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Running head: FINAL PROJECT 1

Final Project

Shauna Cheney

Kaplan University

HW425

Dr. Aguilar

March 8, 2017
FINAL PROJECT 2

Final Project

Part 1

Community health promotion programs are developed and implemented to meet the

needs of the community residents. Furthermore, health promotion programs are an effective way

to address specific health needs for a targeted group of people and focus on areas for

improvement. A community health promotion program involves multiple steps to develop

adequately. The steps of health promotion programming can include assessing needs,

developing a committee, finding funding, creating a budget, writing a mission statement,

identifying goals and objectives, choosing a theory, establishing a timeline, outlining activities,

organizing evaluations, and implementing the program (Hodges & Videto, 2011). Following a

program-planning outline and making sure each step is accomplished leads to successful

program planning development.

Health promotion program planning begins with a needs assessment to determine what

the communitys needs are and decide what needs are a priority for preventative public health

programs. Sometimes a target population is already identified and available and target group

members are part of implementing the needs assessment. However, other times the needs

assessment leads to narrowing a community to a target group that is most affected by a certain

health condition or most lacking in a specific factor determining health. Identifying what the

program should address, as well as the target population that it should be geared to, provides the

groundwork for a successful program. Determining the target population is achieved with

various data collection methods, the needs assessment, and the U.S. Census. Learning more

about a target population and creating sub-groups is achieved with demographic and

socioeconomic profiles, quality of life information, and community capacity knowledge.


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Community or County

The community or county is Placer County, California.

A Description of the Target Population with Socio-Demographic and Health Profile

The U.S. Census Bureau gathers data that helps to determine the demographic and

socioeconomic profiles of communities and counties. According to the data gathered for Placer

County, U.S. Census Bureau (2015b) shows that the total population is 375,391 and is growing

(para. 1). The Census further reveals that the population is made up of almost equal parts male

and female with the highest proportion of individuals below 18 years of age, followed by those

who are 65 and older. In addition, the data reveals that the community is made up of a single

race of mostly white individuals with 85.5% as of 2015 (U.S. Census Bureau, 2015b). Most of

the population is younger than 18 or older than 65, white, and educated. The five-year census

data from 2011-2015 reveal that 94.1 of the population has graduated high school and that

36.4% have obtained four years or more of college education (para. 7). Due to an educated

population, the socioeconomic profile of Placer County is favorable to being employed, owning

a home, and having a substantial income. The U.S. Census Bureau (2015b) data show that the

average household income is $73,948 and the average home cost as $358,500 (para. 11 &

para. 5). Further, the job force is mostly comprised of sales, followed by healthcare. The Census

Bureau provides clear indicators and data for assessing the demographic and socioeconomic

profile of Placer County to determine factors that affect the target population.

Sub-Group within the Target Population

Dividing Placer County into sub-groups can help to narrow the population that will be the

focus of a health promotion program. In Placer County, the sub-group of individuals who will be

assessed are those that are 65 years or older. According to the U.S. Census Bureau (2015a),
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community facts there are 63,004 individuals 65 years or older (para. 1). The sub-group of

Placer County will be those that are white, 65 years or older, half-male and half-female,

educated, and receiving an average income. Assessing epidemiological data for the sub-group

population of Placer County can determine the health priority and need for a public health

promotion program.

Health Priority with Supporting Epidemiological Data

Health needs assessments for Placer County show health needs compared with

surrounding counties and the United States as a whole. The Placer County Health and Human

Services department recommends epidemiological health data retrieval from the Be Well Placer

Community Dashboard (Public health representative, personal communication, February 5th,

2017). Data is displayed from current needs assessments and statistical analysis. The needs are

displayed with a thermometer ranging from green to red and trends that that are going up are

displayed as red. According to the Be Well Placer (2017) website and a customized report,

needs in Placer County show cancer for the Medicare population in the red. Further, the report

shows the Medicare population, consisting of those 65 years and older, in Placer County are

developing more cancer than the California average and have higher cancer rates compared to

the U.S. total as a whole. The trend increasing with further cancer increases expected. The Be

Well Placer Community Dashboard (2017) report shows 8.5% of the Medicare population with

cancer (para. 1). By calculating the data from the U.S. Census Bureau (2015a) community facts,

there are 63,004 individuals 65 years or older, so dividing the percentage of those with cancer

equals 5,355 individuals. Comparisons show that the cancer rates are higher than the normal

average. California on average has 243,195 deaths from cancer a year and Placer Countys

mortality rate shows 2,833 (California Department of Public Health, 2015, p. 4). Comparing
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mortality rates with the state as well as with surrounding counties can be helpful.

Epidemiological data from the CDC (2016) shows Placer County cancer death rates moderately

worse than its surrounding county comparisons. Placer County indicates that there is a health

priority to address cancer prevention in public health promotion programs.

Quality of Life within the Target Population

The quality of life for Placer County residents who are 65 years or older can be

researched to further determine the needs of the residents and investigate what methods and

approaches may be needed as part of a health promotion program for cancer. According to the

Centers for Disease Control and Prevention [CDC] (2016b), only assessing morbidity and

mortality or epidemiological data can create a narrow viewpoint with what creates health. In

addition, the CDC further elaborates that quality of life assesses health with a broad focus, which

includes emotional, physical, mental, social, and spiritual components. Quality of life can be

affected by many factors other than just physical health determinants. It assesses more than just

the absence of disease and existence of life but indicates whether life is fully enjoyed. The

quality of life for those within Placer County who are 65 or older is diminished when people are

suffering from cancer and have decreased social interaction, comfort levels, enjoyable free time,

emotional stamina, and mental energy. Quality of life can be illustrated based upon principles

such as being, belonging, and becoming. According to Kaplan University (2009), being

includes all that someone is as a person incorporating physical, psychological, and spiritual

aspects; belonging illustrates the belonging in a community, belonging socially with others, and

belonging physically; becoming defines achievements and growth opportunities that are practical

and relaxing.
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People generally feel that their quality of life is better when they know who they are and

are able to identify with key characteristics they value. A community can contribute to the

publics self-esteem and purpose by what it provides physically, mentally, and spiritually. The

residents of Placer County can have a clear feeling of being and increase their self-esteem as they

seek out available resources such as beauty salons, fashion centers, gyms, meditation facilities,

and religious groups. Gaining values and having a sense of being and connecting spiritually are

part of the quality of life in Placer County as outlined from a 2010 Religion Census. The census

results are reported in the Placer County, California Religion Statistics Profile and indicate that

there are numerous religious affiliations available in Placer County, that there are numerous

congregations, that many residents attend, and that a high percentage of adherents are Catholic,

Latter-day Saint, or Evangelical Protestant (City-Data.com, 2010). With so many spiritual,

psychological, and physical opportunities, residents of Placer County can identify with who they

are and enjoy purpose and quality of life.

Further data suggests that the quality of life for Placer County is fairly good. Quality of

life is assessed by the County Health Rankings and Roadmaps (2016) for California by

comparing 57 counties and their length of life, quality of life, health behaviors, physical

environment, social and economic factors, and clinical care. According to the rankings, Placer

County ranks fifth out of 57 counties, indicating the quality of life is higher in Placer County

than most surrounding neighborhoods. The rankings show lower than the California average for

physical or mental sick days, smoking, teen births, uninsured, housing problems, violent crimes,

income inequality, unemployment, and long commutes; however, the rankings show higher than

average obesity, social relationships, education, diabetic monitoring, excessive drinking, and

food environment indicators (County Health Rankings and Roadmaps, 2016). These rankings
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indicate that Placer County residents show belonging by having social relationships,

employment, income, and education. In addition, county residents have belonging and increased

quality of life because of the community social events that occur. Each month there are at least

five to fifteen community events that provide social interaction and community connection

(Center for Strategic Economic Research, 2014). Community connection and social interaction

can improve quality of life and promote health.

Another data source that illustrates Placer Countys quality of life is a report done for the

County of Placer Office of Economic Development. The Center for Strategic Economic

Research (2014) compiled data about the quality of life in Placer County and stated, Todays

Placer County represents a rapidly growing and prosperous community characterized by a

healthy and mature economy, attractive business environment, and residents who benefit from a

developed educational, safety, and healthcare infrastructure, in addition to abundant recreational

opportunities (p. 3). The quality of life for Placer residents is positively affected by all of the

factors that promote overall well-being. Residents who have all of the basic needs met and who

are able to have work, school, and enjoyable activities fulfill the requirement for becoming

(Kaplan University, 2009). Placer County residents are able to achieve goals and be successful

educationally, professionally, and personally with the resources Placer County provides.

Additional resources can be outlined in Placer Countys community capacity.

Community Capacity

Implementing a needs assessment, public health promotion program, and evaluation

requires collective resources to address a health need and accomplish the desired outcomes.

Based on the needs assessment, Placer County needs sufficient community capacity to deliver a

public health program that can reach the senior population and address cancer prevention.
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Evaluation of the communitys capacity is best achieved with interviews, Web searches,

newspaper reading, and community drives. According to Hodges & Videto (2011), community

capacity encompasses the competence, means, and capability that a community has to address a

need and is portrayed in local listings, written media, interviews, and online. Placer County has

many resources currently that target those 65 and older and/or address cancer. A few community

resources that the local American cancer Society provides include wig and makeup help for

women with cancer, volunteers for transportation to cancer care, cancer prevention events,

professional education about risks and behaviors, and community outreach programs (Janet,

Personal Communication February 10, 2017). Community programs that are already addressing

cancer can prove helpful to an additional cancer prevention program targeted at those 65 years

and older.

Another community capacity strength that Placer County has is access to doctors, cancer

screenings, and medical facilities. Healthcare infrastructures and organizations are plentiful in

Placer County and are available throughout the community (Center for Strategic Economic

Research, 2014). Other health related resources that are beneficial for cancer prevention,

support, and education are organizations such as the local American cancer Society, Camellias

Womens Health, Placer County Community Clinics, Pink Pearls of Hope Breast Cancer

Foundation, California Department of Healthcare Services, California Colon Cancer Control

Program, California Department of Healthcare Services and Sutter Roseville Medical Center

cancer support groups. Resources that address health and cancer currently will strengthen new

and additional programs and increase the capacity to meet the program objectives.

In addition to healthcare and cancer resources, there are many senior organizations that

provide healthy resources, education, nutrition counseling, social support, activities, recreation,
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and physical activity. A few examples of senior organizations in Placer County include Seniors

First, Auburn Senior Center, Loomis Senior L.I.F.E center, Maidu Community Senior Center,

and Rocklin Parks and Recreation Adult Program. In addition to sufficient healthcare providers

and senior support centers, Placer County has a Health and Human Services Department and a

Placer County Community Health Department. Professionals and leadership are vital to the

communitys capacity but also valuable are the skills and talents of the collective senior

population. Various individuals with experience in different professions may prove helpful in

the process of the health program. Certain local listings asking for volunteers can gather the

resources from individuals within the community. There are many retired people in the local

area that are part of the Del Web Sun City communities within Placer County that substantially

increase the target groups capacity for support. There are 6,703 homes and 80

condominiums in Sun City Lincoln Hills (Sun City Lincoln Hills, 2016). Furthermore, the Sun

City Lincoln Hills offers a long list of activities, events, and clubs, which promote lifestyle

behaviors that could help to prevent cancer. Connected communities of people who fall into the

category of the target group will provide resources for health solutions.

