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A Framework for Planning and
Evaluation: PRECEDE-PROCEED
Evolution and Application of the Model
Lawrence W. Green
Judith M. Ottoson
10 es^ ans journees de sante publique
Montreal, Quebec
October 25, 2006
PRECEDE-PROCEED Model
- P redisposing,
- R einforcing, &
- E nabling
- C onstructs in
- E ducational/Ecological
- D iagnosis &
- E valuation
- P olicy,
- R egulatory &
- O rganizational
- C onstructs in
- E ducational &
- E nvironmental
- D evelopment
Green & Kreuter, Health Program Planning, 4th^ ed., NY, London: McGraw-Hill, 2005.
Some Challenges of Planning and
Evaluation in Public Health
- Health behavior is driven by more than knowledge,
beliefs, and attitudes (motivation)
- Must be enabled, as well as predisposed
- Health behavior usually must be sustained over long
periods to achieve health benefits
- Must be reinforced, as well as enabled
- Communications must be supported by policies and
programs, regulations and organization
- Must adapt programs to different populations and
settings, with sensitivity to their differences.
- In summary: the challenges require more than merely
imparting information, knowledge, or even wisdom…
“Eat fewer calories than your body burns.”
ADAM
food safety
water
shelter love
& EVE
Another way to view the growing complexity of natural history (Adam), social history (Adam and Eve) and their increasingly complex world of health-related concerns with additional layers of relationships.
ADAM
food safety
water
shelter love
& EVE
communication approval
interpersonal skills
contraception
sexual health issues
ADAM
food
safety
water
shelter love
& EVE
communication approval
interpersonal skills
contraception
& FAMILY
sexual health issues
infection control parenting skills health care
grief issues
food storage education
higher level communication and negotiation skills
mental health issues
ADAM
food safety
water
shelter love
& EVE
communication approval
interpersonal skills
contraception
& FAMILY
Quality of life
Phase 1 Social assessment
Health
Phase 2 Epidemiological assessment
Health education
Policy regulation organization
Health Promotion
Phase 5 Administrative & policy assessment
Output Longer-term health outcome
Short-term social impact
Short-term impact
Input Process Long-term social impact
Phase 6 Implementation
Phase 7 Process evaluation
Phase 8 Impact evaluation
Phase 9 Outcome evaluation
Predisposing
Reinforcing
Enabling
Phase 4 Educational & ecological assessment
Behavior
Environment
Phase 3 Behavioral & environmental assessment
*Green & Kreuter, Health Promotion Planning , 3rd ed., Mayfield, 1999.
The Precede-Proceed model as it appeared in the previous Edition of the book, with phases 2 & 3 as separate phases, now combined.
Japanese
Quality of life
Phase 1 Social assessment
Health
Education- al strate- gies
Policy regulation organization
Health Program
Phase 4a
Phase 5 Implementation
Phase 6 Process evaluation
Phase 7 Impact & Outcome evaluation
Predisposing
Reinforcing
Enabling
Phase 3 Educational & ecological assessment
Behavior
Environment
Phase 4bPhase 4b
Phase 2 Epidemiological Assessment
Genetics
Figure 1-2. The generic representation of the new version of PRECED-PROCEED, with new elements highlighted in blue. Phases 4-5 can be viewed as one or two phases, both covered in Chapter 5.
Administrative & policy assessment
Intervention Alignment
Quality of life
Phase 1 Social assessment
Health
Educational strategies
Policy regulation organization
Health Program
Phase 4a Intervention Alignment
Input Process Output Short-termimpact Longer-termhealth outcome Short-termsocial impact Long-termsocial impact
Phase 5 Implementation
Phase 6 Process evaluation
Phase 7 Impact and outcome evaluation
Predisposing
Reinforcing
Enabling
Phase 3 Educational & ecological assessment
Behavior
Environment
Å Precede Evaluation tasks: Specifying
measurable objectives and baselines.
Phase 4b Administrative & Policy Assessment
Æ Proceed Evaluation Tasks: Monitoring & Continuous Quality Improvement
Phase 2 Epidemiological, Behavioral and Environmental Assessment
Genetics
Figure 1-5. Evaluation tasks begin at Phase 1, and continue through as many diagnostic, implementation, and follow-up evaluation phases as required.
Phases 3- Phases 3-4 of PRECEDE.4 of PRECEDE.
Predisposing
Knowledge, Attitudes Beliefs Cultural Values Perceptions
ReinforcingReinforcing
Influence from parents, teachers, employers, peers, etc.
EnablingEnabling Availability of resources Accessibility Skills
BehaviorBehavior
andand
LifestyleLifestyle
Health Education,Health Education, Mass Media,Mass Media, Advocacy,Advocacy, TrainingTraining
EnvironmentEnvironment
Policy, Regulation,Policy, Regulation, OrganizationOrganization
Ecosystem
Phase 3: Educational and Ecological Assessment
Phase 4: Intervention Alignment, Administrative And Policy Assessment
Genetics and
Human Biology
Hallmark: Participation
• Stakeholders
• Community as Center of Gravity
• Health as a Social Issue
• Social Capital or Community Capacity
• Transdisciplinary Collaboration
Hallmark: Flexible and Scaleable
• Global applications (e.g., Global
Eradication of Guinea Worm Disease)
• National applications to local (e.g.,
PATCH, ALA and ACS)
• Over 960 published applications in all
settings (see www.lgreen.net)
• Multiple health issues/concerns
• Tailored, individual approaches scalable
to population-based approaches
• Multiple points of intervention
Hallmark: Evidence-based
and Evaluable
• Start with Outcomes
• Continuous Assessment
• Measurable Objectives
• Ongoing Feedback/Learning System
• Minimizes “Unanticipated Effects”
Hallmark: A Platform for
“Best Practice”
• Evidence-based
• Acknowledges Indigenous Practitioner
Wisdom and Contextual Knowledge
• Tailors Strategies to Meet Unique
Needs, Assets, and Circumstances
• A Generalizable Process, Not a
Generalizable Plan!
