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In other words, the theory you use – whether old, new or personal – frames the way you look at a problem, try to understand it, go about solving it and attempt to measure it (for example, not one epidemiological survey has ever give me a clue about HOW to change risk behaviors, only that it needed to be done for certain population groups).I was recently called into a family planning project at the beginning (thankfully) to help develop an overall approach and strategy.
Research should target practices, social factors and behaviors that fuel HIV epidemics across populations and settings. Work with Community-Based Organizations (CBOs) and Health Departments (HDs) to determine how best to focus and tailor these responses in their particular communities. Research should focus on the process of dissemination that emphasizes studies of training procedures, end-user response to guidance, implementation strategies, contract manager effectiveness, enhancers and barriers to scale up, evidence in the real world for effectiveness, and capacity building.
CDC should undertake a community-driven research agenda that takes advantage of its unique relationships with CBOs and HDs and encourages their input in the identification of emerging issues and potentially effective practice-based interventions.
Social marketing has a central role to play in scaling up interventions and in research-to-practice strategies.
Audiences need to be broadened from at-risk populations and service providers to include DOH and CBO implementation agents (for example, Learning from the Community: What Community-Based Organizations Say About Factors that Affect HIV Prevention Programs -pdf). Theoretical models that drive program development, implementation and evaluation do not reflect a unified conceptualization of behavior change. After a number of posts about the need for more radical behavioral research in HIV prevention and to scale up demonstrably effective programs for HIV prevention, it was an honor and privilege to serve on the DHAP review team and to part of a very knowledgeable, dedicated and fun panel. Gaining insight into why programs achieve scale or not is not sufficient for change at any level of society. The Bringing HIV Prevention to Scale report also examined how the successful national efforts of Brazil, Senegal, Thailand and Uganda scaled up their national HIV prevention activities.
The report also highlights that truly comprehensive HIV prevention programs need to focus on (1) preventing sexual transmission, (2) preventing blood-bourne transmission (including through blood transfusions and sharing injection equipment), (3) preventing mother-to-child transmission, and (4) social strategies and supportive policies. Reading these reviews I have to ask if this problem of scale is really a call for better social marketing - creating and managing markets and resources more strategically? Then again, I guess we could be talking about marketing through social network sites and blogs? About the image: This map shows the distribution of all people between ages of 15 and 49 with HIV. Scaling up programs that have been shown to be effective in promoting health and other social causes in pilot and demonstration projects or larger efficacy and effectiveness trials should be a major focus of social marketers.
Though numerous examples abound to support this conclusion, I will focus on one: HIV prevention programs.
Despite the extraordinary potential of available prevention strategies, most people at risk of HIV infection have little or no access to basic prevention tools. Among the factors the Working Group identifies as fueling the failure to scale HIV prevention efforts are:Inadequate Financing. Our challenge, whether it be in HIV prevention or the prevention of childhood obesity, it to apply the evidence-base of diffusion research through social marketing programs. In developing countries, social marketers have been trying to get more people to use condoms. Since 2003, according to a PSI survey, young men and women in Kenya with multiple partners increased their use of condoms from 33 to 47 percent. Blog that publishes text and some graphics on topics related to social marketing and social change issues. When preparing to implement an EMR or EPM system with a graphical user interface, your entire staff will need to possess at least some computer skills.
Some staff members will need to be able to check patients in and out; others will have to post money or generate claims.
The electronic medical records committee must design a training plan which takes the above factors into consideration. CCHIT had been given an (un)official nod from the government's Office of the National Coordinator for Health Information Technology as the certifying body for EMR standards. At our practice, mind-mapping software has become indispensable for managing projects of any size. I've successfully rid the home office of paper records by scanning them all - then shredding them.
Many computers have monitor or video out-ports which allow a connection to a second monitor. Although no single device can do it all, I have discovered a PDA or smart phone to be especially useful. Some recent legal cases have established that data which is accessible must be able to be produced, including backup. In the world of paper records, charts that are more than seven years old that were purged are considered legally inaccessible.