Resources for healthy solutions, community support, and senior programs all increase the

communitys capacity and quality of life. The assessment of Placer Countys community

capacity, quality of life, socio-demographic characteristics, and epidemiological data provides a

solid framework for program development and implementation. The narrowed sub-group that is

the target of a health promotion program in Placer County can be defined as those that are 65

years or older with cancer. The current strengths in Placer Countys quality of life status and

community capacity will enrich the new cancer prevention strategies for the program to decrease
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the cancer burden in Placer County. Decreasing the cancer burden, saving lives, and reducing

human suffering is the mission and result of the research on Placer County.

Mission Statement

A mission statement, goals, and objectives will provide a framework for the Placer

County health promotion program. If purpose and intent are clearly articulated, programming

leaders can better formulate strategies to best achieve the desired outcomes. Having a mission

statement, goals, and objectives will allow the health promotion team to maintain a clear focus

and direction, allow the funding sources to know the philosophy of the program, and allow the

target population to understand what the new program is about.

The Placer County Cancer Awareness and Prevention Programs mission is to reduce the

cancer rates of Placer County residents 65 years and older by increasing awareness, expanding

resources, providing support, educating the public, and promoting prevention with diet, physical

activity, and regular screenings. The purpose of the program is to save lives and increase the

quality of life for the residents. Placer Countys philosophy is that some cancer is preventable

and the community will see less suffering and more people who are living a fulfilling and

enjoyable life with a cancer prevention program. Placer County will strive to create a unified

community that is supportive of improving Placer County residents health, happiness, and well-

being.

Rationale of the Mission Statement

Cancer can lead to human suffering, loss of loved ones, and a poor quality of life.

According to a needs assessment, Placer County data shows senior residents of the community

have higher rates of cancer compared to other counties in California and the United States as a

whole (Be Well Placer, 2016). Something must be done to intervene, reduce the cancer burden,
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and decrease the incidence of the disease. According the American Cancer Society (2017),

cancer is the second leading cause of death worldwide and over 1500 people per day are

expected to die from cancer this year. Many cancers are preventable with diet and physical

activity. Diet and physical activity are two of the most effective ways to reduce cancer and

maintain a healthy weight (American Cancer Society, 2017). Due to the high rates of worldwide

cancer and higher than average rates of cancer in Placer County, an awareness and prevention

program is crucial to protecting the residents lives. Focusing the awareness and prevention

program on diet and physical activity amongst seniors in Placer County will prevent disease and

increase overall quality of life. The rationale for the mission statement clearly reflects the

philosophy, purpose, and scope of the program.

Program Goals

To decrease the rates of cancer among the 65-year-old population in Placer County.

To reduce the risk factors of cancer for Placer County seniors

To create a supportive environment for those who struggle with cancer and make it easier

for them to locate helpful resources

To become an educated community that is aware of the risks associated with cancer and

the methods to prevent it

To increase healthy eating, physical activity, and the quality of life of senior residents

Goals Discussion

The goals for the Placer County Cancer Awareness and Prevention Program reflect the

goals identified in the needs assessment because they are focused on reducing cancer among the

senior residents of the community. According to Hodges and Videto (2011), goals are designed
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to present an overall purpose of a program with results that are intended to be achieved over an

extended period of time. The goals outlined are in alignment with the mission statements

purpose to reduce cancer incidence and improve the quality of life for senior citizens. The goals

address the scope of the mission statement by concentrating on education, support, and

prevention. The goals also reflect the goals of the Healthy People 2020 from the Office of

Disease Prevention and Health Promotion (2017a) directed at decreasing the incidence of cancer

cases. The goals for the Placer County Cancer Awareness and Prevention Program are clearly

stated to support the needs in Placer County, the mission of the program, and the national

initiative to reduce the cancer burden.

Program Objectives

The program objective levels are outlined by Keyser, Morrow, Doyle, Ogletree and

Parsons (2011) to include the Awareness objective, Knowledge objective, Attitude

objective, Skill development objective, Access objective, Behavior objective, Risk

reduction objective, and Health status objective (as cited in Hodges & Videto, pp. 168-169).

The objective levels support the mission and goals of the Placer County Cancer Awareness and

Prevention Program. The objectives are measurable and will be compared to baseline data

retrieved from surveys, interviews, and questionnaires. The target population will provide

baseline data to be able to indicate where they are currently in regards to cancer awareness,

cancer knowledge, attitudes towards healthy lifestyle changes, and exercise routines. In addition,

the baseline data obtained before the start of the program will also gather information about

Placer County seniors current access to cancer resources, the current number of daily fruits and

vegetables consumed, the current number of nights they cook at home, current cancer screenings

obtained, and current BMI. The baseline data before the start of the program will be compared at
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certain time intervals to determine if the objectives have been met and what percentage of

change occurred.

1. Awareness objective: In six months 70% of Placer County residents over 65 will have

read information and attended a cancer prevention event becoming aware that cancer is

the second leading cause of death, that incidence rates are expected to increase

worldwide, that Placer County seniors have more cancer than the California and United

States average, and that many cancers can be prevented with risk reduction measures.

2. Knowledge objective: After the first large community event in six months, 70% of senior

residents in Placer County will be able to fill out an event evaluation form showing that

they have a knowledge of what cancer is, what the risk factors are, and what preventive

measures can be taken.

3. Attitude objective: In six months, 60% of Placer Countys senior population will respond

in surveys showing an 80% increase in positive attitudes towards making lifestyle

changes that prevent cancer.

4. Skill development objective: In eight months, 60% of the Placer County senior citizens

will have attended local workshops and senior fitness programs and be able to effectively

implement a balanced exercise program into their daily routine.

5. Access objective: In six months after a large cancer prevention program kick off

campaign and event, 39,589 senior citizens will be signed up on the Placer County

Cancer Prevention and Awareness resource website receiving access to resources for

local cancer organizations, cancer support groups, cancer screening information, senior

fitness facilities, farmers markets, cancer prevention events, educational workshops, and

healthy eating tutorials. Data retrieved from the County of Placer Office of Economic
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Development (2014) allowed the calculation of 39,589 senior residents to be determined

showing how many seniors there are in 50% of the Placer County senior population.

6. Behavior objective: In eight months, 50% of Placer Countys senior residents will have

completed an 8-week community course on healthy eating and 40% of those in

attendance will cook at home 80% of the time and eat an unprocessed plant-based food

diet 80% of the time.

7. Risk reduction objective: By the end of February 2018, Placer County seniors will show a

20% increase in cancer screenings and a 20% reduction in obesity rates. In addition, end-

of-year surveys will show that 40% of senior citizens are eating 5-9 servings of fruit and

vegetables, and that 50% participate in moderate exercise for 30 minutes 5 days a week.

8. Health status objective: By the end of 2019 the statistical data for Placer County senior

residents will show a reverse in cancer incidence trends from 8.5% to 7.0% and a lower

than average incidence rate compared to the California and United States average (Be

Well Placer, 2016, para. 4).

The mission statement, goals, and objectives were created to achieve the outcome of

reducing cancer amongst the seniors of Placer County. A mission statement that clarifies the

philosophy, purpose, and scope of the program gives the reader a broad-based view of why the

program exists. Long-term goals for the program help to achieve the purpose of the mission

statement by outlining the direction that the activities and interventions will need to take.

Specific and measurable objectives to reach each goal have been provided to address each

component that will be addressed and what measurable outcome is intended. The Placer County

Cancer Awareness and Prevention program will be organized based upon its mission statement,

goals, and objectives.


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To implement the mission statement, goals, and objectives, financial resources will be

needed. A funding source will be identified according to the program mission and an

organization will be sought after that is aligned with the main program intention. Funding will

be used to carry out the program and financial resources will be allocated based upon a budget.
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A Program Timeline/Logic Model for the Placer County Cancer Program

Figure 1

Long-Term
Outcomes
Short-
Decreased
term incedence of
outcomes cancer
Activities Improved
Increased quality of life
Pre-program cancer Reduced
Input evaluation awareness cancer risk
Kick-off event Improved People live
Community attitudes to longer
health Quarterly
make lifestyle healthier
promotion cancer
changes lives
leaders prevention
events Seniors Lowered BMI
Health signed up on and
educators Regular
resource maintanace
workshops
Local website of a healthy
and
physicians Increase in weight
informational
Target seminars seniors Educated
population visitng fitness community
8 week
volunteers centers about cancer
healthy
Nutritionists eating course High A supportive
Fitness attendance of community
Community
instructors events and with helpful
garden
Cancer workshops resources
started
organization Completion Increased
Development
representativ of an eight- physical
of resource
es week healthy acitivty
website
Senior care eating course Increased
Senior
facility Increase in fruit and
fitness
presidents regular vegetable
tutorials
Health cancer consumption
Doctors to screenings
deparment Increased
integrate
Data Less eating gardening
screening
consultants out and more
notification at
home
Prevent primary care
cooking
Cancer visits.
Foundation Cancer
Grant detected in
early stages
Data from
needs
assessment
Pre-
evaluation for
baseline data
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Logic Model Discussion

The logic model for The Placer County Cancer Awareness and Prevention Program as

shown in figure 1 was created to provide a visual description of the program and provide a map

of how it will operate. It clearly depicts how the strategies chosen will accomplish the desired

goals and objectives. In addition, it is aligned with the philosophy, purpose, and scope of the

mission statement. Furthermore, the logic model expands upon the mission statement and is

beneficial in implementing the necessary steps to achieve the outcomes. Additional benefits of a

logic model include identification of the initial involvement needed, methods for

implementation, and expected end results upon evaluation (Hodges and Videto, 2011).

Following the logic model for the Placer County program will be beneficial in promoting cancer

awareness, motivating risk reduction behaviors, decreasing incidences of cancer, and improving

residents quality of life. The logic model shows that the program will bring about the desired

outcome, which is to reduce the cancer burden in the seniors of Placer County and save lives.

The logic model, funds, and budget for The Placer County Cancer Awareness and

Prevention Program all help lay a foundation for program planning, implementation, and

evaluation. The funding source provides the necessary income to carry out the program, and a

budget specifies where the funds will go. Furthermore, a clear funding source and budget

provide the resources needed to begin work on the program. The workings of the program and

the direction it will go can be followed based on the logic model. As the health promotion team

implements the funds, outlined budget, and logic model, they can stay on course and be

organized in advancing the developing of The Placer County Cancer Awareness and Prevention

Program.
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Program Funding Source

The Placer County Cancer Awareness and Prevention Program will require adequate

funding and financial resources to meet the goals and objectives of the program and effectively

target seniors in Placer County at risk for cancer. To target seniors and fund the needed

resources and supplies, a potential grant-funding source was identified and confirmed to be a

viable means of financial assistance. Grant funding and financial assistance will be sought after

from The Prevent Cancer Foundation. The Prevent Cancer Foundation is a nonprofit

organization that focuses its efforts on cancer prevention for the public by doing research,

providing education, supporting communities, and campaigning for improved policies (Prevent

Cancer Foundation, n.d.-a). The Foundation contributes funding and grants that help

organizations and communities in their cancer prevention efforts. E. C. Warner, the Senior

Director at Prevent Cancer Foundation, confirmed that The Placer County Cancer Awareness

and Prevention Program would qualify for funding since it is focused on prevention, and is

eligible for an award grant of $25,000 (personal communication February 15, 2017). Each year

multiple recipients are awarded grants of $25,000, and there is a long-standing history of

financial support to communities.

