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Columns: Clinical Applications

Using a Health Promotion Program Planning Model to Promote Physical Activity and Exercise

King, Kristi M. Ph.D., CHES; Hartson, Kimberly Rapp Ph.D., R.N.

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ACSM's Health & Fitness Journal: March/April 2020 - Volume 24 - Issue 2 - p 43-48
doi: 10.1249/FIT.0000000000000552
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Physical activity and exercise are priorities for health and fitness professionals. It behooves professionals to use a program planning model to clearly outline the program’s mission, goals, and objectives. Throughout the scientific literature, program planning models have been used as a foundation to test the efficacy of physical activity and exercise programs. Program planning models guide health and fitness professionals through a process of strategically assessing the needs of the priority population, carefully planning appropriate interventions, executing the planned interventions, modifying the plan if necessary, and evaluating the immediate, short-term, and long-term efficacy of the program. In addition, using such a clear, organized framework for reference during the planning and implementation of an intervention ensures tangible products/outcomes for presentation to key stakeholders. Therefore, the purposes of this Clinical Applications column are to describe the steps in a Generalized Program Planning Model (GPPM) as explained by McKenzie et al. (1), to give examples of how to operationalize these steps and to incorporate best evidence in the promotion of physical activity and exercise interventions.

GENERALIZED PROGRAM PLANNING MODEL

Using the GPPM for health promotion programming (see Figure 1) (1), a health and fitness professional can organize interventions to promote physical activity and exercise. The program planning steps include assessing the needs, setting goals and objectives, developing an intervention, implementing the intervention, and evaluating the results.

Figure 1
Figure 1:
Generalized program planning model for health promotion programming (1).

STEP 1: ASSESSING THE NEEDS

Health and fitness professionals must understand the actual (or perceived) needs of their priority population (e.g., sedentary women, older men, etc.) that affect their health directly or indirectly. The following steps and examples for conducting a needs assessment have been adapted for use for health and fitness professionals from the responsibilities and competencies for Health Education Specialists (2):

  1. Develop a simple plan outlining the types of information to gather about the priority population’s needs (e.g., weight loss, increased strength, type 2 diabetes prevention).
  2. Access relevant existing national or local information and data related to health and fitness (e.g., percentage of population physically inactive).
  3. Collect individual data from members of the population (e.g., fitness testing a small sample of women in a potential intervention).
  4. Analyze relationships among behaviors (e.g., physical inactivity), environment (e.g., lack of sidewalks), and other factors that influence health (e.g., family support).
  5. Examine factors that influence the learning process of the priority population (e.g., college students may prefer technology-based programs, and older adults may prefer in-person or group programs).
  6. Examine the factors that enhance or impede engagement in physical activity/exercise by the priority population (e.g., what resources such as gyms or access to personal trainers are available and affordable).
  7. Determine the needs of the priority population, based on the findings of the needs assessment (e.g., because of the prevalence of hypertension among low-income women in the specified zip code and limited access to exercise facilities, a free family-based dance program with childcare will be offered in the mornings at the local library).
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STEP 2: SETTING GOALS AND OBJECTIVES

To effectively plan, implement, and evaluate physical activity and exercise programs, health and fitness professionals must strategically develop a mission statement, goals, and objectives (1). A mission statement describes the purpose and breadth of the program. For example, a mission statement for a worksite-based fitness program may be as follows:

  • The purpose of the Work-well Fitness Program is to engage, support, and inspire employees in the care of their health. We strive to provide a variety of educational, supportive, and easily accessible wellness and fitness programming to meet your needs.

Once an inclusive mission statement is agreed upon by key stakeholders (e.g., managers, employees, individuals, and teams who offer or support programs), determining goals and objectives must ensue. Goals are broad statements that describe the desired results, including the expected direction of change in the outcomes of interest. Examples of goals for new clients at a gym may be as follows:

