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Lecture Note Five.pptx
1. 1
Unit Five
Models for Program
Planning in Health
Promotion
By
Alem Deksisa(MPH, Assist Prof)
10/6/2023 planning in HE/HP
2. PRECEDE-PROCEED
• Many different kind of planning models have been
developed to guide planning process
• Models serve as frames from which to build; Provide
structure & organization for the planning process
• The PRECEDE-PROCEEDE model is a framework for the
process of systematic development and evaluation of
health education programs
• It is the well known and most frequently used model to
plan, implement and evaluate health education and
promotion programs.
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3. 3
FUNDAMENTAL PROPOSITIONS OF THE MODEL
• Health and health risks are caused by multiple
factors.
• Efforts to effect behavioral, environmental and
social changes must be multidimensional
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4. PRECEDE-PROCEED
The model rests on two principles:
1. The principle of participation, which
states that success in achieving change
is enhanced by the active participation
of members of the target audience.
2. The important role of the environmental
factors as determinants of health and
health behavior.
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10. Creating priorities
• Once a list of problems identified in phase 1 & 2, priority should be set among
theseproblems
• Forthe selectedhealthproblem, developprogram goals andobjectives
• Suppose, malaria is the health problem identified in phase 1 & 2, then develop
program goalandhealthobjectiveformalaria.
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11. Example ofprogram orhealthobjectiveformalaria
• Goal:Toreduce the burden ofmalaria inBushulo districtby2014.
• Objective: To reduce the prevalence of malaria in Bushulo district
community from 45% to 10%bythe endof2014.
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12. Phase3:BehavioralandEnvironmental assessment
• This phase involves determining
and prioritizing behavioral and
non behavioral causes (personal
and environmental factors) which
seem to be linked to health
problems selected in Phase 2.
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13. Phase 3….
• Behavioral assessment is the analysis of behavioral
links to the problems that are identified in the
epidemiologicalor socialdiagnosis.
1.Behavioralassessment
• Environmental assessment is a parallel analysis of
factors in the social and physical environment other
thanspecificactionsthatcouldbelinkedtobehaviors.
2.Non-behavioral
assessment
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14. Example
Behaviora
l
Environme
ntal Personal Malaria
•Not properly usingITN
•Stayingoutside atevening
•Not seekingtreatment early
•Not followingcourse ofprescribed drugs
•Presence ofstagnantwater
•LackofITN
•Lackofservices
•Pregnantwomen
•Under fivechildren
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15. Behavioralfactors
• Perhaps, no program has sufficient resources to deal with all behavioral
factors identified!
• So,prioritizationhasoptional!!!
• But,How to prioritizebehavioral factors ??
• Considerthe importance andchangeabilityof eachbehaviors!!!
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17. Behavioralprioritizationmatrix
• Behavioral objectivesarecreatedfrom Quadrant 1&2
MoreImportant LessImportant
Morechangeable Quadrant1
Highpriorityforprogram focus
Quadrant3
Low priority except for political
reason
Lesschangeable Quadrant2
Priority for innovative program:
Evaluationis crucial
Quadrant4
Noprogram
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18. Example :behavioralobjective
• Suppose, improper use of ITN is one of the behavior selected based on the
matrix andbehavioral objective should bedevelopedforthisbehavior
• To increase proper use of ITN from 20% to 60% among Bushulo District
households bythe endof 2014.
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19. Non-behavioral factors
• Justfollow the same procedure to identifyenvironmental factorsand
prioritizeitintermsofchangeability and importance
AND
• WriteSMART,objectivesfortheidentifiedfactors
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21. Phase4…
• Inphase 3,twobroadfactorscouldbe identified
Previousexample
Behavior factors : Improper use of ITN….What is the cause of
improper use??????
Non-behaviorfactor….
