Public health program planning and problem evaluation – Part 4

Lauren Jonkman, PharmD, MPH, BCPSProfession of Pharmacy 5

Timeline for project

TAUGHT DRAFT DUE

1. Problem definition 9/2 Due 9/9 (in class) GROUP2. Problem analysis including map 9/9 Due 9/23 (in class) GROUP3. Literature review of evidence-based interventions

10/7

Due 10/26 (Mrs Gilchrist’s office) GROUP

4. Impact analysis

5. Gap analysis

6. Proposed program description

10/14Due 10/28 (in class) IND

7. Logic model

8. Budget

Group presentation on 11/10Final paper with all 8 sections is due in class on 11/18

Developing your intervention

“Filling the gap”

Two ways to develop your plan Start with evidence based intervention as a framework and

move forward Start with your ultimate goals for the intervention and move

backward

Use a logic model to plan the activity

Logic model

Logic model - outcomes

Short term – outcomes that you can measure immediately after intervention* awareness, knowledge, skills, attitudes, motivation

Medium term – outcomes you could evaluate months to a few years after the intervention

Long term – outcomes you would evaluate years later (often “pie in the sky”)

Outcomes should be a series of “if – then” statements and should relate back to your problem analysis

Logic model – outcomes - example

Reduce proportion of women and health care providers who believe that WIC is a welfare program and not a nutrition program

OutcomesShort-term Medium-term Long-term

Improve nutritional status of women enrolled in WIC

Increase uptake of nutritional recommendations by women who are pregnant

Increase time that WIC dieticians can spend with pregnant women to educate on nutrition (and not just on the details of the program)

Reduce barriers to WIC enrollment for women who are early in their pregnancy

Improve early enrollment of pregnant women into WIC

Reduce infant mortality rate in Allegheny County by:1. Reducing the proportion of infants born with short gestation2. Reducing the proportion of infants born with low weight

Increase use of motivational interviewing by dieticians

Logic model - activities

This is the core of your program/intervention

This is a list of the specific activities that will need to be done to accomplish the specific outcomes.

Also includes a list of who your participants are (who specifically you will be targeting) students, teachers, patients, health care providers, etc

Logic model – activities - example1. Co-locate WIC services within physician

practices that already provide prenatal care (part-time coverage by WIC dieticians based on times that meet the majority of patients’ needs – expect ½ - 1 day/week at most offices)

2. WIC outreach coordinator will educate staff on role of WIC dietician in the office and the value of WIC enrollment on reduction of infant mortality

3. WIC outreach coordinator will create referral system to send WIC eligible patients on their first or second prenatal visit to the WIC dietician for enrollment and nutritional counseling. WIC dieticians will ensure that appropriate referrals occur

4. Change policy to increase visit time for WIC dieticians to interact with pregnant women – from 15 minute visits to 30-45 minute visits

5. Train WIC dieticians in principles of motivational interviewing. Allow dieticians to practice skills using simulated patients and role-play. Video tape several actual encounters to evaluate and provide feedback to improve skills in MI.

Logic model - inputsThis is a list of what

“things” you need to accomplish your activitiestime, money,

manpower, space, specific equipment, etc

WIC program framework

Support of WIC upper mgmt

WIC outreach coordinator

WIC dieticians

Physician practices that provide prenatal care

Office space within MD practices with internet access to access WIC software

MI Trainers

Supplies (computers, educational materials, etc)

Funding

Logic model

Logic model

Situation = problem definition/problem statement – really short

Assumptions = any assumptions you made in planning your program

External factors = things that may happen that may impact your project that are out of your control

Evaluation = how you plan to evaluate your program Process evaluation – did you accomplish all your activities, to what

extent Outcomes evaluation – how will you measure each of your outcomes

(short, medium, and long-term)

Logic model - example

Situation = Infant mortality rate in Allegheny County is significantly higher than national average, enrollment in WIC for women early in pregnancy is lower than ideal

Assumptions1. There is available office space in most of these practices for the WIC dieticians to

use part-time

2. Nutritional counseling of pregnant women is not a revenue stream for these offices currently (and that someone is not paid specifically to do this and only this)

3. Funding for WIC programming will continue at current levels

4. It is unrealistic to expect women to go to current WIC offices early in pregnancy to obtain WIC vouchers and nutritional counseling

5. Offices will be supportive of co-locating WIC services for their eligible patients

6. Most eligible women receive prenatal care from a relatively small number of large to mid-size practices (<10)

7. Barriers to early enrollment: time, location, program image, lack of perceived benefit

Logic model - example

External factors Reimbursement for WIC services Most eligible patients seek prenatal care before their third trimester Ability to find offices that serve high risk population

Evaluation = how you plan to evaluate your program # referrals made change in early enrollment of pregnant women time spent with each woman % of dieticians using MI during encounter change in nutritional practices of women change in infants born with LBW or prematurity change in infant mortality rate over 2 years

