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CHAPTER 3: Getting Started CHAPTER 3 Appendices
The first step in planning any health promotion activity is to define and describe the problem. Take time to identify and gather information about the health problems that are prevalent in your community. Be sure to check your state and county Behavior Risk Factor Surveillance System (BRFSS) results to obtain information about population and disease trends specific to your area. We worked closely with the local and state health departments in conducting our needs assessment. For additional data, contact federal agencies such as the Center for Disease Control and Prevention (CDC), the National Center for Health Statistics, and the National Institutes of Health. Once you have gathered your data and identified the health problems in your area, ask yourself, “Would a walking campaign be beneficial in addressing the health issues in my community?” If so, “How can we communicate this?” Why we started a walking campaign in West Virginia? The Problem: The lack of physical activity contributes significantly to death and disability in the United States.1-4 Physical inactivity alone accounts for approximately 200,000 deaths annually.3 In West Virginia, 70 percent of the adult population reported little or no physical activity in 1998, and our population ranked third worst among the 50 states for having no leisure-time physical exercise at all.6 Seventy-eight percent of the 55 to 64 year old group reported living a sedentary lifestyle, the highest rate for any group in West Virginia.6 All of these factors combine to put West Virginia citizens at risk for overweight, arthritis, osteoporosis, cancer, diabetes, heart disease, and stroke. Wheeling, WV was chosen because of its affordable media, the cooperation of local health agencies, and its proximity to West Virginia University. The Goal: Research shows that moderate intensity and duration of physical activity on almost every day l-4 are effective in improving cardiovascular mortality and risk factor profiles for all ages.7, 8 Walking is an activity available to almost everyone. Income and resources are less of a barrier than for other forms of physical activity. The Target Population: In West Virginia, seventy-eight percent of the 55 to 64 year old age group reported living a sedentary lifestyle.6 Therefore, we chose to focus our campaign on the 50-65 age group because they are among the most sedentary in WV. TopWho should be involved in the planning? Involve partners in the campaign who will enrich the planning efforts with diversity of thought and resources. Identify community members who can represent the target audiences and provide consumer input throughout the planning process. Involving Community Members and
Planning the Campaign with the The Community Health Participatory Planning Program builds social capital by utilizing the instruction of the individual and their commitment to their own fitness and to their community. Sessions focus on participants' commitment to their own fitness and community wide fitness in the context of the community environment with the existing resources, barriers, and policies. This is an interesting dynamic. When a person begins to address increasing his/her own fitness and walking, s/he begins to see the value of designing a community’s social, policy, and physical environment that will support new patterns of behavior. The WHEELING WALKS 12-week Community Health Participatory Planning Program was designed to involve, inform, and develop community leaders about the media-based community physical activity campaign that targets walking. The model is predicated on the concept of participants’ experiencing the challenges of attempting to incorporate regular moderate intensity walking into their lifestyle, while addressing the walking-related needs of their own community. We have found through this project, and several others, that an informed and involved group can help to identify the necessary components, players, resources, and strategies that will lead to the campaign’s short and long term success. Most health professionals know a great deal about health, but in order to make sure that the walking program or other health-related programs are sustained, we need to involve the community. No one individual can successfully identify the needs, assets, resources, barriers, and policies that impact physical activity and walking in such a way as to ensure that a campaign has staying power. This program component (CHPP) is so important to community health efforts that we have developed a special training module for practitioner instruction. Here, however, are the essentials: TopThe Community Health Participatory Planning Model (CHPP) The Community Health Participatory Planning Model (CHPP) has four phases including the 12-week participatory planning program for: (1) assessing the community needs and interests, (2) planning, (3) designing, (4) implementing, and (5) evaluating the media-based community walking intervention. In addressing personal risk factor reduction, participants experience firsthand community and personal barriers to walking for health, transportation, and leisure. As a result, planning for community wide walking related changes is informed by individual efforts toward personal change. The structure also provides a synergistic setting for critical insight and problem solving. The structure of the Community Health Participatory Planning Model enables participants to identify and mobilize community resources to overcome barriers to establishing health in a community. The shared frustration commonly involved in the process can contribute to group cohesion as well as to greater appreciation of the value of both personal and community support. Such direct involvement in the process is known to help overcome resistance to change and, at the same time, to mobilize the talents, energy, and insights of all members.7-10 In addition, a participatory planning approach essentially mandates program ownership. People who have meaningful input develop a commitment to the success of their program.