Eventually, rational minds emerged victorious, and some of the more inane regulations have relaxed somewhat. Consider forming a Legal, Risk & Compliance (LRC) Committee for your practice, to address the above-mentioned issues and others which may arise. Micro Finance, an internationally accepted and practiced program for Poverty alleviation,has been the thrust area of Gram-Utthan post 1995-96. While learning about the theories was repetitive, I felt like I learned a more useful way to apply them to interventions. While I cannot predict what the final report might look like, or how CDC may choose to implement the recommendations of our panel and from the other four, hopefully you will find a new idea or inspiration in these recommendations to improve your ability to design public health change. Learning how programs successfully achieve scale (what some might call observational learning), imitating them (a form of flattery that many are loathe to practice unfortunately) and monitoring performance (through relevant program outputs and behavioral outcomes to feed back to planners what is working and what needs to be adapted to local circumstances) are the components of turning lessons learned into action (note I deliberately left out epidemiological endpoints. These countries have demonstrated that it is feasible to reduce the incidence and prevalence of HIV, slow down the rate of predicted increases in prevalence and keep HIV infection rates at low levels. These authors also note that expanding access to key HIV prevention services including HIV counseling and testing, expanding condom distribution and use, and targeting of high risk and vulnerable groups - injection drug users, sex workers and men who have sex with men - are all necessary for scaled up programs to succeed. Or has the international health community gotten to the point where social marketing is being marginalized as a term reserved only for the promotion and distribution of subsidized commodities through commercial sector channels?

I say 'should be' for while we talk about population-based or social change, the fact is that few evidence-based practices ever achieve the scale necessary to make their promise or vision reality for the thousands or millions of people who could benefit from them.
The Global HIV Prevention Working Group has just released a report on the 'failure to scale' (my words, not theirs).
Although necessary coverage levels vary depending on national circumstances, current coverage levels for essential prevention strategies are woefully inadequate for any national epidemic. Only 9% of risky sex acts worldwide are undertaken while using a condom, and the global supply of condoms is millions short of what is needed. In the most heavily affected countries of sub-Saharan Africa, only 12% of men and 10% of women know their HIV status. It is estimated that fewer than 20% of people with a sexually transmitted infection are able to obtain treatment, even though untreated STIs increase the risk of HIV acquisition and transmission by several orders of magnitude. Years after clinical trials demonstrated that a brief, inexpensive antiretroviral regimen could reduce the risk of mother-to-child HIV transmission by 50% (5), only 11% of HIV-infected pregnant women in low- and middle-income countries receive antiretroviral prophylaxis.
Prevention services reach only 9% of men who have sex with men, 8% of injection drug users, and under 20% of sex workers. An estimated 6 million units of unscreened blood are transfused yearly in developing countries, and 40% of injections administered in health care settings are unsafe.
While financing for HIV has increased dramatically in recent years, available funding is only slightly more than half of amounts needed to support a comprehensive, scaled-up response. Several impediments stand in the way of doing so, not the least of which is the overwhelming (at least to me) lack of understanding among health professionals and policy makers of what this research offers health and social programs (other than fleeting references to The Tipping Point).
But the United Nations Development Program says that breaks down to about 10 condoms a year for every man in Africa — and that is not enough.
Problem is that two of the four major networks (CBS and FOX) rejected the TV ads for not focusing on preventing diseases (which diseases do the ED drugs prevent again?). Featuring expert guidance in electronic medical records, finance, administration and legal issues. However, a large percentage of adults still have limited experience with the latest technology.
Maybe the technical staff won't have to understand the claims process, but they will surely need to be proficient using EMR.
The committee will have to determine what the common tasks for every employee will be, then adding additional skills of increased complexity to the appropriate departments and jobs. According to a report by FierceHealthIT, The Drummond Group, an interoperability testing lab in Austin, Texas, has thrown its hat into the ring.
