COMMUNITY DIAGNOSIS

PROCESS

PEMBEKALAN KEPANITERAAN KLINIK MADYA

DEP. IKM-KP FKUB
Objectives
 Memahami konsep dan tujuan diagnosis komunitas
 Memahami proses diagnosis komunitas
 Mampu mengidentifikasi masalah
 Mampu menerapkan metode penentuan prioritas masalah
 Mampu menyusun rencana program intervensi promosi
kesehatan
 Memahami konsep evaluasi program
Topics
 Community diagnosis concept:
 The definition and aim
 The community diagnosis cycle
 Community diagnosis process:
 The process
 Determine data needed & source of information
 Determine community diagnosis
 Analyzing data
 Determine health priorities
 Determine risk factor and community level indicator
Community diagnosis concept

 to identify the health problem and factors

that affect the health of population and
determine the availability resources
within the community to adequately
address these factors
Perbedaan antara Diagnosis komunitas dan Diagnosis Klinis
No Diagnosis Klinis Diagnosis Komunitas
1 Dilakukan oleh dokter Dilakukan oleh dokter atau epidemiologis
2 Fokus perhatian : pasien Fokus perhatian : komunitas / masyarakat
3 Fokus perhatian : hanya orang sakit Fokus perhatian : orang sakit dan sehat
4 Dilakukan dengan memeriksa pasien Dilakukan dengan cara survey
5 Diagnosis didapat berdasarkan Diagnosis didasarkan atas Riwayat
keluhan dan simtom Alamiah Perjalanan Penyakit ( Natural
history of disease)
6 Memerlukan pemeriksaan laboratorium Memerlukan penelitian epidemiologi
7 Dokter menentukan pengobatan Dokter/epidemiologis merencanakan
plan of action
8 Pengobatan pasien menjadi tujuan Pencegahan dan Promosi menjadi
utama tujuan utama
9 Diikiuti dengan follow up kasus Diikuti dengan program evaluasi
10 Dokter tertarik menggunakan teknologi Dokter/epidemiologis tertarik dengan
tinggi nilai2 statistik
Community diagnosis process

Step 1 •Establishing a community

Assessment team

•Analyzing the county

Step 2 health data book
(secondary data)

•Collecting
Step 3 community data
(primary data)

Step 4 •Combine data

Community diagnosis process

Step 5 •Choosing health priorities

•Developing
Step 6 community health
action plan

•Measuring
Step 7 environmental &
policy changes

•Creating
community
Step 8 assessment
document
Step 1. The Team
Step 2, 3 and 4:
Community diagnosis
process

Establishing community
assessment team

Secondary data Primary data

Data Analysis
(combining data)
List of Problem

Health problem Health Action

priorities Plan
Analysis of risk factor and
resources
Data collection
What are our problems?
What factors contribute to these problems?
What resources are available in the community
to address these problem?

Data? Blum/Lalonde Theory

Source of Information?
Data Collection

Psychobiologic

Environment Health Status Lifestyle

Health Services
Data Collection

Nutrition, Violence,
Immunization

Pollution, Insurance,
Morbidity, Disability,
Sanitation, smoking
Mortality Data
Demography behavior

Health Facilities,
Health Provider,
Utilization
Questions to be Answered by
Community Assessment
 What are the demographic, social & economic
characteristics of the community?
 What is the health status?
 What are the levels of health risk?
 What is the utilization pattern for health services?
 What are the key environmental & occupational health
issues?
 What are the expenditures for health care services?
 What are the available community health resources?
 Is the supply of health care providers sufficient?
 Does the population have access to health care?
 Source of Information

 Primary Data  Secondary Data

 Community perception  Puskesmas data
survey  BKKBN
 Focus Group
 BPS
Discussion
 Hospital data
 Community leader
interview  Provincial data
Data Processing and Analysis

 Entry the data

 Summarize : table and graph
 Analysis:
 Compare with provincial, national or target
 Made a trend analysis if possible
 Analysis the relationship between problem identified
Analyzing Data

•Comparing with national or provincial data

•Understanding the local pattern
•Inferring the impact on community health

•List of health problems and relevant risk

factors
•List of community strengths
 Problem Identification and
Selection

• List of problems?
• Related problem or independent problem?
• What is the underlying problem?
• Can we address all the problem?
• Choosing health problem priority
 Step 5
Determine health priorities
Metode penentuan prioritas
masalah
 Multi-voting technique 
 Strategy grids
 Nominal Group Technique 
 The Hanlon Method 
 Criteria Matrix Technique 
 PAHO
 CARL
 REINKE
 BRYANT
Multi-voting technique