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23. Establishingpriorities withincategories
• Within these three categories of determinants of behavioral and
environmental changes set priorities for intervention in logical order
according toimportance andchangeability
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26. Learning andresourceobjectives
• For each of the prioritized factors, develop learning objectives and resource
objectives
• Predisposingfactors ……Learningobjectives
• Reinforcingfactors …….learning objectives
• Enablingfactors ……….resource objectives
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27. Phase5:AdministrativeandPolicyassessment
• Focuses on administrative and organizational concerns which must be addressed prior to
programimplementation
• Includes assessment of resources, budget development and allocation, development of
implementation timetable, organizationandcoordination withothers
• Analysis of policies, resources and circumstances prevailing organizational situations that
couldhinderorfacilitatethe development ofthe healthprogramPolicyassessment
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28. PRECEDE- phase ends with aComprehensive Intervention plan which is
readyforimplementation andPROCEED begins!
DesignaComprehensive Interventionplan
Readymadeplan
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30. Phase6:Implementation
• Beginningof PROCEED
• The act of converting program objectives into actions through policy changes,
regulationandorganization.
• It is translating the goals, objectives and methods into a community based
healtheducationprograms.
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31. Phases7,8,&9-Evaluation
Phase7:Processevaluation -measurements of implementationprocess tocontrol,assure,
orimprove thequalityof theprogram
Phase 8: Impact evaluation - immediate observable effects of program (changes in
Knowledge,attitude,beliefs,practice etc.)
Phase 9: Outcome evaluation -long-term effects of the program such as reduction in
mortality,morbidity,prevalence ofdisease,improved healthstatus,lifeexpectancy
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32. PRECEDE-PROCEED MODEL Diagram
Qualityoflife
Phase 1
Social
Diagnosis
Health
Phase 2
Epidemiological
Diagnosis
Health
education
Policy
regulation
organization
Public
Health
Phase Administrative &
PolicyDiagnosis
Phase 6
Implementation
Phase 7
Process evaluation
Phase 8
Impactevaluation
Phase 9
Outcome evaluation
Predisposing
Reinforcing
Enabling
Phase 4
Educational &
Ecological
Diagnosis
Behavior
Environment
Phase 3
Behavioral &
Environmental
Diagnosis
Green
&
Kreutzer,
Health
Promotion
Planning,
3rd
ed.,
1999.
Visitthismodelwheneveryougetterribletoconductcommunity diagnosis.
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35. Learning Objectives
Attheendof thesession, you areable
• To describetheconceptofplanningand planningprocessinHE/HP
• DiscussHE/HP implementationstrategies
• ExplainconceptofevaluationofHE/HP program
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36. Introduction
• Health education program : is a set of planned and organized
activities carried out over a time to accomplish specific health related
goalsandobjectives.
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37. Definitionofplanning
• Planning: - is an anticipatory decision making about what needs to be done, how,
who andwithwhatresources.
• To plan is “to engage in a process/procedure to develop a method of
achievinganend.”
• Itiscentralto HEandHPprocess.
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43. Prerequisitetostartplanningprocess
Whyitisimportant
??
Because, it is the individuals in the top level decision making position who are
abletoprovide thenecessaryresource support for the program
Gaining support from decision makers
!!
So,how wecangettheir
support??
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44. Planning …
• “Selltheidea”tothosepeople
• In order for resources and support to follow HE programming, decision makers
need to clearly perceive a set of values/benefits associated with the proposed
program!
• So, program planners should develop the rationale for the program existence and
showhowthenewprogram willmakedifference!!
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45. Planning …
• Use soundly researched data to
develop rationale for planning to
convince decision makers !
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46. Establishingplanningcommittee
• Itissecondimportant taskto beaccomplished atthe earlyentrypointofplanning
• Individuals who willing to serve as planning committee should be established to
coordinate andfacilitatethe planningprocess.
• Thiscommitteesometimes called“Steeringcommittee” or“advisoryboard”
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47. Planningcommittee…
• The members of the committee should encompasses representatives of all
stakeholders .
