Implementing Health Promotion Programs: A Module 6 Guide

Budgeting for program implementation

Budgeting according to Kemper (2015) is the process of designing a plan on how the funds will be spent. The importance of developing a realistic budget for the health program will allow the health educators to get to know in advance whether the project will have enough money for performing the things that are needed to be done or those that the health educator wishes to do. Developing a realistic budget for this health program will also be important since it will allow the health educators to come up a plan for spending the money, and also ensure that enough money will be available for the needed things and for the most important things. Similarly, the realistic budget will and following it will keep the program out of running into debts or out of funds.

Lastly, developing a realistic budget for the program will be helpful for the long term financial planning for the program. This will be also significant in making realistic assumptions about the whole projects income and expenses and plan for the program goals. Below is a detailed overview of the anticipated program costs for the proposed health program. The program will run for two months and will cover the entire district.

Based on the anticipated costs, there are some changes that will be made to the program. Some costs may be adjusted when it will be forecasted that that some weeks coming ahead the finances may be tight or even if the finances will be extra. If these scenario will be forecasted, the health educators will look for ways to readjusting the budget to even the lows and thighs in the finances for easier management of the project

Budgetary concerns can impact the implementation strategy of a health program in several ways. Budgetary concerns cause the health educators to frequently revisit their deadlines and task lists. According to Kemper (2015), cost overruns in a programs implementation stage makes the administrators to see their programs or projects getting out of control.

budgetary concerns can also lead to unexpected budget cuts during the implementation stage of the program. A program with a strong project goals with a scope that has strong statements such as “good to have” “should have” can be disadvantaged in this scenario. The health educators whose duty is to ensure that the project is on course despite constraints in the budget may opt for eliminating the non-critical budgetary allocations before considering staff cuts.

Project evaluation plan

The program will entail working with the communities of the elderly population who are at risk of falling, and therefore it will be imperative to involve them in all the program evaluation phases. Community self-assessment according to Minkler (2012) is the process where the communities identify their resources and need perception. Through self-assessment, the community of the elderly persons strengthens their resources and can help itself to improve on their wellness. The strengths of the community include health determinants such as coping skills, knowledge, education and supportive environment. The health educators will be stimulated with the holistic wellness approach when doing evaluation. This will be helpful in shaping the design and evaluation of the program amongst all the stakeholders involved

Minkler (2012) indicated that a representative of a community of the elderly population who are at a risk of falling can initiate a community self-assessment. However, if it is unlikely, the health educators may opt for approaching the leaders of the community as this will ensure inclusive and active participation by members. Minkler (2012) discussed the significance of being committed to self-assessment by making community leaders and coalitions get involved. Involving every member provides an excellent opportunity of building partnerships

Given that partnerships is integral in community self-assessments, the health educators will look for ways to partnering that supports the whole community is the process of self-assessment and also in identification of the priorities for planning, implementation and evaluation of the health program

The evaluation findings will be utilised by different entities and stakeholders. First, the evaluation findings will be utilised by the policymakers in coming with policies that will be integral in reducing falls among the elderly population. These may include policies of improving facilities in parks and recreational areas and also nursing homes for the elderly people. Similarly, the evaluation findings will be utilised by different institutions and entities to improve on their facilities and also to put in place mechanisms that can helpful in reducing falls among the elderly population. The rational applied in selecting the entities and stakeholders that will utilise the evaluation findings was based upon how related or associated a stakeholder or an entity is associated with the elderly populations.

Evaluation plan

1. State the evaluation question you are evaluating, and explain why it is important.

“Will the proposed program succeed in preventing falls among the elderly? Which aspects of the program can be modified to make it more effective?”

The outcome evaluation question above will be evaluated in this section of the project. The evaluation question above is important because it questions whether the proposed program will be successful, and also gives a room for modification of the program for it to be more effective. The following are the reasons why the paper chose the question above for evaluation

