WEEK6: HEALTH PROMOTION INTERVENTIONS

Learning objectives

 Understand the concepts and processes relevant to the planning of health

promotion interventions and initiatives.

 Develop critical thinking about the planning process to be able to plan and present a
health promotion initiative.

Contents
Learning objectives ....................................................................................................................1
The process of planning and implementing health promotion activities..................................2
Identifying needs and setting priorities .....................................................................................4
What is need? ............................................................................................................................4
The types of needs .....................................................................................................................5
Setting priorities.........................................................................................................................7
Defining purpose and goals .......................................................................................................7
Recording of the purpose and the objectives............................................................................8
Determining an appropriate methodology..............................................................................10
Μethods of health promotion .................................................................................................12
Health promotion techniques ..................................................................................................13
Determining the resources and capabilities ............................................................................15
The application of health promotion interventions in different structures ............................16
An important concluding remark. ............................................................................................18
References ...............................................................................................................................19

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The process of planning and implementing health promotion activities.
The process of design, implementation and evaluation is not characterised by a linear
relationship between its stages but rather these stages create a circular dimension, a
continuous feedback dynamic, as shown by the more generalised form in figure 1 used
widely in project and change management.

Figure 1: The process of developing Health Promotion activities

Evaluation Planning

Implementation

The development of each stage requires the utilisation of all the knowledge, experiences and
skills of the occupational health, in order to finally emerge a complete plan for the activities
that will be developed. This plan will be the roadmap that will answer three fundamental
questions that must be asked: 1) what is sought to be achieved, 2) what actions must be taken
and 3) how it will be certain that what is sought has been achieved.

Using the above questions, the stages of the design, implementation and evaluation process
should be addressed.

1) What is sought to be achieved?

Includes the identification of needs and aspirations and the definition of purpose and
objectives.

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 2) What actions are to be taken?

It concerns the determination of the best methodology for the achievement of the purpose and
the objectives, the identification of all the available resources and the distribution of the
project to the necessary human resources.

3) How is success confirmed?

This includes all evaluation procedures (Ewles & Simnett, 1999); Ewles & Simnett, 2010)

The design of the evaluation stage should not take place at the end of the implementation but
needs to be done concurrently from the beginning as it should be approached as an integral
part of the process. From all the above, seven final steps emerge, which are key components
of the development, implementation and evaluation stages and are presented in Figure 2.

Figure 2: Steps for planning and evaluation and Health Promotion

1. Identification
3. Choice of 4. Identification
of needs and 2. Setting aim
appropriate of resources
definition of and objectives
methodology and capabilities
aspirations

5. Determine 6. Defining a 7.
the evaluation detailed plan Implementation

Just as the process of organising a health activity is not characterised by a linear relationship
between its stages, i.e., design, implementation and evaluation, so do the individual steps that
make it up, which although following a sequence, they interact frequently resulting to are
visiting of previous steps. Organising a health promotion activity in practice is not a rigorous
process that follows the numerical steps, but a dynamic process that is aided by the
understanding of the necessary steps and constantly utilising them, until the implementation
of the selected programme is realised.

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Identifying needs and setting priorities
Every activity planned in the context of Health Promotion; in order to be successful, it must
meet the needs of individuals or groups targeted. Often these needs can be many and
therefore priorities must be determined. Thus, it is necessary to know what needs will be met
and what the priorities will be. Determining needs is not an easy process and raises a number
of questions. For instance: how will the existing needs be met? Are we confident that we
know what these needs are? And if so, how did we acquire this knowledge? Who might know
more about these needs? Is it the health professionals, the public or others? In order to
understand and answer all these questions, professionals must first understand the process of
identifying needs in the field of health. Under the term needs assessment, a complete
methodological tool has been developed, which allows organisations, bodies or individual
professionals to offer better services, responding to the real needs of the population.

What is need?
According to Denton (1976), need is defined as a situation, condition, or circumstance whose
absence or presence reduces or limits the normal functioning of a community. Using this
definition to identify health needs, it turns out that health needs are these situations and
factors which when absent do not allow individuals to achieve full physical, social health and
well-being (Hawe et al., 1990).Such needs may point out to the need for a safe and supportive
environment, the provision of health services, the provision of health information, etc. In
addition, risk factors and related behaviours such as smoking or manifested disorders or
illnesses restrict the potential for functionality and health promotion of individuals. .

