The document discusses planning, implementing, monitoring and evaluating health education and promotion programs. It provides an overview of the PRECEDE-PROCEED model, a widely used framework for systematically developing and evaluating health programs. The PRECEDE-PROCEED model involves multistep assessments to identify problems, behaviors, determinants and solutions. It then guides the development of educational objectives and implementation plans before evaluation of process, impact and outcomes. The model aims to actively engage communities and address environmental factors influencing health.

1. Planning, Implementing, Monitoring &
Evaluating Health Education and
promotion programmes.
By: Beimnet Desalegn(BSc,MPH)
Email: bmte5mesi@gmail.com
9/21/2023 1

2. Contents
 Health Education/Promotion Planning
 Application of PRECEED-PROCEDE
Model
 Health Education/Promotion
Implementation
 Monitoring and Evaluation In HE/P
Program
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3. Definition of planning
 Planning: - is an anticipatory decision making
about what needs to be done, how it has to be
done, and with what resources.
 It is central to health education and health
promotion process.
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4. Why We Plan?
 It provides future direction
 It create efficient use of resources
 It provides a unifying framework
 It helps to adjust change environment
 It also facilitates a base for teamwork
Therefore, health promotion planning is said to
be the central process in achieving
HE/HP program goal and objectives
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5.  Remember that 80% of the Projects fail
due to poor objectives and misleading
or insufficient assumptions, not b/c of
poor implementation
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6. In general, what planning refers to:
 It is drawing feasible goal
 It is about drawing “SMART” objectives
 It is about developing or drawing guiding
directions/strategies, and
 Developing action plan
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7. what we need and Consider in HE/HP
Program Planning
 Problem Identification and needs assessment
 Prioritization
 Formulation of goals and objectives
 Developing program components
 Identification of appropriate communication
methods and strategies
 Completing the action plan (write up)
 Implementation preparation
 Evaluation and Monitoring indicators and
plan
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8. Models for Program Planning in
Health Promotion
 Many different kind of planning models have
been developed to guide planning process
 PRECED-PROCEED
 MATCH
 CDCynergy
 Models serve as frames from which to build;
Provide structure & organization for the
planning process
8

9. PRECEDE-PROCEED
 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.
9

10. 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.
10

11. PRECEDE
P = Predisposing
R = Reinforcing
E = Enabling
C = Constructs
E =Educational/Ecological
D = Diagnosis
E = Evaluation
PROCEED
P = Policy
R = Regulatory
O = Organizational
C = Constructs
E = Educational &
E =Environmental
D = Development
11
PRECEDE - PROCEED
✓Larry Green & Marshall Kreuter
✓PRECEDE created in early 1970s
✓PROCEED created in the 1980s
✓Best known & often used model

12. PRECEDE-PROCEED MODEL Diagram
12
Quality
of life
Phase 1
Social
Diagnosis
Health
Phase 2
Epidemiologic
al
Diagnosis
Health
education
Policy
regulation
organization
Public
Health
Phase
Administrative
& Policy
Diagnosis
Phase 6
Implementation
Phase 7
Process evaluation
Phase 8
Impact evaluation
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.

13. PRECEDE has five phases-PLANNING
PHASE
13

14. Phase 1 – Social Assessment
 Phase 1: seeks to subjectively define the Quality of life
(problems & priorities) of priority individuals or
population
 Identify social problems that impact quality of life
14
Quality of Life (the outcome)
Phase 1 : Social diagnosis

15. Phase 2 – Epidemiological Assessment
➢ Determine health issues associated with the quality of life.
➢ morbidity, mortality, risk factors, disability, incidence,
prevalence of disease
 Sources : Epidemiological data
15
Review
epidemiological data
Phase 2 : Epidemiological
Assessment
List of problems

16. Creating priorities
 Once a list of problems identified in phase 1 &
2, priority should be set among these problems
 For the selected health problem, develop
program goals and objectives
 Suppose, malaria is the health problem
identified in phase 1 & 2, then develop
program goal and health objective for
malaria.
16

17. Example of program or health objective for
malaria
 Goal : To reduce the burden of malaria in
Humbo woreda by 2024.
 Objective: To reduce the prevalence of
malaria in Humbo woreda from 45% to 10% by
the end of 2024.
17

18. Phase 3: Behavioral and Environmental
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.
18

19. Phase 3….
19
• Behavioral assessment is the
analysis of behavioral links to
the problems that are identified
in the epidemiological or social
diagnosis.
1.Behavioral
assessment
• Environmental assessment is a
parallel analysis of factors in
the social and physical
environment other than specific
actions that could be linked to
behaviors.
2.Non-
behavioral
assessment

