A universal program is one delivered to general members of a population. These programs address ‘universal’ problems commonly occurring among certain populations (such as drinking and driving among high school students or bullying among middle school students). We know not all high school students drink and drive and not all middle school students bully. However, an estimated proportion of these populations will do just that, if they do not receive prevention programs that help them develop the knowledge, attitudes, skills and abilities necessary to avoid these or other harmful, risk behaviors.
Below, we’ve listed what we believe to be the best qualities of an effective universal program design.
Quality 1: You’ve defined the program goals.
While the research community is getting better at predicting who might develop risk behaviors (thus permitting the development of ‘targeted interventions’), it is far simpler and less expensive to direct programs at students ‘universally’.
Goals of universal programs aim primarily to prevent a problem behavior from developing in the first place. However, given the ages some youth become involved in risk behaviors, universal program designers cannot ignore the fact that some kids may be experimenting with certain harmful activities while others may be actively involved in them. Therefore goals of an effective universal program should include preventing, reducing, and/or eliminating the identified problem behavior.
Quality 2: You’ve identified the problem and the pervasiveness of the problem.
What is the problem your program addresses? And is it a real problem? Often the problems we ‘perceive’ turn out to be real problems—but you have to review the statistics to assess whether the problem is pervasive enough to address through a universal program.
Statistical sources include the Centers for Disease Control, your local health department, state departments of Education or Children and Family Services, and local schools and law enforcement. These entities generate publicly accessible data bases identifying, among other things, rates of substance abuse, violence, crime, family disruption, and morbidity and mortality associated with the problem behavior.
Once you’ve determined the problem is real and worth the time, cost and effort of designing and implementing a program, you need to assess the underlying causes and the evidence-based solutions to the problem.
Quality 3: You’ve identified underlying or contributing causes and evidence-based solutions to the problem behavior.
Underlying or contributing causes to a problem behavior include a variety of factors. Ideally, your program will address more than one contributing factor. Using childhood obesity as the problem example, consider some of the factors influencing the condition:
- Family history of obesity
- Inactivity
- Poor coping skills
- Poverty and poor eating habits
- Family traditions and culture
Before you can identify an evidence-based solution to the problem behavior, you must identify which factors seem most likely associated with the behavior in your population. To find out, conduct a needs assessment, talk to professionals working with the population, and ask others to share data and information. Some of these factors can be verified statistically by the same sources (e.g. Centers for Disease Control) that helped you identify the pervasiveness of the problem.
Next, you need to know what works and what doesn’t. That means reading the literature, consuming everything you can about the problem and solutions, so that you can structure your program to replicate or improve upon solutions. For example, in the case of childhood obesity, solutions might include
- Access to health assessments to determine medical causes, treatments and other related health issues affecting the child
- Family education programs: cooking, meal preparation, budgeting, family attitudes
- Increased opportunities for the child to engage in physical activity and exercise
When you review these solutions, you begin to understand why targeting one factor might not prove effective. If a child engages in increased physical activity and exercise, yet does not first see a medical specialist, you won’t know if the child has other health problems such as undiagnosed high blood pressure or diabetes that places the child further at risk. Sending a kid to the gym for aerobic exercise when he has other health problems could cause him and you significant difficulty. Or, if a child is otherwise healthy and does increase physical activity, but mom continues to serve foods at home containing high fat or calories, chances are the child will not achieve her weight goal.
Quality 4: Choose a change model to underpin the conceptual framework of your program.
Change is dynamic. It takes time, energy and effort. It is reciprocal. There are setbacks. Above all, it relies on the individual to first form the intention to change and second to decide that the ‘benefits’ of change outweigh the ‘costs’.
Therefore, design your program to incorporate a theoretical change model taking these and other dynamics into account. You can find basic information on change models in Theory at a Glance: A Guide for Health Promotion Practice. U.S. Department of Health and Human Services, at www.cancer.gov/cancertopics/cancerlibrary/theory.pdf .
Quality 5: You’ve addressed the keys to behavioral change: Knowledge, Attitude, Skills and Abilities.
A knowledge program alone will not generally change behavior. However it might help an individual shape the intention to change—for example: Now that I know I have a problem, I plan to do something about it. An attitudinal shift may help the individual think differently about their problem, problems in their families, or among their peers—for example: I think my friends and I could have more fun if we didn’t drink at parties. Altered attitudes go a long way toward promoting change—but as a stand-alone, they may not effect an actual behavioral change.
The most effective programs provide individuals with components that increase their knowledge, shape positive attitudes, and imbue participants with skills and abilities to change behavior (or avoid the behavior). Bottom line: if you know you have a problem, if you want to make a change, you won’t get very far without knowing how to make it happen. Effective universal programs commonly provide the tools that permit an individual to put a plan into action.
Quality 6: Your program is age and developmentally appropriate, and therefore meaningful to the population.
Make sure your program is appropriate to the population you serve. If you are working with students, readability is an issue. Work with a school educator to ensure the language you use and the concepts you present can be understood with meaning by your population. Make sure your topics are relevant to the population: a session on sexually transmitted diseases might be appropriate for middle and high school students, but not for elementary grades. While the consequences of losing a driver’s license might have great impact on high school students, middle school students can’t envision that far into the future (yes, two to three years down the road seems like a life time to kids!).
Quality 7: You’ve built in monitoring measures, piloted the program, and made revisions.
Pilot your program before ‘broadcasting’ or disseminating it to a wide population. Use pre-post measures to see if the pilot population achieves the goals and objectives you envisioned. Monitor the implementation through observation. Some things that appear great on paper fall absolutely flat in practice. Be willing to go back to the drawing board to revise your program as necessary.
