The life and death of a health promotion program: an institutionalization case study

This article presents a case study of a health promotion program that successfully operated for four years but terminated when its federal and state funding ended, i.e., it failed to become institutionalized. The program, which was funded under the federal health education-risk reduction grants, was directed at preventing use of alcohol and tobacco among young adolescents. Evaluations indicated that the program was highly successful. The authors argue that health promotion programs can be viewed as organizational innovations in which institutionalization is the final stage of the innovation process. In the case study, institutionalization did not occur for two reasons: 1) demonstration of effective implementation was the health department's primary goal, and program institutionalization was only a latent concern and; 2) both the county commissioners and the community feared federal and state "dumping." The "CODAPT" model of health education program planning is presented as one way of dealing with the problem of "deep" program implementation but "shallow" institutionalization. Implications of these findings for health education practice and policy are discussed.