Planning Health Promotion
Programs
Planning Health Promotion Programs
 Models for Health Promotion Interventions
 Starting the Planning Process
 Assessing Needs
 Measurement, Measures, Data Collection, and Sampling
 Mission Statement, Goals, and Objectives
 Theories and Models Commonly Used for Health Promotion
Interventions
 Interventions
Models for Health Promotion Programs
A Generalized Model for Program Planning
Understanding
and engaging
Assessing
needs
Setting goals
and objectives
Developing
an intervention
Implementing
the intervention
Evaluating
the results
Selecting a Specific Planning Model to apply
will be based on:
 The preferences of stakeholders (e.g., decision makers,
program partners, consumers);
 How much time is available for planning purposes;
 How many resources are available for data collection
and analysis;
 The degree to which clients are actually involved as
partners in the planning process or the degree to which
your planning efforts will be consumer-oriented (i.e.,
planning is based on the wants and needs of
consumers); and
 Preferences of a funding agency (in the case of a grant
or contract award)
Consider Three Important Criteria
 Fluidity: Steps in the planning process are
sequential, or that they build upon one another
 Flexibility: Planning is adapted to the needs of
stakeholders
 Functionality: the outcome of planning is
improved health conditions, not the production of
a program plan itself
Common Models Used by Planners in
Health Promotion Settings
• PRECEDE-PROCEED (practitioners-driven)
• MATCH (practitioners-driven)
• CDCYNERY (consumer-based planning –
health communication planning)
• SMART (consumer-based planning – social
marketing planning)
Precede-Proceed Model
The best-known and most often used theory of implementation. It has
two major components: PRECEDE, PROCEED, which are comprised
of nine phases, or steps (Green & Kreuter, 2005).
The first five phases consists of a series of planned assessments that
generate information that will be used to guide subsequent decisions.
This series of phases involves considerable sifting and sorting and is
refereed to as PRECEDE which is an acronym for “predisposing,
reinforcing, and enabling constructs in educational/ecological diagnosis
and evaluation” (Green & Kreuter, 2005, p. 9).
The second component, which consists of last four phases, is marked
by the strategic implementation of multiple actions based on what was
learned from the assessments in the initial phase. This second
component Is named PROCEED “for policy, regulatory, and
organizational constructs in educational and environmental
development” (Green & Kreuter, 2005, p. 9).
PRECEDE
Phase 5:
Phase 4:
Phase 3:
Phase 2:
Phase 1:
Administrative
And policy
assessment
Educational
And ecological
assessment
Behavioral and
Environmental
assessment
Epidemiological
assessment
Social
assessment
Health
promotion
Predisposing
factors
Health
education
Reinforcing
factors
Behavior
And lifestyle
Health
Policy
regulation
organization
Enabling
factors
Quality
of life
Environment
Phase 6:
Phase 7:
Phase 8:
Phase 9:
Implementation
Process
evaluation
Impact
evaluation
Outcome
evaluation
PROCEED
The Nine Phases of the PRECEDEPROCEED Model
Phase 1. Social assessment: assessing both objective and subjective
terms of high-priority problems or aspirations for the common good,
defined for a population by economic and social indicators and by
individuals in terms of their quality of life
Phase 2. Epidemiological assessment: delineating the extent, distribution,
and causes of a health problem in a defined population
Phase 3. Behavioral assessment: Delineating the specific health-related
actions that will most likely cause a health outcome. Environmental
assessment: systematically assessing factors in the social and physical
environment that interact with behavior to produce health effects or qualityof-life outcomes.
The Nine Phases of the PRECEDEPROCEED Model
Phase 4. Educational assessment: delineating factors that predispose,
enable, and reinforce a specific behavior or that through behavior affect
environmental changes. Predisposing factor: “any characteristics of a
person or population that motivates behavior prior to the occurrence of the
behavior”; Enabling factor: “any characteristics of the environment that
facilitates action and any skill or resource required to attain a specific
behavior.” Reinforcing factor: “any reward or punishment following or
anticipated as a consequence of a behavior, serving to strengthen the
motivation for or against the behavior.”
Phase 5. Administrative assessment: “an analysis of the policies,
resources, and circumstances prevailing in an organization to facilitate or
hinder the development of the health promotion program.”
