1. The document discusses various models and steps for planning and evaluating health promotion interventions. It describes planning models like PRECEDE-PROCEED and PEN-3 which involve assessing the community and identifying factors influencing health behaviors.
2. The planning process involves defining goals and objectives, identifying strategies and resources, and developing indicators. Evaluation determines whether objectives were met and assesses outcomes, using both qualitative and quantitative methods like surveys, focus groups, and experimental studies.
3. Challenges to evaluation include measuring long-term outcomes, limitations of resources, accounting for complex determinants of health, and ensuring use of lessons learned from the evaluation. Overall the document provides an overview of systematic approaches to planning and
2. Objectives
At the end of the session students will be able to:
Mention purpose of planning health promotion
Describe steps in planning health promotion
interventions
Describe health promotion planning models
Indicates steps in evaluation
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4. What is planning?
…the process of making thoughtful and systematic
decisions …..on:
What to do?
When to do?
Where to do?
Who will do it?
What resources are required?
It is anticipatory- based on predictions, expectations, or
beliefs about the future
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6. Why do we need planning in health education and
health promotion?
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7. Health Education is not
incidental-systematic
There are so many
behavioral problems
to be addressed-
Limited resources
Planning
And
Organizing
Other
determinants
8. It is central
"By failing to plan, you plan to fail."
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9. Purpose of Planning
Helps for problem/need prioritization
To match the resources to the problem to be
solved
To use resources more efficiently to ensure the
best use of scarce resources
To avoid duplication and wastages ??? Examples
Develop a best course of action
What else?
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13. Steps in planning health promotion
programs
Step 1: Manage the planning process
Step 2: Conduct a situational assessment
Step 3: Identify goals, populations of interest,
outcomes and outcome objectives
Step 4: Identify strategies, activities, outputs,
process objectives and resources
Step 5: Develop indicators
Step 6: Review the program plan
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15. 5. PRECEDE – PROCEED Model
One of the best models to develop
comprehensive program planning
Originated in the 1970s from applications in
hypertension trials (Green, Levine , Deeds,
Wolle)
Used both for delivery programs in practice
setting and when conducting behavior change
intervention
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19. Underlying premise of this model
Health education is
dependent on voluntary
cooperation and
participation
Personal determination of
behavioral practices
Change in KP is directly
related to the degree of
active participation
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20. PRECEDE – PROCEED Model …
Therefore, in this model, appropriate health
education is considered to be the intervention
(treatment) for a properly diagnosed problem in
a target population.
This model is multidimensional, founded in the
social/behavioral sciences, epidemiology,
administration and education.
21. Five important and defining approaches
Socio-ecological
Population-centred
Participatory
Quality-of-life focused
Grounded on experience -ongoing revisions and
refinements
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24. PRECEDE-PROCEED …
Phase 1: Social assessment/Situation analysis
Community need to improve its quality of life
Use subjective and objective information from
multiple sources
? Sources of data
? What to consider
?How
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Readiness to change?
Defining the ultimate outcome
25. PRECEDE-PROCEED …
Phase 2: Epidemiological, Behavioral, and
Environmental Assessments
Health or other issues that most clearly influence
the outcome the community seeks- Identify and
set change objectives
? Sources of data- secondary
Uncovers the behavioral and environmental
factors
Identifying the issue and articulate your objectives
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Role of genetics?
Do they change?
26. PRECEDE-PROCEED …
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Epidemiological Assessment: identify health problems
and uncover Behavioral and environmental factors
Environmental- Social and physical factors external to
the individual
Use biomedical science and ecological approach
to identify structural barriers to health- physical,
social, political and economic determinants of health
27. PRECEDE-PROCEED …
Phase 3: Educational and Ecological
assessment
Identify the antecedent and reinforcing factors for the
behaviors and environmental factors identified in Phase 3
Focus on examining the broader causal factors – that
influence behavior, lifestyle, and responses to environment
What are they?
All factors should be prioritized and then addressed
in the intervention, which is planned in the next
stage
Prepare your plan
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28. PRECEDE-PROCEED …
Phase 4: Administrative and policy
assessment and Intervention Alignment
Identifying (and adjust) the internal
administrative and policy issues that can affect
the successful conduct of the intervention
Include generating the funding and other
resources for the intervention
Design action plan – to meet the objectives identified
so far
selecting interventions that are most likely to be
successful- consider team capacity
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29. PRECEDE-PROCEED …
Phase 5: Implementation
Carry out the intervention
Phase 6: Process Evaluation
This phase isn’t about results, but about
procedure. Are things going as planned?