 Multi-voting is typically used when a long list of health problems or

issues must be narrowed down to a top few
 Misalnya ada 12 masalah kesehatan yang ditemukan di komunitas
(pada akhirnya akan dipilih 1 masalah untuk diintervensi)
 Ronde 1: Setiap orang menulis di kertas masalah apa saja yang
diprioritaskan
 Direkap  6 masalah
 Ronde 2  3 masalah
 Ronde 3  1 masalah
Nominal Group Technique
 Nominal (meaning in name only) group technique (NGT) is a
structured variation of a small-group discussion to reach
consensus.
 NGT gathers information by asking individuals to respond to
questions posed by a moderator, and then asking
participants to prioritize the ideas or suggestions of all group
members.
 The process prevents the domination of the discussion by a
single person, encourages all group members to participate,
and results in a set of prioritized solutions or recommendations
that represent the group’s preferences.
Nominal Group Technique
HOW TO PREPARE
 The Meeting Room
Prepare a room large enough to accommodate five to nine
participants. Organize the tables in a U-shape, with a flip chart at the
open end of the U.
 Supplies
Each U-shaped table set up will need a flip chart; a large felt-tip pen;
masking tape; and paper, pencil, and 3” x 5” index cards for each
participant.
 Opening Statement
This statement clarifies member roles and group objectives, and should
include: a warm welcome, a statement of the importance of the task,
a mention of the importance of each member’s contribution, and an
indication of how the group’s output will be used.
Nominal Group Technique
Steps:
1. Generating ideas
 Each person silently generates ideas and write them down
2. Recording ideas
 The moderator writes an idea from a group member on a flip
chart that is visible to the entire group, and proceeds to ask for
another idea from the next group member, and so on.
3. Discussing ideas
 This step provides an opportunity for members to express
their understanding of the logic and the relative
importance of the item.
3. Voting on ideas
Contoh Isi index card si A
Masalah Prioritas
Cakupan pelayanan komplikasi
ibu hamil di Puskesmas
mencapai 19,5% pada trimester I
dari target 88% selama 1 tahun
Cakupan pelayanan bayi dan
balita di Puskesmas mencapai
12,47% pada trimester I dari
target 90% selama 1 tahun
Adanya 1 kasus kematian akibat
DHF yang sebelumnya tidak ada
(KLB)
Contoh Isi index card si E
Masalah Prioritas
Cakupan pelayanan komplikasi
2 ibu hamil di Puskesmas
mencapai 19,5% pada trimester I 3
dari target 88% selama 1 tahun
Cakupan pelayanan bayi dan
3 balita di Puskesmas mencapai
12,47% pada trimester I dari 1
target 90% selama 1 tahun
Adanya 1 kasus kematian akibat
1 DHF yang sebelumnya tidak ada
(KLB)
2
Contoh Rekap Hasil Voting NGT

No Masalah Jumlah pemilih Prioritas

1 Cakupan pelayanan komplikasi 1, 1, 1, 1, 1 II
ibu hamil di Puskesmas 2, 2, 2, 2, 2, 2
mencapai 19,5% pada trimester I 3, 3
dari target 88% selama 1 tahun
2 Cakupan pelayanan bayi dan 1, 1, 1, 1, 1, 1 I
balita di Puskesmas mencapai 2, 2, 2, 2
12,47% pada trimester I dari 3, 3
target 90% selama 1 tahun
3 Adanya 1 kasus kematian akibat
1, 1 III
2
DHF yang sebelumnya tidak ada
3, 3, 3, 3, 3, 3, 3,
(KLB)
3,3
HANLON method

 the Hanlon Method is advantageous when the desired

outcome is an objective list of health priorities based on
baseline data and numerical values
 lebih tepat digunakan untuk menentukan prioritas
masalah kesehatan dengan memperhatikan teknik
responsive dimana tujuan yang dicapai dari program
jelas yang dituangkan dalam criteria dan faktor-faktor
lain yang memungkinkan
HANLON method

