Developing Programs and Evaluation - Assignment Example

? MODULE: DEVELOPING PROGRAMMES AND EVALUATION MODULE SHGM52 MODULE LEADER: ANTHONY DUFFY Health Promotion Specialist Responding Nutritionist’s Letter STUDENT NUMBER: 628587 SUBMISSION DATE: 7/2/2011 WORD COUNT: 3788 Dear Sir/Madam Thank you for your letter asking my advice regarding appropriate ways to deal with diabetic children. It has always been a pleasure to guide professionals about healthy habits and practices. I assure you that I will provide you an effective and comprehensive course of action for delivering health information and mobilizing allied professionals for achieving the objective. Along with my background in health promotion, I have carried out extensive research into the matter, which I believe will aid you greatly. The recommendations that I have come up with are not merely based on superfluous assumptions; rather I have assimilated information regarding the various obstacles that are faced in health promotion and have argued the recommendations I proposed with reasons. This letter will cover the various aspects of empowering families living in Boston, USA, with little or no health awareness and equipping them with information regarding the health of their children. This letter will prove to be an instrumental tool in promoting the health of previously hospitalized diabetic children. The content of the letter has been organized such as to facilitate the achievement of your goals. To reiterate, your goals primarily focus on: 1. Provision of health information to families regarding diabetes as a constituent of their social education problem. 2. Involvement of groups and cooking clubs for encouraging families to make healthier meals for the children. Taking these objectives into account, the letter: Highlights the importance of social education and health awareness of families. Provides a comprehensive action plan for educating families living in Riyadh. Recommends the most appropriate location for the delivery of the plan. Explores ways that can be used for the involvement of cooking clubs and related groups. Looks into appropriate and effective marketing tools for promulgating the service. Sheds light into the costs associated with the project. Analyses the possible impediments that can be faced. Reviews the need to evaluate the project in terms of short and long term effects. The first section of the paper briefly considers the directives that have been adopted by the government for health promotion in the general public. Incidence of Diabetes in children and Government directives: In the USA, extensive research into diabetes is being carried out and the disease is not treated lightly. The incidence of diabetes is growing in the country, particularly among the younger population. It has become one of the most common chronic illnesses in children and teenagers in USA. Statistics report that more than 151,000 children and youth aged less than 20 years have been diagnosed with the condition. In 2007, 186,300 under the age of 20 were reported to have diabetes, representing about 0.2% of the youth in this age group (NDEP 2008). Usually children are diagnosed with the type of diabetes that is referred to as diabetes type I or juvenile diabetes. However over the recent years, it has been seen that some children are even developing diabetes type II, which was predominantly considered adult diabetes. In a study carried out between 2002 and 2003, the SEARCH for Diabetes in Youth, it was found out that every year in US, an alarming 15,000 children and teenagers are diagnosed with juvenile-onset diabetes. Moreover, the study showed that 3700 youth are diagnosed with adult diabetes each year. Although the occurrence of the disease in children aged less than 10 was low, it was seen that adult type II diabetes becomes increasingly common in children aged 10 years or more, especially in minority populations such as non-Hispanic whites and African Americans (NEDP 2008). Due to the rising incidence of the condition in the country, there are a number of directives that have been undertaken by the government to counter the trend. One such initiative has been the National Diabetes Education Program (NDEP). The NDEP (2008) reports that diabetes has become one of the most common diseases in school-going children. The aim of NDEP is to promulgate the latest research results and to disseminate knowledge regarding diabetes. The body is involved in the promotion of the notion that diabetes is controllable, and for type II diabetes, even preventable. The program has launched a number of campaigns such as the Control Your Diabetes. For Life. Campaign, the Small Steps. Big Rewards. Prevent type 2 Diabetes. Campaign and One Call, One Click NDEP Promotion. The goal of these campaigns is to reduce the risk of developing complications that may arise from uncontrolled diabetes and to help children and adults alike to manage their condition effectively. Along with these national directives, there are also a number of directives that are being undertaken at the regional and city level. The Diabetes Program at Children's Hospital Boston is one such example. This Diabetes Program is a multi-disciplinary program guided by the provision of care to