Discussion: Evaluation in Programs

Initial Analysis for Program Planning

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University

Evidence Based Practice I: Assessment and Design

December 23, 2018

Initial Analysis for Program Planning

Breast cancer is a common type of cancer affecting women in the whole world, and in the United States, it is one of the most leading causes of cancer death (The American Cancer Society, 2012). Irrespective of the significant improvements made in breast cancer detection, diagnosis as well as prevention, the American Cancer Society (2012) indicated that black American women are still unequally affected by breast cancer. White women have a 90 percent five-year survival white African Americans have a five-year survival rate of 78 percent, which is lower than that of other races as well as ethnic groups in America (The American Cancer Society, 2012). Therefore, there is a need for a new plan of action and methods to advocate for the prevention of breast cancer, decrease its mortality, as well as enhance survival rate among Black American women. The purpose of this paper is to establish an initial analysis for program planning and needs assessment of the issue of the breast cancer in black American women in the United States of America

Problem Identification and Target Population

Compared with Caucasian female, black American women have increased mortality rates and are more likely to be diagnosed with the disease prior the age of 40 years. Breast cancer incidence and mortality rates trends demonstrate varying patterns among different races. Whereas African American females have a lesser lifetime risk of suffering from cancer of the breast, they have an increased mortality rate than white American women (Allicock, Graves, Gray & Troester, 2013). Greater breast cancer-related deaths are occurring among black American women with nearly 33 percent higher risk of loss of loss due to breast cancer than white American females. A recent report showed that black American females with cancer of the breast have a poorer prognosis when compared to white women that were diagnosed at the same age and stage (Yedjou et al., 2017). Discussion: Evaluation in Programs

Social Cognitive Theory for African Women with Breast Cancer

The social cognitive theory utilizes several concepts associated with behavioral change. First, there is self-efficacy concept which is a belief that people have the ultimate control over their health and can do whatever they want. Second, there is the expectation concept which focuses on the behavioral change outcome (Hodges & Videto, 2011). For instance, a patient must go for regular checkups to keep her health in check and at the required standard. Self-control is another important concept of the social cognitive theory. This provides patients the autonomy as well as total control over their behavior change. Most importantly, African American can, through observational learning, observe whatever white women are doing to increase their survival rates. Finally, it is possible to reinforce the theory using incentives like free checkups as well as rewards for every patient who regularly visits the hospital for checkups (Hodges & Videto, 2011).

Social cognitive theory is appropriate for assessing the problem of breast cancer among Black American women. This is because the theory focuses on the effect of individual experiences, other peoples’ activities and actions as well as environmental aspects on the behavior and health status of the affected population. This is made under the consideration that breast cancer is treatable but can also be fatal if advanced. Also, the social cognitive theory offers support in a social context by installing self-efficacy expectations and utilizing observational, and other reinforcements to achieve the desired behavioral change and perception (Hodges & Videto, 2011).

Literature Review

The phenomenon of higher cancer of the breast mortality among black American females in the America involves various factors. Black American females are more prone to suffer from the cancer of breast at an early age, to get the diagnosis at a later disease stage as well as to die from breast cancer than other women of other racial groups (Karcher et al., 2014). For more than four decades, the United States has witnessed an expansion in the five-year relative survival rate for breast cancer for both white and black American females. In any case, there is as yet a significant racial distinction with new data revealing that the 5-year survival rate for black American and Caucasians women is standing at 79 percent and 92 percent, respectively (Coughlin, 2015). Discussion: Evaluation in Programs

The contrast in survival rate is because of the diagnosis at a later stage as well as poorer stage-specific survival rates amid black American females (Coughlin, 2015). It is believed that various factors, both biological and non-biological, contribute to the higher mortality rate among African American women. Some of the biological factors include more treatment-resistant tumors as well as more aggressive histology. The common non-biological factors are access to care and attitudes about seeking care (Daniel et al., 2018). Given that the non-biological factors are more mutable compared to biological factors, there is a need to develop proactive measures to address the increasing mortality rates among African American women (Daniel et al., 2018).

