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Copyright © 2009 Pearson Education Inc., publishing as Pearson Benjamin Cummings

Planning, Implementing, & Evaluating

Health Promotion Programs: A Primer – James F. McKenzie, Brad L. Neiger, Rosemary Thackeray

Fifth Edition

Lecture by J. McKenzie

Models for Program Planning

in Health Promotion

Chapter 2


Background Information - 1

• Good health promotion programs are not created by chance

• Models serve as frames from which to build; structure & organization for the planning process

• Many different models

• Common elements, but different labels

• Must understand the Generalized Model for Program Planning


A Generalized Model for Program Planning


Background Information - 2

• No perfect model• Can be used in entirety, parts, & combinations• Three Fs of program planning help with selecting the appropriate

model– Fluidity - steps are sequential– Flexibility - adapt to needs of stakeholders– Functionality - useful in improving health conditions

• Also, consider…– Population-based approach– Ecological framework – individuals/priority populations influenced

by many different levels


PRECEDE–PROCEED - 1

• PRECEDE – “predisposing, reinforcing, and enabling constructs in educational/ecological diagnosis & evaluation” (Green & Kreuter, 2005, p. 9)

• Developed in the early 1970s

• PROCEED – “policy, regulatory, and organizational constructs in educational & environmental development” (Green & Kreuter, 2005, p. 9)

• Developed in the 1980s



• Created Lawrence W. Green & Marshall W. Kreuter

• Best known & often used model

• Theoretically grounded

• Comprehensive in nature

• Found in many government programs, including PATCH



• PRECEDE– First 4 phases are assessment phases; social, epidemiological,

behavioral & environmental, educational & ecological, administrative & policy and intervention alignment

• PROCEED

– Last 4 phases; implementation, and process, impact, & outcome evaluation

• Underlying approach – …begin by identifying the desired outcome, to determine what causes it, & then design an intervention to reach the desired outcome


Phase 1 - Social Assessment and Situational Analysis

• Phase 1 - seeks to subjectively define the QOL (problems & priorities) of those in the priority population

• Best accomplished by involving those in the priority population in self-assessment of needs & aspirations

• Assessment means…– identify– describe– prioritize

• Examples of social indicators of QOL: achievement, alienation, comfort, crime, happiness, self-esteem, unemployment, & welfare


Phase 2 - Epidemiological Assessment - 1

• Phase 2 – is the step in which planners use data to identify & rank the health goals or problems that may contribute to or interact with problems identified in Phase 1

• Data include vital indicators (e.g., morbidity, mortality, & disability data) as well as genetic (new addition looks at relationship between genes & health/illness), behavioral (patterns of behavior that protect or put at risk), & environmental (things outside person that can be changed to impact health) factors

• Not all problems health related, then skip Phase 2.

• Risk factors/determinants can be prioritized with 2 X 2 matrix


Prioritization Matrix


Phase 3 - Educational & Ecological Assessment

• Phase 3 – identifies & classifies factors that have potential influence behavior or change the environment

• Predisposing factors – antecedent; impact motivation; e.g., knowledge, attitudes, beliefs, perceptions, & values

• Enabling factors – antecedent; barriers & vehicles; e.g., skills, access, availability, rules, & laws

• Reinforcing factors – subsequent; feedback & rewards; e.g., social benefits such as recognition, appreciation; incentives; disincentives

• Priorities become focus of intervention


Phase 4 - Intervention Alignment & Administrative & Policy Assessment

• The intent of intervention alignment is to match appropriate strategies & interventions with projected changes and outcomes identified in earlier phases

• In administration & policy assessment, planners determine if capabilities & resources are available to develop & implement program

• Close to the end of PRECEDE & moving toward PROCEED; though not a distinct break


Phase 5 - Implementation

• Beginning of PROCEED

• Phase 5 – with resources in hand, planners select methods and strategies of the intervention; examples education, communication, evironmental change, etc.