infants, children, adolescents and young adults with diabetes mellitus and other diabetes related disorders. The Program brings together professionals from various fields of medicine such as endocrinology and diabetology, dietitians, public health workers etc for not only educating the families who have been victim of such a condition but also to empower the patients to live healthy normal lives (Children’s Hospital Boston 2009). The literature presented above is not confined to the US only. In the Kingdom of Saudi Arabia, there is increased awareness regarding diabetes. In reference to the families that you will be counseling, there are several hospitals in Riyadh that provide assistance to diabetic people. Also there are a number of government initiatives in the country that are aimed to promote awareness and health promotion amongst the families. During my research, I came across with the Riyadh Diabetic Club and forums for diabetic educators. I also learnt that KSA observes a world diabetic day as well. Moreover, King Abdul Aziz University Hospital, Riyadh, has a separate diabetic centre where research on diabetes is promoted and carried out extensively. The government has also passed the proposal for the construction of a National Diabetes Centre as an extension of the King Khalid University Hospital at King Saud University. Reports have documented that diabetes and obesity in the country are increasing at a fast rate and are recorded to be very high on the international scale. With the growing prevalence of the disease, King Abdul Aziz University Hospital, King Abdul Aziz University Hospital etc have been actively engaged in the promotion of health in the public. The hospitals arranged for diabetes awareness for children. Statistics have reported that 39.1% of the children below the age of 14 in the KSA have been diagnosed with diabetes (A1 Saudi Arabia 2010). As you can see, there is a lot of support that is available for children with diabetes. Your efforts can be a valuable contribution to the drive for the prevention and management of diabetes, as the famous maxim goes: every drop counts. An Overview of Planning a Health Promotion Program: Planning for a project is an essential for ensuring its success. A systematic approach to health promotion planning is given more importance than the effectiveness of the approach; the main purpose for systematic approach being the identification of goals and means for their implementation (Green & Tones 2010). I appreciate that you have mentioned in your letter that you want a comprehensively planned and organized action plan. This highlights that you understand the importance of setting goals and planning. Fertman and Allensworth (2010) observe that there are a number of health promotion program planning models that can be used by campaign planners. However there are three main elements that are common to all of them. Fertman and Allensworth have listed them out as: 1. Planning the program, compromising of carrying out a needs assessment of the health problem, prioritizing goals and objectives, choosing the most suitable interventions, and deciding upon the various aspects of creation of the plan. 2. Implementing the plan, encompassing the enforcement according to health theories, elimination of disparities and linkage to needs assessment. 3. Evaluating the plan, constituting an analysis of whether the plan has been implemented according to plan, and its short and long term effects. Following these pointers, one can establish that the first phase in the planning of a health promotion plan entails the establishment of clear cut goals and objectives. I have chosen the PRECEDE-PROCEED model for planning, implementing and evaluating the health promotion program, since this model is one of the most popular and successful approaches to health promotion. The model is considered very effective and robust because of its intuitive appeal and logic as well as its practicability (Glanz et al. 2008). Bell and Opie (2002) have given a comprehensive explanation of the procedure for planning research and collecting useful data. You may find it helpful to go through introductory chapters of the book; the link has been given in the references. Establishing clear cut goals and priorities: Green and Tones (2010) state that for creating an effective plan, it is essential to make an assessment of what would be required in the process of achieving the goals; this implies that one specifies the goal as the incumbent steps that need to be taken to accomplish the objective. Embarking with the PRECEDE-PROCEED model, the first step encompasses an assessment of the needs of the target group. It has been well-documented in sources regarding health research that it is more important for the community to identify its needs for itself as compared to the needs which the health professional sees for the community. If the professional considers something as a need and works for its solution, the change that succeeds may be slow. On the contrary, if the community is engaged actively in the identification of a need, and works for interventions, the change that follows would be fast (Tones & Tilford 2001). You can read more about health promotion models in the book by Egger et