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Preceed proceed model of health planning

model of health planning in health education using preceed proceed model.

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Preceed proceed model of health planning

  1. 1. Models of health education planning prepared & presented by: Sudarshan Gautam Subash Adhikari BPH 1st Batch UCMS
  2. 2. Different models or framework • Classical model – PIE model • Comprehensive framework – PRECEDE & PROCEED
  3. 3. THE PRECEDE/PROCEED MODEL  Originators Lawrence W . Green Marshall W. Krueter  A framework of comprehensive health promotion/education programme planning.  It systematically guides the development and evaluation of health education programme.
  4. 4. PRECEDE PRECEDE stands for “Predisposing, Reinforcing, and Enabling Factors construct in Educational Diagnosis and Evaluation.”
  5. 5. PROCEED  PROCEED, which stands for “policy, regulatory, and organizational constructs in educational and environmental development.”
  6. 6. PRECEDE  Look at present outcomes of health habits and quality of life of the target population  Ask “WHY?” rather than “HOW?”  First portion of the model  Diagnostic phase  Built on the belief that there is a need to engage in multidimensional diagnoses to more effectively determine factors that may influence health status in the community.  Begins with desired outcomes and works backwards to determines what causes it or what precede the outcomes.
  7. 7.  Outcomes focus INPUTS OUTCOMES (EDUCATION) (HEALTH)
  8. 8. PROCEED  Implementation & evaluation phase.  Goes beyond educational interventions to the political, managerial, and economic actions necessary to make social system environments more conducive to healthful lifestyles and a more complete state of physical, mental and social well- being for all
  9. 9. PRECEDE (Diagnostic Part) •Phase 1-Social Diagnosis •Phase 2-Epidemiological Diagnosis (Social Epidemiology 1&2) •Phase 3-Behavioral & Environmental Diagnosis •Phase 4-Educational Diagnosis •Phase 5-Administrative & Policy Diagnosis
  10. 10. PROCEED (Implementation & evaluation part)•Phase 6-Implementation •Phase 7-Process Evaluation •Phase 8-Impact Evaluation •Phase 9-Outcome Evaluation
  11. 11. Diagnosis/Situation Assessment…. PRECEEDE framework of diagnosis systematically assess problems and factors related to behavior change in 5 different phases. These systematic and sequential phases guide programme planners to understand and identify the problems and factors to be addressed by health education program.
  12. 12. Phase 1: Social Diagnosis •Determine people’s perceptions of their own needs and quality of life. •Important because of mutual relationship between health and quality of life •Links between social problems & specific health problems used to develop focus for health education
  13. 13. Methodology for social diagnosis •Interviews with key opinion leaders & “target” population •Focus group discussions •RRA, PRA & PLA •Observation –participatory & non- participatory •Surveys •Literature Review –secondary information
  14. 14. Phase 2-Epidemiological Diagnosis  Identify which health problems are most important to population or community that are contributing to or interacting with QoL concerns.  Establish the program goals and objectives.  Identify specific health problem which are associated with a poor quality of life.  Answer “What health problems are important (measured objectively, rather than subjectively)?”
  15. 15. Contd….  Establish the relationships between health problems, other health conditions and quality of life.  Establish dimensions for measuring health problems –indicators for morbidity, mortality, & disability (Ds).  set priorities within health problems and within target population.  Magnitude of health problem (Incidence, prevalence), its distribution with time, place and person and class is identified.  Methods: population census, national demographic surveys, other sample surveys, etc.
  16. 16. Phase 3-Behavioral & Environmental Diagnosis  Focuses on systematic identification of health practices and other factors which seem to be linked to health problems defined in Phase 2.  These are malnutrition, unsafe sex, unsafe drinking water and sanitation, indoor air pollution, tobacco and alcohol consumption, high cholesterol consumption  Includes non-behavioral causes (personal and environmental factors) that can contribute to health problems, but are not controlled by behavior.