Financial support for The Placer County Cancer Awareness and Prevention Program will

be obtained before the start of the program by applying for the 2017 grant cycle. An application

can be obtained on the community grant section of the Prevent Cancer Website and E. C.

Warner, the Senior Director of the foundation will send out the required information (Prevent

Cancer Foundation, n.d.-b). The Foundation further explains on the website that eligibility for

the funding requires a program to be focused on the community and cancer prevention rather

than treatment. The purpose of the funding will be to support the prevention efforts in Placer
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County and provide the financial resources needed to implement an effective cancer prevention

program. Program funding will be used for written material, office supplies, promotional

material, seminars, workshops, campaigns, events, health assessment and evaluation consultants,

postage, and community garden supplies. The funding from the community grant provided by

the Prevent Cancer Foundation will be allocated to individual needs based upon a budget shown

in Table 1.

Program Budget

Table 1

The Placer County Cancer Awareness and Prevention Program

Budget $25,000

Needed Program Personnel Existing Cost


Activity/Requirement Needed Resources

Assessment-Baseline Data Collection

General office Baseline data collection Volunteers from None $400


supplies and surveys and questionnaires the target
postage population

Consultant Pre-data analysis Assessment and None $1,000


evaluation data
analyst
Organizational All program planning, Community Community $7,500
office rental and implementation, and health promotion center
utilities meetings leaders, health
educators, cancer
society
representatives,
senior center
presidents, target
population
Event Facility All seminars, workshops, Target population Community $0
and events volunteers for set center and
up and clean up local park
Technology- Programming functions Electronic Donations $150
computers, support for set up
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printer,
telephones, etc.
Planning & Development

Marketing Campaign, workshop, Graphic designer None $400


materials event flyers, posters, and and printer
brochures
Website Construction of website A volunteer web None $0
and resources developer from
target population
Projector and Workshops and seminars Health educator, None $350
screen nutritionists, and
fitness instructor
volunteers
Community Senior gardening Volunteers from Donated $500
garden land and the target land
supplies population

Program Implementation

Booths, Kick-off event Health educators, None $3000


screening physicians, local
centers, healthy organization
eating leaders, health
demonstrations, departments,
fitness exhibits, nutritionists,
prize giveaways, health coaches,
incentives, food, and fitness
decorations instructors

Educational Events, workshops, All of the above From $0


material seminars various
organization
s already
developed
Booths, Quarterly events Health educators, None $1500
screening physicians, local
centers, healthy organization
eating leaders, health
demonstrations, departments,
fitness exhibits, nutritionists,
prize giveaways, health coaches,
incentives, food, and fitness
decorations instructors
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Educational Eight-week healthy eating Health educator, Healthy $500


literature, course nutritionist, health eating
handouts, coach volunteers handouts
brochures, food, and course
health coaches material

Program Evaluation

General office Post-program data Volunteers from None $400


supplies and collection surveys and the target
postage questionnaires population

Consultant Post-data analysis Assessment and None $1,000


evaluation data
analyst
Misc. Costs

Fees for $2,000


unexpected costs

Program Total $18,700


Cost

A Description of Administrative Tasks

The administrative tasks will involve multiple people who are involved in making the

program a success. According to Hodges and Videto (2011), creating administrative tasks and

objectives will help to make sure duties occur as they are planned. Making sure that

administrative tasks are clearly defined will ensure that they get accomplished and that the

appropriate interventions, marketing, and implementation occur. An example of an

administrative objective for the Placer County Cancer Awareness and Prevention program is that

within one month of the program adoption, the health promotion program leader will assign five

volunteers to gather data from at least 100 Placer County seniors to establish preliminary

baseline information about the current lifestyle choices amongst Placer County seniors. Besides

assigning volunteers to do data collection, the community health promotion program leaders will
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oversee the administrative tasks for each professional participating in the program and designate

who is in charge of what. For example, the health educators will be providing the education at

the events, while the local physicians deliver relevant health information. In addition,

nutritionists, fitness instructors, cancer organization representatives, senior care facility

presidents, and the data consultant will all participate in their assigned duties and tasks.

A clear description of the program activities, timeline, and budget all help participants to

know the assigned duties. Further, meetings will be held at the community center once per

month for those who will be involved with the next months events. The many volunteers who

are donating their time will also have assigned duties that are specified at the regular meetings.

For example, volunteers will be involved with pre-program data collection and post-program

evaluations. The volunteers will also distribute marketing material. Besides distributing

material, the volunteers will be assigned the task website creation. The lead website developer is

a volunteer from the target population and will involve other seniors in gathering and compiling

local resources to include on the website. Local volunteers and various health professionals are

all needed to make the program a success. A successful program will require that each

administrative task be accomplished as planned by all program participators so that program

implementation can proceed uninhibited. As participations follow through with the planned

interventions and administrative tasks, activities can occur to meet the goals and objectives of the

program.

A Discussion of Program Activities

The Placer County Cancer Awareness and Prevention Programs mission is to reduce the

cancer rates of Placer County residents 65 years and older by increasing awareness, expanding

resources, providing support, educating the public, and promoting prevention with diet, physical
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activity, and regular screenings. The purpose of the program is to save lives by reducing cancer

risk factors and increasing the quality of life for the residents. The goals and objectives to reach

the intended outcomes include increasing awareness, fruit and vegetable consumption, physical

activity, access to resources, community support, motivation to change, and regular cancer

screenings. The intended outcomes will be achieved by implementing theory-based activities

that support the Social Cognitive Theorys (SCT) philosophy and concepts.

Developing activities that are aligned with the SCTs concepts will ensure that activities

fall under categories that are proven effective in health promotion programming. According to

Hodges and Videto (2011), programs based on the SCT need to include interventions that will

affect the individual people, their behaviors, and their environment. In addition, the authors

direct planning activities to include interventions that address self-efficacy, expectations,

behavioral capabilities, modeling, and reinforcement (Hodges and Videto, 2011). Two activities

related to each SCT construct will provide direction in the planning and implementation process

and assure that objectives are met based on proven theory and evidence-based research.

Behavioral Capability

1. Tools and resources will be provided to increase senior residents capability to

engage in healthy behaviors with an interactive website. Hodges and Videto

(2011) advise health promotion programs to include activities that use web-based

delivery and social networking opportunities. The Placer County Cancer

Awareness and Prevention Program website will include many different Internet

resources. For example, the website will include physical activity and nutrition

information that is interactive and has trackers. Videos will be included that show

how to perform exercises safely and cook nutritious food. Further, goal-setting
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forms will be included, along with daily journals to write about the experiences or

any barriers. In addition, the website will also include information on community

resources, local fitness facilities, healthy eateries, senior center locations, free

cancer screening clinics, community garden opportunities, support group

locations, events, walking meet up groups, social networks, workshops, and

seminars.

2. Community-wide campaigns with accompanying workshops that address physical

activity, nutrition, and cancer screening. The Community Preventative Services

Task Force (Task Force), a branch of the U. S. Department of Health and Human

Services [DHHS] (n.d.-a), provides a community guide to help program planners

choose health-promoting interventions that are evidence-based and proven

effective. Campaigns are an evidence-based intervention that can improve

physical activity within a community (DHHS, n.d.-c). Campaigns and workshops

will provide knowledge, awareness, and skill development activities. For

example, brochures and flyers will go out as part of the campaign with key

educational factors related to each preventative behavior. Also, workshops at the

community center will provide additional knowledge and skills through

presentations, instructional activities, practice sessions, and breakout sessions.

Environmental

1. Resources will be provided so that local seniors know where they can access

outdoor physical activity opportunities such as bike trails, parks, trails, and

walking paths. The website will have meet up groups and social media networks

so that seniors can go with others if they do not feel safe, do not like driving
FINAL PROJECT 25

alone, or need a ride to attend. Macera (n.d.), with the CDC, stated that

accessibility to places to be physically active is one of the intervention methods

for physical activity that the Guide to Community Preventative Services

recommends and is aligned with the goals for Healthy People 2020. There will

also be field trips from the local community center after fitness workshops to visit

local senior fitness facilities and become familiar with what is available in the

community. Providing accessibility to local exercise opportunities that get

seniors out in nature will increase the environmental factors that are conducive to

good health physically and mentally.

2. A community garden will be started with donated land and finances provided by

the funding source. Community gardens are an evidence-based method to

increase fruit and vegetable consumption within a population (Barnidge, Hipp,

Estlund, Duggan, Barnhart & Brownson, 2013). The garden will serve as a

vehicle for growing and producing healthy food, overcoming barriers to the cost

of fresh produce, developing social connections, volunteer opportunities, getting

outdoors and moving. The community garden will create an environment of

health within Placer County and seniors will be motivated to participate.

Self-efficacy

1. An ongoing 8-week healthy eating course will be provided at the community

center and groups of seniors will be invited to attend. The healthy eating course

will go over how to eat a more plant-based diet, how to minimize processed

foods, how to shop on a budget, how to prepare healthy food at home, and how to

incorporate more fruits and vegetables in the diet. Demonstrations will be given
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but a nutritionist and participants will have opportunities to try various cooking

techniques. Confidence will be built among participants that they have the

capacity and skill to implement a cancer prevention diet based on whole,

nutritious foods. In addition, each participant will be offered a volunteer health

coach. Regular sessions over 8-weeks and personalized coaching to set goals,

track goals, and address barriers to change is similar to the evidence-based

approach used for the Research Tested Intervention Program to address weight

loss through self-efficacy measures and SCT constructs (National Cancer

Institute, 2016). The self-efficacy and SCT methods to eating healthy and

building capacity for behavior change have proven effective and are valid

intervention techniques.

2. One-on-one cancer screening education and advocacy will be implemented as an

intervention technique to encourage regular screenings. The intervention is

evidence-based and has proved to show significant increases in cancer screenings

and cancer prevention (DHHS, n.d.-b). Cancer screening information will be

provided on an individual basis at cancer awareness workshops, the community

health fairs, and by telephone interaction from local volunteers. Seniors who are

signed up on the website will be able to register for cancer screening reminders.

In addition, physicians will schedule regular cancer screening reminders for

patients.

Outcome Expectations

1. A kick-off community health fair will introduce the growing need for cancer

prevention within the community and educate seniors on the main risk factors that
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put them at risk. The expectations of the cancer prevention techniques will be

explained and the anticipated outcomes outlined. Physical activity, healthy

eating, and cancer screening will be the target of the fair and local presenters will

outline the benefits expected with each intervention.

