Health promotion program Development.pptx

UNIT – 10
HEALTH PROMOTION
PROGRAM DEVELOPMENT
Mrs. D. Melba Sahaya Sweety RN,RM
PhD Nursing , MSc Nursing (Pediatric Nursing), BSc Nursing
Associate Professor
Department of Pediatric Nursing
Enam Nursing College, Savar,
Bangladesh.
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INTRODUCTION
• HEALTH PROMOTION PROGRAMS can improve physical, psychological,
educational, and work outcomes for individuals and help control or reduce
overall health care costs by emphasizing prevention of health problems,
promoting healthy lifestyles, improving patient compliance, and facilitating
access to health services and care.
• Health promotion programs play a role in creating healthier individuals,
families, communities, workplaces, and organizations. They contribute to an
environment that promotes and supports the health of individuals and the
overall public.
• In addition, health promotion programs promote policy, environmental,
regulatory, organizational, and legislative changes at various levels of
government and organizations 2

DEFINITION
Health Promotion
The process of enabling people to increase control over and
improve their health”
(World Health Organization 1986)
Health promotion is defined more broadly as “any planned
combination of educational, political, environmental,
regulatory or organizational approaches that support actions
and conditions of living and are conducive to the health of
individuals, groups, and communities
(Green & Kreuter, 2005)
Health promotion Program
Health promotion programs is a planned, organized, and
structured activities and events that focus on helping
individuals make informed decisions about their health 3

WHAT IS HEALTH PROMOTION
PROGRAMME ?
• Health promotion and health promotion programs are rooted
in the World Health Organization’s (1947) definition of health
as “a state of complete physical, mental and social well-being,
and not merely the absence of disease or infirmity.”
• Health promotion programs are designed, implemented, and
evaluated in complex and complicated dynamic
environments. They are multifaceted and multi-leveled.
• Health promotion programs are designed to work with a
priority population (in the past called a target population)—a
defined group of individuals who share some common
characteristics related to the health concern being addressed.
Programs are planned, implemented, and evaluated to
influence the health of a priority population
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COMPONENTS OF HEALTH
PROMOTION PROGRAMS
Health Education to Improve
Individual Health
Environmental Actions to Promote Health
Health knowledge Advocacy
Health attitudes Environmental change related to variables
influencing health outcomes (e.g., education,
transportation, housing, criminal justice
reform)
Health skills Legislation
Social support Policy mandates, regulations
Health behaviors Financial investment in communities and
other resource/community development
Health indicators Organizational development
Health status Criminal justice reforms
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MODELS OF HEALTH PROMOTION
PROGRAMS
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The Generalized Model consists of five basic elements or steps:
(1)assessing needs;
(2)setting goals and objectives;
(3)developing interventions;
(4)implementing interventions; and
(5)evaluating results.
In addition, pre-planning is a quasi-step in the model but is not
included formally since it involves actions that occur before planning
technically begins.
 The first step in the Generalized Model, assessing needs, is the
The Generalized Model

MODELS OF HEALTH PROMOTION
PROGRAMS
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process of collecting and analyzing data to determine the health needs of a
population and can include priority setting and the identification of a
priority population.
 Setting goals and objectives identifies what will be accomplished
 while interventions or programs are the means by which the goals and
objectives will be achieved (i.e., the how).
 Implementation is the process of putting interventions into action and
 Evaluation focuses on improving the quality of interventions
(formative evaluation) as well as determining their effectiveness
(summative evaluation). Collectively, these steps define planning and
evaluation at its core

MODELS OF HEALTH PROMOTION PROGRAMS
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PRE PLANNING
Assessment of
needs and
capacity
Data collection
and analyses to
determine needs
and capacity in
order to set
priorities and
select a priority
population
Statements
outlining what
is to be
accomplished
Strategies and
activities used
to achieve the
goals and
objectives
Carry out the
strategies and
activities
Goals and
Objectives
Intervention Implementation Evaluation
Actions to
determine the
effectiveness of
the intervention
and improve the
quality of
programing

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PRECEDE-PROCEED is composed of eight phases or steps.
Phase 1 in the model is called social assessment and situational
analysis and seeks to subjectively define the quality of life
(problems and priorities) of those in the priority population while
involving individuals in the priority population in an assessment of
their own needs and aspirations. Some of the social indicators of
quality of life include achievement, alienation, comfort, crime,
discrimination, happiness, self-esteem, unemployment, and welfare.
Phase 2, epidemiological assessment, is the step in which the
planners use data to identify and rank the health goals or problems
that may contribute to or interact with problems identified in Phase 1.
PRECEDE-PROCEED Model for Health planning and Evaluation

