The bottom-up community participatory paradigm as the study design, the RE-AIM framework as set of criteria for evaluating the outcomes, preceed-procede model and SMARTER objectives setting were preferred to their alternatives for planning, delivering and estimating the outcomes of the health promotion project in Inner North Canberra, Australia and regarded as the most effective for this program.
The bottom-up community participatory paradigm
The bottom-up community participatory paradigm was adopted for this research as the most appropriate approach which would allow the community to identify the most relevant problems and change the project goals in case if any additional needs are detected.
The community participatory paradigm is defined as a flexible type of study design able to respond to any shifts in the contexts and any newly emerging findings which are significant for the research process, but which were neglected when the research methodology was developed (Ledwith & Springett, 2010, p. 94). This paradigm relies on the needs assessment processes within a certain community and traditionally does not employ any strong experimental designs. This approach is intended to minimize the biases through reducing the power differentials which can occur between the researchers and the participants of the study.
Regardless of particular disadvantages of this approach, including the lack of resources, the weakness of authority structures and the possibility of the radical shifts of the initial goals, the bottom-up community participatory paradigm was preferred over the top down models of intervention and the total quality management paradigms because of its ability to produce significant and the long-term effects upon the community practices (Lawrence & Worsley, 2007, p. 438). The main limitation of the top down paradigms is their authoritative character due to the lack of the participants’ involvement and the increased distance between the researchers and the community which can result in a certain degree of bias and decrease the value of study outcomes and the effectiveness of the following health promotion programs.
The RE-AIM framework is a set of criteria used for evaluating the appropriateness of nutrition promotion programs, notwithstanding the research paradigm which has been adopted for the project.
The RE-AIM framework is intended to evaluate the effectiveness of public health interventions through assessing the five main parameters of the programs, including reach, efficacy, adoption, implementation and maintenance (Shi & Singh, 2011, p. 186). The reach criterion estimates the proportion of the population involved into the project, especially those with high risks of diseases. The efficacy criterion is intended to estimate the positive and negative implications of the health promotion program. The adoption parameter identifies the proportion of the population adopting the recommended changes. The implementation parameter evaluates the extent of correspondence between the program recommendations and its actual implications within the real life settings. The maintenance criterion is used for estimating the long-term effects of the project through identifying the extent to which the health promotion policy has become a part of the organization practices and routines.
In case if a program does not meet any of these criteria, it can be recognized as ineffective and resulting in the waste of resources or even the adverse effects. This framework was adopted for the current study because it is recognized as the most appropriate model for estimating the appropriateness of the public health promotion projects due to its effective account of the resulting changes in the practices and the implementation of the long-term perspective.
Precede- proceed model
The precede-proceed approach as an 8 phase model focusing on planning, implementing and evaluating the nutrition promotion program was adopted in this study because of its detailed guidelines and the main focus on the practical implementation of theoretical concepts instead of explaining or predicting the relationships between the related factors.
As outlined by Green & Kreuter (2005), the precede-proceed model consists of the two main sections, including the precede section covering the planning processes in the first four phases and the proceed sections containing the guidelines for delivering and evaluating the programs. The precede portion includes the phases of social assessment, epidemiological assessment, educational and ecological assessment, and the assessment of the existing policies followed by the intervention alignment. The proceed section contains the implementation, process evaluation, impact evaluation and the outcome evaluation phases (Fertman, 2010, p. 18). Thus, the main advantage of the precede-proceed model is its logical structure which allows creating the links between the findings of causal assessments, planning process and procedures of evaluating the outcomes and combining them into a complex framework.
The SMARTER objectives as an acronym used for the characteristic attributed to a well-written and useful objectives was adopted for planning the current project aimed at improving the fruit and vegetable intake in Inner North Canberra, Australia. This approach was adopted to allow the leaders to formulate high impact objectives which would allow improving the project outcomes.
According to the main principles of the SMARTER objectives, the main criteria which need to be considered for formulating effective goals include specific, measurable, attainable, relevant, time-bound, evaluate and reevaluate parameters (Kaufman, 2003, p. 194). Taking into account all of the above-mentioned characteristics, the leader will be able to develop high-impact objectives which would allow enhancing the effectiveness of the nutrition promotion project at the objective setting stage. Making the objectives specific and measurable, the leaders will be able to evaluate their appropriateness for a particular project and estimate their accomplishment at particular phases of the project planning and delivery.
The SMARTER objective-setting process was adopted for this project for the purpose of achieving high performance in developing the project for improving the fruit and vegetable intake in Inner North Canberra, Australia.
The advances of the research-based approaches to planning, delivering and evaluating the nutrition promotion projects were used or selecting the most appropriate models and techniques for the program aimed at improving the fruit and vegetable intake in Inner North Canberra, Australia. The advantages of the bottom-up community participatory paradigm, the RE-AIM framework, preceed-procede model and SMARTER objectives setting as compared to their alternatives became the rationale for implementing these techniques in the processes of planning, delivering the program and estimating its outcomes.
Fertman, C. (2010). Health promotion programs: From theory to practice. Society for Public Health Education.
Green, L., Kreuter, M. (2005) Health program planning: An educational and ecological approach. 4th edition, New York, NY: McGraw-Hill.
Kaufman, R. (2003). Strategic planning for success: Aligning people, performance and payoffs. San Francisco, CA: John Wiley & Sons.
Lawrence, M. & Worsley, T. (eds.) (2007). Public health nutrition from principles to practice. Sydney: Allen & Unwin.
Ledwith, M. & Springett, J. (2010). Participatory practice: Community-based action for transformative change. Bristol: The Policy Press.
Shi, L. & Singh, D. (2011). The nation’s health. Sudbury, MA: Jones and Bartlett Learning.