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Transcript of Precede-Proceed Model
PRECEDE = Predisposing, Reinforcing, and Enabling Constructs in Educational/Environmental Diagnosis and Evaluation
Phase 1: Social Assessment, Participatory Planning and Situation Analysis
Expand understanding of the community by conducting multiple data collection activities
Interviews, surveys, focus groups, observations
Define quality of life problems for the priority population
Articulate communities' needs and desires
Strengths, gaps, potential for partnerships
Phase 2: Epidemiological, Behavioral and Environmental Assessments
Identifies the health priorities and their environmental and behavioral determinants
Identify health problems, issues, aspirations
Uncover behavioral/environmental factors
Translate priorities into measurable objectives
Conduct secondary data analysis
Overview of the Model
Example: Child Pedestrian Injury Prevention Program
References: Howat, P., Jones, S., Hall, M., Cross, D., & Stevenson, M. (1997).
The PRECEDE-PROCEED model: application to planning a child pedestrian injury prevention program. Injury Prevention, 3(4), 282-287.
National Health Information Center
National Library of Medicine Databases and Electronic Resources
Asked the community what it wants and needs to improve its quality of life.
Phase 1: Social Assessment
Phase 2 - Behavioral Determinants
Phase 2: Epidemiological, Behavioral, and Environmental Assessment
child morbidity and mortality rates due to traffic related trauma
Individual behaviors/lifestyles that contribute to occurrence or severity of health problem
Behavior of others who can directly affect behavior of the individuals at risk
Action of decision makers whose decisions affect the social or physical environment that influences the individuals at risk
Phase 3: Educational and Ecological Assessment
Phase 2 – Environmental Determinants
Social and physical factors external to the individual that can be modified to support behavior or influence the health outcome
lack of knowledge about safe road crossing behavior
perception of low risk of injury while crossing busy roads
Sometimes beyond individual control
Requires more than educational strategies
Matched factors to intervention components
Phase 6/Phase 7/Phase 8: Evaluation
Process Evaluation: Number of homes activities, newsletters, etc.
Example: Poor nutrition among schoolchildren
Poor dietary habits (most proximal behavioral factor)
Gained input from parents, doctors, teachers, and other community members to see this is an important topic to the community
Phase 3: Educational and Ecological Assessment
traffic volume and speed, road design, and roadside obstacles.
Identify antecedent and reinforcing factors that should be in place to initiate and sustain the change process
Identified two main risk factors:
inappropriate road crossing behaviors
children not getting help to cross road.
inability to identify safer road crossing sites
poorly developed road crossing skills
lack of social skills required to ask people to help them cross roads,
inadequate school road safety education
parents allowing children to cross roads alone
parents‘ perceptions that their children have adequate abilities to cross roads safely, unaccompanied.
Predisposing – rationale or motivation for performing the behavior
Knowledge, attitudes, preferences, beliefs, skills, self-efficacy
Educational approach: activities to influence road crossing behavior.
Delivered by mass media, group approaches, and individual approaches.
Reinforcing – rewards or incentives for repetition of behavior
Phase 4/Phase 5: Administrative and Policy Assessment & Intervention Alignment and Implementation
Environmental/Policy approach: involving community members and Road Safety Advisory Committee to influence environmental changes
Social support, peer influence, vicarious reinforcement
Enabling – support or resources for skill development
Impact Evaluation: knowledge about road safety behavior, improved road crossing skills
Programs, services, resources (availability and access)
Outcome Evaluation: decrease in rates of child pedestrian injuries
Phase 4: Administrative and Policy Assessment and Intervention Alignment
Select and align program’s components with priority determinants
Organizational barriers and facilitators
Policies needed to implement program
Building a comprehensive program requires:
Phase 5: Implementation
“The act of converting program objectives into actions through policy changes, regulation and organization” (Green & Kreuter, 1991)
Implementation = beginning of PROCEED
Phases 6-8: Evaluation
Plans should be in place for evaluation of the program
Three types of evaluation:
Program implementation according to protocol
Immediate, observable effects of program
Change in predisposing, reinforcing, and enabling factors
Effect of program on health and quality of life indicators
Long-term effects of the program
Considerations of Using the Precede-Proceed Model
Requires a number of human and financial resources, as well as technical detail
Specifics of intervention development are not emphasized in the details
PROCEED was added to the framework in 1991 to recognize environmental factors as determinants of health/behaviors
PROCEED = Policy, Regulatory, and Organizational Constructs in Educational and Environmental Development
Revised again in 2005 – four planning phases, one implementation phase, and three evaluation phases
Community organizing theories and principles are relevant at this phase
Interpersonal theories of behavior change are useful at this stage
Organizational change theories are relevant when policies and practices of organizations have been identified as environmental factors to be changed
All three levels of change theories (individual, interpersonal and community) useful at this stage
Overview and History of the Model
Stages of the Model and the Connection to Theory
Real Life Example
Developed in the 1970’s by Green, Kreuter, Deeds, and Partridge (originally only PRECEDE)
“Precede-Proceed can be thought of as road map and behavior change theories as the specific directions to a destination.”