An organization made up of industry experts, corporations, and other volunteers, CCHIT has also had its share of critics who charge that it is giving preferential treatment to big players in the EMR software community. The ScanSnap 500 is a device which will scan everything, from PDF files to double-sided documents. Many small, high-definition TV sets have a video in-port able to toggle between cable and satellite and a computer signal. These devices are cell phones that run Windows apps, able to sync with Outlook on your desktop computer to access the Internet, email, and your contact list. No more can you even keep a patient check-in form at the front desk, or risk having a patient learn who else had been in on that day. Although this may seem an unfair burden for a medical practice, experts dealing with these sort of legal cases believe that EMR will result in a decrease of malpractice suits, owing to better documentation and a lower rate of medication-related mistakes. There are still privacy issues which are specific to the electronic aspects of medicine, in regard to inappropriate disclosure of patients' data. In 1995-96, the core team of GU had exposure to some of the micro Finance programs, which were run elsewhere in India.
This is, what the student above referred to, as theory from the 1950s (well, not quite that long ago, but you get the idea). The total DHAP budget in FY2009 was $853 million, of which $28 million (that’s 3.2%!) was for behavioral intervention research.
The second is that very few social marketers seem to know how to transform programs focused on individual behavior change to ones scaled for population impact.
It's a lucky fact that most doctors must keep with technological advances out of necessity. The best part is that you don't need to be a computer genius to use these tools - they're intuitive, making projects easy to follow visually. This application has modules to set up various goals, from business, to family, to personal.
When you set up dual display with the TV as the second monitor, you can double the work area on the desktop.
Some people use the phone connection to access the Web, while others connect through a wireless network.
Even so, if data is kept on a failed hard drive, and the costs of recovering the data is significant, it could create an undue burden; judges could rule that the expense be shared between the two parties. When it comes to electronic information, however, inaccessibility could be more difficult to prove, as electronic data can almost always be recovered. An unauthorized email, unsecured wireless network, a computer monitor left on in view of another patient are some prime examples. Realizing the positive impact of mF and its right approach for Poverty alleviation, GU decided to adopt mF as the strategic program for the development of the community it was working for. It is the canon for behavior change academics, one that must (?) be passed down to the graduate students of today for it’s historical importance – although, unfortunately, most of those instructors I expect still believe it to be operational. It proved to be a daunting task, especially since the last full programmatic review was in 1993. What impressed me (and others on the panel) was how this limited budget was spent on mimicking a drug R&D process of uncovering the most effective elements of HIV prevention programs, testing them, packaging them and then promoting their availability to the community. In part due to the weakness of HIV information systems, many countries do not target limited funds where they would have the greatest impact.

Even fewer researchers and their funders seem to get that developing and testing programs meant to achieve scale need to be designed that way to begin with and not focused on reductionistic minutiae that - again - focuses on individuals, not people. For example, almost all of your employees will need to know how to use the system to look up appointment info. Next, the department should rotate through the training room to receive training on the necessary tasks for their particular jobs. Some newer versions such as Treo 150W can sync up with your contacts and calendar remotely from any location. In fact, most of the current EMR software systems don't even let a provider delete patient records. There was limited attention to what one panel member referred to as ‘the science of the street’ or learning from what is working in communities.
Misallocation of limited resources by donors and affected countries also often occurs as a result of ideological, non-scientific restrictions imposed by donors on how HIV prevention assistance may be used.Capacity Limitations. And finally, as the Working Group makes clear, and as an old saying goes (thanks to Thomas Friedman): A vision without resources is just an hallucination. Still, many other staff members have limited exposure to computers at work - and limited skill as a result. A manual was prepared for the EPM software module, and another is being written for the EMR module.
