Planning, Implementing and Evaluating Health Promotion Programs: A Primer.

Planning, Implementing and Evaluating Health Promotion Programs: A Primer. 4th ed. McKenzie J F, Neiger B L, Smeltzer J. San Francisco, Calif, Benjamin Cummings, 2005, softcover, 432 pp, 78. 80. Traditionally, physical therapist interventions have been designed to treat patients who have illnesses or impairments. The focus has been on meeting the needs of individuals who are sick, rather than on providing services that would prevent illness from occurring in the first place. The number of individuals living with chronic health conditions is a growing concern. Over the next 25 years, the number is expected to double as the baby boomers age, creating enormous demands for health care and social services. The cost for these services will occur at the same time that the health care system is facing pressure to decrease expenditures. Diet, exercise, avoidance of tobacco, and moderate alcohol use would prevent many of these illnesses from occurring, while reducing both morbidity and mortality. Thus, the need for health care providers who can promote a healthier lifestyle and prevent the onset of chronic illness has become increasingly clear. With knowledge of the efficacy of diet and exercise interventions, and skill in patient education, physical therapists are well suited to provide both primary and secondary prevention activities that would help address this problem. McKenzie, Neiger, and Smeltzer have written a text that covers the theoretical and practical knowledge to develop and implement health promotion programs. It provides foundational material for learners who are new to this field of study. The initial chapter does an excellent job describing the concept of health education as compared to health promotion. Most physical therapists will find the role of health educator to be very familiar and comfortable while inaccurately assuming that this is synonymous with health promotion. Health promotion is a combination of activities that go beyond mere education to include “the competent implementation of behavioral change strategies, health education, health protection measures, risk factor detection, health enhancement and health maintenance. ” The book is divided into 3 sections. Part One focuses on planning a health promotion program; Part Two addresses ways to implement a health promotion program; and Part Three covers evaluation of a health promotion program. Each chapter is well-organized and begins with clear, well-stated objectives. These objectives are followed by a list of key terms that will be covered in the chapter, enhancing learner focus on the material to be mastered. At the end of each chapter are questions that test the learner's knowledge of the facts that were presented. The text then guides the application of this information by providing activities that ask for comparison, analysis, evaluation, and development of ideas based on the material. This is followed by a final set of learning activities that are based on information and resources that are found on the World Wide Web. The inclusion of these learning activities provides the instructor with multiple strategies to take the student's knowledge beyond the mere memorization of the facts. Part One is designed to guide the learner in developing and preparing a health promotion program. Chapter Two begins with “Models for Program Planning in Health Promotion, ” including the theoretical basis for how to approach the problem, and how to identify the basic components necessary to a successful plan. The remaining chapters in this section elaborate on the components of the planning process. Chapter Three describes the importance of a planning committee to starting the planning process, while Chapter Four provides information on assessing needs. Identifying data sources, selecting the most appropriate source, and collecting data are described. Chapter Five provides a lengthy description of measurement, measures, data collection, and sampling. Chapter Six builds on the information gathered in the earlier chapters, guiding the student in the development of a specific program by writing a mission statement, goals, and objectives. Chapter Seven provides an excellent overview of “Theories and Models Commonly Used for Health Promotion Interventions. ” In essence, this chapter covers the most commonly used behavior change theories and how to apply them. This is one of the book's strongest chapters. Application of behavior change strategies is an essential tool for all physical therapists that interact with patients and expect adherence to a plan of care. Part One ends with Chapter Eight, “Interventions, ” a description of a wide variety of health promotion strategies ranging from health communication to advocating for changes in public policy. While Part One is a combination of theoretical with practical information, Part Two consists of the nuts and bolts of implementing a program. Chapter Nine, “Community Organizing and Community Building, ” Chapter Ten, “Identification of Resources, ” Chapter Eleven, “Marketing, ” and Chapter Twelve, “Implementation Strategies, ” guide the reader in establishing and sustaining a health promotion program. While much of the material contained in this section might be found in a course on administration or business management, it is helpful to see the information applied specifically to health promotion programs. Part Three completes the objectives of the book by guiding the reader to evaluate the program they have designed and implemented. Chapter Thirteen provides an overview of the topic of program evaluation; Chapter Fourteen covers “Evaluation Approaches, Framework and Designs, ” and Chapter Fifteen completes the book with an explanation of “Data Analysis and Reporting. ” This text is well-written and nicely organized, providing excellent content and structured learning activities. There are ample charts and graphics that complement the written content. Several appendices at the end of the book provide concrete examples and templates for items such as public service announcements and sample medical clearance forms. One flaw that I found in the objectives at the beginning of each chapter was that they are all in the cognitive domain. Given the relative newness of this field of study for many health providers, it would be beneficial to address the traditional attitudes, beliefs, and values that undermine the student's understanding of this challenging new arena. However, this is a minor complaint and is offset by the excellent content and breadth of opportunities to integrate the information into “real-life” situations. Another desirable feature is the inclusion of activities requiring the student to use the Internet to locate information and to evaluate it. This will be very appealing to most students. The text provides extensive information on the pragmatic aspects of providing a health promotion program. The target audience for this text appears to be providers who are already committed to providing health promotion programs. One important area that is not addressed is how health behaviors cause poor health, and why it is important to add these activities to our traditional interventions. This text would serve as an excellent introductory text for this topic, covering a broad array of topics to introduce the learner to this field. However, the cost may be considered excessive for a paperback edition of a book of this length. Nancy Sharby PT, MS Associate Clinical Specialist Department of Physical Therapy Northeastern University Boston, MA