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Public Health
Grant Proposal

for [Insert program title.]

Prepared by

[Insert name.]

Table of Contents

Introduction to the Problem

Epidemiological Assessment

Health Equity Assessment

Significance

Strategic Action Plan

Evaluation Plan

Dissemination Plan

References

Appendix A—Social, Epidemiological, Educational, and Ecological Assessments

Appendix B—Action Steps for the Program

Appendix C—Program Logic Model

Appendix D—Evaluation Plan

Appendix E—Dissemination Plan

Milestone One

Introduction to the Problem

Epidemiological Assessment

The “What”: [Insert summary of the health issue or concern.]

Person
The “Who”

Place
The “Where”

Time
The “When”

[Insert Key Information A.]

[Insert Key Information B.]

[Insert Key Information C.]

[Insert Key Information A.]

[Insert Key Information B.]

[Insert Key Information C.]

[Insert Key Information A.]

[Insert Key Information B.]

[Insert Key Information C.]

The “Why” and “How”: [Insert summary of the causes, risk factors, modalities, etc.]

Health Equity Assessment

Structural Determinants

Societal Structures and Social Relations

Social Stratification

Policy Contexts

[Insert Key Point A.]

[Insert Key Point B.]

[Insert Key Point C.]

[Insert Key Point A.]

[Insert Key Point B.]

[Insert Key Point C.]

[Insert Key Point A.]

[Insert Key Point B.]

[Insert Key Point C.]

Intermediary Determinants

Material Circumstances

Behaviors and Biological Factors

Psychosocial Factors

[Insert Key Point A.]

[Insert Key Point B.]

[Insert Key Point C.]

[Insert Key Point A.]

[Insert Key Point B.]

[Insert Key Point C.]

[Insert Key Point A.]

[Insert Key Point B.]

[Insert Key Point C.]

Differentials

Differential Exposure

Differential Vulnerability

Differential Consequences

[Insert brief summary of how social stratification creates inequities on exposure to health-damaging conditions.]

[Insert brief summary of how differential exposure leads to unjust vulnerability (i.e., stressors/burdens of exposure) based on social group identity.]

[Insert brief summary of how differential vulnerability leads to unjust consequences (i.e., more risk or less protection; e.g., lack of advantages or privilege) based on social group identity.]

Summary of Health Equity Considerations

[Insert one or two paragraphs summarizing your health equity assessment and how this affects the program you will create.]

Please refer to Appendix A for an assessment of social, epidemiological, and educational/ecological dimensions of the problem.

Significance

[Insert statement of proposed program’s importance/benefit to public health.]

[Insert statement of proposed program’s implementation quality, access, and delivery within the larger health system.]

Milestone Two

Strategic Action Plan

The proposed program’s vision is to [Insert vision statement.].

The proposed program’s mission is to [Insert mission statement.].

The proposed program’s objectives and strategies involve the following:

Objective 1: [Insert S.M.A.R.T. Objective 1 here.]

Strategy 1.A: [Insert Strategy 1.A here.]

Strategy 1.B: [Insert Strategy 1.B here.]

Objective 2: [Insert S.M.A.R.T. Objective 2 here.]

Strategy 2.A: [Insert Strategy 2.A here.]

Strategy 2.B: [Insert Strategy 2.B here.]

Objective 3: [Insert S.M.A.R.T. Objective 3 here.]

Strategy 3.A: [Insert Strategy 3.A here.]

Strategy 3.B: [Insert Strategy 3.B here.]

Please refer to Appendix B for information on the proposed program’s action plan.

Please refer to Appendix C for the proposed program’s logic model.

Milestone Three

Evaluation Plan

The proposed program’s plan for process, outcome, and impact evaluations has been detailed in Appendix D. [Insert a written summary of one or two paragraphs explaining main ideas].

Milestone Four

Dissemination Plan

[Insert a brief introduction to the dissemination of findings. In addition, describe what communication strategies/formats/media you considered for the two audiences and your reasoning for choosing one medium over the others to communicate your finding for each of the two audiences.]

The plan for the dissemination of findings has been detailed in Appendix E.

References

[Insert references.]

