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 vs collective 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 an arrangement.
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 Operational Planning (tactical)
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 & Kreuter Precede-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
Required antecedent factors
Main causal factors / determinants
Moderating factors +/-
Mediating mechanisms
Outcome
Impact
Intervention(s)

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

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. Perceived Susceptibility
Concept
Definition
Application
Perceived Susceptibility
One's opinion of chances of getting a condition
Define population(s) at risk, risk levels; personalize risk based on a person's features or behavior; heighten perceived susceptibility if too low.
Perceived Severity
One's opinion of how serious a condition and its consequences are
Specify consequences of the risk and the condition
Perceived Benefits
One's belief in the efficacy of the advised action to reduce risk or seriousness of impact
Define action to take; how, where, when; clarify the positive effects to be expected.
Perceived Barriers
One's opinion of the tangible and psychological costs of the advised action
Identify and reduce barriers through reassurance, incentives, assistance.
Cues to Action
Strategies to activate "readiness"
Provide how-to information, promote awareness, reminders.
Self-Efficacy
Confidence in one's ability to take action
Provide training, guidance in performing action.
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)
Approach
Principle
Application
Autonomy
Personal right to self-determination
Individual choice takes priority, no coercion
Criticality
Worst-off benefit most
Greatest problem
Egalitarian
Minimize disparities
Target most marginalized
Resource Sensitive
Resource scarcity
Cost-effectiveness as the standard
Utilitarian
Greatest good for the greatest number
Collective benefits outweigh individual choices

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
Highly Important
Low Importance
Highly changeable
High priority
Low priority unless resources available
Low changeability
High priority if innovative program can be created
No program warranted

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