Policy and Programs

1. Policy and Programs • Policy • Framework of basic principles that dictate decisions and actions (including programs) • Public (governments) – social, economic, transportation, housing, operational, etc. • Organizational – strategic, operational, etc.

2. Policy • Public policy (governments)is based on: • Demographic, social, economic realities • Research evidence • Philosophical factors / ideology / values e.g. • individual behaviour vscollective action • econometric (cost/benefit) • Politics and power • Implementation: e.g. Window of Opportunity (compelling problem, solution, public support)

3. Programs and Policies • Programs (and Services) • Usually represent the implementation of policies • Program evaluation provides evidence for policy

4. Evidence-based Programs and Policies Application of the best available information derived from clinical, epidemiological, administrative, demographic and other relevant sources and consultations to clearly describe current and desired outcomes for an identified population or organization. • Empirically-based/ research-derived ‘knowledge’ • Reduce political; enhance objectivity as basis for programs and policies • Is evidence apolitical?

5. Program Lifecycle • Pilot– small, trial and error, experimental • Model – more formal, controlled conditions, standard procedures, rigorous evaluation • Prototype – under realistic conditions • Institutionalized – ongoing part of services provided

6. What is a Plan? (HSIP, 2006) A plan is defined as a map or preparation, or anarrangement. Planning defines • where one wants to go • how to get there • the timetable for the journey • can also identify the journey’s milestones • complete planning sets out indicators for tracking progress and ways to measure if the trip was worth the investment. Charting a course, navigating and keeping a travel log are all parts of a good planning process. Broad elements of planning are therefore: • identifying a vision and goals • undertaking strategic planning • and evaluation.

7. Planning • Planning is a series of decisions: • from general and strategic decisions ….. • to specific operational details; • based on the gathering and analysis of a wide range of information. THCU, University of Toronto, 2001

8. Planning Hierarchy • Strategic Planning • Organization’s map for obtaining its broad goals (within its vision and mission). Defines its domain, stakeholders, priorities, strategies. • Operational Planning (tactical) • On an annual basis, how organization will work towards goals in strategic plan • Program Planning (tactical) • Specific goal and objectives, timeline, resources, systematic process for achieving desired ends.

9. Assumptions underlying program planning (Issel, 2009) • A solution / remedy / effective intervention exists or can be developed • Faith in science and capacity of planners & stakeholders • Planning will ensure necessary resources • Everyone involved shares similar views • Planning, implementation and evaluation occur in an orderly fashion

10. Program Planning Models and Steps • Different models • Largely same steps • Emphasis is on different steps based on philosophy: behaviour, ecological, economic, political. • Example: educational-ecological model used in health promotion planning and evaluation – Green & KreuterPrecede-Proceed Model, 2005

11. Program Planning and Evaluation • Cyclical • Interdependent • Planning includes planning for evaluation and evaluating the plan… • Evaluation informs planning for next stage/iteration of a program.

12. Why a program? • Higher level strategic plan needs to be operationalized • New /targeted funds (political) • Trigger event • Environmental scan / Needs assessment • May identify need for program • (Also may identify specific elements of program)

13. Program Planning Environmental scan/ needs or situational assessment: • Wants, needs, assets/strengths (SWOT) • Health and service statistics • Issues that may affect program implementation • What else is going on • What has worked here and elsewhere • Data sources: many

14. Program Planning Steps • Pre-Planning • Stakeholder engagement • They are needed for the planning process: assure meaningful program, full participation, support. • Agree on the vision (may need to wait until further needs assessment done) • Agree on process for making decisions - Governance • Project management: resources (HR, $, time); timeline for program planning, implementation, evaluation

15. Pre-Planning • Understanding the issues. Avoid identifying solution(s) before understanding issue. • Assemble relevant evidence • Assemble relevant theories and models • how things work, how people behave • guides construction of program elements • research evidence shows strength of theory

16. Understanding the issue(s): generic Causal Theory Model Impact Outcome Main causal factors / determinants Required antecedent factors Mediating mechanisms Moderating factors +/- Intervention(s)

17. Older adults and flu shots – causal theory Reduced risk Determinants – fear of flu, perceived vulnerability Outcome – flu shot Antecedents - age, existing health conditions, environment Mediators – vaccine availability, access, cost Moderators- media attention, physician

18. Theories and Frameworks that inform Planned Program • See Tip Sheet from THCU • Stages of Change (Transtheroetical model) • Reasoned Action • Social Learning Theory • Health Belief Model

19. Theories and Frameworks: Health Belief Model

20. Glanz, K., Marcus Lewis, F. & Rimer, B.K. (1997). Theory at a Glance: A Guide for Health Promotion Practice. National Institute of Health.