Appendix A—Social, Epidemiological, Educational, and Ecological Assessments

Description of Current Status

Description of Desired Outcome

Phase 1:
Social Assessment

Quality of Life (QoL)

[Insert text.]

Phase 2:
Epidemiological Assessment

Indicators (mortality, morbidity, disability data)

Other factors (genetic, behavioral, environmental)

[Insert text.]

Phase 3:
Educational and Ecological Assessment

Predisposing Factors

Enabling Factors

Reinforcing Factors

[Insert text.]

Appendix B—Action Steps for the Program

Objective 1: [Insert S.M.A.R.T. Objective 1.]

Strategy 1.A: [Insert Strategy 1.A.]

Action Step(s)

Person(s) responsible

Date to be completed

Resources required

Barriers

Collaborators

Step 1.A.1: [Insert first step.]

[Insert text.]

Step 1.A.2: [Insert second step.]

[Insert text.]

Step 1.A.3: [Insert third step.]

[Insert text.]

Step 1.A.4: [Insert fourth step.]

[Insert text.]

Step 1.A.5: [Insert fifth step.]

[Insert text.]

Strategy 1.B: [Insert Strategy 1.B.]

Action Step(s)

Person(s) responsible

Date to be completed

Resources required

Barriers

Collaborators

Step 1.B.1: [Insert first step.]

[Insert text.]

Step 1.B.2: [Insert second step.]

[Insert text.]

Step 1.B.3: [Insert third step.]

[Insert text.]

Step 1.B.4: [Insert fourth step.]

[Insert text.]

Step 1.B.5: [Insert fifth step.]

[Insert text.]

Objective 2: [Insert S.M.A.R.T. Objective 2.]

Strategy 2.A: [Insert Strategy 2.A.]

Action Step(s)

Person(s) responsible

Date to be completed

Resources required

Barriers

Collaborators

Step 2.A.1: [Insert first step.]

[Insert text.]

Step 2.A.2: [Insert second step.]

[Insert text.]

Step 2.A.3: [Insert third step.]

[Insert text.]

Step 2.A.4: [Insert fourth step.]

[Insert text.]

Step 2.A.5: [Insert fifth step.]

[Insert text.]

Strategy 2.B: [Insert Strategy 1.B.]

Action Step(s)

Person(s) responsible

Date to be completed

Resources required

Barriers

Collaborators

Step 2.B.1: [Insert first step.]

[Insert text.]

Step 2.B.2: [Insert second step.]

[Insert text.]

Step 2.B.3: [Insert third step.]

[Insert text.]

Step 2.B.4: [Insert fourth step.]

[Insert text.]

Step 2.B.5: [Insert fifth step.]

[Insert text.]

Objective 3 [Insert S.M.A.R.T. Objective 3.]

Strategy 3.A: [Insert Strategy 3.A.]

Action Step(s)

Person(s) responsible

Date to be completed

Resources required

Barriers

Collaborators

Step 3.A.1: [Insert first step.]

[Insert text.]

Step 3.A.2: [Insert second step.]

[Insert text.]

Step 3.A.3: [Insert third step.]

[Insert text.]

Step 3.A.4: [Insert fourth step.]

[Insert text.]

Step 3.A.5: [Insert fifth step.]

[Insert text.]

Strategy 3.B: [Insert Strategy 3.B.]

Action Step(s)

Person(s) responsible

Date to be completed

Resources required

Barriers

Collaborators

Step 3.B.1: [Insert first step.]

[Insert text.]

Step 3.B.2: [Insert second step.]

[Insert text.]

Step 3.B.3: [Insert third step.]

[Insert text.]

Step 3.B.4: [Insert fourth step.]

[Insert text.]

Step 3.B.5: [Insert fifth step.]

[Insert text.]

Appendix C—Program Logic Model

Program Summary

Issue/Problem

Priorities

Program Approach

[Insert text.]

Programmatic Considerations

Assumptions (Internal Factors)

External Factors

[Insert text.]

Program Structure

Inputs

Activities

Outputs

Human Resources

Activity Grouping 1

Products

[Insert text.]

Financial Resources

Activity Grouping 2

Services

[Insert text.]

