Planning and evaluating health promotion (2024)

Stage 1: Identify Needs and Priorities

How do you find out what health promotion is needed? If you think you already know, what are you basing your judgement on? Who has identified the need: you, your clients or someone else? Identifying need is a complex process, which is looked at it in depth in the next chapter.

You may have a long list of health promotion needs you would like to respond to, so another issue is how to establish your priorities. Again, this is discussed in detail in the next chapter, but an important point is that you must have a clear view about which needs you are responding to, and what your priorities are.

Stage 2: Set Aims and Objectives

People use a range of words to describe statements about what they are trying to achieve, such as aims, objectives, targets, goals, mission, purpose, result, product, outcomes. It can be helpful to think of them as forming a hierarchy as in Fig. 5.2. At the top of the hierarchy are words that tell you why your job exists, such as your job purpose or remit, or your overall mission. In the middle of the hierarchy are words that describe what you are trying to do in general terms, such as your goals or aims. At the bottom of the hierarchy are words that describe in specific detail what you are trying to do, such as targets or objectives.

It is worth noting that objectives can be of different kinds. Health objectives are usually expressed as the outcome or end state to be achieved in terms of health status, such as reduced rates of illness or death. However, in health promotion work objectives are often expressed in terms of a step along the way towards an ultimate improvement in the health of individuals or populations, such as increasing exercise levels.

In health education work, educational objectives are framed in terms of the knowledge, attitudes or behaviour to be exhibited by the learner. Objectives can also be in terms of other kinds of changes, for example a change in health policy (introducing a healthy eating policy in the workplace) or health promotion practice (providing health information in minority ethnic languages).

The term target is increasingly used in health promotion. Targets usually specify how the achievement of an objective will be measured, in terms of quantity, quality and time (the date by which the objective will be achieved). So a health target can be defined as a measurable improvement in health status, by a given date, which achieves a health objective. This is the approach used in national strategies for health, such as Choosing Health: Making Healthier Choices Easier (Department of Health (DoH) 2004) and in the National service frameworks (www.dh.gov.uk). An example of targets and ways of measuring progress can be found in the Delivering Choosing Health: Making Healthier Choices Easier (DoH 2005).

There is more about national strategies and targets in Chapter 7, section on national public health strategies.

The objectives are framed as health objectives, and the targets are framed as health targets (changes in rates of death or illness by a specific date), behaviour targets (such as changes in population rates of smoking or drinking by a specific date) or progress measures (such as the number of people attending a smoking cessation service and the number setting a date when they plan to stop smoking).

When you plan health promotion initiatives, you need to set aims, objectives and targets or goals and outcomes.

Your aims (or aim, as there does not have to be more than one) are broad statements of what you are trying to achieve. Your objectives are much more specific, and setting these is a critical stage in the planning process.

Objectives are the desired end state (or result, or outcome) to be achieved within a specified time period. They are not tasks or activities. Objectives should be as follows:

It is sometimes difficult to distinguish between aims, objectives and action plans. For example, a dietician who wants to improve the information they give to patients may describe their aim as ‘to produce an information leaflet’ but this is also their objective and their action plan. The answer is to think it through further, and ask ‘Why produce a leaflet? What am I aiming to achieve by producing the leaflet?’ It then becomes clearer that the aim is to improve patient compliance with dietary treatment, and one of the objectives is to improve patients’ understanding of their dietary instructions. The action is to produce the leaflet. The importance of actually thinking through your aims and objectives in this way is that it helps you to be absolutely clear about why you are doing something, not just what you are doing. Failure to think through this stage means that health promoters waste time and energy proceeding with what seems like a good idea only to realise, too late, that what they are doing is not actually achieving what they want.

Stage 3: Decide the Best Way of Achieving the Aims

Occasionally, there might be only one possible way of accomplishing your aims and objectives. Usually, however, there will be a range of options. In Case study 5.1 Jim has a number of options about how to achieve his objective of increasing the sun safety measures being taken by the school and the children. He could write to the schools or to parents of school-age children, he could hand out leaflets at school gates, he could lobby parents to take up the cause, he could find out if there are any school governors’ meetings and ask to speak at them, he could conduct a sun safety campaign in the local media, he could write an article on the issue of sun safety in school playgrounds for the education journals that teachers read, or he could try to meet each Head Teacher face-to-face. Or he could do two or more of these together.