A common misunderstanding of the term need arises when it is defined and confused with the
solution of a problem. For example, it is often said that there is a need for more smoking
cessation programmes, while the need should be expressed by saying that there is a high
number of smokers. Determining needs through solutions is not a good practice as solving the
problem is not always the same and depends on a plethora of factors that change over time.

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The types of needs
The way the term need is conceptually approached differs and therefore many different
interpretations can be given. Bradshaw (1994) and O’Brien (2010) suggest four types of
needs that a health care professional should be able to identify and evaluate in order to help
identify the needs of the target population:

1. Normative needs - Needs determined by experts. These needs are determined by

specialists or professionals, according to their own data and criteria. For example, using the
Body Mass Index, it is determined if a person is normal weight, underweight, overweight, or
obese. Thus, using this criterion, it can become apparent or necessary for a person to modify
the weight with the appropriate intervention. Of course, the opinion of the expert on the need
of an obese person may differ from that of the person, or sometimes there may be differences
between the experts. This type of needs also includes those defined by legislation such as
rules for food safety and hygiene.

2. Felt need. This category refers to the needs that people perceive, that is, what they
themselves feel are needed and which are positively or negatively affected by their
knowledge about the services available that can meet their perceived needs.

3. Expressed need – Demand. The type of these needs refers to the needs that have been
clearly expressed and identified by observation. For example, having large waiting lists at a
breast cancer prevention service may indicate an increased need to be screened for that
particular cancer. However, it should not be overlooked that long waiting lists may also be
the result of poor service. Usually, a felt need becomes an expressed need. However, this
does not always happen. So, when an area does not have a cancer screening service, it does
not mean that there is no need to develop such a service.

4. Comparative need. The needs described in this category arise after a comparison
between similar groups of individuals from which some have received a service and some
not. For example, in a school canteen students may enjoy the services according to the
standards of health promotion whereas the students of a second may not have. It therefore
appears that comparatively there is a lag for policy change in the second school in relation to
the first. The basic premise is of course that the intervention in the first school is ideal and
most suited which is not always the case.

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Useful sources of information to identify needs.

The first and foremost step in identifying and determining the needs is to gather information
and data related to the population to which the activity is intended to be implemented. Care
must be taken here to utilise all potential information tanks to understand what the needs are
and what priorities need to be met.

 Epidemiological data.Epidemiological data and various indicators can affect the

population at national, local or international level. There are various agencies that collect
such data as the Ministry of Health, the Statistical Service, other organisations and health
services but also remaining research agencies, etc.

 Socio-economic data. Health is a multidimensional phenomenon, which is greatly

influenced by economic and social data. Useful socio-economic data to determine needs are
unemployment indicators, income, living conditions, cultural and ethnographic data.

 Lifestyle data. Data relating to the adoption of behaviours that affect the health of
individuals such as smoking, exercise, etc. are extremely useful data.

 The opinion of experts and of the public. The opinion of the experts on what needs
they consider to exist, through their experience and contact with individuals or the
community. Also many bodies represent the opinion of the citizens and can contribute by
submitting their own views or their own data. At the same time, it is very useful to explore
the point of view of the public itself through the use of different methodologies with
techniques that fall into the quantitative and qualitative research such as the use of
questionnaires, interviews, focus groups and panel studies.

 Making use of the media. The printed and electronic press can often be a useful
source of information about the existing needs of a community or group.

The combination of all the sources of information is certainly a more comprehensive

approach to the search for needs and their definition. Apart from the collection of
information, however, their correct and systematic recording is also necessary. Only then can
data be compared and cross-referenced to obtain a global and complete view. The data

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collected at this stage can be evaluated at later stages of implementation and evaluation,
creating a valuable feedback tool.

Setting priorities
The needs identification process can result in a large number of needs to be addressed.
However, daily practice and reality include a number of limiting factors that hinder the
inclusion of all the needs. For example, there may not be enough time, money, materials or
human resources, knowledge, and experience. Priorities should therefore be set. Prioritisation
is also a complex process that is greatly influenced by the knowledge and personal values and
beliefs of professionals who will deal with it. Here are some key factors to keep in mind
when prioritising (Tones & Green, 2019):

 The severity and extent of a problem

 The urgency for tackling a problem.

 The number of people who will be benefiting by the planned activity. Whether the
activities should target high-risk groups or the general population.

 The degree of influence that can be achieved in the targeted population.

 The probability of achieving change.