1. Menentukan skor ranking dengan kriteria spesifik

2. Memasukan nilai rangking dengan metode
PEARL
3. Menghitung prioritas dengan scoring
4. Mengurutkan masalah kesehatan.
Langkah 1
Menentukan skor ranking berdasarkan
kriteria Rangking Besaran masalah Keseriusan masalah Effektivitas masalah
(% dari masalah (masalah dapat tertangai)
kesehatan)
9-10 > 25% Sangat serius 80-100% dapat ditangani
7-8 10-24,9% Relative serius 60%-80%
5-6 1-9,9% Serius 40-60%
3-4 0,1-0,09% Serius sedang 20-40%
1-2 < 0,01% Relative tidak serius 5-20%
0 Tidak serius < 5%
Besaran masalah Keseriusan masalah Kemudahan intervensi
dapat diperoleh didasarkan pada: dilakukan didasarkan
dari data dasar a. apakah Masalah menjadi pada:
individu dan perhatian utama Faktor terkait dengan
masyarakat masyarakat tinggi dan rendahnya
b. Apakah masalah Intervensi potensial dapat
merupakan kebutuhan dilakukan.
masyarakat
c. Apa dampak ekonomi
yang timbul
d. Apa dampak terhadap
kualitas hidup..?
e. Apakah terdapat fasilitas
layanan rumah sakit..?
Langkah 1
Menentukan ranking berdasarkan kriteria
No A B C
magnitude severity feasibility

1 Cakupan pelayanan komplikasi ibu hamil di 5 8 6

Puskesmas Dau mencapai 19,5% pada trimester
I dari target 88% selama 1 tahun

2 Cakupan pelayanan bayi dan balita di 6 8 8

Puskesmas Dau mencapai 12,47% pada
trimester I dari target 90% selama 1 tahun

3 Cakupan penemuan dan penanggulangan 8 8 4

pasien baru TB BTA positif di Puskesmas Dau
mencapai 13,23% pada trimester I dari target
60% selama 1 tahun

4 Adanya 1 kasus kematian akibat DHF yang 8 9 7

sebelumnya tidak ada (KLB)
Langkah 2
Menggunakan PEARL test
 Propriety
 Apakah program intervensi tepat mengatasi masalah yang ada?
 Ekonomis
 Apakah ada dampak ekonomi dari masalah kesehatan? Apakah ada masalah ekonomi jika
masalah tidak ditangani?
 Acceptability
 Akankan masyarakat dapat menerima program yang diberikan..? atau apakah masyarakat
menginginkan/membutuhkan..?
 Resources
 Apakah sumber daya tersedia atau potensial tersedia untuk pelaksanaan program?
 Legality
 Apakah aktivitas program dapat diimplementasi sesuai ketentuan hukum atau peraturan
yang berlaku?
Langkah 2
Menggunakan PEARL test
No P E A R L

1 Cakupan pelayanan komplikasi ibu hamil di Y Y Y Y Y

Puskesmas mencapai 19,5% pada trimester I
dari target 88% selama 1 tahun

2 Cakupan pelayanan bayi dan balita di Y Y Y Y Y

Puskesmas mencapai 12,47% pada trimester
I dari target 90% selama 1 tahun

3 Cakupan penemuan dan penanggulangan Y Y Y N Y

pasien baru TB BTA positif di Puskesmas deleted
mencapai 13,23% pada trimester I dari target
60% selama 1 tahun

4 Adanya 1 kasus kematian akibat DHF yang Y Y Y Y Y

sebelumnya tidak ada (KLB)
No.3
Menghitung prioritas dengan skoring

D = [A+(2xB)]x C
 D = skor prioritas
 A = besaran rangking masalah kesehatan
 B = Keseriusan masalah kesehatan
 C = Potensial tindakan dapat dilakukan
No.3
Menghitung prioritas dengan skoring
No A B C D Prioritas
magnitude severity feasibility

Cakupan pelayanan komplikasi ibu

hamil di Puskesmas mencapai 19,5%
1
pada trimester I dari target 88%
5 8 6 126 III
selama 1 tahun

Cakupan pelayanan bayi dan balita di

Puskesmas mencapai 12,47% pada
2
trimester I dari target 90% selama 1
6 8 8 176 II
tahun

Adanya 1 kasus kematian akibat DHF

3
yang sebelumnya tidak ada (KLB)
8 9 7 182 I
Criteria Matrix Technique
 Untuk menentukan prioritas masalah digunakan beberapa kriteria.
Secara garis besar ada 3 kriteria yaitu:
1. IMPORTANCE
 Besarnya masalah (Prevalence)
 Akibat yang ditimbulkan oleh masalah (Severity)
 Kenaikan besaran masalah (Rate of Increase)
 Derajat keinginan masyarakat yang tidak dipenuhi (Degree of
Unmeet need)
 Keuntungan sosial karena selesainya masalah (Social Benefit)
 Rasa prihatin masyarakat terhadap masalah (Public Concern)
 Suasana plitik (Political Climate)
2. Technical Feasibility
3. Resource Avalability
Criteria Matrix Technique
 Beri nilai skor antara 1 (tidak penting) sampai 5 (sangat penting)
untuk setiap kriteria.
 Prioritas masalah adalah yang jumlah nilainya paling besar.

