and Sub-competencies that resulted from the Health Education Specialist Practice Analysis 2015.

? To assist students, the Companion Website (https://media.pearsoncmg.com/bc/bc_ mckenzie_health_7) has been updated and includes chapter objectives, practice quizzes, Responsibilities and Competencies boxes, Weblinks, a new example program plan, the Glossary, and flashcards.

? To assist instructors, all of the teaching resources have been updated by Michelle LaClair, Pennsylvania State College of Medicine. These resources are available for download on the Pearson Instructor Resource Center. Go to http://www.pearsonhighered.com and search for the title to access and download the PowerPoint® presentations, electronic Instructor Manual and Test Bank, and TestGen Computerized Test Bank.

Students will find this book easy to understand and use. We are confident that if the chapters are carefully read and an honest effort is put into completing the activities and visiting the Weblinks, students will gain the essential knowledge and skills for program planning, implementation, and evaluation.

https://media.pearsoncmg.com/bc/bc_mckenzie_health_7
https://media.pearsoncmg.com/bc/bc_mckenzie_health_7
http://www.pearsonhighered.com
A project of this nature could not have been completed without the assistance and understanding of many individuals. First, we thank all our past and present students, who have had to put up with our working drafts of the manuscript.

Second, we are grateful to those professionals who took the time and effort to review and comment on various editions of this book. For the first edition, they included Vicki Keanz, Eastern Kentucky University; Susan Cross Lipnickey, Miami University; Fred Pearson, Ricks College; Kerry Redican, Virginia Tech; John Sciacca, Northern Arizona University; and William K. Spath, Montana Tech. For the second edition, reviewers included Gordon James, Weber State; John Sciacca, Northern Arizona University; and Mark Wilson, University of Georgia. For the third edition, reviewers included Joanna Hayden, William Paterson University; Raffy Luquis, Southern Connecticut State University; Teresa Shattuck, University of Maryland; Thomas Syre, James Madison University; and Esther Weekes, Texas Women’s University. For the fourth edition, reviewers included Robert G. LaChausse, California State University, San Bernardino; Julie Shepard, Director of Health Promotion, Adams County Health Department; Sherm Sowby, California State University, Fresno; and William Kane, University of New Mexico. For the fifth edition, the reviewers included Sally Black, St. Joseph’s University; Denise Colaianni, Western Connecticut State University; Sue Forster- Cox, New Mexico State University; Julie Gast, Utah State University; Ray Manes, York College CUNY; and Lois Ritter, California State University East Bay. For the sixth edi- tion, reviewers included Jacquie Rainey, University of Central Arkansas; Bridget Melton, Georgia Southern University; Marylen Rimando, University of Iowa; Beth Orsega-Smith, University of Delaware; Aimee Richardson, American University; Heather Diaz, California State University, Sacramento; Steve McKenzie, Purdue University; Aly Williams, Indiana Wesleyan University; Jennifer Banas, Northeastern Illinois University; and Heidi Fowler, Georgia College and State University. For this edition, reviewers included Kimberly A. Parker, Texas Woman’s University; Steven A. Branstetter, Pennsylvania State University; Jennifer Marshall, University of South Florida; Jordana Harshman, George Mason University; Tara Tietjen-Smith, Texas A & M University, Commerce; Amy L. Versnik Nowak, University of Minnesota, Duluth; Amanda Tanner, University of North Carolina, Greensboro; Deric R. Kenne, Kent State University; and Deborah J. Gibson, University of Tennessee, Martin.

Third, we thank our friends for providing valuable feedback on various editions of this book: Robert J. Yonker, Ph.D., Professor Emeritus in the Department of Educational Foundations and Inquiry, Bowling Green State University; Lawrence W. Green, Dr. P. H., Professor, Department of Epidemiology and Biostatistics, School of Medicine, University

aCknowledgments

xvii

xviii Acknowledgments

of California, San Francisco (UCSF); Bruce G. Simons-Morton, Ed.D., M.P.H., Senior Investigator, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health; and Jerome E. Kotecki, H.S.D., Professor, Department of Physiology and Health Science, Ball State University. We would also like to thank Jan L. Smeltzer, Ph.D., coauthor, for her contributions to the first four editions of the book.

Fourth, we appreciate the work of the Pearson employees Michelle Cadden, Senior Acquisitions Editor for Health, Kinesiology, and Nutrition who has been very supportive of our work, and Susan Malloy, Program Manager, whose hard work and encouragement ensured we created a quality product. We also appreciate the careful work of Allison Campbell and Charles Fisher from Integra–Chicago.

Finally, we express our deepest appreciation to our families for their support, encourage- ment, and understanding of the time that writing takes away from our family activities.

J. F. M. B. L. N.

R. T.

1

1

Chapter Health Education, Health Promotion, Health Education Specialists, and Program Planning

Chapter Objectives

After reading this chapter and answering the questions at the end, you should be able to:

?? Explain the relationship among good health behavior, health education, and health promotion.

?? Explain the difference between health education and health promotion.

?? Write your own definition of health education.

?? Explain the role of the health educator as defined by the Role Delineation Project.

?? Explain how a person becomes a Certified Health Education Specialist or a Master Certified Health Education Specialist.

?? Explain what the Competencies Update Project (CUP), Health Educators Job Analysis (HEJA-2010), and Health Education Specialists Practice Analysis (HESPA-2015) have in common.

?? Explain how the Competency-Based Framework for Health Education Specialist is used by colleges and universities, the National Commission for Health Education Credentialing, Inc. (NCHEC), Council for the Accreditation of Educator Preparation (CAEP), and the Council on Education for Public Health (CEPH)

?? Identify the assumptions upon which health education is based.

?? Define the term pre-planning.

Key Terms

Advanced level 1-health education specialist

Advanced level-2 health education specialist

community decision makers entry-level health

education specialist

Framework health behavior health education

health education specialist

health promotion Healthy People pre-planning primary prevention priority population Role Delineation

Project secondary

prevention stakeholders tertiary prevention

2 Chapter 1

History has shown that much progress was made in the health and life expectancy of Americans since 1900. During these 116+ years, we have seen a sharp drop in infant mortality (NCHS, 2015); the eradication of smallpox; the elimination of poliomyelitis in the Americas; the control of measles, rubella, tetanus, diphtheria, Haemophilus influenzae type b, and other infectious diseases; better family planning (CDC, 2001); and an increase of 31.5 years in the average life span of a person in the United States (CDC, 2015e). Over this same time, we have witnessed disease prevention change “from focusing on reducing environmental exposures over which the individual had little control, such as providing potable water, to emphasizing behaviors such as avoiding use of tobacco, fatty foods, and a sedentary lifestyle” (Breslow, 1999, p. 1030). Yet, even with this change in focus we, as a society, have done little to encourage health community design, and as individuals, most Americans have not changed their lifestyle enough to reduce their risk of illness, disability, and premature death. As a result, unhealthy lifestyle characteristics have lead to the United States ranking 94th (out of 225 countries) in crude death rate; 42nd (out of 224 countries) in life expectancy at birth; and 1st in health care spending (CIA, 2015).

Today in the United …

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