The document discusses the planning, implementation, monitoring and evaluation of health education programs. It describes the PRECEDE-PROCEED model, which is a widely used framework for designing, implementing and evaluating health promotion programs. The PRECEDE-PROCEED model involves 5 planning phases (PRECEDE) to identify problems and their causes, followed by 4 implementation phases (PROCEED) which include carrying out the program, and process, impact and outcome evaluation. The document provides an overview of each phase of the model and the steps involved in planning, implementing and evaluating health education programs according to the PRECEDE-PROCEED approach.

1. Chapter 7Chapter 7
Planning, implementation, monitoring and
evaluation of health education programs.
By: Abraham Tamirat(BSc,MPH)
1By:AT (MPH)

2. Definition of planningDefinition 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.
2By:AT (MPH)

3. Purposes of planningPurposes of planning
 Best useof scarceresources
 Avoid duplication and wasteful expenditure
 Helpsfor problem prioritization
 Develop abest courseof action
3By:AT (MPH)

4. Principles of planningPrinciples of planning
 Based on careful analysis of the situations
 Relate to basic needs and interests of the people
 Planned with the people who are involved in its
implementation
 Flexible enough to meet long time situation.
 Should be a continuous process
 Should be achievable considering such factors as
finance, personnel, time etc.
4By:AT (MPH)

5. Steps of planning health education andSteps of planning health education and
interventionintervention
5By:AT (MPH)

6. Step I. situational analysisStep I. situational analysis
 The local situation is the bench mark from where
peopleshould start theprocessof program planning.
 After assembling the facts pertaining to local situations,
it is important to analyze these facts in such away that
they will beuseful to individualsor planners.
6By:AT (MPH)

7. Information for situational analysisInformation for situational analysis
Theinformation collected may include:
 Community and itstopography
 Demographic and socio-economic characteristics
Conductneedassessment
7By:AT (MPH)

8. Community need assessmentCommunity need assessment
• Assessment: is the process of identifying and
understanding a problem or set of problems and
later planning a series of actions to deal with the
problems.
Identify ;
 What is the problem
 Magnitude/size of the problem
 Severity of the problem
 community practice (KAPB), service/resources, cultural
practices/social influences with regard to the problem
8By:AT (MPH)

9. Sources of data forneed assessmentSources of data forneed assessment
9By:AT (MPH)

10. Step II. identify problems and prioritizeStep II. identify problems and prioritize
What do we have at the end of needs
assessment?
A number of problems are emerged out of needs
assessment.
Since it is not possible or feasible to deal with all
the problems at once, we will have to prioritize
10By:AT (MPH)

11. Criteria to prioritizeCriteria to prioritize
1. Magnitude of the problem- How wide spread the
problem is ?
2. Severity of the problem – fatality, consequence,
disability
3. Feasibility – in terms of time, resources, etc.
4. Government concern –Priority policy
5. Community concern – Felt need of the community
11By:AT (MPH)

12. S/N Problem
s
M S F G C Total Rank
1 Malaria
2 TB
3 HIV/AIDS
4
5
6
7
Example of problem prioritization
Score each problem out of five (1-5)
12By:AT (MPH)

13. Step III: Setting objectivesStep III: Setting objectives
13By:AT (MPH)

14. Step III: Setting objectives….Step III: Setting objectives….
• Once the problems have been prioritized, the next step is
to set objective.
• It is impossible to evaluate a course or a program
efficiently without a clearly stated objective.
• A program objective is a series of statement that must
answer:
• What do we want to achieve?
• Where?
• Who is the target group?
• When do we want to achieve?
• Extent of achievement?
14By:AT (MPH)

15. For example,For example, to increase immunization coverageto increase immunization coverage
from 70% to 95%from 70% to 95% among under 5 childrenamong under 5 children inin
Jimma townJimma town by 2012.by 2012.
What
Where
Who
When
Extent
InJimmatown
Increaseimmunizationcoverage
Amongunder5yearchildren
By2012
From70% to95%
15By:AT (MPH)

