Steps to Delivering Programs

Planning

Implementation

Evaluation

Assessment

Early Planning Process

Feasibility study - Research activities designed to help an organization determine whether a program should or should not be developedNeeds Assessment - Research activities designed to help an organization determine how a program should be developed

Early Planning Process

Community Needs Assessment – evaluating the community as a

whole in terms of its health and nutrition status its needs & the resources available to address

those needs

Importance of early planning…

Removes guessworkProvides baseline infoHelps determine how best to use resources, deliver a program, etc.Helps match services with needsEncourages community participationRaises awareness, understanding and acceptance

Steps in community needs assessment

Step 1 Define the nutritional problem

Step 2 Set the parameters of the assessment

Step 3 Collect data

Step 4 Analyze and interpret data

Step 5 Share findings

Step 6 Set priorities

Step 7 Choose a plan of action

Step 1: Define the nutritional problem

Develop a concise statement of the problem of concern

External catalyst often begins processStimulus may point to perceived or “felt” need of community organizational mandate research findings

Step 2: Set parameters of assessment

Define the “community”Define purpose Set goals/objectives Define target groupDefine types of data needed

Step 3: Collect Data – Type

Community organizational power & structure data understand community power

structures community leaders

Step 3: Collect Data – Type

Community characteristics demographics economic structures sociocultural factors ecological data

Step 3: Collect Data - Type

Community Health health statistics from existing

sources Rates of disease, disability, and

death ID who is at risk for being

malnourished Describes population’s health &

nutritional problems

Step 3: Collect Data - Type

Existing community services & programs helps pinpoint gaps in service builds inventory of nutrition

services and programs

Step 3: Collect Data - Type

Rarely need all data Depends on purpose of needs assessmentProvides precise information to clearly define nut’l problem

Step 3: Collect Data - Sources

LibraryComputerized searchGovernment documentsDiscussions with key informants

Step 3: Collect Data - Sources

National Population Health Survey

Canadian Community Health Survey

Nova Scotia Community Counts

Nova Scotia Health Survey

http://www.hc-sc.gc.ca/fn-an/surveill/nutrition/population/national_health_survey-enquete_nationale_sante_e.html

http://www.statcan.ca/english/concepts/health/cchsinfo.htm

http://www.gov.ns.ca/finance/communitycounts/default.asp

http://www.gov.ns.ca/health/1995-survey/default.htm

Step 3: Collect Data - Sources

National Longitudinal Survey for Children and Youth

Canadian Institute for Health Information

Children’s Lifestyle and School Performance Study

GPI Atlantic

Step 3: Collect Data - Methods

Nutritional surveys/questionnaires existing survey data often cost

effective may not adequately represent

target population

Survey Design

Design & conduct own surveyMore than a clipboard & list of questions

Survey Design

Survey design analysis a discipline in itselfUsually requires a team of experts with many backgrounds

Survey Design

Series of scientific & practical decisionsNeeds clearly defined purposeEach question must yield data to answer specific planning questions

Instrument Development

Establish the Framework

Develop a Skeleton

Determine Validity

Make Revisions

Determine Reliability

Make Revisions

Complete Instrument

Survey Design

Specify target population Choose best method to reach the target, i.e., how to conduct survey?

Who will design, conduct & analyze survey

Survey Design

Is survey reliable and valid?Are norms available?Are survey questions easy to read and understandable?Is the format of the questionnaire clear?Are responses clear?

Survey Design

Is the survey comprehensive but brief? Respondent burden minimized?

Does the survey ask “value laden” questions?Are the questions culturally appropriate?

Health Risk Appraisals

Survey tool used to characterize general health status of groupWidely used as screening tool

Health Risk Appraisals

Asks questions about lifestyle factors that influence disease riskOften gives user a score which categorizes their health risk

Health Risk Appraisal

Heart Age Tool www.becel.ca Yields Heart Age score

Evidence-based Using knowledge on CVD risk factors

from Framingham Heart Study over 60 years of study – 1948 to 2008

Algorithm designed 2008 to incorporate weighting of various risk factors

Direct Assessment of Nutrition Status

Dietary Assessment Individuals

recalls, food records, diet histories, food frequency questionnaire

Householdhousehold inventories, food records

Nation food balance sheets, market

databases

Direct Assessment of Nutrition Status

Laboratory Methods biochemical tests functional biochemical tests

invasive and expensive

Direct Assessment of Nutrition Status

Anthropometric Methods body composition physical dimensions require trained data collectors

Clinical Methods physical signs symptoms

Screening

Detect disease or developmental delays early Clinical practice history height/weight/head circumference vision/hearing/development

