Planning health promotion programs:

introductory workbook

Fourth Edition November 2015

Public Health Ontario
Public Health Ontario is a Crown corporation dedicated to protecting and promoting the health of all
Ontarians and reducing inequities in health. Public Health Ontario links public health practitioners,
frontline health workers and researchers to the best scientific intelligence and knowledge from around
the world.

Public Health Ontario provides expert scientific and technical support to government, local public health
units and health care providers relating to the following:

 communicable and infectious diseases

 infection prevention and control
 environmental and occupational health
 emergency preparedness
 health promotion, chronic disease and injury prevention
 public health laboratory services

Public Health Ontario's work also includes surveillance, epidemiology, research, professional
development and knowledge services. For more information, visit www.publichealthontario.ca.

How to cite this document:

Ontario Agency for Health Protection and Promotion (Public Health Ontario). Planning Health Promotion
Programs: Introductory Workbook. 4th ed. Toronto, ON: Queen's Printer for Ontario; 2015.

Previously published as:

The Health Communication Unit, Centre for Health Promotion, University of Toronto. Introduction to
health promotion program planning. 3rd ed. Toronto, ON: University of Toronto; 2001.

ISBN: 978-1-4606-5746-1

All or part of this document may be reproduced for educational purposes only without permission.

Public Health Ontario acknowledges the financial support of the Ontario Government.

© Queens Printer for Ontario, 2015

Contributors Special Thanks
Jodi Thesenvitz Lauren Adelson
Senior Product Development Advisor (former) Product Development Advisor
Health Promotion Capacity Building Health Promotion Capacity Building
Public Health Ontario Public Health Ontario

Susan Snelling Kara DeCorby

Evaluation Specialist Senior Product Development Advisor
Health Promotion Capacity Building Health Promotion Capacity Building
Public Health Ontario Public Health Ontario

Allison Meserve Gobinaa Manoharan

Health Promotion Consultant, Product Development Advisor
Planning and Evaluation Health Promotion Capacity Building
Health Promotion Capacity Building Public Health Ontario
Public Health Ontario
Benjamin Rempel
Manager
Health Promotion Capacity Building
Public Health Ontario

Anna Vanderlaan
Product Development Advisor
Health Promotion Capacity Building
Public Health Ontario

Acknowledgements
Public Health Ontario wishes to acknowledge and thank THCU staff and the many partners who
contributed to earlier versions of this document. THCU (originally known as The Health Communication
Unit) started in 1993 at the University of Toronto and moved to Public Health Ontario’s Health
Promotion, Chronic Disease and Injury Prevention Department in 2011.

Disclaimer
This document may be freely used without permission for non-commercial purposes only and provided
that appropriate credit is given to Public Health Ontario. No changes and/or modifications may be made
to the content without explicit written permission from Public Health Ontario.
Contents
Introduction .......................................................................................................................... 1
What is planning? ......................................................................................................................................... 1
Six-step planning model ................................................................................................................................ 2
Companion tools and resources ................................................................................................................... 3

Step 1: Manage the planning process ..................................................................................... 4

What is step one about? ............................................................................................................................... 4
Why is step one important?.......................................................................................................................... 7
How do I do step one? .................................................................................................................................. 7
Tips .............................................................................................................................................................. 11

Step 2: Conduct a situational assessment............................................................................. 12

What is step two about? ............................................................................................................................. 12
Why is step two important? ....................................................................................................................... 13
How do I do step two? ................................................................................................................................ 14
Tips .............................................................................................................................................................. 27

Step 3: Set goals, audiences and outcome objectives ........................................................... 28

What is step three about? .......................................................................................................................... 28
Why is step three important? ..................................................................................................................... 35
How do I do step three? ............................................................................................................................. 35
Tips .............................................................................................................................................................. 40

Step 4: Choose strategies and activities and assign resources ............................................... 41

What is step four about? ............................................................................................................................ 41
Why is step four important? ....................................................................................................................... 46
How do I do step four? ............................................................................................................................... 47
Tips .............................................................................................................................................................. 52

Step 5: Develop indicators ................................................................................................... 53

What is step five about? ............................................................................................................................. 53
Why is step five important? ........................................................................................................................ 58
How do I do step five? ................................................................................................................................ 58
Tips .............................................................................................................................................................. 59

Step 6: Review the plan ....................................................................................................... 60

What is step six about? ............................................................................................................................... 60
Why is step six important?.......................................................................................................................... 61
How do I do step six? .................................................................................................................................. 61
Tips .............................................................................................................................................................. 66

References .......................................................................................................................... 67
Introduction
This workbook provides a logical six-step approach to assist in planning health promotion programs:

Step 1: Manage the planning process

Step 2: Conduct a situational assessment
Step 3: Set goals, audiences and outcome objectives
Step 4: Choose strategies, activities and assign resources
Step 5: Develop indicators
Step 6: Review the plan

This workbook explains what each step is about, why it is important and how to complete it. Examples,
supplementary resources and tips will help health promotion practitioners to understand and apply
the planning process.

What is planning?
Planning, which includes strategic, program and operational planning, involves a series of decisions
based on collecting and analyzing a wide range of information. The workbook will describe these
various types in more detail, with the bulk of
the discussion focusing on program planning. Find out more about program planning
models by clicking the “Other Planning Tools
and Resources” link in the Online Health
Program Planner1 and in the Health Promotion
Foundations course.2

Planning Health Promotion Programs| 1

Six-step planning model
Figure 1: The six-step planning model

Step 1: Manage the planning process

Step 2: Conduct a situational assessment

Evaluation/feedback

Step 3: Set goals, audiences and outcome objectives

Step 4: Choose strategies and activities and assign resources

Step 5: Develop indicators

Step 6: Review the plan

The model begins with step 1, managing the planning process. That means addressing how key
stakeholders will work together to make decisions, based on good data-gathering and analysis, within
the constraints of time, budget and other resources.

Step 2, involves conducting a situational assessment, a multifaceted process that basically addresses
this question: “Should we proceed, and if so, how?”

Steps 3–5 are planning decisions relating to setting goals, populations of interest and objectives (step
3), strategies and activities (step 4), and indicators (step 5).

Step 6 is a review of the proposed program to see if it is feasible and evaluable. We suggest using a
logic model to do this.

Evaluation is a concurrent process within program planning and development. Consider it at each of
the planning steps.

Planning Health Promotion Programs| 2

We recognize that in practice, program planning is often a dynamic process. However, the step model
is useful for identifying and describing discrete aspects of program planning. We have arranged the
steps in an order that flows logically, and that may be useful in developing a planning group’s work
plan. The steps are all interrelated; the actual process may be less linear than depicted. For example,
earlier steps may be revised as new experiences and insights emerge in later steps.

Companion tools and resources

This workbook is designed to be used with
the Online Health Program Planner
(OHPP).1 The OHPP is a free and The following books about planning may also be
interactive planning tool. It allows users to of interest:
fill in worksheets to create one or more
 Green LW, Kreuter MW. Health promotion
program plans. Those who prefer to work
planning: An educational and ecological
offline can print and/or save worksheets
approach.3
for each step as MS Word documents.
Also available in the OHPP is a sample  McKenzie JF, Neiger BL & Thackeray R.
plan library, and links to a database with Planning, implementing and evaluating health
sources of evidence and other promotion programs: A primer.4
recommended planning tools. To access
these features, you can create a free PHO  Naidoo J, Wills J. Foundations for health
account and log in. In addition to the promotion.5
program planning steps described in this
workbook, the OHPP includes:  Bryson JM. Strategic planning for public and
nonprofit organizations: A guide to
 a sample plan library;
strengthening and sustaining organizational
 links to a database with sources
achievement.6
of evidence and planning tools;
 an Online Business Case Creator;
and
 several Project Management Tools.

Another useful companion is the online Health Promotion Foundations course.2 The Health Promotion
Foundations course is a series of eight interactive online modules introducing the field of health
promotion in Canada. The self-study course presents definitions, concepts, milestones, models,
theories, and health promotion strategies.

Planning Health Promotion Programs| 3

Step 1: Manage the planning process
Step 1: Manage the planning process

Step 2: Conduct a situational assessment

Evaluation/feedback

Step 3: Set goals, audiences and outcome objectives

Step 4: Choose strategies and activities and assign resources

Step 5: Develop indicators

Step 6: Review the plan

What is step one about?

Project management is about developing and managing a “plan to plan”. A good project management
plan clearly describes steps and tasks, assigns people to various roles, sets deadlines and milestones,
and shows resource allocation. This is primarily done through a work plan that indicates tasks
necessary to produce a comprehensive, credible and compelling program plan. However, you may use
many other project management documents and tools to supplement the work plan. For example,
terms of reference that outline roles, responsibilities and decision-making processes can be very
useful.

Project management starts at the beginning of the planning process, and must take into account any
assumptions, expectations and other contextual issues (see Figure 2). Project management does not
end until the program plan is completed and approved, signaling the beginning of the development
and implementation phase.

Planning Health Promotion Programs| 4

The planner must manage five project management areas:

 stakeholder roles and expectations;

 decision-making processes;
 time;
 resources for planning; and
 data-gathering and analysis processes.

It is important to revisit all aspects of project management frequently throughout planning, to balance
stakeholder expectations with resources and a shifting work environment. For example, in the early
stages your work plan may begin as a high-level document, simply identifying broad timelines for each
planning step. As your understanding of the project grows, you can become more specific. You end up
producing a series of project management documents, each more detailed and accurate than the last.

Figure 2: The project management process

Clarify roles, Consider decision- Create a detailed

expectations and making processes; work plan outlining
other contextual time; money and tasks, roles
issues. other resources; assigned, timelines,
and data-gathering. and resources.

STAKEHOLDER ROLES AND EXPECTATIONS

In the planning process, key internal and external stakeholders include the project team, funders,
politicians, community partners, and the intended audience/community. Their participation is critical
to achieving the best results. Without it, you can end up with stakeholders questioning, challenging,
delaying or overruling decisions.

There are four levels of stakeholders:

 core—on the planning team;

 involved—frequently consulted or part of the planning process;
 supportive—provide some form of assistance;
 peripheral—need to be informed.

Consider stakeholders’ roles and level of involvement. This helps to clarify their expectations for the
planning process, and points the way to the best decision-making and communication processes.
Understanding and documenting these areas will also help you develop a realistic work plan.

Because participation is so important in health promotion, the time and cost for each step are often
longer than for other kinds of planning. Participation by stakeholder groups is critical to achieving the

Planning Health Promotion Programs| 5

best results—a lack of participation
may lead to decisions being
overruled, delayed, challenged, or
questioned by either internal or
external stakeholders.

DECISION-MAKING
PROCESSES
Every step of the planning process
requires decisions. Be aware of who
has to be involved, consulted or
informed. Part of planning is
managing the flow of information and options so that decisions are timely and supported. When will
decisions be made, by whom, and by what process? Is consensus required? How will priorities be set?

TIME
It is important to know when overall planning and individual steps should start and end, and how
many hours or days to allocate to each planning step. Map this out through a work plan. Define each
task so it is clear how to complete the six steps of the planning process – the who, what, when and
how of each step.

RESOURCES FOR PLANNING

Before developing a work plan, define and list the type of resources to manage, i.e. money, space,
equipment and personnel.