1. The evaluation question above will be helpful in understanding the effects of different facets of the program are having. The question has been carefully framed and it can evaluate different parts of the program. Furthermore, if an element is added, or modification is done after the commencement of the program, its effects will be evident from the initial program. Therefore, it will be possible to look at different possible program effects entirely.
2. The above question is also important because it shows the program educator clearly define what they will be trying to do. What the program educator will decide to evaluate will define what he will hope to accomplish at the end of the program. The question is well framed and will it clear for the program educator to understand what he will be trying to evaluate and the what the results are desired
3. The question is also important since it shows the program promoter on where changes need to be made. The question is specific and is real and is real to the to the program objectives. Furthermore, the question tells the program promoter exactly where the program will be going on well and where the health program will not be having the effect intended
4. Since the question generally covers the purpose of the proposed health program, the question is important because it also highlights the consequences that are unintended. In a scenario where the program educator will find unusual answers to the evaluation question above, t will mean that the program had some effects that were not expected. Sometimes the effects will be positive such that the elderly people under the program not only will they reduce their incidences of fall, but majority will change their way of living to live healthy lifestyles. However, sometimes the effect will be negative such that the elderly people under the program increased their incidences of falling even though they were trying new methods from the education program. Just like the medication side effects, the unintended program consequences can be of great importance to the program itself
5. The evaluation question above will also guide the future choices of the program educator. For instance, if the program will be particularly successfully in some areas unlike other ways, the program educator will may decide to lay more emphasis on the areas that were more successful or even to make some modifications or even change completely the approaches that were applied in the areas that were unsuccessful
6. Given that the program will involve many stakeholders in designing, and the participants will be subjects that will be evaluated, the evaluation question above will have a higher likelihood of meeting the needs of the community
7. The evaluation question above is also important because it provides the focus for the program evaluation. The question has been carefully chosen and laid out to keep the program promoters from going astray or even to try to do many things at ago. The question is based on whether the program will prevent the elderly people from falling. A very straight forward evaluation question, focussed and on point
8. Lastly, the evaluation question used is important because it determined the factors that need to be recorded during the process of data collection. The question has been clearly chosen and it will make data gathering much easier since it has made obvious the kind of records and data that need to be kept and the areas needing examination.

Discuss which evaluation design you use and why

Control group design

The evaluation design that will adopted by the paper will be control group design. This design is a common way of evaluating the effects of an independent variable using a control group. In this program, there will be two similar groups, the control group and the participants group. Using this design, the control group receives a different intervention or no intervention at all with the main goal being similar to the participant group. In the proposed health program, the eligible population would be randomized to receive either the proposed fall prevention intervention (intervention/participant group) or usual care (control group). In the intervention group, multifactorial intervention entailing a comprehensive assessment of the risk factor reduction. In the case of usual care, this would involve the provision of the community-based elderly primary care in which a standard care from family physician is to be followed by a letter summarizing the self-reported risk factors from the participants to the physician to establish their level of awareness

The main purpose of evaluation for the program educator in evaluating their efforts is to get the most accurate and reliable possible information given their program nature, their questions for evaluation, the time constraints, what the participants will agree with, and the available resources. The vital thing for the proposed program is not to set up a research study that is perfect but to design the evaluation that will be helpful in getting realistic information and to be able to separate the external factors effects and the program effects. There are several factors that prompted the program promoters to choose the control group design and they include:

Consideration of the evaluation questions

The evaluation question asked whether the proposed program will succeed in preventing the falls among the elderly patients, and whether some program aspects can be modified to be effective. Control group design was chosen because the intent of evaluation was to see whether some changes happened. The program educators will want to know whether any change took place, and if it occurred, whether it was caused by the program. Therefore, the design was used help in screening out the external influences effects and also the backgrounds of the participants.

The proposed health program of preventing a fall among the elderly population will incorporate two groups, having different interventions but working towards a common goal. The comparison across the groups will allow the program promoter to screen out the factors that may cause different results.

The nature of the program

The proposed program work with many participants in two groups and begin and end on specific dates. Moreover, the program is designed on a two month time limit where all the participants are expected to undergo through all at once. Control group design was chosen for the project because the work involved working in groups. Moreover, the program will have a clear and well elaborated beginning and end.

Consideration to what the staff and the participants will consent to

He control group design will be chosen after making deliberations and agreeing with the participants. Evaluation design is significant because of the effect that it might have on the evaluation results of the program. CTB (2015) indicated that an evaluation design might raise protests during the process of observation from the participants who may feel that their privacy are infringed. Similarly, the staff who are already overworked may see an evaluation as an additional burden to them. Therefore, control group design will be considered as a compromise and also to overcome these potential obstacles. Moreover, control group design is less intrusive and has different kinds of observations when collecting data among the elderly people who are at risk of falling.

Given that the evaluation will be majorly be based on observation, there are other reasons that can raise objection from the participants. For instance, desire for secrecy, potential for embarrassment or even self-protection. These factors can contribute to a participant’s unwillingness to participate in the evaluation. These concerns can also be raised among the staff members. Therefore, to deal with these issues when control group design shall have been adopted, the program educator will inform the participants from onset about what the program promoters and other staff are hopping to do, meet with the, listen to the participant’s objections and finally come up with an inclusive and satisfactory approach. CTB (2015) noted that staff members in the proposed health program have a lower likelihood of complaining if they are involved in the program evaluation planning, and this is also true to the participants.

