worksheet 1: assessing readiness for strategic...

Public Health Promotion Program Plan for HCV Health Education and Screening among HIV

IDUs in the city of Detroit, Michigan

Written Assignment #7

Tracy Liichow

December 14, 2014

Course #585 Programming and Evaluation in Public Health

Professor Kelly Wheeler, PhD, MPH, CHES

Table of Contents

Introduction......................................................................................................................................1

Needs Assessment........................................................................................................................2

Program Strategic Plan....................................................................................................................3

Mission and Vision Statement.....................................................................................................3

Strengths, Weaknesses, Opportunities and Threats (SWOT Analysis).......................................4

Overarching Objective for the Program.......................................................................................6

Logic Model.....................................................................................................................................6

PRECEDE-PROCEED Model (PPM).........................................................................................6

Program Objectives for Plan Implementation...............................................................................10

Implementation Plan..................................................................................................................11

Marketing Plan...........................................................................................................................14

Program Pro Forma........................................................................................................................17

Program Evaluation.......................................................................................................................18

Program Strategies Summary........................................................................................................20

References......................................................................................................................................21

Tables.............................................................................................................................................24

Introduction

Hepatitis C is a silent killer. According to the Centers for Disease Control and

Prevention (CDC) (2014d), “Hepatitis C virus (HCV) infection is the most common chronic

bloodborne infection in the United States.” Furthermore, in the United States approximately one

quarter of HIV positive individuals are infected with HCV. Human immunodeficiency virus

(HIV) and HCV are both bloodborne pathogens, often “transmitted by sharing drug injecting

equipment and paraphernalia used in the preparation and administration of drugs for injection”

(Mayor et al., 2014, p. 1). Furthermore, African Americans and Hispanics injecting drug users

(IDUs) in the U. S. have disproportionately higher rates of both viral infections (Mayor et al.,

2014).

The Michigan Department of Community Health (MDCH) is dedicated to health

promotion for all Michigan residents. Health promotion can be defined as programs,

interventions, campaigns that promote or are conducive to the overall health and well-being of

individuals, groups, or communities (Green & Kreuter, 2005). Health promotion involves

making an impact upon a population. An effective health promotion program can change lives

for the better. It is very productive and rewarding to see public health embracing health

promotion. The U.S. government’s Healthy People initiative is an example of public health

moving in the right direction. “This focus on good health has given many people in the United

States a desire to do something about their health” (McKenzie, Neiger, & Thackeray, 2013, p. 3).

One of the goals of Healthy People 2020 is to increase immunization rates and reduce

preventable infectious diseases (U. S. Department of Health and Human Services, 2014). CDC’s

Division of Viral Hepatitis (DVH) is leading a national Hepatitis C education campaign which

aims to increase awareness about this hidden epidemic and encouraging people born from 1945-

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1965 to get tested for Hepatitis C (Centers for Disease Control and Prevention, 2014c). This

initiative provides grant funding through Community-based Programs to Test and Cure Hepatitis

C (CDC-RFA-PS14-1413) (Centers for Disease Control and Prevention, 2014e). MDCH will

submit a grant proposal to this CDC program. Therefore, MDCH is sponsoring a health

promotion plan to screen HIV infected injection drug users for HCV in the city of Detroit,

Michigan.

Needs Assessment

In the United States approximately one quarter of HIV positive individuals are infected

with HCV (Centers for Disease Control and Prevention, 2014a). The CDC (2012) recommends

“everyone born during 1945 through 1965, also known as baby boomers, get a blood test for

Hepatitis C.” Despite decreases in acute viral hepatitis, chronic hepatitis infection continues to

affect millions of Americans and in the United States, an estimated 2.7–3.9 million persons are

chronically infected with hepatitis C (Centers for Disease Control and Prevention, 2014b). There

are serious health consequences associated with viral hepatitis, such as chronic liver disease,

including cirrhosis, which was the 12th leading cause of death in the United States in 2011

(Centers for Disease Control and Prevention, 2014f). Viral hepatitis-associated death rates in

2011 were highest among persons infected with HCV (4.82 deaths per 100,000 population)

(Centers for Disease Control and Prevention, 2014f). The U.S. Public Health Service/Infectious

Diseases Society of America guidelines recommend that all HIV-infected persons be screened

for HCV infection (Centers for Disease Control and Prevention, 2014b).

Moreover, there is a lack of health education in Detroit, Michigan regarding hepatitis C.

