STEP 1: PROBLEM IDENTIFICATION AND STATEMENT

Program Planning

Program planning is the process by which a program is conceived and brought to fruition. Program
planning involves multiple steps including the identification of a problem, selection of desired
outcomes, and assessment of available resources, implementation and evaluation of the program.

Steps of program planning

Program planning has 6 steps that are listed as follows

Step 1: Problem identification and statement

In order to identify the problem, there are three steps that are followed which are listed as follows

 Exploration
 Prioritization
 Articulation

Information gathering and exploration

In order to identify the problem information is collected about the issues that are proposed in the
program. The community chosen for program implementation was private school of shadman
colony.in order to gather information, we searched for the existing data by conducting a
questionnaire survey in schools from children. After that we analyzed our data on SPSS software
to get our results regarding to prevalence of obesity among children.

Community need assessment

A needs assessment is a systematic process for determining and addressing needs, or "gaps"
between current conditions and desired conditions or "wants". The discrepancy between the
current condition and wanted condition must be measured to appropriately identify the need. The
need can be a desire to improve current performance or to correct a deficiency. It helps in
identifying problem and baseline guidance in order to start a program in the community. We found
out following information during the community need assessment.

 Overview of the Community

 Lifestyle of the people residing in the community
Overview of the Community

Lifestyle of the people residing in the community

Problem analysis and prioritization

The process of prioritization and decision making to select problems to be addressed is a
challenging process in which information is collected from multiple sources. We collect our
primary data from the children and their parents. Our secondary data was collected through pre
and post-test.
A pretest was conducted in order to highlight the hurdles that were hindering the successful
management of obesity among children.
Developing the causal theory
The Causal Theory is a progressive theory of personality development based upon cause and
effect. It assumes that personality and behavior, including and especially adult behavior, result
from childhood experiences beginning from birth, and perhaps even in utero.
In order to develop the causal theory, the following points should be addressed such as
 Accurate understanding of health program
 Dimensions of their health program
 The causal chain leading to the program
 Causal factors
 Influencing factors
The causal chain in the causal model basically includes the causal factors and influencing factor.
Causal chain for our program was developed keeping in view the scientific evidence base,
community need assessment and the specific content and environment of the program.
 The causal diagram developed for our program is illustrated as follows:

CAUSAL FACTORS INFLUENCINGFACTORS

lack of Poor dietary

Regular
knowledge patterns
monitoring of
related to
weight
nutrition and
diet for treating
obesity

Poor management of
High
obesity
prevalence
of obesity
Poor awareness
about general
healthcare and
getting regular
checkup
Poor use of
health service
including
treatment and
monitoring

Formulating the problem statement

The problem statement is formulated keeping in view the cause of the problem with all the linkage
such that it facilitates choosing the appropriate intervention and intervention point. The problem
statement for the high percentage of obesity among school going boys in shadman colony is as
follows:
The high prevalence of obesity in school going boys aged 12-16, as indicated by the primary and
secondary data is caused by unhealthy eating habits, lack of physical activity, genetic factors and
combination of other social and environmental factors. These factors are influenced by lack of
knowledge about healthy dietary habits to control the obesity rate in children.
STEP 2: SETTING GOALS AND OBJECTIVE
 STEP 2: SETTING GOALS AND OBJECTIVE

This step of program planning focuses on setting goals and objectives, selecting indicators, and
setting targets. This approach aids in the selection of intervention and the further development of
the program with an eye on the planned results. Goals and objective flows from the health program,
and are the linked to the interventions and program activities. Therefore, on one hand while
objectives and target may drive the choice of interventions, on the other they may need to be
adjusted or revised based on the interventions e.g. their feasibility, dosage, intensity, and such
other factors.
GOALS
A goal is an idea of the future or desired result that a person or a group of people envisions, plans
and commits to achieve. People endeavor to reach goals within a finite time by setting deadlines.
The goal of our Obesity Management Program was:
“To manage the weight according to the normal BMI by introducing balanced healthy
dietary habits, increasing physical activity, exercise.”
Balanced and Healthy Dietary Habits

 Provide plenty of vegetables, fruits, and whole-grain products.

 Include low-fat or non-fat milk or dairy products.
 Choose lean meats, poultry, fish, lentils, and beans for protein.
 Serve reasonably-sized portions.
 Encourage your family to drink lots of water.
 Limit sugar-sweetened beverages.
 Limit consumption of sugar and saturated fat.

Reduce sedentary time.

In addition to encouraging physical activity, help children avoid too much sedentary time.
Although quiet time for reading and homework is fine, limit the time your children watch
television, play video games, or surf the web to no more than 2 hours per day. Additionally, the
American Academy of Pediatrics (AAP) does not recommend television viewing for children aged
2 years or younger. Instead, encourage your children to find fun activities to do with family
members or on their own that simply involve more activity.

Exercise and physical Activity

Regular physical activity is important in weight reduction and improving insulin sensitivity in
youth with type 2 diabetes. Aerobic exercise has been shown in a prospective randomized,
controlled study of 64 children (9–11 years old) with hypertension to reduce systolic and diastolic
blood pressure over 8 months. Resistance training (eg, weight lifting) after aerobic exercise seems
to prevent the return of blood pressure to preintervention levels in hypertensive adolescents.
Weight loss through moderate aerobic exercise has been shown to reduce the hyperinsulinemia,
hepatomegaly, and liver enzyme elevation seen in patients with steatohepatitis. Regular physical
activity is also beneficial psychologically for all youth regardless of weight.