• Program begins


Phases 6, 7, & 8 - Evaluation

• Process evaluation – measurements of implementation to control, assure, or improve the quality of the program

• Impact evaluation – immediate observable effects of program

• Outcome evaluation – long-term effects of the program

• Line up with PRECEDE

• Which ones are used depends on the evaluation requirements of the program


Multilevel Approach To Community Health (MATCH) - 1

• Developed in late 1980s

• Used by U.S. Government

• Applied when behavioral & environmental risk & protective factors for disease / injury are known & general priorities determined

• Includes ecological planning - levels of influence


MATCH - 2


MATCH - 3

• Phase 1 – Health Goals Section – Select goals - consider prevalence, importance, & changeability– Select priority (target) population– Identify behaviors associated with health status– Identify environmental factors (barriers & vehicles)

• Phase 2 - Intervention Planning – Select intervention objectives– Identify targets of intervention (TIAs)– Select intervention approaches (ecological levels): Governments,

Organizations, Communities, Individuals


MATCH - 4

• Phase 3 – Development – Create program units or components– Create plans

• Phase 4 – Implementation– Adoption– Implementation– Maintenance

• Phase 5 – Evaluation– Conduct process evaluation– Measure impact– Monitor outcome


Consumer-Based Planning

• Decisions based on consumer input & made with consumers in mind; include consumers throughout

• Based on concepts from–– health communication – strategies to inform & influence individual

& community decisions to enhance health (NCI, 2002)

– social marketing – “the application of commercial marketing technologies to the analysis, planning, execution, and evaluation of programs designed to influence the voluntary behavior of target [priority] audiences in order to improve their personal welfare and that of their society” (Andreasen, 1995, p. 7)


Key Elements that Best Characterize the Practice of Social Marketing


CDCynergy - 1

•Developed by the Office of Communication at the CDC in 1997

•First issued in 1998

•Developed initially for public health professionals at CDC with responsibilities for health communication

•Developed for health communication but can be used with all health promotion planning

•Available on CD-ROM


P 1: Describe Problem (identify & define)

P 2: Analyze Problem (causes, goals, intervention strategies

P 3: Plan Intervention (Is communication dominant or supportive?)

P 4: Develop Intervention

P 5: Plan Evaluation

P 6: Implement Plan

CDCynergy - 2


Navigation controls: Contains 52 steps divided among the phases

CDCynergy - 3

• Other links•Lite•Glossary•Index•CDC Web•Help •My Plan

Active buttons [change

with phase & step] (examples,

resources,& consultant)

Non-changingbuttons (tools for research &media library)

There is also a supplemental resources CD for CDCynergy 3.0


The future of CDCynergy

• Plans to make CDCynergy web-based• Several versions & more to come• http://www.cdc.gov/communication/cdcynergy.htm


Social Marketing Assessment & Response Tool (SMART) - 1

• SMART, created by Neiger & Thackeray (1998), is a social marketing planning framework

• A careful review of the model provides an excellent overview of social marketing

• SMART has seven phases

• The heart of the model is composed of Phases 2, 3 , & 4; usually performed simultaneously


SMART - 2

P 1: Preliminary Planning [problem, name in terms of

behavior, develop goals, project costs]

P 2: Consumer Analysis [segment

priority population & determine needs,

wants, & preferences]; also secondary & tertiary audiences

P 3: Market Analysis [4Ps, competitors, & partners]

P 4: Channel Analysis [interpersonal,

small group,organizational,

community,mass media]

P 5: Developing Interventions, Materials, & Pretesting

P 6: Implementation

P 7: Evaluation


Other Planning Models Explained in Text

• MAPP• APEX-PH• SWOT• Healthy Communities• Healthy Plan-IT• Planned Approach to Community Health


Planning, Implementing, & Evaluating

Health Promotion Programs: A Primer – James F. McKenzie, Brad L. Neiger, Rosemary Thackeray

Fifth Edition

Chapter 2 - The End