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Models for Program Planningin Health Promotion

PRECEDE-PROCEEDOther Models

Models provide structure &organization for the planning process

Many different models

3

Common elements, but differentlabels

Must understand the Generalized

Model for Program Planning

4

AssessingNeeds

e ngGoalsandObjectives

Deve op ngan

Intervention

Implementingthe

Intervention

the

Results

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No perfect model

Can be used in entirety, parts,

combinations

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Three Fs of program planning help usselect an appropriate model:

Fluidity - steps are sequential

Flexibility - adapt to needs of stakeholders

Functionality - useful in improving healthconditions

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PRECEDE predisposing, reinforcing, and enabling

The PRECEDE-PROCEED Planning Model is the mostwidely used planning model, and has been used for

MANY problems, populations, locations.

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constructs in educational/ecological diagnosis &evaluation(Green & Kreuter, 2005, p. 9)

Developed in the early 1970s

PROCEED policy, regulatory, and organizationalconstructs in educational & environmentaldevelopment(Green & Kreuter, 2005, p. 9)

Developed in the 1980s

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Created by:Lawrence W. Green &Marshall W. Kreuter

Best known, most oftenused model

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Theoretically grounded

Comprehensive

Found in manygovernment programs,eg, PATCH

PRECEDE

First 4 phases: Assessment

1) social assessment2) epidemiological, behavioral, environmental assessment3) educational & ecological assessment

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PROCEED

Last 4 phases: Implementation and Evaluation

5) implementation

6) process evaluation

7) impact evaluation

8) outcome evaluation

Underlying approach:

Begin by identifying the desired outcome

THEN determine what causes it

THEN design an intervention to reach the desired

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DO NOT START WITH:

Health problem

Desired program

DO START WITH:

Desired quality of life outcome

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Phase 1: Subjectively define QOL of thepriority population

-

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assessment of needs & aspirations

Assessment:Identify (list)Describe (explain)

Prioritize (rank)

ProblemsProblems

andand

PrioritiesPriorities

What are some examples of socialindicators of QOL?

Achievement

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Alienation

Comfort

Crime

Happiness

Self-esteem

Unemployment

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Phase 2: Use data to identify & rank health issuesthat contribute to problems identified in Phase 1

Data include:Vital Indicators

E morbidit mortalit & disabilit data

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. ., , ,

GeneticRelationship between genes and health and behavior

BehavioralRisky behaviors

Environmental

Things outside person that can be changed to impact health

Rank:

2 X 2 matrix

MoreImportant

LessImportant

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oreChangeable

LessChangeable

Phase 3: Identifies factors that have potential toinfluence behavior or change the environment

1. Predisposing factors

Antecedent; impact motivation

Eg: knowledge, attitudes, beliefs, perceptions, values

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2. Enabling factors

Antecedent; barriers & facilitators

Eg: skills, access, availability, rules, laws

3. Reinforcing factors

Subsequent; +/- feedback

Eg: social benefits like recognition, appreciation;incentives; disincentives

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Phase 4: Intervention Alignment

Matches appropriate strategies & interventions

with projected changes and outcomes

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Phase 4: Administration & Policy Assessment

Determine if capabilities & resources areavailable

Transition to PROCEED

Moving toward PROCEED, but not distinct break

Phase 5: Have resources, selectintervention

Strategies:

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Communication

Environmental change

Beginning of PROCEED

Program begins

Phase 6: Process EvaluationMeasurements of implementation to control,assure, or improve the quality of the program

Phase 7: Impact evaluationImmediate observable effects of ro ram

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Phase 8: Outcome evaluationLong-term effects of the program

Line up with PRECEDE

Depends on evaluation requirements ofprogram

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There are many other models besidesPRECEDE-PROCEED

MATCH (Multilevel Approach to CommunityHealth)

Developed in late 1980s

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. .

