101 Questions for Community Health Promotion Program Planning


Jacquie Rainey and Gordon Lindsay

Health educators usually are not content experts on cancer, nutrition, fitness, or any other health issue. Recommendations for healthy living are borrowed from colleagues in epidemiology and medical sciences. The particular expertise which sets health educators apart is their ability to develop effective programs which address health concerns. No one does this better than a health educator. A review of the Role Delineation Project and the health education credentialing competencies reveals the predominant role of program development in the process of community h education.

A number of comprehensive planning models and texts are available to health education program planners. The purpose of this article is not to summarize these useful resources, but to provide a quick reference checklist of questions that a health educator may ask himself or herself in planning, an organized response to a health need. Every health educator has program development "blind spots" which, if not addressed, can reduce the effectiveness of the intervention. This list of 101 questions for the program planner is not intended to teach the planning process or to serve as a short cut to program development. It is offered to help jog the experienced health planner's memory and identify important points that might have been left out of the planning process.

Epidemiologic Assessment

Goethe once said, "There is nothing as ugly as ignorance in action." Effective community health programs are founded on a solid epidemiologic understanding of local health problems rather than on hunches and biased perceptions. Data is the crystal ball that helps health educators understand complex problems. Statistics are the eyes and ears that direct limited resources to where they are most urgently needed. Questions a health educator should ask concerning an epidemiologic assessment include:

  1. What is the total number of people in the community with this health problem? 2.
  2. What are the estimated prevalence or incidence rates of the health problem in the community?
  3. What proportion of total community mortality cases can be attributed to the health problem?
  4. What proportion of Productive Years of Life Lost (PYLL) can be attributed to the health problem?
  5. How much disability/morbidity in the community can be attributed to the health problem?
  6. What proportion of community hospitalization rates are caused by the health problem?
  7. Geographically, what portions of the community have the highest rates of the health problem?
  8. How do the rates of the problem vary according to ace, race, sex, and socioeconomic status?
  9. In the absence of any new interaction, what is the expected trend of the health problem, i.e. is the prevalence of the problem currently increasing,, decreasing, or staying the same?
  10. What are the direct costs of the problem to the community?
  11. What are the indirect costs of the problem to the community?

Needs Assessment

To begin the planning process the health educator should describe the health problem in terms that will allow him or her to understand how an intervention can help to solve the problem. 'The program planner must understand the target audience well enough to see the problem from their perspective. Needs assessment helps to identify the "real" needs and the "perceived" needs of the target population. If the health education planner is assigned to address a specific health problem, needs assessment can determine who is most affected by the problem. The second part of a needs assessment determines the target population's level of concern regarding the problem. The community must perceive the condition as a hi-h priority problem to be ready for the intervention. Questions a health educator should ask in conducting a needs assessment include:

  1. Based on the health educator's experience and knowledge of the community, what are the priority health concerns of the community?
  2. What do key informants (community leaders, public officials, health professionals, religious leaders) view as the major problems in the community?
  3. Was a recognized method to determine the perceived needs of the opinion leaders used, i.e., focus groups, interviewing, single surveys. or the Delphi technique?
  4. Have perceived needs of this group been prioritized using a recognized method such as a nominal group process?
  5. What does the target population view as the most significant problem in their community?
  6. Were methods such as community forums, focus groups. questionnaires, or interviews used to survey the target population?
  7. Should focus groups made up of representatives of the target population be formed?
  8. Should individual interviews with representatives of the target population be conducted?
  9. If so, should these interviews be conducted face-to-face, by telephone, or by direct mail?
  10. Do the number of newspaper stories in the local paper indicate a concern for a particular health problem in the community?
  11. Do programs exist to deal with identified health problems?

Analysis of Behavior

Effective health promotion is based on a solid understanding of behavioral determinants. Just as a physician cannot prescribe treatment until he or she has made an accurate diagnosis, so a health educator should not select intervention strategies until behavioral antecedents have been understood. The questions a health educator should ask concerning predisposing, reinforcing, and enabling factors related to the behavior include:

  1. What does the literature cite as reasons people perform this behavior?
  2. Does the target population lack the knowledge necessary to carry out the behavior?
  3. Does the population believe they are susceptible to the condition and that the condition is severe?
  4. Does the target population believe they possess the ability to perform the behavior?
  5. Does the target population believe that performing the behavior will generate the desired outcome?
  6. Is the desired behavior in accordance with socially accepted norms?
  7. Does the target population feel they have control over the behavior and its outcome?
  8. What factors are antecedents to the behavior that enable the performance of the behavior?
  9. Does the behavior require acquisition of new skills?
  10. Does the target population have the necessary resources to perform the behavior? 33. Does the tract population have the time required to perform the behavior. and access to transportation or child care if needed?
  11. Does the target population have sufficient funds if there is a monitory cost involved in performing- the behavior?
  12. Does the target population have the literacy level needed to understand the instructions?
  13. Are the necessary environmental supports in place to make performance of the behavior easier?
  14. Is the proposed schedule convenient for the target population?
  15. Do present corporate policies support the performance of the behavior?
  16. Does present -movement policy support the performance of the behavior?
  17. What factors act to reinforce the continuation of this behavior once it has occurred?
  18. Do peers and family support this behavior?
  19. Are there immediate rewards for performance of the behavior?
  20. Can the target population identify long term rewards?
  21. Has a system been created to allow for feedback on performance and accomplishments?
  22. How important are each of the predisposing, reinforcing, and enabling factors in terms of their immediate need for action to occur? How changeable are these factors?