Efforts to prevent breast cancer-related deaths have focused on various risk factors like the promotion of physical activity, reduced alcohol consumption, taking of balanced diet as well as early detection through regular mammography (Albuquerque, Baltar & Marchioni, 2014). In as much as, recent data from a national survey in the United States show that black American females are as unlikely as white females to have had mammograms in the recent past, some patient locations and geographical localities still have some black-white disparities in mammogram rates as well as referrals for breast cancer evaluation and detection. These are caused by socioeconomic factors like family income as well as educational attainment (Coughlin, 2015). Discussion: Evaluation in Programs

Cancer of the breast screening rates are low amid low-income, uninsured as well as underinsured households which lead to higher mortality rates due to breast cancer among these populations (Coughlin, 2015). Another issue is of some Black American females having misconceptions about breast cancer etiology, about their risk factors of breast cancer as well as barriers to receiving timely screening and treatment (Yedjou et al., 2017). Black American women who are at risk are unlikely than their white counterparts to be aware of the present guidelines as well as recommendations related to preventive measures (Coughlin, 2015).

Needs Assessment

Needs Assessment Approach

Monsen et al.’s Problem-Analysis Framework will be used to identify the needs of black American females in reducing mortality rates due to breast cancer. According to Annan et al. (2013), Monsen et al.’s problem analysis framework of 2008 focuses on clear conceptualization and clarity of facts to provide focused interventions. The framework is divided into five major phases, with phase 1 requiring therapist and researchers to focus on the background information, role as well as expectations. In phase 2, there is a need to prepare the initial guiding hypothesis for the problem under study. Phase 3 is about identifying the problem dimensions, and phase 4 is about the preparation of an integrated conceptualization. In phase 5, a researcher or a therapist must prepare an intervention plan and implementation strategy. Finally, phase 6 is about monitoring as well as the evaluation of actions and outcomes.

Method of Data Collection

The data collection methods that will be used for the study include questionnaires and interviews. The questionnaires will be in print and electronic form depending on the convenience of the respondents. The importance of allowing for flexibility so to allow the respondents to choose the type channel through which they can respond to the questions is that the respondents may be busy in income-generating or any other activities and as such, may have limited time to answer the questionnaires (Derguy et al., 2015). Thus, electronic questionnaires will allow for convenience since busy respondents can answer the questions at their free time in their mobile phones, tablets, or PCs. The questionnaires will contain semi-structured-open-ended questions to allow for flexibility and respondents’ free expression. Apart from the questionnaires, face-to-face and telephone interviews will also be conducted depending on the respondent’s convenience. Respondents who will have enough time at their disposal: those who are confident will take face-to-face interviews whereas those who are busy, shy, or value their privacy will take telephone interviews.

Potential Challenges and Possible Solutions

The possible challenges that will be encountered during the data-gathering process are poor cooperation by the respondents. This is because the study deals with breast cancer, which is a sensitive subject among women. Besides, there may be fears of ethical and privacy issues by the respondents in which they may believe that their health information and identities can be exposed in the study, which can significantly reduce the turnout and cooperation of disclosure of accurate information by the respondents. Different distant data-collection options will be provided such as online questionnaires and telephone interviews to increase the likelihood of cooperation. Ethical and privacy issues will be solved by involving community stakeholders and assuring the respondents of maximum privacy since their real names will not be used. Discussion: Evaluation in Programs

References

Albuquerque, R. C., Baltar, V. T., & Marchioni, D. M. (2014). Breast cancer and dietary patterns: a systematic review. Nutrition reviews, 72(1), 1-17. https://doi.org/10.1111/nure.12083.

Allicock, M., Graves, N., Gray, K., & Troester, M. (2013). African American women’s perspectives on breast cancer: Implications for communicating the risk of basal-like breast cancer. Journal of Health Care for the Poor and Underserved, 24(2), 753–767. Doi: 10.1353/hpu.2013.0082.