Applied when behavioral & environmental risk& protective factors for disease / injury areknown & general priorities determined

Includes ecological planning: levels ofinfluence

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Phase 1 Health Goals Section

Select goals - consider prevalence, importance,changeability

Select target population

Identify behaviors associated with health status

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Identify environmental factors (barriers & facilitators)

Phase 2 - Intervention Planning

Select intervention objectives

Identify targets of intervention (TIAs)

Select intervention approaches (ecological levels):governments, organizations, communities, individuals

Phase 3 DevelopmentCreate program units or componentsCreate plans

Phase 4 ImplementationAdoption

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ImplementationMaintenance

Phase 5 EvaluationConduct process evaluationMeasure impact

Monitor outcome

Decisions based on consumer input andinterests

Based on concepts from:Health Communication strategies to

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decisions (NCI, 2002)

Social Marketing application of commercialmarketing technologies to the analysis, planning,execution, and evaluation of programs designed toinfluence the voluntary behavior of target[priority] audiences in order to improve theirpersonal welfare and that of their society(Andreasen, 1995, p. 7)

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Developed by the Office ofCommunication at CDC in 1997

First issued in 1998

Developed for CDC public health

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health communication

Now available to public

Developed for healthcommunication, but can be used

with all health promotion planningAvailable on CD-ROM

P 2: Analyze

Problem (causes,

P 3: Plan Intervention(Is communicationdominant orsupportive?)

P 4: Develop

Intervention

P 5: Plan

Evaluation

P 6:

Implement

Plan

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P 1: Describe

Problem

(identify &

define)

,

strategies

There is also a supplemental resources CD for CDCynergy 3.0

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Plans to make CDCynergy web-based

Several versions & more to come

http://www.cdc.gov/communication/cdcynergy.htm

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SMART (Social Marketing Assessment &Response Tool)

Social marketing planning framework created byNeiger & Thackeray (1998)

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Provides an excellent overview of social marketing

Seven phases

Heart of the model is Phases 2, 3, & 4; usually

performed simultaneously

P 1: PreliminaryPlanning [problem, name in terms of

behavior, develop goals, project costs]

P 2:

Consumer Analysis [segmentpriority population, determine

P 3:

Market Analysis

P 4:Channel Analysis

[interpersonal, small group,

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needs, wants, & preferences]; alsosecondary & tertiary audiences

[4Ps, competitors,& partners]

organizational, community,mass media]

P 5: Developing Interventions, Materials, & Pretesting

P 6: Implementation

P 7: Evaluation

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Healthy People 2010

(A systematicA roach to Health

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Promotion)

Components:Goals

Objectives

Determinants of health

Health status

MAPP (Mobilizing for Action through Planning& Partnerships)

Relatively new; created by NACCHO for use bylocal public health agencies

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Phases:Organizing for Success & Partnership Development

Visioning

Four MAPP Assessments

Identify Strategic Issues

Formulate Goals & StrategiesThe Action Cycle (Implement & Evaluate)

MAPP:

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APEX-PH (Assessment Protocol for Excellencein Public Health)

Components: Organizational capacity, CommunityProcess, Completing the Cycle

Developed by NACCHO for local health depts.

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PACE-EH (Protocol for Assessing CommunityExcellence in Environmental Health)

SWOT Analysis (Strengths, Weaknesses,Opportunities, Threats)

Minimizes planning time

S W

O

T

The Communication Model

NCI, 2002

Healthy Communities

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(Healthy Cities) (USDHHS)

Components: MobilizeAssess Plan for Action Implement Track Progress & Outcomes

Healthy Plan-IT (CDC)

Components:

Priority Setting

Establishin Goals

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Outcome Objectives

Strategy

Evaluation

Budget

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Intervention Mapping

Relatively new 1998

Plans programs that are based on theory &evidence

Draws on PRECEDEPROCEED and MATCH

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models

Steps:1) Needs assessment2) Matrices of Change Objectives

3) Theory-based methods and practical strategies4) Program5) Adoption and Implementation6) Evaluation Planning

Comprehensive Health Education Model (Sullivan, 1973)

Model for Health Education Planning (Ross & Mico, 1980)

Model for Health Education Planning & ResourceDevelopment (Bates & Winder, 1984)

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Planned Approach to Community Health (CDC, nd)

Generic Health/Fitness Delivery System (Patton et al.,1986)

The Planning, Program Development, and Evaluation

Model (Timmreck, 2003)

LOTS of models!

All based on same generalized model

PRECEDE-PROCEDE most commonCan mix and match

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Which models are especially good for:Communication?

Social Marketing?

Partnerships?

Environment issues?

Multiple levels?