  17. 17. Non-behavioral causes •Genetic predisposition •Age •Sex •Climate •Workplace •Adequacy of health care facilities
  18. 18. Phase 3-Behavioral & Environmental Diagnosis (contd.) BehaviouralMatrix: More Important Less Important More Changeable High PriorityQuadrant I Low Priority Except for Political ReasonsQuadrant III Less Changeable Priority for InnovationsAsses sment CrucialQuadrant II No ProgramQuadrant IV
  19. 19. Behavior s More Important Less Important More Changeab le • Sleeping with out bed nets • Uses of LLINs • Sleeping on floor or surface • Delay in health seeking behavior Less Changeab le • Working in evening hours • Outdoor sleeping • Proper management of waste water Behavioral Matrix for mosquito control
  20. 20. Phase 4-Educational Diagnosis  •This phase assesses the causes of health behaviors which were identified in Phase 3.  Three types of causes are identified:  Predisposing factors  Enabling factors  Reinforcing factors
  21. 21.  Identifies those antecedent and reinforcing factors that initiate and sustain the change process  Critical element of this phase is selection of the factors which if modified, will be most likely to result in behavior change  Prioritization of factors is based on relative importance and changeability
  22. 22.  Predisposing factors are the antecedents that provide the rationale or motivation for a behavior. Knowledge Attitudes Beliefs
  23. 23.  Reinforcing factors are those elements that appear subsequent to the behavior and that provide continuing reward or incentive for the behavior to become persistent Social support -reward, or punishment Peer influence Significant others’ support
  24. 24.  Enabling factors are psychological/emotional or physical factors that facilitate motivation to change behavior: Programs, services, and resources necessary for behavioral Accessibility, availability, skills
  25. 25.  Factors are enumerated and rated in terms of importance and changeability  •Priority target groups for intervention are selected  •Measurable objectives are then written How many will know, believe, or be able to do what by when? How much of what resource will be available to whom by when?  Must be driven by a thorough knowledge of the relevant literature, and understanding
  26. 26.  Methods for educational diagnosis - secondary data collection - Primary data collection- quantitative and qualitative surveys -Observations -FGD, In-depth Interviews etc.  Participatory methods of data collection are encouraged.
  27. 27. Phase 5-Administrative and Policy Diagnosis  Focuses on administrative and organizational concerns which must be addressed prior to program implementation.  Includes assessment of resources, evidence-based ground of available resources, development of implementation timetable, organization and coordination with others.
  28. 28.  Assess limitations and constraints  Select the best combination of methods and strategies  e.g Analysis of national health policy
  29. 29. Administrative Diagnosis Analysis of policies, resources and circumstances prevailing organizational situations that could hinder or facilitate the development of the health program. Policy Diagnosis Assesses the compatibility of your program goals/objectives with those of the organization and its administration
  30. 30. Phase 6-Implementation of the Program  Planned activities and strategies are carried out with the target population.  Includes development and implementation of action plan, time table, building commitment, mobilization of resources, supervision and monitoring, organization and coordination with others.
  31. 31. Evaluation •Clear and concise objectives are the foundation for evaluation •From two perspective –Health Program and Health Education program •Health Education Programs intermediate to Health Programs •Three types of evaluation –Diagnostic, Formative & Summative •Three areas of evaluation –process, impact and outcome (some literature outcome as output, effect and impact)
  32. 32. Phase 7-Process Evaluation •To evaluate the process by which the program is being implemented •Ongoing; flow of activities •Includes effectiveness of planning meetings, running meetings, communicating with others who are involved
  33. 33. Phase 8-Impact Evaluation  Health Education Impact –Change in Behavioral and environmental indicators  Program Impact –Change in Epidemiological and social indicators
  34. 34. Phase 9-Outcome Evaluation •Outcome may indicate all -output, effect or impact •Output –Immediate outcome •Effect –More qualitative in nature •Impact –Change in quality of life of the people
  36. 36. • Introduction • Rational of HE Plan • Social Diagnosis of the problem • Epidemiological diagnosis • Behavioral and Environmental diagnosis • Behavioral Matrix
  37. 37. • Education & Organizational Diagnosis • Administrative and policy diagnosis • Implementation of HE Program • Evaluation Plan of HE Program
  38. 38. Introduction • Kala-azar (Visceral Leishmaniasis) is a vector born disease caused by the parasite Leishmania donovani • The vector of kala-azar (Leishmania donovani) commonly known by “Sand Fly” • Transmitted by the bite of the infected female sand fly called “Phlebotomus argentipes”
  39. 39.  Using Bed Net while sleeping is a simple preventing measure of Kala- azar as well as other vector born diseases likes; JE, Dengue and Malaria etc  Environmental, socioeconomic and health behavior related factors directly affects the transmission of disease
  40. 40. Rational • KA is considered as a major public health problem in Nepal with incidence rate: 0.14/10,000 population (DHS Report -2012/13) • Household behaviors promotes the breeding and biting from the vectors. Vector’s biting is an absolute source of disease transmission • Sand flies (vectors) usually have nocturnal biting habit
