Changing community health behaviors: a model for program development and management.

A model has been proposed to improve program development and management of behavior change programs with large-scale community impact. It can be applied to epidemiologic problems of which lifestyle is an important component, such as heart disease, adolescent pregnancy, hypertension, weight control, and cancer control and prevention programs. The model combines two previously existing models: one indicating that program development is an ongoing cyclical process which starts with uncertainty yet can progress to institutionalization with suitable testing; and the second model indicating that program management within each developmental cycle progresses through specific phases which can be hampered by plateaus and setbacks. Nine systems are essential for program development and operations: education (philosophy, objectives, and content), communications, reward, intervention, program process, program development, and program evaluation. These systems can be used as a guide to facilitate selection from the many guidelines recommended in the literature, and to ensure coordination of innovative program elements.