 The level of support available for the needs that are planned to be addressed.

 The likelihood of meeting the needs with the help of the available resources.

Defining purpose and goals

The second step in creating a health promotion plan is defining what you intend to achieve.
The words vision, mission, purpose, goal are often met in the design of health promotion
programmes as well as other projects. Vision and mission together are the reasons that inspire
people to carry out a health promotion activity or any activity. By defining the purpose, the
mission and the vision acquire a more realistic dimension. The purpose is usually quite broad
and general so it is divided into goals or objectives that help to achieve the broader purpose
and are the individual steps that will be taken in order to achieve the purpose. In order to

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check whether the objectives have been achieved, it is necessary to identify indicators which
are criteria that are set for each objective and show the progress towards their achievement.

Recording of the purpose and the objectives

Clearly stating the purpose helps both in guiding the planning stages and in ensuring that all
participating members have a common understanding of what is being sought. The purpose is
therefore a general broad statement of what is to be achieved (Dignan & Carr, 1992; Fertman
& Allensworth, 2010). It is usually not measurable, it can be either long-term or short-term, it
is broad and includes all the dimensions of the programme giving the general direction. In
addition to the general direction offered by the purpose, a detailed, analytical, and specific
record of all that is sought is required. This is achieved by dividing the purpose into specific
sub-objectives. In contrast to the purpose, the objectives are detailed and give in a very
specific way the individual steps to achieve the purpose, thus giving a substantial structure to
the planning. Although adequate recording of goals is a time-consuming and labourious
process, it is necessary as objectives help in the future evaluation and serve the ranking of
objectives at the beginning of the process.

As in many other fields and sciences that deal with the planning of projects, programmes, and
procedures, so in health promotion in order to capture the basic characteristics of goals and
objectives set, the well-known and widely used acronym SMART has been adopted. Thus,
the objectives must be:

 Specific - to specify in detail what will be achieved, to what extent and until when.

 Measurable - to state clearly with quantitative data what is sought.

 Achievable - to be able to be realised satisfactorily.

 Realistic - respond to reality and rely on data that reflects it.

 To be set in time (time limited/specific) - to be set in a certain timeframe within

which they will be implemented.

Furthermore, and in order to record the goals and objectives the broader context that these
goals will serve needs to be understood, i.e., to capture the overall picture. Next, the intended
changes that are expected to occur with the implementation of the proposed health promotion

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activity should be clarified. Then the data collected are utilised to understand the existing
conditions. Finally, the objectives are recorded according to the necessary characteristics that
were previously analysed. For each objective, the corresponding indicators should also be
recorded, which are criteria that will be used to determine whether the objectives were
achieved, or the desired changes occurred. Table 1 presents an example of identifying and
recording a mission and vision, purpose, goals and objectives and indicators to help you
understand and distinguish the distinct differences between these terms (Wills & Naidoo,
2016).

Table 1: An example of identifying and recording of the Vision, Purpose, Objectives,

and Indicators

Vision - Mission Reduction of health inequalities

Purpose Increase the level of knowledge of migrant women regarding

breastfeeding

Objective Increase access to health information using special printed material.

Indicator The distribution of three special leaflets in five languages, in ten

mother and child health centres within the next five months.

Specifically for the field of health promotion and the planning frameworks of related
activities, the following main types of objectives are identified:

1. Behavioural objectives - relate to lifestyle changes or increased use of health services.

2. Policy change objectives, such as promoting policies that contribute to an upgraded work
environment by implementing, for example, anti-smoking programmes.

3. Environmental change objectives - promoting strategies that contribute to a healthier

environment such as reducing tobacco advertising

4. Objectives related to the increase of collaborations and participation such as the

strengthening of the communities and the active participation of its members.

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5. Educational objectives. Goals that concern the increase of knowledge, the acquisition of
new skills and competencies and the change of attitudes and beliefs. These goals are usually
at the core of health education programmes.

Determining an appropriate methodology

One of the most crucial processes in planning a health promotion activity is to choose the
most appropriate methodology to achieve the goal and objectives. The systematic recording
and evaluation of many programmes, interventions, and health promotion activities in
general, in the last decades, has offered a reliable source of knowledge regarding the
effectiveness or appropriateness of some activities in specific situations and conditions.
Regarding the choice of the most appropriate methodological approach, it is useful to try to
answer the following questions:

Which method is the most appropriate and most effective to achieve the goals and objectives
that have been set?