16. Types of objectivesTypes of objectives
16By:AT (MPH)

17. Types of objectives …Types of objectives …
1. Health objectives
 Describe how health status is to be improved
 They are termed as “outcome objective”
 They are ends / represent the true bottom line
of the program
E.g To reduce infant mortality by 2/3rd
by the end
of 2015
17By:AT (MPH)

18. 2. Behavioral objectives
 Behavioral objective refers to the actual things the
program will encourage people to do or not to do!
E.g To reduce cigarette smokers by 50%
3. Learning objectives
 Learning objectives describe knowledge, attitude
or skill development
E.g Clients should able to describe three ways of
HIV/AIDS transmission
18By:AT (MPH)

19. Hierarchy of learning objectivesHierarchy of learning objectives
In order to change
behaviors, these four
factor must be changed
first and you must have
objective for each factor if
you want to change them.
Awareness is easier to
change than
knowledge, knowledge
is easier than attitude
and changing skill
needs more time and
effort.
19By:AT (MPH)

20. Objectives ….Objectives ….
4.Resource objective : Is what the program
planners hope to provide , be it the essential
service or material support
E.g
 To establish three counseling center by the end
of 2012
 To supply 3000 poster for each health center by
the end of 2012.
 To distribute 10,000 hagober at the end of 2013
20By:AT (MPH)

21. Objectives… SMARTObjectives… SMART
21By:AT (MPH)

22. N.B.
 Words open to many interpretations should not be used
whilewriting an objective.
 For example, know, understand, appreciate, enjoy,
believe etc, words open to less interpretation should be
used e.g., write, identify, list, define, differentiate,
compareetc.
22By:AT (MPH)

23. Step IV. Develop plan of workStep IV. Develop plan of work
 A plan of work is a detailed schedule of activities to be
donein agiven period of time.
 It should specify the role of different persons involved,
the time in which the particular activities have to be
carried out, and thedifferent methodsto beused.
23By:AT (MPH)

24. Work plan…Work plan…
In short, an action plan should answer the following
questions.
 When should it start and when should it becompleted?
 Who doesit?
 Who isresponsiblefor seeing it isactually carried out?
 What materialsand resourcesareneeded?
24By:AT (MPH)

25. V: Implementation of the programsV: Implementation of the programs
 Implementation is carrying out the plan or putting the
plan/program into action.
 It is translating the goals, objectives and methods into a
community based health education programs.
25By:AT (MPH)

26. MonitoringMonitoring
 Monitoring is the systematic collection and analysis of
information on the project progress .
 It helps to keep the work on track.
 Enables the planners to detect any kind of
problems related to the performance of the activities as
early as possible and to give relevant solutions
to the problems detected.
26By:AT (MPH)

27. EvaluationEvaluation
 Evaluation: is the process of assessing whether the
health education interventions are attaining their goals
and objectives which are predetermined while planning
the interventions.
 Effectiveness?
 Efficiency ?
27By:AT (MPH)

28. Planning models used in health educationPlanning models used in health education
There are many planning model in health education
and promotion.
Among these models, the Precede-Proceed
model is the well known and most frequently used
model to plan, implement and evaluate health
education and promotion programs.
Developed by Lawrence W. Green and his
colleagues in 1980
28By:AT (MPH)

29. The PRECEDE/PROCEED FrameworkThe PRECEDE/PROCEED Framework
Lawrence W. Green &Marshall W. KreuterLawrence W. Green &Marshall W. Kreuter
PRECEDE
P= Predisposing
R= Reinforcing
E= Enabling
C= Causes
E= Educational
D= Diagnosis
E= Evaluation
PROCEED
P= Policy
R= Regulatory
O = Organizational
C = Constructs
E= Educational
E=Environmental
D= Development
29By:AT (MPH)

30. PRECEDE-PROCEED MODELPRECEDE-PROCEED MODEL
DiagramDiagram
Quality of
life
Phase 1
Social
Diagnosis
Health
Phase 2
Epidemiologi
cal
Diagnosis
Health
education
Policy
regulation
organization
Public
Health
Phase
Administrative
& Policy
Diagnosis
Phase6
Implementation
Phase7
Processevaluation
Phase8
Impact evaluation
Phase9
Outcomeevaluation
Predisposing
Reinforcing
Enabling
Phase4
Educational &
Ecological
Diagnosis
Behavior
Environment
Phase3
Behavioral &
Environmental
Diagnosis
Green&Kreutzer,HealthPromotionPlanning,3rded.,1999.
30By:AT (MPH)

