1 6 Evaluation Plan Name University Class Date Evaluation Plan Evaluation Method Evaluation can be defined as the methods that are utilized to determine the effectiveness of a program or service that is required and likely to be used, whether it is conducted as planned, or whether it helps the purpose, objectives, and goals (Andrews et al., 2014). The main evaluation method that will be used to assess the performance and success of this breast cancer awareness program in the community of African American women in Baltimore County is the formative evaluation. The formative evaluation exercise will be undertaken with the purpose of assessing the strengths and weaknesses of materials, or campaign strategies before implementation. Thus, part of the activities of the valuation will include pretesting. The evaluation will allow for the needed corrections before the full effort goes forward. Its main objective will be to increase the likelihood for program success before the communication activity begins. The procedures and tasks involved in implementing the program will also be examined. This form of evaluation will also explore the administrative and organizational elements of the program (Moore et al., 2014). The formative evaluation exercise will begin with the assessment of the needs of the cancer awareness program. The evaluation process will take place throughout the programming processes. Formative evaluation will be ongoing and will offer information to the planning and implementation team. The primary purpose of this type of assessment will be to strengthen or improve the program being assessed and to determine the quality of its implementation. This medium will give room for the improvement of the program while the activities are in progress. The health promotion program will utilize the formative evaluation to understand the perspectives in which the interventions will take place and the creation of consensus on goals (Tolma et al., 2014). This medium will make it possible to effectively evaluate the participants' responses towards the program and improve it. Furthermore, the formative evaluation will provide insights into the specific behaviors of concern and the causes of such behaviors concerning the breast cancer awareness among African American women. In so doing, the program implementers will effectively identify the community attitudes that can inhibit or promote the program goals. Part of the evaluation activities will entail identification of resources that are available to the program. Thus, the formative evaluation will be critical to improving the relevance, sustainability, as well as the efficacy of the community-based breast cancer awareness program. Evaluation Theory This cancer awareness program will be guided by the theoretical concepts of the social cognitive theory. According to this theory, people’s perception of their capacity to undertake an activity, and their anticipations that the recommended cour.

1. 1
6
Evaluation Plan
Name
University
Class
Date
Evaluation Plan
Evaluation Method
Evaluation can be defined as the methods that are utilized to
determine the effectiveness of a program or service that is
required and likely to be used, whether it is conducted as
planned, or whether it helps the purpose, objectives, and goals
(Andrews et al., 2014). The main evaluation method that will be
used to assess the performance and success of this breast cancer
awareness program in the community of African American
women in Baltimore County is the formative evaluation. The
formative evaluation exercise will be undertaken with the
purpose of assessing the strengths and weaknesses of materials,
or campaign strategies before implementation. Thus, part of the
activities of the valuation will include pretesting. The
evaluation will allow for the needed corrections before the full
effort goes forward. Its main objective will be to increase the

2. likelihood for program success before the communication
activity begins. The procedures and tasks involved in
implementing the program will also be examined. This form of
evaluation will also explore the administrative and
organizational elements of the program (Moore et al., 2014).
The formative evaluation exercise will begin with the
assessment of the needs of the cancer awareness program. The
evaluation process will take place throughout the programming
processes.
Formative evaluation will be ongoing and will offer information
to the planning and implementation team. The primary purpose
of this type of assessment will be to strengthen or improve the
program being assessed and to determine the quality of its
implementation. This medium will give room for the
improvement of the program while the activities are in progress.
The health promotion program will utilize the formative
evaluation to understand the perspectives in which the
interventions will take place and the creation of consensus on
goals (Tolma et al., 2014). This medium will make it possible to
effectively evaluate the participants' responses towards the
program and improve it.
Furthermore, the formative evaluation will provide insights into
the specific behaviors of concern and the causes of such
behaviors concerning the breast cancer awareness among
African American women. In so doing, the program
implementers will effectively identify the community attitudes
that can inhibit or promote the program goals. Part of the
evaluation activities will entail identification of resources that
are available to the program. Thus, the formative evaluation
will be critical to improving the relevance, sustainability, as
well as the efficacy of the community-based breast cancer
awareness program.
Evaluation Theory
This cancer awareness program will be guided by the theoretical
concepts of the social cognitive theory. According to this
theory, people’s perception of their capacity to undertake an