 Which method will be more acceptable to the recipients?

 Which method is the most economically advantageous?

 Which method is easier?

 Which method is more familiar?

The purpose, the goals and objectives, the available resources, the characteristics of the
organisation or community that the activity aims at, the existing knowledge, the existing
theories but also the competence and experience of the health promotion professionals, are
factors that will ultimately influence the choice of methodology. All the above essentially
make up health promotion. In the difficult task of synthesising all the above, the research and
its findings, regarding the most appropriate methodologies each time, can help in the design
of interventions or strategies (Wills & Naidoo, 2016; Tones & Tilford, 2001). Table 2
presents some results of the research on the most appropriate methods in relation to the
intended purpose.

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Table 2: Matching purpose and appropriate methodologies in health promotion

Purpose Appropriate methods

Health awareness Speeches, Teamwork, Mass Media, Events,

Exhibitions or other events, Campaigns

Increase knowledge Individual and group training, media,

brochures and other publications,
campaigns, events, exhibitions, or other
events

Empowerment Group work, techniques for the decision-

making process, techniques for clarifying
values, counselling, techniques for
strengthening social skills, role-playing
games, technique for developing
assertiveness

Change of attitudes and behaviour Group work, counselling, skills

development techniques, self-help groups,
printed material, individual training

Environmentchange community empowerment techniques,

creation of pressure groups, community
work, change techniques, health policy
promotion, environmental promotion,
implementation of legislation and
regulations, creation of knowledge
promotion teams

Source: Ewles and Simnet, (1999)

It should be noted that the current literature, regarding the evaluation of health promotion
programmes on specific topics such as exercise, healthy eating, sexual behaviour, etc. which

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are addressed to different populations with specific characteristics, can be used to help
choose the most appropriate method. A combination of methods is often the optimum
approach since in this way their cumulative advantages can be utilised.

Μethods of health promotion

A widely used way of classifying the techniques used by health promotion in order to meet
the goals and objectives is the use of three main categories which include methods of passive
information, methods of active participation and experiential methods of active participation.

Passive information methods - This category includes lectures, video or movie screenings,
posters, brochures, and articles. These methods do not directly require the active participation
of the population to which they are addressed. The audience is passive listeners, spectators, or
readers. The effectiveness of these methods is questionable (Estabrooks et al., 2017; Schafer
et al., 2021). Simply updating and imparting knowledge does not seem to result in a change
in attitude and behaviour. The attitude and behaviour of people is a long process that begins
in the early years of life and is the result of the influence of the biosocial environment, values
and habits that do not change easily with informative speeches or brochures.

Educational methods of active participation - These methods are summarized in research,

interviews, questionnaires, content analysis, simple and participatory observation, theatrical
play, peer tutoring etc. These methods are developed with the direct participation of the
population to which the programme is addressed and aim at its development and maturity,
their knowledge, their cultural and social level. They are considered more effective than
passive methods.

Experiential methods - They include emotional approaches and aim to boost the individual's
self-esteem, develop personal and social skills, and help the learner practice in choosing goals
and decisions. In addition to the activities mentioned in the active educational methods they
include approaches such as counseling, the circular diagram of experiential learning and
creative expression (Pau & Mutalik, 2017; Gardois et al., 2014).

A well-structured education and health promotion programme includes methods and

techniques of all types. This contributes to amultifaceted approach of the topic and responds
to the interests and abilities of more participants.
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Health promotion techniques
Planning models exist at a macroscopic level serving as an organising framework for an
entire health promotion effort (Crosby & Noar, 2011). There are five health promotion
programme planning models:

1. PRECED (Predisposing Reinforcing Enabling Constructs in Educational -

PROCEED(Policy Regulation Organisational Constructs in Education Environment
Development) model (PPM).

It focuses on investigating the causes of health-related behavioursrs and mostly refers to

needs assessment. It is largely based on voluntary cooperation and collective involvement.
Everyone with a common interest should present their views during the design.

In designing interventions, it includes the following phases:

• Social Diagnosis (what people believe)

• Epidemiological Diagnosis

• Behavioural Diagnosis (hierarchy of risk factors)

• Educational Diagnosis or Health Education Diagnosis (educational and ecological

diagnostics)

• Diagnosis of Effective Strategies

• Administrative Diagnosis (resources to ensure the programme)

• Evaluation of the Process.

