Health education and promotion

1. Planning, Implementation and
Evaluation of Health Promotion
Programs
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2. Brain
storming
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 Health? Health promotion?
 Health Planning?
Vision
Mission
Goals
Objectives,SMART?
 NB:Goals and objectives
build-on mission statement
“If you do not know where
you are going, then any road
will take you every where”

3. Definition of planning
 Planning: - is an anticipatory decision making about what needs to be
done, how it has to be done, and with what resources.
 To plan is “to engage in a process or procedure to develop a method of
achieving an end.”
 It is central to health education and health promotion process.
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4. PURPOSES OF PLANNING
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5. Principles of planning
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1. Based on careful analysis of the situations
(research )
2. Relate to basic needs and interests of the people
3. Planned with the people who are
involved in its implementation
4. Fullest utilization of the existing resources.
5. Flexible enough to meet long time situation.

6. Principles…
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6. It should be a continuous process- new problems may
arise
as old problems are solved
7 Should be achievable considering such factorsas
finance personnel, time etc.
8.Trained personnel should be utilized for preparing a plan.

7. Planning Steps
1. Assessing
need
2. identify
problem &
prioritize
3. setting
goals &
objectives
4. develop
implementa
tion
strategy
5.
Implement
6. evaluate
7. determine
future trend
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Planning steps …
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8. MODELS OF HEALTH PROMOTION
 Theory alone does not produce effective programs,
research, planning, implementing, and monitoring.
 The well-developed planning models that can be
used to integrate diverse theoretical frameworks are:
PRECEDE-PROCEED.
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9. PRECEDE-PROCEED
 Is a community-oriented, participatory model for
creating successful community health promotion
interventions.
 A Planning model that provides a structure for
applying theories.
 Helps to identify the most appropriate intervention
strategies to be implemented.
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10. PRECEDE
P = Predisposing
R = Reinforcing
E = Enabling
C = Constructs
E = Educational/Ecological
D = Diagnosis
E = Evaluation
PROCEED
P = Policy
R = Regulatory
O = Organizational
C = Constructs
E = Educational &
E =Environmental
D = Development
PRECEDE - PROCEED
Lawrence Green & Marshall Kreuter
PRECEDE created in early 1970s: diagnostic part
PROCEED created in the 1980s: Implementation & E part
Best known & often used model
The model views health behavior as influenced by both individual and
environmental forces
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11. PRECEDE- PROCEED...
 The PRECEDE-PROCEED model is a combination of
all the other models.
 Is the most frequently utilized model in health
promotion programs.
 PRECEDE-PROCEED model was complete model for
health promotion planning, implementation and
evaluation.
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12. PRECEDE- PROCEED...
 Two fundamental propositions are emphasized by
PRECEDE-PROCEED model:
1) Health and health risks are caused by multiple factors
2) Efforts to effect behavioral, environmental and social
change must be multidimensional.
 The PRECEDE-PROCEED framework has been used and
tested in different programs in injury prevention and
control, lung diseases, cancer programs, nutrition
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13. PRECEDE ...
 The PRECEDE framework directs initial attention to
outcomes rather than inputs.
 Outcomes include desired behavioral changes such as
use of family planning methods.
 The planner begins the planning process from the
outcome end i.e. ask “why” before “how”.
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14. PRECEDE ...
 It means one has to begin with the desired final outcome and then determine
what causes it i.e. what must precede the outcome. Example:
 Example: What is the desired outcome of HIV/AIDS?
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the desired final outcome for HIV/AIDS program is
decreased morbidity and mortality from HIV/AIDS.
Then from this end, one should systematically workout the
multiple factors contributing to the solution. This is a
diagnosis stage.