3. activity, and their anticipations that the recommended course of
action will yield desired outcomes are significant indicators of
performance. The theory also postulates that behavioral change
or modifications and outcome of developing individual goals
that are founded on the premise of self-efficacy expectations
related to the outcomes of engagements in the recommended
behaviors (Hodges & Videto, 2011). Indeed, if an individual
holds the view that they can perform a behavior and perceive
that the behavior will result in desired outcomes, the individual
can undertake the behavior.
Self-efficacy will be utilized to determine people’s points of
view regarding their capacity to evaluate, plan, and undertake
the recommended behaviors. This medium will be premised on
the acknowledgment of the fact that if people are to attempt a
behavior, they need first to trust that they have the required
capabilities to be involved in the recommended behavior
(Phillips & McAuley, 2013). On the other hand, if people do not
believe that they have the capacity for undertaking the
recommended course of action, they will be deprived of the
incentives to do that. This medium happens even in situations in
which they essentially are able. In light of the above mentioned,
people who have the conviction that they can achieve
something, usually really can. On the other hand, those who do
not believe that they can embrace a certain course of action do
not often pursue it.
Another social cognitive theoretical concept that will be utilized
is outcome expectation. As soon as the target population agrees
to embrace the recommended behaviors, the goal should shift
toward encouraging them to maintain this behavior. Thus,
outcome expectations form a significant aspect of the self-
efficacy construct and are relevant to the breast cancer
awareness initiative (Adams et al., 2017). For instance,
outcomes expectation can be evaluated regarding the capacity of
the African American women to allocate a considerable fraction
of their financial resources to seek healthy diets. Generally, an
individual is more likely to maintain a behavior when the

4. behavior results in the coveted results. This medium is
especially true if they have perceived positive expectations on
the importance of the recommended course of action (Hodges &
Videto, 2011).
The concepts of this theoretical model will be critical in
understanding the behavioral tendencies of the target group.
Thus, the program implementation team will be able to plan
interventions, which are geared toward changing them
effectively. For instance, the concept of self-efficacy will be a
widely explored psychosocial construct in cancer awareness
programs (Fertman, 2016). For instance, going for cancer
screening is one of the trait-specific examples of self-efficacy.
Self-efficacy plays a crucial role in transforming the behavioral
tendencies of the target audience since it acts as a motivator of
healthy practices, deeply founded on the core idea that one can
generate desired effects through one's actions (Roskos-
Ewoldsen & Monahan, 2009). Unless people believe they can
realize the desired changes through their efforts, there will be
minimal incentives to put in that effort. Therefore, awareness of
this model of behavioral changes will be instrumental in raising
awareness of the target audience and making them understand
the counter positioned factors from their points of view relating
to specific behavioral changes (Rogers et al., 2005). Awareness
programming will be adjusted within the theory as a vehicle for
communicating the dynamics of the potential change, as well as
an important instrument for unbalancing restraining and
supportive forces at the level of personal decision making
(Kettner, Moroney & Martin, 2017).
Performance Measurement, Monitoring, and Evaluation
Timeline
Performance Measuring, monitoring, and Evaluation Indicator
Description of the Process
From

5. To
1
Participation Rate
Determining the percentage of women who have a screening
mammogram within thirty days as a proportion of African
American women. For the cancer awareness campaign to
minimize mortality among African Americans, they must be
encouraged to take part in the initiative in adequate numbers.
1st February 2019
28th February 2019
2
Retention Rate
Examining the estimated figure of women who have decided to
return for screening within 30 days, expressed as a percentage.
The maximum benefits of the screening exercise are attained
through regular participation in the screening initiative.
1st March 2019
30th March 2019
3
Annual Screening Rate
Calculating the estimated percentage of women who have
returned for screening exercise within the next year (12
months). The optimal gains made from the screening process
will be attained through continuous involvements of black
women in the screening initiative. Nonetheless, the participants
may be recalled on a yearly basis as a result of the increased
risk of breast cancer. This medium will be based on patient or
screening history.
1st April 2019
1st April 2020
4
Abnormal Call Rate
This monitoring and assessment process will seek to determine
the percentage mammograms that will be identified as abnormal
in the screening exercise. The abnormal call rate will serve as
an important indicator of the quality of the mammography

6. imaging and interpretation. It can also be crucial in the context
of positive predictive values, cancer detection rate, as well as
post screen cancer rate.
1st April 2019
30th April 2019
Evaluation Plan
Goals and Objectives
The main goal of this plan is to determine the degree to which
the program completion process adheres to the overall purpose
of the cancer awareness initiative among African American
women. Thus, one of the plan’s objectives includes increasing
the level of engagement with African American women to
reduce breast cancer among its population. Moreover, the
evaluation plan aims at determining the population of Black
women or target audiences who are involved and comparing
them to the actual figure that was identified as the main target
to be realized.
Identification of the Target Population
The program will target African American women in the United
States. In particular, a total of 2000 women will be targeted for
the breast cancer awareness initiative. This population will be
sampled from Baltimore County Maryland, in the United States.
The outcomes of this study will inform evidence-based practices
regarding the prevention and response to breast cancer among
minority groups in the United States.
Evaluation Plan
Task
Activities/ Data Required
Duration
1
Needs Assessment
Investigating the needs of the target audience regarding
communication, health literacy needs, medication, and behavior
change requirements. Thus, a requirements assessment will also
require analysis of financial and human resource data needed