American Cancer Society. (2012).Cancer facts and figures for African Americans 2011–2012. Atlanta, GA: American Cancer Society. Retrieved from: https://www.cancer.org/research/cancer-facts-statistics/cancer-facts-figures-for-african-americans.html

Annan, M., Chua, J., Cole, R., Kennedy, E., James, R., Markúsdóttir, I., … & Shah, S. (2013). Further iterations on using the Problem-analysis Framework. Educational Psychology in Practice, 29(1), 79-95. DOI: 10.1080/02667363.2012.755951

Coughlin, S. S. (2015). Intervention approaches for addressing breast cancer disparities among African American women. Annals of Translational Medicine & Epidemiology, 1(1), 1-12. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4283773/

Daniel, J. B., Gaddis, C. L., Legros, J. R., Bennett, M. D., & Turner, N. C. (2018). Breast Cancer Knowledge, Beliefs and Screening Practices among African American Women in a Rural Setting: A Pilot Study. International Journal of Health Sciences, 6(1), 29-38. DOI: 10.15640/ijhs.v6n1a3

Hodges, B. C., & Videto, D. M. (2011). Assessment and planning in health programs. (2nd ed.). Sudbury, MA: Jones & Bartlett Learning.

Karcher, R., Fitzpatrick, D. C., Leonard, D. J., & Weber, S. (2014). A community-based collaborative approach to improve breast cancer screening in underserved African American women. Journal of Cancer Education, 29(3), 482–487. Doi: 10.1007/s13187-014-0608-z.

Yedjou, C. G., Tchounwou, P. B., Payton, M., Miele, L., Fonseca, D. D., Lowe, L., & Alo, R. A. (2017). Assessing the racial and ethnic disparities in breast cancer mortality in the United States. International Journal of Environmental Research and Public Health, 14(486), 1-14. Retrieved from: https://doi.org/10.3390/ijerph14050486

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Program Design Elements

Name

University

Evidence Based Practice I: Assessment and Design

January 6, 2019

Program Design Elements

A program is only successful when it does not only achieve its objectives but also meets or exceeds stakeholders’ expectations. It is the stakeholders who take responsibility of ensuring that a project reaches its goals. They remain accountable and sacrifice their time and resources for the good of the project. The success of a project depends on the involvement of all key stakeholders. Some of the familiar stakeholders include the community, the government, organizations, project managers and project sponsors (Kettner, Moroney & Martin, 2017). This paper discusses the importance of involving community members and organizations in the process of developing goals and objectives for a breast cancer awareness program among African American women. Discussion: Evaluation in Programs

Stakeholder Involvement

Importance of Involving Representatives in Goal Development

Involvement of representatives in goal development is a vital process that ensures the needs and expectations of the target population are catered for in the project (Hodges & Videto, 2011). There are various benefits associated with the involvement of representatives in the process of developing goals and objectives for the breast cancer awareness program for the selected population. It is undeniable that engaging the representatives can lead to the accommodation of local agendas within the local and national programs that aim at reducing breast cancer among African American women. Discussion: Evaluation in Programs

Consideration of the stakeholders’ needs and interests throughout the evaluation process is critical to productive development of interventions. Representatives can play a major role in the process of goal development of programs targeted at African American women who have breast cancer. Given that many campaigns and communication efforts are complex and sophisticated, stakeholders normally help in identifying the right objectives and ensuring that the outcomes are utilized to make a difference (Hodges & Videto, 2011). Stakeholders are much more likely to not only support the program assessment but also act on the program’s outcomes. Their involvement ensures that the suggestions and areas of differences are solved throughout the development process which in turn has the benefits of preventing conflicts or sabotage of the entire project.

Stakeholders Involved in the Program Planning Process

The community is one of the relevant stakeholders who will be involved in the program planning process. Soong et al. (2015) asserted that community members have the responsibility of identifying and evaluating problems that are healthcare oriented and solve them amicably. The efforts directed at solving such problems must also accommodate the possible barriers to the solutions. Breslau et al. (2015), in their support, indicated that the community solution to health problems start from the activities of the community members which implies that African-American women community can solve the problem if they are involved right from the initiation phase of the project to its implementation phase.

