Acknowledgements. Program Planning Steps. Overview. Program Planning Steps. Program Planning Steps 3/28/2011

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1 Assessing Readiness to Advance Public Health Policies January 24, 2011 Cam Escoffery, PhD, MPH, CHES Rollins School of Public Health Emory Cancer Prevention and Control Research Network (CPCRN) Shawna L. Mercer, MSc, PhD, Director The Guide to Community Preventive Services Centers for Disease Control and Prevention (CDC) Acknowledgements Material for this presentation about providing technical assistance on using evidence was provided by: The Cancer Prevention and Control Research Network of the Prevention Research Center Program, CDC Cancer Prevention and Control Research Network Prevention Research Center Program, CDC 2 Overview Assessing the fit of organizational characteristics to match potential program, practice or policy (P 3 ) characteristics Readiness to implement Adaptation of the selected program or policy Program Planning Steps Planning & Assessment What s the problem? Setting Objectives What do we want to achieve? Selecting Interventions What works? Implementing How do we do it? 3 Evaluating Did it work? How well? 4 Program Planning Steps Program Planning Steps Planning & Assessment What s the problem? Planning & Assessment What s the problem? Setting Objectives What do we want to achieve? Setting Objectives What do we want to achieve? Selecting Interventions What works? Selecting Interventions What works? Implementing How do we do it? Implementing How do we do it? Evaluating Did it work? How well? 5 Evaluating Did it work? How well? 6 1

2 Before You Hit the Ground Running Consider the goals, objectives and target audience for your proposed program, practice or policy (P 3 ) Consider the characteristics of the organization or setting Consider the policy context Selecting an Evidence-based Option 1. Acquire information about potential options 2. Review the materials and tasks/steps from each for fit to your objectives and community 3. Decide on which option to adopt or adapt Then, select the best one to match those goals, objectives, and audience 7 8 Why it is important to understand evidence-based options Reading about potential options helps to: Consider which matches your goals and audience Gauge fit to the community and organization or the need for adaptation Review the program s, practice s, or policy s methods, facilitators guide, or implementation protocol to understand the steps for delivery Learn the costs of implementation 9 Definition of Fit Overall compatibility between a program, practice or policy and: The audience and community served External context and/or The organization that will implement it Ideal Match 10 Program Fit Considerations Program Health behaviors/topics Goals Type of strategies (e.g., individual to policy) Time span Setting Audience Age Education Gender Race/ethnicity Socioeconomic status Organization Fit with mission Leadership support Availability of a project coordinator/champion Resources Finances/cost Staff & expertise Facilities Partnerships Community Priorities and values Readiness for prevention program (climate) Fit with other programs/policies Leadership and support 11 Criteria for Selecting an Evidence- Based Program/Practice/Policy Choose an option that is well-matched with: The health topic The audience Setting or organizational capacity Do you have what is needed to implement it? Delivery methods that fit your organizational objectives & structure Using computer technology Calling participants for follow up Promoting access Making policy changes 12 2

3 Policy Considerations Level of policy (e.g., organizational, community, legislative) Extent to which policy goals align with your organization, community, or region Policy window (e.g., politics, other problems, solutions) Policy timing (e.g., teachable moment, national or regional interest in the topic) 13 Considerations for Policy Options Which option will best address the specific problem? Which option will have support of the community to pursue? Which option will attract stakeholders to participate? Which option fits best with the other programs, services, and supports? Available to those who will be affected by the policy? (equity) Which option needs to be in place before others? 14 Matching P 3 to the Organization and Community Policy Approaches Priorities and values Readiness for prevention Interface with other delivery methods and strategies in use New or existing partnerships Awareness of prevention/policy efforts Knowledge about the issue (e.g., local information and data) Community leadership/support for the issue (e.g., decision makers, influencers, coalitions) Community climate (e.g., nonawareness, concern, mobilized) Availability of technical assistance &/or training Resources to support efforts External forces in the environment (e.g., opposition, threats) Research-tested Intervention Programs (RTIPs) It is a database of actual programs and products that you can adapt for your own use Link to RTIPs 17 It provides: program summaries include a list of journal articles about the program actual program materials (e.g., brochures, implementation manual, fliers, handouts) or ways to access them It is linked to the Community Guide to Preventive Services recommendations 18 3

4 3/28/2011 RTIPs Program Summary The Need The Program Community Guide Finding Time Required Intended Audience Suitable Settings Required Resources About the Study Program Scores Dissemination Capability Research Integrity Intervention Impact Publications Readiness for Implementation Define phases of implementation Pre-implementation Implementation Evaluation Maintenance Discuss important factors or tasks in each phase Pre-Implementation Pre-Implementation Training Hiring staff or recruiting volunteers or champions Program staff orientation/training Knowledge about health issue and solution Intervention overview (e.g., components, outcomes) Materials/resources Logistics Logistics for each component Necessary knowledge about topic Logic model (big picture of program, practice, or policy) Intervention (e.g., logic, model, core elements) Necessary skills for P3 (e.g., advocacy, team building, nuts and bolts writing briefs, counseling/education, computer, etc.) Technical assistance Developers or researchers 23 Materials/components Updating or adapting materials/components Lessons learned 24 4