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These data include traditional vital indicators (e.g., mortality, morbidity, and
disability data) as well as genetic, behavioral, and environmental factors and
represent a traditional needs assessment. It is important to note that ranking
the health problems in this phase is critical, because there are rarely, if ever,
enough resources to deal with all or multiple problems. Also, this phase of the
model is used to plan health programs. Note that in the model arrows connect
the genetics, behavior, and environment boxes of Phase 2 with the health box
of Phase 2 and with Phase 1. Once identified, the risk factors or conditions
related to broader health problems need to be prioritized. This can be
accomplished by first ranking these factors by importance and changeability
and then using the 2 × 2 matrix

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Phase 3, educational and ecological assessment, identifies and classifies the
various factors that have the potential to influence a given behavior into three
categories: predisposing, reinforcing, and enabling.
Predisposing factors include knowledge and many affective traits such as a
person’s attitude, values, beliefs, and perceptions. These factors can facilitate
or hinder a person’s motivation to change and can be altered through direct
communication. Barriers or facilitators created mainly by societal forces or
systems make up enabling factors, which include access to health care
facilities or other health related services, availability of resources, referrals to
appropriate providers, transportation, negotiation and problem-solving skills,
among others.

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Reinforcing factors involve the different types of feedback and rewards that
those in the priority population receive after behavior change, which may
either encourage or discourage the continuation of the behavior. Reinforcing
behaviors can be delivered by, but not limited to, family, friends, peers,
teachers, self, and others who control rewards. “Social benefits—such as
recognition, appreciation, or admiration; physical benefits such as
convenience, comfort, relief of discomfort, or pain; tangible rewards such as
economic benefits or avoidance of cost; and self-actualizing, imagined, or
vicarious rewards such as improved appearance, self-respect, or association
with an admired person who demonstrates the behavior—all reinforce
behavior”

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Phase 4 comprises two parts: (1) intervention alignment; and (2)
administrative and policy assessment. The intent of intervention alignment
is to match appropriate strategies and interventions with projected changes
and outcomes identified in earlier phases
In administration and policy assessment, planners determine if the capabilities
and resources are available to develop and implement the program. It is
between Phases 4 and 5 that PRECEDE (the assessment portion of the model)
ends and PROCEED (implementation and evaluation) begins.
However, there is no distinct break between the two phases; they really run
together, and planners can move back and forth between them.

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The four final phases of the model—Phases 5, 6, 7, and 8—make up the PROCEED
portion. In Phase 5—implementation—with appropriate resources in hand, planners
select the interventions and strategies and implementation begins. Phases 6, 7, and 8
focus on the process, impact, and outcome evaluation, Phases 5–8: Implementation
and Evaluation At this point, the health promotion program is ready for implementation
(Phase 5). Data collection plans should be in place for evaluating the process, impact,
and outcome of the program, which are the final three phases in the PRECEDE-
PROCEED planning model (Phases 6–8). Typically, process evaluation determines the
extent to which the program was implemented according to protocol. Impact evaluation
assesses change in predisposing, reinforcing, and enabling factors, as well as in the
behavioral and environmental factors. Finally, outcome evaluation determines the effect
of the program on health and quality-of-life indicators.

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NEED ASSESSMENT
• A needs assessment is a process
for determining the needs,
otherwise known as "gaps,"
between current and desired
outcomes.
• The process of identifying,
analyzing, and prioritizing the
needs of a priority population is
referred to as a needs assessment
• A needs assessment is a formalized
approach to collecting data in order to
identify the needs of a group of
individuals.
DEFINITION OF NEED ASSESSMENT
DEFINITION OF NEED
A need is defined as “the difference
between the present situation and a more
desirable one”
Gilmore (2012).
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• To identify the priority population
• To determine the needs of the priority population
• To find out which subgroups within the priority population have the greatest need
• To identify the geographical location of the identified subgroups
• To determine what is currently being done to resolve identified needs
• To evaluate How well have the identified needs been addressed in the past
• To develop an intervention to meet the needs of the priority population.
Indirectly, numbers 5 and 6 purpose, provides some information about the community
capacity and whether part of the identified needs may include the need to build
capacity. Capacity building refers to activities that enhance the resources of
individuals, organizations, and communities to improve their effectiveness to take
action
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PURPOSE OF NEED
ASSESSMENT

 Review of Existing health planning
 Basis of Health program or policy planning
 Ensure efficient use of resources
 Identifies the inequities in health and assess to services
 To identify the health problems of the population
 Setting the priority
 Allocation of resources
 To improve the Health status of the population
 To determine the risk of subpopulation based on the geographical location
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IMPORTANCE OF NEED
ASSESSMENT