DATA-GATHERING AND ANALYSIS PROCESS

Making the best possible planning decisions requires good data about the intended audience, the
political and social environment, stakeholder opinions, possible programs and other factors.

How much data you gather and analyze is a matter of where stakeholders’ expectations and practical
considerations meet. Stakeholders may want to incorporate different degrees of rigour and evidence
into the planning process. For example, they may or may not expect original research, qualitative
and/or quantitative data, etc.

Practical considerations include the amount of time available, budget, project team expertise, and
accessibility to quality data relevant to the program being planned. Make expectations for data-
gathering and analysis explicit and realistic.

Good processes for collating, sorting, prioritizing and interpreting the data are also critical. Much of
this takes place during the situational assessment (step 2).

Planning Health Promotion Programs| 6

Why is step one important?
Consider some common planning problems:

 Mismanaging time and missing deadlines, which can result in lost opportunities and
decrease the impact of the program.
 Poor management of budgets and other resources, which may lead to unanticipated costs
and even an inability to complete the program plan.
 Misleading, weak or incomplete data, which can lead to ill-informed decisions.

These problems can start a detrimental cycle, where poor processes lead to poor decision making,
which leads to even worse processes.

Proper decisions lead to good project outcomes – and that takes time, creativity and a supportive
climate. The right project management plan determines how you:

 make critical decisions within steps 3 and 4;

 choose indicators in step 5; and
 review and approve the program plan in step 6.

How do I do step one?

UNDERSTAND THE CONTEXT
Planning must occur within the context of your specific situation:

 Why you are going through a

planning process now? The Online Health Program Planner (OHPP)
includes four worksheets to help you
 Are you modifying an existing plan,
complete this step. To access these
or starting a new one?
worksheets please create an account and log
 What if anything, has already been
in:
decided (audiences, issues,
1.1: Understand the context
strategies)?
1.2: Identify stakeholder roles and
 What kind of content do you have
expectations
to include in your plan (e.g., a
1.3: Assess resources for planning
template or form from your
1.4: Develop a work plan for the planning
potential funder or your
process
organization)?
 Might any other circumstances or
expectations affect how you carry out your planning process or your final program?
 What time will be available to implement the program that you plan?
 What financial resources are available to implement the program that you plan?

Planning Health Promotion Programs| 7

IDENTIFY STAKEHOLDER ROLES AND EXPECTATIONS
At the outset of the project, you should:

 identify the key stakeholders;

 determine their overall degree of involvement (peripheral, supportive, involved or core
(see Figure 3);
 determine the roles for each stakeholder in the planning process, engaging them in a
meaningful way; and
 ensure you understand why each stakeholder is interested or involved with the program
and/or planning process.

Figure 3: Stakeholder wheel

It is important to focus on the process of developing a health promotion program, not only on its
result. Participation of clients, staff and stakeholders is critical.

Planning Health Promotion Programs| 8

This may include:

 working and planning with people, rather than for them;

 consulting stakeholders at key points in the planning process;
 involving the intended audience in program design; and
 using a participatory approach.

CHOOSE A DECISION-MAKING PROCESS

Establish a clear decision-making process for the core planning group early on. Will the group run on
consensus, majority vote, or some other method?

Outline any other decision-making processes that will be used, specific to the context. For example,
different processes may be required for subcommittees, certain individuals, certain circumstances,
etc.

Revisit the decision-making process regularly to ensure it is effective.

DETERMINE PLANNING START AND END DATES

Consider when planning should/must begin and end, the reasons for these timelines, and other
deadlines and milestones related to the planning process.

Base your decisions on things such as funding submission deadlines, organizational budget
requirements, request deadlines, events or meetings already planned, etc.

ASSESS RESOURCES FOR PLANNING

Allocate financial, material, and human resources in the work plan. Before doing this, you must create
an inventory of available resources, which should include:

 allocated budgets;
 staff time;
 equipment;
 space;
 expertise; and
 in-kind contributions from volunteers and partners.

Review and update these resources as needed.

DETERMINE COMPLEXITY OF DATA-GATHERING AND ANALYSIS

PROCESS
Set general guidelines for:

 how much data to collect;

Planning Health Promotion Programs| 9

  how much, if any, original research to conduct;
 the balance between qualitative and quantitative research; and
 the type of evidence to incorporate into the planning process.

Answering the following two questions can help you set these guidelines.

 What expectations do stakeholders have about the rigour of the data and evidence to
incorporate into the planning process?
 What expectations do stakeholders have about the need for new data (versus compiling
existing data) to inform decisions throughout the planning process?

Ensure that these guidelines are consistent with the resources you have assessed and identified.

DEVELOP THE WORK PLAN FOR THE PLANNING PROCESS

Many different work plan formats are available. A variety of software packages can help you decide on
format and content. Different organizations also have in-house formats and systems for work plan
development. Regardless of format, a good work plan identifies:

 tasks or steps in the planning process;

 who will be responsible for each task;
 who will consult and/or otherwise support the lead on each task;
 what days/hours are allocated to each task;
 the deadline for each task;
 dollars required for each task;
 other resources required for each task; and
 who will approve the work done.

Planning Health Promotion Programs| 10

Tips
DECISION-MAKING PROCESSES
 Consider the political context for your planning process. What factors may influence the
decision-making? Think about who needs to be consulted and who needs to approve
decisions.

TIME
 You may have to compromise in order
to meet timelines. Allow for as much
time as possible to involve people
appropriately.

RESOURCES FOR PLANNING

 Remember to make efficient use of
your time to maximize the resources
you are able to dedicate to planning,
money already allocated, and
opportunities to make progress on
other projects.

 Partnering can help make the most

efficient use of your resources, and
better position you to meet
stakeholder expectations. For
example, consider partnering with
those who are undergoing a similar process, or who have already planned a program
relating to your topic or intended audience.

DATA-GATHERING AND ANALYSIS PROCESS

 Look for community and organizational strengths and assets that can facilitate collecting
data, while acknowledging and addressing where you may need external support.

Planning Health Promotion Programs| 11

Step 2: Conduct a situational assessment
Step 1: Manage the planning process

Step 2: Conduct a situational assessment

Evaluation/feedback

Step 3: Set goals, audiences and outcome objectives

Step 4: Choose strategies and activities and assign resources

Step 5: Develop indicators

Step 6: Review the plan

What is step two about?

A situational assessment is like a “snapshot of the present” – use it to plan for the future. It involves
gathering, analyzing, synthesizing, communicating and discussing data. The purpose is to inform
planning decisions about goals, objectives, audiences, promising strategies and activities (steps 3 and
4). This step includes examining the trends and factors that may help or hinder your potential
program. Work with your key stakeholders to identify whether local organizations and agencies, local
politicians, or others in the community are willing to support your program in the ways you are
beginning to design it.

In line with the definition of health promotion principles in the 1986 Ottawa Charter,7 situational
assessment results should also:

 show the positive (strengths and issues, rather than needs or deficits);
 result from ongoing, meaningful input from the intended audience(s);
 look broadly and deeply at health issues; and
 be complete, convincing, credible and compelling.

Planning Health Promotion Programs| 12

 Look for situational assessment data on socio-environmental determinants of health

What is health? The World Health Organization defines health as a state of complete
physical, mental and social well-being and not merely the absence of disease or
infirmity.7 The models, set of beliefs, theories, and assumptions we use affect the data
we collect. We need to look for data about the broadest socio-environmental conditions
affecting the lives of the people we work with - this information is not always easy to
find but it is essential to the most complete assessment.

Why is step two important?

It is impossible to make good planning decisions without good data. Your situational assessment
findings should include not only possible options, but also data that will help you set priorities. Draw
upon the situational assessment results for all subsequent planning decisions.

Involving stakeholders in data-gathering and interpretation is a great way to gain meaningful

participation and long-term support for your program.

Situational assessments are used to:

 choose goals, intended audiences and outcome objectives (step 3); and
 select the most promising strategies and activities for your program (step 4).

What information may come to light as part of a situational assessment? Some

examples:

 A successful program may be already underway that addresses your topic/situation

(in your community or another).

 Individuals with the highest number of health risk factors (e.g., high smoking rates,
low physical activity) may live in lower-income areas with poorly-maintained housing
and few recreation facilities.

 The community most at risk may have a high level of “social capital” (e.g., a history of
successful lobbying at the municipal level, lots of volunteerism, an informal childcare
exchange/support system, and one major community festival every season).

Together, these aspects can affect the direction a health promotion program, and the
level of involvement of community members in the program’s implementation.

Planning Health Promotion Programs| 13

How do I do step two?
It is helpful to make your health promotion
theory, model or approach explicit. Your The Online Health Program Planner (OHPP)
model will guide your search for information includes five worksheets to help you complete
and ultimately suggest a range of different this step:
kinds of intervention strategies. 2.1: Develop a data-gathering plan
2.2: Summarize the situation
Consider, for example, the implications of
2.3: Analyze influences on the situation
the following two approaches: behavioural
2.4: List possible actions
and socio-environmental.
2.5: Consider how to proceed
If you use a behavioural approach, you are
concerned about the behaviours of individuals and how these risk factors can promote health or,
conversely, lead to disease and disability.8

When considering trends, influences and possible solutions for the situation, your strategies might
include:

 Looking at data about lifestyle factors that may lead to or prevent disease, such as
nutrition, physical activity and smoking.
 Exploring sources of data such as national fruit and vegetable intake data, rates of eating
out in restaurants, and use of community recreation centres.
 Polling community members, e.g. their desire for more community recreation facilities.

Your suggestions for solutions might include everything from developing tax incentives for physical
activity to workplace programs to improve cafeteria selections.

If you use a socio-environmental approach, you are concerned about the conditions in the
psychosocial, socio-economic, and physical environments that create conditions for ill-health or
wellness.8

Here, when considering trends, influences, and possible solutions, you might:

 Look at data about which socio-economic levels are most affected by a particular health
problem.
 Explore sources of data such as national crime and poverty statistics, and geographic
breakdowns showing differences in incidence of a disease.
 Poll community members about their barriers to finding meaningful employment.

Using this approach, your possible programs might include developing affordable housing, supporting
the government in making changes to the minimum wage, or working with isolated individuals to
develop a sense of community.

Planning Health Promotion Programs| 14

Following, we review the six sub-steps to conducting a situational assessment:

1. Identify key questions to answer through the assessment.

2. Develop a data-gathering plan.
3. Gather the data.
4. Organize, synthesize and summarize the data.
5. Communicate the information.
6. Consider how to proceed with planning.

1. IDENTIFY KEY QUESTIONS TO ANSWER THROUGH THE

ASSESSMENT
The first part of conducting a situational assessment is
determining what you want to know. Start with three
important questions.

1. What is the situation?

2. What is making the situation better or worse?
3. What possible solutions, interventions and
actions can you take to deal with the
situation?

Each of these may lead to a series of more specific

questions to guide your situational assessment.

For example:

 What is the situation?

a. What impact is the current situation having on health and quality of life for various
groups of people?

b. How do local stakeholders and the public perceive the situation?

c. How do local stakeholders and community members describe their needs related to the
situation?

d. What solutions do local stakeholders and community members favour and why?

e. What are the benefits of acting now versus acting later?

 What influences are making the situation better and worse?

a. What risky or negative health behaviours of various groups are affecting the situation?

b. What makes people behave in these ways?

