Community Diagnosis &

PIE of Health Education /Promotion

program

By : Birtukan G.(BSc, MPH/Nutrition)

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 Learning objectives
 Definition and Concepts of Community
diagnosis and Community analysis.
 Purpose of Community diagnosis

 Stages of Community Diagnosis

Discuss the HE/HP program planning/ evaluation
Discuss Steps for HE planning program
Discuss PRECEDE-PROCEED model

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 Definition of a “Community”
A cluster of people with at least one
common characteristic (geographic
location, occupation, ethnicity, housing
condition……)

A group of people with a common

characteristic or interest living together
within a larger society.

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 Definition of Community Diagnosis
Community diagnosis: generally refers to
the identification and quantification of health
problems in a community as a whole in terms
of mortality and morbidity rates and ratios,
and identification of their correlates.

 Its purpose is to define existing

problems ,determine available resources and
set priorities for planning ,implementing and
evaluating health action by and for
community.

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 Purpose of community diagnosis
 To find the common problems or diseases which can be easily prevented

in the community.
 defining those at risk or those in need of health care.

 Establish an epidemiologic baseline for measuring

improvement over time
 To Analyze the health status of the community

 To Evaluate the health resources, services, and systems of care within the

community
 Identify priorities, establish goals, and determine courses
of action to improve the health status of the community

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 The product of analysis is the “community
profile”
 To analyze assessment data is helpful to
categorize the data. This may be done as
following:
-Demographic -Health
resources and services
-Environmental -Health policies
-Socioeconomic -Study of target
groups

Community is diagnosed using:

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Health Indicators: Indicators of health are variables used
 Stages of community diagnosis
The process of community diagnosis
involves four stages:
1. Initiation
2. Data collection and analysis
3. Diagnosis
4. Dissemination

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 1. Initiation
In order to initiate a community diagnosis
project, a dedicated committee/ working
group should be set up to manage and
coordinate the project.

At an early stage it is important to identify

the available budget and resources to
determine the scope of the diagnosis.

Common areas to be studied include health

status, lifestyles, living conditions,
socioeconomic condition , physical and
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social infrastructure, public health services
 2. DATA COLLECTION AND ANAIYSIS
The project should collect both quantitative
and qualitative data.

For the community data, it can be collected

by conducting surveys through
-self administered questionnaires,
-face to face interviews,
-telephone interviews.
-FGD: used to collect information from a group through
guided discussions of the study topic.

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 3.Diagnosis
Diagnosis of the community is reached
from conclusions drawn from the data
analysis

It comprises three areas

 Heath status of the community

 Determinants of health in the community
 Potential for health policy development

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 4.Dissemination
The production of the community diagnosis
report is not end in itself efforts should be
put into communication to ensure that
targeted actions are taken.

The targeted audience for community

diagnosis includes policy makers, health
professionals and the general public in the
community.

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 Planning, Implementation
and Evaluation (PIE) of
Health Education
program

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 Planning, Implementation and
Evaluation (PIE) of Health Education
program
Planning: It is an anticipatory decision making about
what needs to be done, how it has to be done, and with
what resources to be accomplish a certain goal/
objectives.
 Is coming from the assumption of

“ resources are scarce/limited ”

There is a saying
“If you fail to plan, you are planning to fail”.

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 Planning….
Purposes of planning:-
1. Match resources with problem
2. Best use of scarce resources
3. Avoid duplication and wasteful expenditure
4. Helps for problem prioritization
5. Develop a best course of action

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 Steps in planning HE
intervention
Situational
Analysis (I)
reconsideration
Identifying
Problems &
Prioritize(II)
Evaluation
(VI)

Setting
Objectives(III)
Implem-
entations Develop plan
(V) of work (IV)

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 Steps…
Step I. situational analysis
 The local situation is the bench mark from where

people should start the process of program planning.

 After assembling, analyze the facts in useful way for

planning.

