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

1. Planning and Evaluation of Health
Promotion Interventions
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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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3. What is planning?
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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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5. Planning
Uncertain and
dynamic
environment
Effort
made to
be certain

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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10. Is there a wrong plan?
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12. What do you understand?
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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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14. Planning models
 PRECEDE-PROCEED Framework
 PEN-3
 Others
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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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16. PRECEDE – PROCEED Model …

17. PRECEDE – PROCEED Model …
 The PRECEDE model is a framework for the
process of systematic development and
evaluation of health education programs

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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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22. PRECEDE-PROCEED Planning Model
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23. 2022 edition
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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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33. PEN-3 Model ...
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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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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

41. Example 2
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https://www.cdc.gov/pcd/issues/2020/pdf/20_0245.pdf

42. Nudge theory_ read about it
Indirect way of
suggestion
Behavioral economics???

43. Can we apply in Ethiopia?
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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

45. Evaluation of Health promotion
What is evaluation?
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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

47. Evaluate to learn
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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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53. How to measure

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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56. Many Thanks!
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