  • To improve fitness outcomes
  • To increase physical activity
  • To decrease percent body fat
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Typically, only one or two goals are necessary because they are generally encompassing of multiple positive health outcomes. Next, corresponding objectives should be developed for each goal. These objectives will help determine if each goal is met or not. The objectives must be specific, measurable, attainable, realistic, and time sensitive (SMART). It is very important to set challenging yet realistic objectives. For example, although a health and fitness professional may wish for clients to improve all fitness outcomes, a realistic ideal may be to improve in three of five outcomes (e.g., cardiovascular, muscular strength, muscular endurance, flexibility, or body composition). There are three main types of objectives: process, impact, and outcome. Process objectives refer to the tasks and activities that are required on a daily basis to achieve the impact and outcome objectives. Impact objectives are focused on the immediate effects of a program and also may include learning, behavioral, and environmental objectives. Lastly, outcome objectives are focused on the final health and fitness outcomes (1). Although health and fitness outcomes are the main purposes of the program, including learning, behavioral, and environmental objectives may facilitate the achievement of health and fitness outcomes in the future. For example, a client learning about health and fitness (learning objective) and engaging in healthy behaviors may purchase a park access pass (environmental objective) and go hiking on an outdoor trail. Although gaining access to parks and hiking trails will not elicit immediate improvement in cardiorespiratory fitness (outcome objective), achieving this impact objective may set up the client for potential success in the future, if continued (see Table 1).

TABLE 1
TABLE 1:
Types of Objectives, Targeted Outcomes, and SMART Objectives

STEP 3: DEVELOPING AN INTERVENTION

The intervention should follow from the assessed needs, mission statement, goals, and objectives. When planning the intervention, remember to regularly revisit the goals and objectives to ensure that the program stays true and focused on the original purpose. Although this process is presented in a linear fashion, planning the intervention often unveils logistical problems and new ideas arise. It may be necessary to revise the mission statement, goals, and objectives to ensure that they all flow together as one large strategic plan to address the assessed needs.

When developing an intervention, it can be helpful to consider how an individual’s health behavior is influenced by the surrounding context and environment (3). A variety of personal, peer, family, social, sociocultural, organizational, community, policy, and physical environmental factors can positively or negatively influence a person’s engagement in physical activity (4,5). These factors can be organized as a framework called an ecological model. In fact, the 2018 Physical Activity Guidelines Advisory Committee recently conducted a systematic review of physical activity interventions and concluded that the most effective interventions addressed multiple social ecological levels (i.e., individual, community, communications environment, and physical environmental and policy), were based on behavior change theories, and were implemented in different settings throughout the community (6) (Table 2). Research indicates that interventions are most effective when they operate on multiple levels and account for the four domains of physical activity that contribute to “active living,” including active recreation, household activities, occupational activities, and active transportation (7).

TABLE 2
TABLE 2:
Socioecological Level and Physical Activity Intervention Strategies and Approaches (6)

STEP 4: IMPLEMENTING THE INTERVENTION AND ORGANIZING RESOURCES

When implementing an intervention, developing and adhering to a logic model is a systematic and visual way for planners to share and present their understanding of the relationship among the resources they have to operate a program, the activities they plan to implement, and the outcomes they expect (1). For example, the implementation of an effective physical activity and exercise intervention requires organization among appropriate allocation of human, curriculum, fiscal, technical, location, equipment, supplies, and time resources; securing external funding through community grants or businesses; gaining approval/support from key stakeholders and/or decision makers; and training staff members or volunteers. In addition to using a logic model as a road map to keep the intervention organized and “on track,” a visual chart of the projected timeline for planners to know what to do and when is also useful (Table 3). The following logic model and projected timeline not only help the program team stay organized, they also can be presented when pitching the project to potential supporters, collaborators, and key stakeholders (Figure 2). For example, it may be useful when attempting to gain support from health care organizations in agreeing to allow an ACSM Certified Exercise Physiologist® (ACSM-EP) to present the Exercise is Medicine® initiative to medical offices. In addition to these options, there are also several commercially available project trackers created for the business industry that can be helpful in tracking and visually representing progress of the program.

TABLE 3
TABLE 3:
Projected Timeline
Figure 2
Figure 2:
Logic model.

STEP 5: EVALUATING THE RESULTS

Evaluation of the program once again takes us back to the goals and objectives set for the program. Data and information to evaluate the objectives are collected on an on-going basis and at the completion of the program, depending on the objective. Sometimes it is necessary to make adaptations to the plan and program when challenges arise. To determine if program goals were met, evaluate each of the processes, impacts (learning, behavioral, and environmental), and outcome objectives. If each objective is written in SMART terms, program evaluation can be simple. For example, the following behavioral objective can be evaluated:

  • During participation in the 4-week fitness walking program, 80% of the participants will use the online platform to report engaging in walking at least five times per week.

