Planning, Implementing, & Evaluating Health Promotion

Programs A Primer (6th Edition), 6th Edition

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Library of Congress Cataloging-in-Publication Data

McKenzie, James F.
   Planning, implementing, and evaluating health promotion programs : a primer / James F.
McKenzie, Brad L. Neiger, Rosemary Thackeray. — 6th ed.
    p. ; cm.
   Includes bibliographical references.
   ISBN 978-0-321-78850-4 — ISBN 0-321-78850-8
I. Neiger, Brad L. II. Thackeray, Rosemary. III. Title.
   [DNLM: 1. Health Promotion—United States. 2. Health Education—United States.
3. Health Planning—United States. 4. Program Evaluation—United States. WA 590]

613.0973—dc23
2011053408

ISBN-10: 0-321-78850-8
ISBN-13: 978-0-321-78850-4

www.pearsonhighered.com 1 2 3 4 5 6 7 8 9 10—RRD—16 15 14 13 12
 This book is dedicated to seven special people—
Bonnie, Anne, Greg, Mitchell, Julia, Sherry, and Callie Rose

and to our teachers and mentors—

Marshall H. Becker (deceased), Mary K. Beyer, Noreen Clark, Enrico A. Leopardi,
Brad L. Neiger, Lynne Nilson, Terry W. Parsons, Glenn E. Richardson, Irwin M.
Rosenstock (deceased), Yuzuru Takeshita, and Doug Vilnius
This page intentionally left blank
 Contents

Preface. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xiii

Chapter 1 Health Education, Health Promotion, Health Education

Specialists, and Program Planning . . . . . . . . . . . . . . . . . . . . . . . . . 1
Health Education and Health Promotion. . . . . . . . . . . . . . . . . . . . . 4
Health Education Specialists. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
Assumptions of Health Promotion. . . . . . . . . . . . . . . . . . . . . . . . . 10
Program Planning. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
Review Questions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
Activities. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
Weblinks. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15

Part I Planning a Health Promotion Program . . . . . . . . . . . . . . . 17

Chapter 2 Starting the Planning Process. . . . . . . . . . . . . . . . . . . . . . . . . . . . 18

The Need for Creating a Rationale to Gain the Support of
Decision Makers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
Steps in Creating a Program Rationale. . . . . . . . . . . . . . . . . . . . . . 21
Step 1: Identify Appropriate Background Information. . . . . . . . 21
Step 2: Titling the Rationale. . . . . . . . . . . . . . . . . . . . . . . . . . . . 28
Step 3: Writing the Content of the Rationale . . . . . . . . . . . . . . . 28
Step 4: Listing the References Used to Create the
Rationale. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31
Planning Committee. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31
Parameters for Planning. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34
Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35
Review Questions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35
Activities. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36
Example 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37

v
vi contents

Example 2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39
Weblinks. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41

Chapter 3 Models for Program Planning in Health Promotion. . . . . . . . . . . . 43

Generalized Model. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49
PRECEDE‐PROCEED . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53
The Eight Phases of PRECEDE‐PROCEED . . . . . . . . . . . . . . . . 53
Mobilizing for Action through Planning and Partnerships
(MAPP) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55
MAP‐IT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57
SMART . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58
The Phases of SMART. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60
Other Planning Models. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63
SWOT (Strengths, Weaknesses, Opportunities, Threats)
Analysis. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63
Healthy Communities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 64
The Health Communication Model. . . . . . . . . . . . . . . . . . . . . . 65
Intervention Mapping . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66
Healthy Plan‐It. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66
Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67
Review Questions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 68
Activities. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 68
Weblinks. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69

Chapter 4 Assessing Needs. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71