There are unmet needs among people living with HIV (PLWH) who are injecting drug users

(Broz et al., 2014). Health disparities are an everyday reality in Detroit. The city is a depressed

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community. The Detroit metropolitan area has the highest number of HIV positive people in the

state of Michigan. Therefore, the target or priority population for this program is residents of the

city of Detroit, who are injection drug users and HIV positive baby boomers.

Program Strategic Plan

Mission and Vision Statement

The health promotion program’s mission is to increase the number of HIV positive

injecting drug users (IDUs) who are knowledgeable and screened for HCV and to combine

linkage to care and treatment for those diagnosed positive for HCV infection. MDCH’s

commitment and purpose for this health promotion program is to provide HCV health education

and screening to HIV positive injecting drug users.

The basic social, economic, and political needs are evident. Currently, the social

conditions are not favorable toward health promotion. The social conditions are bleak. The

social conditions and perceptions shared and experienced by those in the priority population are

highlighted by discrimination and stigma. Some of the social indicators are discrimination, lack

of education, welfare, homelessness, crime, substance abuse, and mental health. The social

conditions and perceptions stand as barriers to wellness. It is the role of public health to reduce

the barriers to wellness. MDCH is devoted to promoting healthy outcomes. MDCH along with

the help of the CDC responds to needs of the communities in which we serve. We stand by the

many stakeholders and support them in endeavors to encourage health behavior changes for the

better.

MDCH and this program planner’s vision for this health promotion is to decrease the

number of HIV positive individuals infected with HCV in the next two to five years. The health

promotion plan will benefit the population now and in the near future. As a result of this health

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promotion plan more HIV positive individuals will be tested for HCV infection and in treatment

if needed.

Strengths, Weaknesses, Opportunities and Threats (SWOT Analysis)

There are a number of strengths that will contribute to the planning and implementation

success. The funding provided by the federal government is strength. The authority of the

state’s health department is a major strength. There has been buy-in from senior leadership at

the health department. Additionally, the program planning team is thoroughly engaged and

committed to the health promotion. The stakeholders believe in the project and they are devoted

to the mission. Table 1 describes the stakeholders and their roles. The local health department,

Detroit Department of Health and Wellness Promotion (DHWP), supports the initiative and they

are key stakeholders. They are sharing resources. HIV and HCV communication networks

already exist in the city.

Community partnerships provide a strength to the health promotion program. A

partnership will be established with a Federally Qualified Health Center (FQHC) in the area,

Detroit Community Health Connection (DCHC). DCHC has several locations around the city.

Planning for community participation will focus on stakeholder involvement and ownership.

Monthly meetings will be set up with HIV/AIDS community-based organizations (CBO) in the

Detroit area. The following is a list of the CBOs who will be contacted, AIDS Partnership

Michigan (APM), Community Health Awareness Group (CHAG), and Health Emergency

Lifeline Program (HELP). There will have to be another partnership established. A partnership

with the national organization Hepatitis C Support Project (HCSP), a long-standing nationally

recognized HCV activist group, will greatly enhance the program and provide the necessary

HCV educator certification credentialing.

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Furthermore, there will be a partnership established with the Michigan Primary Care

Association (MPCA) to assist with the linkage to care portion of the program. MPCA's purpose

is to advance comprehensive, accessible, and affordable community-based primary health care

services so that all Michigan residents can benefit (Michigan Primary Care Association, n.d.).

The association has information available on low-income based primary care services and

facilities in Michigan. This information can be used to contact and connect low-income

individuals who are HCV and HIV co-infected to primary medical care services.

There will have to be a partnership or at least a memorandum of understanding (MOU)

enacted with a methadone clinic providing an outreach opportunity. The city of Detroit has

several methadone clinics providing methadone replacement therapy and structured counseling

(Methadone.US, 2014). The methadone clinics are located near the FQHC DCHC sites offering

excellent outreach opportunities. Additionally, focus groups will be developed from partnerships

with the CBOs, FQHC, and methadone clinics to assist with planning efforts. As members of the

community or target population, they will provide data and information used to identify specific

benefits and barriers to HCV screening (Glanz, Rimer, & Viswanath, 2008).

There are also weaknesses that exist and have been identified. MDCH has a bureaucratic

process that has to be followed even though it can be cumbersome. The number of middle

managers assigned to a project has often times been more than necessary and has led to

leadership inefficiencies. Therefore, a clear delineation of roles and responsibilities has to be

established. Furthermore, some of the stakeholders may have different opinions about how the

program should be setup and how it should accomplish its goals. Consequently, the stakeholders

who represent the population may influence the ability to obtain commitments from participants.

