H EALTH C OMMUNICATION

P A R T N E R S H I P

The new

P-Process
Steps in Strategic
Communication

THE HEALTH COMMUNICATION

PARTNERSHIP
The Health Communication Partnership (HCP)
links five leading institutions together to
accomplish its goal of strengthening public health
in the developing world through strategic
communication programs. HCP and its partners
work to create an environment that encourages
individuals, families, and communities to act
positively for their health and to access and
advocate quality services.
This integrated approach to improving
health is based on growing evidence that
strategic health communication can influence
behavior. In addition to the five main partners,
HCP works with many Southern-based
partners worldwide as well as global
programming partners, especially from the
corporate, education, and faith-based sectors.
For a complete list of HCP partners, see
www.hcpartnership.org.
Supported by the U.S. Agency for
International Development (USAID),
HCP includes Johns Hopkins Bloomberg
School of Public Health/Center for
Communication Programs, the Academy for
Educational Development, Save the Children,
The International HIV/AIDS Alliance, and
Tulane Universitys School of Public Health and
Tropical Medicine

December 2003

THE P-PROCESS
STEPS IN STRATEGIC
COMMUNICATION

Evaluation &
Replanning

Step 1 ANALYSIS
Step 2 STRATEGIC DESIGN
Step 3 DEVELOPMENT & TESTING
Step 4 IMPLEMENTATION & MONITORING
Step 5 EVALUATION & REPLANNING

STRATEGIC
COMMUNICATION
Communicating strategically requires
a clearly defined strategy with specific
goals established in advance. The
P-Process is a framework designed to guide
communication professionals as they develop
strategic communication programs. This step-by-step
road map leads communication professionals from a
loosely defined concept about changing behavior to a
strategic and participatory program with a measurable
impact on the intended audience.
The P-Process is used to develop communication
programs addressing a wide range of topics such as
encouraging safer sexual behavior to prevent HIV
transmission, promoting child survival, reducing
maternal mortality, increasing contraceptive
prevalence, preventing infectious diseases, or
promoting environmental health.
The Health Communication Partnership (HCP)
addresses family planning, maternal health, child
survival, HIV/AIDS, and other infectious diseases
such as malaria and tuberculosis. HCPs programs are
designed to initiate positive change across three broad
domains: within social-political environments, in
health service delivery systems, and among
communities and individuals. The P-Process is key to
designing successful communication strategies to
strengthen public health worldwide.
Used successfully around the world to design
health communication programs since 1982, the
original P-Process has now been revised to reflect
better both the goals of HCP and the overall
evolution in the field of strategic communication in
the past decade.
Major changes include the following:

AND THE

P-PROCESS

Participation and Capacity Strengthening

These two concepts appear throughout this revision
because they are considered essential to building
strong partnerships and coalitions from the international
and national level to the local and community level.
Both concepts are also crucial to increase the
sustainability of program efforts and outcomes.

Expanded Analysis
Although the first step remains analysis, this revised
P-Process divides Step One into a situation analysis
and a communication and audience analysis.

Emphasis on Community and Processes

In Step Three, this revised P-Process underscores the
need for participatory processes and the facilitation
of group action to address health issues.

Implementation and Monitoring

Step Four of the P is larger to indicate the relative
significance of this step in any program.

Management and Feedback

The original P-Process linked management to
implementation and monitoring in Step Four. In this
revised version, management is no longer exclusively
presented as part of the fourth step because it is
central to and inferred in all steps of the
communication programming process.

Return to Analysis or Strategic Design

The original P-Process completed the circle of the P
by bringing Step Fiveimpact evaluationback to
the design stage. This revision allows communication
professionals to use impact evaluation results to return
to either the design stage, if expanding or revising
existing programs, or to the analysis stage, if
developing new programs.

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4

STEP 1

ANALYSIS

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Analysis is the first step in developing

effective communication programs, but
this step does not need to be long and detailed if the
program is built upon well-documented past
experiences. Program staff need to understand the
problem, the people, their culture, existing policies
and programs, active organizations, and available
communication channels. Usually much of the
situation analysis is available from demographic,
epidemiological, sociological, and economic studies
and accessing such data will speed up the steps below.