Four types of needs (Bradshaw, 1972) ought to be considered in a needs assessment
• Expressed need is the problem revealed through health care–seeking behavior. In
other words, expressed need is manifested as the demand for services and the market
behavior of the target audience. Measures of expressed need include the number of
people who request services, the types of services sought, and utilization rates
• Normative need is a lack, deficit, inadequacy, or excess as defined by experts and
health professionals, usually based on a scientific notion of what ought to be or what
the ideal is from a health perspective. A norm or normal value is used as the gauge for
determining if a need exists. For example, a community with an infant mortality rate
above the national average would have a normative need related to causes of infant
mortality. At an individual level, having a body mass index (BMI) greater than 29.9
indicates, normatively, a need for weight reduction. Given that the health professional
is an outside observer, normative need reflects norms through the eyes of an observer
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TYPES OF NEEDS

• Perceived or felt need, which is the sense of lack as experienced by the
target audience. Perceived needs are demonstrated in what members of the target
audience say that they say they want, and in their stated deficits and
inadequacies. For example, parents in a community may demand a new school
based on their perception that their children have too far to travel to go to school.
Perceived need is the view through the eyes of the person having the experience
• The relative or comparative need is the identified gap or deficit as identified
through a contrast between advantaged and disadvantaged groups. Relative need
entails a comparison that demonstrates a difference that is interpreted as one
group having a need relative to the other group. Most health disparities are stated
as relative need. For example, the black infant mortality rate is twice that of the
white infant mortality rate.
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TYPES OF NEEDS

ACQUIRING NEED ASSESSMENT DATA
• Data collection plays a pivotal role in assessing the quality of life
of the population of interest and in establishing priorities for
health promotion programs. There are two major categories of
data: primary data and secondary data.
Primary data
 Primary data are new, original data that did not exist before,
obtained directly from individuals at the site, usually by means of
surveys, interviews, focus groups, or direct observation.
 Primary data constitute new information that will be used to
answer specific questions.
 Primary data are more expensive and time consuming to collect,
Collection of quality primary data requires technical expertise in
order to identify representative samples, design instruments,
and complete data analysis.
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ACQUIRING NEED ASSESSMENT DATA
Sources of primary Data:
 Single – step or Cross-
Sectional Surveys
 From priority population –
Self Report
• Online Surveys
• Mail Surveys
• Face- to – face interviews
• Telephone interviews
 Proxy Measures
 From Significant others
 From opinion leaders
 From Key informants
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Multistep Survey: Delphi
technique
Community Forum ( Town hall
meeting)
Meetings
Focus group
Nominal group process
Observation
 Direct observation
 Indirect observation(proxy
measures)
 “Windshield” or “Walk- through
walk tours)
 Photovoice and video voice
Self - Assessment

Secondary data :
 Secondary data are already exist because they were
collected by someone for another purpose.
 The data may or may not be directly from the individual or
population that is being assessed.
 Secondary data sources include Healthy People
information, vital records, census data, and peer -
reviewed journals.
 The problems with secondary data are that some
information may not exist for some settings, the data
may be old, or the data may not have been correctly
collected. 24
ACQUIRING NEED
ASSESSMENT DATA

Information to be collected can be divided into two broad
categories: quantitative and qualitative.
• Quantitative data are statistical information (for
example, percentages, means, or correlations) such as
one would typically find in professional journals.
• Qualitative data are more narrative, with fewer
numbers. They include the perceptions and
misperceptions of community members in regard to
quality of life issues in the community. Qualitative
methods include one - on - one interviews with key
informants, focus groups, public hearings, and
observational methods. 25
ACQUIRING NEED
ASSESSMENT DATA