Community Health Participatory Planning Program (CHPP)
Phase I & II
Process Detail 1. The process commences with the interest of one or two people in a goal of targeting the promotion of a walking campaign in the local community. 2. These one or two invite others (not more than five) from the community who are keenly interested in the promotion of physical activity (exercise) and walking to become a local Steering Committee for health promotion. Who should be invited to CHPP? The best advice is to be inclusive, however, potential participants should be informed that this program requires a significant time commitment for 12 weeks. Members of several well-respected agencies such as the American Heart Association, the American Cancer Society, Kiwanis, etc. Solicit names of potential participants from businesses, agencies, churches, schools, civic and community organizations that have status or importance in the community. With a name and some contact information the process becomes fairly easy. Ask the steering committee members to bring their address books and rolodexes to the first steering committee meeting. The purpose of the steering committee is to help form a large group to participate in the 12-week session. Other community members, such as homemakers, teachers, and students, will hear about the campaign and will want to become involved. Make a commitment to involve all interested individuals as early and as much as possible. These individuals will prove to be invaluable resources. Their initiative to voluntarily email or call about the campaign is an indication of their commitment to make a difference personally and globally. Note: This list includes maximum ethnic, socio-economic, professional/non-professional, and geographically diversity; and mover-and-shaker-type individuals in the local community. This broad-based involvement is inherent to the participatory planning approach.11-12 How many should be invited? Approximately 20-60 participants are preferable. The location of the sessions may dictate how many people can be invited. It is important to ensure parking availability and that persons with disabilities can easily access the facility. Note: Encourage the development of personal and professional support systems during this stage of the campaign. Relationship development encourages participants to reach the campaign goal – significant behavior change and improved well-being. 3. The Steering Committee meets for 90 minutes once a week for 3-5 weeks to:
Note: Be sure to have local phone books available.
At the first steering committee meeting thoroughly explain and discuss the intent. Ask the participants to provide names, positions, addresses, phone numbers, and email addresses of people they feel may be interested in the campaign. Make this step easier by obtaining all the contact information at one meeting. Tasks Include:
b. mission statement for Community Advisory Committee c. brief summary of the problems associated with a sedentary lifestyle, including obesity, cardiovascular disease, diabetes, some cancers, etc . d. why participatory planning is so important to the success of the walking campaign e. the challenge and how it won’t happen unless WE do it.
4. Steering Committee members call prospective members to invite them to participate. The coordinator follows up by:
Recruitment vehicles:
Planning the first Community Participatory Planning sessions Timing is everything. Be sure to schedule the sessions at a convenient time for participants. To encourage maximum participation, you may want to schedule the same session at two separate times on the same day, or on two different days. For example, Session 1 can be scheduled on Tuesday, October 16 at 12 noon and again at 6:00PM. Or, Session 1 can be scheduled on Tuesday, October 16 at 12 noon and on Thursday October 18 at 6:00 PM. If you plan to have two sessions, consider scheduling them in different locations. This approach often leads to a more diverse attendance and it is an excellent way to accommodate busy people with random schedules. Note: If you schedule only one session, consider beginning at 5 PM. This allows for both workers and non-workers to attend since blue and white collar workers will be participating, the 5-6:00 pm time seems to work reasonably well.. Note: If you schedule a session at two separate times/locations, be sure to schedule the same speaker/facilitator for both sessions. Location: It is also very important to choose a central location with:
The Framework of a Productive Session
Note: When an individual is recommended, get his/her name and contact information. Make the contact and ask the person suggesting the name to also contact the individual about the project. Think Diversity After the first session, review the participant list. Do the participants represent the community? Is there anyone missing? Do you have a nice mix of males and females? Note: Be sure all ethnic and racial groups in the community, as well as age ranges, are represented.