SITUATION ANALYSIS
Conduct a situation analysis resulting in an in-depth
description of the major health and development
problems being addressed:

Determine severity and causes of problems

Review existing health and demographic data,
survey results, study findings, and any other
information available on the problem.

Identify factors inhibiting or facilitating

desired changes
Consider the basic social, cultural, and economic
challenges facing the people the program would
like to reach.

Develop a problem statement

Develop a clear statement that sums up the
problems to be addressed.

Carry out formative research

Listen to understand the audiences needs and
priorities. Conduct baseline research, both
quantitative and qualitative, to establish the
current status and accurately measure the
programs progress and final impact.

ANALYSIS (continued)
AUDIENCE/COMMUNICATION ANALYSIS
From the overall situation analysis, carry out a
detailed audience and communication analysis.

Conduct a participation analysis

At the national and international level, identify
partners and allies to help initiate policy change
and strengthen communication interventions. At
the community level, segment the primary,
secondary, and tertiary audiences. Identify field
workers/change agents.

Carry out a social and behavioral analysis

Assess knowledge, attitudes, skills, and behaviors
of participants at the individual level using data
from formative research and additional in-depth
studies, if required. Identify social networks,
socio-cultural norms, collective efficacy, and
community dynamics (including leadership
patterns) at the community level.

Assess communication and training needs

Analyze audiences media access and use; the
capacity strengthening needs of local media,
traditional media, NGOs, and communication
agencies; the organizational capacity of partners
and allies; and other resource needs. Determine
the availability of communication materials and
skills development needed for interpersonal
communication and counseling.

In many cases programs will be built on existing

initiatives and the process of analysis need not be
long and arduous if program staff access all
available resources and listen to all participants.

STEP 2

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STRATEGIC
DESIGN

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Every communication program or project

needs a strategic design. Follow these steps:

Establish communication objectives

Set objectives that are Specific, Measurable,
Appropriate, Realistic, and Time-bound
(SMART). Select key audience segments and
quantify the changes in knowledge, attitudes,
skills, behaviors, policies, or process changes
expected within a specific time.

Develop program approaches & positioning

Select a behavior change model upon which to
base the program. Explicitly state the assumptions
underlying the basic strategy and approach.
Explain why and how the program is expected to
change health behavior. Position the program
clearly to benefit the audience.

Determine channels
Consider a coordinated, multimedia approach for
a synergistic impact. Where possible, achieve scale
by including mass media tied to community
mobilization and interpersonal communication
among family, friends, community, social networks,
and service providers.

Draw up an implementation plan

Develop a work schedule with regular
benchmarks to monitor progress. Prepare a
line-item budget. Complete a management plan,
including partners roles and responsibilities.
Make sure all involved know what is expected.

Develop a monitoring and evaluation plan

Identify indicators and data sources to monitor
program implementation as well as audience
reaction to it. Select the study design to measure
process outcomes and assess impact.

STEP 3

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DEVELOPMENT
& TESTING

Developing concepts, materials, messages,

stories, and participatory processes
combines science and art. These not only must be
guided by the analysis and strategic design in Steps
One and Two, but also must be creative to evoke
emotion that motivates audiences.

Develop
This step may involve the development of
guidelines, tools, toolkits, possibly including
facilitation manuals for group interaction or
training manuals for counseling, job aids for
service providers, an interactive Internet process,
TV or radio scripts, educational comic books, or
any number of other interventions. Involve key
stakeholders managers, field workers, and
members of the audience in design workshops
to ensure that the end products meet their needs.

Test
Test concept with stakeholders and
representatives of the audiences to be reached.
Follow concept testing with in-depth pretesting
of materials, messages, and processes with
primary, secondary, and tertiary audiences.
Feed back results to partners and allies to
ensure maximum ownership and use.

Revise
Make changes based on pretest results for
messages, stories, or participatory processes that
are not understood correctly, not remembered, or
are not socially or culturally acceptable.

Retest
Retest materials to ensure revisions are done well
and make final adjustments before replication,
printing, or final productions.

STEP 4

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5

IMPLEMENTATION
& MONITORING

Implementation emphasizes maximum

participation, flexibility, and training.
Monitoring involves tracking outputs to be sure that
all activities take place as planned and potential
problems are promptly addressed.