  41. 41.  Using of bed net to prevent the risk of biting during sleeping time is a key preventing measure of disease transmission  Only three-fifths or almost 61% of households have mosquito nets (NDHS- 2006)
  42. 42. Kala-azar Prone 12 districts and Incidence Rate
  43. 43. 1. Social Diagnosis of the problem: • 12 terrai lower land districts of Nepal are considered as Kala-azar prone districts • Those who have poor housing condition and poor sanitation practices, higher chances of getting disease. • Socially and economically disadvantaged groups with high illiteracy and poverty, suffered greater compared to others. It is the disease of poorest of the poor • Almost about 50% people are illiterate and 24.7 % people are below of poverty line in Nepal • Lack of knowledge about on preventive measures including use of bed net during sleeping time are the determining factors for disease transmission
  44. 44. 2. Epidemiological diagnosis:Disease causing agent (vector):Sand fly or Phlebotomus Argentipes Population at risk :Almost 8 million (12 districts) : Higher incidence among men Highest risk group :Below the age of 15 years (>50% in <15 years of age) Occupation :High pre. among Farmers Seasonality of transmission :Epidemic (Rainy & post-rainy season – 90% cases occur ) Incidence rate :0.75 in 2011 and 0.14 in 2012 Average case fatality :1.02 percent
  45. 45. 3. Behavioral and Environmental diagnosis (a) Behavior factors for disease incidence and transmission: • Sleeping without bed nets • Outdoor sleeping or sleeping on floor/surface • Expose of body parts at evening hours • Traditional animal husbandry practices • Improper management of waste water • Delay in health seeking • Not using of LLINs Negative Behaviors
  46. 46. • Using Khatiya for sleeping • Practices of waste-material fumigation in dusk to drive the vectors • Sleeping habit on second floor • Using of bed nets Positive Behaviors Behavior factors for disease incidence & transmission:
  47. 47. (b) Environment conditions for disease incidence and transmission: • Paddy field surrounding of houses • Favorable temperate and climates for vectors • Poor environmental and housing condition which is appropriate to vectors for the breeding • Nocturnal biting habits of the vectors • Only 61% of households (84% in Tarai and 46% in Hill) have mosquito net (NDHS’o6) • Limited number of bed nets in house hold, three in ten own one net, one in two owns two to three nets, and one in five owns at least four nets
  48. 48. Behavior s More Important Less Important More Changeab le • Sleeping with out bed nets • Uses of LLINs • Sleeping on floor or surface • Delay in health seeking behavior Less Changeab le • Working in evening hours • Outdoor sleeping • Proper management of waste water Behavioral Matrix
  49. 49. 4. Education & Organizational Diagnosis: (a) Predisposing Factors: • Lack of Knowledge on disease causing, transmitting agents and preventive ways of Kala-azar • False believes and misconceptions about treatment and prevention of kala-azar • Negative attitude towards using bed nets.
  50. 50. Education & Organizational Diagnosis…… (b) Enabling Factors: • Poor housing leading to aggravate breeding. • Lack of affording capacity to use bed net and adopt other preventive measures • Inaccessible treatment facilities and costly • Lack of access on education and communication • Traditional practices of treating diseases and superstition • Less availability of bed-nets • Lack of acceptable and affordable treating system • Favorable environment for vectors breeding and bites
  51. 51. Education & Organizational Diagnosis…… (c) Reinforcing Factors: • Family environment (Less approval of using bed net by family) • Use of bed net by role models of community(teachers) • Wide spread use of bed net in community • Bed net promotional advertisement in local media • No punishment & reward system for users and non-users • Interaction with HWs and teachers
  52. 52. 5. Administrative and policy diagnosis:(a) National, International and Local Responses: • MOHP considered vector born diseases as priority one program and has been implementing various measures for controlling the disease • The Kala-azar elimination programme has been expanding after successive piloting at Saptari district to all 12 epidemic districts by adopting PHC approach • Collaboratively implementing the Kala-azar elimination program by adopting a same protocols (Miltefosine-oral and rK-39 diagnostic tools) in Nepal, India and Bangladesh
  53. 53. Administrative and policy diagnosis………. National, International and Local Responses……… • Establishment of sentinel surveillance sites with in the districts through early warning reporting system • Providing various anti- Kala-azar services at community in free of cost, through existing health networks • Peripheral level health workers were trained on appropriate skills required for prevention and control of vector borne diseases including Kala-azar • Establishment of Vector Borne Disease Research and Training Centre (VBDRTC)
  54. 54. (b) Disease control and preventive strategies: • Health education and promotion • Bi-annual Indoor Residual Spraying (IRS) at 12 endemic districts • Distribution and promotion of insecticide treated bed nets (ITBN) and long lasting insecticide bed nets (LLIBN) per identified household at endemic areas • Early diagnosis, prompt and complete treatment (EDPCT) of Kala-azar cases along with appropriate laboratory diagnostic facilities • Training to HPIs, PHOs, DHOs and MOs on Kala- azar control and management • Research on the epidemiology of Kala-azar, vector bionomics and effectiveness of different anti-Kala- azar drugs. Administrative and policy diagnosis……….
