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Developing Culturally Appropriate Needs Assessments and Planning 137

factors (which provide motivation and rationale), reinforcing factors (which provide
rewards and incentives), and enabling factors (which facilitate performance) associ-
ated with the health problems (Green & Kreuter, 2005; McKenzie et al., 2005). By
identifying these factors planners gain a clearer idea of what the focus of the program
can be. Before making this decision, the PRECEDE - PROCEED, intervention map-
ping, and CDC - Cynergy models recommend assessing the provider organization ’ s
capacity to address the problem(s) and determining whether the political context is or
is not favorable. To accomplish this, CDC - Cynergy suggests conducting a SWOT
analysis, that is, one that provides insight into the organization ’ s strengths, weaknesses,
opportunities, and threats (Green & Kreuter, 2005; McKenzie et al., 2005). The fi ve
models coincide in saying that health promotion programs should focus on the health
problems that are most important, that are serious, and that are capable of change.
Other factors that should be taken into account according to the CDC - Cynergy model
are the availability of effective interventions, the concern of the community, and the
resources (personnel, time, and money) available, to ensure selecting a manageable
number of health problems (McKenzie et al., 2005).
Regardless of what model they decide to use, health education professionals need
to be clear that the first step in the development of a health promotion program is to

determine what the most important health problems of the community are. Reviewing
the epidemiological data is one way to obtain this information but not the only way. As
stated earlier, when working with minority groups and subgroups, it is always better
to use a mix of methods (interviews, surveys, ethnographic research, and so forth) to
make sure that you are obtaining fi rsthand information about the specifi c characteris-

tics of the population, the most significant health problems that affect them, and the
various factors associated with those health problems.
One strategy to accomplish this is to combine the PRECEDE - PROCEED and the
SMART models. The first offers a thorough assessment of the health problems and of

the environmental, behavioral, and risk factors related to them. The second model pro-
vides detailed information on the different segments of the population affected by the
health problems, including their learning styles, readiness for change, self - effi cacy,
locus of control, and other factors that influence their behavior (McKenzie et al.,

2005). All this is important to know when working with diverse populations. Even
though minority groups are often clustered into large categories (for example Hispanics,

Native Americans, Asians, and Pacific Islanders) by data collectors, each subgroup
might be affected in different ways by the same problem and each might have diverse
characteristics and behaviors that need special types of interventions.

Intervention Planning and Development
After identifying one or more health problems that the program will focus on, health
education professionals must develop the goals, desired outcomes, and objectives that
will guide their program and then determine the interventions that can be used to
accomplish these desired outcomes. What is going to change after implementing the
program? Who is going to be the target of the intervention? What types of interventions

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