Other than the community, organizations will also be involved in the program planning process because organizations can provide technical, financial and mobilization assistance as well as media sponsorship for successful implementation of the breast cancer awareness program among African American women. Kettner, Moroney, and Martin (2017) asserted that organizations could financially sponsor the logistics and planning activities of a health awareness program. Media organizations can enhance program implementation by advertising the program, broadcasting radio and television jingles as well as granting interviews. Government agencies and local partners can provide technical and mobilization support. These initiatives can play significant roles in influencing African American women’s perception of breast cancer awareness and prevention. Discussion: Evaluation in Programs

How Representatives can be Involved

Various strategies can be used to undertake stakeholder engagement for breast cancer programs among African American women. Some methods, according to O’Haire et al. (2012) include partnership, participation, consultation, and push communications as well as pull recommendations. Partnership programs entail establishing shared accountability and responsibility with stakeholders. Fawcett and Ellenbecker (2015) indicated that partnership involves close cooperation and information sharing. It should also require an engagement method in which part of the team is included in the delivery of tasks or with the responsibility for a specific area. This method is characterized by the establishment of limited ways of sharing responsibilities. In conference strategy, stakeholders participate, but team members are not accountable and cannot influence anything outside of consultation boundaries.

Push communication strategy is a one-way stakeholder engagement mechanism. When using push communications, organizations can spread a message across all stakeholder groups. This medium can alternatively be directed specific individuals with the utilization of communication channels like social media, emails, podcasts and broadcast media (O’Haire et al., 2012). Furthermore, they can use the nominal group technique. Stakeholders ideas and views can be obtained through a nominal approach that is free of interference and threats (O’Haire et al., 2012). The method enhances creativity and open sharing of information.

Every individual in the group has the freedom to share and learn new ideas. Stakeholders can choose the proposed ideas. This approach aims at promoting open communication of views and a listing of predetermined needs from stakeholders in non-hierarchical discussion forums (O’Haire et al., 2012). This form of engagement aims at structuring discussions when groups are having problems in reaching universal agreement on complex issues. Discussion: Evaluation in Programs

Program Design Elements

Program Mission, Goals, Objectives and Activities

Program Gantt Chart

References

Breslau, E. S., Weiss, E. S., Williams, A., Burness, A., & Kepka, D. (2015). The implementation road: Engaging community partnerships in evidence-based cancer control interventions. Health Promotion Practice, 16(1), 46-54. https://doi-org.ezp.waldenulibrary.org/10.1177/1524839914528705

Fawcett, Jacqueline, and Carol Hall Ellenbecker. “A proposed conceptual model of nursing and population health.” Nursing outlook 63, no. 3 (2015): 288-298. https://doi.org/10.1016/j.outlook.2015.01.009.

Hodges, B. C., & Videto, D. M. (2011). Assessment and planning in health programs (2nd ed.).

Sudbury, MA: Jones & Bartlett.

Kettner, P. M., Moroney, R. M., & Martin, L. L. (2017). Designing and managing programs: An effectiveness-based approach. (5th ed.). Thousand Oaks, CA: Sage

O’Haire, C., McPheeters, M., Nakamoto, E., LaBrant, L., Most, C., Lee, K., … & Guise, J. M. (2011). Engaging stakeholders to identify and prioritize future research needs. Methods Future Research Needs Reports, No.4. Retrieved from https://ezp.waldenulibrary.org/login?url=https://search.ebscohost.com/login.aspx?direct=true&db=mnh&AN=21977526&site=ehost-live&scope=site

Soong, C. S., Wang, M. P., Mui, M., Viswanath, K., Lam, T. H., & Chan, S. S. (2015). A “community fit” community-based participatory research program for family health, happiness, and harmony: Design and implementation. JMIR Research Protocols, 4(4). https://doi-org.ezp.waldenulibrary.org/10.2196/resprot.4369.