  55. 55. 6. Implementation Plan of Health Education Program: “Use of bed net to Prevent Kala-azar”
  56. 56.  Goal: To improve health status of Kala- azar risk population of Siraha district.  General Objective : To increase the use of bed nets during sleeping time to prevent Kala- azar.
  57. 57. Specific objectives: At the end of Health Education Program: • 90% participants will be able to list mode of transmission of Kala-azar(K) • 90% participants will be able to explain the importance of using bed net (K) • 80% participants will be able to differentiate the ordinary bed nets and LLINs (K) • 60% participants will adopt any types of bed nets based on their needs or capacities (P)
  58. 58. Contents of HE session • Introduction of Kala-azar • Mode of transmission of Kala-azar • Importance of using bed nets • Various types of available bed nets • Difference between ordinary net and LLINs
  59. 59. Target Audience: Mothers group members Male farmers group members Community forest users groups Female Community Health Volunteers (FCHVs)
  60. 60. HE Methods : • Brainstorming • Lecture • Group Discussion • Demonstration HE media/Materials: • Flip chart: How to use bed net properly & life cycle of sand flies • Posters /Pamphlets relating to importance of using bed nets • Multimedia: LCD, Lap-Top • Materials for demonstration (Plain bed net and LLIBN net)
  61. 61. Human and other resources plan: • Health educators team from TU, MMIHS , BPH students • District Public Health Officer and District Supervisors from DHO, Siraha • Local health facilities' staffs • Local INGOs /NGOs and staffs • Transportation will be managed from MMIHS, Nakkhu • Budget and other necessary materials will be made available from EDCD and PSI
  62. 62. H.E Topic Target groups Methods and Media Resource person Location Date and duration of session • Introduction of kala-azar and its mode of transmission  FCHVs  Mothers groups members  Male farmers groups member  Forest consumer’s groups  Brain storming  Lecture  Group discussion  Flip chart & poster  Multimedia  BPH students  Local HWs  Saurya English Boarding School , Siraha-7 1st March, 2014, (20 minutes)  Importance of using bed net  Same as above  Same as above  Same as above  Same as above 1st March, 2014, (20 minutes)  Discussion and Q/A session at the end of health education session of 1st day 20 minutes  Various types of bed net available at market  Same as above  Same as above  Same as above  Same as above 2nd March, 2014 (20 minutes)  Introduction and demonstration ITBN/LLIN and differences between ordinary net and  Same as above  Demonstration of available bed nets  Same as above  Same as above 2nd March, 2014 (35 minutes)
  64. 64. 1. Process evaluation • Plan of health education program • Materials identification, preparation, uses • Using of TL method and medias • Arrangement and allocation of necessary resources Techniques of process evaluation Pre and Post training evaluation Regular monitoring of sessions and feedback in post session. Question/ Answer Tools for process evaluation (checklist, questionnaire) 7. Evaluation Plan
  65. 65. Process Indicators  No. of health education session conducted  No. of supervision conducted  No. of review meeting conducted  Number of participants attended HE session
  66. 66. 2. Impact evaluation  Assesses the changes in the KAP that occurred in the participants as a result of the Intervention. Techniques of Impact evaluation  Household survey  Observation  Pre test/post test (assessment of knowledge)
  67. 67. Impact indicator • % of participants able to explain importance of using bed net • % of participants able to list mode of transmission of Kala-azar • % of participants able to differentiate the ordinary bed nets and LLINs/ITBN • % of participants adopting any types of bed nets
  68. 68. 3. Outcome Evaluation Identifying the changes in the health status of the participating group Long-term effects of the program
  69. 69. Outcome Indicator  Incidence of Kala-azar  Prevalence of Kala-azar Source of data : HP register; Hospital records; VDC profile