al. (1999); see References. Moreover health is not confined to a certain field. There are a number of determinants of health. As part of the social assessment that you undertake, you need to identify the social indicators of health in the target group (Fertman & Allensworth 2010). For instance, is it poverty, crime rate, low education levels etc that are stopping the families from managing the health of their diabetic children? In your case, you have identified that there is a dearth of sound knowledge amongst families regarding the treatment, prevention and management of diabetes in children. However it would further augment your health promotion plan if you make some effort collecting information regarding other social indicators that affect the approach of these families to management of diabetes. Therefore what can be ascertained from this discussion is that you need to actively engage the target group in identifying the need. For devising an effective action plan, you need to have knowledge of what are their beliefs, scope of knowledge, readiness to accept what you have to say and attitudes. Furthering upon phase 2 and 3 of the PRECEDE-PROCEED model, you need to identify the related health problems and factors that have a role in the poor management of the chronic condition. An assessment is to be made regarding the environmental, behavioral and genetic indicators that culminate in the poor management of diabetes in children, as well as the factors that impede the development of a positive environment and positive attitudes. These factors include predisposing, enabling and reinforcing factors. An analysis needs to be made of the factors that prevent or detract families from the motivation to change, from change itself or from continuing motivation or change by giving feedback or gains (Fertman & Allensworth 2010). Moreover after identification of these factors, you need to specify the goals and prioritize them in accordance with the social assessment that you have carried out. One way of doing this is by making questionnaires and distributing them in the families with previously-hospitalized diabetic children. Dunning and Martin (1996) have expounded on the development of questionnaires in a survey on non-insulin dependent diabetes. It would be helpful if you give the article a read. You can read about empowerment models, the health belief models and the health action models in the book by Robinson and Elkan (1996). These models will provide a resourceful tool for comprehending the beliefs and attitudes of the families. Laverack (2004) discusses in detail the principles of empowering people and their contribution towards helping people bring dramatic changes in their lifestyles. Moreover if you are still unsure about identification of health promotion needs and priorities, you can read chapter 6 of the book by Ewles and Simnett (2003); see References. Jones has also provided an interesting account of the challenges and issues in promoting public health (Douglas, Earle, Handsley, Lloyd & Spurr, 2007); you may find it helpful to go through it. Health promotion action plan: Phase 4 of the PRECEDE-PROCEED model requires that the plan drafted needs to be aligned with the administrative and policy framework of the region. This has been discussed in detail in the earlier part of the letter. Phase 4 states that the health planner should ensure that the setting in which the plan is targeted at supports the resources required to create and enforce the program. In this regard, one can see that there are a number of government initiatives which are in action in the country not only at the national level but also at the city level, supporting the care of children with diabetes. Therefore, you have a solid support available for backing up your efforts as mentioned in the earlier part of the letter. The next question that arises with respect to your health promotion plan is that how will you engage the community. There are a number of marketing maneuvers that can be undertaken for the purpose of informing the families. The foremost thing that you need to emphasize upon is the fact that the management of diabetes is very poor, which is why the children have been hospitalized once. The goals and priorities that you have set in the phase 1, 2 and 3 of the PRECEDE-PROCEED model are to be reflected in the plan. The factors identified are targeted in particular and you need to convince the families that your plan is an integral tool for the alleviation of the obstacles impairing the quality of the life of diabetic children. This can only be successful if you have correctly identified the factors. For example, if the parents say that they do not have any idea on what diet to give to their diabetic children, which is why they are failing to control the chronic condition, you need to convince them that your recommendations, for example the engagement of cooking clubs, will provide a practical solution to their problem. It must be noted that health promotion is prejudiced and it primarily stems from human values; the notion has been discussed in detail by Seedhouse (2004). Therefore you need to be acutely aware of the philosophy behind health promotion practice. Talking more about the prejudice impregnated in