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This article presents six implications for practice that suggest how to optimize the institutionalization of health promotion programs. These six implications were derived from a study of ten health promotion programs funded by the Virginia State Health Department and operated by local schools- and community health agencies. Institutionalization refers to the long-term survival of health promotion programs, i.e., survival well beyond an initial grant funding period. To generate the implications for practice, a multiple case design for cross-case comparisons was applied to the ten health promotion programs. In brief, the six practice implications are: 1) cultivating a "program champion"; 2) favoring organizations with mature "subsystems"; 3) favoring organizations in which health promotion "fits" with the organization's mission; 4) avoiding brokering relationships; 5) altering lengths of funding periods; and 6) funding existing worthy programs. The significance of these practice implications for both funding and implementing agencies is briefly discussed.

Purpose. The purpose of this study was to determine the extent of implementation of school health education curricula, to identify factors which enhanced or impeded implementation, and to examine the link between the adoption and implementation phases of the diffusion process. Design. The study used an experimental design; 22 school districts were randomly assigned to intervention and control conditions. Setting. The study was conducted in North Carolina. Subjects. All teachers in the study districts identified by their schools as "eligible to teach health" were included in the sample. Intervention. An in-depth training was conducted on the use of the middle school tobacco prevention curriculum that had been adopted. Measures. Three measures were used to assess implementation of the curricula. Independent variables of interest included organizational size and climate, teacher training, how long it took to make the adoption decision, and attitudes toward tobacco use prevention curricula. Response rates for these measures ranged from 44% to 78%. Results. Nonparametric correlations and regression modeling indicated that larger organizational size and teacher training were the strongest predictors of curricula implementation. A favorable organizational climate within school districts also improved implementation. Conclusions. While interventions to increase adoption of school health education curricula should focus on larger school districts, the majority of efforts to improve implementation should focus on smaller districts.

Purpose. This article reports on a process evaluation of three Planned Approach to Community Health (PATCH) projects and three Community Chronic Disease Prevention Programs (CCDPP) that operated in the State of Maine. PATCH and CCDPP are similar approaches to community health promotion developed and disseminated by the Centers for Disease Control. The evaluators studied how the Planned Approach to Community Health and the Community Chronic Disease Prevention Program models worked as community health strategies across the six field sites. Research Methods Used. Qualitative methods were used in a cross-case comparison of the six field sites. In studying each site, the evaluators focused on six stages common to both the Planned Approach to Community Health and the Community Chronic Disease Prevention Program models: Stage 1: conducting a community needs assessment; Stage 2: analyzing needs assessment data; Stage 3: setting priorities for the project based on the data; Stage 4: implementing activities; Stage 5: producing process outcomes; and Stage 6: institutionalizing the project. The analysis focused on how each of the six communities traversed these stages. Summary of Findings. Eight recommendations for refining Planned Approach to Community Health and Community Chronic Disease Prevention strategies resulted from the study: 1) do a community capacity assessment prior to initiating a community needs assessment; 2) do not overly rely on Behavioral Risk Factor Surveys; 3) analyze needs assessment data rapidly for community consumption; 4) allow flexibility and community input in determining priority health objectives; 5) provide technical assistance throughout a project, not just in the beginning; 6) fund at least one full-time local coordinator and extensive capacity building; 7) emphasize multiple interventions around one chronic condition at a time; and 8) emphasize program institutionalization. Conclusions. Community development approaches like Planned Approach to Community Health and Community Chronic Disease Prevention are promising health promotion strategies. To be optimally effective, however, these strategies need refinement based on systematic study in field settings. Because this study was limited to six sites in Maine, some of these findings may have limited generalizability.

Once a health promotion program has proven to be effective in one or two initial settings, attempts may be made to transfer the program to new settings. One way to conceptualize the transference of health promotion programs from one locale to another is by considering the programs to be innovations that are being diffused. In this way, diffusion of innovation theory can be applied to guide the process of program transference. This article reports on the development of six questionnaires to measure the extent to which health promotion programs are successfully disseminated: Organizational Climate, Awareness-Concern, Rogers's Adoption Variables, Level of Use, Level of Success, and Level of Institutionalization. The instruments are being successfully used in a study of the diffusion of health promotion/tobacco prevention curricula to junior high schools in North Carolina. The instruments, which measure the four steps of the diffusion process, have construct validity since they were develóped within existing theories and are derived from the work of previous researchers. No previous research has attempted to use instruments like these to measure sequentially the stages of the diffusion process.