The Nine Phases of the PRECEDEPROCEED Model
Phase 6. Implementation: “the act of converting program objectives into
actions through policy changes, regulation, and organization.”
Phase 7. Process evaluation: “the assessment of policies, materials,
personnel, performance, quality of practice or services, and other inputs
and implementation experiences.”
Phase 8. Impact evaluation: “the assessment of program effects on
intermediate objectives including changes in predisposing, enabling, and
reinforcing factors, as well as behavioral and environmental changes.”
Phase 9. Outcome evaluation: an “assessment of the effects of a program
on its ultimate objectives, including changes in health and social benefits
or quality of life.”
Features
• Complicated at first glance
• Follows a logic sequence beginning by
“identifying the desired outcome, to
determine what causes it, and finally to
design an intervention aimed at reaching
the desired outcome” (McKenzie et al.,
2005, p. 18).
An Application
• Consider a hypothetical example using a school
setting
• Phase 1: planners seek to define the quality of
life of the priority population so that the desired
outcomes can be identified
– Involving all parties (teachers, parents, PE teachers,
health evaluators, students) in the process of
assessing needs.
– Identifying social indicators: health status, fitness,
self-esteem, class attendance, academic
performance
An Application (cont.)
• Phase 2: planners use data to identify and
rank health goals or problems that are
associated with economic concerns and
school conditions
– Collecting and analyzing data
– Ranking those health concerns as they related to the
quality-of-life issues identified in Phase 1
– e.g., overweight and obesity, physical inactivity
(through epidemiological assessment) → health
status, fitness, self-esteem, school performance
An Application (cont.)
• Phase 3: planners determines what risk
factors or determinants contribute to
overweight and obesity, and physical
inactivity
–
–
–
–
Lack of rigorous physical activity program?
Lack of access to physical activity facilities?
Unhealthy school lunch program?
Easy access to high carbohydrate/calorie
food/drinks?
An Application (cont.)
• Phase 4: planners conduct educational
and ecological assessment
– Surveying students and teachers about their
knowledge of health risk factors
– Conducting an evaluation of existing programs and
environment
– Observing students’ levels of physical activity.
– Deciding an appropriate health promotion intervention
(comprised of an education component, behavior
change, and new policies that promote school-wide
physical activity)
An Application (cont.)
• Phase 5: planners determine what
organizational and administrative support and
resources are available to carry out the health
promotion intervention.
–
–
–
–
–
–
Health education built into the curriculum?
Hiring a health educator/consultant?
Increasing level of intensity in PE?
Restructuring school lunch program?
More after school physical activity and/or sport programs?
More education on promoting healthy nutrition and physical
activity habits.
An Application (cont.)
• Once the availability of program resources
is determined, Phase 6, implementation,
can begin
• The evaluation components (Phases 7,8,
and 9) of this program will be based on the
objectives that were created during
assessment phases.
• Ensure that criteria (standards of
acceptability) noted in each objective were
clear.
An Application (cont.)
• e.g., in phase 7 (process evaluation), planners may be
concerned with determining the availability of the
educational component of the intervention for each
student.
• e.g., in phase 8 (impact evaluation), planners would be
interested in evaluating changes in the behavior of the
students (e.g., become more active?) and the school
environment (e.g., program availability, access to healthy
school foods, etc.)
• As for outcome evaluation, Phase 9, planners may be
looking for an overall increase in school-wide physical
activity and consumption of healthy food (i.e., low-calorie
and nutritious).
The MATCH Planning Model
• MATCH is an acronym for Multilevel
Approach to Community Health
• By: Simons-Morton, D. G., SimonsMorton, B. G., Parcel, G.S., & Bunker, J.F.
(1988). Influencing personal and
environmental conditions for community
health: A multilevel intervention model.
Family and Community Health, 11(2), 2535.
Insert the MATCH Planning Model here
An Application
• Assumption:
– Needs assessment is complete
– Heart disease is the focus of the program we
are planning
Health Problem Behavioral Risk
Factors
Heart disease
1. Lack of exercise
2. Poor eating habits
Environmental Risk
Factors
1. Lack of exercise facilities
2. School lunch program
Phase 1: Goal Selection
• Heart disease is the leading cause of death
• Several of the behaviors associated with the disease are
changeable
• Therefore, optimal health-status goal is to reduce the
prevalence of heart disease.
