Disease Management & Health Outcomes

, Volume 11, Issue 3, pp 149–157 | Cite as

Designing and Evaluating Health Promotion Programs

Simple Rules for a Complex Issue
  • Nicolaas P. Pronk
Practical Disease Management


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.


Program Design Health Improvement Health Promotion Program Physical Activity Program Work Plan 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



The authors have provided no information on sources of funding or on conflicts of interest directly relevant to the content of this review.


  1. 1.
    Green LW, Kreuter MW. Health promotion planning: an educational and environmental approach. Mountain View (CA): Mayfield, 1991.Google Scholar
  2. 2.
    Breckon DJ. Hospital health education: a guide to program development. Palo Alto (CA): Mayfield, 1984.Google Scholar
  3. 3.
    Rohrer JE. Planning for community-oriented health systems. Baltimore (MD): APHA United Book Press, Inc, 1996.Google Scholar
  4. 4.
    Langley GJ, Nolan KM, Nolan TW, et al. The improvement guide. a practical approach to enhancing organizational performance. San Francisco (CA): Jossey-Bass, Inc, 1996.Google Scholar
  5. 5.
    Health and behavior: the interplay of biological, behavioral, and societal influences. Washington, DC. Committee on Health and Behavior, Research, Practice, and Policy Board on Neuroscience and Behavioral Health, Institute of Medicine, National Academy of Sciences, 2001.Google Scholar
  6. 6.
    Wheatley MJ, Kellner-Rogers M. A simpler way. San Francisco (CA): Berrett-Koehler Publishers, 1996.Google Scholar
  7. 7.
    Harman W. Global mind change: the promise of the twenty-first century. San Francisco (CA): Berrett-Koehler Publishers Inc, 1998.Google Scholar
  8. 8.
    Bohm D. Wholeness and the implicate order. New York: Routledge, 1997.Google Scholar
  9. 9.
    Wilbur K. Sex, ecology, spirituality: the spirit of evolution. Boston (MA): Shambhala, 1995.Google Scholar
  10. 10.
    Von Bertalanffy L. General systems theory: foundations, development, and applications. Rev ed. New York: George Braziller Publishers, 1968.Google Scholar
  11. 11.
    Prigogine I, Stengers I. The end of certainty. New York: The Free Press, 1996.Google Scholar
  12. 12.
    Maturana HR, Varela FJ. The tree of knowledge: the biological roots of human understanding. Rev ed. Boston: Shambhala, 1998.Google Scholar
  13. 13.
    Abraham R, Shaw C. Dynamics. Santa Cruz (CA): Aerial, 1985.Google Scholar
  14. 14.
    Sheldrake R. A new science of life. Los Angeles (CA): Tarcher, 1981.Google Scholar
  15. 15.
    Murphy M. The future of the body. Los Angeles (CA): Tarcher, 1992.Google Scholar
  16. 16.
    Evans G, Barer ML, Marmor TR, editors. Why are some people healthy and others not? The determinants of health of populations. New York: Aldine de Gruyter, 1994.Google Scholar
  17. 17.
    Isham G. Population health and HMOs: the partners for better health experience. Healthc Forum J 1997 Nov/Dec; 40(6): 36–39.PubMedGoogle Scholar
  18. 18.
    Pronk NP, O’Connor PJ. Systems approach to population health improvement. J Ambul Care Manage 1997; 20(4): 24–31.PubMedGoogle Scholar
  19. 19.
    Senge PM. The fifth discipline: the art and practice of the learning organization. New York: DoubleDay, 1990.Google Scholar
  20. 20.
    Hughes TE, Faulkner DL, Gibson PJ. The role of population research in disease prevention and management. Dis Manage Health Outcomes 1997; 1(1): 42–8.CrossRefGoogle Scholar
  21. 21.
    Van de Ven A, Koenig R. A process model for program planning and evaluation. J Econ Bus 1976; 28(6): 161–70.Google Scholar
  22. 22.
    US Department of Health and Human Services. Physical activity and health: a report of the surgeon general. Atlanta (GA): US Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, 1996.Google Scholar
  23. 23.
    Wing RR, Hill JO. Successful weight loss maintenance. Annu Rev Nutr 2001; 21: 323–41.PubMedCrossRefGoogle Scholar
  24. 24.
    American College of Sports Medicine position stand on the appropriate intervention strategies for weight loss and prevention of weight regain for adults. Med Sci Sport Exerc 2001; 33: 2145–56.CrossRefGoogle Scholar
  25. 25.
    O’Connor PJ, Rush WA, Rardin KA, et al. Are HMO members willing to engage in two-way communication to improve health? HMO Pract 1996; 10(1): 17–9.PubMedGoogle Scholar
  26. 26.
    Pronk NP, Entzion K. Worksite health promotion and managed care: creating partnerships for population health improvement. AWHP’s Worksite Health 1998; Summer: 10–7.Google Scholar
  27. 27.
    Abrams DB, Orleans CT, Niaura RS, et al. Integrating individual and public health perspectives for treatment of tobacco dependence under managed health care: a combined stepped care and matching model. Ann Intern Med 1996; 18: 290–304.Google Scholar
  28. 28.
    Glasgow RE, Vogt TM, Boles SM. Evaluating the public health impact of health promotion interventions: the RE-AIM framework. Am J Public Health 1999; 89(9): 1322–7.PubMedCrossRefGoogle Scholar
  29. 29.
    Lindberg R. Active living: on the road with the 10,000 steps program. J Am Diet Assoc 2000; 100(8): 878–9.PubMedCrossRefGoogle Scholar
  30. 30.
    Pronk NP, O’Connor PJ, Isham G, et al. Building a patient registry for implementation of health promotion initiatives: targeting high-risk individuals. HMO Pract 1997; 11(1): 43–6.PubMedGoogle Scholar

Copyright information

© Adis International Limited 2003

Authors and Affiliations

  1. 1.Center for Health PromotionHealthPartners Research Foundation, HealthPartnersMinneapolisUSA

Personalised recommendations