PRIMARY DATA METHOD AND TOOLS
Single-Step or Cross-Sectional Surveys
Single-step surveys, or as they are often called cross-sectional (point-in-
time) surveys, are a means of gathering primary data from individuals or
groups with a single contact—thus, the term single-step. Such surveys
often take the form of written questionnaires and interviews. When
individuals or groups (also sometimes called respondents or
participants) are answering questions about themselves, the information
that is provided is referred to as self-report data.
Written Questionnaires. Probably the most often used method of
collecting self-reported data is the written questionnaire. It has several
advantages, notably the ability to reach a large number of respondents in
a short period of time, even if there is a large geographic area to be
covered. This method offers low cost with minimum staff time needed.
However, it often has the lowest response rate.
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PRIMARY DATA METHOD AND
TOOLS
Survey Questionnaires:
 Surveys, especially written questionnaires, are the most common form of
gathering data for a needs assessment (public perceptions and behaviors in
regard issues).
 Questionnaires can be administered in four ways — as mail surveys, as
telephone surveys, face to face (as discussed earlier), or as electronic surveys
(Fowler, 2002; Dillman, 2007)
 Mail surveys allow a large quantity of data to be collected in a relatively short
period of time. The main disadvantages are that special expertise is required to
create valid and reliable mail surveys and to sample the population correctly
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TOOLS
 Telephone surveys are more time consuming, more expensive to conduct, and
response rate (due to screening by telephone answering machines and the difficulty
of interviewing people on cell phones). However, the response rate for telephone
surveys may be higher than that for mail surveys for groups of individuals who do
not read well
 Web surveys contact community members through an e - mail message and embed
a URL in the message. Clicking on the URL takes the respondent directly to the Web
site so that the questionnaire can be completed online. Unfortunately, the digital
divide means that many of the economically disadvantaged and the elderly do not
use computers as a method of communication
 Two very important attributes of a questionnaire are validity and reliability.
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TOOLS
 A valid questionnaire is one that correctly measures what you want it to measure.
The higher the validity, the more complex the assessment is.
 Face validity, in which the questions are based on previous questions or a review of
the literature, is the weakest form of validity to use.
 Content validity is based on how well the questionnaire items reflect all of the
content areas that one is attempting to measure To establish content validity, the
questionnaire is sent to a panel of six to eight experts on the topic of the survey and
on survey research. The experts are asked to add any other items needed, delete
unneeded items, and reword any items that are unclear.
 More complex forms of establishing questionnaire validity, such as the procedures
used to establish criterion - based validity or construct validity, are usually the most
appropriate for health needs assessments.
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TOOLS
 Test - retest reliability (stability) of an instrument means that the same results
will be obtained each time the instrument is given to the same sample of
subjects (DeVon et al., 2007).
 To determine this form of reliability score, the instrument is given to a group
of subjects ( n ! 30 to 50) and then the same instrument is given to the same
subjects a second time, one to two weeks later.
 The results of the respondents ’ first and second surveys must be matched
and are generally entered into a computer software program that can
calculate the reliability score
 In the case of parametric data, the score generated is a Pearson product -
moment correlation coefficient. The reliability score can vary from – 1.0 to
"1.0; the preferred score is 0.7 or higher. 30

TOOLS
 If the needs assessment items are nonparametric in nature, then other more
appropriate analyses such as kappa coefficients or percent agreements should be
calculated in order to determine the test - retest reliability.
 Two other attributes of questionnaires to consider are readability and acceptability.
A number of readability formulas — for example, the SMOG or the Dale - Chall
formulas — can be applied to a written questionnaire to assess reading level.
Another one is the Flesch - Kincaid formula, which is included in some popular word
processing software, making it easy to obtain a reading level.
 Acceptability relates to questionnaire wording and formatting (for example, the
print is easy to read, the questionnaire is not too long, the instructions appear at
appropriate places); the creators should also ensure that there are no offensive
statements or material that unnecessarily touches on sensitive issues.
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TOOLS
 To assess acceptability, one should pilot - test the questionnaire with ten to
twenty people.
Selecting a samples:
 Three techniques of survey research are key to obtaining results that
represent the health - related perceptions, behaviors, and needs of the group
being assessed at a site.
 First is correctly selecting the people who will receive the questionnaire.
 Second is selecting a large enough sample that the results will be
representative of the entire population.
 Third is making sure the return rate is high enough (better than 50 percent) to
reach this adequate sample size. 32

A representative sample can be accomplished through
random selection of individuals, which involves selecting
members of the population in such a way that each
member has an equal chance of being selected to
receive the questionnaire.
The second factor to be considered is power analysis.
Power analysis deals with having an adequate number
of individuals to be able to generalize the findings from
the sample to the population.
The third factor is survey return rates
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• Nominal Group Process
• The nominal group process is a highly structured process in
which a few knowledgeable representatives of the priority
population (five to seven people) are asked to qualify and
quantify specific needs. Those invited to participate are asked
to record their responses to a question without discussing it
among themselves. Once all have recorded a response,
participants share their responses in a round-robin fashion.
While this is occurring, the facilitator is recording the
responses on a chalkboard or flipchart for all to see. The
responses are clarified through a discussion. After the
discussion, the participants are asked to rank-order the
responses by importance to the priority population. This
ranking may be considered either a preliminary or a final vote.
If it is preliminary, it is followed with more discussion and a
final vote 34

• Windshield tour or walk-through,
The person(s) doing the observation “walks or drives
slowly through a neighborhood, ideally on different days
of the week and at different times of the day, on the
lookout for a variety of potentially useful indicators of
community health and well-being). Potentially useful
indicators may include:
• “(A) Housing types and conditions, (B) Recreational
and commercial facilities, (C) Private and public sector
services, (D) Social and civic activities, (E) Identifiable
neighborhoods or residential clusters, (F) Conditions of
roads and distances most travel, (G) Maintenance of
buildings, grounds and yards” 35