15. PRECEDE ...
 PRECEDE takes into account the multiple factors that
shape health status and help the planner to reach at and
focus on specific targets.
 The PROCEED part provides additional steps for
developing policy and initiating the implementation
and evaluation process.
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16. PHASES OF PRECEDE PROCEED MODEL
 There are nine phases with in the PRECEDE-
PROCEED model
1) The PRECEDE ------- diagnosis of a problem
2) The PROCEED ------- implementation and
evaluation.
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17. PROCEED ...
 Phase 1: Social diagnosis
 Phase 2: Epidemiological diagnosis
 Phase 3: Behavioral and Env.tal diagnosis
 Phase 4: Educational and organizational
diagnosis
 Phase 5: Administrative and policy Diagnosis
 Phase 6: Implementation
 Phase 7: Process evaluation
 Phase 8: impact evaluation
 Phase 9: Outcome evaluation 18
PRECEDE
PROCEED

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19. PROCEED ...
PHASE 1: SOCIAL DIAGNOSIS
 It encompasses subjectively defined problems and
priorities of individuals or communities.
 The social indicators include: absenteeism,
achievements, crime, discrimination, aesthetics, comfort,
crowding, happiness, and performance.
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20. PROCEED ...
 Objectives of Social Diagnosis
 Increase community involvement: Active partners
 Determine the concerns with quality of life or conditions of living
 Verify and clarify the concern analysis of existing social indicators (data
available)
 Document the status of the target population
 Rationalize selection of priority problems
 Justify for further expenditure of resources on selected social problems or
goals
 Evaluation of the rationale in cost-benefit terms
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21. PROCEED ...
PHASE 2: EPIDEMIOLOGICAL DIAGNOSIS
 To identify specific health goals or problems that may
contribute to the social goals noted in PHASE 1.
 Vital indicators: disability, discomfort, fertility, fitness,
morbidity, mortality; help to assert the importance, the
priority and the allocation of resources.
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22. PROCEED ...
 Objectives
To determine the magnitude/impact of the problem
Risk group identification
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23. PROCEED ...
PHASE 3: BEHAVIORALAND ENVIRONMENTAL
DIAGNOSIS
 To identify the specific health related behavioral and
environmental factors that could be linked to the health
problems chosen as most deserving of attention in phase
2.
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24. PROCEED ...
 Environmental - those external to an individual or
beyond his or her personal control.
 Indicators: compliance, consumption patterns,
preventive actions, self-care, and utilization.
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25. PROCEED ...
 Objectives of Behavioral and Environmental Diagnosis
 Behavioral Diagnosis
 It is a systematic analysis of the behavioral links to the goals or
problems that were identified.
 Environmental Diagnosis
 It provides a parallel analysis of factors in the social and
physical environment that linked to the behavioral diagnosis.
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26. PROCEED ...
 Prepare a list of target behaviors and then categorize
 Preventive behaviors
E.g. stop smoking, keep personal hygiene
 Treatment behaviors
E.g. medical consultation, taking medication.
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27. PROCEED ...
 Rating the relative importance of behaviors is
required, the rating considers:
1. The importance of the behaviors for the desired
change,
2. Feasibility of the intervention; For evaluating the
importance and changeability of factors,
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28. PROCEED ...
 Steps in the Environmental Diagnosis:
 Separating behavioral and non-behavioral causes of the
health problem
 Eliminating non-behavioral causes that can not be
changed
 Rating environmental factors in terms of importance
 Rating environmental factors in terms of changeability
 Choosing environmental targets 29

29. PROCEED ...
PHASE 4: EDUCATIONALAND ORGANIZATIONAL
DIAGNOSIS
 The educational diagnosis is made through identification
of factors such as:
 Predisposing factors: knowledge, attitude, value, belief
 Reinforcing factors: peers, husbands, religious.
 Enabling factors: accessibility and availability of
facilities 30

30. PROCEED ...
 Objectives of Educational and Organizational
Diagnosis
 Predisposing Factors
Positive: children’s health is extremely valued by
parents
Negative: parents consider diarrhea simple and self-
limiting associated with developmental milestones
such as teething
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31. PROCEED ...
 Enabling Factors
Positive: Clinic is closed by
Negative: High treatment cost
 Reinforcing Factors
Positive: teachers can identify ill children
Negative: husband against family planning
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32. Importance can be estimated in the following parameters
1. Prevalence 2.Immediacy
/urgency
3. Necessity
How
widespread or
frequent is the
factor?
Askshow
compelling or
urgent is
the factor ?
Is factor which
its absence or
presence is must
for change to
occur
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33. Rating factors in terms of Changeability
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Knowledge
Beliefs
Attitude
Value

34. PROCEED ...
PHASE 5: ADMINISTRATIVE AND POLICY
DIAGNOSIS
 Focuses on administrative and organizational concerns
which must be addressed prior to program implementation
 Analysis of policies, resources, and circumstances
prevailing in the organizational situation that could
facilitate or hinder the development of the health
promotion program. 35