Planning Health Promotion Programs| 15

 c. What political, economic, environmental, social and technological trends are
influencing the situation?

d. What conditions in the social or organizational environments, or at the broader public

policy level, are causing or helping to alleviate the situation?

e. What internal strengths and weaknesses are present in your organization that may
affect your course of action?

f. What opportunities and threats in your environment may affect your course of action?

 What possible actions can you take to deal with the situation?

a. What are other organizations, similar to yours, doing to address this situation?

b. What has your organization done in the past?

c. What evidence exists to support various courses of action?

To explore your issues, audiences, and the scope of possible causes and solutions, refine your specific
questions. To do that:

 Ask your stakeholders what they want and need to know to make decisions about the
program.

 Review documents that outline your mandate, planning requirements and

community/organization expectations. For example, you may need to adhere to funding
proposal guidelines or practice standards (e.g., Ontario Public Health Standards). You may also
have a relatively narrow scope if you are refining an existing program versus starting a new
one from scratch.

 Select one or more health promotion, social science or behaviour change theories that apply
to your situation (e.g., Stages of Change; Health Belief Model).8 Then identify variables within
the theories, and create research questions that will help you understand what influences the
behaviours you are interested in changing.

To use your resources effectively and efficiently, it’s best if your questions do not change much over
the course of your planning. The more specific questions will relate to your specific issue(s),
audience(s), and the scope of possible causes and potential solutions that you are willing or able to
consider.

2. DEVELOP A DATA-GATHERING PLAN

A data-gathering plan is a clear and realistic list of specific tasks or action steps. A good plan takes into
account the five main areas of project management: 1) stakeholder roles and involvement; 2)
resources; 3) time; 4) decision-making; and 5) data collection.

Planning Health Promotion Programs| 16

Each task should have assigned responsibilities (lead and support), a deadline, and necessary
resources allocated. Use the most skilled person or people available to do the work. Try to be accurate
about the necessary time, people and dollars needed for a particular task. This will help you prioritize
before you collect data, and be on schedule/budget when you proceed to data collection.

In general, data-gathering tasks can be seen as:

 collecting various types of data (e.g., a scan of what others are doing to address a similar
situation);
 using a combination of methods (e.g., face to face consultation, surveys, accessing
existing large data sets, etc.); and
 accessing various sources (e.g., researchers, community organizations, government
websites, etc.).

There are many appropriate routes, which each have their advantages. For example, published
literature may give you a broad perspective about what works across many different locations.
Consultative methods, such as focus groups, can provide rich data specific to your environment and
community. It’s a good idea to draw on a variety of types, methods and sources of data. The following
provides a good starting point.

TYPES OF DATA

 community health status indicators

 quantitative polling/survey data
 community stories/testimonials
 evaluation findings
 research findings
 cost-benefit data
 syntheses and guidelines
 best or recommended practices
 environmental scans (from organizations like yours)
 stakeholder mandates, agendas, policies, guidelines, etc.

METHODS FOR GATHERING DATA

 consulting with stakeholders (interviews, focus groups, forums, etc.)

 surveys
 searching the literature (e.g. published and/or unpublished, single studies and/or
reviews, a review of internal documents)
 examining existing large data sets (e.g. previous surveys, hospital admissions, arrest
reports, etc.)

Planning Health Promotion Programs| 17

 Methods for gathering data may include both primary and secondary data collection.
Primary data: collected by you (e.g., surveys, focus groups, and other means). Secondary
data: collected by someone else (existing data). For cost reasons, as you work toward
answering your key situational assessment questions it usually makes sense to tap into
all possible secondary sources of data first, then use primary data collection to fill in
gaps.

SOURCES OF DATA

 community service organizations

 polling companies
 community spokespersons
 public libraries
 consultants
 websites
 resource centres
 researchers
 government departments
 private sector
 other stakeholders

There are two primary ways to generate your own type/method/source combinations for your data-
gathering plan.

1. Start with type. Consider which types of information you want, and then determine which
methods you want to use to get the information. Finally, choose the sources that will give
you the information you want.

2. Start with source. Think about where the data might be and who has the information. For
each source, consider what types of data they might have, and determine the best method
to get it.

The ideal plan may include an extensive data collection process. However, with limited time and staff
support you’ll have to prioritize each task based on the importance of having the information and the
feasibility of obtaining it. As with all other parts of program planning, the final data collection plan will
likely be a compromise.

The following examples of type, method and source generally provide a substantial amount of good
data, relative to the investment of time and money.

Planning Health Promotion Programs| 18

Table 1: Examples of data sources

IF YOU WANT TYPE OF DATA DATA GATHERING EXAMPLES OF SOURCES

METHOD

Information about Community health Literature Local Board of Health;

community needs status indicators search/review Community Health Status
Reports; Rapid Risk Factor
Surveillance System - (RRFSS)9-
11
; Canadian Community
Health Survey –CCHS10; Public
Health Agency of Canada
(PHAC) infobase11

Information about Environmental scan Focus group; key Staff from community service
what conditions – informant interview organizations that are already
in the social or, working on the problem;
organizational project team; local public
environments or health epidemiologist;
at the broader members of the intended
public policy level audience; municipal planning
– are causing or department
helping to
alleviate the
situation

Information about Best practice Search of databases National Guidelines

what evidence synthesis and populated with Clearinghouse; Turning
exists to support guidelines; guidelines or pre- Research into Practice (TRIP);
various courses of Summaries of appraised systematic Healthevidence12-14
action systematic reviews reviews

Guidance about Review of Internal document Strategic plans from your own,
the nature and stakeholder review or related organizations;
scope of the final mandates, policies, professional standards and
program you guidelines, etc. guidelines; your own budget
develop documents; documents
summarizing the political
agendas/priorities of your
funder, etc.

Planning Health Promotion Programs| 19

It is also important to track information gaps.
This will support future program planning It may take some digging to find unpublished
efforts, and help you when opportunities to reports, often called “grey literature”, but it is
generate or gather more data arise (e.g., a grant generally worth it. Examples include: internal
or university partnership opportunity) during planning documents, literature reviews,
planning, implementation or evaluation. results from small-scale audience analysis
efforts, and informal program evaluation
results. Often, these reports contain useful
3. GATHER THE DATA information about what worked and didn’t so
After developing your data-gathering plan, keep you can avoid repeating the mistakes of
research efforts in line with your available others. Heeding the advice of these reports
resources to stay on time and within budget. can also be a good way of engaging
community members and organizations in
As you gather data, keep good records about
program planning. You can find links to public
where it came from. For example, was the study
health grey literature sources here:
published in a peer-reviewed journal or is it an
http://www.ophla.ca/pdf/Public%20Health%
unpublished report? Who analyzed the
20Grey%20Literature%20Sources.pdf 15
information, researchers or community
members? Careful record-keeping will help you
assess the calibre of information and weight it accordingly as you move into the analysis phase of
situational assessment (and eventually into the decision-making phase of planning).

Most importantly, never lose sight of your situational assessment questions. Keep good notes about
which sources of data are meant to answer specific questions. This will help you structure your data-
gathering (e.g., developing focus group questions), and save time later when you organize your data. It
will also make it easier to, if necessary, divide the work of organizing and synthesizing the data (step
4).

Public Health Ontario produces a series of Evidence Briefs, short summaries of the
evidence on key public health topics informed by rapid knowledge synthesis methods,
which can be found on the PHO website. Peel Public Health also makes their Rapid
Reviews publicly available on their website.

4. ORGANIZE, SYNTHESIZE AND SUMMARIZE THE DATA

At this stage, the challenge is to take the wealth of information collected and make it meaningful. Start
by sorting the key lessons gathered from each of your data collection tasks. Then organize them
around the three broad situational assessment questions in general, and your specific questions,
recapped below from an earlier section of this workbook:

1. What is the situation? Consider the trends, impacts, public and stakeholder perception of
the situation.

Planning Health Promotion Programs| 20

 2. What is making the situation better or worse?
3. What possible solutions, interventions and actions can you take to deal with the situation?

As you are listing key lessons from your data, keep track of data sources. The strength of the evidence
relating to various factors may affect your decisions. For example, opinions and ideas that
stakeholders put forward are important, but could conflict with published reviews in peer-reviewed
journals. Good source records will help you in steps 3 and 4 when you must make decisions in line with
stakeholder expectations about the type and rigour of evidence to apply.

When organizing, it is also important to keep track of data that suggest specific directions or
conclusions related to planning steps 3 and 4. That’s where you will make decisions about program
goals, objectives, audiences, promising strategies and activities. This type of sorting can also help you
keep track of gaps in your analysis that require further data collection.

One way to do this is to generate an “evidence table”. Use a spreadsheet to help track the types of
information you are interested in (e.g., source of information, date, geographic focus, type of research
design, research question it addresses, etc.). You can sort the information by any variable at any time.
A standard evidence table format can also help you consolidate your information when more than one
person is reviewing sources of data.

Once the relevant information has been pulled out of your sources, it is time to synthesize and
summarize the information into key findings. These findings – answers to your situational assessment
questions – should indicate the results of your situational assessment that cannot be ignored. They
should also be convincing, compelling, evidence-informed and readable. These findings are the inputs
that you will use to make decisions in the next steps of the planning process.

Below are some ideas for how to synthesize and summarize your information into key findings for
each type of situational assessment question.

1. WHAT IS THE SITUATION?

The large amounts of data collected during the situational assessment, from stakeholders, literature
and various other sources, can be overwhelming. That makes it difficult to decide which goals,
objectives, and priority populations are most obviously linked to the data. To synthesize what is known
about the situation, try some of these strategies.

 Focus on the 20% of the information that conveys 80% of the most important findings
(known as Pareto’s Law).
 Use charts and maps (e.g., mind mapping) to present visual representations of the
information.
 Divide each piece of important information by theme.
 Split up the data among planning committee members. Ask them to review it with a few
specific questions in mind, e.g., what priority population should be our focus?
 Cull the data before analysis for those aspects of most use.

Planning Health Promotion Programs| 21

  Designate one person per research question. Have them review all data, but look only for
answers to their particular research questions.
 Sort the data based on the relative importance of the source. Then, starting at the top of
the pile, deal with whatever amount you can handle.

To summarize the situation, select the most significant findings. Then develop a concise summary (as
little as one paragraph, or 5-6 bullet points). To supplement this summary, you may wish to compile
additional background documents. In your summary, include insights about:

 the size and growth of the situation;

 the burden and impact of the problem;
 health inequities;
 public perception of the problem;
 stakeholder perceptions and concerns; and
 the potential consequences of acting now versus later.

2. WHAT INFLUENCES ARE MAKING THE SITUATION BETTER AND WORSE?

Situational influences (sometimes called factors)

can be people, circumstances or environments. Involve others in interpreting the data. Work
with your stakeholders to ensure that you are
To uncover your key findings related to this interpreting the data in a way that resonates
question, try to further sort and organize your with their experience.
data. Classify each influence or factor according
to the following characteristics:

 How it is affecting the situation – is it making it better or worse?

 At what level of the environment does this factor influence the situation – individual,
interpersonal, organizational, community or public policy?
 How significant is the factor – to what degree is it affecting the situation?
 How able will you be to effect change on this factor, with available resources?
 Is potential action on the factor in line with your mandate and priorities?