20. Example
20
Beha
vioral
Enviro
nment
al
Person
al
Malari
a
•Not properly using ITN
•Staying outside at evening
•Not seeking treatment early
•Not following course of prescribed
drugs
•Presence of stagnant water
•Lack of ITN
•Lack of services
•Pregnant women
•Under five children

21. Behavioral factors
 Perhaps, no program has sufficient resources to
deal with all behavioral factors identified!
 So, prioritization has optional !!!
 But, How to prioritize behavioral factors ??
 Consider the importance and changeability of
each behaviors !!!
21

22. Behavioral factors ….
• Evidence as it is clearly linked
to health problem
• How it prevalent in the
population
Importance
• Reasonable evidence whether
the behaviors is changed
• Review past experience
• Still in developmental stages
• Not deep rooted in culture
Changeability
22

23. Behavioral prioritization matrix
 Behavioral objectives are created from Quadrant 1&2
23
More Important Less Important
More
changeable
Quadrant 1
High priority for
program focus
Quadrant 3
Low priority except
for political reason
Less
changeable
Quadrant 2
Priority for innovative
program: Evaluation is
crucial
Quadrant 4
No program

24. Example :behavioral objective
 Suppose, improper use of ITN is one of the
behavior selected based on the matrix and
behavioral objective should be developed for
this behavior
 To increase proper use of ITN from 20% to
60% among Humbo worda households by the
end of 2024.
24

25. Non-behavioral factors
 Just follow the same procedure to identify
environmental factors and prioritize it in
terms of changeability and importance
AND
 Write SMART, objectives for the
identified factors
25

26. Phase 4: Educational & Organizational
assessment
 Identifies causal factors that must be
changed to initiate and sustain the process of
behavioral and environmental change identified
in Phase 3
26

27. Phase 4…
 In phase 3, two broad factors could be identified
Previous example
✓ Behavior factors : Improper use of
ITN….What is the cause of improper
use??????
✓ Non-behavior factor….
27

28. Educational assessment
28
Predisposing
factors
Awareness
Knowledge
Attitude
Beliefs
Enabling
factors
Availability
Accessibility
Skills
Laws
Reinforcing
factors
Families
Peers etc.

29. Establishing priorities within categories
 Within these three categories of determinants of
behavioral and environmental changes set priorities for
intervention in logical order according to importance
and changeability
29

30. Importance can be estimated in the following
parameters
1.
Prevalence
How
widespread
or frequent
is the
factor?
2.
Immediacy
Asks how
compelling
or urgent is
the factor ?
3. Necessity
Is factor
which its
absence or
presence is
must for
change to
occur
30

31. Rating factors in terms of Changeability
Knowledge
Beliefs
Attitude
Value
31

32. Learning and resource objectives
For each of the prioritized factors, develop
learning objectives and resource objectives
 Predisposing factors ……Learning objectives
 Reinforcing factors …….learning objectives
 Enabling factors ……….resource objectives
32

33. Phase 5: Administrative and Policy
assessment
 Focuses on administrative and organizational concerns
which must be addressed prior to program
implementation
 Includes assessment of resources, budget development
and allocation, development of implementation
timetable, organization and coordination with others
 Analysis of policies, resources and circumstances
prevailing organizational situations that could hinder or
facilitate the development of the health program Policy
assessment
33

34. PRECEDE- phase ends with a Comprehensive
Intervention plan which is ready for
implementation and PROCEED begins !
34
Design a Comprehensive Intervention plan
Ready made
plan

35. PROCEED has four phases:
Phase 6: Implementation
Phase 7: Process evaluation
Phase 8: Impact evaluation
Phase 9: Outcome evaluation
35

36. Phase 6: Implementation
 Beginning of PROCEED
 The act of converting program objectives into
actions through policy changes, regulation and
organization.
 It is translating the goals, objectives and
methods into a community based health
education programs.
36

37. Phases 7 , 8, & 9 - Evaluation
✓ Phase 7: Process evaluation - measurements of
implementation process to control, assure, or improve
the quality of the program
✓ 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 of disease, improved health status, life
expectancy
37

38. PRECEDE-PROCEED MODEL Diagram
38
Quality
of life
Phase 1
Social
Diagnosis
Health
Phase 2
Epidemiologic
al
Diagnosis
Health
education
Policy
regulation
organization
Public
Health
Phase
Administrative
& Policy
Diagnosis
Phase 6
Implementation
Phase 7
Process evaluation
Phase 8
Impact evaluation
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
Visit this model whenever you get terrible to conduct community diagnosis,
DTTP

39. 9/21/2023 39