QUESTION 1
What are the main streams of influence, according to the Theory
of Triadic Influence? Please provide examples factors/attributes
that belong to each of those streams. What is the
relationship/correlation between each of those streams?
Your response should be at least 200 words in length.
QUESTION 2
The PRECEDE-PROCEED approach has several key
assessment/diagnosis phases. Please describe the
epidemiological assessment. What are some key sources of data
used in this assessment? Which main questions is this
assessment is trying to address/answer?
Your response should be at least 200 words in length.
QUESTION 3
What specific questions the evaluators are bringing forward as
they are trying to collect the necessary evaluation data? What
are the three main types of evaluation discussed in the
PRECEDE-PROCEED approach? What is each of them trying to
identify, measure, evaluate?
Your response should be at least 200 words in length.
QUESTION 4
What are some of the key assumptions behind the PRECEDE-
PROCEED approach? What are some of the key benefits of
using this approach? What are some of the “real-life” examples

of using this approach?
Your response should be at least 200 words in length.
Unit Lesson Study Guide
In Unit 4, we will continue to discuss health behavior and its
association with factors that could influence such behaviors.
These types of influences are referred to as multilevel factors of
behaviors, and they typically fall into five main categories:
1. individual factors,
2. inter-personal factors,
3. organizational factors,
4. community factors, and
5. policy factors
Consider the following scenario:
A 50-year-old man may purposely postpone getting a prostate
cancer test because he is scared of finding out that he may have
prostate cancer. This is an example of an individual- level
factor. However, we need to look into this further and consider
the following: his inaction might also be influenced by his
primary physician’s failure to actually recommend and insist
that he would need to take the prostate test. Another factor
might be the difficulty of scheduling an appointment due to
either unavailable equipment or the unavailability of staff at his
local clinic. Another limiting factor could be that the fee for the
exam is so high he cannot afford it, and his insurance does not
cover this type of procedure. Thus, all these interpersonal,
organizational, and policy factors are influencing this man’s

behavior to not complete the prostate test. Therefore, for health
promotion practitioners, it is very important to be aware of all
these factors so effective change strategies or interventions can
be prescribed.
One of the multilevel theories that will be discussed is the
Theory of Triadic Influence (TTI). TTI behaviors arise due to
one’s current social situation, general cultural environment, and
their personal characteristics. Any health-related behaviors are
influenced by an individual’s decisions.
What would be some of the influences that would affect a
person’s decision-making process? These influences could
include:
-related behaviors,
-
related behaviors, and
-related behaviors
Multilevel Theories
These influences could be further described as social,
interpersonal, and attitude-related sources of influence. In
addition to the three types of influence noted above, there are
also some direct or indirect causes of influence.
These causes are categorized as
and environment),

When we refer to the ultimate category, we typically think of
one’s family characteristics and parenting styles (whether an
individual has elevated or decreased parenting expectations or
supervision) as well as certain environmental influences and
their own behavioral pattern, level of behavior control, and
intelligence. Some examples of distal influences would be one’s
emotional attachments and behavior shown to them by their
siblings, parents, or spouse. Proximal influences include things
such as approval of behaviors as shown by one’s parents,
siblings, and spouses as well as one’s own beliefs and attitudes
towards a certain behavior or behaviors.
Let’s now transition and discuss how certain health promotion
practitioners use health promotion programs and methods.
Developing Health Promotion Programs
The following is a real-world example of how a health
promotion would be developed.
A local health organization is concerned with the teenage
smoking problem and wants to develop a successful and
effective health promotion program/policy.
Step 1: This would trigger the first step of the development
process: the need to clearly describe the problem. Certain
promotional considerations include causes (smoking and
second-hand smoke has a direct and serious effect on the health
and well-being of teenagers) of the problem (teenage smoking),
impact of the problem, and what the possible solutions would
be.
Step 2: Next, we can move to our second phase: finding out
whether the targeted local community is actually ready for the
development of a health promotion program or policy. Here, we
would try to assess and evaluate whether additional education