Ideally, present your findings within an ecological or multi-level approach16. For example, the five
levels of influence– individual, interpersonal, organizational, community and public policy – have many
political, economic, environmental or technological considerations. At each level, certain types of
changes will ultimately have an impact on a particular health problem.

 For individuals the bottom line is maintaining a personal behaviour change.

 For interventions at the interpersonal level, the goal is to leverage the impact that family
and friends have on an individual’s beliefs and behaviours.
 For organizations the desired impact is to change policies (e.g., rules, incentives and
rewards, sanctions and punishments, allocation of resources).

Planning Health Promotion Programs| 22

  For communities the desired change is to impact formal and informal social norms
among groups and organizations.
 For the public policy level, the desired impact is to change formal laws.16

The situational assessment results might be organized by how the information relates to these four
levels of change. There are many other ways to present data. For example, a table may suffice or a
force-field analysis.

A force-field analysis visual depicts the positive and negative factors, as well as levels of influence
(individual, interpersonal, organizational, community, public policy). You can show the strengths of
effects by making some arrows bigger or heavier (see Figure 4).

Figure 4: Force-field analysis of intimate partner violence

Factors that make the Factors that make the situation
situation better worse

National policies
Public Policy
support women to
(political, economic, social,
obtain high levels of
technological environments)
education17

High unemployment
Community rate 17

Workplace provides
regular education about Organizational
domestic violence to all
17
employees

Parental history of
Interpersonal intimate partner
violence17,18

No prior history of Individual

physical abuse17,18

Planning Health Promotion Programs| 23

Keep in mind that you can position some, if not most, factors on both the positive and negative “sides”
by flipping the perspective. For example, a history of intimate partner violence between an individual’s
parents would be a negative contributing factor to the situation; parents who provided an example of
a healthy, safe relationship would be considered a positive protective factor.17,18 Either way, each
factor represents a focal point and potential opportunity to act.

This type of sorting can help you see which factors and levels require the most attention to achieve
your goals. It can also help you identify gaps in your data. For example, your analysis may primarily
focus on the individual level, without information about how social networks, organizational
environments, communities and public policies influence the situation. You may discover that most
factors influencing the situation are outside your mandate area, or unrealistic to address. Still, more
data collection may be warranted.

3. WHAT POSSIBLE SOLUTIONS, INTERVENTIONS AND ACTIONS CAN YOU TAKE TO DEAL
WITH THE SITUATION?

At this point, your data will vary in scope. For example, you may discover the following
types of promising actions:

1. A program with a well-organized series of activities to facilitate change among a

well-defined target group.

2. A strategy or approach to facilitate change, such as re-orienting health services (then

allowing more specific activities).

3. An individual activity such as forums, posters or counseling.

List ideas about possible actions to address the situation. For each idea, keep track of:

 where it came from;

 what information you have about evidence of effectiveness for this possible action; and
 details to inform your choices about strategies and activities for your program (step 4),
e.g. whether the action is practical for your community.

To organize and summarize key findings, try SWOT analysis (see Table 2). A SWOT considers the
Strengths and Weaknesses of your organization, and Opportunities and Threats outside your
organization, in this case related to the program you are developing.

Planning Health Promotion Programs| 24

Table 2: SWOT analysis

FACTOR EXAMPLE

Strength Your organization has credibility with funders

Internal accountability mechanisms make it hard to partner with other

Weakness
organizations

Opportunity The provincial government has a new grant related to your program issue

Threat Your local council has twice refused to fund such a program

Mapping of your SWOT results (see Table 3) – strengths and weaknesses, against opportunities and
threats – can help you discover your most significant findings and lead you to logical possible actions.
For more about this process, see Comparative advantage for damage control: Clarifying strategic
issues using SWOT analysis.19

Table 3: SWOT analysis with strategies for each quadrant19

OPPORTUNITIES THREATS

Invest Defend

Strengths Clear matches of strengths and Areas of threat matched by areas of

opportunities lead to competitive strength indicate a need to mobilize
advantage resources

Decide Divest

Weaknesses Areas of opportunity matched by Areas of threat matched by areas of

areas of weakness require a weakness indicate need for damage
judgement call control

5. COMMUNICATE THE INFORMATION

Before disseminating the results of your situational assessment, be clear about who needs the
information, and the best way to get it to them. Your communication plan should include:

 key audience(s);
 communication objectives;
 communication channel(s), or the means by which a message is sent; and
 communication vehicles, or the formats used to deliver messages.

Planning Health Promotion Programs| 25

 Some stakeholders might want
individual or group briefings. Others
may be satisfied with a written report.
Some may require more detail, while
others prefer a brief synopsis.

Regardless of the audience and format,

use a variety of techniques to express
the key findings — graphs and charts,
and stories and analogies. It’s important
to balance text and visuals.

If using a written report format,

consider a one-page briefing note about
key findings, a three-page executive summary, and a 25-page detailed report. Each document length
will appeal to different audiences.

6. CONSIDER HOW TO PROCEED WITH PLANNING

After collecting and organizing your data, it is time to evaluate the situational assessment results and
decide how to proceed. Base this decision on the quality and quantity of data, and your understanding
about how to improve the situation with your resources.

Consider:

 What are the gaps in data quality or quantity, relative to stakeholder expectations?
 How might that restrict your ability to make evidence-based decisions about goals,
audiences, objectives, strategies, activities and resources?
 How do you perceive your ability to affect the situation with your available time,
financial resources and mandate?
 What are your next steps in the planning process? Will you proceed now, or must you
revisit research questions, project scope or resources?

Planning Health Promotion Programs| 26

The Population Health Assessment and Surveillance Protocol of the Ontario Public Health
Standards20 describes situational assessment like this:

“A situational assessment influences planning in significant ways by examining the legal and
political environment, stakeholders, the health needs of the population, the literature and
previous evaluations, as well as the overall vision for the project. The phrase “situational
assessment” is different from “needs assessment”. This is intentional. The new terminology
is used as a way to avoid the common pitfall of only looking at problems and difficulties.
Instead, it encourages considering the strengths and opportunities for individuals and
communities. In a health promotional context, this also means looking at socio-
environmental conditions and broader determinants of health.”

Tips
 Don’t underestimate how long it will take to assess the situation from every angle.
 Involve a wide range of stakeholders by asking questions about issues and assets in small
groups or by using surveys.
 Build partnerships with others who have expertise in interpreting or gathering data.
 As the final product may be useful to many people in the community, use it as an
opportunity to seek additional funding or sponsorship.
 Help the process by collecting lots of readily-available information.
 Prepare a clear focus and agenda for any stakeholder meetings to examine the data.
 Use a mix of quantitative and qualitative methods to collect data.
 Talk to people to understand the true meaning behind the numbers.
 Focus on strengths, capacities and resources—not just deficits and problems.
 Focus on the determinants of health, rather than health as just the absence of disease.

Planning Health Promotion Programs| 27

Step 3: Set goals, audiences and outcome
objectives
Step 1: Manage the planning process

Step 2: Conduct a situational assessment

Evaluation/feedback

Step 3: Set goals, audiences and outcome objectives

Step 4: Choose strategies and activities and assign resources

Step 5: Develop indicators

Step 6: Review the plan

What is step three about?

As part of the situational assessment process, you kept track of findings that suggested directions or
conclusions related to choosing goals, audiences and objectives. In step 3, you now apply that
information. Doing so before program strategies and activities (step 4) is important. It allows you to
ask and answer this question: “Which strategies and activities will best advance our goals and
objectives within the limits of our resources?”

You should expect to reconsider and modify the goals and objectives as the actual program takes
shape. The most important thing is that the goals, objectives, strategies, activities and resources all
make sense together. For instance, what happens if available resources cannot support your work
toward all outcomes? You may have to revisit decisions about the scope of your goal, the number of
audiences you are interested in, and outcome objectives.

Planning Health Promotion Programs| 28

Involve stakeholders in a meaningful way to generate possibilities and make decisions. That will help
create a clear, concise, credible and compelling statement of goals, audiences, and outcome
objectives.

Your step 3 decisions will create a large part of a logic model that visually summarizes your program.

SET GOALS
A goal is a broad statement that provides overall direction for all aspects of a program over a long
period. Because of the need for flexibility, these tend to be descriptive, global statements of what is
intended. Most health promotion programs have a single goal, although more complex programs may
have several.

Goals do not have a deadline. They also are not measurable in exact terms because they often include
subjective words like evaluate, know, improve and
understand.

What goals do is serve as an anchor and framework for

program planning. They provide a set of clear end points,
around which you can organize many strategies or
activities. As the situation evolves, your strategies and
activities may change, but that rarely affects well-stated
goals. This is particularly important in situations where
stakeholders may have conflicting goals, or when you need
innovation or a new approach.

CHOOSE AUDIENCES
The audience of interest requires special attention to achieve your goals. There are generally two
kinds of audiences: primary and secondary.

The primary audience, often mentioned in the goal, is the group whose health you are concerned
with.

Secondary audiences influence the primary audience, for example through:

 social influences (informal networks including family and circles of friends);

 policies and procedures (of various organizations where people work, play, worship,
receive health and social services); and
 legislation and regulations (at various levels of government).

A plan with multiple parts and strategies may have a number of secondary audiences.

Planning Health Promotion Programs| 29

WRITE OUTCOME OBJECTIVES
An outcome objective is a brief statement specifying the desired changes caused by a health
promotion program. Depending on the accepted terms of your organization, changes may also be
called results, impacts, or effects. Good objectives include four components:

1. who you want to change (audience);

2. what you want to change in the audience (outcome);
3. by how much; and
4. by when.

Objectives differ from goals in a number of ways, as shown in Table 4.

Table 4: Goals vs. objectives

GOAL OUTCOME OBJECTIVE

Scope General Specific

Time Not time-limited Time-limited, relative to goals

Identify how much of what

Set general direction (e.g. “to
Purpose should happen, to whom and by
increase or decrease…”)
when

Measurability Need not be measurable Measurable

Could be many, at each level of

Number 1-2 per program
change

Link Links back to strategic directions Links back to goals

Planning Health Promotion Programs| 30

Objectives can be set at five different levels of change, as seen in Table 5.

Table 5: Characteristics of objectives at each level16

TYPE OF
LEVEL OF OUTCOME, CONTRIBUTING
RELEVANT AUDIENCES
OBJECTIVE RESULT, IMPACT FACTORS
OR EFFECT

Segments most in need. For

An individual’s:
example:
 knowledge
 men
Maintain a  beliefs
Individual personal behaviour  children
change  attitudes
 lower-income groups
 skills
 smokers
 self-efficacy
 homeless people

Opinions of networks such as:

 Frequency and
content of  Families
Social networks
conversations
Interpersonal influence  Groups of friends
about a health
behaviour change
issue within a  Colleagues
social network
 Teammates

Decision-makers (primary) or
 Views about costs employees, unions, customers
and benefits of (secondary) of organizations such
policy change as:
Organization Develop policies  Confidence and  Schools
competence in
developing  Worksites
effective health  Places of worship
promoting policies
 Primary health care settings

Planning Health Promotion Programs| 31

 TYPE OF
LEVEL OF OUTCOME, CONTRIBUTING
RELEVANT AUDIENCES
OBJECTIVE RESULT, IMPACT FACTORS
OR EFFECT

 Interactions Opinion leaders of communities

between such as:
organizations and
smaller social  Geographical communities
Change the social
Community networks (i.e.,  Shared interest communities
environment
families) (e.g. artists’ community)
 Community  Collective identity (e.g., African
organization and American community)16,21
coordination of
services
 Actions of special
interest groups Elected officials; the public; special
Develop formal
Society interest groups; media of a town,
laws  Media coverage
region, province, country
 Public opinion

Planning Health Promotion Programs| 32

Table 6 shows examples of objectives at five different levels, divided into five components.