A dashboard can handle your mind maps while helping to delegate the logistics of who, where, what and when of your projects. Although a bit larger and heavier than a regular cell phone, these devices make up for the added weight with increased flexibility. The initial support to GU-mF program was provided by various national level support agencies like RMK, NMDFC, and NBCFDC etc. When I have done research into what theories people use in public health programs, practitioners can describe (maybe) one or two, and academics describe their own (developing your own theory must be a prerequisite for tenure now). However, among the practitioners I have worked with, they find it a very useful and comprehensible road map for thinking about a variety of public health problems.
Indeed, these activities were labeled ‘homegrown’ solutions and had little weight or prominence in the Diffusion of Effective Behavioral Interventions (DEBI) model.
Due to inadequate human capacity, countries often have difficulty programming substantial infusions of new funding.Service Fragmentation. In order to gauge an employee's computer literacy, they can be asked about the applications they've used, and to give examples of the sorts of tasks they've performed.
This has become a major area of law and will become increasingly important as EMR becomes the norm. That some authors want to impose a single theory on social marketers borders on malpractice.People in the advertising and public relations worlds who work on social marketing projects don’t even know what a theory is – unless they have been in the game for a while. The integrative theory incorporates elements of 3 widely used theories in behavior change and communication interventions: the health belief model, social cognitive theory and theory of reasoned action.
The panel concurred that focusing such a small budget on the full spectrum of R&D activities was not practical or effective. HIV prevention has frequently not been integrated into schools, workplaces, and other institutions, and HIV efforts are insufficiently linked with other health-related service systems, such as TB or sexual and reproductive health.Stigma and Discrimination.
It's also possible to tell an employee's competency through the vocabulary they are familiar with.
The bottom line for medical practices is that a reliable and secure backup process is a must. They want you to believe that their past ‘experiences’ give them a better feel for what will work with an audience than any textbook.
In this model, whether a specific behavior is performed depends upon (1) if one intends to engage in that behavior - which you can see depends on a whole lot of things, (2) if they have the requisite skills and abilities to perform the behavior, and (3) if there are no environmental constraints (broadly defined) to performing the behavior. Rather, we suggested more of the CDC behavioral research endeavor should focus on the improving the science at the ends of the spectrum – innovation (often gleaned from communities) and dissemination (how to achieve scale for effective programs).
The stigma associated with HIV and with membership in a vulnerable group deters many at-risk people from seeking HIV prevention services or learning their HIV status and also discourages the kind of political leadership required to implement a robust and evidence-based HIV prevention effort. What they often fail to intuit is that these ‘experiences’ form their own naive or folk psychological theories.
We threw around phrases such as ‘community-driven research’ and ‘community-to-science’ to reinforce our point. Among the constraints identified in the audience research are the few facilities available in rural counties, busy clinic staff that makes local outreach and promotion efforts difficult, making time in their busy schedules for setting clinic appointments, and difficulties using the centralized referral service.Second, we need to assess if the person has the necessary skills to access and effectively use family planning methods over time. We asked: How about establishing an Innovations Lab for behavioral change research for HIV prevention to respond to emerging needs through formative research and Phase 1 studies and leave Phase 2 and 3 work to other agencies (NIH, HRSA, SAMHSA) to fund?
About several dozen to several thousand research studies validating them (and some will still argue ‘what do the researchers know! Among the determinants of these intentions we found that conservative community values can play an important role in reducing conversations and public education activities around family planning.
Looking at the CDC as an institution, we were also asking ourselves quite often: What are the rewards and incentives for staff who conduct innovative behavioral research and dissemination of practices? We did not hear much about women believing they were not susceptible to becoming pregnant (though other research informs us that this is the most common reason from women to discontinue using contraceptives). There was also evidence that women do talk with each other about birth control, though no common times or places were discovered that might guide communication strategy. Now some people will ask ‘what about…?’ And if you think that’s an important variable to consider, first make sure your audience does too.
While I am not going to defend this particular theory as all-encompassing (that is why there will be a second installment to this topic), what you can take away from this is: the theory you use helps you to focus in thinking about the issue, asking relevant questions of your audience and forming program strategies that are both theoretically- and research-driven.

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