4.

07
April 6, 2018
PRECEDE-PROCEED MODEL
Dr. Eufemia Collao
Department of Family and Community Medicine

I. Planning Models
II. PRECEDE/PROCEED
A. Assumptions Behind
B. Why use PRECEDE-PROCEED
C. How does one use PRECEDE-PROCEED
III. Phases of the PRECEDE-PROCEED Model
1. Phase 1: Social Diagnosis
2. Phase 2: Epidemiological Diagnosis
3. Phase 3: Behavioral & Environmental Diagnosis HOW DOES ONE USE PRECEDE/PROCEED
4. Phase 4: Educational & Organizational Diagnosis
5. Phase 5: Administrative & Policy Diagnosis PHASE PROCEDURE REMARKS
6. Phase 6: Implementation 1 Social Diagnosis Ask the community what
7. Phase 7: Process Evaluation it wants and need to
8. Phase 8: Impact Evaluation improve its quality of life
9. Phase 9: Outcome Evaluation 2 Epidemiological Identify the health or
Diagnosis other issues that clearly
PLANNING MODELS influence the outcome
 3F’s of program planning that help with selecting the appropriate the community seeks
model In this first 2 phases, you create the objectives for your
o Fluidity – steps are sequential intervention
o Flexibility – adapt to need of stakeholders 3 Behavioral and  Identify the specific
Environmental health-related actions
o Functionality – useful in improving health conditions
Diagnosis that are linked to the
 Categories identified health
o Practitioner driven problems
PRECDE

o Consumer-based  Identify the factors in

the environment that
PRECEDE-PROCEED MODEL interact with behavior
 Is a community-oriented, participatory model for creating 4 Educational and Identify the predisposing,
successful community health promotion interventions Organizational enabling, and reinforcing
Diagnosis factors
5 Administrative  Identify (and adjust
PRECEDE PROCEED and when necessary) the ff
- Predisposing - Policy Policy Diagnosis that can affect
- Reinforcing and - Regulatory and successful conduct of
- Enabling - Organizational the intervention:
- Constructs in - Constructs in 1. Internal administrative
- Educational - Educational and issues
- Diagnosis and - Environmental 2. Internal and external
- Evaluation - Development policy issues
In the phases 3-5 you plan the intervention
6 IMPLEMENTATION
 Since behaviour change is voluntary, health promotion is more
likely to be effective if it’s participatory. 7 Process Determine whether the
 Health and other issues must be looked at in the context of the Evaluation intervention is
community. proceeding according to
plan
 Health and other issues are essentially quality-of-life issues.
8 Impact Evaluation  Is the intervention
 Health is itself a constellation of factors that add up to a healthy life having the intended
PROCEED

for individuals & communities. impact on the behavior

and environmental
WHY USE PRECEDE-PROCEED? factors it is aimed at?
 A logic model provides a procedural structure for constructing an  Adjust accordingly
intervention. 9 Outcome  Are the intervention’s
 A logic model provides a framework for critical analysis Evaluation effects producing the
 PRECEDE/PROCEED incorporates a multi-level evaluation. outcome(s) the
community identified in
 One has the chance to constantly monitor and adjust one’s
Phase 1?
evaluation.
 Adjust accordingly
 The model allows leeway to adapt the content and methods of the
intervention to one’s particular needs and circumstances.