2. Physical activity workshops will be provided and the benefits of exercise will be

addressed. The expected outcomes of a regular physical activity program will be

included, as well as safe exercise measures, and proper technique. Participants

will set goals with a fitness instructor and map out plans that help them to achieve

their own personal goals.

Modeling

1. Modeling opportunities will exist at the 8-week healthy eating course as

participants watch cooking skills being demonstrated and then engage in cooking

techniques themselves. In addition, workshops and other community gatherings

will provide opportunities for participants to show that they have observed how to

prepare a healthy meal by bringing food to share. Health coaches that are

provided with the 8-week healthy eating course will also personally be an

example of consuming a nutritious diet and as seniors work one-on-one with

them, they can repeat positive behaviors.

2. Physical activity workshops will be held where seniors can come to learn various

exercise techniques and practice new routines and methods with a trained fitness

professional. As the group exercises and learns together, they can observe one

another and provide feedback. These group gatherings also offer a great way to

unite as a community and build social networks. The Office of Disease


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Prevention and Health Promotion (2017c) recommends social support and

networks as an evidence-based intervention to increase physical activity. As

Placer County residents gather to learn about fitness, practice exercise techniques,

and meet up for outdoor activity, they will create relationships and provide

support to one another in creating long-term fitness routines.

Reinforcement

1. Personalized health coaching will support seniors as they change behavior and

provide positive feedback and reinforcement. The Dietary Guidelines for

Americans is an evidence-based standard for a healthy diet and evaluation of

nutritional status can be compared to the recommendations (Office of Disease

Prevention and Health Promotion, 2017b). Placer County seniors can compare

their diet the guidelines and reward themselves for coming close to the

recommendations. Health coaches can also reinforce positive dietary changes and

implementation of the dietary guidelines. Each participant in health coaching will

set their own incentives and rewards for reaching milestones in healthy lifestyle

improvements.

2. Health fairs and quarterly events will offer prizes to participants who can answer

questions correctly in fun quizzes, correctly demonstrate physical activity skills,

and complete a healthy eating meal plan. Those who can say they have increased

physical activity, in-home cooking, fruit and vegetable consumption, and cancer

screenings will be entered into a raffle for large prizes. Fun, engaging activities

will be included during health fairs and events to reinforce healthy living and

proactive cancer prevention behavior with prizes and rewards.


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3. The website that will be offered as a community resource to seniors will also

provide a place for testimonials so that individuals can receive positive feedback

from their peers. In addition, local support groups, and social media networking

groups can also encourage and commend healthy choices.

Relationship between the Program Activities and Intended Outcomes

The program activities developed based upon the SCT align with the intended outcomes

of the overall program mission and goals. The activities each contribute to reaching the desired

outcome of improving the health of Placer County residents and reducing the rate of cancer. The

rationale for choosing activities was founded on the goal to reduce cancer risk factors with

interventions focused on healthy eating, physical activity, and regular cancer screenings. The

program activities each support one of the program objectives. First, the behavioral capability

activities support the objective to have 70% of Placer County residents over 65 aware of cancer

and its effects. Both a resource website and campaigns will help to reach the objective to

increase awareness. Second, the environmental activities will support the program objective to

increase access to cancer prevention resources. Both a community garden and resources to local

trails, walking paths, and parks provide access to health resources that contribute to cancer

prevention.

Third, the self-efficacy activities will support the program objectives to increase fruit and

vegetable consumption through an 8-week healthy eating course and will support the program

objective to increase cancer screenings with one-on-one cancer screening support. Fourth, the

expectation activities will support the program objective to increase Placer County residents

knowledge. Fifth, the modeling activities will support the program objective to increase fruit and

vegetable consumption and regular physical activity level. Lastly, the reinforcement activities
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will support the attitude program objective, the behavior objective, and the risk reduction

objective.

Each activity successfully helps to achieve the objectives, goals, and mission statement of

the Placer County Cancer Awareness and Prevention program. The activities that target Placer

County seniors at risk for cancer will be implemented by those in the target population, local

health educators, nutritionists, fitness professionals, and various other stakeholders of the

prevention plan. Activities that support the program objectives will be funded by the Prevent

Cancer Foundation, and a budget will be followed. Activities that were developed based on

theory, evidence-based activities, adequate funding, and a detailed budget all provide the

groundwork for program implementation.

Methods to Tailor Program Activities

Methods to tailor program activities will be focused on addressing the needs of a senior

population. Various factors will be considered with the 65 and older population, and limitations

and barriers will be accounted for. Tailoring activities to seniors also involves previously

gathered socio-demographic information of the sub-group. The sub-group mostly consists of

white, educated, males and females, who make an average income. According to Hodges and

Videto (2011), it is also important to tailor interventions to make sure that specific challenges are

accounted for and any population needs are addressed, which will ensure that the program

resonates with the intended group of people. Seniors are more susceptible to special needs

associated with being on a fixed income, reduced social support, and decreased balance. In

addition, they may have certain dietary restrictions based on health conditions that could affect

dietary choices. Also, the program activities will be tailored to seniors by being simple,

enjoyable, and steadily paced. By tailoring activities to be low cost, social, helpful for balance,
FINAL PROJECT 31

simple, enjoyable, and steadily paced, seniors can progress through the community-based

program and learn to prevent cancer with healthy lifestyle changes.

Tailoring activities to address the special considerations for the senior population can

easily be accomplished by involving the target population in the program planning process.

Certain needs can easily be addressed with slight modifications. Evidence-based tailoring

methods for seniors show that seniors prefer activities that are simple, free, and easily accessible

(King, 2001). Seniors are on a fixed income, and although most in Placer County have sufficient

income for their needs, many prefer to travel and enjoy leisure activities with their resources.

Activities that are free have been implemented into the Placer County Cancer Awareness and

Prevention Program due to the adequate funding received from an outside source. Providing

activities at no charge will be more appealing to seniors, so more are expected to participate.

In addition to being no charge, activities will be tailored to fit the seniors needs by

providing numerous opportunities for social interaction. Many seniors are retired, single, and

lonely, so interventions are targeted towards more group gatherings. Social events and

gatherings will address various components of the cancer prevention program, which will

include instruction on balance. Additionally, physical activity programs and workshops will

provide adequate education and support on safety and proper form to prevent falls from lack of

balance. Balance exercises will be encouraged as part of a regular physical activity routine.

Along with physical activity tailoring, a nutritionist and health coach will support dietary

changes and tailor eating changes to fit individual needs. Coordination with physicians may be

necessary when particular health issues require vitamin or mineral limitations.

Further, the program will be tailored to seniors by being educational but enjoyable. The

activities will be upbeat, positive, and motivating. Instead of focusing on the negative side of
FINAL PROJECT 32

unhealthy lifestyles and the risks of getting cancer, the program activities will focus on the

positive side. Many seniors worry about aging and the ailments that come with it, so the

program is intended to provide a positive approach to aging. Some of the program focus will be

on aging in a healthy way, and how to increase the quality of life while avoiding cancer.

Also, the activities and workshops will be challenging to provide growth for the seniors

but not overwhelm them by asking too much too fast or expecting performance beyond their

capabilities. The strategies to carry out the SCT methods of program planning will be paced in a

way that a person 65 years and older can gradually change habits and routines. Many seniors

have established routines, and like the way they do things currently, so there can be some

resistance to change. If healthy habits are progressively added in that crowd out the bad

behaviors, then seniors will see that change can be comfortable and enjoyable. Dietary,

financial, social, and physical needs of seniors can all be accommodated for when tailoring

activities for health promotion programming. Tailoring the activities to seniors will be

accomplished by following the SCT method of developing activities and being culturally

competent about the target population.

Culturally Appropriate Activities

Health promotion programming and activities also need to be culturally appropriate.

According to Hodges and Videto (2011), the culturally appropriate material will be relevant to

the target populations language, style of learning, and location. Language, style of learning, and

location will be considered; also, material will be culturally appropriate for seniors by including

larger text, subheadings on videos, technology support, and multiple pictures. The CDC (2016)

recommends program planners to deliver health education to seniors in larger text, simple fonts,

and in black on white color. In addition, the language will be simple and not involve technical or
FINAL PROJECT 33

medical terms so that all the seniors will be able to understand it. Furthermore, all material and

correspondence will be in English since the data shows that the population predominantly speaks

English (U.S. Census Bureau, 2015a). Simple language that is English will include various

learning styles. The delivery of education will include various styles of learning such as visual,

auditory, written, and participatory. Some learning will be accomplished by performing the

skills after being instructed with verbal, written, or auditory material. A broad-based delivery of

material will ensure that all the seniors are able to learn in a way that resonates with them. To

increase the seniors abilities to learn and understand material will further involve a

consideration for technical differences and abilities. The seniors will be given support at the

events and workshops on how to use the Internet, resource website, and social media networking

groups. It is appropriate to include training since many seniors are not comfortable with

technology.

In addition to simple language, multiple learning styles, larger text, and lots of pictures,

the program activities will also be culturally appropriate in location. Seniors are more likely to

be uncomfortable in unfamiliar environments or traveling extended distances from their homes.

All events will remain within the centralized community, and no extensive travel will be

required. The locations and events will also be planned strategically for seniors so that they are

not in environments of extreme heat or extreme cold. Seniors can often be at risk of heat

exhaustion or getting cold easily. Also, the events will be held during the day since many

seniors have a hard time traveling at night.

In addition to the location of the events, Hodges and Videto (2011) explained that

programs should offer a wide variety of strategies and include family when appropriate. Many

seniors do not live with family, but children and grandchildren will be invited to attend when
FINAL PROJECT 34

family support would be beneficial. It is culturally appropriate to include the family for the

senior population because many seniors have family members involved in their decision-making

process. The Healthy People 2020 initiative by the Office of Disease Prevention and Health

Promotion (2017c) also uses social support as an effective intervention for seniors in making

behavior changes. Including families will allow the seniors to feel supported in the changes they

are making and provide family members with an understanding of why attending the activities is

beneficial to their loved one. Also, family members may provide positive feedback and reinforce

the good behaviors that are being adopted. Having the program activities tailored around social

strategies to preventing cancer is a beneficial approach for seniors.

Including family, technology training, language, style, and location are all examples of

how the Placer County Cancer Awareness and Prevention program can adapt activities to the

senior population. Communication with seniors will occur throughout the program so that any

alterations can be made to help the seniors be more engaged in the program. Communication is

important because overcoming barriers is crucial to the delivery of the program and its overall

ability to meet the objectives. As program planners are culturally competent and understand the

senior population and the various aspects that may affect their behavior, they can create

successful interventions.

A Discussion of the Theory Guiding the Program and Citations to Relevant Literature

Health promotion program planning involves careful organization to make sure every

step of planning is done efficiently and effectively. Each step of the program planning process

builds upon previous steps and ultimately leads to a program that is ready to be implemented.

