Developing a Health

Promotion Program
dr. Harun Al Rasyid, MPH
Objectives
2
Students are able to:
Determine health issue
Determine target group
Make appropriate program goal and objectives
Select appropriate method of health promotion
program

What we have
learned last
semester
3
Definition of health
promotion
Behavioral theories
used in health
promotion


Health Promotion
Developing Health Promotion Program
10/6/2014
5

Planning Methods Evaluation
Planning A Health
Promotion Program
What do you want to achieve?
Why do you want to achieve it?
How will you achieve it?
Who is the program aimed at?
How will it happen?
Where will it happen?
When will it happen, or when will it
stop?
How will you know if you achieved
what you wanted?

Why develop a plan?
To ensure the program is appropriate to
the:
health problem
identified target group
available resources
To apply accepted theory and experience
To maximise the opportunity for achieving
the desired change
To enable the program to be implemented
by others
To enable the program to be evaluated
and possibly duplicated

Why Might Health Promotion
Programs Fail?
Inadequate needs assessment
Inadequate planning
Inadequate applied research
Underestimation of diffusion and
adoption barriers

Planning Questions
1. How serious is the health issue,
concern or problem?
2. Which behavioural and
environmental risk factor are
involved?
3. What contributes to those risk
factors?
4. Which combination of interventions
might change these factors
5. How can these interventions be
implemented?
Evaluation questions
1. Has the implementation carried
out as intended?
2. Have the interventions been
executed as planned?
3. Have the causes of behavioural
or environmental risks changed?
4. Has the risk itself changed?
5. Has the problem lessened?

Planning A Health
Promotion Program
Determine the health issue
Building a rationale
Needs assessment
Determine the target group
High risk group
Primary, secondary, tertiary target group
Determine goal and objectives
Determine the methods and strategies
Evaluation planning

Needs Assessment
Should provide answers for the
following questions:
What does the community REALLY
need?
What are the most relevant issues?
Is the need for directional change
indicated?
How much time, money, and other
resources required?
Steps in needs
assessment: Part one
Identifying the health
problem
Consultation
Data collection and
preliminary review of literature
Interim presentation of
findings to stakeholders
Collaboratively determine
priorities

Steps in needs
assessment: Part two
Analysis of the health
problem
More specific literature
review
Describe target group
Exploring the health problem
Analyzing the contributing
factors
Assessing community
resources


Defining Target Group
The nature of the target group will
influence the style of the planned
intervention
Include demographic characteristics, such
as: age, sex, ethnic composition
May be appropriate to include other
factors, eg: education, employment
profiles, area of residence
You may need to re-define your target
group as you progress through the
planning stage and before finalizing goals
and objectives
You may want to use a primary/secondary
target groups framework



Analysis of the factors contributing to
the health problem
Risk markers: factors that identify where the problem
is occurring
Risk Factors: account for why the problem is
occurring
Contributing Risk Factors: contribute to, or
account for the risk factor
predisposing: predispose a person into behaving in a
certain way (knowledge, attitudes and beliefs)
enabling: enable a behaviour, or situation to occur
(usually focus on skills)
reinforcing: reward of punish the carrying out of a
behaviour or the maintenance of the situation

DETERMINING
GOALS
what do you ultimately
want to achieve with
the program
corresponds to health
problem
Usually a health indicator /
diagnosis, but may be a
behaviour or
environmental concern if
that is defined as the
health issue

DETERMINING
OBJECTIVES
the changes to be
brought about by the
target group
corresponds to risk
factor
Generally a behavioural/
environmental focus

DETERMINING
SUB-OBJECTIVES
what has to happen to
achieve an objective
corresponds to
contributing risk factor -
skills, knowledge,
awareness etc
generally only separated
out from general
objectives for large
projects or where helpful

GOAL
corresponds to
Health Problem
OBJECTIVE
Risk Factor
SUB-OBJECTIVE
Contributin
g Risk
Factor
Example
Excessive
exposure of school
children to ultraviolet
light
To reduce
exposure of school
children to ultraviolet
light
Health Problem Goal
Risk Factor Objective
Children do not
wear hats
To increase the
proportion of
children who wear
hats
Example
Children do not like
wearing hats
(predisposing)

Hats are not supplied by
the school (enabling)
Hats are not a
compulsory part of
uniform (reinforcing)
To increase the
proportion of children
who like wearing hats
To make hats free for
school children
To make wearing hats
compulsory for school
children
Contributing Risk
Factor
Sub-Objective
Example 2
Excessive
exposure of school
children to ultraviolet
light
To reduce
exposure of school
children to ultraviolet
light
Health Problem Goal
Risk Factor Objective
Not enough shade
in school
playgrounds
To increase the
amount of shade in
school playgrounds
Example
Parents and teachers
not sufficiently aware of
risk of sun exposure
(predisposing)

Insufficient funds to build
shelters (enabling)
Education Department
has no policy on shade
areas (reinforcing)
To increase teachers
and parents knowledge
of risk of sun exposure

To acquire Rp 5 million
for shade shelter
To have shade
protection incorporated
into Education
Department school
policy
Contributing Risk
Factor
Sub-Objective
Writing GOAL and
OBJECTIVES
Should be SMART:
Specific
Measurable
Achievable
Relevant
Time Specific

Example
Untuk meningkatkan proporsi anak
sekolah sebesar 40% yang suka memakai
topi sampai akhir Januari 2009
Untuk meningkatkan tingkat pengetahuan
para guru dan orang tua sebesar 25%
tentang resiko paparan sinar matahari
sampai akhir program