• The greater number of the committee members, the greater the chance of priority
population developsfeelingof program ownership
• Include “Doers”and“influencers” individualsinthe committee
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51. Step I:Needassessment
Need: is a variety of felt urgencies related to the existence, continuation, and
maintenanceoflife andtheenhancementofliving.
Assessmentmeans…
»Identifytheneed
» Describetheneed
» Prioritizetheneed
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54. Stepstoconductneedassessment
Step1: Determine thepurpose andscope ofneedassessment
A) What is the
goal of need
assessment?
B) What we hope
to gain from the
assessment?
C) How
extensive is the
need assessment
?
D) What kind of
resource is
available?
E) To what
extent the
community
involved in need
assessment?
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55. Stepstoconductneedassessment…
Address “serviceneed”and“servicedemands.
Service needs: health professionals believe on what should happen with respect to
healthpromotionprogram.
Service demands: priority population believe on what should be done to resolve their
problem.
Step2:GatheringData
Gatherdatafromappropriate sources Triangulate data source (primary Vs
Secondary)
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56. Conductingneedassessment…
Informal approach to analysis –Which referred to as “eyeballing data” it is to mean
lookingfordifferencebetween“whatisandwhatoughttobe”
Formalapproachtoanalysis–Whensometypeofstaticallyanalysisapplied
Step3: Analyzingthe Data
Analyzeallthedatawithgoalofidentifyingandprioritizehealthproblems
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58. StepII:IdentifyingproblemandSettingpriority
• Resource arelimited!
• Problemsaretoomany!
• It is not feasible to address every
problems come out from need
assessment !
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So what?????
Plannersshould prioritizeit!!!
If so, what approaches to use to set
priority???
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59. Approaches tosetpriorities
A. Basicrankingorderbygroup ofstakeholders(keyinformants,funding agency,
opinionleadersetc.)
B. Usenominalgroup process
C. Basic PriorityRating(BPR) –Morecomplex process
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60. B.Nominalgroupprocess
• Highly structured process in which few knowledgeable representative of the priority
population (5-7 people) are askedto prioritizethe problems.
• The group allowed to rank the topics on a five-Point Likert Scale (1-very low,5-very
high)
• Then,basedontotalscore, the problemswillbe listeddown
• Problems with least score could be dropped ! And the remaining will ranked again and
theprocesswillcontinueuntil thedesiredproblemwillobtained!
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61. C.BasicPriority Rating(BPR)
First presented by Hanlon (1974) and it greatly help planners to quantify subjectiveprocess of
prioritizing theproblem
a.Magnitude oftheproblem(score:0-10)
b.Seriousness oftheproblem(score:0-10)
c.Effectivenessof theintervention(score:0-10)
• Considertheeffectivenessofinterventionstrategyintermsof behavior changeand
interestofthe targetpopn (inhealtheducation)
d.PEARL(Propriety,Economics,Acceptability,Resource andLegality
(score:0or1)
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65. The Hanlon Method: Sample Criteria Rating
Rating Size of Health Problem (% of
population w/health problem)
Seriousness of
Health Problem
Effectiveness of
Interventions
9 or 10 >25% (STDs) Very serious (e.g.
HIV/AIDS)
80% - 100% effective
(e.g. vaccination
program)
7 or 8 10% - 24.9% Relatively Serious 60% - 80% effective
5 or 6 1% - 9.9% Serious 40% - 60% effective
3 or 4 .1% - .9% Moderately
Serious
20% - 40% effective
1 or 2 .01% - .09% Relatively Not
Serious
5% - 20% effective
0 < .01% (Meningococcal
Meningitis)
Not Serious (teen
acne)
<5% effective (access to
care)
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66. Considerations when ranking health problems against the 3
criteria
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• Size of health problem should be based on
baseline data collected from the individual
community.
Size of Health
Problem (% of
population w/health
problem)
• Does it require immediate attention?