• Photovoice (formerly called photo novella)
It is a form of participatory data collection (i.e., those in the
priority population participate in the data collection) in which those
in the priority population are provided with cameras and skills
training (on photography, ethics, data collection, critical
discussion, and policy), then use the cameras to convey their own
images of the community problems and strengths . “Photovoice has
3 main goals: (1) to enable people to record and reflect their
community’s strengths and concerns; (2) to promote critical
dialogue and enhance knowledge about issues through group
discussions of the photographs; and (3) to inform policy makers”
Photovoice has been used a lot with “marginalized groups of
various ages that want their perspective seen and heard by those in
power”. 36

Focus Group:
• A focus group is a qualitative data collection technique in which a small
group of individuals meet to share their views and experiences on some
topic. Usually the ideal group size is six to twelve participants who are
similar in some way.
• The subjects should not know one another personally because that
might affect the willingness of some members to share different
opinions and values. The groups should be of the same race or ethnicity,
gender, educational status, and socioeconomic status.
• Focus groups typically take sixty to ninety minutes
• Besides the group moderator, it is usually helpful to have an observer
who serves as a recorder in order to capture the specific comments and
unique words of the participants.
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• The focus group leader should not try to take extensive notes because
that might cause him or her to miss important elements of nonverbal
communication (for example, facial expressions, gestures, or other body
language).
• Respondents are usually provided with drinks and, sometimes, a snack
and are paid for the time they spend to participate in a focus group
Delphi Technique:
 This technique might be used with a group of health experts (for
example, physicians or dentists) who cannot conveniently meet in
person.
 First, a group of professionals are asked to respond to a few open -
ended questions. Their responses are returned and are compiled into
one list.
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TOOLS
 Second, the experts are asked to respond to the combined list and
add more items, eliminate items they do not support, and reword
items that they think need to be clarified. The experts send their
responses back, and again, the responses are compiled into one
master list.
 The process can be stopped at this point, or the list of responses
can be sent to the experts again in order for them to rate or rank
the items. This process can be cumbersome if postal mail is used, or
it can be simplified by using electronic or Web - based
communication. 39

SECONDARY DATA METHODS AND TOOLS
• No health promotion program should be undertaken without a prior search of
secondary sources. From secondary sources, you can get the big picture as well as an
overview of how to proceed to address a health problem.
There are many other reasons for using secondary data:
• It is far cheaper to collect secondary data than to obtain primary data. In other
words, you can get a lot of information for your money and time — usually, more
than you would get using the same amount of money to collect primary data.
• National, state, and local health data are publicly available and accessible
electronically. The time involved in searching these sources is much less than that
needed to collect primary data.
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• Secondary sources of information usually yield more accurate data than those obtained
through primary research. A government agency that has undertaken a large - scale survey
or a census is likely to produce far more accurate results than custom - designed surveys
that are based on relatively small sample sizes. However, not all secondary sources are
more accurate.
• Secondary sources help define the population. Secondary data can be extremely useful
both in defining the population and in structuring the sample to be taken. For instance,
government statistics on a county ’ s demographics will help decide how to stratify a
sample and, once sample estimates have been calculated, these can be used to project
those estimates to the population.
• Sometimes sufficient secondary data may be available that are entirely adequate for
drawing conclusions and answering the questions, making primary data collection
unnecessary
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Internal Sources of Secondary Data
• Working in a particular setting may have the advantage of allowing the use of internal
sources of secondary information.
• All organizations collect information in the course of their everyday operations. Attendance
rates, performance scores (grades, annual tests), number of sick days taken, production
statistics, sales figures, and expenses are some of the data that might be available.
• Health data that are collected as a by - product of health services — for example, clinic
records, data from immunization programs, data from water pollution control programs,
clinical indicators, or data from health office visits and insurance claims — are possible
internal sources of secondary data. Much of this information is of potential use in planning
a health promotion program.
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External Sources of Secondary Data
 Large numbers of organizations provide health data, including national and local
government agencies, trade associations, universities, research institutes, financial
institutions, specialist suppliers of secondary marketing data, and professional health policy
research centers.
 The main external sources of secondary information are government (federal, state, and
local), voluntary health associations, private foundations, national and international
institutions, professional associations, and universities.
Problems with Secondary Information
When deciding whether to use a particular source of secondary data, it may be helpful to ask
the following questions:
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o How easy will it be to access and use the data source?
o Do the data help address the desired specific program area?
o Do the data apply to the target population?
o Are the data relatively current?
o Are the data collection methods acceptable?
o Finally, are the data biased?
o Are the data trustworthy?
o If the answer to these questions is yes, the data source is good to use.
Whenever possible, use multiple sources of secondary data. In this way, different sources can
be cross - checked and used to confirm one another. When differences occur, an explanation
for the differences must be found or the data should be set aside.
44