What to Expect from a Needs Assessment . . . . . . . . . . . . . . . . . . . 74
Acquiring Needs Assessment Data . . . . . . . . . . . . . . . . . . . . . . . . . 74
Sources of Primary Data. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75
Sources of Secondary Data. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 86
Steps for Conducting a Literature Search. . . . . . . . . . . . . . . . . . 92
Using Technology to Map Needs Assessment Data. . . . . . . . . . . 94
Conducting a Needs Assessment. . . . . . . . . . . . . . . . . . . . . . . . . . . 95
Step 1: Determining the Purpose and Scope of the Needs
Assessment. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 95
Step 2: Gathering Data. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 96
Step 3: Analyzing the Data. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 97
Step 4: Identifying the Risk Factors Linked to the
Health Problem. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 102
Step 5: Identifying the Program Focus . . . . . . . . . . . . . . . . . . . 102
 contents vii

Step 6: Validating the Prioritized Needs. . . . . . . . . . . . . . . . . . 103

Application of the Six-Step Needs
Assessment Process . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 104
Heath Impact Assessment. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 106
Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 107
Review Questions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 107
Activities. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 108
Weblinks. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 109

Chapter 5 Measurement, Measures, Measurement Instruments,

and Sampling. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 111
Measurement. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 112
The Importance of Measurement in Program Planning
and Evaluation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 114
Levels of Measurement. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 114
Types of Measures. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 116
Desirable Characteristics of Data. . . . . . . . . . . . . . . . . . . . . . . . . 117
Reliability. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 118
Validity. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 119
Fairness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 121
Bias Free. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 122
Measurement Instruments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 123
Using an Existing Measurement Instrument. . . . . . . . . . . . . . . 124
Creating a Measurement Instrument . . . . . . . . . . . . . . . . . . . . 125
Sampling. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 129
Probability Sample. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 130
Nonprobability Sample . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 133
Sample Size . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 134
Pilot Testing. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 135
Ethical Issues Associated with Measurement. . . . . . . . . . . . . . . . . 137
Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 137
Review Questions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 138
Activities. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 138
Weblinks. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 139

Chapter 6 Mission Statement, Goals, and Objectives. . . . . . . . . . . . . . . . . . 141

Mission Statement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 143
Program Goals. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 144
viii contents

Objectives. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 145
Different Levels of Objectives. . . . . . . . . . . . . . . . . . . . . . . . . . 145
Developing Objectives. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 147
Criteria for Developing Objectives. . . . . . . . . . . . . . . . . . . . . . 147
Elements of an Objective. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 148
Goals and Objectives for the Nation. . . . . . . . . . . . . . . . . . . . . . . 150
Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 159
Review Questions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 159
Activities. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 159
Weblinks. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 160

Chapter 7 Theories and Models Commonly Used for Health Promotion

Interventions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 162
Types of Theories and Models . . . . . . . . . . . . . . . . . . . . . . . . . . . 166
Behavior Change Theories . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 166
Intrapersonal Level Theories . . . . . . . . . . . . . . . . . . . . . . . . . . 168
Interpersonal Level Theories. . . . . . . . . . . . . . . . . . . . . . . . . . . 188
Community Level Theories. . . . . . . . . . . . . . . . . . . . . . . . . . . . 195
Cognitive‐Behavioral Model of the Relapse Process. . . . . . . . . . . 197
Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 200
Review Questions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 200
Activities. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 202
Weblinks. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 203

Chapter 8 Interventions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 205

Types of Intervention Strategies . . . . . . . . . . . . . . . . . . . . . . . . . . 208
Health Communication Strategies . . . . . . . . . . . . . . . . . . . . . . 208
Health Education Strategies. . . . . . . . . . . . . . . . . . . . . . . . . . . 219
Health Policy/Enforcement Strategies. . . . . . . . . . . . . . . . . . . . 224
Environmental Change Strategies. . . . . . . . . . . . . . . . . . . . . . . 227
Health‐Related Community Service Strategies . . . . . . . . . . . . . 228
Community Mobilization Strategies. . . . . . . . . . . . . . . . . . . . . 228
Other Strategies. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 232
Creating Health Promotion Interventions. . . . . . . . . . . . . . . . . . . 241
Criteria and Guidelines for Developing Health
Promotion Interventions . . . . . . . . . . . . . . . . . . . . . . . . . . . 241
Designing Appropriate Interventions . . . . . . . . . . . . . . . . . . . . 242
Adapting a Health Promotion Intervention . . . . . . . . . . . . . . . 249
 contents ix

Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 251
Review Questions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 251
Activities. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 252
Weblinks. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 253

Chapter 9 Community Organizing and Community Building . . . . . . . . . . . . 255

Community Organizing Background and Assumptions. . . . . . . . . 257
The Processes of Community Organizing and Community
Building. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 259
Recognizing the Issue. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 261
Gaining Entry into the Community . . . . . . . . . . . . . . . . . . . . . 263
Organizing the People . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 264
Assessing the Community. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 268
Determining Priorities and Setting Goals. . . . . . . . . . . . . . . . . 270
Arriving at a Solution and Selecting Intervention Strategies. . . 273
Final Steps in the Community Organizing and Building
Processes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 274
Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 274
Review Questions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 275
Activities. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 275
Weblinks. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 276

Part II Implementing a Health Promotion Program . . . . . . . . . 279

Chapter 10 Identification and Allocation of Resources . . . . . . . . . . . . . . . . . 280

Personnel . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 281
Internal Personnel . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 282
External Personnel. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 284
Combination of Internal and External Personnel. . . . . . . . . . . 285
Items Related to Personnel. . . . . . . . . . . . . . . . . . . . . . . . . . . . 285
Curricula and Other Instructional Resources. . . . . . . . . . . . . . . . 292
Space . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 295
Equipment and Supplies. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 296
Financial Resources . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 297
Participant Fee. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 297
Third‐Party Support. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 298
Cost Sharing. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 298
Cooperative Agreements. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 298
x contents

Organizational Sponsorship. . . . . . . . . . . . . . . . . . . . . . . . . . . 299

Grants and Gifts. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 299
Combining Sources . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 302
Preparing and Monitoring a Budget. . . . . . . . . . . . . . . . . . . . . 302
Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 307
Review Questions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 307
Activities. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 307
Weblinks. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 308

Chapter 11 Marketing: Developing Programs That Respond to the Wants

and Needs of the Priority Population. . . . . . . . . . . . . . . . . . . . . . 311
Marketing and Social Marketing . . . . . . . . . . . . . . . . . . . . . . . . . 312
Exchange. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 313
The Marketing Process and Health Promotion Programs. . . . . . . 314
Consumer Orientation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 314
Segmentation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 316
Marketing and the Diffusion Theory . . . . . . . . . . . . . . . . . . . . 322
Marketing Mix. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 324
Pretesting. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 335
Continuous Monitoring. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 337
Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 339
Review Questions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 339
Activities. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 339
Weblinks. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 340

Chapter 12 Implementation: Strategies and Associated Concerns. . . . . . . . . 342

Logic Models. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 343
Defining Implementation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 346
Phases of Program Implementation. . . . . . . . . . . . . . . . . . . . . . . . 346
Phase 1: Adoption of the Program. . . . . . . . . . . . . . . . . . . . . . 347
Phase 2: Identifying and Prioritizing the Tasks to
Be Completed. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 347
Phase 3: Establishing a System of Management. . . . . . . . . . . . 350
Phase 4: Putting the Plans into Action . . . . . . . . . . . . . . . . . . . 354
Phase 5: Ending or Sustaining a Program. . . . . . . . . . . . . . . . . 357
Concerns Associated with Implementation. . . . . . . . . . . . . . . . . . 358
Safety and Medical Concerns. . . . . . . . . . . . . . . . . . . . . . . . . . 358
Ethical Issues. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 360
 contents xi

Legal Concerns. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 362

Program Registration and Fee Collection. . . . . . . . . . . . . . . . . 362
Procedures for Record Keeping . . . . . . . . . . . . . . . . . . . . . . . . 363
Procedural Manual and/or Participants’ Manual. . . . . . . . . . . 363
Program Participants with Disabilities. . . . . . . . . . . . . . . . . . . 364
Training for Facilitators. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 364
Dealing with Problems. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 367
Reporting and Documenting . . . . . . . . . . . . . . . . . . . . . . . . . . 367
Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 368
Review Questions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 368
Activities. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 369
Weblinks. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 369