7. for the launching of the initiative to succeed
30 Days
2
Developing the Project Plan
Designing the main goals, identifying relevant groups designing
the intervention procedure, as well as identifying evaluation
indicators
15 days
3
Evaluation Preview
Engaging stakeholders, clarification of the purpose of the
assessment, identification of key questions, as well as the
identification of resources
20 days
4
Evaluation Design
Specification of the assessment design, Identification of
information gathering methodologies, as well as locating and
developing data gathering instruments
25 days
5
Collecting Data
The main data types will include: cancer screening rates,
participation rates, and level of turnout for the project
12 days
6
Analyzing and Interpreting Data
Identifying the analysis tool and interpreting the evaluated
study results and outcomes.
25 days
References
Adams, R. N., Mosher, C. E., Cohee, A. A., Stump, T. E.,
Monahan, P. O., Sledge, G. W., Jr, … Champion, V. L. (2017).
Avoidant coping and self-efficacy mediate relationships

8. between perceived social constraints and symptoms among
long-term breast cancer survivors. Psycho-Oncology, 26(7),
982–990. https://doi-
org.ezp.waldenulibrary.org/10.1002/pon.4119.
Andrews, M. L., Sanchez, V., Carrillo, C., Allen-Ananins, B., &
Cruz, Y. B. (2014). Using a participatory evaluation design to
create an online data collection and monitoring system for New
Mexico's Community Health Councils. Evaluation and program
planning, 42, 32-42.
https://doi.org/10.1016/j.evalprogplan.2013.09.003.
Fertman, C. I. (2016). Health promotion programs: from theory
to practice. New Jersey: John Wiley & Sons.
Hodges, B. C., & Videto, D. M. (2011). Assessment and
planning in health programs (2nd ed.). Sudbury, MA: Jones &
Bartlett Learning.
Kettner, P. M., Moroney, R. M., & Martin, L. L. (2017).
Designing and managing programs: An effectiveness-based
approach (5th ed.). Thousand Oaks, CA: Sage.
Moore, H. K., Preussler, J., Denzen, E. M., Payton, T. J., Thao,
V., Murphy, E. A., & Harwood, E. (2014). Designing and
operationalizing a customized internal evaluation model for
cancer treatment support programs. Journal of Cancer
Education, 29(3), 463-472. Doi: 10.1007/s13187-014-0644-8
Phillips, S. M., & McAuley, E. (2013). Social cognitive
influences on physical activity participation in long‐term breast
cancer survivors. Psycho‐Oncology, 22(4), 783-791.
https://doi.org/10.1002/pon.3074
Rogers LQ, Shah P, Dunnington G, Greive A, Shanmugham A,
Dawson B, & Courneya KS. (2005). Social cognitive theory and
physical activity during breast cancer treatment. Oncology
Nursing Forum, 32(4), 807–815. https://doi-
org.ezp.waldenulibrary.org/10.1188/05.ONF.807-815
Tolma, E. L., Stoner, J. A., Thomas, C., Engelman, K., Li, J.,
Dichkov, A., & Neely, N. (2019). Conducting a formative
evaluation of an intervention promoting mammography
screening in an American Indian Community: The Native

9. Women’s Health Project. American Journal of Health
Education, 50(1), 52–65. https://doi-
org.ezp.waldenulibrary.org/10.1080/19325037.2018.1552216
Roskos-Ewoldsen, D. R., & Monahan, J. L. (Eds.).
(2009). Communication and social cognition:
Theories and methods. London: Routledge.
1
2
Developing an Intervention and Determining its Impact
Name
University
Class
Date
Developing an Intervention and Determining its Impact
Infections acquired by patients within the healthcare setting are
a significant problem affecting the United States health care
system. Healthcare-acquired infections mainly occur when the
pathogens are transferred to the patients. Therefore, a
significant intervention to reduce infections is one that limits
the transfer of pathogens. The following is a hand-washing
intervention for nurses that can help to reduce the transmission
of germs to patients; hence, reducing the acquisition of
infections.
Outline of the Intervention
The proposed intervention for healthcare-acquired infections is
a handwashing education program for nurses. Nurses play an