The evaluation consists of calculating the percentage of participants of the fitness program who used the online platform to report engaging in walking at least five times per week during the 4-week fitness walking program, and then determining if the percentage is more or less than the 80% target. A health and fitness professional can definitively report to key stakeholders whether each of the program objectives were met. Further, if objectives were not met, the health and fitness professional has a clear foundation from which to make data-driven, strategic recommendations for future interventions. It is often helpful to key stakeholders to see visual representations of the results and key findings for each objective, for example, providing a table, a chart, or a graph that shows the percentage of participants in the fitness program who reported walking at least five times per week compared with the percentage of participants who did not report walking at least five times per week (see Figure 3).

Figure 3
Figure 3:
Pie chart results.

Lastly, once the results have been tallied and analyzed, a well-written narrative summarizing the findings should be written. Below is an excerpt from the results of a school-based intervention that was implemented in rural, public elementary schools:

  • “A total of 999 kindergarten to third grade children participated in data collection consisting of 4-day pedometer tracking and previous-day fruits and vegetables consumption recall from baseline in January 2011 through 12 follow-up assessments ending May 2013 … Children’s nutrition and physical activity behaviors significantly improved over the 3-year intervention … The percentages of children who met the nutrition recommendation increased from 11% to 23% for girls and 12% to 23% for boys, while the percent who met the physical activity recommendation increased from 1% to 16% for girls and 3% to 7% for boys. This school-based intervention could be disseminated to promote healthy behaviors among rural disadvantaged children” (8).

CONCLUSION

Health and fitness professionals can become integral partners within a variety of community, clinical, or school-based sectors given that they have the knowledge, attitudes, skills, experience, and credentials necessary to develop, implement, and evaluate evidence-based physical activity programs as well as conduct exercise testing and prescription (9,10). Using a program planning model to guide the process of conducting a needs assessment, setting goals and objectives, developing an intervention, implementing the intervention, and evaluating the program results will help keep the program planners organized and on track, as well as assist in communicating the strategic plan and progress to gain and maintain support of key stakeholders.

References

1. McKenzie JF, Neiger BL, Thackeray R. Planning, Implementing, and Evaluating Health Promotion Programs: A Primer. 7th ed. San Francisco (CA): Pearson; 2017.
2. National Commission for Health Education Credentialing, Inc. A competency-based framework for health education specialists: areas of responsibilities, competencies, and sub-competencies for health education specialists—2015. 2015; [cited 2019 October 4]. Available from: https://www.nchec.org/responsibilities-and-competencies.
3. McLeroy KR, Bibeau D, Steckler A, Glanz K. An ecological perspective on health promotion programs. Health Educ Q. 1988;15(4):351–77.
4. National Institutes of Health. Developing interventions for health-enhancing physical activity (R21/R33 — clinical trial optional) — PAR-18-307 research project Grant. 2017; [cited 2019 Nov 3]. Available from: https://grants.nih.gov/grants/guide/pa-files/PAR-18-307.html.
5. King KM, Gonzalez GB. Increasing physical activity using an ecological model. ACSMs Health Fit J. 2018;22(4):29–32.
6. King AC, Whitt-Glover MC, Marquez DX, et al. Physical activity promotion: highlights from the 2018 Physical Activity Guidelines Advisory Committee systematic review. Med Sci Sports Exerc. 2019;51(6):1340–53.
7. Sallis JF, Cervero RB, Ascher W, Henderson KA, Kraft MK, Kerr J. An ecological approach to creating active living communities. Annu Rev Public Health. 2006;27:297–322.
8. King KM, Ling J. Results of a 3-year, nutrition and physical activity intervention for children in rural, low-socioeconomic status elementary schools. Health Educ Res. 2015;30(4):647–59.
9. King KM, Jaggers JR, Wintergerst K. Strategies for partnering with health care settings to increase physical activity promotion. ACSMs Health Fit J. 2019;23(4):40–3.
10. McClary King K, Terson de Paleville D. Partnering with schools to implement physical activity interventions. ACSMs Health Fit J. 2018;22(2):38–41.
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