Working Through Social Institutions

Community health education is seldom a door to door initiative. In order to reach people with a message, health education must go where people are already organized in groups such as the workplace, schools, churches, and neighborhood associations. These environments offer the opportunity to deliver the program to large intact groups where natural social support networks already exist. Questions the health. educator should ask regarding, social institutions include:

  1. Have the major employers, civic organizations, churches, schools, clubs and other social institutions in the community been identified?
  2. What are the benefits for participating in the intervention to these groups?
  3. Have these benefits been communicated to leaders of these institutions?
  4. Have these institutions been invited to co-sponsor the community health program?
  5. What voluntary or financial resources are available from those groups
  6. Can the newsletters, meetings, mailing lists, organizational policies, facilities or social support network of these institutions be used to address the health problem.

Goals and Objectives

Community health promotion should be driven by clearly defined goals and objectives. It is easy to be a busy health educator. It is harder to be an effective health educator. Use of goals and objectives increases the effectiveness of the planning by forcing the planner to clarify the purpose and quantify realistic projected outcomes of the program. Measurable objectives are the foundation for evaluating the program. Questions the health educator should ask in writing coals and objectives include:

  1. What criteria will be used to determine how high objectives are set?
  2. Do objectives coincide with Healthy People 2000 objectives?
  3. What objectives have been met by other communities addressing this issue. Based on prevalence rates, resources and other local conditions, what should local objectives be?
  4. What is the broad goal of the program?
  5. Are all objectives measurable and answer the questions: who will do how much and by when?.
  6. What are the specific outcome objectives?
  7. What are the specific impact objectives?
  8. What are the specific process objectives?

Political Groundwork

Sometimes programs are terminated, not because of ineffectiveness, but because they lack the support of key decision makers. Effective health educators are good politicians. They know the importance of working the "powers that be." They recognize the sensitivity of turf issues and address these problems. Questions the health educator should ask in regard to politics include:

  1. Will the intervention be led by a "program champion" who has the charisma, vision, and interpersonal skills to mobilize people?
  2. How will the program be made highly visible?
  3. How can the media and the program be used to make your administrators and key look good?
  4. Are the appropriate administrators sufficiently informed regarding details of the intervention?(Administrators don't like surprises).
  5. What agencies and organizations already are involved with this health topic and may perceive your pro, as a threat to their
  6. What can be done to gain the support and endorsement of these agencies and organizations?
  7. Should a coalition of interested groups be formed to address the health problem?
  8. Have groups been identified who will actively oppose your intervention? What arguments will these groups use?
  9. What preemptive measures can be taken to diffuse the opposition before it mobilizes?
  10. Are positive relations with the budget and personnel offices of the planning agencies being kept informed of the program's development? These overhead agencies can make life very difficult for anyone who fails to abide by their rules.
  11. Is the pro-ram founded on the philosophy that the intervention is being done "with the community," rather than "to the community?"

Implementation Sometimes programs may fail because they are based on poor theory. However, a conceptually sound program can fail because it was poorly implemented. The following, questions may help to determine if enough attention has been given to the "nitty gritty" details of implementation.

  1. Were program materials pretested?
  2. What is the educational level of your target populations
  3. Is the message appropriate for the target audience, language, values, media?
  4. Is the message content appropriate to meet the stated objectives?
  5. What is the proposed one year budget?
  6. What is the proposed benefit to cost ratio?
  7. Is there a financial commitment from other agencies?
  8. What are the credentials of your vendors?
  9. How successful have these vendors been in the past?
  10. Are their canned programs appropriate to meet the objectives of this program?
  11. Is there a marketing plan for the program?
  12. Was the target audience included in all stages of planning for the program?
  13. Is there an accessible location for the program?
  14. Does the program involve a convenient time and reasonable amount of time commitment - remember time is one of the most valuable commodities we have today?
  15. Have the appropriate channels to advertise the program been identified?
  16. Who can get the attention of the target population?
  17. What strategies will prompt belief chance?
  18. What prompt a decision to act?
  19. What will prompt action?

Evaluation The reasons for conducting, an evaluation will differ from program to program. Primarily program evaluation is used to verify if the program worked in this setting and produced the desired change. Recent trends make an evaluation component necessary to meet the demand of public and fiscal accountability. Questions to consider in planning for evaluation include:

  1. Was evaluation considered throughout the planning process"
  2. What is the coal in conducting the evaluation? Deciding this will help to detennine the evaluation design.
  3. Who is requesting the evaluation and what is his or her goal?
  4. Does the planner have the expertise and resources to conduct all phases of evaluation?
  5. Does the planner have access to instruments for evaluations that are valid and reliable?
  6. Are methods established to collect data such as attendance, effectiveness of individual sessions, appropriations of message, acceptability of facilities, as well as reduced morbidity, mortality, and increased quality of life?
  7. Does the planner have instruments to measure changes in knowledge, attitudes, and behaviors?
  8. Is there a method established to contact the target population for follow-up evaluation?
  9. Have multiple strategies to address the different stages of change been developed?
  10. How will the results of the evaluation be utilized?

Health promotion can be described as a process with well defined schemes for planning. Without following a plan including identified needs, program goals and objectives, intervention strategies, and an evaluation component. Well-intended health educators may fall into the trap of "doing" healthe ducation while losing sight of the original program goals. The preceding list of questions health educator should ask himself or herself in the planning process can help to keep a health promotion program on track. This list of 101 questions is not comprehensive and should not be used as a guide to health promotion program planning. Rather these 101 questions were developed as a checklist for the experienced health promotion program planner to use in reviewing the planning process.

Extracted from Journal of Health Education - September/October 1994, Volume 25, No. 5:309-312

Return to Ch 3

Posted February 10, 1997