 Skor = I x T x R (I = P+S+RI+DU+SB+PB+PC)

Importance
No Masalah T R Skor Prioritas
P S RI DU SB PB PC
1 A 5 4 3 4 2 3 1 3 4 264 2
2 B 2 5 3 2 5 4 3 5 3 360 1
3 C 1 2 1 1 3 2 4 3 3 126 3
 SETELAH
MENENTUKAN PRIORITAS
MASALAH MAKA DILANJUTKAN
MEMBUAT RENCANA INTERVENSI
 Data sekunder + Diskusi dg Menentukan
Pembimbing lapangan masalah

Survey Identifikasi karakteristik

kelompok sasaran &
(Data Primer) faktor risiko

Analisis data primer + Konfirmasi faktor

sekunder risiko yang akan
diintervensi
& penentuan
intervensi (solusi)
Menyusun rencana kegiatan
(Goal, Objectives, Sub-
objectives, Intervensi, Evaluasi)

Action

Evaluasi & Laporan

 PLANNING HEALTH
PROMOTION ACTION
Planning models

Social Ecological Model

• Interrelationship of human beings and their
environments

PRECEDE-PROCEED model
• uses an ecological approach to program
planning and is considered by many to be
the gold standard in health promotion
planning
Planning models

Multilevel Approach to
Community Health (MATCH)
• focuses on assessing population health and
working with communities to address the
identified health issues
Consumer-based planning
models
• Focus on intended audience, borrowing
concepts from business marketing field
Precede/proceed model

PRECEDE PROCEED
P  Predisposing P  Policy
R  Reinforcing R  Regulatory
E  Enabling O  Organizational
C  Causes in C  Constructs in
E  Educational E  Educational and
D  Diagnosis and E  Environmental
E  Evaluation D  Development
Precede/proceed model

 Phase 1: Social assessment

 Phase 2: Epidemiological assessment
 Phase 3: Behavioral and Environmental assessment
 Phase 4: Educational and Ecological assessment
 Phase 5: Administrative and Policy assessment
 Phase 6: Program implementation
 Phase 7: Process evaluation
 Phase 8: Impact evaluation
 Phase 9: Outcome evaluation
 PHASE 1
ask the community what it wants and needs
to improve its quality of life
 PHASE 2
identify the health or other issues that most
clearly influence the outcome the community
seeks
 PHASE 3
identify the behaviors and lifestyles and/or
environmental factors that must be changed
 PHASE 4
identify the predisposing, enabling, and
reinforcing factors that act as supports for or
barriers to changing the behaviors and
environmental factors
Analysis of the factors contributing
to the health problem

 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
 PHASE 5
identify (and adjust where necessary) internal
and external policy issues that can affect the
successful conduct of the intervention
 PHASE 6
Implementation of the intervention
PHASE 7, 8 & 9
Evaluation
What is health promotion?

Combination of educational, organisational,

economic, social and political actions designed
with meaningful participation, to enable
individuals, groups and whole communities to
increase control over, and to improve their health
through attitudinal, behavioural, social and
environmental changes

Howatt et al. (2003)

 Health Promotion

health education
- behavioural
- structural attitudinal
------------------------- behavioural
organisational environmental
actions and Improved
------------------------- social Health
economic status
changes
actions
conducive
-------------------------
to health
political actions
Including advocacy
 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
TARGET GROUP
 Primary
 persons whose behaviour is to be modified
 It is shown from the number or focus of interventions developed

 Secondary
 people who will be used as intermediaries to get the message across to the
first target group
 People who are around the primary group

 Tertiary
 people who can facilitate the communication process and behaviour
change
 People who has authorities in the community
Identifying Risk factors Using
Fishbone Diagram
 Fungsi dasar diagram Fishbone (Tulang Ikan) adalah
untuk mengidentifikasi dan mengorganisasi penyebab-
penyebab yang mungkin timbul dari suatu efek spesifik
dan kemudian memisahkan akar penyebabnya
fishbone
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
 corresponds to