• Target population: elementary school children
• Health behavioral goals: ↓ sedentary lifestyle and
improve eating habits
• Environmental goals focus on
– available exercise facilities,
– school's curriculum with regard to PA and nutrition,
– School policies that can influence PA and eating
habits
Phase 2: Intervention Planning
• Identify the following elements:
– the levels of society at which planners plan to
intervene;
– what intervention objectives will be;
– the mediators with which we will be
concerned;
– what intervention approaches we will take
See the Table for Summary
Step 1
Focus of Intervention
Step 2
Objectives
Individual students
5th and 6th graders
Health behaviors
Exercise
Eating habits
Organizational
Board of education
School administrators
Teachers
School cafeteria workers
Governmental
City council
City parks and recreation
board
City parks and recreation
workers
Programs
Practices
Policies
Resources
Programs
Practices
Policies
Resources
Step 3
Mediators
Knowledge
Attitudes
Skills
Behavior
Knowledge
Attitudes
Skills
Behavior
Knowledge
Attitudes
Skills
Behavior
Step 4
Intervention Approaches
Educational
Teaching
Positive reinforcement
Organizational Change
Curricula change
School lunch menu policy
in-service training
Political Action
Lobbying
Policy advocacy
Interest-group pressure
Phase 3: Program Development
• Focus on several program components
– Training teachers for PA and nutrition
– Training cafeteria workers to create healthier
school lunches
– Soliciting board of education for changes in
related to curriculum PE and health education
– Lobbying the city parks and recreation board
for better equipped parks and exercise
facilities
Phase 4: Implementation Preparations
• Planners need to facilitate the adoption,
implementation, and maintenance of their
program components by preparing those
impacted by the program for change
– Showing these who are affected the possible
consequences of no change
– Programs that have been successful
– Opinion leaders in the community support the change
• Planners need to select and , if necessary,
training the implementors so they can conduct
the in-service sessions for the teachers and
cafeteria workers, and prepare those who will be
lobbying the city parks and recreation board
Phase 5: Program Evaluation
• Process evaluation will involve:
– Examining the success of the implementation of the
various program components
– Quality of the in-service session
– Pros and cons of the program components
– Impact evaluation: knowledge, attitudes, and health
practices of the students with regard to PA and
nutrition, and change in PA facilities at the city park
level
– Outcome evaluation (i.e., ↓ the prevalence of heart
disease)?
CDCynergy Planning Model
• Developed by the Office of Communication
at the Cents for Disease Control and
Prevention (CDC) (Centers for Disease
Control and Prevention, 2003)
CDCynergy Planning Model
• Use six phases involving multiple steps to help
planners
– acquire a thorough understanding of a health
problem
– Explore a wide range of possible strategies for
influencing the problem
– Systematically select the strategies that show the
most promise;
– Understand the role excommunication can play in
planning, implementing, and evaluating selected
strategies;
– Develop a comprehensive community plan
CDCynergy Planning Model
Phase 1: Describe Problem
• Identify and define health problems that
may be addressed by your program
interventions.
• Examine and/or conduct necessary
research to describe the problems.
• Assess factors and variables the can
affect the project’s direction, including
strengths, weaknesses, and threats
(SWOT).
CDCynergy Planning Model
Phase 2: Analyze Problem
• List causes of each problem you plan to
address.
• Develop goals for each problem.
• Consider strengths, weaknesses, opportunities,
threats, and ethics of health: (1) engineering, (2)
communication/education, (3)
policy/enforcement, and (4) community service
intervention options.
• Select the types of intervention(s) that should be
used to address the problem(s).
CDCynergy Planning Model
Phase 3: Plan Intervention
• Decide whether communication is needed as a dominant
intervention and/or as support for other intervention(s).
– If communication is used as a dominant intervention, list possible
audiences.
– If communication is to be used to support Community Services,
Engineering, and/or Policy/Enforcement interventions, list possible
audiences to be reached in support of each selected interventions.
• Conduct necessary audience research to segment intended
audiences.
• Select audience segment(s) and write communication objectives for
each audience segment.
• Write a creative brief to provide guidance in selection appropriate
concepts/messages, settings, activities, and materials.
CDCynergy Planning Model
Phase 4: Develop Intervention
•
Develop and test concepts, messages, settings, channel-specific activities,
and materials with intended audiences.