Phases 3- Phases 3-4 of PRECEDE.4 of PRECEDE.
Predisposing
Knowledge, Attitudes Beliefs Cultural Values Perceptions
ReinforcingReinforcing
Influence from parents, teachers, employers, peers, etc.
EnablingEnabling Availability of resources Accessibility Skills
BehaviorBehavior
andand
LifestyleLifestyle
HealthHealth Education,Education, Media AdvocacyMedia Advocacy
EnvironmentEnvironment
Policy, Regulation,Policy, Regulation, OrganizationOrganization
Ecosystem
Phase 3: Educational and Ecological Assessment
Phase 4: Intervention Alignment, Administrative And Policy Assessment
Genetics and
Human Biology
Concerns, Aspirations Felt needs, Assets,
Setting Priorities
GoalsVision
Phase 1. Social &
Quality-of-Life
Assessments &
Situation Analysis
Phases 2-3. Epidemi-
ological, Educational
& Ecological
Assessments
causes, determinants^ For each goal, assess
feasibility of eachAsses importance,
Set priorities
tivesObjec-
Phase 4. Administrative
& Policy Assessment,
PROCEED to Action,
Formative evaluation^ For each objective, assess
dence for changeAssess theory, evi-resources, polices
Select methods,
Assign roles
Pretest Methods
TacticsStrategy
Implementation
Activate Timelines for
Training, Interventions
Evaluation…of methods…intermediate objectives…ultimate goals
Phase 5
Phase 6Æ Phase 7^ Phase 8
Figure 2-6. Summary of the Phases of PRECEDE-PROCEED
Social goals & objectives
Community engaged?
NO
Yes
Select & apply procedures for community participation (Ch 2)
Collect/Analyze data, get consensus, set priorities (Chap 2)
Are health objectives clear?
Go to Chap 3
If Not
Yes
Are behavioral & environmental causes, objectives clear?
Go to part 2 of Chap 3
Yes
Are Predisposing, Enabling, and Reinforcing factors clear? If Not Go to Chap 4
Yes
Are best practices & resources for program available, & policies in place? If Not
Go to Chap 5
If Not
Implementation & Evaluation
Yes
Plan
PROCEED
PRECEDE
Fig 2-7. Flow diagram in applying PRECEDE-PROCEED.
Quality of life
Phase 1 Social assessment
Health
Educational strategies
Policy regulation organization
Health Program
Phase 4a Intervention Alignment
Input Process Output Short-termimpact Longer-termhealth outcome Short-termsocial impact Long-termsocial impact
Phase 5 Implementation
Phase 6 Process evaluation
Phase 7 Impact and outcome evaluation
Predisposing
Reinforcing
Enabling
Phase 3 Educational & ecological assessment
Behavior
Environment
Å Precede Evaluation tasks: Specifying
measurable objectives and baselines.
Phase 4b Administrative & Policy Assessment
Æ Proceed Evaluation Tasks: Monitoring & Continuous Quality Improvement
Phase 2 Epidemiological, Behavioral and Environmental Assessment
Genetics
Figure 1-5. Evaluation tasks begin at Phase 1, and continue through as many diagnostic, implementation, and follow-up evaluation phases as required.
Feasibility Standards
- Practical procedures
- Political viability
- Cost effectiveness
The feasibility standards are intended to ensures that an evaluation will be realistic, prudent, diplomatic, and frugal
Propriety Standards
- Service orientation
- Formal agreements
- Rights of human subjects
- Human interactions
- Complete and fair assessment
- Disclosure of findings
- Conflict of interest
- Fiscal responsibility
The propriety standards are intended to ensure that an evaluation will be
conducted legally, ethically, and with due regard for the welfare of those
involved in the evaluation, as well as those affected by its results
Accuracy Standards
- Program documentation
- Context analysis
- Describe purposes and procedures
- Defensible information sources
- Valid information
- Reliable information
- Systematic information
- Analysis of quantitative information
- Analysis of qualitative information
- Justified conclusions
- Impartial reporting
- Metaevaluation
The accuracy standards are intended to ensure that an evaluation will reveal and
convey technically adequate information about the features that determine the
worth or merit of the program being evaluated.
Quality of life
Phase 1 Social assessment
Health
Educational strategies
Policy regulation organization
Health Program
Phase 4a Intervention Alignment
Input Process Output Short-termimpact Longer-termhealth outcome Short-termsocial impact Long-termsocial impact
Phase 5 Implementation
Phase 6 Process evaluation
Phase 7 Impact and outcome evaluation
Predisposing
Reinforcing
Enabling
Phase 3 Educational & ecological assessment
Behavior
Environment
Å Precede Evaluation tasks: Specifying
measurable objectives and baselines.
Phase 4b Administrative & Policy Assessment
Æ Proceed Evaluation Tasks: Monitoring & Continuous Quality Improvement
Phase 2 Epidemiological, Behavioral and Environmental Assessment
Genetics
Figure 1-5. Evaluation tasks begin at Phase 1, and continue through as many diagnostic, implementation, and follow-up evaluation phases as required.