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Nevertheless, opportunities are present and available. It is an opportunity to interact and

educate HIV positive IDUs. Moreover, it is an opportunity and rewarding to work with

community based groups. Perhaps the project can assist in building their capacity. Interestingly,

there is an opportunity to strengthen poor communities as a result of the health education given

as part of this program.

One of the threats to the planning of the program is the possibility of funding cuts. The

program is funded primarily by a grant from the CDC as stated above. Another similar threat is

that there may not be enough resources. There is a project budget. However, the actual expenses

may be more than what was allotted in the budget. Potentially another threat could be a health

promotion project that already exists and targets the same population. An extensive and ongoing

needs assessment and monitoring will have to put in place in order to identify possible threats.

Overarching Objective for the Program

The HIV/HCV health education program, named “HIV screening to stop the silent killer

HCV”, will reduce the lack of HCV health education among PLWH who are injecting drug users

born between 1945 and 1965 in the next three years. HIV positive injecting drug users will

become knowledgeable and screened for HCV and for those diagnosed positive for HCV

infection will be linked to medical care and treatment.

Logic Model

PRECEDE-PROCEED Model (PPM)

The plan needs a framework. As McKenzie, Neiger, and Thackeray (2013) indicate

models designed for planning purposes serve as frames or direction from which to construct and

organize the health promotion planning process. The PRECEDE-PROCEED planning model

will be planning tool used for the program planning process. This logic model was chosen

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because of its detail and appropriateness for the topic and priority population. Crosby,

DiClemente, and Salazar (2011) suggest that the PRECEDE-PROCEED Model (PPM) is

effective in changing health behaviors. “PRECEDE stands for Predisposing, Reinforcing,

Enabling Constructs in Educational/ Environmental Diagnosis and Evaluation . . . PROCEED, on

the other hand, stands for Policy, Regulatory, and Organizational Constructs in Educational and

Environmental Development” (Crosby et al., 2011, p. 48). According to McKenzie, Neiger, and

Thackeray (2013, p. 53), the basic foundation of PPM is to “begin by identifying the desired

outcome, to determine what causes it, and finally to design an intervention aimed at reaching the

desired outcome.” PPM assists the planner by making an ecological approach workable.

Gielen, McDonald, Gary, and Bone (2008, p. 409) suggest, “PRECEDE-PROCEED is an

example of a logic model, in that it links the causal assessment and the intervention planning and

evaluation into one overarching planning framework.” The types of measures used to describe

the program are demographic in nature. The health promotion program will be focused on the

social and economic characteristics of the targeted population. A mixed method approach will

be used meaning quantitative and qualitative measures will be utilized. “Quantitative and

qualitative measures both have their individual strengths and weaknesses, yet their greatest

utility may occur when both are used together in the measurement process” (McKenzie et al.,

2012, p. 113). It is predicted that the target population would respond well to qualitative

measures.

The purpose or intend of this health promotion plan is aimed at changing a baby boomer

who is HIV positive and an IDU from an uninformed person who has not been tested for HCV to

an HIV positive IDU who is well informed/educated and screened or tested for HCV.

Subsequently, a health behavior change is at the core of this particular health promotion project.

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Behaviors are complex and this is the basic assumption of the PPM (Crosby et al., 2011). The

model is comprehensive and intriguing. It works backward from problem to solution.

In particular, the phases that deal with social, environmental, ecological, and

administrative and policy assessments compel a planner to engage outside factors. The

stakeholders and decision makers can come to the table and have input after reviewing the

framework established by the PPM. In regards to phase four, administrative and policy

assessment, Crosby, Salazar, and DiClemente (2011, p. 53) assert, “In many ways this is the

most challenging and most critical phase of the entire planning process. . . . to assess the capacity

and resources available to implement programs and change policies.” Changing policies and

building capacities are outside factors and can be quite challenging to the planning process.

While phase one presents the desired health outcome phase two presents the

epidemiological data discovered during the needs assessment. In phase three, the planning team

identifies the predisposing, reinforcing, and enabling factors because behavior is formed by these

factors (Glanz & Rimer, 1997). Factors that motivate a change are predisposing factors and

“they include knowledge, attitudes, cultural beliefs, and readiness to change” (Glanz & Rimer,

1997, p. 41). Peer support can be a reinforcing factor and peer pressure can be an enabling

factors. “Reinforcing factors, which come into play after a behavior has been initiated; they

encourage repetition or persistence of behaviors by providing continuing rewards or incentives”

(Glanz & Rimer, 1997, p. 41). The planning will have to address these issues as the detailed

objectives are developed.