the health promotion field, Seedhouse (2004) argues that the main purpose of the models and values health promotion, as buttressed by theorists, is to promote good lives; professionals should have a clear and comprehensive vision of this good live, which itself should be based on a set of political notions. On the other hand, Seedhouse is of the point of view that health promotion is not about the promotion of good lives, but about promoting health itself. He observes that good lives are promoted as a consequence of promotion of health. Seedhouse also draws attention to an apparent paradox in the attitudes of people regarding health. He observes that it occurs on a frequent basis that health is weighed against values, and at times health is given priority over other values and vice versa. For example some people give up their job on the account that the stressful lifestyle is causing their health to fall. On the other hand, people may give up their health concerns for another value. Therefore, you should be aware of the prejudice that exists in the health promotion profession. For more information regarding it, read the book by Seedhouse (2004). Since you have specifically mentioned that you are aiming at the involvement of cooking clubs for promoting health awareness regarding healthy foods for diabetic children, the following section will be helpful in coming up with such an approach. Working with cooking clubs and related groups: Effective health promotion requires that there is good teamwork and collaboration with the professionals coming from various fields. You may often come across with problems relating to ambiguously defined roles in an inter-professional team where it is difficult to work together due to competition, rivalry and other issues. Therefore you need to ensure that for an ideal team compromising of members from various fields, your focus should be on encouraging the members to undertake a common task, selecting members according to the expertise that are relevant to your health promotion plan, designating roles to the members according to their competency, encouraging members to help and complement each other and consigning them towards the achievement of the goals. Balloch and Taylor (2001) provide an insight into the barriers that one may face in partnerships and recommendations to overcome them. You can read chapter 5 of the book for more information; see the References section. The inclusion of cooking clubs is a good idea. I believe it is a novel approach since other initiatives have focused on social education classes, brochures etc. In order to approach cooking clubs for participating in your health promotion initiative, you need to present the partnership as a productive one, aiming to provide help to families without any criticism or judgmental advice (Naidoo & Wills, 1998). Moreover for convincing the cooking groups to cooperate with you, you need to explain them your idea in detail, stressing upon the need to develop healthy eating habits in diabetic children. There are a number of clubs that are operating abroad for the promotion of diabetics cooking. One such club is the Diabetics Friendly Cooking Class. You can access their website and find out more about the whole experience; see Diabetics Society (2011) in References. Implementation: Phase 5 of the model is concerned with the implementation of the program. The focus of the PRECEDE-PROCEED health promotion plan shifts from precede to proceed. The implementation of the plan encompasses the development of recommendations for the achievement of the goals and the integration of advocacy, financial and technical backing into the substance of the plan (Timmreck 2003). In developing the action plan itself, you can integrate various elements that will make the plan more effective. One such method is the formal introduction of the plan. You need to participate in an effective outreach program and promulgate the information you have collected and the solutions you have come up with. There are a number of ways through which you can do this. As mentioned earlier, there are a number of hospitals with endocrinology units in Riyadh. You can approach the hospital and ask them to put up posters regarding the program you are offering. Interested families who are visiting the hospital can contact you. You can also disseminate brochures. The cooking clubs you are working with can help you in this regard. Since many of them are already publishing brochures for the marketing of their services, you can ask them to publish a brochure particularly for the purpose of offering cooking classes to parents with diabetic children. Another interesting way of reaching out to the families and giving them awareness regarding diabetes would be to organize a public awareness event. You can ask the cooking clubs to come to the event and at the same time, you can also ask speakers from NGOs and physicians etc to come for giving some information to the attending families regarding the prevention, treatment and management of diabetes. Moreover, there are a number of fact sheets and brochures that are published by the government of KSA and NGOs for the promotion of health awareness regarding diabetes. You can disseminate these brochures amongst