Table 6: Sample objectives at each level16

LEVEL OF IN WHO WHAT YOU WANT

OBJECTIVE BY HOW MUCH (AUDIENCE) TO CHANGE
(OUTCOME) BY WHEN

…who agree that

depression and
anxiety are highly
To increase by
…adults between treatable
Individual 10% the number …within 2 years
ages 50-80… disorders that
of…
should be
discussed with a
doctor…

…who agree that

mental health
…people who
problems such as
provide informal
To increase by anxiety and
care (unpaid …in the next 12
20%, the depression are
Interpersonal caregivers) to the months
percentage of… often closely
elderly in
linked to physical
Ottawa…
health
complaints…

…that give all

patients a
...physician offices
To increase by 10, screening tool for …within the next
Organizational in Niagara
the number of... depression to take 18 months
Region…
home once a year
…

…that participate
in collaborative
…service
To increase by 5, care models for …within the next
Community providers in the
the number of the management 18 months
Durham Region…
of depressive
disorders…

…who feel that a

national mental
To increase by 3 …Cabinet …in the next 18
Public Policy health strategy is
the number of… members… months
a priority for
Canada…

Planning Health Promotion Programs| 33

SHORT, MEDIUM AND LONG-TERM OBJECTIVES
Short-, medium- and long-term objectives create
stepping stones – a series of changes needed to Objectives don’t always state how much
bring about sustainable long-term changes. change you wish to achieve and by when. The
choice to set specific change targets and/or
For instance, you require changes in knowledge timelines depends on your:
to create medium-term changes in health-  knowledge of the existing situation in the
related behaviours, or support for a healthy community (the baseline);
public policy among decision-makers. Longer-  knowledge of what amount of change is
term objectives often refer to changes in possible;
community conditions, including the social,  confidence in the ability of intervention to
economic, and physical environments. bring about the desired change; and
 ability to collect data identifying the degree
The steps and efforts needed to achieve the
of change.
program goal will dictate your timeframes. In
general:

 short-term objectives are 2 months to 1 year;

 medium-term objectives are 1-5 years; and
 long-term objectives are over 5 years.

OTHER CHARACTERISTICS OF GOOD OBJECTIVES

Well-crafted program objectives are SMART. That’s an easy way to remember these key features:

 Specific (clear and precise)

 Measurable (amenable to evaluation, information needed to assess objective readily
available and accessible)
 Appropriate (aligned with mandates and stakeholder expectations, theory and other
evidence)
 Realistic (reasonable considering the resources and other circumstances)
 Time-limited

In addition, good objectives are credible to key stakeholder groups.

Planning Health Promotion Programs| 34

Why is step three important?
Setting goals is critical to designing your program, and is also a time when stakeholders become
invested and inspired. Identifying audiences is important because knowing who you want to change –
which individuals, families, groups, organizations, communities and public policies – suggests different
strategies and activities. Concise, well-written objectives help you focus your planning efforts, and
clarify next steps for stakeholders, particularly those interested in evaluation or research. Also,
objectives are the basis for selecting indicators (step 5), which is critical for the evaluation process.

How do I do step three?

First, ensure that everyone agrees to use the same terms. Table 7 identifies our terms in the left-hand
column, and a number of other commonly used terms on the right. Your choice of terms doesn’t
matter, as long as it is clear and acceptable to stakeholders, and used in a consistent way.

Table 7: Common terms used in planning

OUR TERM ALTERNATIVES

Goal Purpose, mission

Outcome objectives Outcomes, impacts, effects, results

Population of interest, priority population, target group, community of

Audience
interest

Indicator Criteria for success

Activities Process, implementation, outputs

Process objectives Implementation objectives

Resources Budget, assets, inputs

Planning Health Promotion Programs| 35

Communicate the results of the situational assessment to everyone who will participate in the
process. That will help you to decide on goals, audiences, and outcome objectives, so decisions are
evidence-informed. Pay particular attention to information about:

 lessons learned from similar

programs and trials; The Online Health Program Planner (OHPP)
includes a worksheet to help you complete
 what the research literature says
this step and build your program logic model:
about your topic;
3.1: Set goals, audiences, and outcome
 what behaviour change and health
objectives
promotion theories say about your
situation;
 which levels of the environment (public policy, community, organizational, interpersonal
or individual) are most influencing your situation;
 community and organization assets and strengths; and
 all determinants of health — behavioural and socio-environmental (e.g., housing
conditions, degree of isolation).

SET GOALS
Create a simple statement that captures the broad direction of the program. Examples include:

 “to increase [a positive quality or state of affairs]”; or

 “to decrease [problems]”.

CHOOSE AUDIENCES
Look at your situational assessment data results and identify which individuals, networks,
organizations and/or communities:

 must change because they have significant bearing on the situation (something that
should be done);
 may change given the resources at hand, e.g., pregnant or breastfeeding women living in
high-risk circumstances, children in low-income families (something that could be done);
and
 are unlikely to change, as they are aligned with the mandates, expectations and interests
of key stakeholders, or aligned with something your organization is expected to do.

Consider using a simple diagram like the one shown in Figure 5 to organize discussion, analysis and
recording of the choice of audiences. You’ll find the best audiences in the place where these three
circles overlap. We recommend that you consider audiences at five levels (individual, interpersonal,
organizational, community, public policy), even if your final objectives do not include all levels.

Planning Health Promotion Programs| 36

Figure 5: Factors affecting choice of audiences and strategies

has significant bearing on

the situation (should)

Best
choice
is aligned with your
mandate and is amenable /likely to
stakeholder interests occur (could)
(would)

There are countless other methods and tools for decision-making. One example of a good source is the
Mind Tools website.22 Whatever process is used, take the opportunity to first generate a number of
interesting and broad alternatives (divergent thinking), and then prioritize the choices to a small
number of specific alternatives (convergent thinking).

We call the audience that we ultimately want to change the “primary” audience; this is shown at the
individual level. Other audiences are also important for change because they are a means to reaching
your goal; we call these “secondary”.

Programs often begin with the secondary audience, then move to the primary audience. For example,
a program may begin by working with physicians (a secondary audience) to enhance their tobacco
interventions, with a view to increasing cessation among young women (the primary audience).

Planning Health Promotion Programs| 37

WRITE OUTCOME OBJECTIVES
Develop your outcome objectives in a four-step process:

1. Begin with stating the primary or secondary audience (who).

2. Carefully consider what specific change you would like to see. This choice should be very
strategic. Changes selected should be significant, feasible, and within your mandate.
Health promotion theories (see Table 8 for some examples) and other data reviewed
during your environmental scan can provide insights into which factors significantly have
an impact on the situation.

3. Consider how much change is attainable. Again, draw on your situational assessment data.
Stakeholders, surveys or benchmarks discussed in the literature may provide direction in
this area.

4. Finally, set a timeline for reaching the objective (when).

Table 8: Health promotion theories 8

LEVEL OF OBJECTIVE RELEVANT THEORIES TO CONSIDER

Stages of Change
Individual
Health Belief Model

Interpersonal Social Cognitive Theory

Organization Organizational Theory

Community Diffusion of Innovations Theory

Public Policy Social Change Theory

Determine the likelihood of change by reviewing evaluations of past interventions with the audience.
Your mandate, and your organization’s capacity to work on various factors affecting the situation, are
also important.

Sometimes it helps to start with a “straw dog”—a sample objective that you can tailored to your
situation. Table 9 shows some examples of outcome objectives at each level.

Planning Health Promotion Programs| 38

Table 9: Sample outcome objectives at each level16

LEVEL SAMPLE OBJECTIVES

Increase awareness of risk factors, personal susceptibility, solutions, or health

problems
Increase knowledge (or recall, comprehension, analysis, synthesis) of ideas
and/or practices
Increase awareness of local services, organizations, etc.
Change (increase positive, decrease negative, or maintain) attitudes
Individual
Increase intention to make and sustain change
Increase information-seeking behaviour
Increase perceived social support
Increase confidence about making behaviour changes (self-efficacy)
Change behaviour

Increase favourable knowledge and attitudes held by members of social

Interpersonal networks
Increase supportive activity (number of discussions of health issues)
Increase number and kinds of health-related interactions within networks

Increase the number of gatekeepers, decision-makers and/or other influential

people in organization considering policy changes or adopting specific
programs
Increase the number of gatekeepers, decision-makers, other influential people
and/or organizational members (or students, employees, etc.) who feel that
the issue is important and change is necessary (building an agenda)
Organizational
Increase the quantity and quality of information regarding the issue and the
policy change required
Increase organizational confidence and competence in making health-related
policy changes
Change/implement policy, and/or adopt/change program

Increase collaboration between organizations and groups of individuals

Community Increase social support for positive changes
Change social norms and behaviours

Increase the importance communities and society attach to an issue by

increasing media coverage
Public Policy
Increase societal/public values and norms (attitudes and opinions) that
support the policy change you are recommending

Planning Health Promotion Programs| 39

LEVEL SAMPLE OBJECTIVES
Increase the number of politicians who support the policy change you are
recommending
Change/implement a policy

Tips
STAKEHOLDER ROLES AND EXPECTATIONS
 If community development is important to your program, involve community members;
if strengthening partnerships is important, involve community partners. Always involve
your staff because their understanding and buy-in is critical when it comes to
implementation.

 Ask people to work with you to come up with a meaningful goal. It can be an important
learning opportunity for everyone involved.

 Brainstorm collectively, but appoint a designated writer to fine-tune wording of goals

and objectives.

DECISION-MAKING PROCESS
 Use the large group to decide on the essence of the goals and objectives. Have a small
group or single person approve the final writing.

TIME
 Choose goals, audiences and outcome objectives as an important foundation for your
program plan. This phase often requires many rewrites. Make sure there is enough time
to do it properly, with adequate consultation with stakeholders.

 Avoid using large groups to wordsmith each goal and objective; you can get bogged
down. Instead, designate one person to develop the wording after the group/team has
drafted the goals.

DATA GATHERING AND ANALYSIS PROCESS

 Data-gathering does not end with the situational assessment. Now that you have more
focus, continue to look for data (within reason, given available resources) that will help
inform setting SMART objectives.

Planning Health Promotion Programs| 40

Step 4: Choose strategies and activities and
assign resources
Step 1: Manage the planning process

Step 2: Conduct a situational assessment

Evaluation/feedback

Step 3: Set goals, audiences and outcome objectives

Step 4: Choose strategies and activities and assign resources

Step 5: Develop indicators

Step 6: Review the plan

What is step four about?

Step 4 is the planning phase in which you identify strategies, choose activities, assign resources and
write process objectives. In step 2, you tracked findings that suggested directions or conclusions
related to your program. In step 3, you determined goals, audiences and outcome objectives. Step 4 is
where the previous two steps meet to answer this question: “Which strategies and activities will best
advance our goals and objectives within the limits of our resources?”