10. essential role in the continuum of care. There are various
instances when the nurses come into contact with the patients in
the process of administering care. During the process of patient
caring, there is a possibility of the transfer of pathogens from
one patient to another or from the general health care
environment to a patient. Therefore, this intervention includes
an education program that teaches nurses the vital information
on handwashing so that they can have a better chance at
sterilizing when taking care of the patients. There are many
nurses' education programs that have already been carried in a
significant number of healthcare institutions, but there are still
some cases of infection that have been presented. Therefore,
this education program will be specifically altered to include
factors that will enhance its effectiveness in improving nurses'
hygiene.
First, the education program will be carried out for six
months. It is expected that nurses' undergoing an extended
period of training will enable better results by enhancing the
possibility of maintaining the lessons that have been learned in
training. Additionally, this training program will focus mainly
on compliance rather than spreading the knowledge on
handwashing. This component of the intervention training has
been included on the assumption that the nurses already
understand the knowledge of hand hygiene and the techniques
of hand washing. Hand hygiene is a big part of nursing training
and also training for other medical professions. Medical
professionals are often taught the importance of maintaining
sterility when dealing with patients to minimize transfer of
pathogens. In spite of this training, there is a significant
percentage of healthcare professionals who still fail to maintain
the required standards of hand washing. Thus, this handwashing
training program will mainly focus on training the nurses on
compliance to the standards of handwashing. The training will
be offered in the practice setting rather than in a theoretical
model so that it can be easier to identify the mistakes that the
nurses make in the handwashing process and develop strategies

11. to improve them.
Review of Literature Supporting the Intervention
A multitude of literature has been written on the effect of
training healthcare professionals on handwashing hygiene on
the spread of infections within the healthcare setting. According
to Al-Khawaldeh, Al-Hussami & Darawad (2015) nurses beliefs,
attitudes, and knowledge on handwashing compliance directly
affects their hand sanitation practices. This conclusion was
made based on a cross-sectional study done with nursing
students as the subjects. The study found that knowledge,
attitudes, and beliefs on hand sanitation were significant
variables affecting the nurses' compliance with the hand
washing guidelines provided to them. Therefore, this study
recommended that training is used as a technique for promoting
hand washing knowledge and promote positive beliefs and
attitudes on sanitation among the nurses.Sopjani, Jahn, and
Behrens (2017) evaluated the impact on handwashing training
on the knowledge and practices of undergraduate nurses on
Kosovo. This study analyzed the knowledge level for the
participants before and after they underwent an education
program for hand cleanliness in the healthcare setting. The
study results showed that there is a significant difference
between the nurses' knowledge level before and after the
training. After the training, the subjects were more likely to
understand more about the importance and techniques of
maintaining sanitation in the healthcare setting. The study
maintained that training could help to maintain a satisfactory
level of knowledge that will improve nurses' practices with
regards to hygiene.
The effectiveness of training nurses on handwashing has been
established by many studies. However, some researchers have
questioned the sustainability of this intervention, transfer of
germs is still an issue even though many training programs have
been conducted. A study by Doronina et al. (2017) evaluated the
effectiveness of interventions that have been used to improve
handwashing compliance among nurses working in healthcare

12. institutions. The researchers, in this case, conducted a
systematic review of six studies evaluating different types of
interventions that have been used to promote hand hygiene in
healthcare institutions. Among the studies assessed, three were
randomized control trials, one was a controlled before-after
study, and one was an interrupted time series. In the studies that
evaluated the impact of education as an intervention technique
to promote hygiene, it was found that the teaching was
effective. However, this meta-analysis shows that education was
effective but not sustainable because most healthcare
professionals fail to maintain the compliance for a long time
after the intervention.
A study by Gould et al. (2017) evaluated the impact of
observing hand hygiene in the practice setting. Instead of just
theoretically training nurses on maintaining hand cleanliness,
this study investigated the effect of practically watching the
nurses' hygiene behaviors while they practice. In a literature
review, this study examined the impact of the Hawthorne effect,
which is the alteration of behavior due to the understanding that
they are being observed. This study suggests that most positive
results of the positive interventions in investigations of the
effectiveness of handwashing interventions have been affected
by this effect. Therefore, the research indicates that the
researchers investigate the efficacy of interventions for an
extended period after the intervention has been administered.
This helps to take into account the practices of the subjects
after the Hawthorne effect is no longer in occurrence. Based on
the suggestions of Gould et al. (2017) it is likely that having an
intervention based in the practice setting for an extended period
will have a better chance at determining the actual effect of the
intervention.
Luangasanatip et al. (2015) conducted a meta-analysis
comparing the efficiency of various hand hygiene interventions
for nurses. This study evaluated 41 types of research on hand
hygiene intervention. Among various other factors, time was
found to be one of the variables that affect the effectiveness of