HEALTH PROMOTION
METHODS
Choice of Methods
Four factors determine the choice of
methods:
Time
Audience
Environment
Outcome
FOCUS ON THE INDIVIDUAL
Patient Education
Hospital inpatient program
General health education materials
Education for specific ailments (e.g. Diabetes, asthma,
etc.)
Outpatient settings
Counseling, brief interventions, and
motivational interviewing
Programmed learning, self-help materials,
and the internet
FOCUS ON GROUP
Group Methods
Didactic approach
The goal is transmission of knowledge or information
Directed at group of individuals to bring about
individual behaviour change
Examples: lectures, seminar
Experiential group learning
Best performed when the behavioural outcome
required is a complex one and requires detailed
development of components that have been identified
in HBM (intentions, attitudes, barriers, and beliefs)

FOCUS ON GROUP
Didactic
group
method
Description
Lecture -
discussion
Best for knowledge transmission or motivation in
large groups. Requires dynamic, effective speaker
with more knowledge than the audience
Seminar Smaller number (2-20). Leader-group feedback.
Leader most knowledgeable in the group. Best for
trainer learning.
Conference Can combine lecture or seminar techniques. Best for
professional development.
Video
conferencing
Opportunity for group learning with professionals,
such as rural and remote doctors, nurses, and so on.
FOCUS ON GROUP
Experientia
l group
method
Description
Skills training Requires motivated individuals. Includes explanation,
demonstration and practice; for example relaxation,
childbirth, exercise
Behaviour
modification
Learning and unlearning of specific habits. Stimulus-
response learning. Generally behaviour-specific; for
example smoking cessation, phobia desensitisation
Inquiry
learning
Used mainly in school settings. Requires formulating
and problem solving through group cooperation
Peer group
discussion
Useful where shared experiences, support and
awareness are important. Participants homogenous in
at least one factor; for example old people, prisoners,
teenagers.
FOCUS ON GROUP
Experientia
l group
method
Description
Simulation Useful for influencing attitudes in individuals with
varying abilities. Generally in school-setting but
relevant to tother group
Role-play Acting of roles by group of participants. Can be useful
where communication difficulties exist between
individuals in a setting; for example families,
professional practice. Require skilled facilitator.
Self-help Requires motivation and independent attitude.
Valuable for ongoing peer support and value
clarification. Can be therapy or a forum for social
action.
USING THE MEDIA
Mass media methods
Advertising
Publicity
Edutainment
Civic journalism
Websites and interactive
information technology
Mass media methods
Advertising
the paid placement of messages in
various media vehicles by an
identified source.
Disadvantage: Cost | Advantage:
large exposure

Publicity
The unpaid placement of messages
in the media, usually in news or
current affairs program, but also in
feature article or documentaries

Edutainment
Use the combination of education and
entertainment
Deliberate inclusion of socially
desirable messages in entertainment
vehicles, such as TV soap opera
(sinetron).

Civic journalism
Attempts to build community
consensus and cooperation
Emphasizes similarities and seeks to
emphasize more moderate views
Websites and interactive
information technology
For health promoters, the web
provides a relatively efficient and
inexpensive forum for the
dissemination of information and
materials
Dietary habit questionnaire online
immediate diagnosis and prognosis
about dietary changes
Choosing media methods
Factors:
Goals and objectives (outcomes)
Cost
Effectiveness
Complexity of messages delivered
Time
Relationship with the media
Type of media available
A framework for using media in social
marketing
Advertisin
g
Publicity Edutainme
nt
Web sites Civic
journalism
Objectives:
Educate ** ** **** ***** ****
Motivate **** ** **** ** ***
Advocate *** *** ** ** ****
A summary of media method
Limited reach media
Type Characteristics
Pamphlets Information transmission. Best where cognition rather than
emotion is desired outcome.
Information
sheets
Quick convenient information. Use as series with storage
folder. Not for complex behavior change.
Newsletter Continuity. Personalized. Labor-intensive, requires detailed
commitment and needs assessment before commencing.
Posters Agenda-setting function. Visual message. Creative input
required. Possibility of graffiti might be considered.
T-shirts Emotive. Personal. Useful for cementing attitudes and
commitment to program/idea.
Stickers Short message to identify/motivate the user and cement
commitment. Cheap, persuasive.
Videos Instructional. Motivational. Useful for personal viewing with
adults as back-up to other programs.
DVDs and CDs Provides the opportunity for portable, attractive, easy to use,
multimedia transmitted information
A summary of media method
Mass reach media
Type Characteristics
Television Awareness, arousal, modeling, and image creation role. May
be increasingly useful in information and skills training as
awareness and interest in health increases.
Radio Informative, interactive (talkback). Cost-effective and useful in
creating awareness, providing information.
Newspaper Long and short copy information. Material dependent on type
of paper and day of week.
Magazines Wide readership and influence. Useful as supportive role and
to inform and provide social proof.
Internet Can serve wide role from personal information transmission
ato group sessions to blogging
Components of successful media
campaigns
Carry out informative research
Base the campaign on a model of attitude-
behaviour change
Fully understand the topic being communicated
Use skilled creative personnel
Understand the audience
Components of successful media
campaigns
Target the message
Take account of interpersonal and peer
influences
Optimize contact with the message
Use multiple channel
Use a credible source or spokeperson
Components of successful media
campaigns
Set realistic goals and a realistic duration of
the study
Provide environmental support for change
Ensure that input from a behavioral scientist
guides the communication agency