Part of the program planning process that is crucial to development is recognizing a theory or

model to base the program on, so that proven interventions can be utilized. A social or
FINAL PROJECT 35

behavioral theory or model is composed of concepts that guide and explain behavior and the

techniques to change it (Hodges & Videto, 2011). Understanding peoples behavior helps

program planners know how to address it. The professional literature contains many resources to

learn about different theories and models, and program planners can choose one that is best

suited to their target population.

The Social Cognitive Theory (SCT) is a valid and appropriate theory for the Placer

County Cancer Awareness and Prevention Program because it is supported by research, is

relevant, and has been applied to interventions similar to the Placer County program. The theory

has proven effective based on research for promoting positive behavioral change that reduces

risk factors associated with cancer development. The theory has successfully been applied to

key lifestyle determinants such as physical activity that reduce the rate, incidence, and recurrence

of cancer. The SCT that has been applied to the same target population and to the same

behaviors that the Placer County program will focus on which include cancer reduction, seniors,

physical activity, and behavior change. The SCT is specifically effective for the Placer County

Cancer Awareness and Prevention Program because the target population is senior citizens, and

the SCT principles will help seniors who are particularly susceptible to self-efficacy barriers.

Also, the SCT will be effective for seniors by implementing constructs that will affect

environmental and social factors that are influential to many seniors who are alone or have

limited access to resources. Program planners can include environmental components of the

SCT by increasing access to resources and ensuring safe walking trails.

In addition to environmental components, the concepts of modeling and reinforcement

outlined in the SCT will allow seniors the opportunity to learn new skills that are associated with

reducing cancer by learning, observing, reproducing, practicing, and evaluating. Receiving


FINAL PROJECT 36

positive feedback will reinforce motivation as well as continue to confirm and build self-

efficacy. According to Hodges and Videto (2011), the SCT also emphasizes the development of

outcome expectations and addresses the need to establish a hope in individuals that certain

behaviors will result in beneficial outcomes. It is important for seniors who engage in a cancer

prevention program to believe the interventions will be beneficial and are worth the time and

effort invested to achieve the results. The broad scope of the SCT provides a framework for the

development of environmental and behavioral interventions to decrease cancer risk amongst

seniors make it a favorable choice in theory selection. The Placer County Cancer Awareness and

Prevention Program based on the SCT framework will guide program development and

implementation.

An Evaluation Plan and Data Collection Strategy

The Placer County Cancer Awareness and Prevention Program will utilize evaluations

throughout the program planning and implementation process. Evaluations will be a necessary

resource in providing data regarding the interventions and strategies, the program components,

the programs effectiveness, and the results of the program (CDC, 2010). The evaluation process

will help to determine if the target population was satisfied with the program and if the program

goals and objectives were met. Gathering the information will require various forms of

evaluations that will act as guides, resources for improvements, and as monitoring tools.

According to Hodges and Videto (2011), evaluation types include formative, summative process,

impact, and outcome. Each type of evaluation will act as a guide in choosing evaluation

questions for the Placer County Cancer Awareness and Prevention Program. Developing

questions for each type of evaluation will ensure that the evaluation is comprehensive and will

address each step and component of the program.


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Formative: What sufficient preliminary data was gathered from the target population to provide

a baseline for future dietary, physical activity, and cancer screening progress? How is the

material culturally appropriate for the senior population and being understood? Are the seniors

showing progress towards heathier lifestyle changes by regular attendance at activities and

events? How are seniors engaging in the activities and learning new skills?

Summative: How were the resources utilized by the seniors of Placer County? How do Placer

County residents feel they are more knowledgeable about cancer, the risks, and the preventative

measures?

Process: How are the program interventions and activities being implemented? Is the budget

followed? Are marketing efforts adequate and sufficient throughout the program? Are seniors

enjoying the activities? Are program stakeholders participating throughout the process and

delivering the agreed upon services?

Impact: What short-term program objectives were met? By how much are the risks for getting

cancer decreasing with the implementation of healthier lifestyle behaviors? Do more seniors

engage in physical activity, healthy eating practices, and regular cancer screenings? Do Placer

County seniors feel they have greater access to resources for cancer prevention within the

community?

Outcome: Were long-term goals reached? Are there fewer reported cancer cases in Placer

County seniors following the program? Is the community more united in a fight against cancer

and committed to maintaining a health-promoting environment? How has the quality of life

increased for Placer County seniors?


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Data Collection

After evaluation questions have been outlined, a plan for gathering the data relevant to

answering the questions will be organized and implemented. The formative, summative,

process, impact, and outcome evaluation methods will occur at appropriate times throughout the

program and at the end of the program to provide a wide range of data, information, and

feedback. Continuous evaluation will allow for any program alterations to take place. An

evaluation consultant who specializes in health program evaluations will take the lead, and

program stakeholders will take part with delegated responsibilities from the consultant. The

target population volunteers will also help with the data collection efforts. The planning for the

evaluations will include when the data will be collected, where the data will come from, how it

will be gathered, and who will collect it.

The type of data necessary to address the evaluation questions will include feedback from

the program participants, data from website usage, counts for attendance at program activities,

marketing reach descriptions, cancer screening records, program activity checklist, and cancer

registry data. According to the CDCs (2010) recommendations for evaluating cancer programs,

data sources can include the cancer registries, surveys and questionnaires, vital statistics,

program attendance records, interviews, and observations. Surveys and questionnaires will be

used to gather data before the program for the needs assessment and preliminary information

collection. Data collection for the needs assessment will come from research, the cancer

registries, the U.S. Census, public health statistics, and Placer Countys website. Data will

include information on the quality of life status, demographic and socioeconomic profiles,

incidence and prevalence rates, and other pertinent measures.


FINAL PROJECT 39

Data for the preliminary surveys and questionnaires will be retrieved to show baseline

information on how many days of physical activity the seniors currently engage in, what their

level of knowledge is about cancer, how they perceive their quality of life, and how many

servings of fruits and vegetables are consumed per day. Volunteers trained in interviewing will

do personal interviews at the local senior housing communities and at local senior centers. Help

will be given to answer questions. Volunteers will do the data gathering instead of other

program stakeholders to reduce any bias. Interviews will be beneficial to seniors because

according to Hodges and Videto (2011) interviews can help individuals who may have difficulty

with technology, varying abilities to understand information, or who require cultural tailoring,

and accommodations. Interviews will be done to help seniors with completing, understanding,

reading, and interpreting the questions, but also written private data collection methods will be

used. For those who are uncomfortable with personal interviews, mail-in surveys, and

questionnaires will be given. In addition, interviews and surveys will be conducted over the

phone.

Other data will be obtained throughout the program in the development phase, as it is

being implemented, after events, and at the conclusion of the evaluation. Data that will be

collected during the program will include multiple methods and instruments. Focus groups or

group interviews will be held throughout the program to gather information and feedback from

participants and stakeholders. Focus groups and group interviews allow for elaborate responses

and exploratory discussions to gather more in-depth feedback (Hodges & Videto, 2011). Other

data collection methods will include gathering data after events and activities. Written surveys

will be at every event to be filled out anonymously and put in a box. In addition, data will be

gathered from rosters and attendance records for program events. Another method for collecting
FINAL PROJECT 40

information will include observations by the program planners and stakeholders, as they are

involved in the program activities. Observations may be biased, so they would not be used alone

but can provide a useful analysis of the programs success, participants enjoyment, participants

engagement, and the programs implementation.

Lastly, methods to gather data to be evaluated and analyzed by the evaluation consultant

will include the same public records used in the beginning of the program evaluation such as

cancer screening records, cancer registry entries, U.S. Census data, and the Placer County

community health records. Gathering data at the end of the program, during the program, and at

the beginning will help the program to be analyzed and the effectiveness determined. Assessing

whether or not the goals and objectives were met will be crucial to decide if the program was

effective at meeting its intended outcomes. Evaluation is expected to occur long after the

program has completed to obtain sufficient evidence if the cancer rates have gone down. If the

program is a success, then consideration can be given to continuing the program and what the

long-term sustainability would be. A detailed report will be given to program stakeholders and a

simple result brief will be given to the senior population of Placer County. Following an

evaluation process is a key component of a health promotion plan and will be included in the

Placer County Cancer Awareness and Prevention Program to help seniors reduce cancer.

An Implementation Plan and Discussion of Sustainability

The Placer County Cancer Awareness and Prevention Program has all of the components

to implement successful interventions. The program was founded on evidence-based theory and

activities and is aligned with appropriate goals and objectives. Proper funding has been

identified, and a plan is in place to evaluate the program. In addition, the staff roles and

administrative tasks have been outlined in the section entitled administrative tasks. Many parts
FINAL PROJECT 41

of the program are complete and organized; however, a program implementation and

sustainability plan are still needed to make sure the program is delivered as outlined and has the

potential to be maintained long-term. According to Hodges and Videto (2011), a program cannot

progress towards the intended goals and objectives unless there is acceptance of the program,

stakeholder support, participant training, and adequate resources. Further, leadership is

paramount in the implementation process, so the health promotion program leaders will guide the

committee of stakeholders during monthly meetings. The Placer County Cancer Awareness and

Prevention Program has achieved leadership, acceptance, stakeholder support to participate in

the program, sufficient resources, and will provide volunteer training as needed. In addition, the

Placer County implementation plan includes an evidence-based theory, logic model, timeline,

program budget, clear administrative tasks, and activity objectives that will assist in the

implementation efforts. Lastly, the implementation plan is set up for success by involving the

target population.

An implementation plan will be more successful if the target population is involved and

will create a better chance for long-term sustainability (Hodges & Videto, 2011). The target

population of seniors in Placer County will be key participants in every step of the program

including implementation. When people are part of the decision process, they generally like the

ideas that are accepted and are more likely to support them. Also, the target population can help

with implementation because the volunteers are at the forefront of seeing their peers and can

recognize favorable or negative responses to the program implementation. Lastly, involving the

target population can help to remove barriers to program acceptance.

Barriers can impede the programs success if they are not recognized and removed

quickly. First, a potential barrier could include the ability of the program participants to follow
FINAL PROJECT 42

through. For example, if an agreed upon arrangement with a physician, fitness instructor, or

nutritionist did not end up happening it could cause a delay in the implementation trying to find

replacements. Second, the seniors ability to use technology may create a barrier since many

resources are delivered online; however, training may compensate. Third, unforeseen costs

could exceed the program budget and require limitations or alterations in the program activities.

Nevertheless, barriers can be recognized and modifications can be made with proper evaluating,

consistent communication, and careful planning.

An effective way to plan for the implementation is with implementation objectives

(Hodges & Videto, 2011). For example, a helpful implementation objective for the Placer

County program will include an objective stating that health promotion program leaders will

hold one board meeting each month with the program participants and volunteers to designate

specific duties and report on previous tasks. Regular meetings will allow the potential barriers to

be discussed and offer a chance to find solutions. In addition, discussions at monthly meetings

can include an evaluation of the programs implementation progress. The progress of an

effective implementation plan will be determined by evaluating if the interventions are being

delivered as planned, if the activities are being fully completed, and if the interventions occurred

as many times as they are supposed to (Hodges & Videto, 2011). Evaluating the success of the

programs implementation can help program leaders address whether or not the program is being

delivered in a way that will accomplish the goals and objectives. Effective implementation plans

provide a foundation for a program to be maintained long-term and to be sustainable.