1 of 4 [3A Transers]
 PRECEDE-PROCEED MODEL

PHASES OF PRECEDE-PROCEED PHASE 3: BEHAVIORAL AND ENVIRONMENTAL DIAGNOSIS

PHASE 1: SOCIAL DIAGNOSIS Behavioral Diagnosis
 Process of determining people’s perception of needs, quality of life  Systematic analysis of the specific health-related actions that are
aspirations for the common good through broad participation, linked to the identified health problems which most likely affect or
application of multiple information gathering activities designed to could effect a health outcome
expand understanding of the community  Focuses on:
 Guide Questions o Behavioral
o Non-behavioral causes
o Describe the demographic characteristics of a population
whose quality of life you would like to measure.  Personal and environmental factors which seem to be linked to
health problems determined in Phase 2
o Gather information about social problems and perceived
 Behavior of interest may be
quality of life of your target
o Behaviour of the people whose health is in question OR
o List down health problems related to the quality of life o Behavior of those who control resources or rewards
concerns  Community leaders
 QUALITY OF LIFE - Subjectively defined problems and priorities of  Legislators
individuals or communities  Parents
 Social Indicators:  Teachers
o Absenteeism o Hostility  Health professionals
o Achievement o Illegitimacy  Indicators and dimensions
INDICATORS DIMENSIONS
o Aesthetics o Performance
o Compliance o Frequency
o Alienation o Riots o Consumption patterns o Persistence
o Comfort o Self-esteem o Coping o Promptness
o Crime o Unemployment o Preventive actions o Quality
o Crowding o Votes o Self-care o Range
o Discrimination o Welfare o Utilization
o Happiness
Example:
PHASE 2: EPIDEMIOLOGICAL DIAGNOSIS BEHAVIORAL CAUSES OF NEONATAL TETANUS
 Process of pinpointing the important / priority health problems of (-) Preventive Behavior  Non-submission of women
the target population, extent, distribution, and causes 15-44 years old to tetanus
 Guide Questions toxoid immunization
o Which problem has the greatest impact in terms of death,  Submission of infant to
disease, days lost from work, rehabilitation costs, disability, improper
family disorganization, and costs to communities and agencies  umbilical cord cutting
for damage repair or cost recovery? (+) Preventive Behavior  Proper cleaning of infant
o Which problems are the most susceptible to intervention/ navel
most changeable? (-) Treatment Behavior  Non-submission to early
o Which problem has the greater potential for an attractive diagnosis
yield in improved health status, economic savings, and other  and treatment of neonatal
benefits? tetanus
 Non-compliance to
o Which problem is not being addressed by other agencies in
therapeutic
the community?
 regimen
o Are any of the problems highly ranked as a
national/community priority?
Behavioral Assessment
 STEPS
 Step 1: Delineating the Behavioral and Non-behavioral Causes of the
1. Set priorities among prevailing health problems Health Problem
2. Identify risk factors  Step 2: Developing a Classification of Behaviors
3. Develop health objectives o Preventive
 EXAMPLE o Treatment
o To reduce neonatal tetanus to less than one case per 1,000  Step 3: Rating Behaviors in Terms of Importance
live births in all provinces, cities and municipalities by 2006  Step 4: Rating Behaviors’ Changeability
 Health Vital Indicators and Dimensions  Step 5: Choosing Behavioral Targets (objectives)
Vital Indicators Dimensions
Four Categories of Possible Action
o Disability o Distribution
o Discomfort o Duration
o Fertility o Functional level
o Fitness o Incidence
o Morbidity o Intensity
o Mortality o Longevity
o Physiological risk o Prevalence
factors