The model provides a visual display of the inputs, outputs, and outcomes. The following

is the graphical presentation of the PPM to be incorporated into the program:

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Phase 4Administrative and policy assessment

Phase 3Educational and ecological assessment

Phase 2Epidemiological assessment

Phase 1Social assessment

Phase 5Implementation

Phase 6Process evaluation

Phase 7Impact evaluation

Phase 8Outcome evaluation

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HEALTHPROMOTIONPROGRAM

Educate priority population

HCV testing

Train HIV case managers to become certified HCV educators

Conduct multimedia HCV awareness campaign

Conduct HCV health educational workshops using small group format

Linkage to care component

Key Stakeholders:Establishing partnerships with community based organizations (CBOs) and using their case managers to assist with identifying focus group participants

Decision Makers:State of Michigan Health Department, Planning team, and Local Detroit Health Department team members

Predisposing factors

Enabling factors

Race/ethnicity

Inputs Outputs Activities Participation

OutcomesShort Medium Long

HIV infected injection drug users who

tested positive for HCV linked to care

Environment

Behavior

Age

AssumptionsPartnerships will work well and resources will be sufficientParticipation will be consistent.

External FactorsPolitical environment and ecological environment changes

Changing medical and general healthcare environment

HIV infected injection drug users tested for

HCV

HIV infected injection drug users educated

about HCV

HIV infected injection drug users screened

for HCV and HCV positives linked to care in the city of Detroit, Michigan

Reinforcing factors

Program Objectives for Plan Implementation

Health education strategies provide opportunities for targeted populations to gain

knowledge about a health topic (McKenzie et al., 2013). Health communication strategies are

included in nearly all of the health promotion interventions planned and designed (McKenzie et

al., 2012). The program, HIV screening to stop the silent killer HCV, will use both strategies.

Utilizing both strategies will deliver a comprehensive program intervention to the targeted

population, PLWH who are injecting drug users born between 1945 and 1965 and who are

residents of the city of Detroit. Glanz, Rimer, and Viswanath (2008, pp. 3–4) indicate that public

health professionals have seen changes in their roles just being simply one intervention or one

behavior change strategy “now realize that multiple interventions at multiple levels are often

needed to initiate and sustain behavior change.” The targeted population would benefit from

multiple interventions at multiple levels. Yet, the program described above is a good beginning

and it will have an intervention that is multifaceted.

All the activities or means to deliver a health promotion that occur between two

measurement points is described as an intervention (McKenzie et al., 2012). Therefore, the

planning team with the information gathered from the focus groups will develop an intervention

that contains structured activities utilizing health communications and health education

strategies. Consequently, community participation is essential to the project. Community

involvement will be highly stressed and valued. Members of the priority population will be

placed on the planning committee along with HIV case managers. Additionally, the health

communication strategy is the multimedia hepatitis C awareness campaign that will be developed

by the planning team. A citywide kick-off event coordinated with the CBOs and FQHC will be

held to announce the multimedia campaign. The health educational strategy will be in the form

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of two workshops using a small group format. Possibly using peer reviewed videos as well as

peer testimonials. HIV case managers will be contacted to assist in all of the presented

educational formats. In addition, a program coordinator will have to be hired and be the lead

person responsible for the program’s implementation.

There will be support provided by the HIV case managers and the peer support groups

already established in the agencies. The support will focus on reinforcing the messages given in

the media campaign. The program participants will be tracked and contacted by the HIV case

managers.

Implementation Plan

SMART objective 1: To educate 35% of the population of HIV IDUs born between 1945 and 1965 and who are residents of Detroit, MI about HCV with the involvement in the form of resources and cooperation of HIV CBOs, FQHCs, and methadone clinics starting April 1, 2015 and ending March 30, 2018.Key Component ObjectiveSpecific - What is the specific task? To educate HIV IDUs born between 1945 and 1965 about HCVMeasurable - What are the standards, measure or parameters?

To educate 35% of the population of HIV IDUs born between 1945 and 1965 and who are residents of Detroit, MI about HCV

Achievable - Is the task feasible? Yes, when connected with HIV CBOs, FQHCs, and methadone clinics. Their involvement and their inclusion of program peer representatives make this doable.

