The Health Promotion Process

• Situation Analysis Capacity building

• Prioritisation Skills/knowledge
• Planning Structures/ Relationships
– Aims (overall goal) Funding/resources
– Objectives (what will be achieved)
– Strategies (how they will be achieved) Evaluation
– Actions (what will be done, by whom, – Formative
by when) – Process
• Implementation – Impact
– Outcome
– Dissemination

WHO Collaborating Centre for Obesity Prevention

 ANGELO Process

• Situation Analysis Capacity building

• Prioritisation Skills/knowledge
• Planning Structures/ Relationships
– Aims (overall goal) Funding/resources
– Objectives (what will be achieved)
– Strategies (how they will be achieved) Evaluation
– Actions (what will be done, by whom, – Formative
by when) – Process
• Implementation – Impact
– Outcome
– Dissemination

WHO Collaborating Centre for Obesity Prevention

WHO Collaborating Centre for Obesity Prevention
 ANGELO Process
1. Situation analysis
2. Scan Behaviours Knowledge and Skills Environments

3. Prioritise Importance Changeability

4. Merge
List of potential targets for action plan

5. Formulate SMART format

Action Plan
Reference: Simmons et al. (2009). Health Promotion International, 24(4):311-324.

WHO Collaborating Centre for Obesity Prevention

 ANGELO Process
1. Situation analysis
2. Scan Behaviours Knowledge and Skills Environments

3. Prioritise Importance Changeability

4. Merge
List of potential targets for action plan

5. Formulate SMART format

Action Plan
Reference: Simmons et al. (2009). Health Promotion International, 24(4):311-324.

WHO Collaborating Centre for Obesity Prevention

 Situation analysis
• Size of problem
• Nature of the problem – especially local
contexts
– Who, where, when, why
– You have great data here
• Existing activities, organisations,
champions
• Future options
– Opportunities
– Capacity
• International literature and experiences

WHO Collaborating Centre for Obesity Prevention

 ANGELO Process
1. Situation analysis
2. Scan Behaviours Knowledge and Skills Environments

3. Prioritise Importance Changeability

4. Merge
List of potential targets for action plan

5. Formulate SMART format

Action Plan
Reference: Simmons et al. (2009). Health Promotion International, 24(4):311-324.

WHO Collaborating Centre for Obesity Prevention

 Choosing target behaviours
• Draft list of potential behaviours, knowledge/skills gaps and environmental
barriers is worked up before workshop
– add others to list if needed

• Scan potential behaviours to change

e.g. Decrease Increase
TV viewing Active play
Screen games Active transport
High fat/sugar snacks Active recreation/sport
Fast foods Fruit
High fat meals Vegetables
High sugar drinks (incl fruit juice) Whole grain cereals
Water
Breastfeeding

WHO Collaborating Centre for Obesity Prevention

WHO Collaborating Centre for Obesity Prevention
 STEP 1: BEHAVIOURS
What are the behaviours that are the highest priority for action?
Importance (what is the relevance and Changeability (how easy or hard is this to
impact of this in our situation?) change?)

1 = not important at all 1 = very hard to change

2 = a little important 2 = hard to change
3 = somewhat important 3 = possible to change
4 = very important 4 = easy to change
5 = extremely important 5 = very easy to change

Score
(use whole range of scores)
List of potential behaviour
patterns to target Importance Change- Total
1-5 ability (IxC)
1-5
Rank Points
(1-5) (5-1)
1. Increase the number of women who
choose to breastfeed

2. Extend the duration of breastfeeding

3. Increasing the amount of vegetables

eaten
 Use the
full
range of
the scale

WHO Collaborating Centre for Obesity Prevention

Prioritise: Moving to a shorter list
• Feasibility • Relevance
• Sustainability • Effectiveness
• Acceptability • Reach
– parents, children, • Effects on equity
professionals, funders, • Other positive effects
organisations etc
• Other negative effects
• Affordability
• Cost-effectiveness
‘Importance’
‘Changeability’

WHO Collaborating Centre for Obesity Prevention

Activity

WHO Collaborating Centre for Obesity Prevention

Choosing related knowledge and skills

WHO Collaborating Centre for Obesity Prevention

 Choosing related environments

ANGELO Framework (Analysis Grid for Environments Linked to Obesity)

Environment Micro-environment Macro-environment

size
(settings) (sectors)
Environment
type
Food PA Food PA

Physical What is available?

Economic What are the financial factors?

Policy What are the rules?