Time constraints

The important thing for the proposed health program for reducing fall among the elderly people is to select an evaluation design that will give the program promoters reliable and reasonable information. According to CTB (2015), an evaluation design should be good enough for the program promoter to see reasonable indication that actually changes are taking place and they are because of the program results. The limits of time can only control an evaluation program based on the program considerations, funding and other factors.

Control group design will considered because of the imposed time constraints to the health program. The design fitted well with the program structure which corresponds with the regular program cycle. Time constraints also depended on the funding sources and that is another reason why control group design was preferred. The health program will be conducted within the timeframe of funding to show to the funders that it is successful and to be eligible for refunding. Evaluation time schedule will be part of the grant and it will be shown to the funders within the allocated time frame

Available resources

Control, group design was also favored for the proposed health program because of the available resources. Resources from the program include money, personnel, equipment, material, space, skills and expertise. Despite the fact that the program will work with the available resources, some of these resources will substitute one another. For instance, an experienced staff during the evaluation program will substitute money that would have been used for hiring a consultant. Moreover, the proposed health program will also consider partnering with the local universities to get the much needed expertise and also equipment. With the available resources, control group design will be the best option for the proposed evaluation program

Discuss the strengths and weaknesses of the design used. Identify any threats to measurement reliability and validity that you might encounter when collecting data, and discuss what you would do to reduce these threats.

Strengths

The core strength of control group design is that it is the most reliable design. In most evaluation designs, control, group design is essential and allow the researchers to isolate and eliminate variable

The design also provide a baseline from factors that can skew evaluation data such as environmental variation, researcher bias and other normal variation. The design also helps the program promoter to show that the experimental deign design used has capability of generating results from evaluation

Weakness

According to CTB (2015), control group design is the most difficult evaluating design to set up since the program evaluator need to find the groups that are appropriate, observe the groups regularly. CTB (2015) elaborated that the randomised control groups are the gold standard, and it should be totally selected randomly either among the program population of the intervention, or even the larger population if it’s appropriate. Rando groups eliminates the selection problems in addition to other issues such as differences in race, culture or other factors that might arise.

Threats to measurement reliability and validity during data collection

Reliability in the techniques was determined by the experiments producing consistent results. Validity, on the other hand, is the extent to which a measurement, conclusion or concept corresponds accurately or is well founded to the real world. Some of the threats to measurement of reliability and validity that the program may encounter when collecting data two. They are referred to as validity threats and reliability threats

Validity threats

These are threats to the program promoter’s claims that what was done caused changes in the direction the program promoter was aiming for. Validity and reliability threats are posed generally by factors that operate at the same time as the intervention or the program that may have an effect on the issues the program will be trying to address. Some of the validity threats that the program promoter might encounter when collecting data include the following:

History– the personal histories of the participant such as their background, cultures, education, experience among others, and other external events that may occur during the evaluation period such as conflict, election, disaster or even a new law may influence the data collection process. For instance, some cultures may not permit a participant to disclose some information or a conflict in the area of research may hamper data collection process

Maturation-these are social, psychological and physical processes that occur as time goes by. The elderly participants may develop arthritis, or they can get tired during the period of learning activities and this may hamper data collection

The effect of observation or testing to the participants-the presence of the program itself or the participants taking part may affect the attitude or behavior of the participants, or even the experience that they are being videotaped, tested or even measured or observed

Regression toward the mean– this refers that with time every low or high scores from a test or measurement often tend to drift to the average of the group hence resulting to validity threats

Participants selection– this may occur when the program promoter slant his selection of the participants towards a particular group that has a lower likelihood or recording some changes than across the population where the group was selected. For example, the program promoter may select the elderly populations who already has knowledge and skills about preventing falls and leaving out those who does not have the skills, and who need the knowledge. Similarly, participant’s selection can also results to validity threats when the participants chose to enroll themselves into the program. Since the self-selected participants are motivated already to make changes

Loss of participants/data- if too many participants drop out in the middle of the evaluation or too little information is collected. This creates unreliable results especially if they compared to another group of participants

Reliability threats

These are factors that affects a program promoter’s ability of applying the results in other data collection processes. That is to increase the chances of the program promoter’s data collection process to be reproduced somewhere else using other different participants. Reliability threats may be due to other factors interaction with the intervention or the program or may be because of specific program conditions. For example;