CONDUCTING A HEALTH NEEDS ASSESSMENT
OR STEPS OF HEALTH NEEDS ASSESSMENT
• Needs assessments consist of four basic steps:
1. Determining the purpose and scope of the need assessment,
2. Gathering data,
3. Analyzing the data
4. Identifying risk factors linked to health problem
5. Identifying the program focus
6. Validating the need
7. reporting the findings
1. Determine the purpose and scope of the need assessment .
• Work with the key informants and stakeholders (that is, an advisory committee)
to determine the scope of the work and the purpose of the needs assessment.
45

CONDUCTING A HEALTH NEEDS ASSESSMENT OR
STEPS OF HEALTH NEEDS ASSESSMENT
• Ask who will be involved and what decisions will be based on the
needs assessment. Think carefully and critically about what
information is needed in order to make the decisions.
• Who ultimately will use the results to make decisions about the
intervention or prevention programs? Whenever possible, take an
ecological approach to the needs assessment.
• Assess both the stakeholders and their environment. In the
environmental assessment, include an analysis of organizational and
community assets and capacity
2. Gather the data .
• Gather only the needed data.
• Consider culturally appropriate data - gathering approaches tailored
to the target population and setting
46

• Gather multiple types of data — both qualitative and
quantitative. provides an overview of types of data that could be
secured in order to address the various dimensions of health.
3. Analyze the data .
The planner must analyze all of the data collected with the goal of
identifying and prioritizing the health problems. One systemic way
to analyze the data is to use the first few phases of PRECEDE-
PROCEED model of guidance. start by asking and answering the
following questions.
1, What is the quality of life of those in the priority population?
2, What are social conditions and perceptions shared by those in the
priority population?
47

3, What are the social indicators (e.g., absenteeism, crime,
discrimination, performance, welfare, etc.) in the priority population that
reflect the social conditions and perceptions?
4. Can the social conditions and perceptions be linked to health
promotion? If so, how?
5. What are the health problems associated with the social problems?
6. Which health problem is most important to change?
The problems/needs must be prioritized not because the lowest-priority
problems/needs are not important, but because organizations have
limited resources to deal with all identified problems/needs. Thus,
“priority setting is critical in narrowing the scope of activity to reflect the
availability of resources within the context of stakeholders’ values and
preferences. In addition, priority setting helps health promotion
practitioners stay focused on problems that actually affect the health
48

The actual process of setting priorities can take many different forms and
can range from subjective approaches such as simple voting procedures,
forced rankings, and the nominal group process with stakeholders to more
objective but time-consuming processes such as the Delphi technique and
the basic priority rating (BPR) model.
BPR model The BPR model requires planners to rate four different
components of the identified needs and insert the ratings into a formula in
order to determine a priority rating between 0 and 100.
The components and their possible scores (in parenthesis) are:
A. size of the problem (0 to 10)( for scoring the size of the problem when
using incidence and prevalence rates)
B. seriousness of the problem (0 to 20) (the severity of the problem
measured in mortality, morbidity, or disability; and the urgency of
solving the problem because of additional harm) 49

C. Effectiveness of the possible interventions (0 to 10) (Planners will need
to estimate this score based upon the work of others or their own expert
opinions. In scoring this component, planners should consider both the
effectiveness of intervention strategies in terms of behavior change, as well
as the degree to which the priority population will demonstrate interest in the
intervention strategy.)
D. Propriety, economics, acceptability, resources, and legality (PEARL) (0
or 1) any need that receives a zero will automatically drop to the bottom of
the priority list because a score of zero (a multiplier) for this component
will yield a total score of zero in the formula.
The formula in which the scores are placed is: Basic Priority Rating (BPR)
= (A + B) C
3
50
* D

4. Identifying risk factors linked to health problem.
Step 4 of the needs assessment process is parallel to the second part of Phase
2 of the PRECEDE-PROCEED model: epidemiological assessment. In this
step, planners need to identify the determinants of the health problem
identified in the previous step. That is, what genetic, behavioral, and
environmental risk factors are associated with the health problem?
Thus, if the health problem is lung cancer, planners should analyze the
health behaviors and environment of the priority population for known risk
factors of lung cancer. For example, higher than expected smoking
behavior may be present in the priority population, and the people may live
in a community where smokefree public environments are not valued.
Once these risk factors are identified, they too need to be prioritized
51