the attending families. Emails and text messaging can also be a good way of informing the families. A number of families must have contacted you regarding diets for their diabetic children. You can email these families information regarding diabetes as well as invite them to the health awareness and cooking events that you host. You can also email them recipes which you get from cooking clubs. Advertisements on the television, radios, social networking sites, and other internet sites can also be put up. Cost and duration: The engagement of cooking groups and other bodies such as local NGOs like the Youth Initiative and the Diabetes Centers at the hospitals mentioned in the earlier parts of the letter can become a long process. Moreover the publication of materials and the marketing of the plan are also cost-dependent. This follows that you need to make a financial plan with respect to your health plan. In health economics, there are three tools that you can use for making your plan as cost-effective as possible. The first tool relates to cost analysis, which refers to the calculation of the costs of the program. The second tool, cost effectiveness analysis, entails the comparison of the efficiency and productivity of the program with the goal. The third tool is cost benefit analysis and constitutes the benefits and costs of the undertaken endeavour. The use of economics in health promotion has been expounded upon by David Cohen and Hale and you can refer to chapter 8 for reading the article; the article is published in the book by Bunton and Macdonald (2002). With respect to the duration of the plan, you need to have a rough estimate of the deadline at which you want to start implementing the program. Moreover you also need to make a rough estimate of the duration of the enforced plan. In the process of making the plan, you need to take into account time and task management tools. These tools can be made use of during all phases of the health promotion plan, and, as aptly put by Nnakwe (2009), ‘should list goals, objectives, action strategies, and time lines that indicate tasks or activities that must be done, by whom, and when’. Stephens (2008) discusses various aspects of making health promotion programs more effective. You may find it a helpful read. Evaluating the effects: There are three dimensions of program implementation that you need to consider: fidelity, completeness and dose (Bartholomew 2006). Fidelity entails the degree to which the program has been implemented keeping the interventions intact. Completeness refers to the fraction of the program activities that have been delivered to the target group, whereas dose encompasses the proportion of the plan that has been received by the target group. Therefore in deciding upon the effectiveness of the plan, these aspects need to be considered. Moreover there are a number of approaches used by health promotion planners for evaluating their plans. Evaluation can be considered a conglomeration of three parts. Formative evaluation compromises the collection of information during the process of implementation for the purpose of developing or improving the program (Hodges & Videto 2010). On the other hand, summative implementation is carried out to collect information to establish whether the program has worked out in the intended way or not. Process evaluation helps to find out the information crucial for establishing why a plan may or may not have worked out (Hodges & Videto 2010). In order to evaluate your program, you need to answer the following questions as put forward by Hodges and Videto (2010): Implementation: has the plan been enforced as required? Effectiveness: has the program been able to accomplish its goals? Efficiency: are the activities of the program making appropriate and economical use of its resources? Cost effectiveness: is the plan marked with adequate value and benefit to the program’s actions to validate its costs? Attributions: is there an explicit connection between the actions of the program and progress with goals and priorities? You may start the first set of the evaluation three weeks into the program, and subsequent evaluations can be carried out after every two months. The evaluation can be carried out in the form of questionnaires which the families can fill. You can use the Quality-adjusted life cycle (QUALY) questionnaire for this purpose. The last two phases of the PRECEDE-PROCEED model are impact evaluation and outcome evaluation. These two aspects of evaluation will be covered in the questionnaires, and will judge the effect that the campaign has had on the behaviors and attitudes of the families, and the subsequent effect on the quality of life of the children. Valente (2002) provides an informative insight into the evaluation of health programs, particularly in Part I of the book; see References. Conclusion: I believe that you have a novel and different idea for promoting health amongst families. You should be able to appreciate that the plan needs to be holistic and multidisciplinary. It involves the participation of various individuals and the cooperation of the families. Throughout planning and implementation of the plan, your actions should always be guided by the goals and objectives of the