Although the program is planned with organized principles and practices, the program

needs to be sustainable. According to Hodges and Videto (2011), a sustainable program is one

that continues to provide a positive health impact over time and has become an ordinary practice
FINAL PROJECT 43

within the associated organizations. Creating a sustainable program will ensure that the goals

and objectives can be achieved long-term. Cancer reduction can take some time, and a continued

program will benefit the seniors in Placer County by reducing cancer risks longer than the length

of the program. In addition to decreasing cancer risks with an ongoing program, a continuing

program will also increase the quality of life and the overall health of the residents.

A continued program will require maintaining the programs financial

resources. Maintaining the program will require adequate funding after the primary funding

source is depleted. Possible solutions to gain further funding can include fund raising, applying

for grants, and soliciting donations. Finding ways to be resourceful and utilize the skills and

tools available within the community can help to save on costs. In addition, utilizing volunteers

instead of hiring professionals reduces costs. However, financial resources will still be required

to carry on certain activities. As program volunteers, stakeholders, and a designated program

leader work to obtain additional funding, the sustainability of the program will be enhanced.

Another important factor to consider in order to sustain the program over time is the

ability the program has to become part of the senior citizens culture within the community and

the organizations involved in the program. According to Hodges and Videto (2011), the process

of a program becoming part of the culture and way of life for the organizations involved in the

program is called institutionalization (p. 198). The senior centers, community center, and

health educators can all be part of the program becoming a regular routine in their services. As

they begin to promote healthy lifestyle behaviors like physical activity and healthy eating, they

can get in the habit of promoting cancer-reducing habits. By doing this, the program can become

a regular part of the organizations and its offerings.


FINAL PROJECT 44

Lastly, to help the program become sustainable long-term the target population will be

involved in the planning, implementation, and evaluation. By involving the community in the

process of the program, skills can be built to help the seniors know how to carry out their own

program. Building the abilities of the seniors to help one another in organizing activities and

gathering resources will cut back on costs and create unity as seniors work together. Examples

of seniors working together could be, teaching one another workshops and inviting volunteer

speakers, holding physical activity gatherings, planning healthy meal potlucks, supporting one

another in cancer screenings, maintaining a current website of cancer resources, etc. As seniors

work together, they can identify a potential leader to oversee the sustainability efforts.

Planning for future funding and building the communitys capacity to maintain a program

will remove a few barriers to continued implementation over time. Also, as the initial program

builds momentum, more and more people may become involved creating a culture of health and

providing a framework for further adoption. Helping the program to become a way of life

amongst the seniors in Placer County will decrease the likelihood of it dissolving and increase

the likelihood that there will be continued success. Once the community sees the benefits of the

program after a successful evaluation, motivation will increase to see the positive impacts

continue.

Continuing the Placer County Cancer Awareness and Prevention Program will help

Placer County seniors to reduce cancer rates, maintain a healthy lifestyle, increase the quality of

life, and create a unified community. The Placer County program is created to be comprehensive

so that overall mission to reduce cancer can be accomplished. The comprehensive community

program includes a needs assessment, program committee, adequate funding, detailed budget,

mission statement, goals and objectives, proven theory, outlined logic model, strategic activities,
FINAL PROJECT 45

thorough evaluation, and an implementation and sustainability plan. Following a program-

planning outline and making sure each step is accomplished can lead to a successful program

delivery. With a successfully delivered health promotion plan the seniors of Placer County will

have every tool, skill, and resource they need to reduce their cancer risks and live healthier,

longer lives.

Part 2

A Discussion of Workplace Wellness

Workplace wellness involves promoting health and well-being within the workplace

environment. Most people spend at least eight hours a day at work, which creates an ideal

environment to promote healthy living. The benefits of implementing a workplace wellness

program are that there can be decreased absenteeism, stress, workers compensation claims, and

healthcare costs. A workplace wellness program can also create a happier workplace culture.

Integrating workplace wellness programs into any business can enhance the lives of employees

and increase their overall quality of life. As people improve lifestyle behaviors, they generally

feel better, think better, and perform better. In addition, healthy lifestyle habits can decrease the

incidence of disease. Healthier lifestyle behaviors should be promoted and supported while

people are working at large or small businesses.

Multiple organizations have integrated health and wellness programs into their employee

offerings and have had much success. According to the Wellness Council of America (2016),

successful programs include those from large and small business such as Kimberly Area School

District, SC Johnson, Werner Electric Supply, and FVSBank. Workplace wellness programs can

be customized for any organization large or small with varying professional specialties. The
FINAL PROJECT 46

CDC (2015b) discussed various components of a workplace wellness program that can be

included such as improving access and time for physical activity, increasing health education

through lunch-and-learns, providing healthier break room snacks, and changing policies to be

aligned with health and wellness. The components of a workplace wellness program can be

based on employee needs assessments and interest surveys to make sure implementation is

targeted at what will be most effective. Developing a program based on the target population,

health needs, interests, and organizational factors will likely engage more people and show

positive results when evaluated. An example of identifying a target population and

implementing workplace wellness is a program created for a small dental office in Placer

County, California.

A Description of the Workplace Target Population

The dental office for the workplace wellness program has its own individual, community,

organizational, and socio-demographic factors that are relevant to health and program planning.

Organizationally, the business is healthy financially and has provided a stable work environment

for many employees for over twenty-five years. There are 11 people in the office including the

dentist. The dentist is male, but all other employees are female. The primary race of the dental

office is white with one woman being half-Hispanic. When compared with the community, the

racial variance is consistent. Placer County is composed of mostly white individuals according

to the U.S. Census Bureau (2015b). The Bureau also provides other county information that can

be compared to the socio-demographic profile of the dental office. For example, educational

attainment and income can be looked at to determine if it is consistent with community averages.

The skills and educational level of the dental employees vary by the role and the specific

job duties entailed. All of the employees graduated college, have specialized certifications or
FINAL PROJECT 47

licenses, and are experienced professionally. According to the dental team (personal

communication, February 20, 2017), only thirty-percent have a four-year college degree. The

Placer County community data also shows that about thirty-percent of the residents have a four-

year degree and over ninety-percent have graduated high school (U.S. Census Bureau, 2015b).

The income diversity in Placer County and the dental office can also be compared.

The dental office employees income is based on education, certifications, and licenses,

with no variance depending upon experience. Based upon employee conversations (personal

communication, February 20, 2017), the salary ranges from approximately $76,000 to $25,000

according to what is standard in the dental industry for dental hygienists, dental assistants, and

front office managers. Placer County community residents make on average a little over $70,000

with a low percentage of people in poverty (U.S. Census Bureau, 2015b). In many ways, the

dental community and Placer County share commonalities demographically and socio-

economically.

The Placer County residents and dental office employees also have commonality in

regards to health needs. The employees are at risk for obesity and chronic disease associated

with poor lifestyle choices. Based upon observations made in the dental office, there is a lack of

healthy eating, physical activity, and stress reduction. In comparison, the Placer County

residents as a whole are statistically showing poor diet and exercise behaviors, and a needs

assessment done by a local hospital declared healthy eating and physical activity intervention to

be a main health need for local residents (Lawless & Rosenbaum, 2016). The hospitals needs

assessment did not gather data related to stress reduction, but the community, organizational, and

individual observations indicate that stress reduction is also a health need and concern for

positive intervention.
FINAL PROJECT 48

The individual, organizational, and community data illustrate that the small dental office

would be an appropriate target population for a workplace wellness program. The educational

level and the economic level of the individuals and the organization provide the opportunity for

increased understanding of why workplace wellness could be beneficial. The income level of the

employees and organization will allow for the adequate implementation of healthy eating and

physical activity within the organization as well as at home. The gathering of relevant

information pertaining to the target population provided a framework in which a wellness

program can be initiated. The workplace wellness program for the dental office in Placer County

will be initiated and formulated based on a clear mission statement, goals, and objectives.

A Program Mission Statement

The dental office of Placer County is committed to providing a work environment where

employees can engage in meaningful work, serve the community with compassion, and

experience an enjoyable life by being healthy and well. The mission of the dental offices

workplace wellness program is to improve the quality of life for the employees at work and at

home through diet, physical activity, and stress reduction promotion. The dental office believes

that employees who are healthier in mind and body will get sick less, have more energy, save

more money on healthcare costs, avoid disability, be less stressed, decrease obesity, avoid

chronic diseases, and experience greater happiness. The dental office team is committed to

providing a workplace culture that is supportive to living a healthier and happier life.

Goals

To improve workplace culture by promoting a positive environment that is

supportive to physical, mental, and emotional health


FINAL PROJECT 49

To motivate employees to want to make behavioral and lifestyle changes that will

improve their overall quality of life and reduce stress

To increase physical activity and healthy eating amongst employees at work and

at home

To decrease absenteeism, disability, obesity, burnout, and chronic disease while

increasing energy, and overall happiness

Objectives

1. Six out of 10 employees to increase moderate aerobic exercise from 0-1 days to 3-5 days

for 30 minutes and 2 days of strength training on most weeks by the eleventh month of

the program.

2. An increase in consumption of fruits and vegetables from 2 per day to 3-5 per day

amongst 60% of the dental employees and 5 days of cooking at home by the eleventh

month of the program.

3. Ninety percent of employees by the eleventh month of the program will exhibit greater

happiness and less stress by implementing a stress reduction technique into their

professional and personal life at least 10 minutes per day.

4. A report of fewer sick days for the whole office reported one year after the program

compared to the sick days from the prior year.