GOAL Health Problem

OBJECTIVE Risk Factor

SUB-OBJECTIVE Contributing
Risk Factor
Example

Health Problem Goal

 Angka kejadian Diare  Menurunkan angka
di Desa Tumpakrejo kejadian diare di Desa
Tumpakrejo menjadi
sebesar 0.74% sebesar 0.5% dalam
waktu 1 tahun

Risk Factor Objective

 Kurangnya pengetahuan  Meningkatkan proporsi
warga tentang perilaku warga yang memiliki
hidup bersih dan sehat pengetahuan PHBS
kategori baik sebesar
minimal 75%
Example
Contributing Risk
Factor
 Warga tidak suka
menghadiri acara
penyuluhan (predisposing)
 Jumlah kader yang memiliki
pengetahuan baik tentang
PHBS masih sedikit(enabling)
 Belum ada peraturan dari
Desa terkait PHBS
(reinforcing)
Sub-Objective
 Meningkatkan jumlah
warga yang bersedia hadir
pada acara penyuluhan
kesehatan
 Meningkatkan jumlah kader
yang memiliki pengetahuan
baik tentang PHBS
 Melakukan advokasi ke
perangkat desa untuk
membuat draft perdes
tentang PHBS
Writing GOAL and
OBJECTIVES

 Should be SMART:
› Specific
› Measurable
› Achievable
› Relevant
› Time Specific
Example

 Meningkatkan proporsi warga yang

bersedia hadir pada acara
penyuluhan kesehatan menjadi 90%
dalam waktu 3 bulan
 Untuk
meningkatkan proporsi kader
kesehatan yang memiliki
pengetahuan PHBS kategori baik
menjadi 80% sampai akhir program
HEALTH PROMOTION
METHODS

Choice of Methods
 Four factors determine the choice of methods:
 Time
 Audience
 Environment
 Outcome
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 Description
group
method
Lecture - Best for knowledge transmission or motivation in
discussion 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 Opportunity for group learning with professionals,
conferencing such as rural and remote doctors, nurses, and so
on.
FOCUS ON GROUP
Experiential Description
group
method
Skills training Requires motivated individuals. Includes
explanation, demonstration and practice; for
example relaxation, childbirth, exercise
Behaviour Learning and unlearning of specific habits.
modification Stimulus-response learning. Generally behaviour-
specific; for example smoking cessation, phobia
desensitisation
Inquiry Used mainly in school settings. Requires
learning formulating and problem solving through group
cooperation
Peer group Useful where shared experiences, support and
discussion awareness are important. Participants
homogenous in at least one factor; for example
old people, prisoners, teenagers.
FOCUS ON GROUP
Experiential Description
group
method
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.
Choosing media methods
 Factors:
 Goals and objectives (outcomes)
 Cost

 Effectiveness

 Complexity of messages delivered

 Time

 Relationship with the media

 Type of media available
A summary of media method
Limited reach media

Type Characteristics
Pamphlets Information transmission. Best where cognition rather than
emotion is desired outcome.
Information Quick convenient information. Use as series with storage folder.
sheets 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’
EVALUATION
EVALUATION IN HEALTH
PROMOTION

Types of evaluation
 Process Evaluation
 Measures the activities of the program, program quality
and who it is reaching
 Impact Evaluation
 Measures the immediate effect of the program (does it
meet its objectives?)
 Outcome Evaluation
 Measures the long-term effect of the program (does it
meet its goal?)
 PROCESS EVALUATION

The main questions in process evaluation

1. Is the program reaching the target group? Are all parts of the
program reaching all parts of the target group?
2. Are participants satisfied with the program?
3. Are all the activities of the program being implemented?
4. Are all materials and components of the program of good quality?
Process evaluation: ASSESSING
PROGRAM REACH

 The number of people who participate in the

program (attendance list)
 Survey where are those people coming from?
Where did they see or hear about the program?
Process evaluation: ASSESSING
PARTICIPANT SATISFACTION

 Questionnaire
 It only works well with a group which
has no reading or language problems
 Group Interview (Focus Group)
Process evaluation: ASSESSING PROGRAM
MATERIALS AND COMPONENTS

