HD535 Unit 3 Stakeholder Priority Process Example

Fourteen Seats and One Reversal: A Unit 3 Stakeholder Priority Process for a Caregiver Epinephrine Program

[Student Name]

Purdue University Global

HD535: Health Education Program Planning

Unit 3 Stakeholder Priority Process

[Instructor Name]

[Date]

The stakeholders, their remarks and every score are composite; the nominal group technique guide and the food allergy studies cited are real.

Who Sat at the Table

The group had fourteen voting seats. Each seat is listed with the voice it brought and why that voice was needed.

Three parents of children aged four to eleven with food allergy, recruited through the health center's pediatric clinic, because they manage the condition daily. Two grandparents who provide regular after-school care, because the listening survey found many children spend those hours with relatives who had never been shown the device. A regular sitter who cares for two children with allergies, because sitters are rarely asked. A pediatric nurse educator from Heights Community Health Center, who would deliver training. A pediatrician from the same clinic, who writes the prescriptions. A school nurse covering three elementary schools, who knows what schools already do. A pharmacy manager from one of the two pharmacies in Marlow Heights, who sees refill problems. An after-school program director. A care coordinator from the main Medicaid health plan. A fire department paramedic captain, who sees reactions on arrival. A community health worker who works with families in the neighborhood.

I facilitated and did not vote. Meetings were held on two weekday evenings at the public library, with food, childcare and Spanish interpretation.

The Five Options

Options came from the community assessment and the listening survey.

A. Classroom lessons teaching children aged eight to twelve to recognize reaction signs and tell an adult. B. Hands-on training for caregivers, with practice injectors, scenario drills and peer instructors. C. Training for school staff in recognizing reactions and using stock epinephrine. D. Pharmacy navigation: help with fills, prior authorization, refills before expiry and a second set for a relative's home. E. A labeling campaign for restaurant menus and school cafeteria lines.

Criteria, Defined Before Voting

Members agreed on four criteria and their meaning before any option was scored.

Reach of the problem: the share of severe reactions the option could plausibly affect, based on where reactions happen. Feasibility: whether the option could be running within eighteen months with resources the partners could name. Burden: whether the option helps the households that currently carry the most cost and risk. National data show lower-income families with food-allergic children spend more on emergency and inpatient care than higher-income families (Bilaver et al., 2016), and this criterion asked whether the option would shift that. Acceptability: whether families in Marlow Heights would take part.

Each member scored each option from one to five on each criterion.

The Process

The group followed nominal group technique: silent individual scoring, a round-robin in which each member gave one reason without debate, clarification of each option, and a second private vote (McMillan et al., 2016). The method was chosen because it limits the influence of the most senior or confident speakers, a real risk in a room with a physician, a fire captain and a grandparent.

Round One and Round Two

In round one, school staff training ranked first, pharmacy navigation second, caregiver training third, child lessons fourth and labeling fifth.

The round-robin changed the order. The school nurse said state law already requires staff training and that her schools held stock epinephrine. A grandparent said, "I would be too scared to stick him. I'd call his mother first." A parent described a reaction at a cousin's birthday party where four adults were present and none knew how to use the injector in the child's bag. The paramedic said that in most calls for children's reactions, the reaction began at home or a relative's home and no one had injected before the crew arrived. He cited Pumphrey's study of deaths from anaphylaxis in the United Kingdom, where epinephrine was often late or missing (Pumphrey, 2000).

In round two, caregiver training ranked first, pharmacy navigation second, school staff training third, child lessons fourth and labeling fifth. Members' scores for reach of the problem moved most: caregiver training rose from a mean of 3.1 to 4.4, and school staff training fell from 4.2 to 2.9.

The vote moved because caregivers described where reactions actually happen, and once the group heard that most begin in homes rather than classrooms, an option aimed at school staff could no longer claim to reach most of the problem.

The Reversal

The draft design trained parents first and offered sessions to other caregivers in a second phase. The two grandparents and the sitter objected. They are often the adults present after school, and a second phase might never come. Parents agreed. The group decided that each family would bring at least one other regular caregiver to the second session from the first cohort onward.

Decision Log

Three design features trace to remarks made in the room.

The grandparent's fear of hurting the child led to a rule that every caregiver practices on a trainer until completing three clean injections, beginning with practice on a thigh pad.

A parent's account of being told to "come back Thursday" for an out-of-stock injector led to the pharmacy navigator role being kept and combined with training.

The sitter's remark that "nobody ever showed me; they just put it in his backpack" led to each family receiving a second practice injector to keep with the other caregiver.

Limits of the Process

The process had weaknesses that the record should state. Caregivers held five of fourteen seats, enough to be heard but not a majority. Only one of the five spoke Spanish as a first language, although more than a quarter of the neighborhood's households do. Evening meetings suited most members but excluded parents who work night shifts, who are among those most likely to rely on grandparents after school. Nominal group technique limits the pull of confident speakers, but it can only rank the options brought to the room, and all five came from the planner's assessment. A second round of listening sessions, held on a Saturday and in Spanish, is planned before the design is final, so that those voices can test the ranking.

What the Record Shows

Pharmacy navigation stays as a support to caregiver training rather than a separate program. Child lessons and labeling are set aside for now, with reasons recorded. The record will be shared with all fourteen members, who can correct it before it guides the plan.

References

Bilaver, L. A., Kester, K. M., Smith, B. M., & Gupta, R. S. (2016). Socioeconomic disparities in the economic impact of childhood food allergy. Pediatrics, 137(5), e20153678. https://doi.org/10.1542/peds.2015-3678

McMillan, S. S., King, M., & Tully, M. P. (2016). How to use the nominal group and Delphi techniques. International Journal of Clinical Pharmacy, 38(3), 655-662. https://doi.org/10.1007/s11096-016-0257-x

Pumphrey, R. S. H. (2000). Lessons for management of anaphylaxis from a study of fatal reactions. Clinical & Experimental Allergy, 30(8), 1144-1150. https://doi.org/10.1046/j.1365-2222.2000.00864.x