21. Ethical Framework (Issel, 2009)

22. Program Planning • Setting priorities • Brainstorming • Nominal Group Techniques (and DELPHI)- iterative • Stakeholders solicited for priority issues • Collected, ranked by frequency • Grid of Importance vs Changeability

23. Program planning – priority-setting cont’d • PEARL : which solutions …….. • Propriety: are our responsibility? • Economic: can we afford? • Acceptability: will they be OK with (culture, specific group)? • Resources: do we have enough staff, time, etc? • Legality: does the law permit?

24. Program Planning • More assessment • Wants, needs, assets/strengths (SWOT) • Health and service statistics • Issues that may affect program implementation • What else is going on • What has worked here and elsewhere • Data sources: many

25. Program Planning • Set program foundations • Based on assessment, and in alignment with directions of organization, decide on • Mission : inspire to act • What are you going to do and how • Brief, focus on outcome, broad • Example: To prevent injury in older British Columbians by developing effective community-based programs • Goal : global statement of what want to achieve • Target i.e. specificpopulation of interest • Example: Ensure the safe and effective use of pharmaceuticals by British Columbians over the age of 75 years.

26. Objectives • Objectives – multiple for each goal • Specific (What?) Reduce reportable adverse drug reactions… • Measurable (How much?) …by 50% • Attainable /realistic (capability- with such a program) …by 20% • Relevant (make sense)….. in vacationing ….. in British Columbians over the age of 75 years living in residential care….. • Time-bound (By when?)….. by 2018

27. Program Planning • Identify strategies, activities, resources • Use theories, frameworks to guide strategies • Identify resource requirements • Start/stop/continue elements of existing programs • Prepare Work Plan • Steps, timeline, who is responsible • Links among steps : Critical path, Gantt Chart

28. Strategies (Bower, 2009) • Approach to getting things done • Good strategies: • Consistent with mission, goals, objectives, ethical framework • Point to the overall path and specific ways of doing things • Fit resources, opportunities, public opinion, assets • Minimize resistance, gain allies & support

29. Program Planning • Identify stages where evaluation warranted • Planning • Implementation • Specific milestones • Routine monitoring for ongoing programs • End of intervention • Post intervention • Meta-evaluation

30. Program evaluation • Not done consistently in programs • Often not well-integrated into the day-to-day management of most programs • A tool for using science as a basis for : • decision-making and action, • making efforts outcome-oriented, • being accountable • Programs must routinely conduct practical evaluations that inform their management and improve their effectiveness.

31. Program Planning • Review the plan using Logic Model • Shows the relationships among all parts of a program • Effective overview for program review • Does everything fit together and make sense? • Useful communications tool • Explains program to stakeholders, others

32. Planning • Where does research enter the picture? • See red • Example of an evidence-based health promotion planning model Green, LW & MM Kreuter (2005) Health program planning: An educational and ecological approach.

34. PRECEDE-PROCEED MODEL -phases • Determining the quality of life or social problems and needs of a given population. • Identifying the health determinants of these problems and needs. • Analyzing the behavioral and environmental determinants of the health problems. • Identify factors that predispose to, reinforce, and enable the behaviors and lifestyles. • Which health promotion, health education and/or policy-related interventions would best be suited to encouraging the desired changes in • behaviors • environments • factors that support those behaviors and environments.

35. PRECEDE-PROCEED MODEL –phases cont’d • Interventions identified in phase five are implemented. • Process evaluation of those interventions. • Impact evaluation of the interventions • on the factors supporting behavior, and on behavior itself. • Outcome evaluation - determining the ultimate effects of the interventions on the health and quality of life of the population.

36. Phase 5 Administrative & policy assessment Phase 4 Educational & ecological assessment Phase 2 Epidemiological assessment Phase 1 Social assessment Phase 3 Behavioral & environmental assessment Predisposing Public Health Health education Behavior Reinforcing Quality of life Health Policy regulation organization Environment Enabling Surveillance, Planning and Evaluating for Policy and Action: PRECEDE-PROCEED MODEL* Phase 6 Implementation Phase 7 Process evaluation Phase 8 Impact evaluation Phase 9 Outcome evaluation Input Process Short-term social impact Output Short-term impact Longer-term health outcome Long-term social impact *Green & Kreuter, Health Promotion Planning, 4thed, 2005.

37. PRECEDE and PROCEED function in a continuous cycle. • Information gathered in PRECEDE guides the development of program goals and objectives in the implementation phase of PROCEED. • This same information also provides the criteria against which the success of the program is measured in the evaluation phase of PROCEED. • Data gathered in the implementation and evaluation phases of PROCEED clarify the relationships examined in PRECEDE between the health or quality-of-life outcomes, the behaviors and environments that influence them, and the factors that lead to the desired behavioral and environmental changes. • These data also suggest how programs may be modified to more closely reach their goals and targets.