 Leaflets and Audiovisual Materials

 Attraction
 Comprehension
 Acceptability
 Personal Involvement
 Persuasion
 ATTRACTION
 Does the leaflet create interest? Catch people’s attention? What do
people like most and least about it?
 COMPREHENSION
 Is the leaflet easy to understand? Is there anything confusing in the
leaflet?
 ACCEPTABILITY
 Is there anything offensive or irritating in the leaflet? Does it conflict with
cultural norms?
 PERSONAL INVOLVEMENT
 Does the leaflet seem to be directed at the reader personally?
 PERSUASION
 Is the leaflet convincing? Does it seem to persuade the reader to do
something?
IMPACT AND OUTCOME EVALUATION

 The better the evaluation design and methods

that we use in assessing impact and outcome, the
more confident we can be that the observed
effects of a program were caused by the
intervention and did not occur by chance or
were not due to other factors or influences
Impact Evaluation:
 immediate effects;
 evaluates objectives;
 conducted immediately
after a program/project;
 short-term changes in
awareness, knowledge,
attitudes, structural changes,
attendance figures;
 utilises record keeping,
surveys, observation,
qualitative and quantitative
methods.
Outcome Evaluation:
 longer-term effects;
 evaluates goals / aims;
 conducted some time after
the program/project;
 assesses longer-term
changes in knowledge,
attitudes, skills, behaviours,
morbidity and mortality
 utilises record keeping,
surveys, observation,
qualitative and quantitative
methods.
Evaluation Design

 There is no single, perfect evaluation design that is best for all health
promotion programs, or even for a specific type of health promotion
evaluation task
 “...it all depends”
 Objectives
 Practicalities
 $$$$
Symbols for Designs

X = intervention
O = observation/measurement

Intervention O1 X1 O2 X2 O3 O4
Control O1 O2 O3 O4
Design 1
 Single Group, Post-Test only

X___________O
 Problems
 Did a change really occur?
 What did people start at?
 Was the change due to your program?
 Advantage
 Quick, not attrition, cheap
Design 2:

 Single Group, Pre-test & Post-test

O1___________X___________ O2

 Advantage
 Ability to detect if a change has occurred
 Problem
 Was the change because of your intervention/
program?
Design 3
 Non-Equivalent Comparison Groups Post-test
only
X________________O
________________O
 Advantage
 Avoids effect of pre-measurement (test effects), i.e.
can be an intervention itself
 Problem
 Was the change because of your intervention?
 Were both groups the same when the program
began?
 Design 4

 Non-equivalent Comparison Groups - Pre-test

& Post-test
O1 _________X____________ O2
O1 ______________________ O2
 Advantage:
 Compare results of people who do and do not
receive the program
 Know what groups have changed from (ie were
they the same at the start)
(This is a stronger design but ...)
Design 4, Continued...

 Problem
 Similarto design 3, unsure if change was your
intervention
 May need to control for known differences
between groups (strengthen design)
 Cost
 Finding
appropriate comparison group
 Contamination of comparison group
 Extentto which program can be generalised
from one group to another
Design 5
 Randomised Control Trial (Equivalent Groups, Pre/ Post
test)
O1 __________X__________ O2
Population R
O1 ______________________ O2

 Rules out alternative explanations

 Cost?
 Strong design
Design 6
 Single Group Time Series

O1____O2_____O3___X___O4____O5____O6

 Advantage
 Observe natural changes (size & direction) before & after
program
 Best used for program subject to seasonal / cyclical
changes
 Problem
 Testing effect
 Cost
Other Designs

 Staggered Designs
O1_____X1____O2
O1_____X1____O2

 Cross-over designs
O1_____X1____O2___________O3
O1____________O2____ X1____O3
Which Design?

 Some are better than others

 Which design produces better evidence that your program
has worked?
 Choosing a design will depend on what information you
want, what you need and what you are practically able to
get given resources and time constraints
 Usually, as a minimum, aim for a single group, pre-test &
post-test design
Instruments of evaluation

PROCESS EVALUATION IMPACT EVALUATION

 Daftar hadir peserta  Pre-test & post-test
 Observation sheet  Pengetahuan
 Antusiasme, keaktifan peserta  Sikap

 Kuesioner kepuasan  Perilaku (self-reported)

 Checklist  Observation sheet, Photo/Video

recording
 Keterlaksanaan acara sesuai
rencana  Pengamatan perilaku
 Perubahan lingkungan
 Checklist
Questions?