Community Resources

Activity Grouping 3

Infrastructure

[Insert text.]

Material Resources

Activity Grouping 4

Other

[Insert text.]

Program Function

Outcomes

(Note: Please adjust cell merging to reflect the scaffolding of outcomes from short-term to intermediate to long-term. Add/delete rows as needed to meet project expectations.)

Short-Term Outcomes
(Predisposing Factors/Intrapersonal Level)

Intermediary Outcomes
(Reinforcing Factors/Interpersonal Level)

Long-Term Outcomes
(Enabling Factors/Community Level)

[Insert text.]

Impact
(Note: Impact should focus on the single goal/purpose of the program, but phrased in terms of achieving health equity.)

[Insert text.]

Appendix D—Evaluation Plan

Objective 1: [Insert S.M.A.R.T. Objective 1–from Appendix B.]

Strategy 1.A: [Insert strategy.]

Evaluation Question

Indicator(s)

Data Source / Instrument

Qualitative or Quantitative Data?

Target Population

Timeline

Individual(s) Responsible

[Insert text.]

* The first column indicates evaluation type: process (P), outcome (O), or impact (I).

Strategy 1.B: [Insert strategy.]

Evaluation Question

Indicator(s)

Data Source / Instrument

Qualitative or Quantitative Data?

Target Population

Timeline

Individual(s) Responsible

[Insert text.]

* The first column indicates evaluation type: process (P), outcome (O), or impact (I).

Objective 2: [Insert S.M.A.R.T. Objective 2–from Appendix B.]

Strategy 2.A: [Insert strategy.]

Evaluation Question

Indicator(s)

Data Source / Instrument

Qualitative or Quantitative Data?

Target Population

Timeline

Individual(s) Responsible

[Insert text.]

* The first column indicates evaluation type: process (P), outcome (O), or impact (I).

Strategy 2.B: [Insert strategy.]

Evaluation Question

Indicator(s)

Data Source / Instrument

Qualitative or Quantitative Data?

Target Population

Timeline

Individual(s) Responsible

[Insert text.]

* The first column indicates evaluation type: process (P), outcome (O), or impact (I).

Objective 3: [Insert S.M.A.R.T. Objective 3–from Appendix B.]

Strategy 3.A: [Insert strategy.]

Evaluation Question

Indicator(s)

Data Source / Instrument

Qualitative or Quantitative Data?

Target Population

Timeline

Individual(s) Responsible

[Insert text.]

* The first column indicates evaluation type: process (P), outcome (O), or impact (I).

Strategy 3.B: [Insert strategy.]

Evaluation Question

Indicator(s)

Data Source / Instrument

Qualitative or Quantitative Data?

Target Population

Timeline

Individual(s) Responsible

[Insert text.]

* The first column indicates evaluation type: process (P), outcome (O), or impact (I).

Appendix E—Dissemination Plan

The Priority Population

Health Professionals

Target Audience Description
The “recipient” (include level of education, health literacy level)

[Insert one- to two-sentence summary.]

Communication Event
Summary of communication need

[Insert one to two sentences.]

Message Objective
What is the intent?

[Insert one-sentence summary.]

Timing
Duration, frequency, etc.

[Insert one to two sentences.]

Vehicle
List several types of media/communication strategies-formats appropriate for audience

[Insert text.]

Vehicle of Choice
Medium (form) + Channel (route)

Medium → [Insert one sentence.]

Channel → [Insert one sentence.]

Medium → [Insert one sentence.]

Channel → [[Insert one sentence.]

Explanation for Why You Chose Medium Over Other Options

[Insert text.]

Description of Health Literacy

[Insert one-sentence summary.]

[[Insert one-sentence summary.]

Sender(s)
Author, distributor, coordinator, etc.

[Insert one to three sentences.]

Feedback Mechanism
Currently available and needed avenues

Available Mechanisms → [Insert one to three sentences.]

Needed Avenues → [Insert one to three sentences.]

Available Mechanisms → [Insert one to three sentences.]

Needed Avenues → [Insert one to three sentences.]

P.E.S.T.L.E. Analysis of External Influences

The Priority Population

Health Professionals

Political