Community settings health risk appraisal, blood pressure,

serum cholesterol levels

Focus Groups

Information on values and concerns of community members5-12 people in sessions 1 to 3 hours

Group talks about their concerns, beliefs, experiences and problems in a specific areaFacilitator guides the discussion

Nutrition Status Indicator

Quantitative measure guides screening, diagnosis and program

evaluation

Units of info that reflect nutritional status of populationEstimates nutritional healthNo single “best” indicator, so several may be used Health status, health outcomes,

determinants of health, health system

Nutrition Status Indicator

Examples include: weight loss of 10 pounds or more

over short time below or above healthy weight access to safe, adequate food supply weight for height serum cholesterol levels breastfeeding initiation rates and

duration times

Reference Data

“Standard” against which collected data will be compared Growth charts from NCHS BMI and WHR standards for

healthy adults RNI/DRI, CFGHE, or international

standards from FAO/WHO

Step 5: Analyze & Interpret Data

Consult a statistician or qualitative data analyst descriptive statistics reliability and validity of

information thematic analysis of qualitative

data

Step 5: Sharing Findings

Describe process usedSummarize Presenting quantitative and

qualitative data

Portray current and desired situations Show trends – what do the themes

and statistics say? Look at “don’t know” answers

Highlight gaps

Step 6: Set Priorities

Who is to get what at whose expenseGive priority to community preferences and concernsHigher priority to common problems than to rare onesHigher priority to more serious problems

Step 6: Set Priorities

Higher priority to nutrition issues with easier solutionsHigher priority to nutrition issues with increasing frequency of occurrence

Step 6: Set Priorities

How important is the problem?Are there solutions or programs and services that could address the problem?How many people are potentially at risk by the problem?

Step 6: Set Priorities

How many are affected by the problem now?What is potential impact of doing nothing? Potential years of life lost, loss of

earning/productivity, etc. economic burden to health

system and community

Step 7: Choose Plan of Action

Share key findingsUse findings to change public policyAlter an existing programOrganize a workshop to obtain more input?Develop new programPostpone action at this point

Step 7: Choose Plan of Action

What financial and human resource adjustments are needed? Consider costs of each proposed

action plan build into budget plan

Step 7: Choose Plan of Action

What are the timelines?Do actions fit within short-term and long-term business plans?Can you achieve reasonable results in the timelines set?

Step 7: Choose Plan of Action

What changes or additions do you need to make to the performance measure established in your business plan?

Needs/Assets

Traditional Needs Assessment: “what is wrong within the community that needs to be fixed”

Asset Mapping: focuses on strengths & opportunities already present within the community

Kretzmann and McKnight. (1993)

Community AssetsLocated inside the community, largely under community control Assets located within the community but largely controlled by outsiders.Resources originating outside the community, controlled by outsiders.

Kretzmann and McKnight. (1993)

Asset Mapping

Goals To ID assets &

capacities To design an asset

map to graphically show connections

To develop a community resource

Connect community citizens and nurture relationships

Asset Mapping

Important Elements

Emphasizes the positive

Belief that everyone has a talent or gift to share with others

Community dialogue

Outcomes include: Planning, Action, Connections & Resources

Yarmouth Stroke Project: Asset MappingPurpose:

• Discover the assets of organizations in relation to persons with stroke and their caregivers;

• Discover the assets of individuals associated with organizations in the community who have a particular expertise or special interest in stroke;

• Identify the location and accessibility of the community’s assets in relation to stroke victims and their families/caregivers.

Yarmouth Stroke Project: Asset Mapping

Methods:Designed questionnaireIdentified key contacts and built contact listConducted face-to-face interviewsCreated a database of resources/servicesAnalysis to identify strengths, opportunities and gaps

Mapping Food Security Assets in Antigonish

Honours Thesis by Rita MacAuley (2002)Assessed contributions of programs and services Categorized by six components of

food security Developed linkages mapping of

assets present

Health Impact Assessment

“any combination of procedures or methods by which a proposed policy or program can be judged as to the effects it may have on the health of the population” (Frankish et al., 1996)

Health Impact Assessment

“…enables government departments to work across jurisdictional boundaries to consider the broad spectrum of factors that determine health, thus assisting policy makers as they make decisions about the impact of their programs and policies on the health of the population they serve.” (Gillis, 1999)

Community Health Impact Assessment

“Used as a strategy by the PATH project to increase public understanding of the broad determinants of health and, through this educational process, to empower citizens to have an active voice in decisions influencing their health.” (Gillis, 1999) PATHways to Building Healthy Communities

in Eastern Nova Scotia