Realistic - Are sufficient resources available? (Inputs from logic model)

Yes, resources provided by MDCH and DHWP with assistance from HIV CBOs, FQHCs, and methadone clinics.

Time-Bound - What are the start and end dates?

Three years. Start date of April 1, 2015 and end date of March 30, 2018.

SMART objective 2: To test 35% of the population of HIV IDUs born between 1945 and 1965 and who are residents of Detroit, MI for HCV with the involvement of a FQHC with several locations providing facilities and other resources starting April 1, 2015 and ending March 30, 2018.Key Component ObjectiveSpecific - What is the specific task? To test HIV IDUs born between 1945 and 1965 for HCVMeasurable - What are the standards, measure or parameters?

To test 35% of the population of HIV IDUs born between 1945 and 1965 and who are residents of Detroit, MI for HCV

Achievable - Is the task feasible? Yes, when connected with at least one FQHC that has several locations.

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Yes, the partnership with the FQHC that has the facilities to perform testing along with the added resources of MDCH makes this possible.



SMART objective 3: To train a total of 15 HIV case managers to become certified HCV educators with 5 case managers each coming from the three HIV CBOs within a twelve month period with training and certification provided by HCV Advocate as a result of a contractual agreement.Key Component ObjectiveSpecific - What is the specific task? To train HIV case managers to become certified HCV educatorsMeasurable - What are the standards, measure or parameters?

To train 15 HIV case managers to become certified HCV educators with 5 case managers each coming from the three HIV CBOs.

Achievable - Is the task feasible? Yes, resources provided by HCV Advocate.Realistic - Are sufficient resources available? (Inputs from logic model)

Yes, a contract will be enacted with HCV Advocate. They are willing to provide services.


One year. Start date of January 5, 2015 and end date of December 18, 2015

SMART objective 4: To conduct one multimedia HCV awareness campaign per year for three years focused on Detroit residents who are HIV IDUs and born between 1945 and 1965 that includes five radio advertisements, one YouTube video message, and one Facebook page with the assistance of MDCH, community partners, and HCV Advocate.Key Component ObjectiveSpecific - What is the specific task? To conduct a multimedia HCV awareness campaign focused on

Detroit residents who are HIV IDUs and born between 1945 and 1965.

Measurable - What are the standards, measure or parameters?

To conduct one multimedia HCV awareness campaign per year focused on Detroit residents who are HIV IDUs and born between 1945 and 1965 that includes five radio advertisements, one YouTube video message, and one Facebook page.

Achievable - Is the task feasible? Yes, when connected with the resources provided by MDCH and community partners and peer planning group members.


Yes, resources will be offered by MDCH, community partners, and the Hepatitis C Support Project (HCSP).



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SMART objective 5: To conduct 2 workshops per year over a three year period in the summer and fall months starting the summer of 2015 using a small group format to educate 20 Detroit HIV IDUs born between 1945 and 1965 about HCV with 10 participants in each workshop with educational materials being provided by MDCH, DHWP, HIV CBOs, and the HCV Advocate organization. HIV case managers who are certified HCV educators will conduct the workshops.Key Component ObjectiveSpecific - What is the specific task? To conduct workshops using a small group format to educate

Detroit HIV IDUs born between 1945 and 1965 about HCV in an informal manner.

Measurable - What are the standards, measure or parameters?

To conduct 2 workshops per year using a small group format to educate 20 Detroit HIV IDUs born between 1945 and 1965 about HCV with 10 participants in each workshop.

Achievable - Is the task feasible? Yes, when connected with MDCH and HIV CBO case managers certified HCV educators.


Yes, with resources provided by MDCH, DHWP, HIV CBOs, and the Hepatitis C Support Project (HCSP).


Three years. Summer and fall workshops. The workshops beginning in 2015 and ending 2018.

SMART objective 6: To link 35% of the identified Detroit HIV IDUs and born between 1945 and 1965 who tested positive of HCV to primary medical care within three months of positive diagnosis with the involvement of MDCH, MPCA and HIV CBOs utilizing case managers and specialized tracking software over a three year period starting April 1, 2015 and ending March 30, 2018.Key Component ObjectiveSpecific - What is the specific task? To link Detroit HIV IDUs born between 1945 and 1965 and tested

positive for HCV to primary medical care.Measurable - What are the standards, measure or parameters?

To link 35 % of the identified Detroit HIV IDUs born between 1945 and 1965 who tested positive for HCV to primary medical care within three months of positive diagnosis.

Achievable - Is the task feasible? Yes, when connected with the resources provided by MDCH and MPCA.


