Chapter 19 Planning health promotion interventions

Overview

We have seen in Chapter 18 how needs assessment and targeting may be carried out, and the importance of carrying out this process and being clear about the context in which this is done. This chapter builds on the discussion of the first stage of planning – needs assessment – in Chapter 18. Firstly, definitions of planning are given and the reasons for planning discussed. Planning at different levels, from broad strategic planning through project planning to small-scale health education planning, is considered. The Ewles & Simnett (2003) and PRECEDE–proceed models (Green & Kreuter 2005) are reviewed in detail. Quality and audit issues and how this relates to planning are then considered.

Definitions

Planning is one of those terms which is used in many different ways. Other related terms are used in equally imprecise ways, so that often the same activity is labelled in different ways by different people. There are no hard and fast rules about the way terms are used, but the following definitions are presented as a means of clarifying the differences between related activities. These are the definitions we shall be using in this chapter.

• Plan – how to get from your starting point to your end point and what you want to achieve

• Strategy – broad framework for action which indicates goals, methods and underlying principles. It derives from evidence, identified needs and experience. It may be used at all levels as in a programme strategy or an implementation strategy

• Policy – guidelines for practice which set broad goals and the framework for action

• Programme – overall outline of action. The collection of activities in a planned sequence leading to a defined goal or goals

• Priority – the first claim for consideration

• Aim or goal – broad statement of what is to be achieved

• Objective or target – specific and precise statements of the intended outcomes that will contribute to the achievement of the aim

• Stakeholders – all those individuals or groups who have an interest in the programme

BOX 19.1

Policy development

Judy has been given a remit to develop a health promotion programme with the aim of reducing the suicide rate. Her health authority’s policy includes a commitment to equal opportunities. She decides her priority will be unemployed people, who are known to be at increased risk of suicide. She consults with stakeholders. Judy’s objectives are: (1) to set up a support group for unemployed people; and (2) to provide specialist counselling services. Her strategy is to network with existing community groups, and to recruit and train volunteer counsellors.

Reasons for planning

Health promoters usually have no problem in finding things to do which seem reasonable. Work areas are inherited from others, delegated from more senior members of the workplace or demanded by clients. It is possible to be kept very busy reacting to all these pressures, and planning health promotion interventions may seem a luxury or a waste of time. However, there are sound reasons for planning health promotion or being proactive in your work practice:

• It ensures a systematic and logical approach to establishing priorities.

• It helps direct resources to where they will have most impact.

• It makes clear what is to be achieved, the methods and how success will be demonstrated.

Planning takes different forms and is used at different levels. It may be used to provide the best services or care for an individual client, as in the nursing process, or planning may be for group activities, such as antenatal classes. Planning may also refer to large-scale health promotion interventions targeted at whole populations.

The degree of formality of the planning process also varies. When planning a one-to-one intervention, the process is informal and may involve no one else. Planning for a group intervention may involve liaising with other professionals as well as the target group, to find out what their aims and objectives are and what sorts of methods and resources are available and acceptable. A written plan may be produced to act as a guide and a statement of agreed outcomes and methods. Planning a large-scale intervention will usually involve more long-term collaborative planning. Often a working group (or taskforce or local forum) will be established early on to identify interested groups and gain their support and expertise. A written plan will usually be produced, outlining not only objectives and methods but also a timescale of what is to be achieved when; funding details and a budget; who is responsible for which tasks; and how the intervention will be evaluated and the findings reported back.

There has been much greater emphasis on systematic planning in recent years due to a need for greater economic accountability, more focus on targets and their achievement, and the need to include evidence as part of project development. It is particularly important for practitioners to be clear about the rationale for interventions, the goals and the approach adopted.

Health promotion planning cycle

Planning involves several key stages or logical stepping stones which enable the health promoter to achieve a desired result. The benefit is being clear about what it is you want to achieve, i.e. the purpose of any intervention. Planning entails:

1. An assessment of need.

2. Setting aims – what it is you intend to achieve

3. Setting objectives – precise and measurable outcomes

4. Deciding which methods, interventions or strategies will achieve your objectives

5. Evaluating outcomes in order to make improvements in the future.

Some planning models are presented in a linear fashion. Others show a circular process to indicate that any evaluation feeds back into the process, as illustrated in Figure 19.1. This seemingly rational and simple approach describes how decisions should be made. It does not take into account that there may not be agreement on objectives or the best way to proceed and that in real life, planning is often piecemeal or incremental. There is no grand design, but circumstances dictate many small reactive decisions.

Figure 19.1 Health promotion planning cycle.

BOX 19.2

What do you think would be the best starting point for planning an intervention or programme? Why?

Think of any planned activities you have been involved with. What was the starting point? Why?

Figure 19.1 suggests that the planning cycle begins with a needs assessment through which the programme’s focus and any specific target groups may be identified. The underlying causes and contributory factors that led to the problem and the areas that will need to be addressed are then identified. Figure 19.2 shows how understanding the effects of a problem can help to identify indicators and desired outcomes from an intervention. Turning the problem, in this case antisocial activity by young people in a neighbourhood, into a positive statement gives a purpose for the intervention. Addressing the causes of the problem identifies outputs and activities. The aims and objectives can then be clearly stated. This provides a number of options for intervention and at this point many other issues come into play such as resource availability, capacity and potential obstacles. These issues will then be considered alongside any evidence of effective interventions. The actual intervention or programme and its methods can then be selected. The practicalities of implementation will need to be explored and the evaluation and monitoring plans put in place. This simple model can be applied to all levels of planning activities, from large-scale strategic planning, to middle-scale project planning and small-scale interventions with clients.