As a study tool, please list each step


Health Behavior





Developed by Green et al 1970s

Predisposing, reinforcing and enabling constructs in educational/environmental diagnosis and evaluation

Educational diagnosis should precede a intervention plan

Counter emphasis on implementation without proper planning


Developed in 1991

Policy, regulatory, and organizational constructs in educational and environmental development

Recognize environmental factors impact on health




Step1: Social Assessment

People have come together and have a “shared vision”

Felt needs are identified

A specific health problem has been identified and some preliminary measurable health objective has been stated.

Some activities have commenced to initiate a needs assessment and learning about the problem.

Focus groups

Key informant interviews

These activities help to clarify the first phase in the model and move the group into the second phase.


Step 2: Epidemiological Assessment


Often secondary sources




Set priorities and prepare to write goals and objectives


Step 3: Behavioral and Environmental Assessment

List all possible risk factors associated with the problem. This should incorporate a thorough literature review.

Break into two lists – one titled behavioral with the other titled environmental.


Step 3 (con’t)

Identify criteria to shorten the list. Talk with experts and community personnel to determine which ones to eliminate

Determine prevalence of the behavior or how frequently the environmental factor is involved.

Determine if there is sufficient evidence whether the factor contributes to the problem

Each factor should be classified as important or not as important

Determine changeability.

Group process in conjunction with literature review should allow classification of low or high likelihood of change.

Create an importance and changeability matrix.


Step 3 cont.

Set objectives on the important and changeable factors.

Who is expected to change?

What is expected to change?

How much will change?

When will it change?


Step 4: Educational and Ecological Assessment

Predisposing Factors

cognitive and affective attributes

knowledge, self-efficacy, locus of control, attitudes, beliefs, perceptions

these provide a rationale or motivation to perform a given behavior


Step 4 cont

Reinforcing Factors

Social support and the role it plays in rewarding or supporting a given behavior

Parents, family members, co-workers, peers, friends, health care providers, supervisors, can also include influential media.


Step 4 cont.

Enabling Factors

Factors that assist in promoting the chosen action.

Educational resources, supportive policies, changes, skill development environmental

“At the end of this phase, there should be specific objectives stated for each of the three factors”


Step 5: Administrative and Policy Assessment

Step One

Plan for time utilization and personnel needs.

Gantt Charts should be used to outline both areas.

Step Two

Assessment of Available Resources

Material needs (educational, computer, paper, curriculum etc), building needs, training or re-training of personnel. Etc.

Step Three

Identification of barriers. Financial, goal conflict, amount of change necessary, group and staff commitment etc.


Policy Diagnosis

Step One

Assess policies, regulations, organization

Determine – loyalty of personnel

are your goals consistent within the organization?

do you have the flexibility to do new things?

is there flexibility for the administrators to determine policy implementation?

Step Two

Assessment of politics

Who within the organization and outside of the organization want this to succeed?

A plan for maximizing involvement of those who can help.


Steps 6-9: Implementation and Evaluation

Step 6; Implementation

Programs are like a child, it needs room to breathe, to experiment, to adapt to new circumstances and people“

Checklists – process evaluation begins.


Step 7; Process Evaluation

Are you doing what you said that you would do?

Are you following the Gantt charts as set out in the original document?

If there are changes, how have these been documented?

Methods – interviews, focus groups, paper trail. Discussions center on predisposing, reinforcing, and enabling factors.


Step 8; Impact Evaluation

There should be measurable changes as set out by the objectives derived in phase 3. Planning should have defined how these changes would be measured. Generally, paper and pencil measures, measures of observation, records etc.


Step 9; Outcome Evaluation

Are you achieving the program’s goals? Is there a reduction in CVD, perhaps a type of cancer, STD’s, illegal use of substances etc. Etc.

Usually done by examining the bottom line after a few years of programming.


of the planning model.  Then, list actions that take place at each step to help you plan a program.

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