Planning Health Promotion Programs| 41

IDENTIFY STRATEGIES
A strategy is a broad approach to facilitating
change. Choose strategies according to the
results they are intended to create, or the
typical activities they might include.

Many theories or frameworks list related

strategies. For instance, the Ottawa Charter
for Health Promotion7 identifies five types of
strategies: 1) build healthy public policy; 2)
create supportive environments; 3)
strengthen community action; 4) develop
personal skills; and 5) reorient health
services. A program can include one or more
strategies. Each strategy contains one or
more activities.

Other terms can be used to describe the five Ottawa Charter strategies and additional strategies.
Examples include education, health communication, and self-help. Table 10 shows clusters of
strategies. The terms shown are not necessarily identical in meaning, but are often associated with
similar activities.

Table 10: Health promotion strategies and associated activities

CLUSTERS OF RELATED EXAMPLES OF ASSOCIATED ACTIVITIES

STRATEGIES AND TERMS

Efforts to influence policies, operating procedures, by-laws,

regulations and legislation can have a direct impact on health. For
example:
Build healthy public policy;
By-law development;  Municipal alcohol policies help minimize alcohol-related
Legislation; injuries.
Regulation;  School board cafeteria policies help ensure young people eat
Volunteer and organizational more nutritious food and less junk food.
policies;  Seat belt and bicycle helmet laws help protect people from
Political action injury.
 Laws that regulate the handling of hazardous materials
combined with company policies and procedures make
workplaces safer.

Create supportive The places where people live, work and play can impact behaviour.
environments; For example:

Healthy environments  The design of a community may dictate whether walking is a

pleasant experience for residents.

Planning Health Promotion Programs| 42

 CLUSTERS OF RELATED EXAMPLES OF ASSOCIATED ACTIVITIES
STRATEGIES AND TERMS
 The location of a recreational facility can make it easier or
more difficult for children to participate in activities.
 A gym in a workplace can make it easier for employees to get
daily activity.

Communities can mobilize and work together to improve health

through projects such as community gardens, healthy lifestyle
community projects, neighbourhood anti-drug initiatives, Block
Parent associations and community economic development projects.
Some projects, such as healthy lifestyle and anti-drug programs, are
Community mobilization; designed to help people change behaviours. Others, such as
Community development; community gardens and community economic development projects,
Foster public participation; attack the root causes of poor health, including poverty.
Community organization;
Coalition building; Strengthen Organizations that work to help communities mobilize usually act as a
community action catalyst, by:
 doing outreach in the community;
 bringing key people (professionals and people in the
community) together; and
 helping the community develop the skills (capacity) it needs to
organize and manage projects.

Working with people – one-to-one or in groups – can help them

Develop personal skills;
develop knowledge and skills needed to improve their health, and
Counseling;
provide the ongoing support they may need to have more control
Personal empowerment
over their lives.

Strengthen community health The health sector can move toward health promotion, beyond clinical
services; and curative services. It can also be designed in ways that are
Re-orient health services sensitive to the needs of different cultures and socioeconomic groups.

Fact sheets, brochures, and media can help people become more
knowledgeable about health. For example, a copy of Canada’s Food
Guide combined with a cooking demonstration and recipes, can give
people both the information and skills they need to eat better.
Provide information;
Education Education may include seminars and workshops that professionals
organize. It may also involve more general programs from a range of
health-related and non-governmental organizations – such as literacy
classes, life skills workshops and group counselling – that help people
develop the skills to understand and act on health information.

Campaigns that use traditional marketing tools and techniques - such

Health communication; Social
as advertising campaigns, slogans and logos – may influence attitudes
marketing;
and encourage social change (social marketing).
Risk communication;
Some campaigns strive to make certain practices socially
Communication for social
unacceptable, like drug abuse, social smoking, and texting while

Planning Health Promotion Programs| 43

 CLUSTERS OF RELATED EXAMPLES OF ASSOCIATED ACTIVITIES
STRATEGIES AND TERMS
change; driving. Others work to make practices more acceptable, such as
recycling, using condoms and talking more openly to your sexual
Entertainment education;
partners.
Online, interactive health
communication;
Tailored communication

Self-care;
People directly affected by poverty or illness, or who care
Self-help; passionately about an issue, can develop a sense of their own power,
control and influence. That can help them and others improve health.
Mutual support

CHOOSE ACTIVITIES
An activity is a specific product or service (something you do or produce). Activities are done within
the context of one or more broad strategies, in order to achieve your outcome objectives. For
example, you might distribute pamphlets, posters, and articles as part of an educational strategy. Or
you might hold a community forum as part of a community mobilization strategy.

Activities describe the specific ways you’ll apply the strategy. Some activities may be part of more than
one strategy. For instance, a given event may be primarily an educational strategy, but also an
opportunity to gather support for a policy initiative.

RELATIONSHIP BETWEEN PROGRAMS, STRATEGIES, ACTIVITIES AND

TASKS
One common point of confusion at this stage in the planning process is the difference between
activities and tasks. In this workbook:

 Activities are products or services that you make or provide for a given audience, e.g., an
event, a phone-in counseling service, or a self-help group. Another common term for activity is
output. Each activity may require multiple tasks.

 Tasks are part of operational work plans that assign people, resources, and deadlines to make
activities happen. That includes things like: hiring a designer; buying media time; researching
an event venue; or finding out local politician positions on an issue. Tasks are sometimes
called action steps. A program contains one or more strategies, or broad approaches to
facilitating change. For example, building healthy public policy, or creating supportive
environments are strategies. Each strategy contains one or more activities.

Planning Health Promotion Programs| 44

ASSIGN RESOURCES
Resources include money, expertise, time, space and equipment. That can come through funded
budgets, donated funds or revenue, and/or goods and services provided in-kind by partners. Allocating
resources now will help you create realistic process objectives.

WRITE PROCESS OBJECTIVES

Similar to outcome objectives, good process objectives include four components:

1. what you want to do or produce (activity);

2. who you are doing or producing it for (audiences);
3. how much; and
4. by when.

Table 11: Sample process objectives at each level16

LEVEL OF HOW WHAT YOU WANT FOR WHOM BY WHEN

OBJECTIVE MUCH TO DO OR PRODUCE (AUDIENCE)

...educational
pamphlets on the
most effective …to adults from
Individual 2,000 …by next January
treatment options 50- 80…
for depression and
anxiety sent …

…training sessions on …to people who

how to distinguish provide informal
between physical care (unpaid
Interpersonal 6 …by next January
health complaints caregivers) to the
and elderly in
anxiety/depression… Ottawa…

…visits to help
...to physician
implement a
Organizational 20 offices in Niagara …by next October
depression screening
Region…
system…

…between
organizations and
…social networking groups concerned
platform established with the …by next
Community 1
to increase management of September
collaboration… depressive
disorders in
Durham Region…

Planning Health Promotion Programs| 45

 LEVEL OF HOW WHAT YOU WANT FOR WHOM BY WHEN
OBJECTIVE MUCH TO DO OR PRODUCE (AUDIENCE)

…breakfast meeting
about why a national
…..for Cabinet …in the next two
Public Policy 1 mental health
members… months
strategy should be a
priority for Canada…

Why is step four important?

This step connects what you want to do (strategies and activities) with what you want to achieve
(goals and outcome objectives).

In step 4, setting clear strategies and activities, assigning resources and writing process objectives
provides:

 the foundation for detailed budgets and operational work plans;

 the information to determine indicators (step 5), which is key to making the program
evaluable; and
 approximately half of the information for a logic model, which is reviewed in step 6.

Your goals, objectives, strategies, activities and resources should:

 be based on good evidence (collected in step 2, situational assessment);

 be developed using well-founded processes (as described in step 1, project
management); and
 make sense together.

If you do not meet the above criteria, you may want to collect more evidence or revisit decisions
about the scope of your goal, audiences and outcome objectives.

This section is presented in the order of strategies, activities, resources, and then process
objectives. However, this is not a linear process.

For example, you may choose to begin by brainstorming strategies or activities. Although
resources are not officially assigned until activities are chosen, available resources in fact
inform those choices. Also, once you begin work on your process objectives, you may
realize that your resource allocations are insufficient, causing you to revisit your activity
and resource decisions.

The process of reflecting back and forth between all the parts of step 4 is continuous.

Planning Health Promotion Programs| 46

How do I do step four?
IDENTIFY STRATEGIES The Health Promotion Foundations course,
Begin by compiling possible health promotion Module 3: Models of Health & Health
strategies. One way is to create a list for each of Promotion2 includes a wealth of content that
the outcome objectives developed in step 3. may inform your choice of strategies.
Another option is to list activities for each of the
outcome objectives, then cluster the activities into strategies.

Either way, generate your strategy options by focusing on this question: What do you need to do to
reach your goal and outcome objectives in a way that is consistent with your health promotion values?

Use the results of your situational assessment to help identify the most effective strategies for your
situation. Some examples of strategies are shown in Table 12. These are based on strategies from the
Ottawa Charter7 and from a classic article by Epp, called Achieving Health for All: A Framework for
Health Promotion.23 To help you make proper links, each strategy cluster is shown with sample and
possible outcomes.

Table 12: Sample strategies, with related activities and outcomes

CLUSTERS OF RELATED SAMPLE ACTIVITIES—THINGS EXAMPLES OF OUTCOMES—

STRATEGIES YOU DO OR PRODUCE FOR AN OBSERVABLE CHANGES IN
AUDIENCE AUDIENCE/ENVIRONMENT

1. Build healthy public policy;  Awareness campaign  New policies, procedures, by-
laws, regulations, legislation
By-law development;  Community letter-writing
Legislations;  Deputation to council, board,
etc.
Regulation;
Volunteer and
organizational policies;
Political action

2. Create supportive  Support groups  Increase in perceived support

environments; dealing with an illness, situation,
 Organizational flex time
addiction, etc.
Healthy environments arrangement
 Changes in organizational
 Provide free childcare to
procedures
allow adults workout time
 Structural changes in the
 Improved school parks
environment (green space,
sidewalks, parks, trees, healthy
food choices)

Planning Health Promotion Programs| 47

CLUSTERS OF RELATED SAMPLE ACTIVITIES—THINGS EXAMPLES OF OUTCOMES—
STRATEGIES YOU DO OR PRODUCE FOR AN OBSERVABLE CHANGES IN
AUDIENCE AUDIENCE/ENVIRONMENT

3. Community mobilization;  Create local action group  Increase ability, capacity or

confidence of individuals and
Community development;  Train local leaders
groups to affect community
Foster public  Neighbourhood anti-drug change, policies, etc.
participation; forum
Community organization;  Block parents
Coalition building;  Community economic
development projects
Strengthen community
action  Corporate contribution
initiatives (donations of
volunteers, money or other
resources)

4. Develop personal skills;  Parenting skill workshops  Increase confidence in ability to

that include role modeling perform a behaviour
Counselling;
discipline techniques
 Increase in number of attempts to
Personal empowerment
 Cooking demonstrations change a behaviour
 Personal fitness program
development and training
 Telephone smoking cessation
counselling

5. Strengthen community  Promote use of healthy  Increase patient accessibility to a

health services; lifestyle screening tools broad spectrum of clinical and
during annual physical exams prevention services
Re-orient health services
 Change physician billing rules  Changes in patient lifestyle
so lifestyle counselling is behaviours
billable
 Improve linkages between
 Develop/fund physical health care and social
multidisciplinary medical services in community (children’s
team (nurses, nurse- aid, etc.)
practitioners, dietitians, etc.)
who have more time to work
on prevention and health
behaviour issue

6. Provide information;  Materials that help people  Increase understanding of health

become more information
Education
knowledgeable about health
 Increase motivation
including fact sheets,
brochures, newspaper and  Increase knowledge about where
magazine articles, television to get more information

Planning Health Promotion Programs| 48

CLUSTERS OF RELATED SAMPLE ACTIVITIES—THINGS EXAMPLES OF OUTCOMES—
STRATEGIES YOU DO OR PRODUCE FOR AN OBSERVABLE CHANGES IN
AUDIENCE AUDIENCE/ENVIRONMENT
programs, etc.
 Events, demonstrations,
workshops, classes, groups

7. Health communication;  Text message campaign  Increase knowledge and

about smoking cessation awareness
Social marketing;
services for teens
 Change attitudes
Risk communication;
 Online health assessment
 Modify behaviours
Communication for social and tailored advice tool
change;  Increase number of discussions
 Contest to develop your own
about a topic
Entertainment education; web video about health
Online interactive health conditions on your
communication community

8. Self-care;  Create an online community  Increase sense of one’s own

for sharing concerns, power to affect health or life
Self-help;
questions, etc. about a circumstances
Mutual support specific topic
 Increase in perceived social
 Train community peer support in dealing with an illness
support workers on an issue or circumstance
(cooking, prevention, etc.)