• Evaluation of the Outcome of the Intervention

• Evaluation of the Final Outcome of the Intervention

2. PATCH (Planned Approach to Community Health) model

It is similar to the PRECEDE-PROCEED model and its main feature is the active
participation of the members of the target group in all phases of the design and
implementation of a health promotion and education programme. It may involve private,
state, and social actors where individuals are given a sense of support by these actors.

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Areas of Implementation: The programmes are implemented in various areas such as schools,
workplaces, health services and include campaigns by the media, involvement of politicians
etc. (Braverman et al., 2011).

There are five phases in the design of a programme: 1) Mobilisation of the Community. 2)
Collection and organisation of data on health issues. 3) Hierarchy of Health Needs.4)
Development of an integrated intervention plan. 5) Evaluation of the Programme.

3. Model of Community Organisation

Involves the design and implementation of health promotion and education programmes in
the community with emphasis on the involvement of important people for the community
from the initial stages. It distinguishes five stages: 1) analysis of the community; outlining its
profile and identifying its needs and resources, 2) programme planning and preparation, 3)
implementation, 4) maintenance and stabilisation and 5) dissemination and reassessment of
activities (Braverman et al., 2011).

4. Intervention Mapping Model

It suggests intervention at multiple levels, to bring effectiveness in a programme. It refers

simultaneously to levels of the individual and relationships between its members, group,
organisation, community, and society. It is based on the principle of interaction of the
individuals and their environment including family, social networks, organisations,
communities, and societies (Braverman et al., 2011).The action is carried out in five stages,
as follows: 1) identification and formulation of its immediate objectives; the objectives
mentioned concern both the target group and all groups of people who are connected to it,
e.g. in a programme to modify school environment, it not only focuses on the behaviour of
students but also on that of teachers, administration, etc 2) selection of models, methods and
strategies that match the programme, 3) design of the programme and preparation of its
implementation, 4) adoption of the programme and application - implementation and 5)
model evaluation.

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 5. ABC Model (Analysis of problem – Behavioural intervention – Continuation)

It is a combination of the previous models where during the design of a programme three
basic phases are distinguished: 1) analysis of the problem, 2) behavioural intervention and 3)
continuation.

Planned Actions:

 Analysis of the problem through the evaluation of the target group, the goal, and the
ways of approaching it, the assessment of its needs, the studied behaviour and its
causal factors. Needs are prioritised depending on the availability of resources and the
behaviour to be changed is determined (specifying whether the changes ultimately
concern the people who demonstrate it or the environment or both).

 Behavioural Intervention: definition of goals and objectives, selection of methods

and techniques, pilot implementation and evaluation

 Continuation: cross-sectoral cooperation with the help of support teams,

dissemination, and support policies (Braverman et al., 2011).

Determining the resources and capabilities

The planning stage is essentially the capture of all available resources, whether they relate to
material resources or human resources, but also an opportunity to identify any other
additional resources that will be necessary. Therefore, all the necessary resources should be
fully recorded in order to implement the planned health promotion activity.

The human resources that should be considered at this point relate to the skills, experiences,
competences and knowledge of the professional or group of health professionals who
organise the activity as well as the people of other specialties who contribute, the recipients
targeted for the activity, the people who can influence its recipients’ activities such as
relatives, colleagues and friends or role models such as athletes, religious leaders, artists, etc.
In addition to human resources, the assessment also concerns the financial resources, the
logistical infrastructure as well as the pre-existing policies and strategies.

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The application of health promotion interventions in different structures
Health promotion in educational structures

Schools and universities have developed a variety of health promotion strategies since the
early twentieth century. Over time, these initiatives have evolved into local, state, national,
and international health promotion programmes. It can be said that today, health promotion in
schools is based on a model of eight main interventions:

1. Health education: classroom education that addresses the physical, mental, emotional,
and social dimensions of health. It promotes knowledge, attitudes, and skills and
adapts to any age or developmental level - designed to motivate and help students
maintain and improve their health and reduce risk behaviours. Examples: Obesity
prevention programmes, diabetes prevention programmes, conflict resolution
programmes, special intervention weeks (diet, asthma, dentistry, etc.).

2. Physical education: planned, sequential training that promotes lifelong physical

activity. Examples: Sports and games, hiking and mountaineering, etc.

3. Health services: services that promote student health. It concerns the detection and
prevention of health problems and ensuring access to preventive services, emergency
services, referral, or management of acute or chronic illness. Examples: dental
information, vaccinations, asthma training, etc.