5 Pre-Implementation for P 3 Enlist community/stakeholder input Best outreach/recruitment strategies Estimate number in target population Incorporate previous needs assessment data Conduct formative research on any adapted materials/language Feedback from expert panel Focus groups/discussion with target populations Pilot testing Pre-Implementation for Policies Build and work with a collaborative group for setting agenda Get supporting data for rationale (e.g., policy institute, govt or special panel report, issue briefs) Identify decision makers, champions/change agents or influencers Brainstorm or strategize advocacy efforts (e.g., memo/briefs, media kits, media channels, events, interpersonal meetings) Draft policy or legislation 25 Receive feedback from organizations and interest groups about formation and implementation 26 Pre-Implementation Plan for program evaluation Determine evaluation focus and questions (e.g., process, outcome) with stakeholders Create or modify data collection tools (e.g., surveillance systems to monitor health impacts) Discuss dissemination plans 27 Implementation Conduct program, policy, or practice Track implementation of core elements of P 3 Program or practice (e.g., which components used, steps taken) Policy Documentation of policy Procedures for policy Communication Enforcement Collect process measures Program or practice (e.g., attendance, timeliness of activities, satisfaction with activities) Policy Track participants Revisions of policies Advocacy efforts (e.g., media outlets, events) Adoption and enforcement Monitor and evaluate activities 28 Evaluation of Policies Collect evaluation or surveillance data that demonstrate health impacts Track Reactions to policy Changes in policies over time Enactment and enforcement Track impact of policy over time (e.g., reduction of smoking) Examples of Maintenance Activities If P 3 is successful, consider: Referrals for further service, if needed Seeking additional funding Making it a part of the organization s standards Maintaining/securing program champion(s) Publicize or share successes Document policy process 29 Surveillance of the impact of the program/policy (e.g., tracking of smoking rates, BMI of children) 30 5

6 Learning about the Use of Evidence-based Programs, Practices, or Policies The field of translation is still young Will an evidence-based option work in every setting?? Document what works or does not work in terms of implementation and outcome measures. Activity logs (e.g., core elements, satisfaction) Staff meeting/policy formulation documents (e.g., staff burden, threats, and satisfaction) Changes in behaviors, environment or policies making Adaptation is Changes Additions Deletions Substitutions to the selected evidence-based P 3 in order to make it more suitable for a particular population and/or an organization s capacity. Develop case study of effective P Program Fidelity Fidelity: faithfulness to the elements of the program, in the way it was intended to be delivered Components of fidelity*: Adherence to program protocol/implementation guide Dose or amount of program delivered Quality of program delivery, and Participant reaction and acceptance * Rabin, Brownson, Haire-Joshu, Kreuter, Weaver. A glossary for dissemination and implementation research in health. Journal of Public Health Management Practice, 2008, 14(2), Fidelity vs Fit, Some evidence Review of over 500 studies showed a relationship between the level of implementation (fidelity) and program outcomes However, fidelity was below 100%; some adaptation always occurs and there is some evidence that it improves outcomes Durlak, J. A. & DuPre, E. P. (2008). Implementation matters: A review of research on the influence of implementation on program outcomes and the factors affecting implementation. Am J Comm Psych, 41, Core Elements & Key Process Steps Core elements*: Required components that represent the theory and internal logic of the intervention and most likely produce the intervention s effectiveness Key process steps: Required steps that are conducted to contribute to the intervention s effectiveness Critical steps taken in program implementation in the program s methods section or implementation protocol *Eke, Neumann, Wilkes, Jones. Preparing effective behavioral interventions to be used by prevention providers: the role of researchers during HIV Prevention Research Trials. AIDS Education & Prevention 2006, 18(4 Suppl A): Green, Yellow & Red Light Adaptations Provides guidance on whether a particular adaptation is safe (green) should be made cautiously (yellow) should be avoided (red) 36 6

7 Things That Can Probably Be Modified in an Program Names of health care centers or systems Pictures of people and places and quotes Hard-to-read words that affect reading level Wording to be appropriate to audience Ways to recruit your audience Incentives for participation Timeline (based on adaptation guides) Cultural preferences based on population 37 Things That Can Probably Be Modified in a Policy Names of entities Setting of the policy Rationale or background data or statistics on how the issues affects the setting Variations of policy development steps (e.g., composition of coalitions, use of media) Updating standards (e.g., physical activity, policy solutions) that are part of the policy 38 Things That Can Probably Be Modified: Proceed with Caution Substituting activities or policy solutions that fit your context Adding activities or solutions to address other risk factors or behaviors/health issue Changing the order of the curriculum or steps (sequence) Things That Cannot Be Modified The health communication model or theory The health/policy topic/behavior Deleting core elements or whole sections of the program/policy (e.g., structure of brief or legislation) Reduction of program Timeline Dosage (e.g., activities, time/ session) Putting in strategies that detract from the core elements 41 Key Message: If you choose an evidence-based program to adopt, do not change the core elements (what are they) or key process steps. 42 7

8 Example with Policy/Process Steps Cancer Prevention and Control Research Network (CPCRN) Training Topics What do we mean by evidence-based? Needs assessment & program planning Finding an evidence-based strategy or program Adapting the evidenced-based program to meet your needs Evaluating your program Important Concepts Define evidence-based (EB) Continuum of evidence Benefits of using EB strategies/programs Community and target audience analysis Determinants of behavior Sources of EB strategies & programs Selecting a strategy or program ( fit ) Define: adaptation, core elements, fidelity Discuss what can & cannot be changed Process evaluation (e.g., implementation, fidelity, program adaptations) Outcome evaluation 45 For more information on how to select an evidence-based program or policy that meets the needs and constraints of your community: Cam Escoffery, PhD cescoff@emory.edu Emory CPCRN, Co-PI Kurt Ribisl, PhD Principal Investigator CPRCN Coordinating Center at UNC Chapel Hill kribisl@ .unc.edu