13. these interventions. The interventions that were applied over an
extended period were more likely to yield positive results.
Therefore, this study demonstrates that conducting an education
program for an extended period is more likely to have a more
significant impact on improved hand sanitation by nurses.
The Impact of the Intervention
The proposed nurses' education program is expected to have a
positive impact on improving nurses' practices when delivering
care. The nurses who will undergo this intervention will be
trained for six months on knowledge and compliance of hand
washing while their methods are observed to identify the
possibility of limitations that reduce the sanitation in the
healthcare environment. It is expected that by the end of the
training, the nurses will have learned the proper application of
hygiene standards as part of their daily practices and not just
for the study. This intervention focuses on compliance more
than the knowledge, even though both components are included.
The focus on compliance will help to enhance the sustainability
of the intervention. The nurses are expected to maintain the
changes caused by the training for an extended period because
the intervention requires them to practice for six months.
The change in the nurses' behaviors is expected to have a
positive impact on the reduction of the risk of healthcare-
acquired infections. With more nurses being hygienic, there
will be reduced transfer of disease-causing pathogens, which
cause the life-threatening infections that are currently a
population health issue. Patients in the process of receiving care
will have a higher chance of having positive outcomes because
of the reduced risk of getting infected by germs available in the
healthcare environment. In general, the effectiveness of this
intervention strategy will help to improve the overall quality of
care.
Conclusion
Healthcare-acquired infections are one of the top ten population
health issues affecting the United States. A majority of the
infections in the healthcare setting are caused by problems that

14. could have been avoided. The nurses are the health care
professionals who spend the most time with the patients.
Therefore, they have a high risk of being agents transferring
pathogens to the patients under their care. This is why an
intervention on training for hand-hygiene compliance is
recommended as the best strategy for reducing the occurrence of
infections. Studies have shown that improved education on hand
hygiene has been an excellent strategy for improving nurses'
practices. However, maintaining compliance for an extended
period is still a problem. This intervention attempts to address
this problem to enhance the effectiveness of training programs.
References
Al-Khawaldeh, O. A., Al-Hussami, M., & Darawad, M. (2015).
Influence of nursing students handwashing knowledge, beliefs,
and attitudes on their handwashing compliance. Health, 7(05),
572.
Doronina, O., Jones, D., Martello, M., Biron, A., &
Lavoie‐Tremblay, M. (2017). A systematic review of the
effectiveness of interventions to improve hand hygiene
compliance of nurses in the hospital setting. Journal of Nursing
Scholarship, 49(2), 143-152.
Gould, D. J., Creedon, S., Jeanes, A., Drey, N. S., Chudleigh,
J., & Moralejo, D. (2017). Impact of observing hand hygiene in
practice and research: a methodological reconsideration. Journal
of Hospital Infection, 95(2), 169-174.
Luangasanatip, N., Hongsuwan, M., Limmathurotsakul, D.,
Lubell, Y., Lee, A. S., Harbarth, S., ... & Cooper, B. S. (2015).
Comparative efficacy of interventions to promote hand hygiene
in hospital: a systematic review and network meta-analysis.
BMJ, 351, h3728.
Sopjani, I., Jahn, P., & Behrens, J. (2017). Hand Hygiene
Training and Its Impact on the Knowledge of Undergraduate
Nursing Students in Kosovo. Global Journal of Health
Science, 9(4), 142.

15. 1
2
Program Design Elements
Name
University
Evidence Based Practice I: Assessment and Design
January 6, 2019
Program Design Elements
A program is only successful when it does not only achieve its
objectives but also meets or exceeds stakeholders' expectations.
It is the stakeholders who take responsibility of ensuring that a
project reaches its goals. They remain accountable and sacrifice
their time and resources for the good of the project. The success
of a project depends on the involvement of all key stakeholders.
Some of the familiar stakeholders include the community, the
government, organizations, project managers and project
sponsors (Kettner, Moroney & Martin, 2017). This paper
discusses the importance of involving community members and
organizations in the process of developing goals and objectives
for a breast cancer awareness program among African American
women.
Stakeholder Involvement
Importance of Involving Representatives in Goal Development
Involvement of representatives in goal development is a vital
process that ensures the needs and expectations of the target