FINAL PROJECT 50

A Program Timeline

Figure 1- Dental Office Workplace Wellness Program Flow Chart

Get Management Support

Wellness Committee Formation

Needs Assessment and Interest Survey

Mission Statement, Goals, Objectives

Strategies and Activity Planning

Implement Program

Evaluation
FINAL PROJECT 51

Figure 2- Dental Office Workplace Wellness Program Timeline

Month 1

Obtain management support for workplace wellness (WW) program


Organize a wellness committee
Gather data, conduct a needs assessment, do an interest survey
Develop a mission statement, program goals, and objectives
Conduct a baseline data questionnaire to establish current habits and patterns
that can be used for comparison at the end of the program evaluation

Month 2
Develop a timeline
Obtain
Gathera data
funding
andsource
conduct a health needs assessment
dfd
Determine a budget
Choose
Write astrategies
missionand activitiesgoals,
statement, for program
and objectives
Assign duties to wellness committee
Begin to implement program

Month 3

Kick-off workplace wellness event. Posters & flyers for marketing


Present about what workplace wellness is and the benefits to the office and
team members. Speech by the dentist
Review of the mission statement, goals, and objectives
Award prizes for fun health games and taste healthy food options
Introduce yoga teacher, nutritionist, and fitness instructor
Announce the health coach and her free services to support them
Distribute California Family Fitness gym memberships
Schedule monthly healthy eating potlucks and first walking meeting
FINAL PROJECT 52

Month 4

Fitness challenge-how many steps per day


Distribute electronic step counting watches
Present incentives and prizes
Introduce private Facebook group to support each other
Hold a lunch and learn with a fitness instructor, fitness demonstrations
Schedule meet at gym girl nights after work
Present incentives for a full month calendar tracker filled out by next
monthly walking meeting
Goal setting for 3-5 days of 30 minutes moderate intensity activity and
2 days of strength training

Month 5

Half day healthy eating event presented by a nutritionist


Healthy food provided and cooking demonstration
Presentation, 3-5 servings of fruit and veggies, cook once eat twice,
healthy on a budget, healthy on the go
Present incentives for a full month calendar tracker filled out by next
monthly walking meeting
Goal setting for a minimum of 5 servings of fruits and vegetables,
cooking at home 5 days a week, healthy meal planning

Month 6

Stress management workshop presented by a Stress master Associate


Yoga instruction presented by a yoga teacher
Deep breathing demonstration videos and journaling discussion
Chair massage therapy sampling with a massage therapist
FINAL PROJECT 53

Month 7

Summer community 5K race


Give prizes for attendance and first, second, and third place winners
Summer family healthy BBQ at the park- sign-up sheet for food
Family fun at the park day including fitness games provided by a fitness
instructor

Month 8

Lunch and learn about reducing sick days


Wellness presentation from a local doctor and nurse
Review of sick days the prior year
dfd and sick days so far this year
Healthy food provided
Goal setting

Month 9

Extended monthly meeting


Healthy food provided
Establish a wellness library at work
Display books, videos, magazines, and fitness equipment
Discuss resources available within the community
Discuss how the dental office can promote health to the patients and
community
Evening at Baagan the local restaurant for a free plant based eating
workshop and dinner
FINAL PROJECT 54

Month 10

Office trail hike for team and family


Picnic provided
Scavenger hunt along the way and prizes
Family photos provided at the top of the water falls
Team photo for the local newspaper to report on the workplace wellness
program and year overview

Month 11

Program wrap up event


Check in with successes
Team testimonial sharing
Fill out end of program questionnaires
Give access to health coach to continue goals and overcoming barriers
Give away prizes
Close with future organizational and personal goals

Month 12

Evaluate data compared to pre and post program questionnaires


Focus group discussions about results and program
Determine if objectives have been met, goals achieved, and the purpose of
the mission statement accomplished.
Report to stakeholders, team, and management
FINAL PROJECT 55

The program timeline and flow chart displayed in figures 1 and 2 represent how the

program will be organized and operate. The steps to develop a workplace wellness program are

outlined as well as the monthly activities that will take place while implementing the program.

To implement the program, the wellness committee will address program planning and

workplace governance by communicating with each other. A wellness leader will be decided

upon and each month the team will gather to have meetings and plan events. Responsibilities

will be delegated and each month someone new will be in charge of that months activity. It is

purposed that five people be on the wellness committee from the target group and that someone

from each department is present. Decisions will be voted upon and choices will be made based

upon what alternatives are aligned with the mission statement, goals, and objectives. As the

wellness committee plans and works as a team, they will be able to implement the program

flowchart and timeline to deliver an effective workplace health promotion program.

A Program Budget

Figure 3- Budget for Workplace Wellness Program

Dental Office Workplace Wellness Program Budget

Program Component Program Unit Quantity Total


Activity/Requirement Cost Cost
Assessment
Needs assessment Office supplies $2 10 $20
Interest Survey Office supplies $2 10 $20

Planning
Mission statement, goals, and Office supplies/printing $15 1 $15
objectives posters
Wellness committee Meetings Meeting materials, $25 10 $250
office supplies, snacks, meetings.
etc. Once per
month
Kick-off marketing Posters and flyers for $20 1 $20
kick-off event
FINAL PROJECT 56

Monthly communication Posters, flyers, etc. $20 9 months of $180


materials events
Program Implementation
Food Events $125 9 months of $1125
events
Prizes and incentives Events, lunch and $150 5 events $750
learns, challenges and with prizes
etc. or
incentives
Fit bits Fitness challenge and $150 10 $1500
yearlong workplace
wellness program
Nutritionist-discounted Healthy eating event $30 1 $30
free/partial volunteer
Yoga instructor-discounted Stress management $30 1 $30
free/partial volunteer event
Fitness instructor-discounted Fitness challenge and $50 2 events $60
free/partial volunteer fun day at the park
Stress management associate- Stress management day $50 1 $50
discounted free/partial
volunteer
Massage therapist-discounted Stress management day $30 1 $30
free/partial volunteer
Health Coach-Fellow Employee Support throughout and $0 N/A $0
after
5K race registration Summer community $20 10 $200
run
Books, videos, magazines, and Wellness library $350 1 wellness $350
in-office fitness equipment library
Misc./unexpected Various unexpected $500
program costs
Program Evaluation
Focus Groups Refreshments $5 5 $25
Needs and interest survey, Office supplies-paper $20 16 $20
health questionnaire, workshop and printer ink
evaluations, informal
interviews, follow-up
questionnaires, evaluation
report
Program Budget Total $5175
(Funds $5500)
FINAL PROJECT 57

A Discussion of Potential Funding Sources

Appropriate health promotion programs require adequate funds to effectively reach the

target population and address needs through activities. Funding for the dental offices workplace

wellness program will come from three sources. First, the employer of the dental office will

provide $2500 for the first year of the program. He sees the value in a health promotion program

and believes that it will save him money in the end. He looks forward to having employees feel

better with increased energy, because he thinks it will help them to interact with the patients

better and lead to more efficient work. More efficient work will lead to less overtime pay as

well. He also is concerned with how many sick days are taken each year. Sick employees result

in expensive staffing solutions when they are absent. He is happy to support a positive

workplace culture within the dental office and sincerely desires to provide an environment that is

supportive to professional and personal well-being.

Second, funding will be received from the dental supply company as a pilot program to

see if they want to engage in dental and medical workplace wellness in the future. As a supplier,

they can distribute information, healthy office supplies, ready-made programs, stress reduction

tools, and much more. They would also like their name to be marketed as the first supply

company to promote workplace wellness as it is evaluated and possibly discussed in the local

newspapers. According to a leader at Henry Schein supply for medical and dental offices, J.

Sorenson (personal communication, February 19, 2017) expressed that she thinks it is a good

opportunity to promote dental employee health. Henry Schein will donate $1500 to the program.

Lastly, funding is anticipated from a local fitness facility upon written proposal. The

owner of the California Family Fitness has been a patient, and it can be assumed that he would

be a willing contributor. Funding the program will provide exposure to the fitness club since
FINAL PROJECT 58

brochures, cards, and discounts will be displayed at the dental office. At least thirty-two people

from the community enter the dental office each day and it provides for an inexpensive way to

market. In addition, shirts will be provided displaying the support of the dental office and the

clubs name for employees to wear in attendance at any community fitness races or events. Free

gym memberships are expected for each employee. The contribution expected will be $1500

plus the free shirts and gym memberships to the employees.

The total funding to be obtained for the dental office workplace wellness program will

amount to $5500, which will adequately meet the budgeting needs and provide for extra

resources if additional supplies are needed. The internal and outside funding sources unite the

dental office with the companies in the community to promote greater health and well-being.

Sufficient funds will allow the activities to be implemented that will help to achieve the goals

and objectives. Any additional funds will be carried over into the next year. Receiving three

sources of funding will help to make the health and wellness program a success.

A Description of Appropriate Program Activities

With access to adequate funding various strategies and activities will be provided to help

employees meet the goals and objectives outlined in the program and to increase motivation for

making healthy lifestyle changes. Various components and strategies will be implemented based

upon the needs that were recognized. Decreasing stress, increasing healthy eating, and

increasing physical activity will be the focus of the programs. A full timeline of the activities

and what will be included each month can be found in figure 2. The program will start with a

kick-off event to introduce the program and some of the program participants. The wellness

committee will explain in a presentation what workplace wellness is, why it is beneficial, and

how it can help the organization and team. The doctor will give a speech and acknowledge his
FINAL PROJECT 59

support and the support of the funding sources. Next, a local physician will give a presentation

about the risks of a sedentary lifestyle, unhealthy eating, and high stress. He will discuss the

benefits of adopting healthy lifestyle changes and the long-term positive implications with

avoiding chronic diseases and obesity. The health benefits will be addressed in detail so that the

team understands all that diet, physical activity, and stress reduction techniques can do for their

professional and personal lives.

After the presentations, the wellness committee will introduce the teachers and supporters

that will be involved in the program such as the nutritionist, fitness instructor, yoga teacher, and

health coach. The health coach will be available free of charge throughout the program to

provide individualized support and encouragement when making behavioral changes. Once

introductions are over the team will receive their free California Fitness Gym memberships.

Next, the team will receive and overview of the activities to follow in the next few months.

Activities that will be included over the course of the program will include a different

theme for each month. One month the focus will be on physical activity and the office will do a

fitness challenge together and receive fitness instructions so that they feel confident starting an

effective exercise routine. Goals will be set, and a Facebook support group will be created.

Another months activity will address heathy eating, and a nutritionist will discuss how to eat

healthy on a budget, cook more at home, prepare healthy snacks, and implement more fruits and

vegetables into the diet. She will discuss ways to crowd out processed food and eat a more

plant-based diet. A cooking demonstration will follow and each team member will make goals

with the health coach.

Other months will focus on seminars, workshops, lunch and learns, and events. One

month will focus on stress, and a Stress Master Associate and yoga teacher will teach techniques.
FINAL PROJECT 60

Breathing exercises will also be demonstrated as well as chair massages. A different month will

focus on how to prevent getting sick. An additional month will include a fun race to give the

opportunity for team members to engage with the community. In the summer, there will be a

healthy BBQ. The team will also have another chance in the summer to get together with

teammates for at trail hike and scavenger hunt.

Each month, there will also be a healthy walking meeting for the team and a healthy

potluck lunch. Additional resources that will be available at the office will include a wellness

resource library. The library will give team members access to fitness equipment to use during

lunch, and videos and books to check out and take home. With all the tools and resources that

will be available, employees will be encouraged to set their own personal goals, overcome

barriers, and take steps to improving their health. The health coach will provide each employee

with monthly information packets, goal workbooks, and personalized coaching as they progress

through the program.

The program will add new things each month as the employees progress, and at the end

of the program there will be a wrap-up and program evaluation. The various activities that are

targeted towards healthy eating, physical activity, and stress reduction are all aligned with

meeting the program objectives. At the completion of the program, the activities will be

evaluated to see if they were effective. The activities effectiveness will be determined based

upon pre and post-questionnaire responses. Management and stakeholders will be notified of the

program results and the obtainment of the program objectives.


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A Discussion of Leadership Support, Management, the Workplace Health Improvement

Plan, Resources, and Communication

A program will not be successful if management does not support it, if there is not a

health improvement plan, if resources are not accessible, if communication methods are not in

place, and if the program is not based on relevant literature and theory. To begin a successful

workplace wellness program, the support of the management must be obtained. The owner and

manager of the dental office gave their support of the program at the beginning and agreed that it

would have positive benefits to the organization and the team. According to the Wellness

Council of America (2007), getting management support is vital to a programs success in

meeting objectives and getting results. Support from the management in the dental office will

motivate the employees to take action.