Yes, resources will be offered by MDCH and MPCA as well as HIV CBOs utilizing case managers and tracking software.



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Marketing Plan

When a public health promotion professional attempts to change behavior that will improve

health and produce healthy outcomes than social marketing should be employed (McKenzie et

al., 2013). The heart of the social marketing process is understanding the target population

(McKenzie et al., 2013). Understanding the target population involves identifying their needs

and wishes (McKenzie et al., 2013). The better a planner knows the priority population the

better he or she will be in a position to develop a marketing strategy.

The successful social marketing strategy for promoting the “HIV screening to stop the

silent killer HCV” program involves the inclusion of the target population in the planning

process and the needs assessment done before the planning starts. Additionally, the planning

team will conduct marketing research. The marketing strategy will be monitored for

effectiveness. The focus groups made up of the priority population will provide crucial

information. A list of the primary audience segments will be developed from the information

collected.

Product

The product is actually the screenings for HCV. One of the main objectives of the

program is HIV positive injecting drug users (IDUs) will be screened for HCV.

Price

The price associated with the program is nonfinancial for the participants. However,

there is a cost involved. The priority population will be giving up time. The program will have

to demonstrate that it is a worthy project and worthy of the time involved in participating. “Price

is not the same thing as barriers” (McKenzie et al., 2013, p. 327). The priority population has

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become accustomed to various types of barriers. The program will provide incentives. The

priority population will be able to see the benefits and value the program provides.

Place

The place will be the FQHC that is familiar and assessable to the target population. The

planning team will also consider offering services during the best time or most convenient time

for the priority population (McKenzie et al., 2013).

Promotion

Advertisement will be the tool used for promotion. “Common channels for advertising

have included broadcast media (television and radio), print media (newspapers and magazines),

outdoor media (billboards, bus wraps, and so forth)” (McKenzie et al., 2013, p. 329). The

program will use radio and print media, which will include plain language produced flyers. The

other forms of media will be utilized as part of the multimedia HCV awareness campaign.

Process

Process involves how the product or service is delivered (Tracy, 2004). The process of

service delivery is crucial since it ensures that the same standard of service is repeatedly

delivered to the customers” (Management Study Guide, 2013, p. 1). The product will be

delivered at the place or location of the program, which will be at the FQHC.

Physical evidence

The space provide by the FQHC will have to be transformed into a comfortable and

inviting atmosphere. The project will strive incorporate enhanced participant experience

(Management Study Guide, 2013).

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People

The people involved in the project must not overlooked because they affect the marking

process. The staff’s attitude, appearance, and general overall demeanor reflect upon the

program. If the staff is enthusiastic about the program, this enthusiasm will be a marketing tool

and win over the priority population (Management Study Guide, 2013).

In summary, the type of media and materials to be used are plain language produced

flyers and radio ads and the delivery process will be the FQHC. The time frame of the marketing

process will take place during the end of the first quarter of 2015 and continue into the third

quarter of 2015. Please refer to the Gantt chart. The resources used will be the FQHC, CBOs,

and HCV advocate. Additionally, a public relations firm may be consulted and contracted. The

main objective of the social marketing strategy is to convey to the priority population above all

costs that the program has value and benefits them personally.

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Program Pro Forma

Revenue and Support Amount

Contribution from sponsors (Michigan Department of Community Health) 20,000$

Gilts -$

Grant from Centers for Disease Control and Prevention 600,000$

Participant fee -$

Sale of curriculum material -$

Total income: 620,000$

Expenditures

Direct Costs

Personnel

Salary & wages - Administration

Project Coordinator 60,000$

Assistant Project Coordinator 45,000$

Salary & wages - Two Educators and Three HIV Case Managers 75,000$

Subtotal Salary & Wages 180,000$

Fringe benefits* (include payroll taxes, health insurance, state unemployment taxes, etc.) 72,000$

Consultants and Contractors (HCV Advocate Educators, etc.) 30,000$

Supplies

Instructional materials 112,000$

Incentives 35,000$

Meeting costs 25,000$

Equipment (audio visual, copier lease, etc.) 12,000$

Travel 1,000$

Postage 500$

Advertising 500$

Multimedia costs (radio ads, etc.) 40,000$

Marketing 10,000$

Total of direct costs: 518,000$

Indirect costs (includes rent, insurance, telephone, & other utilities)

Total of indirect costs: 100,000$

Total expenditures: 618,000$

Balance: 2,000$

* Fringe benefits are 40% of the total salaries and wages

12 Month Pro Forma Budget for a Three Year Project "HIV screening for the silent killer HCV"

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Program Evaluation

The health promotion program “HIV screening for the silent killer HCV” has included

evaluation as part of its plan starting from the beginning. The planning model chosen,

PRECEDE-PROCEED, relies heavily upon program evaluation. Green and Kreuter (2005, p.