4. Nutrition services: nutrition education in an environment that promotes healthy

eating. Examples: healthy food in school canteens, personalized nutrition guidance,
etc.

5. Counselling, psychological and social services: services that prevent and address
problems facilitate positive learning and healthy behaviour, providing help that
focuses on students' cognitive, emotional, behavioural and social needs. Examples:
collaborations with mental health programmes and programmes on drugs and alcohol
consumption, social, emotional and behavioural support, promoting positive
behaviour in the classroom, etc.

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 6. Healthy school environment: creating a healthy and supportive environment that
promotes learning and addresses the physical, emotional, and social climate of the
school. Examples: competent liaisons with juvenile justice, security building, first aid
training, and action plan for school climate change, etc.

7. Promoting staff health: activities to assess, educate, maintain and improve the health
of school staff, acting as role models for students. Examples: health risk assessments,
health newsletter, workplace health promotion programme, etc.

8. Family and community involvement: developing relationships between schools,

families and the community, with the aim of interacting messages to achieve health
promotion goals. Examples: Community gait programme, family health interventions,
service arrangements with community health organisations (e.g., health examinations,
mental health care) (Tappe et al., 2014).

Health promotion in health organisations

Traditionally, health institutions and organisations have focused on the traditional role of
patient care, downplaying their role in promoting health. However, in the 1980s and 1990s
the healthcare system became more complex and costly. Concerns were raised about health
care costs and the continuing need for education, training, skills and information for patients
and their families (Giloth, 1990). Health organisations gradually launched health promotion
programmes that considered the unique characteristics of the hospital environment (for
example, the provision of services twenty-four hours a day, seven days a week). Public health
initiatives have taken place, in conjunction with scientific advances and technology, and new
health interventions have been proposed for prevention (Johnson, 2000).Examples of such
health promotion programmes:

 Patient and Family Health Education: Provision of programmes to manage cancer-

related fatigue, pain management, or support the caregivers of the chronically ill.

 Provision of clinical care to promote a healthy lifestyle: Encouragement of change to

reduce cancer risk, improve adherence to cancer treatment, enhance survival from
long-term effects of cancer treatment, and address psychosocial and behavioural
issues of cancer patient.

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  Cancer prevention. Promoting the science and application of cancer prevention in
minorities and vulnerable populations through multidisciplinary programmes (Villejo
et al., 2014).

Health promotion in the workplace

As the promotion of health in the workplace moves in the modern era, emphasis is placed on
protecting the health of workers, ensuring safe working conditions and insurance coverage
for employees and changes in lifestyle or attitudes, for the personal health of employees.
There is now a tendency for the employer to invest in employees' health, in order to ensure
maximum productivity and reduce absences for health reasons.

Workplace health promotion programmes have adopted an approach similar to that of school
health promotion programmes. Typically, an occupational health promotion programme
consists of health education programmes, a supportive social and physical environment, links
to related programmes, such as smoking cessation and health control, and appropriate follow-
up services (Linnan et al., 2014).

An important concluding remark.

Figure 3 below present an improved and much more detailed version of the on present in the
beginning of this weekly overview in figure 1. This improved rendering is also very helpful
to the students to understand better the important steps in the planning and development of
health promotion interventions.

Figure 3: Health Promotion planning cycle

Source: https://nursekey.com/planning-health-promotion-interventions/

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 Table 3: Possible mistakes from omissions at the design stage

 Intervention for a problem that is insignificant. For example, there is no reason to

organise a smoking cessation programme in a school with a lot of sports activity
and low rates of smokers.

 Intervention aimed at unhealthy behaviours e.g., intervention that considers alcohol

abuse as a risk factor for cancer, without considering that the combination of
alcohol and smoking can increase the chances of developing cancer.

 The non-involvement of the target group.

 Intervention addressed to the wrong target group. e.g., a healthy eating programme
in a school whose canteen does not have healthy options cannot be addressed only
to students but also to those in charge of the canteen.

 Intervention dealing with the wrong causal factor. For example, in a smoking
cessation programme, the exclusion of the role of the peer pressure as a stimulus for
smoking.

 Developing a programme without clearly stating its goals and objectives.

 The non-"pilot" implementation of the programme.

 Incomplete or absent dynamic evaluation in all phases of the programme.

 Implementation of a programme without the appropriate support.

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