1. Planning Models in Health Education and Health Promotion
CHAPTER 2
Planning Models in Health Education and Health Promotion

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Concept of Model
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Eclectic, creative, simplified, miniaturized applications of concepts toward addressing problems
Used for macro-level planning of interventions
May not have enough empirical evidence to be called a theory
Do not present guidance for micro-level management
Examples of models used in health education and health promotion: PRECEDE-PROCEED, MATCH, PATCH, Ecological Planning Approach

3. Concept of Theory
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Set of interrelated concepts, definitions, and propositions that present a systematic view of events or situations by specifying relations among variables in order to explain and predict the events or situations
Refined through rigorous empirical testing

4. Competencies for Planning Health Education (HESPA, 2015)
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2.1 Involve priority populations, partners, and other stakeholders in the planning process
2.2 Develop goals and objectives
2.3 Select or design strategies/interventions
2.4 Develop a plan for delivery of health education/promotion
2.5 Assess factors that influence implementation of health education/promotion

5. Definitions of PRECEDE-PROCEED
PRECEDE: Predisposing, reinforcing, enabling constructs in educational/ ecological diagnosis and evaluation
PROCEED: Policy, regulatory, and organizational constructs in educational and environmental development
EMPOWER: Expert methods for planning and organization within everyone’s reach

6. Applications of PRECEDE-PROCEED
Coalition building
Enhancing community participation
Planning health education programs
Planning multiple-channel interventions
Implementing health risk appraisals at worksites
Planning Employee Assistance Programs (EAP) at worksites
Influencing healthy worksite culture
Comprehensive school health education
Improving self-care and compliance behaviors

7. Components of PRECEDE-PROCEED
Social assessment and situational analysis phase
Epidemiological assessment
Educational and ecological assessment
Administrative and policy assessment and intervention alignment phase
Implementation phase
Process evaluation
Impact evaluation
Outcome evaluation

8. Strengths of the PRECEDE-PROCEED Model
Popular and most researched model
In existence for four decades
Very comprehensive and covers all areas of planning
Initiation of the model utilizes community inputs and participation
Phased evaluation is also a strong feature

9. Some Limitations of the PRECEDE-PROCEED Model
Too comprehensive to be applied in a reasonable time period at a setting
Requires heavy financial and human resource input to become functional
Mixture of several theories
Comparative studies lacking

10. Planned Approach to Community Health (PATCH) Model
Planning model developed in the mid-1980s by the Centers for Disease Control and Prevention (CDC) in partnership with state and local health departments and several community groups
Capacity building is a very important part of the PATCH model

11. Key Elements of the PATCH Model
Community members participate in the process
Data guides the development of programs
Participants develop a comprehensive health promotion strategy
Evaluation emphasizes feedback and program improvement
Community capacity for health promotion is increased
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12. Five Phases of PATCH Model
Mobilizing the community
Collecting and organizing data
Choosing health priorities
Developing a comprehensive intervention plan
Evaluation

13. CDC PATCH Model Communication
Reproduced from: Centers for Disease Control & Prevention

14. Other Planning Models MATCH (Multilevel Approach to Community Health)
Phase 1: Goals Selection
Step 1: Select health status goal
Step 2: Select high-priority target population(s)
Step 3: Identify health behavior goals
Step 4: Identify environmental factor goals

15. Other Planning Models (cont’d)
MATCH (Multilevel Approach to Community Health)
Phase 2: Intervention Planning
Step 1: Identify the targets of the intervention
Step 2: Select intervention objectives
Step 3: Identify mediators of intervention objectives
Step 4: Select intervention approaches

16. Other Planning Models (cont’d)
MATCH (Multilevel Approach to Community Health)
Phase 3: Program Development
Step 1: Create program units or components
Step 2: Select or develop curricula and create guides
Step 3: Develop session plans
Step 4: Create or acquire instructional materials, products, and resources

17. Other Planning Models (cont’d)
MATCH (Multilevel Approach to Community Health)
Phase 4: Implementation Preparations
Step 1: Facilitate adoption, implementation, and maintenance
Step 2: Select and train implementers
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18. Other Planning Models (cont’d)
MATCH (Multilevel Approach to Community Health)
Phase 5: Evaluation
Step 1: Conduct process evaluation
Step 2: Measure impact
Step 3: Monitor outcomes
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19. Other Planning Models (cont’d)
Intervention mapping
Needs assessment or problem analysis
Creating matrices of change objectives
Selecting theory-based intervention methods and practical strategies
Translating methods and strategies into an organized program
Planning for adoption, implementation, and sustainability of the program
Generating an evaluation plan

