Designing and Evaluating Health Promotion Programs: Simple Rules for a Complex Issue

Health improvement planning models exist to support strategic management of health improvement efforts and to guide program administrators in taking a comprehensive approach to health promotion planning from problem identification to program evaluation and diffusion. This article outlines a model which follows four simple steps to program design and four simple steps to program evaluation. The first phase is characterized as the 4-Ss of program design, which includes size, scope, scalability, and sustainability. The second phase is characterized as the penetration, implementation, participation and effectiveness (PIPE) Impact Metric. Penetration refers to the proportion of the target population that is reached with invitations to engage in the program or intervention. Implementation refers to the degree to which the program has been implemented according to the design specifications and the associated work plans. Participation refers to the proportion of invited individuals who enroll in the program according to program protocol. Effectiveness refers to the rate of successful participants. It is considered in the context of programming conducted in the real-world setting. The product of all elements of the PIPE Impact Metric can be calculated to represent the impact from a program administration perspective, while the product of participation and effectiveness can be calculated to represent the impact of the program from a user/consumer perspective. The model is designed to inform program administrators about opportunities for improvement. First, administrative impact can be compared with user/consumer impact. Secondly, the PIPE Impact Metric total score, as well as its individual subscores, should be considered in the context of the 4-Ss of program design. This model has been derived from work conducted in the applied setting, however it is based on scientific theory and appears congruent with findings from existing, but more complicated, models. The results of the application of the model indicate the presence of a simple set of rules related to critical health improvement program design and evaluation features. Whereas additional experience with the model will allow for further modifications and evolution, early experience indicates it serves program planners and administrators well in terms of systematic program improvement and documentation of effort and impact.