• Is there public demand?
• What is the economic impact?
• What is the impact on quality of life?
• • Is there a high hospitalization rate?
Seriousness of
Health Problem
• Determine upper and low measures for
effectiveness and rate health problems
relative to other limits/indicator.
Effectiveness of
Interventions
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67. Steps…
• Use standard measures such as prevalence, incidence, mortality, morbidity etc.
to compare your problems
But,dotnotcompareappleswith
oranges!!!
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69. Step III: Missionstatement,goals&objectives
• To plan, implement and evaluate effective HE/HP programs, planners must have a
solid foundation inplaceto guide themthroughout theirwork
• Mission,goalsandobjectives providessuch foundation.
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70. Goalsandobjectives…
• Without mission statement, goals and objective, program may lack direction and at
bestitisdifficult to evaluate
A.Mission statement
• Itisnarrativesthatdescribes thegeneralfocusofprogram
E.g.mission statementofHE/HP inhealthcare setting
• “The program is aimed at helping patients and their families to understand and
copewithphysicalandemotionalchangesassociatedwiththeirillness”
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71. B. Goal
• Goal “abroadtimelessstatementofalongterm programpurpose.”
• Providesoveralldirections ofthe program
• Usuallytakes longerto complete
• Doesnothaveadeadline
• Oftennot measurableinexactterms
• Moregeneralinnature
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72. Goal …
• Goalshould besimple,conciseandincludetwobasiccomponents
• 1St :who willbeaffected
• 2nd:whatwill be change asaresultof theprogram
• Goals typically uses verbs such as improve, increase, promote, protect,
minimize,prevent,reduceetc.
• Aprogram neednot have asetofstatedgoals !
E.g.“TopreventthespreadofHIV in highschoolstudents”
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73. C.Objectives
• Objective is more precise and represents smaller steps which lead to achieve
program goal
• Objectives is measurable terms of the specific changes that will occur in the
prioritypopulation atagivenpointintime asaresultof exposure tothe program.
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74. Elementsofobjectives
• For objective to provide direction andto be useful in the evaluation process, itmust
be written such a way that it can be clearly understood, state what to be
accomplished andismeasurable
• To ensure that an objective is indeed useful, it should include the following
information
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75. For example, to increase comprehensive knowledge on STI from 60% to 90% among
ACSHMC students by2022.
What
Where
Who
When
Extent
ACSHMC
STDknowledge
Among AHMCstudents
By2022
From60%to90%
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77. N.B.
• Words open tomanyinterpretations shouldnot beused whilewritinganobjective.
• For example,know,understand,appreciate,enjoy,believe etc,
• words open to less interpretation should be used e.g., write, identify, list, define,
differentiate,compare etc.
Relationshipamongprogramfoundations
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78. Steps…..Developing implementation strategy
1. Assessing
need
2.identify
problem&
prioritize
3.settinggoals&
objectives
4.develop
implementation
strategy
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79. Step IV:Developing intervention strategy
• Once the goals and objectives has been developed, planners need to decide on the
mostappropriate meansofreaching the goalsandobjectives.
• The planners,musta setof activitiesthatwould permitthe ;
• effective(leadstodesiredoutcome)
• efficient(usesresourceinresponsiblemanner)
• These plannedactivitiesmake upintervention
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80. Intervention strategies
•When applied to planning ofHP programs, intervention issomething that occurs b/n
the beginningandthe endof aprogram.
•Or it describes all activities that occurred b/n pre-and post program measurements or
b/n two measurementpoints.
•Intervention that include several activities are more likely to have an effect on priority
popn thanthatconsistsof asingleactivity
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81. Intervention strategies…
• In other words, the “size” of the dose is important in health
promotion”
• Some people may change by single “dose” others may need multiple
“doses”
Multiplestrategy is ok!!
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84. Implementation
• Implementation is carrying out the plan or putting the plan/strategy into
action.