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 Acquiring need assessment data
Primary data
 survey –quantitative data
 interview (FGD, IDI)-Qualitative

Secondary data
 Existing records
 Data collected for various purpose

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 Step II. Identify problems and
prioritize.
 A number of problems are emerged out of

needs assessment. Since it is not possible

or feasible to deal with all the problems at
once, we will have to prioritize and
evaluate them according to pre-defined
criteria and select for action.
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 Step 3 Setting objectives

Without objective, program may lack direction and

at last it is difficult to evaluate

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 Con’t…

“If you do not know where you are

going, then any road will ..…,”

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 Objective…
A program objective is a series of
statement that must answer:
 What do we want to achieve?

 Where?

 Who is the target group?

 When do we want to achieve?

 Extent of achievement?
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 Objective…
For example, to increase immunization
coverage from 60% to 90% among under 5
children in “X”village within the project
period ( by 2017 E.C).
 What: Increase immunization coverage

 Where: In village “X”

 Who: Among under 5 year children

 When: Within the project period/by 2017

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E.C
 Step 4. Develop plan of
work
 A plan of work is a detailed schedule of activities

to be done in a given period of time.

 It should specify the role of different persons

involved, the time in which the particular activities

have to be carried out, and the different methods to
be used.

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 Step 5. Implementation
Implementation is carrying out the
plan or putting the plan into action.
It is translating the goals and
objectives into a community
based health education programs.
Implementation is the most
crucial part of planning process.
“A plan that is not
implemented is no plan at all!”
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 Step 6. Evaluation

Comparisons of an object of interest against standard

of acceptability.

Making a value judgment!!!

what has been achieved? and how it has been

achieved?

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 Types of evaluation

• measurements obtained during the

Process evaluation implementation of program activities to
ensure quality service delivery

• Immediate observable effect of the

program leading to outcome of the
Impact evaluation program !
• Short term changes: Awareness,
knowledge, attitude , skills or behaviors
• Long-term consequences of the program;
Outcome evaluation usually the ultimate goals of a
programme
• Indicators: morbidity, mortality,
prevalence etc..
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 Planning Model

There are many planning model in health education

and promotion.

 Among these models, the Precede-Proceed model is

the well known and most frequently used model to
plan, implement and evaluate health education and
promotion programs.

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 PRECEDE-PROCEED
Model(PPM)
 It is a planning model come from Johns Hopkins university and
was designed as a way to teach students about health promotion.

 Useful in evaluating health promotion programs.

 PPM: to identify the most effective ways to promote change by

conducting local need assessment and program evaluation.

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 PRECEDE – PROCEED model
Best known & often used model

PRECEDE: focus on identifying educational factors that

influence change.
PROCEED: focus on identifying ecological factors that influence
change.

PRECEDE PROCEED
P= P = Policy
Predisposing R = Regulatory
R = Reinforcing O=
E = Enabling Organizationa
C = Constructs l
E=Educational C = Constructs
29 D = Diagnosis E = Educational
E = Evaluation
 The 9 phases within the PRECEDE-
PROCEED model

E
PHASE 1 SOCIAL DIAGNOSIS

ED
PHASE 2 EPIDEMIOLOGICAL DIAGNOSIS

EC
)
-5
(1
PHASE 3 BEHAVIORAL & ENV’TAL Dx

PR
PHASE 4 EDUCATIONAL & ORGANIZATIONAL Dx
PHASE 5 ADMINISTRATIVE & POLICY DIAGNOSIS
PHASE 6 IMPLEMENTATION
PHASE 7 EVALUATION (PROCESS)
E D
PHASE 8 EVALUATION (IMPACT)
CE
PHASE 9 EVALUATION( OUTCOME)
RO (6
-9)
P
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 PRECEDE -PLANNING PHASE---has five phases
PRECEDE: model is a framework for process of
development & evaluation of HE programs.
Phase 1: Social Assessment/diagnosis

Phase 2: Epidemiological Assessment

Phase 3: Behavioral and environmental Assessment

Phase 4: Educational and organizational Assessment

Phase 5: Administrative and policy Assessment

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 Phase I:Social assessment/diagnosis
 Identify& evaluate social problems that impact quality of life of
target population.

