Public program planning

Similar to clinical care, public health programs have to follow the process of care
Assessment, Diagnosis, Planning, Implementation, Evaluation (ADPIE). However, the
terminologies used in public health are slightly different.

Program planning process in the Dental hygiene process of care in

community clinical practice
Needs assessment (identifying the primary Assessment/ Examination
issue) Diagnosis

Program planning Treatment planning

Program implementation Implementation/ Treatment

Program evaluation Evaluation/ Treatment evaluation

1. Needs Assessment (Identifying the primary issue):

To better understand a health problem, you should review population health data to
identify morbidity rates, incidence, and prevalence of the disease. By reviewing
surveillance data, survey results, health records, and other data sources, you can also
obtain information about the distribution of the health problem in terms of person, place,
and time, as well as the risk factors.
But what if there is no data to describe the needs of the population? Well, you will have
to create your own. You may learn about the health problem and health status of the
community by meeting with or surveying community members, leaders, and
stakeholders. Through focus groups, surveys, and/or interviews, you may ask them their
opinion about:

• The importance of the health problem

• Who is affected by the health problem?
• Why the health problem exists?
Always keep in mind the definition; assessment is an organized and systematic approach
to identify a target group and to define the extent and severity of oral health needs
present. Different tools can be used to assess the needs. Examples include surveys,
interviews, focus groups, clinical exams, screenings, or a combination of all of them.
The results of your assessment can be presented to stakeholder, decision-makers, and
staff member to communicate the needs. In other words, you are expressing why
something should be done about this. Remember, visuals are very effective in
communicating numbers (bar charts, pie charts, etc.)
Realistically, not all the needs assessed can be addressed. However, prioritizing the needs
will ensure the effectiveness of the program. Prioritization can be decided by asking a
series of questions:

• What is the health problem?

• Who is being affected?
• How much of the population is affected?
• When did the problem occur or when was it identified?
• Where is this problem located?
After assessing and analyzing health data needs, you will write a health problem
statement that describe what is the health problem, who is being affected, how much of
the population is affected, when did the problem occur (or when was it identified), and
where is the problem located.
Use the health problem statement to plan the program.
2. Program Planning
Planning is an organized response to reduce or eliminate one or more problems. It is
arguably the most important steps in the process as it involves setting the core basis for
how the program will look like. A poor planning will set up for a potential failure.
“If you don't know where you are going, you'll end up someplace else.” ― Yogi Berra
“By failing to prepare, you are preparing to fail.” ― Benjamin Franklin
“Give me six hours to chop down a tree and I will spend the first four sharpening the
axe.” ― Abraham Lincoln
Steps involved in the program planning include but not limited to the following a)
creating goals, objectives, lesson plan (work plan), b) identifying the available tools and
resources, c) selecting the appropriate intervention, and d) choosing the evaluation
method.
a) Creating goal(s), objectives, work plan/ lesson plan /program activities:
Goals provide a broadly-based statement of what changes will take place, from which
specific objectives are developed.
Objectives are more specific than goals; they describe in a measurable way the desired
end result of program activities. An objective that monitors progress of a program should
contain five elements. To help remember these elements, the acronym SMART is used.
 SMART Description
S Provides the “who” (target population and persons doing the activity) and
the “what” (action/activity).
Uses only one action verb since objectives with more than one verb imply
that more than one activity or behavior is being measured.
M Specifies “how much” change is expected.
Remember: It is impossible to determine whether objectives have
been met unless they can be measured.
A Can be attainable within a given time frame and with available program
resources.
R Accurately addresses the scope of the problem and programmatic steps that
can be implemented within a specific time frame.
T Specifies a time frame indicating when the objective will be measured or a
time by which the objective will be met.

The work plan/lesson plan /program activities are outlines of a set of goals and processes
by which a team and/or person can accomplish those goals and offering the reader a
better understanding of the scope of the project. Many templates for work plans exist.
Below is just one example.

Work plan
Objective(s) to be addressed:
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________

Task Person Resources Time Due date Date

responsible used estimate completed

b) Identifying the available tools and resources:

Now that you know where you are headed (program goals and objectives), the
incremental steps you need to take to get there (objectives), and the obstacles that might
get in the way, you are ready to develop an intervention.
This involves four main tasks:
 • Determining a health strategy
• Researching existing evidence-based interventions
• Comparing interventions
• Selecting an intervention to adapt or create

c) Selecting the appropriate intervention:

Based on the available resources, a comparison between the potential interventions will
be done to choose the most appropriate one. Some of the criteria used to compare
programs are:
a) Feasibility
b) Acceptance/ Compatibility
c) Cost
d) Organization capacity (i.e. setting, physical facilities, personnel)
e) Effectiveness
Additional criteria might be used to compare interventions. A table like the one below to
help with this comparison.

Criteria Option A Option B Option C

Feasibility
Acceptance/Compatibility
Cost
Organizational Capacity
(i.e. setting, physical
facilities, personnel)
Effectiveness

The benefits for all the options are compared to choose the best possible option within
the given circumstances.
d) Developing the program Method of evaluation:
The final step of planning involves the choice of the appropriate evaluation method.
Ultimately, some sort of evaluation has to be performed. Otherwise, the success of the
program cannot be objectively decided Evaluation is measuring the actual – what is really
happening – and comparing it to the intended – what we want to happen.
During the planning process, you will plan for evaluation by considering the following:

• Do you have the resources to do an evaluation?

• What component of the program will you evaluate?
 • What do you want to know about your program? For example, do you want to
learn whether all the activities were implemented as planned? • When will you
evaluate the program? For example, will you evaluate the program one year after
implementation, several years after implementation?
• What type of data will you need to address the evaluation questions?
• What type of evaluation (formative, summative, or both)?

3. Program implementation
Implementation includes the process of putting the plan into action. If things were
planned properly, things should go smoothly during the implementation phase.
4. Program evaluation
A judgment of merit or worth of the program. It is done by measuring the results of the
program against the objectives developed during the planning stage. This process is
ongoing and should identify problems and solutions to assist in revising the program as
needed (Program outcomes vs Program objectives).
Self-reflection is a critical component of program evaluation where it allows the program
administrators gain the most out of their experience. The purpose of self-reflection is to
improve the quality of the project if was to be done in the future. Some of the examples
include:

• What was the overall impression about the program?

• What went super well and awfully bad?
• What could be done in the future to improve the bad points and maintain the
good ones?
• If I would to repeat this program again, what could be possibly changed to
improve the outcome?
Case study
You were assigned as the public health dental hygienist in a rural community in Ontario.
During the visit to one of the grade schools, you learned from the instructors that the
students are frequently missing days from school due to sick days/dental visits. Previous
data from the municipality reveals that it was labelled as a high caries risk school due to
the high prevalence of tooth decay among the children. The school resides in a local
community where water fluoridation practices are not implemented. In addition, the
vending machines in the school have options that are sugar dense. The school buildings
are old with little to no renovations and the only physical facilities available are a medical
room and sinks with running water. However, due to funding cuts, only $5,000 were
available/school. Your team consists of a group of 5 hygienists, 2 nurses, a dentist and the
volunteering efforts of the teachers in the school.
You decided on doing an intraoral exam in addition to a survey sent out to the parents.
The exam reveals a prevalence of decay of 50%, the average dT+DT is 4 and majority of
the parents responded having no dental insurance and relying on low income dental
program (Health Smiles Ontario) to provide their children will the necessary dental care.
In the light of the discussed oral health program planning, develop a comprehensive
program.