Socio-cultural What are the attitudes, beliefs, perceptions

and values?
Swinburn et al Prev Med 1999

WHO Collaborating Centre for Obesity Prevention

WHO Collaborating Centre for Obesity Prevention
WHO Collaborating Centre for Obesity Prevention
 ANGELO Process
1. Situation analysis
2. Scan Behaviours Knowledge and Skills Environments

3. Prioritise Importance Changeability

4. Merge
List of potential targets for action plan

5. Formulate SMART format

Action Plan
Reference: Simmons et al. (2009). Health Promotion International, 24(4):311-324.

WHO Collaborating Centre for Obesity Prevention

 Prioritise
1) Individually score each behavior item on importance and changeability
• Importance (score 1-5) How relevant is it and how big an impact would a change
make?
• Changeability (score 1-5) How amendable is the factor to change?

Calculate Total score = Importance x Changeability

Allocate points: 1. Highest score 5 points Note: No
2. 4 points ties allowed
3. 3 points
4. 2 points
5. 1 point

2) Group score: Add individual points together for each behaviour

Highest score = highest priority

WHO Collaborating Centre for Obesity Prevention

WHO Collaborating Centre for Obesity Prevention
 ANGELO Process
1. Situation analysis
2. Scan Behaviours Knowledge and Skills Environments

3. Prioritise Importance Changeability

4. Merge
List of potential targets for action plan

5. Formulate SMART format

Action Plan
Reference: Simmons et al. (2009). Health Promotion International, 24(4):311-324.

WHO Collaborating Centre for Obesity Prevention

 Merge
• From the group scores list the top priorities in each of the three areas
– Behaviours
– Knowledge and Skills
– Environments – by each setting
• About 6-8 in each
Behaviours Know/Skills Home enviro School enviro N’hood enviro

1. 1. 1. 1. 1.
2. 2. 2. 2. 2.
3. 3. 3. 3. 3.
4. 4. 4. 4. 4.
5. 5. 5. 5. 5.
6. 6. 6. 6. 6.
WHO Collaborating Centre for Obesity Prevention
Session outline

1. The priority setting process

2. The ANGELO process
3. Developing an action plan

WHO Collaborating Centre for Obesity Prevention

 ANGELO Process
1. Situation analysis
2. Scan Behaviours Knowledge and Skills Environments

3. Prioritise Importance Changeability

4. Merge
List of potential targets for action plan

5. Formulate SMART format

Action Plan
Reference: Simmons et al. (2009). Health Promotion International, 24(4):311-324.

WHO Collaborating Centre for Obesity Prevention

 Action Plan

• Overall aim
– Simple, broad statement about the overall goal of the program
• Objectives
– What will be achieved
– Typically 8-10 objectives
• 4-5 objectives from target Behaviours
• Guiding objectives of capacity building, social marketing, evaluation
– SMART (Specific, Measurable, Achievable, Relevant, Time-bound)
• Strategies
– How the objectives will be achieved
– Knowledge/skills, environmental elements as strategies
• Action steps
– Who will do what, by when, and what stage is it at
– Living document

WHO Collaborating Centre for Obesity Prevention

 Example
• Target: Children 5-12 years old
• Aim: To improve the health and wellbeing of 5-12 y.o. and strengthen the
community through healthy eating and physical activity promotion
• Objectives:
– To achieve a high awareness of the healthy eating/physical activity messages among
parents and children
– To build community capacity to promote physical activity and healthy eating
– To evaluate the process, impact and outcomes of the project
– To significantly decrease the time spent watching TV & playing on computers or
electronic games
– To significantly decrease the consumption of high sugar drinks and to promote the
consumption of water
– a. To investigate the potential for improving the quality (fat content and type of fat) of
deep-fried chips
b. To improve the quality of deep-fried takeaway chips
…

WHO Collaborating Centre for Obesity Prevention

 Example
Objective Five: Water versus Sweet Drinks
To significantly decrease the consumption of high sugar drinks
and to promote the consumption of water
Strategies Action steps By Time Status Process Evaluation
Who line

5.1 Examine Baseline Data (inc. socio-cultural PW April  Results of research

School information, environmental school audits)) 06 documented
Canteen Audit current settings eg. whether there PW/ June  Results of research
& Vending are existing Policies, vending machines 06 documented
Machine Princ
and product
Policies Research beyond the intervention settings Number of
PW July ►
for existing programs, policies, practice in 06 programs, polices
relation to water and sweet drinks practice sourced
etc and documented

WHO Collaborating Centre for Obesity Prevention