Produce and disseminate

Develop and implement a dissemination plan
that may include local government, NGOs, the
private sector, as appropriate, and the media for
maximum coverage.

Train trainers and field workers

Plan for training at all levels. Begin with training
of trainers (TOT). Provide continuing
opportunities for more training. Concentrate on
building institutional capacity and teamwork as
well as individual skills.

Mobilize key participants

Share information, results, and credit with
partners, allies, and communities. Keep everyone
involved motivated towards the strategic goal.

Manage and monitor program

Check program outputs to ensure quality and
consistency, while maximizing participation.
Track existing service statistics and conduct
special studies using surveys, focus groups,
observation, and other techniques to measure
outputs as well as audience reaction.

Adjust program based on monitoring

Use data from monitoring to make mid-course
corrections or adjustments in activities,
materials, and procedures and to finetune
program components.

STEP 5

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5

EVALUATION
& REPLANNING

Evaluation measures how well a program

achieves its objectives. It can explain why
a program is effective (or not), including the effects of
different activities on different audiences. Sound
program evaluation stimulates program improvements
and redesign, guides cost-effective future funding
allocations, and supports advocacy and fundraising.

Measure outcomes and assess impact

Many evaluations measure outcomes to
determine if the desired change has occurred in
knowledge, attitudes, or behavior among the
intended audience, or in a given policy relevant
to the program. More rigorous study designs
assess impact, which links the change in outcome
to one or more intervention activities.

Disseminate results
It is important that everyone involved be aware
of the programs impact, whether it is positive
or not. Share impact results widely with
partners, allies, key stakeholders, the media, and
funding agencies.

Determine future needs

Results demonstrate where follow-up is needed
and where program activities can be extended.

Revise/redesign program
A good evaluation will show if the program
is weak and where it needs revision in design
processes, materials, or overall strategies and
activities. Alternatively, and sometimes
simultaneously, it will show what works and how
to replicate positive impact. Program staff may
have to return to the analysis stage if the situation
changes markedly or if new causes are found for
problems being addressed.

PARTICIPATION &
CAPACITY STRENGTHENING
Throughout the process, keep in mind . . .

PARTICIPATION
A strong communication program should fully engage
multiple stakeholders at the national, district, and
community level.

CAPACITY STRENGTHENING
A successful plan always considers ways to build
capacity at the institutional and community level.

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Remember that . . .

Monitoring and feedback are essential

elements of good management.
Well-managed and facilitated strategic
communication programs can have a
measurable impact.
A well-managed program tracks outputs to
ensure quality and timely delivery throughout the
program period.
Program effectiveness and sustainability are
enhanced by involving stakeholders
whenever possible.
Involving stakeholders ensures that programs
match their needs, and it builds their capacity to
design and manage their own health
communication program in the future.

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THE ORIGINAL P-PROCESS

The Johns Hopkins Bloomberg School of Public
Health/Center for Communication Programs (CCP)
and its partners in the USAID-supported Population
Communication Services (PCS) project developed the
P-Process in 1982 as a tool for planning strategic,
evidence-based communication programs. Two
decades later, the P-Process continues to influence the
development, implementation, monitoring, and
evaluation of numerous communication strategies,
projects, and programs as well as communication
materials and tools for mass and community-based
media, interpersonal communication and counseling
(IPC/C), and training and capacity strengthening in
strategic communication. Through numerous
communication interventions, the impact of the
P-Process spans the globe.

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Suggested Citation:
Health Communication Partnership (December 2003).
The new P-Process, steps in strategic communication.
Baltimore: Johns Hopkins Bloomberg School of Public
Health / Center for Communication Programs / Health
Communication Partnership.

The Health Communication Partnership

based at:
Johns Hopkins Bloomberg School of Public Health
Center for Communication Programs
111 Market Place, Suite 310
Baltimore, Maryland 21202
Phone: 410-659-6300 Fax: 410-659-6266
Website: www.hcpartnership.org
E-mail: [email protected]

Kim S. Martin, Editor

Rita C. Meyer, Graphic Designer, Multimedia Services

The Health Communication Partnership

Center for Communication Programs

In partnership with:

Tulane Universitys School of Public Health

and Tropical Medicine

Supported by a five-year cooperative agreement from

the U.S. Agency for International Development
(#GPH-A-00-02-00008-00)