Part III Evaluating a Health Promotion Program . . . . . . . . . . . . 371

Chapter 13 Evaluation: An Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 372

Basic Terminology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 373
Purpose of Evaluation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 376
Framework for Program Evaluation. . . . . . . . . . . . . . . . . . . . . . . 377
Practical Problems or Barriers in Evaluation. . . . . . . . . . . . . . . . . 380
Evaluation in the Program Planning Stages. . . . . . . . . . . . . . . . . . 381
Ethical Considerations. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 382
Who Will Conduct the Evaluation? . . . . . . . . . . . . . . . . . . . . . . . 382
Evaluation Results . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 384
Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 384
Review Questions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 384
Activities. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 385
Weblinks. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 385

Chapter 14 Evaluation Approaches and Designs. . . . . . . . . . . . . . . . . . . . . . . 387

Formative Evaluation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 388
Pretesting. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 394
Pilot Testing. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 396
Summative Evaluation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 396
Selecting an Evaluation Design. . . . . . . . . . . . . . . . . . . . . . . . . . . 397
Experimental, Control, and Comparison Groups. . . . . . . . . . . . . 401
Evaluation Designs. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 403
Internal Validity. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 405
xii contents

External Validity. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 407

Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 408
Review Questions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 408
Activities. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 409
Weblinks. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 409

Chapter 15 Data Analysis and Reporting . . . . . . . . . . . . . . . . . . . . . . . . . . . . 411

Data Management . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 413
Data Analysis. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 413
Univariate Data Analyses. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 416
Bivariate Data Analyses. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 416
Multivariate Data Analyses . . . . . . . . . . . . . . . . . . . . . . . . . . . 418
Applications of Data Analyses. . . . . . . . . . . . . . . . . . . . . . . . . 418
Interpreting the Data . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 420
Evaluation Reporting. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 421
Designing the Written Report. . . . . . . . . . . . . . . . . . . . . . . . . . 422
Presenting Data . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 423
How and When to Present the Report . . . . . . . . . . . . . . . . . . . 425
Increasing Utilization of the Results. . . . . . . . . . . . . . . . . . . . . . . 425
Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 426
Review Questions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 426
Activities. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 427
Weblinks. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 427

Appendix . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 429

Glossary. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 435

References. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 451

Name Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 477

Subject Index. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 482

Text Credits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 493

 Preface

T his book is written for students who are enrolled in their first professional course
in health promotion program planning. It is designed to help them understand and
develop the skills necessary to carry out program planning regardless of the setting. The
book is unique among the health promotion planning textbooks on the market in that
it provides readers with both theoretical and practical information. A straightforward,
step-by-step format is used to make concepts clear and the full process of health promo-
tion planning understandable. This book provides, under a single cover, material on all
three areas of program development: planning, implementing, and evaluating.

Learning Aids
Each chapter includes chapter objectives, a list of key terms, presentation of content,
chapter summary, review questions, activities, and Weblinks. In addition, many of the
key concepts are further explained with information presented in boxes, applications,
figures and tables. There is also an Appendix with the Code of Ethics for the Health
Education Profession, an extensive list of references, and a Glossary.

Chapter Objectives
The chapter objectives identify the content and skills that should be mastered after reading
the chapter, answering the review questions, completing the activities, and using the
­Weblinks. Most of the objectives are written using the cognitive and psychomotor (behav-
ior) educational domains. For most effective use of the objectives, we suggest that they be
reviewed before reading the chapter. This will help readers focus on the major points in
each chapter and facilitate answering the questions and completing the activities at the end.

Key Terms
Key terms are introduced in each chapter and are important to the understanding of the
chapter. The terms are presented in a list at the beginning of each chapter and then are
printed in boldface at the appropriate points within the chapter. In addition, all the key
terms are presented in the Glossary. Again, as with the chapter objectives, we suggest
that readers skim the list before reading the chapter. Then as the chapter is read, particu-
lar attention should be paid to the definition of each term.

xiii
xiv Preface

Presentation of Content
Although each chapter could be expanded—in some cases, entire books have been writ-
ten on topics we have covered in a chapter or less—we believe that each chapter contains
the necessary information to help students understand and develop many of the skills
required to be a successful health promotion planner, implementer, and evaluator.