22), creators of the PRECEDE-PROCEED planning model, indicate that “Evaluation is not

viewed as a separate enterprise. Rather, it is integrated as a basic component throughout all

phases of the Precede-Proceed Model.” Additionally, the evaluation process intensifies as soon

as implementation begins so that any problems can be detected early and be corrected (Glanz &

Rimer, 1997).

Program evaluation can be broken down into two overarching categories, quality and

effectiveness. According to McKenzie, Neiger, and Thackeray (2013, pp. 372–373), “every

effort should be made to address the two most critical and basic purposes of program evaluation:

(1) assessing and improving quality, and (2) determining effectiveness.” Program evaluation can

be both formative and summative. Formative relates to quality improvement while summative

evaluation pertains to ensuring effectiveness (McKenzie et al., 2013).

In the proposed health promotion, a health behavior change is strived for. In other words,

a health behavior theory is incorporated into the program. DiClemente, Salazar, and Crosby

(2013) suggest that program evaluation is propelled by health behavior theory. The PRECEDE

portion of the model has four formative evaluation phases “in which diagnostic and assessment

data serve to set program priorities, goals, objectives, and targets, and also as baseline measures

for later summative evaluation” (Green & Kreuter, 2005, p. 9). The summative evaluation will

answer the question, did the program do what it intended to do or provide? Regarding the “HIV

screening for the silent killer HCV” program the summative evaluation will be broken down into

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three areas, namely process, impact, and outcome. Process evaluation will identify and expose

any problems with the implementation phase. The impact evaluation will focus on observable

effects of the program whereas the outcome evaluation will focus on the long-term results of the

program (McKenzie et al., 2013). The planning committee will initiate a subcommittee that will

be delegated the task of developing a program evaluation. The planning subcommittee will have

a priority population member actively participating to ensure that stakeholders’ views are

represented. Program evaluation has always been challenging. The “HIV screening for the

silent killer HCV” program will look to key decision makers to assist in the ongoing monitoring

of the program evaluation process.

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Program Strategies Summary

The rate of HCV infection can be reduced. Reduction in the rate of HCV infections in

the United States is a CDC priority. There is a sizable portion of U.S. citizens who are

chronically infected with Hepatitis C. The health promotion described in this paper is doable

because of the stakeholders and decision makers. It will lead to a reduction of HCV infections in

Michigan. The health promotion program’s mission to increase the number of HIV positive

injecting drug users (IDUs) who are tested for HCV is planned with a community focus.

Even though the PPM framework is complex, it is comprehensive enough to offer a

rigorous and efficient program plan. The PPM sets in emotion the desired outcome first as the

planner works backwards to develop interventions and establish process evaluations. Using the

PPM the program’s goals are within reach. Its purpose can become fulfilled.

The health promotion program’s purpose is to decrease the number of HIV positive

individuals infected with HCV in the next two to five years. The project has SMART objectives

and an efficient pro forma to guide it. The project will use social marketing and various

intervention activities. The health promotion plan will benefit the priority population now and in

the future. The planning, implementation, and evaluation of the program, “HIV screening for the

silent killer HCV”, is fortunate to have many strengths forged by the number of partnerships that

will be established.

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References

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Tables

Table 1Identifying Stakeholders and Their Role

Stakeholder Description Level of Engagement Needed

Federal health department Centers for Disease Control and Prevention (CDC)

Grantor and decision maker

State health department Community Health (MDCH)

Decision maker

Local health department Health and Wellness Promotion (DHWP)

Decision maker

Federally Qualified Health Center (FQHC)

Detroit Community Health Connection (DCHC)

Decision maker and provider of participants

AIDS Service Organization (ASO)

AIDS Partnership Michigan (APM)

Case managers and members of the targeted population

Community Based Organization (CBO)

Community Health Awareness Group (CHAG)


Community Based Organization (CBO)

Health Emergency Lifeline Program (HELP)


HCV advocate organization

Hepatitis C Support Project (HCSP)

Consultant and contracted agency

Detroit Methadone clinics Methadone clinics located on the east and west sides of the city

Place where IDUs seek treatment

Networking organization of primary medical care services

Michigan Primary Care Association (MPCA)

Association with information on primary care facilities in Michigan and limited partner.

