2. Brain
storming
2
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.
3
5. Principles of planning
5
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…
6
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.
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”.
14
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?
15
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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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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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
50
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33. Rating factors in terms of Changeability
34
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
36
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;
38
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
43
• 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
47
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
48
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
PRECEDE takes into account the multiple factors that shape health status and help the planner to reach at and focus on specific targets.
It generates objectives and is used for the identification of priorities and the setting of objectives.
There are nine phases with in the PRECEDE-PROCEED model
The first five phases are that of the PRECEDE part which is helpful for diagnosis of a problem
The rest four phases are that of the PROCEED part for implementation and evaluation.