5. Identifying the Program Focus.
The fifth step of the needs assessment process is similar to the third phase of
the PRECEDEPROCEED model: educational and ecological assessment. With
behavioral, environmental, and genetic risk factors identified and prioritized,
planners need to identify those predisposing, enabling, and reinforcing factors
that seem to have a direct impact on the risk factors. In the lung cancer
example, those in the priority population may not have
(1) the skills necessary to stop smoking (predisposing factor),
(2) access to a smoking cessation program (enabling factor), or
(3) people around them who support efforts to stop smoking (reinforcing
factor).
“Study of the predisposing, enabling, and reinforcing factors automatically
helps the planner decide exactly which of the factors making up the three 52

• In addition, when prioritizing needs, planners also need to consider any
existing health promotion programs to avoid duplication of efforts.
Therefore, program planners should seek to determine the status of
existing health promotion programs
6. Validating the Prioritized Needs.
The final step in the needs assessment process is to validate the identified
need(s). Validate means to confirm that the need that was identified is the
need that should be addressed Validation amounts to “double checking,”
or making sure that an identified need is the actual need. Any means
available can be used, such as
(1) rechecking the steps followed in the needs assessment to eliminate any
bias,
(2) conducting a focus group with some individuals from the priority
population to determine their reaction to the identified need (if a focus
group was not used earlier to gather the data), and
(3) getting a “second opinion” from other health professionals.
53

7. Report and share the findings .
• Identify the options for sharing the findings of the needs
assessment.
• Think about how best to communicate the findings.
• In sharing the information, identify any factors that are linked to
the health problem.
• Validate the need for the program before continuing with the
planning process.
• Tailor all communications to the program participants,
stakeholders, and staff.
54

PROMOTING NEED ASSESSMENT
• Conducting a needs assessment is an exciting event in the
development of a health promotion program. It is often the first
public acknowledgment that a school, workplace, health care
organization, or community is working to address health
problems at a site.
• Publicity to promote the needs assessment creates awareness of
the needs assessment, enhances the chances that individuals
and groups who have been asked to participate will respond, and
increases the visibility of the organizations that form the advisory
committee.
• Have a media kickoff for the needs assessment, and distribute
press releases and information packets. Use e - mail and
telephone messages to let people know about the needs 55

PROMOTING NEED ASSESSMENT
• For a needs assessment that is focused on a community,
attempt to reach as many forms of mass media as
possible (for example, local radio or TV programs, local
newspapers, and newsletters of various community
organizations). Numerous service clubs (for example,
Rotary club, lions club ) may provide a forum in which to
communicate the importance of the health needs
assessment.
• Finally, be sure to obtain copies of newsletter articles and
newspaper clippings to share with the advisory
committee. This form of sharing can bolster support from
the advisory committee.
56

REPORTING AND SHARING THE
FINDINGS
1, Analysis of Need Assessment Data:
• How the results of a needs assessment are analyzed will largely
depend on the purpose of the needs assessment. The data may be
largely descriptive in order
• It is often useful when reporting descriptive statistics (percentages,
means, standard deviations, and so on) to make comparisons with
other appropriate data sources. For example, if the assessment of a
site includes a question on the percentage of adults who are current
smokers, it would be useful to report the findings not only for that
site but also for the state or nation, if the secondary data exist. This
comparison could be presented in tabular format or graphical
format.
• The data could also be separated by important characteristics such
as gender, race, or socioeconomic indicators.
57

FINDINGS
• If data beyond descriptive statistics are desired, it would be
important to hire a statistician to determine what types of
analyses are possible and appropriate based on the sample
obtained for the needs assessment.
• One new technique that can be used in reporting the results of
needs assessments is a geographic information system (GIS) .
• Uses of GIS technology in health include determining the
geographic distribution of various diseases (both infectious
and chronic), analyzing spatial trends in health, analyzing
needs assessment data to help plan the most effective
interventions, and analyzing health outcomes based on
distances between individual homes and health care
institutions. 58

FINDINGS
2, Establishing Priorities:
 The advisory board plays an important role during the needs
assessment to establish program priorities.
 Most board members will come together to look at the needs
assessment data (for example, numbers, summaries of
interviews, and secondary data reports) and to discuss and
decide on program priorities based on the data.
 Frequently the needs assessment produces a lot of information
(such as numbers, tables, and charts). So the first task is to
reduce the information to a manageable number of health
concerns and topics.
 One way to group the data to facilitate ratings is to divide them
into three areas: types of death or disability, behavioral risk
factors, and nonbehavioral risk factors.
59