Program Budgeting and Financial Analysis

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University

Evidence Based Practice I: Assessment and Design

January 20, 2019

Program Budgeting and Financial Analysis

Every initiative requires financial resources, and that is why it is essential to prepare a budget for a program. A program project, at its core, is developed for a specific activity. It includes the revenue and the expenditure components for that particular project. Many organizations use program budgets for successful implementation of their initiatives. By listing all the sources of revenues and expenditures, it is possible to control all the financial activities in which a project takes part in (U.S. Small Business Administration, n.d.). Another important aspect in healthcare programs is financial analysis. Policymakers must perform financial analysis for effective allocation of resources and determination of economic benefits of a given initiative (U.S. National Library of Medicine, 2008). This paper discusses the budgetary requirements and cost-effectiveness of a breast awareness campaign among African American women in Baltimore County Maryland.

Program Budget

A functional budgeting system, which deals with the inputs and outputs of a program or a project is adopted for this breast cancer awareness program among African American women in Baltimore County Maryland. According to Kettner, Moroney, and Martin (2017) functional budgeting systems usually focus on management and are mainly concerned with a program’s efficiency and productivity. Because of its principal purpose, functional budgeting system is generally thought of as efficiency budgeting. The primary goal of this breast cancer awareness program is to increase awareness and enhance access to breast cancer screening as well as diagnosis among African American women. Like in any other budget, there are various sources of revenues and expenditure items for this program’s budget (see Table 1). Discussion: Evaluation in Programs

Table 1: Budget Line Items for Breast Cancer Awareness Program

A budget comprises of two principal sections: the revenue part and the expenditure part (Hodges & Videto, 2011). The total budget required for six months, from the start up to the completion of this campaign, is 1 million United States dollars. The program income membership contribution accounts for 10% of the total revenue. By organizing special events such as sporting activities, this campaign intends to raise 15,000 dollars, which is 15% of the total revenue. Program income from various activities like sales of branded shirts is expected to raise 30% of the total revenue. Government grants and contributions will account for 25% of the total revenue. From, third party payments such as nongovernmental agencies, this awareness campaign will raise $100,000 in revenues. Endowment income and other income will contribute 5% each to the total amount of financial resources required for successful implementation of this campaign. Discussion: Evaluation in Programs

These revenues will go toward development and distribution of educational materials, which will account for $100,000 of the entire budget. This medium is because there is a need to develop and distribute materials that are culturally appropriate to the African American population to realize the program’s goals and objectives. Also, it is important to organize educational workshops for trainers from which they can learn appropriate methods and techniques for spreading the program’s purpose to the target population. Also, it is important to arrange for educational workshops for community leaders and women groups from where they can be sensitized about the importance of breast cancer screening and diagnosis. This activity is expected to cost 23% of the entire expenditure. Trainers must also have one-on-one educational sessions with the most affected group for successful sensitization, and this will account for 7% of the total expenditure. Total salaries for the program’s director, two counselors, three training specialists, and four support services staff is $200,000 for the six months. There is a need to rent an office from where the administrative functions can be carried out. Other utilities like electricity and waters, transport and telephone are also important for successful implementation of the program. Office supplies like pens and books as well as equipment like personal computers and projectors are other essential requirements. Discussion: Evaluation in Programs

Break-Even Analysis

Dirubbo (2006) defined break-even as a point at which revenue is equal to expenditure. As such, the break-even point focuses on the minimum expectation for a program’s revenue. All revenues earned after break-even analysis point represent margin over profit. Conducting a break-even analysis is necessary to determine the break-even point for this breast cancer awareness program among black American women. Mathematically;

Break-Even Point = Fixed cost/Contribution margin

Contribution margin = sales price per unit- variable cost per unit.

For this campaign, 30,000 branded shirts will be sold at $10 each to raise revenue of $300,000

Out of the $1 million, variable cost is expected to account for 40% with the remaining 60% as fixed costs. The variable cost will be incurred on 100,000 program participants. Therefore;

Fixed cost = $600,000

Variable cost per unit = $400,000/100,000

=$4

Selling price per unit =$10

The Break-Even Point = $600,000/($10-$4)

= $100,000

Budget Variance

Sometimes budgets have variance when revenues do not match with the expenditures (Hodges & Videto, 2011). As for this program, a budgetary variance may arise if the sale of branded shirts does not meet the intended target of surpassing the intended number of 30,000 branded shirts. Also, failure to receive $250,000 in grants from the government may lead to a variance in the budget. An increase in the cost of developing and distributing educational materials may adversely affect the budget. A favorable variance may also arise if the cost of generating and distributing educational materials is lower than the budgeted figure of $100,000. Changes in economic performance may affect the prices of equipment such as personal computers, which may affect the budget either favorably or adversely. An increase in the cost of a personal computer will cause an adverse variance while a decrease in the price of a computer will lead to a favorable variance.

