Using the Precede-proceed model, Study notes of Nutrition

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Claudine Matlo September 24 2012

USING THE PRECEDE-

PROCEED MODEL

Outline

1. Introduction
2. Defining the PROCEDE-PRECEED model
3. 2 visual examples of program planning
4. The steps of the PROCEDE-PRECEED model
5. Case studies

Introduction:

• The PRECEDE-PROCEED model is a tool for designing,

implementing, and evaluating health behavior change programs.

• Originally Developed in the 1970’s by Green and colleagues
• ‘When a problem affecting a particular population has been

identified health, and the health professional must do something to fix the problem…a planning model like PRECEDEPROCEED, which has been the cornerstone of health promotion practice for more than three decades, can help guide this process.’ (p. 408)

PRECEDE - Predisposing Reinforcing Enabling Constructs

In

Educational / Environmental Diagnosis Evaluation

PROCEED Policy Regulatory Organizational Constructs Educational Environmental Development

PRECEDE – based on the premise that just as a medical diagnosis precedes a treatment, so should an educational diagnosis precede an intervention plan.

Criticism was that there was too much emphasis on implementing programs and too little on designing interventions to strategically meet needs.

PROCEED - was added in 1991 to recognize environmental factors as determinants of health and health behavior.

Lifestyle (Environment) – recognition of impact, behaviors sometimes being influenced outside of the individual i.e. media campaigns for ‘health’ medications.

The ‘new’ version…

• Is a streamlined, more efficient planning model.
• 1. merges two phases Epidemiological assessment & Behavioral + Environmental assessment
• 2. provides options for skipping phases when appropriate evidence already exists
• I.e. the use of secondary data
• What has stayed the same is the

emphasis on the ‘fundamental principle of

participation which states that success in

achieving change is enhanced by the

active participation of the intended audience…’ (p. 409).

Causal and action

• Causal Theory – seeks to identify the determinants of an outcome
• Action theory – explain how interventions affect the determinants

and outcomes.

• Causal + Action = program theory depicted as logic models
• PROCEDE-PRECEED is a form of a logic model
  • Assessment, intervention planning and evaluation into one

framework or model

PRECEDE-PROCEED Framework

PRECEDE __________________________________________________________________________________________ Phase 5 Phase 4 Phase 3 Phase 2 Phase 1 Administrative Educational and Behavioural and Epidemiologic Social Policy Assessment Ecological Environmental Assessment Assessment Assessment Assessment

Phase 6 Phase 7 Phase 8 Phase 9 Implementation Process Impact Outcome ____________________________________________________________________________________Evaluation^ evaluation^ evaluation PROCEED

Health Quality of Life

Behaviourand lifestyle

Environment

Reinforcing factors

Predisposingfactors

Enablingfactors

HEALTHPROMOTION Healtheducation

Policy,Regulation, Organization

PRECEDE-PROCEED Framework (L. Green)

www.lgreen.net/precede.htm

Theory and Phase 1

• Community organizing theories and principles are relevant
  • Working with community groups to identify common problems, goals, mobilize resources, develop and implement strategies - Ex the Tenderloin project with low-income older adults (TSOP, Minkler, 1983) - Example of community mobilization – not as ‘process’ focused; but community driven, involves members in problem identification, needs assessment, and program design.

Phase 2: Epidemiological, Behavioral, and

Environmental Assessments

• Identify the health priorities and their behavioral and environmental

determinants.

Epidemiological Assessment –

1. Identify health problems, issues or aspirations on which the

program will focus.

2. Uncover behavioral and environmental factors most likely to

influence identified priority health concerns

3. Translate those priorities into measurable objectives

Occasionally secondary data analysis is done using existing data

sources such as vital statistics, and other data bases including

National health information center and Canadian Communities Health

Survey (CCHS).

Phase 2 cont..

• Environmental Determinants

Social and physical factors external to the individual – often beyond

their control, that can be modified to support the behavior or

influence the health outcome.

This stage requires strategies other than education.

Ex poor nutrition among school age children:

• Most proximal – poor dietary habits

Affected by availability of unhealthy foods in school

• Most distal – school policies around foods served/avl in schools

Older adult example?

Theory & Phase 2

• Through the use of theory, literature, and planning groups input, an

inventory of behavioral and environmental influencing factors should be made.

• Useful theories include:
  • Interpersonal theories of behavior change – emphasize interaction between individual and environment – ex Social Cognitive Theory – behavior, cognition, and other personal factors have a reciprocal relationship with the environment; behavior can be influenced by observing others and receiving reinforcement - Peer to peer programs
  • Organizational Change theories – useful when policies or practices of formal organizations have been identified as needing change.
  • Community mobilization can be used to change environmental conditions that influence health and health behaviors
  • Diffusion of Innovations theory – describes and predicts process by which new ideas are adopted by a community

Theory & Phase 3

• All 3 levels of change theories are useful at this stage-
  • Individual – most appropriate for addressing predisposing factors – how to communicate to individuals i.e. phone calls, mass media, social media?
  • Interpersonal – appropriate for reinforcing factors – indirect communication channels through friends family and methods such as train the trainer. - (Brain Fitness)
  • Community – enabling factors - environmental change - i.e. organizations delivery of services, policies, laws, and regulations
    • Organizational change theories - for example with the use of walking aids a campaign may be developed in the building that emphasis the benefits and advantages to utilizing walking aids. This would also draw on SGT looking further at the social influences. The HBM would also be useful - perceived susceptibility

Phase 4: Administrative and policy assessment

and intervention alignment

• The planner will select and align the programs components, priority

is the determinants of change previously identified.

• Identify resources
• Identify organizational barriers & facilitators
• Identify policies that are needed for program implementation 2 levels of alignment between assessment of determinants and selection of interventions