18.3 Developing Program Goals and Measurable Objectives to Demonstrate Outcomes

Goals, Objectives, and Outcomes in Program Planning

The nurse and program team create goals, objectives, and outcomes before developing the action plan. Goals are statements that explain the program’s purpose and what the program plans to accomplish (Division for Heart Disease and Stroke Prevention [DHDSP], 2018; Substance Abuse and Mental Health Services Administration [SAMHSA], 2018). Goals align with the identified health problem, vision, and program values. Goals are achieved through program objectives and activities. For example, the overarching goal of the KHCFBP, mentioned throughout the chapter, was to increase physical activity of adults, adolescents, and children through biking.

Objectives are statements of specific actions or behaviors that lead to accomplishing program goals (DHDSP, 2018; SAMHSA, 2018). Objectives should be specific, measurable, achievable, relevant, and time-bound (SMART) in order to provide clarity, establish accountability, focus timing, communicate realistic expectations, and direct evaluation (DHDSP, 2018). SMART objectives can be short-term, intermediate, or long-term and can be related to process or outcomes. Process objectives direct activities to be completed in a specific time frame and describe participants, interactions, and activities (DHDSP, 2018). Outcome objectives state the intended results of activities or the program, focusing on changes in knowledge, skills, and attitudes of participants and community members or in policies, systems, or environments (DHDSP, 2018). For example, the KHCFBP team wrote objectives to provide clarity, accountability, and focus for the program activities. Table 18.6 provides examples of short-term, intermediate, and long-term objectives based on the KHCFBP goals.

Writing SMART Objectives

The SMART method is one approach to ensure that the objectives of community health programs are well-written. Well-written objectives answer “WHO is going to do WHAT, WHEN, and TO WHAT EXTENT?” (DHDSP, 2018, p. 2). The SMART method is used to determine whether the program has achieved what it intended (see Table 18.7).

The nurse and program team use baseline data to determine change, so it is included within the objective. Baseline data can be local information, such as data gathered during community health assessment, or state or national information, such as data within state health assessment reports, national health data sites, or Healthy People 2030. Assessment, Analysis, and Diagnosis discusses methods for gathering baseline data. When baseline data is not available, it should be stated that baseline data will be gathered as a first activity of the program (DHDSP, 2018).

The nurse and program team determine relevancy and reasonableness by gathering evidence for program activities. Literature, best practice, and theory provide rationale that the objective, and activities stemming from the objective, directly lead to change (DHDSP, 2018). DHDSP (2018) has developed a guide for writing SMART objectives that can be used by the nurse and program team.

Healthy People 2030 in Program Planning

The nurse and program team can use Healthy People 2030 to establish a baseline for measurement, align objectives with national leading health indicators and priorities, address SDOH, and find evidence-based resources to address identified community health problems. Health People 2030 includes evidence by topic related to health conditions, health behavior, population, setting and system, and social determinants of health. It also includes Healthy People in Action posts to describe how communities are implementing evidence-based programs based on Healthy People 2030 goals and objectives. This evidence provides a rationale for the choice of community health program goals, objectives, outcomes, and activities.

Create an Action Plan

The nurse and program team determine program goals and objectives and search for potential evidence-based strategies to meet objectives before creating the program action plan. An action plan provides concrete steps to achieve program goals and objectives. A written action plan improves efficiency and accountability, helps the team ensure all program details are considered, and provides credibility for program strategies. An action plan should be complete, communicating every step of the program implementation and plan for evaluation; clear; and current. The action plan is a work in progress and may be revised as resource availability and community needs change. The team may also modify the action plan if processes and activities are not working as planned.

The action plan includes health promotion and disease prevention interventions based on assessment data, health behavioral change and health promotion theories, relevant literature, and input from community members, partners, and the target population (Fernandez et al., 2019). The team writes action steps for each program objective, including information regarding what intervention will occur, who will carry it out, when the intervention will take place and for how long, what resources are needed to carry out interventions, and what communication should occur (CDC, 2013). According to Issel and Wells (2018), the nurse and program team should choose interventions that

• are evidence-based and have been proven to reduce the identified health problem;
• are tailored to the target population, including cultural and linguistic appropriateness, learning needs, and motivation level;
• lead to improved health outcomes;
• are flexible with the ability to adjust activities to the participants’ needs;
• are technologically and logistically practical;
• are of reasonable cost;
• are acceptable to participants, partners, and policymakers; and
• address community priorities.

In addition to interventions, the nurse and program team consider potential barriers to the action plan, communication strategies, and plan for evaluation, all of which are discussed in detail in Implementation and Evaluation Considerations. The program team identifies potential barriers to address before implementation, such as resource availability, time involved to carry out actions, and community support (CDC, 2013). As part of the action plan, the program team plans strategies for communication. This includes what needs to be communicated and to whom, as well as accountability, method, and timing for communication (CDC, 2013). Examples of communication include program advertisement and recruitment, updates to the program team and partners, and dissemination of the program evaluation. The CDC offers a program planning workbook to assist in an action plan and communication strategy development. Finally, the nurse and program team plan for the evaluation of the process and outcome objectives to determine the efficiency and effectiveness of program implementation and to improve and account for program decisions and actions.

The goal of any community health program is to motivate and empower the community to adopt healthy behaviors and reduce unhealthy ones. The nurse, throughout the process of program planning, engages the community through partnerships and coalitions to increase the efficiency and effectiveness of program interventions. Health promotion, disease prevention, and behavior change theories and models are also used to increase effectiveness in achieving program goals. The nurse and program team choose evidence-based, relevant, and current interventions to enhance opportunities for success. Finally, the process and outcomes of program planning and implementation are evaluated to determine if program revisions are needed to ensure the achievement of goals and objectives.