After generating a list of potential strategies, use specific criteria to prioritize the options. For
example, consider whether the strategy:

 has significant bearing or potential to have an impact on the situation (should be done);
 is amenable/likely to occur given your available resources, expertise, etc. (could be
done); and
 is aligned with your mandate and stakeholder interests (what your organization is
expected to do).

Planning Health Promotion Programs| 49

Look back at Figure 5 for a visual representation of these factors.

Other planning frameworks identify criteria

to help you decide on the most appropriate The Online Health Program Planner (OHPP)
strategies, e.g., Ontario’s Public Health includes four worksheets to help you
Standards (which speak to need, impact, complete this step:
capacity and partnerships). 4.1: Choose strategies and brainstorm
activities
CHOOSE ACTIVITIES 4.2: Assess and choose activities
4.3: Assign resources and outcome objectives
If you are planning for an existing program,
4.4: Develop process objectives
review the activities you currently offer.
Completing these worksheets will also help
Decide whether to continue, stop or adapt
you build your program logic model.
the activities by considering:

 What you know, from the available evidence (from step 2), about the expected or actual
effectiveness of this activity for meeting your outcome objectives.
 What you know about the appropriateness of this activity for your intended audiences
(from step 2).
 What you know about the financial and human resources required to implement this
activity properly.
 What resources you have to implement this activity, and how that compares to what
resources are required.

You may choose to include other criteria for decision-making, such as potential for impact, alignment
with your mandate, political support, etc.

Once you have reviewed existing activities, brainstorm potential new ones for each strategy. Prioritize
the new suggestions, based on the above criteria.

WRITE PROCESS OBJECTIVES

Write one or more process objectives for each of your activities. Recall that good process objectives
include four components:

1. what you want to do or produce (activity/output);

2. who you are doing or producing it for (audience);
3. how much (number and type of products or services); and
4. by when.

The number of products and services you can realistically deliver is closely tied to your available
resources. If necessary, reduce that number or increase the required budget to cover the desired level.

Planning Health Promotion Programs| 50

ASSIGN RESOURCES
It is essential to match chosen activities with sufficient and available resources. Look at your overall
budget and other resources as outlined in step 1 to do the following steps.

1. Allocate what is available to specific activities.

2. Examine the gaps between what is needed and what you have.
3. Explore ways of obtaining the required resources from other organizations, alternative
funding sources, etc.
4. Consider which activities you will keep and which parts will be on hold until new resources
are found (in the next fiscal cycle, for example).

In step 4, it is common to realize that you need more data about potential strategies and
activities to help you prioritize. This is a normal part of the ongoing 5-point project
management process described in step 1. You may need extra time to research and rank
good/better/best practices, as well as review previous discussions about decision-
making, as you come to agreement on what level of evidence you are willing to accept
about a strategy or activity. Some sources of effectiveness evidence include:

Ministry of Health and Long Term Care. MHPS Guidance Documents. Available from:
http://www.mhp.gov.on.ca/en/healthy-communities/public-health/guidance-
documents.asp24

Ministry of Health and Long Term Care. Literature search statements for the Ontario
Public Health Standards. Available from:
http://www.health.gov.on.ca/english/providers/program/pubhealth/oph_standards/op
hs/litss.html#fstandard20

Health Evidence. Available from: http://healthevidence.org/13

Quebec Population Health Research Network (QPHRN). Available from:

http://www.santepop.qc.ca/en/index.html25

National Collaborating Centre for Methods and Tools. Public Health +. Available from:
http://www.nccmt.ca/tools/public_health_plus-eng.html26

National Collaborating Centre for Healthy Public Policies (NCCHPP). Available from:
http://www.ncchpp.ca/en/27

Planning Health Promotion Programs| 51

 Public Health Agency of Canada. The Canadian best practices portal (CBPP) intervention
database. Available from: http://cbpp-pcpe.phac-aspc.gc.ca/intervention/search-
eng.html28

Institute national de santé publique du Québec (INSPQ). Bilingual publications about

synthesizing evidence. Available from:
http://www.inspq.qc.ca/english/Default.aspx?pageid=22329

Tips
STAKEHOLDER ROLES AND EXPECTATIONS
 Involve those who are going to implement the program and other stakeholders in the
community. This step can go quickly if only a few people are involved, but whenever
possible allocate the time to involve others.

DECISION-MAKING PROCESSES
 As you look at your program at different times, ideas will change out of necessity and out
of inspiration. Keep good documentation and be open to changing your plan.

 Ensure your decision-making process provides guidance for ongoing reflection and
possible decision changes.

DATA GATHERING AND ANALYSIS PROCESS

 Drawing on the literature from your situational assessment in step 2 is important in step
4. So it may be appropriate to work with a small group of partner organizations or staff.
Each can review different parts of the literature, or cover an area of expertise (e.g.,
nutritionists, communications specialists, educators, community developers).

 From a health promotion viewpoint, look for assets, strengths and resources you can
build on, and include strategies addressing the socio-environmental determinants of
health.

 Consider pre-testing materials or pilot-testing ideas on a small scale before mounting a

broader strategy.

Planning Health Promotion Programs| 52

Step 5: Develop indicators
Step 1: Manage the planning process

Step 2: Conduct a situational assessment

Evaluation/feedback

Step 3: Set goals, audiences and outcome objectives

Step 4: Choose strategies and activities and assign resources

Step 5: Develop indicators

Step 6: Review the plan

What is step five about?

Step 5 is about choosing indicators that assess the extent to which you’ve met your process and
outcome objectives. Indicators help you decide whether your program is effective and successful. They
help answer:

 How will you know the strategy has been implemented?

 How will you know if you’ve achieved the objective?
 How will you measure progress toward your desired outcome?
 How will you know what is different after your program?

A program also needs indicators to be measurable – that means reliable, valid, and accessible. It is
important to identify: what you will measure, where the data are available and any limitations on
accessibility (e.g., frequency of information collection).

Planning Health Promotion Programs| 53

There is more to evaluation than establishing indicators. An evaluation plan also considers how data is
gathered, how often, and from whom.

OUTCOME INDICATORS
Outcome indicators measure progress toward your outcome objectives. Each objective should have
one or more clearly defined indicator of success. Indicators can also provide a measure of progress for
more than one objective.

Indicators can be short-, medium- or long-term, consistent with the objectives they measure.

For health promotion programs, you can state the objectives in positive terms even if the outcome
indicator is stated in negative terms. For example, the objective may be to promote moderate and
safe drinking. One indicator may be a reduction in the number of motor vehicle accidents involving
impaired driving.

Table 13 shows some indicators for the outcome objectives that were given as examples in step 3. The
table notes where the data are available and limitations of availability, to guide discussion.

Table 13: Example outcome indicators and data availability

OUTCOME INDICATORS DATA AVAILABILITY LIMITATIONS ON DATA
OBJECTIVE AVAILABILITY

To increase by  Percentage of  Canadian Community  Collected every 5 years

10%, within 2 people who agree Health Survey,
 Limited sample from
years, the number that depression and Mental Health and
our region, so harder to
of adults between anxiety are highly Well-Being
generalize
50- 80 who agree treatable disorders component, Statistics
that depression Canada  A free public access file
 Percentage of
and anxiety are is available for
people who can  Regional Psychiatry
highly treatable download, but this
identify two Program Annual
disorders, which omits some data due to
possible treatments Survey
they should discuss privacy reasons
for
with a doctor
depression/anxiety
 Number of doctor/
patient discussions
about depression
and anxiety
disorders

Planning Health Promotion Programs| 54

OUTCOME INDICATORS DATA AVAILABILITY LIMITATIONS ON DATA
OBJECTIVE AVAILABILITY

To increase by  Percentage of  National Initiative for  Research study ends

20%, in the next 12 informal caregivers the Care of the before the program is
months, the to the elderly who Elderly complete, so results
percentage of can list three could potentially be
people providing physical health inaccurate
informal care to complaints that (underestimated)
the elderly in depression/anxiety
Ottawa who agree may cause
that mental health
problems are often
closely linked to
physical health
complaints

To increase by 10,  Number of  No known source; will  Physicians are difficult

within 18 months, physician offices have to collect this to reach
the number of that give all patients ourselves
physician offices in a screening tool for
Niagara Region depression
that give all
patients an annual
take-home
screening tool for
depression

To increase by 5,  Number of  No known source; will  Types of community

within 18 months, organizations and have to collect this organizations providing
the number of groups engaged in a ourselves services may vary
community collaborative effort greatly between regions
partners in to manage
 There is no exhaustive
Durham Region depressive
list of all organizations
that participate in disorders
that provide these
collaborative care
services
models for the
management of
depressive
disorders

Planning Health Promotion Programs| 55

OUTCOME INDICATORS DATA AVAILABILITY LIMITATIONS ON DATA
OBJECTIVE AVAILABILITY

To increase by 3, in  Number of MPs  Canadian Institutes of  A process is underway

the next 18 who can name one Health Research where survey
months, the statistic that (CIHR) 15-minute administrators are
number of indicates a need for survey of knowledge prioritizing survey
Members of a national mental and attitudes toward questions; this one may
Parliament who health strategy health research not make the survey
feel that a national funding
 Number of  The survey happens
mental health
mentions in the three months after our
strategy is a
national news program finishes, so.
priority for Canada
media about lack of the effects may have
mental health faded
services in Canada
 The service has a fee

PROCESS INDICATORS
Process indicators measure both the quantitative and qualitative aspects of program delivery:

 Quantitative measures focus on numbers (e.g., number of girls registered in fitness programs).
 Qualitative indicators use words (e.g., what participants liked, barriers or facilitators to
change, lessons learned in working with this audience).

Table 14 shows examples of indicators (quantitative and qualitative) for the process objectives used as
examples in step 4.