• It is translating the goals, objectives and methods/strategies into a
communitybasedhealtheducationprograms.
• Implementationisthemostcrucialofplanningprocess
• “Aplanthatisnotimplementedisnoplanatall!”
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86. AdoptionoftheProgram
• Once, program is packed and ready to be implemented, the next crucial task is
effectivelymarketingtheprogram/productstoprioritypopulation
• Itisnothingbuttelling(advertizing)thepeoplethatyouhaveanewprogram.
• It is persuasively communicating the primary users of the program in order to create
sustainabledemandsforyourprogram!
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88. Putting planinto action
• There arethree waystoputplanintoaction
1. Byusing pilotingprocess
2. Byphrasing init,insmallsegments
3. Byinitiatingthe totalprogram allatonce
• These three strategies are best explained by using an inverted triangle shown
onnextslide
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89. Putting plan….
Totalprogram
Phrasein
Pilot
Fig.Puttingplanintoaction
Test program in small scale with priority
populationto validatethewholeprogramprocess
Once, the program piloted, it could be
expanded, but not to all priority
population
Implementing the total
program all at once, is mistakes
, start with pilot, then phrase in,
thentotal
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91. Monitoring
• Monitoring is the routine tracking of priority information about a programme
anditsintendedoutcomes.
Inputmonitoring
• What interventionsandresources are needed?
• Checking whetherthe program resources go to theintendedactivities.
Output monitoring
• Are theprogram implementedasplanned!!
• Checking whetherthe intendedservicesare deliveredasexpected.
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92. Monitoring…
Impact monitoring
• Areinterventionsworking/making adifference?
• Follow short term changes in the priority population! (Knowledge, attitude,
beliefs,behaviors)
Outcomemonitoring
• Track the long term changes in the priority population (Incidence, prevalence,
morbidity,mortalityetc)
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93. Step VI:Evaluationofthe program
1. Assessing
need
2.identify
problem&
prioritize
3.settinggoals
&objectives
4.develop
implementation
strategy
5.Implement
6.evaluate
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94. Evaluation…
• Evaluation has been defined as “ the comparisons of an object of interest against
standardofacceptability
• Making avaluejudgmentaboutthe program achievement
• A critical assessment of the good and bad points of an intervention, and how it can
beimproved.
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95. • Evaluation is the process of assessing what has been achieved (whether
the specified goals, objectives and targets have been met) and how it has
beenachieved.
• A process that determine relevance, effectiveness and impact of
activitiesinlightoftheir objectives.
)
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Definition
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96. Common terms in evaluation
Effectivenes
• What has been achieved
Efficiency
• How the outcome has been achieved, and how
(value for money, use of time & other
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98. Typesofevaluation
• Any combination of measurements obtained during the
implementation of program activities to ensure quality service
delivery
Processevaluation
• Immediate observable effect of the program leading to outcome
oftheprogram!
• Indicators: Awareness,knowledge,attitude,skillsor behaviors
Impactevaluation
• Long-term consequences of the program; they are usually the
ultimate goalsofaprogramme
• Indicators:morbidity,mortality,prevalenceetc..
Outcomeevaluation
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99. Evaluation…
1.Formativeevaluation
• Any combination of measurement obtained and judgments made before or
during the implementationofthe methods, activities orprogram
2.Summative evaluation
• Any combination of measurements and judgments that permit conclusion to
bedrawn aboutimpact,outcome orbenefitsofthe program
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101. Frameworkforprogram evaluation
• Evaluationshould carried outbasedonwellacceptedframework
• CDC established evolution framework which could be applied in public health
activitiesincludinghealth promotion programs
• This framework comprised of six steps that must be completed in any
evaluation,regardlessof thesetting.
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103. Standardsofeffective evaluation
• Evaluationstandards assessthe qualityofactivities
• They provide practical guideline for the evaluator to follow when having to
decideamongevolutionoption
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