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Table 2Gantt chart for health promotion program HIV Screening for Silent Killer HCV

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December-14 January-15 March-15 April-15 June-15 August-15 September-15 November-15

Conduct needs assessmentCDC grant written and submitted

Partnerships and MOUs establishedArrange and set up planning team

Notification of grant awardPlanning team meeting

Hire Project Team LeaderConfirm goals and objectives

Conduct focus groupsCollect data from focus groups

Begin HIV case manager trainingsBegin marketing program

City wide kick off eventConduct multimedia HCV campaign

Review data from monitoringConduct first workshop

Begin testing/screening for HCVCollect and analyze data for evaluation

Conduct second workshopCollect data for linkage to care

Implement linkage to careEvaluate program and write report

Start Date Duration

Table 3Formative Evaluation Table

Element How will the element be addressed in the program?

1. Justification The program will approved by stakeholders because they will be a part of the planning team and assist in the development of the program.

2. Evidence The program is evidence-based which clearly demonstrated in the data provided in the needs assessment.

3. Capacity The professionals involved in the program have adequate knowledge, skills, and abilities to design and implement the program because they are hired and trained public health consultants with graduate level degrees.

4. Resources The program has adequate resources primarily due to an awarded CDC grant. In addition, the Michigan Department of Community Health (MDCH) will provide resources. Local partnerships will contribute resources.

5. Customer Orientation

The program is adapted to the needs of the priority population because of the inclusion of the priority population. The priority population focus group will also ensure customer orientation. The interventions will be culturally appropriate. The HIV case managers receive cultural sensitivity training. MDCH has culturally appropriate standards that organizations receiving funding that to be in compliancy.

6. Multiplicity Multiplicity has been placed into the program. Multiple components are built into the program interventions.

7. Support There is a support component is built into the intervention. HIV case managers and peer support groups will provide ongoing support and reinforcement.

8. Inclusion The program will have an adequate range and number of participants are involved. This will be ensured because of the focus groups input and the locations of the intervention activities. There will also be a social marketing component in the program.

9. Accountability The program will be monitored by the CDC due to grant requirements. There will be accountability.

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There will be a number of status reports due. The lead program coordinator will also ensure staff accountability.

10. Adjustment There will so be periodic program review sessions and/or meetings with key decision makers. The program will be monitored by MDCH. The program activities will be modified based on feedback received from participants, partners, or other stakeholders. Using the PRECEDE-PROCEED model will enhance the program’s ability to monitor and adjust accordingly.

11. Recruitment Recruitment of the target population is a top priority for program. The program will not work unless community involvement is present. The priority population will be adequately recruited through appropriate channels and places consistent with cultural and other unique characteristics. Methadone clinics are an example of the places that will be used for outreach.

12. Reach A high proportion of priority population will be given the opportunity to participate in the program as part of the planning committee, focus groups, and volunteer staff positions.

13. Response The program has a requirement that over 50% of the program has to have priority population actually participating.

14. Interaction Customer service will be emphasized with HIV case managers. Customer service training will be made available. Surveys will be done to gage the quality of interactions between program staff and the participants.

15. Satisfaction Surveys will be given the participants to ascertain if their needs were met and how satisfied they were with the program. Follow-up will be completed by program staff. Follow-up is key objective of program because of the linkage to care component.

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Table 4Process Evaluation Table

Element How will the element be addressed in the program?

1. Fidelity There will be special review of data and information collected after the intervention by the staff and key decision makers to determine program’s fidelity. A Gantt chart will be used along with a logic model.

2. Dose The planning committee will set the number of units delivered before the intervention methods are started.

3. Recruitment The priority population will be adequately recruited through appropriate channels and places consistent with cultural and other unique characteristics. Methadone clinics are an example of the places that will be used for outreach. The appropriate channels used will be the CBOs and FQHC.

4. Reach The priority population will be reached using social marketing techniques. A high proportion of priority population will be given the opportunity to participate in the program as part of the planning committee, focus groups, and volunteer staff positions.

5. Response The program has a requirement that over 50% of the program has to have priority population actually participating. There will be ongoing monitoring by the program coordinator and other staff members to ensure the priority population is well represented.

6. Context External factors that may influence the program results will be identified in the SWOT analysis. One of the external factors will probably be a competing program.

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worksheet 1: assessing readiness for strategic...

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