Phase III The 12-Week Sessions Affecting behavior and community changes are the primary goals to remember when planning your sessions. Make the sessions one hour in length. Invite various respected community resource persons to assist in delivering the content of each session. It is important to remember the value of everyone’s time. Attendance can be near 80% when the sessions are kept concise, dynamic, and interactive. In addition, we suggest you provide refreshments for session participants, if resources are available! Starting with the first session, members are encouraged to walk for health, transportation, fitness, and wellness consistent with their own perceived needs and interests. All changes, however, are voluntary. No walking classes are held. PROGRAM OVERVIEW Session 1 - is enrollment of participants and orientation--a review of the nature and content of the program. Session 2-12 - provide a supportive environment for participants to learn more about walking for health, fitness, and transportation and to become empowered to address the communitywide promotion of walking. The weekly sessions include: questions and answers (5 minutes), and overview of the specific walking related topic (20 minutes), small-group interaction (15 minutes), and large-group discussion (20 minutes). Session topics/major activities:
Potlucks--to enhance information exchange, develop
a further sense of community, and promote healthful eating behaviors,
Sessions 6 and 12 include potluck meals. Participants bring a
low-fat dish (less than 20% fat) along with the recipe. In these
sessions, interactions and discussions are less structured so
that participants have time to informally interact with each other. DETAIL OF SESSIONS
Session 1 - Orientation and enrollment
in the 12-week Community Health Participatory The Program:
c. ask all to join, complete registration forms, if interested. d. Distribution of logs for participants to record walking behavior (bouts of 10 minutes and more). Note: Sessions 2-6 focus on dimensions of walking in the target community, as noted in the box. In addition to imparting baseline information on specific topic areas, the sessions served as a springboard for reflection, discussion, and the opportunity to further examine the community’s overall walking environmental context--exploring the social, policy, administrative, and physical barriers, as well as assets of the community.
Session 2 - Prevalence and consequences of a sedentary lifestyle A presentation on the prevalence and consequences of a sedentary lifestyle is provided. Health Screening: For those interested, a personal health screening is offered one hour prior to Session 2 or after the session. Included in the health screening: physiologic measures of weight, height, blood pressure, resting heart rate, and assessment of personal physical activity behaviors using the Behavior Risk Factor Survey Questions (See Appendix 3-a). This provides a profile of individual and communityrisks and behaviors. The health screenings are not mandatory. The health screening is repeated prior to and after Session 11.
Session 3 - Benefits of walking This session commences with the distribution of individual health screening results. The presenter interprets, and the group discusses, the results.
Session 4 and 5 – See Overview chart above for session topics.
Session 6 - Task Force Identification/Potluck At this session, members identify issues for further investigation in task forces and, potentially, for later advocacy. Identified by the participants, these often include:
Individual task forces are formed based on the topics. Participants can chose on which task force to serve. Outside people resources who have a particular expertise or represent a certain constituency group can be invited to join specific task forces. Note: During Session 11, each community walking task force will be expected to present a 3-5 page summary of the current status and recommendations for change.
Developing Task Forces A task force is a group of people who work on a specific aspect of the campaign. Dividing the campaign into specific areas of interest, then assigning those areas to a task force, ensures that all aspects of the campaign will be addressed. The types and number of task forces may depend on your specific campaign goals. Assignments to the task forces should be voluntary and by interest. However, important task forces, such as fundraising and working with the media, may require advance recruiting by the community organizer to ensure the right individuals are represented on the teams. Each task force should have a recorder. The recorder is responsible for providing a written report to the community organizer on Week 11 of the educational sessions. This report should contain contacts, ideas, discussion points, handouts, local expert opinions and any other information the task force feels could enhance the campaign. Note: The imperative task forces of the WHEELING WALKS campaign were: (1) Working with the Media, (2) Fundraising, and (3) Environment and Policy. These task forces worked together to be sure we purchased adequate advertisement time on TV and radio and secured sufficient newspaper coverage to fully saturate our community, as well as mobilize the resources for the continuation of the campaign impact. Note: The term media refers to paid and earned media. Both types need to be thoroughly discussed by the respective task forces. (See Chapter 4 and 7 for more information about paid and earned media.)
Sessions 7-11 Sessions 7-11 begin with 15 minutes of questions and answers related to personal and community walking, the underlying causes of ill health, and the role of the organizational structure and policy for promoting walking. For the next 25 minutes, the group separates into its specific task forces to address needs assessments, problem solving, and planning. Remaining time is utilized to address issues brought before the larger group. Task force members may hold additional meetings and gather information outside the regularly scheduled weekly sessions. Presenters and Steering Committee members are available to assist the task forces upon request. Presenters and Steering Committee members can also help with drafting the separate task force proposals.
Session 11 - The physical activity assessment and personal health screening, as mentioned in Session 2, is repeated. Task force reports are due this session.
Session 12 - Review results of the physical activity assessment and personal health screenings conducted in Session 11. Finalize task force recommendations and enjoy the final potluck.