Another factor that will help the employees take action is a workplace health

improvement plan. The employer himself will take action to improve the environment to be

healthier for the employees. Action steps such as allowing water in the operatory, giving breaks

for healthy snacks, encouraging stretch breaks, and reducing overbooking will all create a

healthier workplace. In addition, stress will be reduced and employees can feel more nourished

and energized. The workplace health improvement plan will not only include the organizational

plan but the health promotion program plan as well. As outlined in figures 1 and 2, a clear plan

is included to achieve the mission statement, goals, and objectives. The workplace health

improvement plan includes the mission statement, goals and objectives, the activities, the

strategies, the wellness committee and duties, the communication plan, and the evaluation

process (CDC, 2015c). The combination of organizational improvements and wellness program
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improvements will create a healthier workplace culture. With a healthy workplace culture and

management support, employees can make healthier lifestyle choices.

Another factor that will promote healthier choices is an abundance of resources available

to the employees. There will be a full wellness library in the office containing videos, books,

and fitness equipment. Also, employees will have access to resources such as a health coach,

fitness instructor, yoga teacher, Stress Master Associate, and local physician. All of the local

resources, which include presenters and teachers of the program, will take part in the designated

monthly activities. Community resources for healthy living will be included in the program such

as local trails, community 5k races, nearby parks, and a local gym. The internal resource of a

dental employee that is also a health coach, will be utilized. Various resources will give the

employees what they need to succeed at making positive behavioral changes.

Another factor that will help employees make positive lifestyle changes is adequate

communication. According to the CDC (2015a), a good workplace, health promotion

communication plan can increase employee knowledge, promote awareness, initiate action,

improve relationships, increase program participation, improve behaviors, and increase health.

Communication will be paramount to the success of the workplace wellness plan in the dental

office. Communication will occur throughout the program amongst the wellness committee and

then be delivered to the employees. Daily communication will occur in the morning huddles and

any flyers or reminders can be given at that time. Communication will also include

correspondence through a private Facebook group and office email. In addition, communication

about events will occur with posters, flyers, meeting announcements, and break room reminders.

The team will have a healthy potluck each month and a walking meeting to communicate and

engage further. Lastly, each employee will have access to a health coach in case they have any
FINAL PROJECT 63

questions, problems making change, or need further support. Adequate communication on

various levels will increase the potential impact the program can have on the lives of the team

members.

The communication for the program will be based on the Health Belief Model (HBM).

This theory is the basis of how the program objectives and activities were chosen. The HBM is a

theory about how people perceive a health need and how ones viewpoint affects the probability

that they will change lifestyle behaviors (Hodges & Videto, 2011). Hodges & Videto explained

further that the HBM can promote change by defining the risk, explaining the repercussions of

the risky behavior, illustrating how to take action and the benefits for doing so, providing support

and solutions to roadblocks, removing fears, and reinforcing ones capabilities to change. The

program plan and communications will align with the HBM by communicating the risks of

stress, unhealthy eating, and a sedentary lifestyle. In addition, those involved with the program

will illustrate the benefits of making change, explain how change can be made, provide support

to making change, and reinforce each employees own capabilities for improvements. The

health coach will be crucial to communicating in a manner that supports each component of the

HBM and each activity will focus on supporting change in a manner consistent with the theory.

The dental office workplace wellness program will be successful since it has management

support, a clear health improvement plan, adequate resources, a strategic communication plan,

and an evidence based theory. As employees engage in the workplace wellness promotion plan,

they will receive every necessary component that can motivate change. The internal motivation

present within each employee may be enhanced with the monthly activities, support of the team,

and influence of the health coach. Many barriers to change have been removed since so many
FINAL PROJECT 64

resources have been provided to encourage change. Program success will ultimately be

determined during the evaluation.

A Program Evaluation Plan

A program evaluation plan for the workplace wellness program will need to be

comprehensive to provide adequate data for analysis. Those who have vested interest in the

program such as the employer and funding sources will want to know the outcomes of the dental

office health promotion program. In addition, doing evaluations throughout the program will

help to identify areas of improvement, the level of engagement, employee satisfaction, and

potential barriers. Multiple evaluations will be included such as a formative evaluation, process

evaluation, outcome evaluation, and impact evaluation. According to Hodges and Videto (2011),

the evaluations must identify various measures of the program such as if the program is being

productive, if it is being implemented as planned, if it is using the funds appropriately, and if the

activities are aligned with the goals and objectives. Evaluating the program with formative,

process, outcome, and impact evaluations and looking at how it is being implemented can help

program planners measure if it is successful or not. Recognizing areas for improvement and

removing barriers is key to helping employees to be engaged.

Evaluations answer questions that help to focus the data collection methods and identify

what resources will be required to gather the information. Questions will need to be answered

before planning an evaluation such as when will the evaluation occur, who will do the

evaluation, how will the evaluation be done, and what will be evaluated? Formative and process

evaluation questions help to evaluate the program prior and during. Questions can include is the

correct need being addressed, is the interest present amongst the leadership and employees, is

there appropriate funding for the program, is the program being implemented as planned, and is
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the material being understood? In addition, evaluations can include asking outcome and impact

evaluation questions such as how many employees are actively participating, how many

employees are eating more fruits and vegetables, how many employees are being physically

active, and how much has the stress level gone done?

Once evaluation questions are in place, the plan to gather the data can be outlined.

Gathering data and feedback facilitates program enhancements, shows program value, measures

development, and builds accountability (WELCOA, 2007). The wellness committee and

wellness leader for the dental office of Placer County will gather crucial data as part of the

evaluation. The evaluation plan and date collection methods will be discussed and

responsibilities determined at the monthly wellness committee meetings. Data collection

methods will include health needs questionnaires, healthy lifestyle questionnaires, interest

surveys, workshop evaluations, informal interviews, informal lunchroom focus groups, and

program completion questionnaires. The wellness leader will delegate responsibilities to the

wellness committee. Since the office is so small and the employees meet together every day,

questionnaires and surveys will be put in each employees lockers. An anonymous box will be

left in the lunchroom. To incentivize employee participation, a raffle ticket will be obtained for

each submission. Drawings for incentive prizes will occur every other month.

At the conclusion of the evaluation, all data will be collected and analyzed by the

wellness committee. In addition, one final focus group and group interview will occur to discuss

the employee satisfaction with the program. Topics for discussion will also include what

worked, what did not work, and what improvements could be made. The wellness committee

will determine if the goals and objectives were met and what the sustainability is for a program

the following year. A report will be written to give to the employer, the funding sources, and
FINAL PROJECT 66

each employee. Wrapping up the program with a comprehensive evaluation plan will help all

stakeholders to know if the program was a success.

A Program Implementation Plan and description of programs, policies, health benefits, and

environmental supports

The program implementation plan is explained in full detail throughout the wellness

program and is included in the description of the funding source, budget, timeline, activities, and

communication plan. All of these components make up the plan for implementation. According

to Hodges and Videto (2011), a plan for implementation makes sure that the activities and

interventions are being delivered as planned, that the planned amount of activities is occurring,

and that the activities are complete in their scope. Each month the wellness committee will meet

and make sure things are being implemented as planned, that the funding is being used

appropriately, and that the duties and tasks are being completed. Furthermore, the wellness

committee will follow the flow available in figure 1, and the program implementation timeline in

figure 2. Each month programs will be implemented that address strategies to reach objectives

by increasing physical activity, increasing fruit and vegetable consumption, and increasing stress

reduction practices. The health benefits for employees engaging in the health promotion

program and activities will be increased energy, decreased chronic disease risk, decreased

obesity risk, decreased stress, increased productivity, decreased sickness, and a better quality of

life.

In addition to the workplace implementation plan, the policies and environment will also

support positive change. According to Elia & Rouse (2016), the office environment and policies

should reflect the mission statement and be supportive of employees being healthy. The policies

of the dental office and the mission statement of the program will be supportive of healthy
FINAL PROJECT 67

lifestyle choices too. New policies will be implemented based on the workplace wellness

program and the dental office employees will be able to take healthy snack breaks, have water to

drink in their operatory, and have stretch breaks. Another healthy office policy will be a

reduction in overbooking and overtime hours. Meeting policies will include walking during

meetings. All other policies included within the program will be supported on an organizational

level. Also, the environment of the dental office will be conducive to less stress and healthy

lifestyle choices. The once a month potluck and healthy food that will be provided at work

functions creates an environment where nutritious choices can be made. Fitness equipment in

the breakroom also provides a physically fit environment. Team gatherings for the year will

include an environment that supports health while out on trails, in parks, or outside at a BBQ.

The full implementation plan, office policies, and the surrounding workplace

environment all create a positive atmosphere conducive to health. Having a clear plan for

implementation helps to organize activities and prevents any from being neglected or forgotten.

Each activity will promote the mission of the workplace wellness program. The office policies

will also promote the mission of the workplace wellness program and will create a culture of

wellness within the workplace. The environment within the small dental office will be

surrounded with healthier options that will promote healthier employees.

Program Sustainability

Commitment to healthier employees will be the mission throughout the yearlong

workplace wellness program. The workplace wellness program has clear needs addressed, a

defined mission statement, long-term goals, specific objectives, a funding source and budget, a

program implementation plan, strategic activities, management support, a communication plan,

and a method for evaluation. Each component of the program has created a foundation for a
FINAL PROJECT 68

healthier workplace culture in the dental office. Now that the foundation is laid and the

groundwork has been done, a continuation of the program can occur. Sustainability could be

achieved on a smaller scale with less expensive activities and events. The workplace culture of

health is already established, so all that is needed is the continued effort of the wellness

committee in planning future motivational strategies. The team can continue low cost activities

such as walking for meetings, holding monthly healthy potlucks, gathering for healthy BBQs,

going on team trail hikes, attending community fitness races, practicing stress reduction

practices, and meeting at the gym. Sustainability is achievable long-term with the dental office

workplace wellness promotion program with a little creativity and planning. Healthy living can

become a way of life, and each employee can contribute to making it a way of life at the dental

office. As employees work together, take what they have learned from the health program, and

commit to improving their professional and personal lives through healthy living, they can

experience an improved quality of life at work, at home, and in the community.

Improving the health and quality of life for employees can result from a workplace

wellness program. In addition, workplace wellness programs can reduce absenteeism, stress,

workers compensation claims, and healthcare costs. The small dental office of Placer County,

California has planned for an effective program to improve the workplace culture and health of

employees. The program includes multiple components: a clearly defined need, a program

mission statement, goals, and objectives, a program implementation timeline, a budget, a funding

source, a strategic plan for program activities, a method for evaluation, and a plan for

implementation and sustainability. As the health promotion program is carefully followed and

implemented, the dental employees of Placer County can make lifestyle changes that improve the

health of the organization and the health of each individual. The workplace wellness program
FINAL PROJECT 69

can lead to a better quality of life at work and at home and increase the potential to live a longer,

healthier, more productive life.


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