31. PRECEDEhas five phases-PLANNING PHASEPRECEDEhas five phases-PLANNING PHASE
Phase1: Social diagnosis
Phase2: Epidemiological diagnosis
Phase3: Behavioral and environmental diagnosis
Phase4: Educational and organizational diagnosis
Phase5: Administrativeand policy diagnosis
31By:AT (MPH)

32. Phase 1 – Social DiagnosisPhase 1 – Social Diagnosis
 Phase1: seeksto subjectively definetheQuality of life(problems
& priorities) of priority individualsor population
 needs
 Identify social problemsthat impact quality of life,
 Identifyhealthissues frompeoplepointof view
Quality of Life
Phase1
Social
diagnosis
32By:AT (MPH)

33. Phase 2 – Epidemiological DiagnosisPhase 2 – Epidemiological Diagnosis
 Determine health issues associated with the quality of life. e.g.,
morbidity, mortality, risk factors, disability, incidence, prevalence of
disease
 Objective data is gathered, usually from secondary data sources /
Epidemiological data
 Creating priorities among the problem or list of problem
To identify
health
problems
Phase2
Epidemiological
Diagnosis
33By:AT (MPH)

34. Phase 3: Behavioral and Environmental DiagnosisPhase 3: Behavioral and Environmental Diagnosis
In phase 3, indentify behavioral and non-
behavioral causes (environmental factors) which
seem to be linked to health problems identified
in Phase2 and put them separately.
Phase3: Behavioral and non-
behavioral diagnosis
To identify
1.Behavioral and
2. Non-behavioral causefor the
health problem
34By:AT (MPH)

35. Phase 4: Educational &Organizational DiagnosisPhase 4: Educational &Organizational Diagnosis
 Identifies causal factors that must be changed to initiate
and sustain the process of behavioral and environmental
change identified in Phase 3.
Educational Diagnosis Organizational Diagnosis
1. Predisposing factors (knowledge, attitude,
beliefsetc. )
2. Enabling factors (money, resource, time,
accessibility, availability etc.)
3. Reinforcing factors (peer pressure)
Review the organizational
objectives and focus on areas that
facilitatechanges
35By:AT (MPH)

36. Phase 5Phase 5:: Administrative and PolicyAdministrative and Policy
DiagnosisDiagnosis
 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
Diagnosis
36By:AT (MPH)

37. PRECEDE- phase ends with aPRECEDE- phase ends with a
Comprehensive Intervention plan which isComprehensive Intervention plan which is
ready for implementation and PROCEEDready for implementation and PROCEED
beginsbegins
Design a Comprehensive Intervention planDesign a Comprehensive Intervention plan
Ready
made plan
37By:AT (MPH)

38. PROCEED hasfour phases:PROCEED hasfour phases:
Phase6: Implementation
Phase7: Processevaluation
Phase8: Impact evaluation
Phase9: Outcomeevaluation
38By:AT (MPH)

39. Phase 6: ImplementationPhase 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.
39By:AT (MPH)

40. Phases 7 , 8, &9 - EvaluationPhases 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
40By:AT (MPH)

41. PRECEDE-PROCEED MODEL DiagramPRECEDE-PROCEED MODEL Diagram
Quality of
life
Phase1
Social
Diagnosis
Health
Phase2
Epidemiological
Diagnosis
Health
education
Policy
regulation
organization
Public
Health
Phase
Administrative
& Policy
Diagnosis
Phase6
Implementation
Phase7
Processevaluation
Phase8
Impact evaluation
Phase9
Outcomeevaluation
Predisposing
Reinforcing
Enabling
Phase4
Educational &
Ecological
Diagnosis
Behavior
Environment
Phase3
Behavioral &
Environmental
Diagnosis
Green & Kreutzer, Health Promotion Planning, 3rd ed., 1999. 41By:AT (MPH)

42. 42By:AT (MPH)