Financial Analysis

Program owners can use different methods of financial analysis, whose suitability, according to the United States National Library of Medicine (2008), depended on the purpose of an assessment, availability of data plus other resources. Some of the commonly used financial analyses are the cost of illness analysis, cost-effectiveness analysis, cost consequence analysis, and cost-benefit analysis. Others are cost-utility analysis, cost minimization analysis, and budget impact analysis. Cost-effectiveness analysis is the appropriate method for this awareness campaign. Discussion: Evaluation in Programs

Cost-Effectiveness Analysis

The cost-effective analysis is the comparison of costs measured in monetary units against the non-monetary outcomes (U.S. National Library of Medicine, 2008). In essence, it compares the costs plus health effects of a program or an intervention to assess the degree to which it can be considered as providing value for money. This medium can enable decision-makers to determine whether or not to allocate resources for a particular program (Palumbo, Sikorski & Liberty, 2013). Mathematically;

Cost-effectiveness ratio = cost of intervention A ($)-cost of intervention B ($)

effect of intervention A- effect of intervention B

We can assume that at the cost of $1million, the breast awareness campaign would help educate 100,000 women of the benefits of screening and mammography to compute the cost-effectiveness ratio. Alternatively, a screening coordination program may be used to help lessen the problem of breast cancer among Black American women. This program is anticipated to cost 2.5 million dollars and reach only 80,000 women.

Cost effectiveness analysis for cancer awareness program=$1,000,000-2,500,000

100,000-80,000

= -70

The negative incremental cost of effectiveness ratio for cancer awareness campaign implies that by adopting the program rather than screening coordination initiative, there is an improvement in the number of women reached out to and reduction in cost.

Conclusion

In conclusion, budget preparation is an important component of a program. At least 1 million dollars will be required for the successful implementation of this awareness program. More than half of these resources will be allocated on some important budgetary elements like preparation of educational materials, organization of workshops and salaries. An analysis of break-even point shows that revenue will equate expenditure at $100,000 for this program. Most importantly, the cost-effectiveness analysis proves that a breast awareness campaign is more effective than screening coordination. Discussion: Evaluation in Programs

References

Dirubbo, N. E. (2006). Break-even analysis–can I afford to do this? The Nurse Practitioner, 31(7), 11. Retrieved from https://ezp.waldenulibrary.org/login?url=https://search.ebscohost.com/login.aspx?direct=true&db=mnh&AN=16862051&site=ehost-live&scope=site.

Hodges, B. C., & Videto, D. M. (2011). Assessment and planning in health programs (2nd ed.). Sudbury, MA: Jones & Bartlett Learning.

Kettner, P. M., Moroney, R. M., & Martin, L. L. (2017). Designing and managing programs: An effectiveness-based approach (5th ed.). Thousand Oaks, CA: Sage.

Palumbo, M. V., Sikorski, E. A., & Liberty, B. C. (2013). Exploring the cost-effectiveness of unit-based health promotion activities for nurses. Workplace health & safety, 61(12), 514-520. Doi: https://doi.org/10.1177/216507991306101203.

Hiatt, J. (2006). ADKAR: a model for change in business, government, and our community. Prosci.

U.S. Small Business Administration. (n.d.). Writing a business plan. Retrieved January 17, 2019 from http://www.sba.gov/category/navigation-structure/starting-managing-business/starting-business/writing-business-plan.

U.S. National Library of Medicine. (2008). HTA 101: IV. Cost analysis methods. Retrieved January 17, 2019 from http://www.nlm.nih.gov/nichsr/hta101/ta10106.html.