related to teen smoking cessation would be necessary. Step 2
would also assess who from the targeted community and other
organizations would actually support their efforts. What is the
overall public view/opinion related to the problem, and who
would actually be concerned and affected by the program?
Step 3: The third step would incorporate the development of
goals, objectives, and a clear direction that would prompt the
health promotion program to consider so they can move
forward. The program would specifically focus on setting the
concrete objectives. One of the common ways to do such a task
would be to use the specific, measurable, assignable, realistic,
and time-specific (SMART) objectives. Once there are clearly
defined objectives and a clear direction, the program can then
move to the fourth step.
Step 4: In the fourth step, the goal would be to identify the key
decision makers. Some of these individuals could be the
community’s political leaders, school organizations, healthcare
partners (local community hospitals, clinics, etc.), parent
organizations, local work organizations, and student-based
organizations. Again, the key here is to identify whom the
organization should work with and communicate with on how to
successfully implement the program and policy.
Step 5: In this step, the focus is on building and creating actual
support for the policy. The organization would need to find
approaches for us to effectively communicate and persuade key
decision makers who were previously identified. Techniques
would include writing letters and producing mass media
announcements, posters, or radio/Internet ads. There would also
be face-to-face meetings with the community’s leaders. The key
would be to build a strong and supportive coalition.
Step 6: In this step, we will develop and document the program
as well as the policy and revise as needed based on the data
gathered from the previous steps. Some of the components of

the written document would include an executive summary
describing the purpose of the program’s goals and objectives,
specific procedures for actually promoting the program, and
steps to monitor and evaluate the success of our program
implementation.
Step 7: The next step would be to actually implement the
program. Evaluation
Health Promotion Program
The next phase is to evaluate the health promotion program.
This step provides an opportunity to modify and update the
program based on the evaluation. As with development, an
evaluation is a process, and there are a few specific phases.
Typically, there are 10 steps that are part of the evaluation
process.
Step 1: Clarify our health promotion program (assess and
conclude whether the program has had clearly defined goals,
strategies, and interventions).
Step 2: Engage the key stakeholders. During the review, we
want to have a clear understanding of the stakeholders’ true
interests, desires, and expectations regarding that program’s
direction and goals.
Step 3: Diagnose/evaluate the resources. Evaluators need to
know their resources in terms of money and proper staffing
because, depending on the program they are evaluating, proper
resources should be available and/or in place.
Step 4: Organize and select specific evaluation questions.
Evaluators are usually trying to come up with specific questions
that their evaluation is trying to address.
Step 5: Come up with the methods of measurement and certain
procedures. We want to know what we will measure, when we

will collect the data, how will we collect the data, who will
collect the data, and who will use the data.
Step 6: Develop a strict work plan. Evaluators will identify
specific roles and tasks that each of them will be conducting
and involved in.
Step 7: Collect the necessary data (possibly by using some type
of questionnaire).
Step 8: Process that data and analyze the results that are noted.
We will we process the data we obtained in those questionnaires
and will try to analyze the results.
Step 9: Interpret the results and draw conclusions (results will
be interpreted and findings and recommendations will be
presented).
Step 10: Take the necessary action or actions. Evaluators will
engage the key decision makers and collaborate with them in
order to think of ways to further improve the program.
Unit 4 Article Review
For this assignment, choose a peer-reviewed article to review.
Use the databases in the CSU Online Library or another source
that contains peer-reviewed articles, and find an article about a
concept tied to the unit outcomes in this unit. Write a three- to
five-page review (not counting the cover page and references
page) of the article that includes the following information:
· ( How does the article relate to what you are learning in this
course or within this unit?
· ( Discuss the meaning or implications of the article’s contents
as well as any flaws you find in the article.

· ( What could have made the article better?
· ( Was any information left out? How could the author expand
on the results?
· ( Does the article’s information relate to your professional or
personal life? How?