16. population are catered for in the project (Hodges & Videto,
2011). There are various benefits associated with the
involvement of representatives in the process of developing
goals and objectives for the breast cancer awareness program
for the selected population. It is undeniable that engaging the
representatives can lead to the accommodation of local agendas
within the local and national programs that aim at reducing
breast cancer among African American women.
Consideration of the stakeholders’ needs and interests
throughout the evaluation process is critical to productive
development of interventions. Representatives can play a major
role in the process of goal development of programs targeted at
African American women who have breast cancer. Given that
many campaigns and communication efforts are complex and
sophisticated, stakeholders normally help in identifying the
right objectives and ensuring that the outcomes are utilized to
make a difference (Hodges & Videto, 2011). Stakeholders are
much more likely to not only support the program assessment
but also act on the program’s outcomes. Their involvement
ensures that the suggestions and areas of differences are solved
throughout the development process which in turn has the
benefits of preventing conflicts or sabotage of the entire
project.
Stakeholders Involved in the Program Planning Process
The community is one of the relevant stakeholders who will be
involved in the program planning process. Soong et al. (2015)
asserted that community members have the responsibility of
identifying and evaluating problems that are healthcare oriented
and solve them amicably. The efforts directed at solving such
problems must also accommodate the possible barriers to the
solutions. Breslau et al. (2015), in their support, indicated that
the community solution to health problems start from the
activities of the community members which implies that
African-American women community can solve the problem if
they are involved right from the initiation phase of the project
to its implementation phase.

17. Other than the community, organizations will also be involved
in the program planning process because organizations can
provide technical, financial and mobilization assistance as well
as media sponsorship for successful implementation of the
breast cancer awareness program among African American
women. Kettner, Moroney, and Martin (2017) asserted that
organizations could financially sponsor the logistics and
planning activities of a health awareness program. Media
organizations can enhance program implementation by
advertising the program, broadcasting radio and television
jingles as well as granting interviews. Government agencies and
local partners can provide technical and mobilization support.
These initiatives can play significant roles in influencing
African American women's perception of breast cancer
awareness and prevention.
How Representatives can be Involved
Various strategies can be used to undertake stakeholder
engagement for breast cancer programs among African
American women. Some methods, according to O’Haire et al.
(2012) include partnership, participation, consultation, and push
communications as well as pull recommendations. Partnership
programs entail establishing shared accountability and
responsibility with stakeholders. Fawcett and Ellenbecker
(2015) indicated that partnership involves close cooperation and
information sharing. It should also require an engagement
method in which part of the team is included in the delivery of
tasks or with the responsibility for a specific area. This method
is characterized by the establishment of limited ways of sharing
responsibilities. In conference strategy, stakeholders
participate, but team members are not accountable and cannot
influence anything outside of consultation boundaries.
Push communication strategy is a one-way stakeholder
engagement mechanism. When using push communications,
organizations can spread a message across all stakeholder
groups. This medium can alternatively be directed specific
individuals with the utilization of communication channels like

18. social media, emails, podcasts and broadcast media (O'Haire et
al., 2012). Furthermore, they can use the nominal group
technique. Stakeholders ideas and views can be obtained
through a nominal approach that is free of interference and
threats (O’Haire et al., 2012). The method enhances creativity
and open sharing of information.
Every individual in the group has the freedom to share and learn
new ideas. Stakeholders can choose the proposed ideas. This
approach aims at promoting open communication of views and a
listing of predetermined needs from stakeholders in non-
hierarchical discussion forums (O’Haire et al., 2012). This form
of engagement aims at structuring discussions when groups are
having problems in reaching universal agreement on complex
issues.
Program Design Elements
Program Mission, Goals, Objectives and Activities
Mission: To eliminate breast cancer as a significant health
problem among African American women by preventing breast
cancer and diminishing suffering from breast cancer through
education and advocacy
Goals
Objectives
Activities
Tasks
Activities/Data Required
Duration
To promote awareness about breast cancer prevention
By 2020, increase to 75% proportion of African American
women who understand the importance of annual clinical breast
exams
Identifythe population who underutilize clinical breast exams

19. Develop a media campaign to educate African American women
about the benefits of early breast cancer detection
Train faith-based organization members on how to educate their
congregations about the benefits of breast cancer screening
To increase early detection of breast cancer through screening
By 2020, increase to 60% the proportion of Black American
women who have received a mammogram screening
Reduce depictions of breast cancer screening among African
women
Advocate for increased clinical breast cancer examination and
mammography among black American women
Devise targeted and effective mass media campaigns
To improve the quality of life of breast cancer survivors and

20. their loved ones
By 2020, decrease breast cancer-related deaths for Black
American women by 50%
Promote existing best practice programs
Develop guidelines for best practice programs that advocate for
and promote healthy living
Market existing programs for breast cancer survivors
Program Gantt Chart
Activities
Month and Year of Plan
01/2019
02/2020
03/2020
04/2020
05/2020
Identifythe population who underutilize clinical breast exams

21. Develop a media campaign to educate African American women
about the benefits of early breast cancer detection
Train faith-based organization members on how to educate their
congregations about the benefits of breast cancer screening
Reduce depictions of breast cancer screening among African
American women
Advocate for increased clinical breast cancer examination and
mammography among black American women
Devise targeted and effective mass media campaigns
Promote existing best practice programs