Budget

Includes costs for: Personnel Consultants Supplies Travel (if needed) Space rental (if needed)

Important to include a justification for each of your expenses

Budget - example

Personnel Project coordinator – full time, $55,000 Registered dietician x 2 – full time, $43,000 each

Consultants Motivational interviewing consultant – $9,000

Supplies MacbookPro x 3, $7500 Microsoft Office x 3, $600 Printers Cell phone etc, etc

Final Paper

Problem definition (3 points) – update with my feedback What is the problem How is it affecting people in our County Who is specifically at risk Where is this problem most prevalent What trends did you identify Why do you believe this problem is important to address

Problem analysis + map (2 points) – update with feedback Provide visual “map” of direct and indirect contributing factors

and determinants (1 point) Describe what you found (explain terms, areas for intervention,

etc) (1 point)

Final Paper

Literature review of evidence-based interventions (5 points) Identify the top 2 interventions to best impact each of the 3 primary

determinants you included on your problem analysis map. Describe the intervention (who, where, what, effect) Evaluate the external validity of the intervention (feasibility, population

differences, etc)

Impact analysis (1 point) Rank each intervention that you analyzed in terms of impact Evaluate the effectiveness & reach for each intervention in a local setting

Gap analysis (1 point) Describe what you found that is already in place in the County for this

problem Based on the interventions with the most impact, describe what gaps exist

in the County

Final Paper

Program description + logic model (5 points) Using template provided, create logic model for proposed

intervention Current situation and setting you are applying your

intervention Inputs – what will you need to make this intervention work Outputs – what activities will be completed to apply your

intervention Outcomes – a minimum of 3 short-term outcomes, 2 medium-

term outcomes, and 1 long-term outcome will be expected Assumptions – what assumptions have you made about your

population and/or your site to apply this intervention External factors – what external factors might impact your

ability to carry out this project

Final Paper

Program description + logic model (5 points), continued Describe intervention you designed:

Background information on site you’re implementing program with (how it fits their mission, etc)

What specific activities you will be implementing (do they happen at once, are they staged, etc) & what inputs you need to accomplish these activities

Process measures for each of your activities (how you’ll know whether they were accomplished or not)

Outcomes (short, medium, and long term) with measures and method for evaluating them

Any additional comments or thoughts that might impact the intervention

Final Paper

Budget (2 points) Layout a budget for your proposed project (should be reasonable

based on scope and impact). Personnel – who, hours, wages/salary Consultants (outside people who you bring in for a specific part

of project) – who, hours, fee Supplies – technology, equipment, and other supplies (includes

both one time costs such as computers as well as recurring costs such as cell phone service, etc)

Travel – traveling for work (if needed), or traveling to conferences to share results of intervention

Other – might include space rental or other costs not listed above Provide justification for each of your budgeted items – why is this

needed, how will it be used

Final Paper

References (1 point) Cite references where they are needed (i.e. anything that you

state as truth or fact should be referenced) Cite references using guidelines listed in the American Journal

of Health System Pharmacists style-guide

Grammar/writing style (can lose up to 5 points) Writing should be free from major errors in grammar that take

away from the message (i.e. someone should read it before turning it in)

Writing should be clear, concise, and focused

Final Paper

Points possible: 20 points

Suggested length: 10-12 pages (well referenced) (11 point font or greater, 1.5 spacing minimum, use the headings provided)

Turn in paper copy at the same time you give your presentation on November 18

Hints: Update completed sections with my feedback Use the headings provided for your paper Intervention proposed should match the evidence that you

found – that is the point of this assignment

Presentation

Points possible: 10 points

Maximum length: 12 minutes

All group members do not need to present (but all should be able to answer questions)

For the presentation: Briefly lay out problem, importance, & determinants (3

minutes) Brief review of lit review and impact analysis (3 minutes) Describe program you are implementing + outcomes expected

+ total cost (6 minutes)

Public Health Presentation

Presentation Schedule8-10am 10-noon

Scaife 5 – J. Thorpe

PCLC – Odukoya

Scaife 5 – J. Thorpe

PCLC – Odukoya

8:00- 8:20

1 (accidental overdose)

5 (substance use)

10:00- 10:20

6 (alcohol abuse)

14 (prescription drug abuse)

8:20- 8:40

2 (STDs)

7 (tobacco use)

10:20- 10:40

12 (obesity)

15 (HPV vaccination)

8:40- 9:00

3 (asthma)

8 (mental health)

10:40- 11:00

13 (chlamydia)

17(unintended pregnancies)

9:00- 9:20

4 (literacy)

9 (diabetes)

11:00- 11:20

16 (homelessness)

18 (diabetes)

9:20- 9:40

10(tobacco use)

11 (HIV/AIDS)

11:20- 11:40

19 (tobacco use)

Poverty Simulation schedule: 4028-9am

4029-10am

40210-11am

40211-noon

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