Phase VI The Next Step - Form a Community Advisory Board After completing the 12-Week educational session, ask for and seek volunteers to remain with the project as members of a Community Advisory Board. This board will serve as a sounding group for the intricacies of the campaign. They will become the champions of the campaign and be your eyes and ears in the community. It is important to keep the participants of the Community Health Participatory Planning Program regularly informed, even if they choose to not become members of the Community Advisory Board. If the planning sessions were as successful as you designed them to be, the former participants may be willing to help with a special project, act as an advocate at their school or workplace, offer to contact specific groups and individuals to start walking, or even just attend public health events. Community Advisory Board Activities Now that you have a well informed and committed group of individuals, you are ready to plan the campaign agenda. The board members may participate and assist in many different ways. They may:
Note: Some board members may not be willing to do campaign tasks themselves, but know others that will. Meetings The Community Advisory Board should meet at least quarterly between the end of the planning process and the implementation of the eight-week mass media campaign. The group should schedule a meeting prior to the campaign Kick Off and a wrap-up meeting after the campaign. If data is being collected, schedule a final results meeting to update the board of the findings. Schedule this meeting after data collection and analysis. Other Responsibilities During the campaign, the board serves as the key group of participants. They continue to promote policy and environment changes and attempt to attend all events. Invite the board to attend all campaign events, participate in walking efforts at their worksite and church, and alert you to media and newsletter possibilities. Recognize them as Walking Campaign Community Advisory Board Members whenever you can. Note: This meeting can be held in conjunction with a campaign results press conference for the media. Top Job Description of CHPP Coordinator
Work 10 hours a week for 16 weeks, or 160 hrs. Paid $15/hr. or $20/hr. if trained at Masters-level $15/hr. x 160 hrs. = $2,400 $20/hr. x 160 hrs. = $3,200 Tasks
1. U.S. Department of Health and Human Services. Physical Activity and Health: a Report of the Surgeon General. Atlanta, Ga.: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, 1996. 2. NIH Consensus Development Panel on Physical Activity and Cardiovascular Health. Physical activity and cardiovascular health. JAMA 1996; 276:241-246. 3. Pate RR, et al. Physical Activity and Public Health: a Recommendation from the Centers for Disease Control and Prevention and the American College of Sports Medicine. JAMA 1995;273;402-407. 4. Fletcher, et al. Statement on Exercise: Benefits and Recommendations for Physical Activity Programs for all Americans. American Heart Association. Circulation 1996;94:857-862. 5. McGinnis JM, Foege WH. Actual causes of death in the United States. JAMA1993; 270:2207-2212. 6. West Virginia 1998 Behavioral Risk Factor Survey. WV DHHR, Bureau for Public Health, Office of Epidemiology and Health Promotion. April, 2000. 7. Glasgow RE, McCaul KD, Fisher KJ. Participation in worksite health promotion: a critique of the literature and recommendations for future practice. Health Edu Q 1993;20(3): 391-408. 8. Heaney C, Israel B. Social networks and social support. In: Glanz K, Lewis FM, Rimer BK, Eds. Health behavior and health education: theory, research, and practice (2nd Ed.). San Francisco, CA: Jossey-Bass Publishers, 1997. 9. Purdey AF, Adhikari G B, Robinson SA, Cox PW. Participatory health development in rural Nepal: clarifying the process of community empowerment. Health Edu Q 1994;21:329-343. 10. Wallenstein N, Sanchez-Merki V, Drew L. (1999) Freirian Praxis in Heath Education and Community Organizing. In M. Minkler (Ed.), Community Organizing and Community Building. New Brunswick, NJ: Rutgers University Press, p. 195-211. Glasgow, et al., 1993 11. Green LW, and Kreuter MW. 3rd Edition. Health Promotion Planning: an educational and Ecological Approach. Mountain View, CA: Mayfield Publishing Company. 1999. 12. Reger B, Cooper L, Booth-Butterfield S, Smith H, Bauman A, Wootan M, Middlestadt S, Marcus B, Greer F. WHEELING WALKS: A Community Campaign Using Paid Media to Encourage Walking among Sedentary Older Adults. Prev Med Sept 2002;35:285-292. 13. Baker EA, Israel BA, Schurman SJ. A participatory approach to worksite health promotion. J Ambul Care Manage 1994;17(2):68-81. 14. Palank CL. Determinants of health-promotion behavior: a review of current research. Nurs Clin North Am 1991;6(4):815-832. 15. Stange KC, Strecher VJ, Schoenbach V J, Strogatz D, Dalton B, Cross AW. Psychosocial predictors in a worksite health promotion program. J Occup Med 1991;33(4):479-485. 16. Stange KC, Strogatz D, Schoenbach VJ, Shy C, Dalton B, Cross
AW. Demographic and health characteristics of participants and
nonparticipants in a worksite health promotion program. J Occup
Med 1991;33(4):474-478. CHAPTER 3 Appendices
Behavior Risk Factor Survey Questions Please place the last four digits of your social security number as a confidential identification:_________
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