22. Develop guidelines for best practice programs that advocate for
and promote healthy living
Market existing programs for breast cancer survivors
References
Breslau, E. S., Weiss, E. S., Williams, A., Burness, A., &
Kepka, D. (2015). The implementation road: Engaging
community partnerships in evidence-based cancer control
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1
7
Initial Analysis for Program Planning
Name
University
Evidence Based Practice I: Assessment and Design
December 23, 2018
Initial Analysis for Program Planning
Breast cancer is a common type of cancer affecting women in
the whole world, and in the United States, it is one of the most
leading causes of cancer death (The American Cancer Society,
2012). Irrespective of the significant improvements made in
breast cancer detection, diagnosis as well as prevention, the
American Cancer Society (2012) indicated that black American

24. women are still unequally affected by breast cancer. White
women have a 90 percent five-year survival white African
Americans have a five-year survival rate of 78 percent, which is
lower than that of other races as well as ethnic groups in
America (The American Cancer Society, 2012). Therefore, there
is a need for a new plan of action and methods to advocate for
the prevention of breast cancer, decrease its mortality, as well
as enhance survival rate among Black American women. The
purpose of this paper is to establish an initial analysis for
program planning and needs assessment of the issue of the
breast cancer in black American women in the United States of
America
Problem Identification and Target Population
Compared with Caucasian female, black American women have
increased mortality rates and are more likely to be diagnosed
with the disease prior the age of 40 years. Breast cancer
incidence and mortality rates trends demonstrate varying
patterns among different races. Whereas African American
females have a lesser lifetime risk of suffering from cancer of
the breast, they have an increased mortality rate than white
American women (Allicock, Graves, Gray & Troester, 2013).
Greater breast cancer-related deaths are occurring among black
American women with nearly 33 percent higher risk of loss of
loss due to breast cancer than white American females. A recent
report showed that black American females with cancer of the
breast have a poorer prognosis when compared to white women
that were diagnosed at the same age and stage (Yedjou et al.,
2017).
Social Cognitive Theory for African Women with Breast Cancer
The social cognitive theory utilizes several concepts associated
with behavioral change. First, there is self-efficacy concept
which is a belief that people have the ultimate control over their
health and can do whatever they want. Second, there is the

25. expectation concept which focuses on the behavioral change
outcome (Hodges & Videto, 2011). For instance, a patient must
go for regular checkups to keep her health in check and at the
required standard. Self-control is another important concept of
the social cognitive theory. This provides patients the autonomy
as well as total control over their behavior change. Most
importantly, African American can, through observational
learning, observe whatever white women are doing to increase
their survival rates. Finally, it is possible to reinforce the theory
using incentives like free checkups as well as rewards for every
patient who regularly visits the hospital for checkups (Hodges
& Videto, 2011).
Social cognitive theory is appropriate for assessing the problem
of breast cancer among Black American women. This is because
the theory focuses on the effect of individual experiences, other
peoples' activities and actions as well as environmental aspects
on the behavior and health status of the affected population.
This is made under the consideration that breast cancer is
treatable but can also be fatal if advanced. Also, the social
cognitive theory offers support in a social context by installing
self-efficacy expectations and utilizing observational, and other
reinforcements to achieve the desired behavioral change and
perception (Hodges & Videto, 2011).
Literature Review
The phenomenon of higher cancer of the breast mortality among
black American females in the America involves various
factors. Black American females are more prone to suffer from
the cancer of breast at an early age, to get the diagnosis at a
later disease stage as well as to die from breast cancer than
other women of other racial groups (Karcher et al., 2014). For
more than four decades, the United States has witnessed an
expansion in the five-year relative survival rate for breast
cancer for both white and black American females. In any case,
there is as yet a significant racial distinction with new data

26. revealing that the 5-year survival rate for black American and
Caucasians women is standing at 79 percent and 92 percent,
respectively (Coughlin, 2015).
The contrast in survival rate is because of the diagnosis at a
later stage as well as poorer stage-specific survival rates amid
black American females (Coughlin, 2015). It is believed that
various factors, both biological and non-biological, contribute
to the higher mortality rate among African American women.
Some of the biological factors include more treatment-resistant
tumors as well as more aggressive histology. The common non-
biological factors are access to care and attitudes about seeking
care (Daniel et al., 2018). Given that the non-biological factors
are more mutable compared to biological factors, there is a need
to develop proactive measures to address the increasing
mortality rates among African American women (Daniel et al.,
2018).
Efforts to prevent breast cancer-related deaths have focused on
various risk factors like the promotion of physical activity,
reduced alcohol consumption, taking of balanced diet as well as
early detection through regular mammography (Albuquerque,
Baltar & Marchioni, 2014). In as much as, recent data from a
national survey in the United States show that black American
females are as unlikely as white females to have had
mammograms in the recent past, some patient locations and
geographical localities still have some black-white disparities in
mammogram rates as well as referrals for breast cancer
evaluation and detection. These are caused by socioeconomic
factors like family income as well as educational attainment
(Coughlin, 2015).
Cancer of the breast screening rates are low amid low-income,
uninsured as well as underinsured households which lead to
higher mortality rates due to breast cancer among these
populations (Coughlin, 2015). Another issue is of some Black