 It enables planners to understand social problems which affects

the quality of life of populations.

 It followed by a link between social problems and specific

health problems.

 The link is essential in life and, in turn, how the quality of life
affects social problems.

 Quality of life is a manifestation of ultimate values of health.

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 Phase 2 – Epidemiological Assessment

Phase 2 :
Epidemiological List of
Assessment
problems
Review
epidemiological
data
 Determining which of the subjective matters identified during
social assessment phase can be objectively confirmed as serious
health issues.
 Identify the major health and health related problems with in the
community through literature review and surveys.
 Creating priorities & develop program goals and
objectives.

33 Epidemiological data: Vital stastics(mortality,…),morbidity,
incidence, prevalence of disease
 Phase 3 - Behavioral and Environmental Diagnosis

It answers "What's the cause" of identified problem.

This phase is to identify and prioritize the behavioral

and environmental risk factors associated with the
problem.

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 Example for behavioral and Environmental
assessment.

•Presence of stagnant
water
•Lack of ITN
•Lack of services

Enviro
Beha Malari
nmenta
vioral a
l

•Not properly using ITN

•Staying outside at evening
•Not seeking treatment early
•Not following course of
prescribed drugs
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  Perhaps, no program has sufficient resources to deal with all
behavioral factors identified!

 Consider the importance and changeability of each behaviors to

rate the behavior !!!
More Important Less Important
More High Priority for Low Priority Except
Changeable Program Focus to Demonstrate
Change for Political
Purposes

Less Priority for No Program

Changeable Innovative
Program;
Evaluation Crucial

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 Phase 4: Educational & Organizational assessment

 It answers "What's the solution? of the identified

problem.

 Identify the predisposing, enabling, and reinforcing

factors that act as supports for or barriers to
changing the behaviors and environmental factors
identified in Phase 3.

 The critical element of this phase is the selection of

the factors which if modified, will be most likely to
result in behavior change.
Previous example
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 Behavioral factors : Improper use of
 Educational & organizational…

Predisposing factors Enabling factors Reinforcing factors

Awareness Availability
Families
Knowledge Accessibility

Attitude affordability
Peers etc.
Beliefs acceptability

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 Phase 5: Administrative and Policy assessment

Includes assessment of resources, budget

development and allocation, development
of implementation timetable, organization
and coordination with others.
Analysis of policies, resources and
circumstances prevailing organizational
situations that could hinder or facilitate
the development of the health program.

which must be addressed prior to program

implementation
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 Design a Comprehensive
Intervention plan
PRECEDE- phase ends with a
Comprehensive Intervention plan which
is ready for implementation and
PROCEED begins !
P
R
O
C
E
E
Ready D
made plan
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 PROCEED (Implementation & evaluation phase)

Next 4 phases

Phase 6: Implementation

Phase 7: Process evaluation

Phase 8: Impact evaluation

Phase 9: Outcome evaluation

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 Phase 6: Implementation

The act of converting program objectives into actions.

It is translating the goals and objectives into a

community based health education programs.

Selection of methods and strategies of the intervention,

for example, education &/or other resources.

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 … Evaluation
 Phase 7: Process evaluation -
measurements of implementation process
to control, assure, or improve the quality of
the program

Phase 8: Impact evaluation - immediate

observable effects of program (changes in
Knowledge, attitude, beliefs, practice etc.)
Assesses change in predisposing,
reinforcing, and enabling factors, as well as
in the behavioral and environmental
factors.
Assesses the shorter-term changes in
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perceptions or attitudes that lead to
 The “PROCEED” part…
Phase 9: Outcome evaluation
Long-term effects of the program.
Determines the effect of the program on
health and quality-of-life indicators.

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 Visit PRECEDE- PROCEED MODEL BEFORE
PLANNING HE/HP PROGRAM
THANK YOU!
???

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