plan. All actions and activities should remain focused on the empowerment of the families and in ameliorating the conditions of the diabetic children. I cannot over emphasize the importance of planning before the implementation of the plan, and evaluation after it has been launched. With all this in mind, I hope you found the information and the reference books that I gave in the letter useful. If you have any questions, feel free to contact me. Once again, it is a great idea and I wish you the very best with it. Yours faithfully References Balloch, S. and Taylor, M. (2001) Partnership Working Policy and Practice. Bristol: The Policy Press. Bartholomew, L. K. (2006) Planning health promotion programs: an intervention mapping approach. San Francisco, CA: John Wiley and Sons. Bell, J. and Opie, C. (2002) Learning from Research. Buckingham: Open University Press. Bunton, R. and Macdonald, G. (2002) Health promotion: disciplines, diversity, and developments. 2nd edn. Oxon, OX: Routledge. Children’s Hospital Boston (2009) Diabetes Program. Available at: http://www.childrenshospital.org/clinicalservices/Site1870/mainpageS1870P0.html (Accessed: 4 February 2011) Diabetics Society (2011) Diabetics Friendly Cooking Class. Available at: http://www.diabetessociety.org/whats-new/diabetes-friendly-cooking-class (Accessed: 6 February 2011) Douglas, J., Earle, S., Handsley, S., Lloyd, C.E., Spurr, S. (2007) A Reader in Promoting Public Health. Milton Keynes, MK: SAGE Publications. Dunning, T. and Martin, M. (1996) ‘Developing a questionnaire: some methodological issues’, Australian Journal of Advanced Nursing 14(2), pp.31-8. Egger, G., Spark, R., Lawson, J. and Donovan, R. (1999) Health promotion strategies & methods. London: McGraw-Hill. Ewles, I. and Simnett, I. (2003) Promoting health: a practical guide. London: Baillere Tindall. Fertman, C.I. and Allensworth, D.D. (2010) Health Promotion Programs: From Theory to Practice. San Francisco, CA: John Wiley and Sons. Glanz, K., Rimer, B.K., Viswanath, K. (2008) Health behavior and health education: theory, research, and practice. 4th edn. San Francisco, CA: John Wiley and Sons. Green, J. and Tones, K. (2010) Health Promotion: Planning and Strategies. 2nd edn. London: SAGE Publications Ltd. Hodges, B.C. and Videto, D.M. (2010) Assessment and Planning in Health Program. 2nd edn. Sudbury, MA: Jones & Bartlett Learning. Laverack, G. (2004) Health promotion practice: power and empowerment. London: SAGE. NDEP (2008) Overview of Diabetes in Children and Adolescents. Available at: http://ndep.nih.gov/media/diabetes/youth/youth_FS.htm (Accessed: 4 February 2011) Nnakwe, N.E. (2009) Community nutrition: planning health promotion and disease prevention. Sudbury, MA: Jones & Bartlett Learning. Robinson, J. and Elkan, R. (1996) Health needs assessment: theory and practice. New York, NY: Churchill Livingstone. Seedhouse, D. (2004) Health promotion: philosophy, prejudice and practice. 2nd edn. Chichester: J. Wiley. Stephens, C. (2008) Health promotion: a psychosocial approach. Berkshire: Open University Press. Timmreck, T.C. (2003) Planning, program development, and evaluation: a handbook for health promotion, aging, and health services. 2nd edn. Sudbury, MA: Jones & Bartlett Learning. Tones, K. and Tilford, S. (2001) Health Promotion Health Promotion: effectiveness, efficiency and equity. 3rd edn. Cheltenham: Nelson Thornes Ltd. Valente, T.W. (2002) Evaluating health promotion programs. New York, NY: Oxford University Press. Appendix Dear Sir or Madam I have bachelor degree in nutrition. Furthermore, I had training in the field of healthcare, King Abdul-Aziz Hospital, Jeddah, KSA in the capacity of Dietitian. As a part of my practical training, I have been asked to conduct a survey concerning the appropriate means of dealing with Diabetic children. These children with diabetes had to stay in the hospital for couple of days to control their blood sugar. Unfortunately, their parents poorly educated and they do not follow the instructions which I gave them about the diet and the exercises the children should do. Moreover, i explained to them many times about this chronic disease and how it will affect their children’s lives and it will cause other disease in the future. But, still they come to me with the same problem every month. I am addressing this message seeking your help to find out the proper ways of the possibility to manage with such case. My aims and objectives are: - Provide health education to the families about diabetes as part of social education programs. This will empower them and give them the knowledge to improve their children’s health. - Involve groups and cooking clubs to develop skills and confidence in preparing healthier meals for diabetic children. They will be able to work coordinately with the health visitors to enhance the parenting program and contribute to Partnership Working. Taking all the above into consideration I would like your expert advice on the following: 1. The best way to plan the initiative. 2. The most appropriate location. 3. How to approach the managers of the other groups and cooking clubs in order to bring them on board. 4. How to advertise the service. I look forward to hearing from you Yours faithfully, Dietitian Read More