Responsibilities and Competencies Boxes

Within the first few pages of each chapter, readers will find a box that contains the re-
sponsibilities and competencies for health education specialists that are applicable to the
content of the chapter. The responsibilities and competencies presented in each chapter
are the result of the National Health Educator Job Analysis 2010 (HEJA2010) and are
published in A Competency-Based Framework for Health Education Specialists—2010
(NCHEC, SOPHE, & AAHE, 2010). These boxes will help readers understand how the
chapter content applies to the various roles and responsibilities assumed by health edu-
cation specialists. In addition, these boxes should help guide candidates as they prepare
to take either the Certified Health Education Specialist (CHES) or Master Certified
Health Education Specialist (MCHES) exam.

Chapter Summary
At the end of each chapter, readers will find a one- or two-paragraph review of the major
concepts covered in the chapter.

Review Questions
The questions at the end of each chapter provide readers with some feedback regarding
their mastery of the content. These questions also reinforce the objectives and key terms
presented in each chapter.

Activities
Each chapter includes several activities that allow students to use their new knowledge
and skills. The activities are presented in several different formats for the sake of variety
and to appeal to the different learning styles of students. It should be noted that, depend-
ing on the ones selected for completion, the activities in one chapter can build on those
in a previous chapter and lead to the final product of a completely developed health
promotion program.

Weblinks
The final portion of each chapter consists of a list of updated links on the World Wide
Web. These links encourage students to explore a number of different Websites that are
available to support planning, implementing, and evaluating programs.
 Preface xv

New to This Edition

In revising this textbook, we incorporated as many suggestions from reviewers, col-
leagues, and former students as possible. In addition to updating material throughout the
text, the following points reflect the major changes in this new edition:
• Chapter 1 includes information about the revised areas of responsibility, competen-
cies, and subcompetencies based on the National Health Educator Job Analysis
(NCHEC, SOPHE, & AAHE, 2010). Along with this information is an explanation
of the new Master Certified Health Education Specialist (MCHES) credential. In
­addition, the generalized model is introduced with information on the pre-planning.

• Chapter 2, which was Chapter 3 in the previous edition, has been expanded to in-
clude information on return on investment (ROI), social math, and increased cover-
age of evidence-based practice to help in creating program rationales. In addition, a
section has been added on writing problem statements.

• Chapter 3, which was Chapter 2 in the previous edition, has been reorganized and
updated. Greater emphasis and explanation has been added on the Generalized
Model. Specifically, more information has been provided on pre-planning and how
knowledge of this model serves as a foundation for understanding all others.
Information is also presented on other key planning models, such as PRECEDE-
PROCEED, Mobilizing for Action through Planning and Partnerships (MAPP),
MAP-IT, and SMART. The chapter concludes with brief explanations of six planning
models including SWOT, Healthy Communities, the Health Communication Model,
Intervention Mapping, and Healthy Plan-It.

• Chapter 4 has been expanded with additional information on community capacity,

electronic interviews, and photovoice. In addition, the chapter includes new informa-
tion on the BPR model 2.0 for prioritizing the needs identified through the needs as-
sessment process, and new information on health impact assessment.

• Chapter 5 has been updated and focuses on various aspects of measurement and
sampling with enhanced descriptions of the measurement process within the context
of planning and evaluation as well as more comprehensive explanations of the levels
of measurement used in data collection and analysis.

• Chapter 6 includes new information on methods for setting targets for objectives,
Healthy People 2020 goals and objectives, and MAP-IT: the Action Model to
Achieve Healthy People Goals.

• Chapter 7 has been expanded and several new theories and models have been added
including the protection motivation theory, the information-motivation-behavioral
skills model, social capital theory, and social network theory.

• Chapter 8 features new information on health communication strategies including

the impact of health literacy and health numeracy, the use of social media, adult