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30. PRECEDE-PROCEED …
Phase 7: Impact Evaluation
The desired effect on the behavioral or
environmental factors that it aimed at changing –
i.e., is it actually doing what you expected?
Phase 8: Outcome Evaluation
Is the intervention really working to bring about
the outcome identified by the community?
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31. Limitations
Feasibility in a reasonable time period at a
setting: Too comprehensive
Resource demanding: High financial and
human resource input
Several theories are embedded: Mixture
Studies lacking: Comparative
32. The PEN-3 model
PEN-3 is a cultural model that was developed by
Airhihenbuwa in 1989, to guide a cultural
approach to HIV/AIDS in Africa
The PEN-3 model was designed as a culturally
relevant framework for the development of health
education strategies and programs
It consists of three interrelated and
interdependent dimensions of health (cultural
identity, relationships and expectations, and
cultural empowerment)
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34. Community engagement is a crucial aspect of the PEN-3 model concept
Defining
target
audience
The factors
that influence
For culturally
relevant
interventions
and
instruments
35. PEN-3 Model
Used to design culturally specific, locally relevant
health intervention and prevention programs to
educate communities
Can be used as quantitative and qualitative
health assessment tool
1. Cultural Identity
Assists in defining the target audience (person,
extended family, and neighborhood)
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36. 2. Relationships and expectations
Perceptions: knowledge, attitudes, and beliefs
that may contribute to or hinder engagement in a
particular health behavior
Enablers are community or structural factors
such as availability of resources, accessibility,
referrals, skills, and types of services
Nurturers are the reinforcing factors that the
target audience receives from their social
networks.
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37. PEN-3 Model
3. cultural empowerment: crucial in the
development of culturally relevant interventions
and instruments to assess the target health
behavior of ethnic minority cultures
Positive: that lead the target audience to engage in the health
behavior
Existential: that have no harmful health consequences and
should not be changed but incorporated in the intervention or
instrument
Negative: that prevent the target audience from engaging in
the health behavior or that lead them to engage in a harmful
behavior
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38. Stages
Assessment stage: cultural empowerment and
relationships & expectations domains
Using 3x3 table
Identify attitudes and cultural beliefs
Intervention stage: cultural identity- highlights
point of entry
The research team and community leaders identified the
point of entry for the health intervention
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39. Cultural empowerment and relationship & expectations
Domains Positive Existential Negative
Perception PP EP NP
Enabler PE EE NE
Nurturer PN EN NN
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40. 40
Example 1
Stigma, Culture, and HIV and AIDS in the Western Cape, South Africa: An
Application of the PEN-3 Cultural Model for Community-Based Research
44. Other Models
Planned Approach to Community Health (PATCH)
Model
MATCH (Multilevel Approach to Community Health)
Intervention mapping model
Comprehensive Health Education Model (CHEM)
Social Ecological models
Social marketing? 44
46. Evaluation
Has the health education interventions attended
predetermined goals and objectives?
Did it work?
Two fundamental tasks in evaluation-determining
outcome and understanding the process of change
Purposes
Find out if objectives were met: Effectivness and
Effeciency
Find out the reasons for success or failure
48. Developmental model for the evaluation of
health education programs
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Don Nutbeam, Christopher Smith, John Catford, 1989
49. Steps
Evaluation
1. Engage
stakeholders
2. Describe
the program
3. Focus the
evaluation
design
4. Gather
credible
evidence
5. Justify
conclusions
/Analyze
6. Ensure
use and
share
lessons
learned
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• Utility
• Propriety
• Accuracy
• Feasibility
Standards
50. Principles of evaluation
Participation
Use of multiple methods
Capacity building
Appropriateness
WHO European Working Group on Health Promotion Evaluation
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51. Approaches
1. Need assessment/ context evaluation: how
certain setting contribute to or impede a program
2. Process evaluation/ Formative: to determine
the extent, fidelity, and quality of intervention
3. Impact evaluation/ summative: assesses the
program’s effectiveness in achieving desired changes in
targeted mediators such as knowledge, attitudes, beliefs,
and behavior of the target group
4. Outcome evaluation/summative: examines the
effects of the program on health status, morbidity, and
mortality.
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52. How?
Qualitative Vs Quantitative
Is it possible to apply experimental study?
RCT? What are challenges?
Quasi-experimental
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54. Challenges of evaluation
Measuring outcome
Resource: Time, Staff, fund
Leadership and sustainable health promotion
infrastructures
Dynamic and complex determinants of health
Partnerships : Conflict of interest
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55. Challenges …
Lack of evidence based Health Promotion
Methodology and standardization challenges
Corruption ?
Globalization?
War and terrorism?
Professional ethics?
Evaluation plan???
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