35. PROCEED ...
 Policy Diagnosis
 Policy refers to sets of objective rules guiding the
activities.
 Regulation: act of implementing, enforcing rules or lows
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36. PROCEED ...
Administrative diagnosis includes:
 Assessment of resources needed time/personnel/ budget
 Assessment of available resource
 Assessment of barriers to implementation policy
diagnosis
 Assessment of policies, regulations and organization
 Assessment of political forces 37

37. PROCEED Part: It has four phases;
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Phase 6: Implementation
Phase 7: Process evaluation
Phase 8: Impact evaluation
Phase 9: Outcome evaluation

38. Phase 6. Implementation
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• Implementation is the act of converting program
objectives into actions through policy changes,
regulation and organization.
• Requires identification of intervention strategies
• At the end of PRECEDE part and once the goals and
objectives have been developed, planners need to
decide on the most appropriate means of reaching
the goals and objectives.

39. Phase 6. Implementation…
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The planners, must consider a set of activities that would permit
the most;
 Effective (leads to desired outcome)
 Efficient (uses resource in responsible manner)
Intervention that include several activities are more likely to have
an effect on priority population than that consists of a single
activity

40. Types of intervention
strategies in HP
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1. Health communication &HE strategies
2. Health policy/
reinforcementstrategies
3. Health engineering strategies
4. Community mobilization strategies
5.Other strategies (e.g. advocacy)

41. 1. Health communication strategies
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 There is a several reason to use health communications as
intervention strategy
1st: All forms of intervention includes some
communication
2nd:Very useful to achieve many goals and objectives
form of
 3rd: probably highest penetration rate of any intervention strategies
4th : More so much cost-effective
Health communication is a thread that runs through all the phases
of a program planning.
Its a heart of health promotion interventions.
May involve interventions like social marketing,advocacy etc

42. 2. Health policy/reinforcement strategies
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• These strategies includes executiveorders, laws,
policies, regulations, formal and informal rules.
• These are mandated or regulated activities because they
are required to guide individual or collective behaviors.
• Usually, it applied when other strategies are failed !
However, it is mandatory !!
• Example, prohibiting smoking at public places.

43. 3. Health engineering strategies
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• Health engineering strategies are those designed to
change the structure or the type of services or system of
care to improve the delivery of health promotion services
• Some of this strategies creates forced choice
• E.g. services integration, restructuring health systems etc

44. 4. Community mobilization (CM)
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• Is a participatory capacity-building process through which community,
individuals, groups, or organizations plan, carry out, and evaluate activities
to improve their health.
• Why CM?
Group/community behavior change is successful only
when “everyone in the group” behaves the same way.
CM influences norms, beliefs, cultures @societal level to bring about
social change
Most of the HP interventions areas requires community participation
for collective action.
• Note: CM-build ownership & self-reliance-sustainability

45. 5.Advocacy
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• The process of influencing key decision-makers and opinion-
formers (individuals and organizations) for changes to policies
and practices that will work in people’s favor.
• Actions designed to gain political commitment, policy support,
social acceptance and systems support for a particular health goal
or program (WHO, 1998).
• Advocacy is always directed at influencing policy, laws,
regulations, decisions on funding made at the upper-most levels of
public or private sector institutions

46. PROCEED ...
PHASE 7: PROCESS EVALUATION
 Evaluation is the process of assessing what has been
achieved (whether the specified goals, objectives and
targets have been met) and how it has been achieved.
 Evaluating the change brought in terms of changing the
Predisposing, Enabling and Reinforcing factors
responsible for the behavioural causes
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47. PROCEED ...
PHASE 8: IMPACT EVALUATION
 Evaluating the change brought in terms of changing the
Behavioural and Environmental factors that are
responsible for the health problems
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48. PROCEED ...
PHASE 9. OUTCOME EVALUATION
 Evaluating the change brought in terms of changing the
Health status and Quality of life of the intended
community
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49. Evaluation Standards
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• Ensures the information
needs of intended users.
1. Utility
2. Feasibility
• Ensuresrealistic, prudent/
practical , diplomatic, and frugal.
• Ensure whether the
evaluation is ethical
3. Propriety
• Reveal and convey technically
accurate information.
4. Accuracy

50. Any question and
comments?
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