27. American females having misconceptions about breast cancer
etiology, about their risk factors of breast cancer as well as
barriers to receiving timely screening and treatment (Yedjou et
al., 2017). Black American women who are at risk are unlikely
than their white counterparts to be aware of the present
guidelines as well as recommendations related to preventive
measures (Coughlin, 2015).
Needs Assessment
Needs Assessment Approach
Monsen et al.'s Problem-Analysis Framework will be used to
identify the needs of black American females in reducing
mortality rates due to breast cancer. According to Annan et al.
(2013), Monsen et al.’s problem analysis framework of 2008
focuses on clear conceptualization and clarity of facts to
provide focused interventions. The framework is divided into
five major phases, with phase 1 requiring therapist and
researchers to focus on the background information, role as well
as expectations. In phase 2, there is a need to prepare the initial
guiding hypothesis for the problem under study. Phase 3 is
about identifying the problem dimensions, and phase 4 is about
the preparation of an integrated conceptualization. In phase 5, a
researcher or a therapist must prepare an intervention plan and
implementation strategy. Finally, phase 6 is about monitoring as
well as the evaluation of actions and outcomes.
Method of Data Collection
The data collection methods that will be used for the study
include questionnaires and interviews. The questionnaires will
be in print and electronic form depending on the convenience of
the respondents. The importance of allowing for flexibility so to
allow the respondents to choose the type channel through which
they can respond to the questions is that the respondents may be

28. busy in income-generating or any other activities and as such,
may have limited time to answer the questionnaires (Derguy et
al., 2015). Thus, electronic questionnaires will allow for
convenience since busy respondents can answer the questions at
their free time in their mobile phones, tablets, or PCs. The
questionnaires will contain semi-structured-open-ended
questions to allow for flexibility and respondents' free
expression. Apart from the questionnaires, face-to-face and
telephone interviews will also be conducted depending on the
respondent's convenience. Respondents who will have enough
time at their disposal: those who are confident will take face-to-
face interviews whereas those who are busy, shy, or value their
privacy will take telephone interviews.
Potential Challenges and Possible
Solution
s
The possible challenges that will be encountered during the
data-gathering process are poor cooperation by the respondents.
This is because the study deals with breast cancer, which is a
sensitive subject among women. Besides, there may be fears of
ethical and privacy issues by the respondents in which they may
believe that their health information and identities can be
exposed in the study, which can significantly reduce the turnout
and cooperation of disclosure of accurate information by the

29. respondents. Different distant data-collection options will be
provided such as online questionnaires and telephone interviews
to increase the likelihood of cooperation. Ethical and privacy
issues will be solved by involving community stakeholders and
assuring the respondents of maximum privacy since their real
names will not be used.
References
Albuquerque, R. C., Baltar, V. T., & Marchioni, D. M. (2014).
Breast cancer and dietary patterns: a systematic
review. Nutrition reviews, 72(1), 1-17.
https://doi.org/10.1111/nure.12083.
Allicock, M., Graves, N., Gray, K., & Troester, M. (2013).
African American women's perspectives on breast cancer:
Implications for communicating the risk of basal-like breast
cancer. Journal of Health Care for the Poor and Underserved,
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American Cancer Society. (2012).Cancer facts and figures for
African Americans 2011–2012. Atlanta, GA: American Cancer
Society. Retrieved from:
https://www.cancer.org/research/cancer-facts-statistics/cancer-
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Annan, M., Chua, J., Cole, R., Kennedy, E., James, R.,
Markúsdóttir, I., ... & Shah, S. (2013). Further iterations on

30. using the Problem-analysis Framework. Educational Psychology
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Coughlin, S. S. (2015). Intervention approaches for addressing
breast cancer disparities among African American women.
Annals of Translational Medicine & Epidemiology, 1(1), 1-12.
Retrieved from:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4283773/
Daniel, J. B., Gaddis, C. L., Legros, J. R., Bennett, M. D., &
Turner, N. C. (2018). Breast Cancer Knowledge, Beliefs and
Screening Practices among African American Women in a Rural
Setting: A Pilot Study. International Journal of Health
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Fonseca, D. D., Lowe, L., & Alo, R. A. (2017). Assessing the
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