•
Finalize and briefly summarize a communication implementation plan. The
plan should include:
–
–
–
–
–
–
–
–
Background and justification, including SWOT and ethics analyses
Audiences
Communication objectives
Messages
Settings and channels for conveying your messages
Activities (including tactics, materials, and other methods)
Available partners and resources
Tasks and timeline (including persons responsible for each task, date for
completion of each task, resources required to deliver each task, and points at
which progress will be checked)
– Internal and external communication plan
– Budget
•
Produce materials for dissemination
CDCynergy Planning Model
Phase 5: Plan Evaluation
• Determine stakeholder information needs
• Decide which types of evaluation (e.g., implementation, reach,
effects) are needed to satisfy stakeholder information needs.
• Identify sources of information and select data collection methods.
• Formulate an evaluation design that illustrates how methods will be
applied to gather credible information.
• Develop a data analysis and reporting plan.
– Finalize and briefly summarize an evaluation implementation plan. The
plan should include:
– Stakeholder questions
– Intervention Standards
– Evaluation methods and design
– Data analysis and reporting
– Tasks and timeline (including persons responsible for each task, date
for completion of each task, resources required to deliver each task,
and points at which progress will be checked
– Internal and external communication plan
– Budget
CDCynergy Planning Model
Phase 6: Implement Plan
 Integrate, execute, and manage
communication and evaluation plans.
 Document feedback and lessons learned.
 Modify program components based on
feedback.
 Disseminate lessons learned and evaluation
findings.
SMART Planning Model
• SMART – Social Marketing Assessment
and Response Tool (Neiger, 1998; Neiger
Thackeray, 2002).
• Central focus of SMART is consumers
• SMART is composed of seven phases.
The Phases of SMART
• Phase 1: Preliminary Planning
– Integrate, execute, and manage
communication and evaluation plans.
– Document feedback and lessons learned.
– Modify program components based on
feedback.
– Disseminate lessons learned and evaluation
findings.
The Phases of SMART
• Phase 2: Consumer Analysis
– Segment and identify the priority population.
– Identify formative research methods.
– Identify consumer wants, needs, and
preferences.
– Develop preliminary ideas for preferred
interventions and communication strategies.
The Phases of SMART
• Phase 3: Market Analysis
– Establish and define the market mix.
– Assess the market to identify competitors
(behaviors, messages, programs, etc.), allies
(support systems, resources, etc.), and
partners.
The Phases of SMART
• Phase 4: Channel analysis
– Identify appropriate communication channels.
– Assess options for program distribution.
– Determine how channels should be used.
– Assess options for program distribution.
– Identify communication roles for program
partners.
The Phases of SMART
• Phase 5: Develop Interventions, Materials,
and Pretest
– Develop program interventions and materials
using information collected in consumer,
market, and channel analysis.
– Interpret the marketing mix into a strategy that
represents exchange and societal good.
– Pretest and refine the program.
The Phases of SMART
• Phase 6: Implementation
– Communicate with partners and clarify
involvement.
– Activate communication and distribution
strategies.
– Document procedures and compare progress
to time lines.
– Refine the program.
The Phases of SMART
• Phase 7: Evaluation
– Assess the degree to which the priority
population is receiving the program.
– Assess the immediate impact on the priority
population and refine the program as
necessary.
– Ensure the program delivery is consistent with
established protocol.
– Analyze changes in the priority population.
Other Planning Models
• A Systematic Approach to Health Promotion (Healthy
People 2010) (USDHHS, 2000)
• Mobilizing for Action through Planning and Partnerships
(MAPP) (NACCHO, 2001)
• Healthy Communities (USDHHS, 2001)
• Assessment Protocol for Excellence in Public Health
(APEX-PH) (NACCHO, 1991)
• SWOT (Strengths, Weaknesses, Opportunities, Threats)
Analysis (Johnson, Scholes, & Sexty, 1989).
• The health Communication Model (NCI; 2002)
• Healthy Plan-It (CDC, 2000)
Summary
• Various planning models with the PRECEDEPROCEED model the most popular one in
health promotion
• They all share common characteristics
• Seek to understand and engage community
members, assess needs, set goals and
objectives, develop an intervention, implement
the intervention, and evaluate the results (back to the
Generalized Model, Slide #3)
10 Minutes Break