20. Other Planning Models (cont’d)
Assessment Protocol for Excellence in Public Health (APEXPH)
A form of self-assessment tool
Leads to development of a practical plan of action
Focuses on local health department’s capacity and the community’s actual and perceived needs

21. Other Planning Models (cont’d)
APEXPH (cont’d)
Helps a local health department build its relationship with other local governmental agencies, and community, state, and federal agencies
Provides a protocol through which a health department can assess health needs, set priorities, develop policy, and ensure that health needs are met
Fits local situations and resources

22. Other Planning Models (cont’d)
APEXPH (cont’d)
Organizational capacity assessment
Community process
Completing the cycle
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23. Other Planning Models (cont’d)
Sullivan (1973): Comprehensive Health Education Model (CHEM)
Involve people
Set goals
Define problems
Design plans
Conduct activities
Evaluate results

24. Other Planning Models (cont’d)
Ross and Mico (1980): Model for Health Education Planning (MHEP)
Initiate
Needs assessment
Goal setting
Planning/programming
Implementation
Evaluation

25. Other Planning Models (cont’d)
Model for Health Education Planning and Resource Development (MHEPRD)
Health education plans
Demonstration programs
Operational programs
Research programs
Implementation process
Information and statistics

26. Other Planning Models: PEN 3
Figure 2-2: The PEN-3 model.

27. Other Planning Models (cont’d)
PEN-3 model
Cultural identity
P represents person
E represents extended family
N represents neighborhood

28. Other Planning Models (cont’d)
PEN-3 model (cont’d)
Relationships and expectations
P represents perceptions
E represents enablers
N represents nurturers

29. Other Planning Models (cont’d)
PEN-3 model (cont’d)
Cultural empowerment
P represents positive
E represents existential (exotic)
N represents negative

30. Other Planning Models (cont’d)
CDCYNERGY or Cynergy by CDC (1999)
Problem definition and description
Define the problem and consider resources
Problem analysis
Set goals

31. Other Planning Models (cont’d)
CDCYNERGY (cont’d)
Communication program planning
Choose primary and secondary target audiences and set communication objectives
Program and evaluation development
Program implementation and management
Feedback

32. Other Planning Models (cont’d)
Social Ecological models:
Based on the work of Urie Bronfenbrenner, a developmental psychologist
Five layers:
Microsystem: Immediate environment such as family, school, peer group, and worksite
Mesosystem: Linkages between two or more settings such as home and school

33. Other Planning Models (cont’d)
Five layers (cont’d)
Exosystem: Indirect influences, e.g., for a child, the relationship between home and father’s workplace
Macrosystem: Culture comprising customs, lifestyles, belief systems, etc.
Chronosystem: Changes over time in the environment

34. Other Planning Models (cont’d)
Figure 2-3: Social-ecological model for planning multilevel health behavior interventions.

35. Application Exercise
Mkumbo and colleagues (2009) have used intervention mapping to develop and implement a school-based sexuality and HIV/AIDS education program in Tanzania.
The first step of this model entails performing needs assessment, which they conducted in a participatory manner, involving the researchers, the curriculum developers, the teachers, and the students.
The second step entails creating matrices of change objectives based on the determinants of behavioral and environmental conditions.

36. Application Exercise (cont’d)
The third and fourth steps entail choosing theory-based methods and developing a program. They developed a program consisting of five lessons, organized around 23 sessions, with the aim of delaying the onset of sexual intercourse and increasing correct and consistent condom use among young people.
The fifth step is about planning for the adoption, implementation and sustainability of the program, and the sixth step is about evaluation. The last two steps are not very clear in this application.

37. Application Exercise (cont’d)
This is an application of a Western model in a sub-Saharan African country.
Read this article and prepare a critique of 250 words.

38. Websites to Explore Centers for Disease Control & Prevention (CDC)
Intervention mapping
National Association of County and City Health Officials (NACCHO)

39. Websites to Explore (Cont’d)
PRECEDE-PROCEED Model
Social-ecological model: Violence prevention

40. Skill Building Activity
Choose any one behavior.
Choose any one target population where this behavior will be most suitable.
Draw a diagram explicating the links between various components of the PRECEDE-PROCEED model and the chosen health behavior.
Present your final work in a word-processed diagram.

41. Skill Building Activity (Cont’d)
Figure 2-4: Application of the PRECEDE-PROCEED model for changing moderate-intensity leisure time physical activity in a small group of African American women in a midwestern city through a brief first-time educational intervention.