Data collection interaction with the intervention or the program– the initial observation during data collection might change the way the subjects will perceive or react to the whole program, and this may make different in the end results. Because it cannot be assumed that another participants group will also have a similar reaction or achieve same final outcomes, reliability becomes questionable

selection procedures interaction with the intervention or program-if the selected participants are sensitive to the purpose or methods of data collection, it cannot be assumed that it will be effective with other participants who are ready for the program and are particularly less sensitive

Ways of reducing the threats

Some of these threats may be beyond the control of the program promoter like history and maturation of the participants. However, to reduce these threats, the program educator will discuss the procedures before with the participants for them to understand and be ready and comfortable during the data collection process. Moreover, one type of instrument will be used to prevent regression towards the mean. Selection will also be broad to avoid selecting a particular group of participants with a similar characteristics. Full cooperation will also be expected from participants till the end to prevent dropping out or loss of data

Describe the methods you would use to collect data to answer the evaluation question.

Focus groups

These are small groups of people possessing a distinctive insight into the resources and health needs of the elderly population who are at risk of falling. This method of program, evaluation will consist of about 8-12 elderly participants who will come together and then discuss their common concern of falling. During focus groups, field notes will be taken for ensuring validity of contents. The moderator of the focus groups will influence the quality and nature of the information to be collected during these sessions

key informant interviews

These will be interviews with the persons who work or lie with the elderly persons who are at risk of falling and also who possess the special insight into the resources and the needs of the elderly. These interviews will be done either face to face, over the telephone or even tapping during evaluation of the program

surveys

This evaluation method will also be used especially with the participants using either open ended questions and asking for specific answers, or close-ended questions and requesting the participants to choose from given choices. This method will also be adopted after designing easily understood, simple and good questions. The survey questions will be structured to collect information on barriers to access to healthcare, satisfaction with their elderly homes, and their health status among others. When the programs will be evaluated, a representative random sample of the elderly participants who have undergone intervention or have used the program will be evaluated

Describe any modifications needed to an existing instrument, an instrument that would need to be developed, and/or existing records to access and provide your rationale.

The existing instrument that will need modification will be the questionnaire. Questionnaires will be modified with close-ended questions in order to get structured information from the respondents. A Likert scale will be used for designing the questionnaires. The answer choices in the Likert scale range from one extreme to another, therefore revealing the degree of opinion of respondents. Numerical values will be assigned for each scale point such as 5 for strongly agree, 4 for agree, 3 for neutral, 2 for disagree and 1 for strong disagreement.

The instrument that would need to be developed for the program is Morse Fall scale. This instrument is used for measuring risk of falls for the residents of the long term care homes, and hospitalized patients. This instrument was chosen to be developed its specific, sensitive and has high predictive values. This will be helpful to the program educator to make informed choices when collecting data

Summarize the ways in which your evaluation results might be used to improve the program’s quality, utility, and impact on the priority populations, and provide an explanation for why you think the results might be used in these ways.

The evaluation results that will be gotten from the proposed program/intervention will be used me improving the programs quality, utility and impact on the priority of the elderly population in risk of falling in several ways. Positive results from the evaluation will indicate that the program is successful and can be applied among the older population. The evaluation findings can also be used to detect where there were internal errors, where there is need for change both in methods of data collection, selection of instruments and the participants to improve the quality and utility of the program

The results will indicate that education on behavioral change to the elderly patients by the health care providers will be key in giving knowledge and skills to the elderly people to prevent them from having falls. The behavioral therapy works on specific environments and actions that either maintain or change behaviors (Schildmann et al, 2010). For instance, the patient trying to feel positive of his or her condition, the patient can be encouraged to change his or her habits that may deteriorate their health condition and increase chances of falling. Therefore, the patient will be encouraged to change behavior to practice activities that can promote healthy living in accordance to his condition and reduce chances of falling. Schildmann et al (2010) observed that replacement of negative behaviors with behaviors that are positive is the best strategy that helps in changing of behaviors, especially when reinforcement of new behaviors is done.

References

CTB,. (2015). Chapter 37. Op threats to measurement reliability and validity erations in Evaluating Community Interventions | Section 4. Selecting an Appropriate Design for the Evaluation | Main Section | Community Tool Box. Ctb.ku.edu. Retrieved 6 August 2015, from http://ctb.ku.edu/en/table-of-contents/evaluate/evaluate-community-interventions/experimental-design/main

Schildmann, J., Gordon, J.-S., & Vollmann, J. (2010). Clinical ethics consultation: Theories and methods, implementation, evaluation. Farnham, Surrey, England: Ashgate.

Kemper, B. (2015). Budgeting, spending and saving.

Minkler, M. (2012). Community organizing and community building for health and welfare. New Brunswick, N.J: Rutgers University Press.

Herman Bailey

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