Planning Health Promotion Programs| 56

Table 14: Example quantitative and qualitative process indicators

EXAMPLES OF QUANTITATIVE EXAMPLES OF QUALITATIVE

PROCESS OBJECTIVE
INDICATORS INDICATORS

2,000 educational pamphlets on  Number of pamphlets sent  Recipient comments about

the most effective treatment what they did and didn’t
 Percentage (when asked) who
options for depression and like about the pamphlet
remember receiving the
anxiety, sent to adults aged 50-80 pamphlet
by next January  Percentage (when asked) who
remember reading the pamphlet

6 training sessions, conducted by  Number of attendees at each  Facilitator list of topics

next January on how to session discussed during each
distinguish between physical session
health complaints and  Participant ideas about how
anxiety/depression to people to improve the sessions
who provide informal care
(unpaid caregivers) to the elderly
in Ottawa

20 visits to physician offices in  Number of visits completed  Visitor notes about what
Niagara Region, by next October, barriers physicians or their
 Number of offices that declined
to help implement a depression staff mentioned in relation
visit
to implementing the
screening system
screening system

1 social networking platform  Number of members  List of organizations and

established by next September, groups that joined the
 Number of unique visits to
to increase collaboration social networking platform
webpage(s)
between organizations and  List of conversation topics
 Time spent on webpage(s)
groups that offer services to on the webpage(s)
manage depressive disorders

1 breakfast meeting for Cabinet  Cost of the meeting, including  List of which Cabinet
Members in the next two months planning time, clean-up and Members attended
follow-up
to present why a national mental  Session transcripts showing
health strategy should be a  Number of attendees and questions/comments from
priority invitations declined Cabinet Members
 Percentage of attendees who
stayed for the entire session.

Planning Health Promotion Programs| 57

Why is step five important?
Establishing indicators is a critical step towards ensuring your program can be evaluated. Step 5 is also
important because it indicates a real commitment to achieving results and measuring achievement.

How do I do step five?

Each objective, both process and outcome,
should have at least one indicator. Indicators The Online Health Program Planner (OHPP)
may be quantitative or qualitative. They should includes two worksheets to help you
all be reliable, valid and accessible. Thus it is complete this step:
important to identify not only what you will 5.1: Develop outcome indicators
measure, but also where the data are available 5.2: Develop process indicators
and any limitations on accessibility.

DEVELOP A WORKING LIST OF Clearinghouses and other repositories for

indicators can help with this step. Some
INDICATORS
examples:
For each process and outcome objective, draft
one or more indicators that will assess the Canadian Institute for Health Information
extent to which you’ve met the objective. (CIHI) and Statistics Canada. Health indicators.
http://www.cihi.ca/CIHI-ext-
REVIEW EXISTING SOURCES OF portal/pdf/internet/DEFINITIONS_062011_EN
INDICATORS 30

You could get ideas from sources such as:

Health Canada. Health indicators.
 the mandate of your regulating http://www.hc-sc.gc.ca/hcs-
agency (e.g., % of children sss/indicat/index-eng.php31
immunized by 2020);
 population health status measures Association of Public Health Epidemiologists
your organization uses (e.g., in Ontario. Core indicators for public health.
expected rates of mortality or
http://www.apheo.ca/index.php?pid=4832
morbidity);
 standards set out by governments
or professional organizations;
 values/opinions expressed in previous evaluations (e.g., % in community rating the
service as excellent); and
 benchmarks established through research (e.g., expected smoking rate decreases).

Planning Health Promotion Programs| 58

CHECK RELIABILITY AND VALIDITY

For each indicator, consider:

 Is it reliable? Reliability is the extent to which the indicator will give consistent, accurate
measurement over time. An established measure that other credible individuals and
organizations have used may be more reliable than something you develop on your own.

 Is it valid? Validity is the extent to which the indicator measures what you set out to
measure. For example, you might ask recipients whether they liked a pamphlet. A
response of “yes” may or may not mean the pamphlet is useful or effective.

CHECK ACCESSIBILITY

For all indicators, ask:

 What is an appropriate timeframe for observing a result?

 Is the measure available at that time?
 Are the sources of data required to assess this result accessible?
 Are the providers of the measure reliable, responsive, and timely?
 Do you have the resources for any direct costs, e.g. fees or licenses?
 Do you have the expertise to analyze or otherwise manage the data provided?

PRIORITIZE
Rank and choose your indicators based on which are the most reliable, valid and accessible.

REVIEW
Review indicators periodically to ensure continued relevance for your information needs.

Tips
 Involve partners and staff in identifying how to know if they have been successful in
achieving goals and objectives.

 Look for indicators of empowerment, community strength and determinants of health

that align with your overriding health promotion theory or perspective.

 Indicators may or may not be included in your program logic model. This depends on
the user and layout of the logic model. If the users are evaluation-oriented, for instance,
it may be a good idea to include indicators. If your audience is not evaluation-oriented,
leaving indicators out can make the logic model easier to understand.

Planning Health Promotion Programs| 59

Step 6: Review the plan
Step 1: Manage the planning process

Step 2: Conduct a situational assessment

Evaluation/feedback

Step 3: Set goals, audiences and outcome objectives

Step 4: Choose strategies and activities and assign resources

Step 5: Develop indicators

Step 6: Review the plan

What is step six about?

Step 6 is about reviewing your plan to ensure it is:

 complete;
 logical; and
 aligned with the results of your situational assessment.

One of the best ways to do this is with a logic model. A logic model is a graphic depiction of the
relationship between all parts of a program. In addition to helping with the program review process, it
can be a useful tool for communicating with stakeholders.

Planning Health Promotion Programs| 60

Why is step six important?
Once the entire plan is in place and presented in an overview, such as a logic model, you can do a
more comprehensive review. This will look at whether the plan is complete, logical and aligned with
the situational assessment (step 2). Because of errors or omissions, you may need to revisit one or
more planning steps, and update your associated worksheet entries. Step 6 is also an important step
in planning for a comprehensive evaluation.

How do I do step six?

ASSEMBLE A LOGIC MODEL
Logic models come in many shapes and sizes. Decide on the overall design of your logic model, then
build it.

There are many possible logic model formats. In general, a logic model should include your decisions
made in steps 3 and 4 regarding your:

 goals;
 audiences;
 outcome objectives;
 strategies;
 activities;
 resources;
 process objectives; and
 outcome and process indicators.

As previously noted, some organizations use different terms that mean the same as the above list of
program plan elements.

The order in which these elements are presented and the exact display can vary. For instance, some
logic models separate short-, medium- and long-term objectives and indicators. Others omit indicators
and resources. And some depict the direct one-to-one relationships between elements, as shown in
Figure 8.

Planning Health Promotion Programs| 61

Figure 8: Generic program logic model A

This can result in a logic model with many small boxes. So some people prefer to use wider boxes that
span many columns, in order to show all objectives or indicators together. See Figure 9 for an
example.

Note that this logic model in Figure 9 does not include indicators, but does separate short-, medium-
and long-term outcome objectives. A design like this is often accompanied by a more detailed planning
document that shows the exact relationship between each objective and its associated strategies,
activities, etc.

Planning Health Promotion Programs| 62

Regardless of whether you decide to use a logic model, step 6 is the last in the planning process. At
this point, you review and possibly adjust your plan, creating something that you can realistically
implement with your stakeholders’ buy-in.

Figure 9: Generic program logic model B

Planning Health Promotion Programs| 63

ASSESS THE PLAN FOR The Online Health Program Planner (OHPP)
can help you create a logic model in MS Word.
COMPLETENESS
To do that, complete the following
Ensure that the information in your plan includes worksheets:
everything you need to implement it. Your logic 3.1: Set goals, audiences, and outcome
model, or other final program plan format, must objectives
also include the information stakeholders 4.1: Choose strategies and brainstorm
(specifically decision-makers) need, to provide activities
feedback and support. 4.2: Assess and choose activities
Consider the following questions to ensure your 4.3: Assign resources and outcome objectives
plan is complete: 4.4: Develop process objectives

 Does the program include broad Some OHPP worksheets help you review your
goals (step 3)? plan for completeness, logic, and alignment
 Have you identified audiences, with the situational assessment:
including individuals, social 6.1: Review your plan
networks, organizations, 6.2: Review your plan using a population
communities and/or governments health approach lens
(step 3)?
 Are your outcome objectives SMART (specific, measurable, appropriate, realistic, and
time-limited (step 3))?
 Have you identified a few major strategies to advance the objectives, and reflect your
overall health promotion theory (step 4)?
 Do the activities fall within clearly defined strategies (step 4)?
 Are the process objectives SMART (step 4)?
 Have you identified the resources (people, funds, materials) required (step 4)?
 Does your plan have at least one indicator for each objective (step 5)?
 Are the indicators reliable, valid and accessible (step 5)?

ASSESS THE PLAN FOR LOGIC

Consider the following questions to assess your plan for logic:

 Will the short-term objectives contribute to the long-term objectives?

 Will the strategies effectively contribute to the goals and objectives?
 Have you chosen the best activities to advance the strategy?
 Are the activities appropriate to the audiences?
 Are the resources adequate to implement the activities?

Planning Health Promotion Programs| 64

CHECK THE ALIGNMENT OF YOUR PLAN WITH YOUR SITUATIONAL
ASSESSMENT
Go back to step 2, the situational assessment. Review the fit of the plan with your data-gathering and
decision-making at that time.

Is the plan consistent with the key findings of the situational assessment? In particular, does your
program plan consider the major influences on your situation (the second key question in your
situational assessment analysis)? This check should also review any new data that arose during the
planning process. Finally, will stakeholders be satisfied with the proposed program plan?

REVIEW PLAN PRESENTATION

Ensure the logic model (or other plan format) presents the information in a clear and compelling
manner. Consider the following questions:

 Is it user-friendly?
 Is it easy to follow the arrows and/or flow of logic?
 Is there enough white space?
 Is it presented in an order that is useful for you and your stakeholders?

CONSIDER HOW TO PROCEED

After doing all the checks noted above, revise accordingly if needed. Approve your plan according to
your agreed-upon decision-making process. Then develop your full evaluation plan before
implementation begins. When implementing your plan, use formative and/or process evaluations to
make any required changes.

Find out more about developing an evaluation plan here:

Ontario Agency for Health Protection and Promotion (Public Health Ontario). Evaluating
health promotion programs: introductory workbook.33

Wholey JS, Hatry HP, Newcomer KE. Handbook of practical program evaluation.34

Saunders RP, Evans MH, Joshi P. Developing a process-evaluation plan for assessing
health promotion program implementation: a how-to guide.35

Centers for Disease Control and Prevention National Center for Chronic Disease
Prevention and Health Promotion, Office on Smoking and Health. Developing an
effective evaluation plan. Available from: http://www.cdc.gov/obesity/downloads/cdc-
evaluation-workbook-508.pdf36

Planning Health Promotion Programs| 65

 W.K. Kellogg Foundation. W.K. Kellogg Foundation evaluation handbook. Available from:
http://www.wkkf.org/resource-directory/resource/2010/w-k-kellogg-foundation-
evaluation-handbook37

Tips
 When creating logic models, it often helps to have the various components on sticky
notes. You can remove, change and move items easily, while having a working version in
view.

 Involve those who are going to implement the program and other stakeholders in the
review of the plan as they may have important insights into what you may have missed.

Planning Health Promotion Programs| 66

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Public Health Ontario
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