FINDINGS
(Social, physical, and environmental factors that affect health are
considered nonbehavioral risk factors.)
 Once the data are grouped, then the advisory board can
prioritize what to address within each group and among groups.
 Identifying which problems to address will require that criteria
(for example, importance, feasibility of change, magnitude of
problem, and cost) be established by the advisory board. These
priorities provide justification for starting new programs and
continuing or terminating existing programs.
 One simple method of establishing priorities is to use only two
categories to assess each health - related problem: importance
and feasibility.
 Importance factors include the number of people affected,
mortality rate, and potential impact on the population.
60

FINDINGS
 Feasibility factors include how difficult it will be to correct the
problem, availability of resources, effectiveness of available
interventions, and potential acceptance of solutions at the site.
Process for Determining Health Priorities
61
Feasibility
High (3) Moderate (2) Low (1)
Importance High (3) 6 points 5 points 4 points
Moderate (2) 5 points 4 points 3 points
Low (1) 4 points 3 points 2 points
 On the basis of the priorities it has set, the advisory board then
establishes program goals

FINDINGS
 Which programs will actually be implemented is not based just on
the results of an analysis but depends on a variety of issues.
Factors to Consider in Making Action Decisions Following a Needs
Assessment
62

FINDINGS
 Initially, it would seem that the most serious health problems
(based on data from the needs assessment) should be the ones
to be addressed first.
 In reality, other factors — for example, insufficient resources, a
lack of available effective interventions, or the political and social
values of the school, workplace, health care organization, or
community — may play significant roles in determining which
needs are addressed.
 A second approach to making decisions on which interventions to
pursue is to use the PEARL model PEARL is an acronym that
represents five feasibility factors that have a high degree of
influence in determining how a particular problem can be
addressed.
o Propriety : Does the problem fall within the organization ’ s overall
63

FINDINGS
o Economic feasibility : Does it make economic sense to address the
problem? Will there be economic consequences if the problem is
not addressed?
o Acceptability : Will the community or target population accept an
intervention to address the problem?
o Resources : Are resources available to address the problem?
o Legality : Do current laws allow the problem to be addressed?
 The score is 1 if the answer is yes and 0 if the answer is no. When
scoring is complete, the five scores for that option are multiplied
to obtain a final score
 A third approach to making program priority decisions, often used
in combination with the two just mentioned, is consensus
building. Essentially, consensus building (also called collaborative
problem
64

FINDINGS
solving or collaboration) is bringing together advisory board
members, program staff, program participants, and stakeholders to
use the needs assessment results and data to express their ideas,
clarify areas of agreement and disagreement, and develop shared
program direction.
3, Writing the Final Report and Disseminating Findings:
 Once analysis of the data is complete and the ranking of priorities
has been agreed on, then it is time to write the final report on the
needs assessment.
 The final report contains an executive summary,
acknowledgments, a table of contents, demographics of the
community, methods of data collection, main findings,
established priorities, references, and appendixes.
 Prioritizing the health needs at the site helps to focus the
65

FINDINGS
Here are three tips for writing the final report:
Start with a plan .
 Think about the information that the audience needs and the format that is most
appropriate.
 Both written and oral reports can be developed.
 Tailor presentations to program staff, participants, and stakeholders.
 Remember to plan ahead; don’t wait until there are results to think about how to share
them.
Keep it simple .
 Needs assessment reports do not need to be elaborate.
 It is most important that the information shared be clear, simple, and timely.
 Use brief sections and subsections, and make titles clear and informative. 66

REPORTING AND SHARING THE FINDINGS
 Mix didactic and data - rich information with supporting evidence and anecdotal
descriptions. Varying the material in this way will make the report more interesting and
readable and the findings more believable.
Respect adult learning styles .
 Three principles of adult learning are important to keep in mind when communicating the
findings of a needs assessment.
 First, adults are most interested in information that is directly relevant to the projects and
problems they are dealing with in their own lives.
 Second, they are most likely to use information that relates to their own personal
experiences.
 Third, different people learn in different ways; some are visually oriented, others prefer
narrative text, and some learn best when they hear something instead of reading it.
 Therefore, it may be beneficial to combine a few different methods of information
67

CONCLUSION
• Conducting a needs assessment provides an unbiased look at
a target population within a particular setting and provides a
foundation for the work of putting together a program that is
culturally appropriate and based on health theory in order to
address identified health problems and concerns.
• When conducting a needs assessment, it is essential to use a
variety of methods to collect and analyze data from both
primary and secondary sources and to conduct a capacity
assessment of the site: school, workplace, health care
organization, or community. Then, working with the advisory
board, program participants, staff, and stakeholders, establish
program priorities using approaches such as PEARL and
consensus building to maximize program support in the later
program planning decisions as well during the program
implementation and evaluation.
68

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