OBJECTIVES

A specific result that a person or system aims to achieve within a time frame and with available
resources. In general, objectives are more specific and easier to measure than
goals. Objectives are basic tools that underlie all planning and strategic activities. They guide the
further development of the program, serve as the programmer’s framework for decision making
and resource allocation, and provide a structure for program evaluation.

The objectives for our program were

 To educate about the risk factors that are related to the obesity
 To educate the children and their parents about dietary resources
 To educate them about the consequences of obesity
 To provide the education about the exercise and increase physical activity for the
management of obesity
 To motivate them to reduce their weight to normal BMI

SELECTING INDICATORS

The indicators you select should answer your evaluation questions and help you determine
whether or not your program objectives have been achieved.

The indicators and means of verification of our program were:

INDICATORS MEANS OF
VERIFICATION

Food intake 24-hour-recall, Food frequency

Questionnaire

Weight and Physical activity BMI

Knowledge about the health Pre-test and Post-test

dietary habits regarding
obesity management
STEP 3: SELECTING INTERVENTION
 STEP 3: SELECTING INTERVENTION

PURPOSE:
The purpose of a nutrition intervention is to resolve or improve the nutrition diagnosis or nutrition
problem by provision of advice, education, or delivery of the food component of a specific diet or
meal plan tailored to the patient/client’s* needs.
Determining a nutrition intervention:
The nutrition diagnosis and its etiology drive the selection of a nutrition intervention. Nutrition
intervention strategies are selected to change nutritional intake, nutrition-related knowledge or
behavior, environmental conditions, or access to supportive care and services. Nutrition
intervention goals provide the basis for monitoring progress and measuring outcomes.

Demand side Supply side incentives Demand side incentives

behavior Long routes
change
Providing Economic development to Increasing knowledge among the children
primary health increase the income of low and their mothers on life style
services to socio-economic class. modifications to treat childhood obesity.
control
childhood
obesity
Policies on Participatory programs and Improving the childhood obesity through
awareness for policy development on healthy diet and physical activity
controlling childhood obesity
childhood
obesity
Food policies Marketing regulations to Increase intake of fruits, vegetables and
to increase high sodium, fat and sugar lower the intake of sugar, salt and fat.
supply of foods
fruits,
vegetables and
whole grains
Providing Planning to increase Getting engaged in outdoor games for
accessibility to exercise like walk, outdoor about 30 mins
parks and games.
recreations
centers.

Short routes
 Community Microcredit cum nutrition Nutrition knowledge to mothers and
based education children to control obesity
Nutrition and
health service
programs for
the
management
of childhood
obesity
Facility based Balanced diet including Promoting healthy lifestyle
nutrition and whole grains, vegetables,
health fruits, proteins and healthy
knowledge fats

The intervention dosage

The term intervention dosage refers to the strength, duration and amount of the intervention. The
intervention dosage for childhood obesity management program is for 4 weeks. In these 4 weeks
we have observed dietary and lifestyle modifications among the children.
Developing impact theory / effect theory
The intervention theory explains how the intervention affect the causal factors including
influencing factors how they interact with them
Causal factors
1. Lack of knowledge related to nutrition and diet for treating obesity
2. Poor access to basic health care services
3. Poor dietary patterns
4. Poor use of health services including treatment and monitoring
5. Poor management of obesity
Influencing factors
1. Poor management
2. High prevalence of obesity
3. Regular monitoring of weight
Intervention packages

Intervention packages for population-based approaches

Structures to support policies and intervention
 Leadership
 ‘Health-in-all’ policies
 Dedicated funding for health promotion
  NCD monitoring systems
 Workforce capacity
 Networks and partnerships
 Standards and guidelines

Population wide initiatives and policies

Marketing of unhealthy foods and beverages to children

• Nutrition labelling
• Food taxes and subsidies
• Fruit and vegetable initiatives
• Physical activity policies
• Social marketing campaigns

Community based intervention

Multi-component
community-based interventions
• Early childcare settings
• Primary and secondary
schools
• Other community
Settings

Intervention packages based on community-based intervention

1. Community engagement
2. Program design and planning
3. Implementation
4. Sustainability
5. Governance and transparency
6. Evaluation
The desired behaviors targeted by interventions typically include:

• increased fruit and vegetable consumption;

• reduced consumption of beverages high in sugar (e.g. “soft” drinks);
• reduced consumption of foods high in fat, saturated fat, salt and sugar;
• decreased television viewing and other screen-based activities;
• increased competitive and non-competitive sport participation;
• increased active transport to schools.

These behaviors may be targeted through education campaigns, changes to school and other
organizational policies, activities and competitions, promotion programs and the involvement of a
broad range of stakeholders in the community.

DPAS is not a national program itself, it is a comprehensive tool to guide specifically a number of
detailed action points to promote a healthy diet and physical activity.

The following model is intended for country use. It aims to explain how policies and programs,
and their implementation, influence populations leading to behavior changes and longer-term
social, health and economic benefits. The model suggests how adequate monitoring and evaluation
indicators can be integrated in the process of behavior change.

National strategic Supportive environment Social

Leadership on Environmental
Supportive Policies Behavior
diet and physical Change Health
activity
Supportive programs Economic

Monitoring, evaluation and surveillance