2 of 4 [3A Transers]
 PRECEDE-PROCEED MODEL

 A well stated objective: PHASE 4: EDUCATIONAL AND ORGANIZATIONAL DIAGNOSIS

SMART RUMBA  Identifies causal factors that must be changed to initiate and sustain
o Specific o Realistic the process of behavioral and environmental change identified in
o Measurable o Understandable Phase 3:
o Attainable o Measurable  Theory is applied in this phase
o Realistic o Behavioral o Predisposing individual factors – individual theories
o Time-bound o Achievable o Enabling factors – interpersonal level theories
o Reinforcing factors – community level and systems
Environmental Diagnosis  Priorities become focus of interventions.
 Systematic assessment of factors in the social and physical
environment that interact with the behavior to produce health
effects or quality of life outcomes
 Can concentrate attention on those aspects of the environment that
are:
o More social than physical ( e.g., organizational and economic)
o Interactive with behavior in their impact on health
o Changeable by social action and health policy
 Environmental or Non-behavioral factors
o Genetic predisposition
o Age
o Gender
o Existing disease
o Workplace
o Adequacy of health facilities
 Environmental factors include:
o Determinants outside the person that can be modified to
support behaviour, health, or quality of life:
 Physical
 Social
 Economic
 Indicators and dimensions
INDICATORS DIMENSIONS FACTOR DEFINITION EXAMPLES
o Economic o Access
 Antecedents to
o Physical o Affordability  Knowledge
behavior that
o Services o Equity
provide the  Beliefs
o Social
Predisposing motivation for the  Attitudes
Example:
Factors behavior; factors  Confidence
 List of Environmental Factors
within the target  Perceived needs
o Lack of TT2 group; and abilities
o Lack of training among TBAs on hygienic practices in cutting
 Impact motivation
umbilical cords
Environmental &
o Inavailability of sterile equipment and supplies needed in
 Antecedents to Personal
cutting umbilical cord
behavior that allow a Resources that
 Environmental Objective
motivation to be impact:
o 100% OF TBAs in the Municipality of Tagumpay will be
realized; · Accessibility
trained on hygienic practice of cutting umbilical cord by the
characteristics of the · Availability
year 2009 Enabling
env’t or skills or · Affordability
Factors
resource required to · Programs and
Environmental Assessment
attain specific Services
 Step 1: List of environmental factors which affect the health problem
behavior · Skills
 Step 2: Identify which Environmental Causes of the Health Problem
 Antecedent · Money and Time
are Changeable · Facilities
barriers & vehicles
 Step 3: Rate Environmental Factors on Relative Importance · Laws
 Step 4: Rate Environmental Factors on Changeability  Factors following a
 Step 5: Choosing the Environmental Targets behavior that Positive or
provide the Negative
Selecting Determinants of Behavioral and Environmental Change continuing reward or Feedback from:
 Identifying and Sorting incentive for the · Peers
 Setting Priorities Among Categories Reinforcing
persistence or · Family
 Establishing Priorities Within Categories Factors
repetition of the · Healthcare workers
o Importance (Prevalence, Immediacy, Necessity) behavior · Law enforcement
o Changeability  Subsequent · Media
 Example objective: feedback and · Others
o By 2005, 90% of women aged 15-44 will be able to: rewards
 State the dangers of neonatal tetanus
 Name the benefits of TT vaccination
 Identify places and days they can avail of TT vaccination
 Express confidence in submitting to TT vaccination

***Sa PPT ni doc, under ito ng Phase 4, pero mukhang misplaced lang

3 of 4 [3A Transers]
 PRECEDE-PROCEED MODEL

SAMPLE VERBS FOR FORMULATING OBJECTIVES PHASE 6: IMPLEMENTATION

Behavioral Non-Behavioral  The act of converting program objectives into actions through policy
 To clarify  To know changes, regulation, and organization (Green & Kreuter, 1991)
 To explain  To have  Setting Priorities Among Categories
 To find  To be familiar with
 To demonstrate  To understand PHASE 7: PROCESS EVALUATION
 To conduct  To be aware of
 The potential object of interest in this type of evaluation include all
 To organize  To appreciate
program inputs, implementation activities, stakeholder reaction
 If the intervention is being implemented
PHASE 5: ADMINISTRATIVE AND POLICY DIAGNOSIS Example:
 Focuses on administrative and organizational concerns which must  Process Evaluation Effects Of STD Educational Efforts
be addressed prior to program implementation
o Provision of accurate education about STDs to all senior high
o Assessment of resources school students by 2003
o Budget development & allocation
o Development of implementation timetable o Identification of and establishment of contact with all high
o Organization and coordination with others risk groups in the community through hotlines and other out-
reach programs
 Determine if capabilities & resources are available to develop &
implement program
 Close to the end of PRECEDE & moving toward PROCEED PHASE 8: IMPACT EVALUATION
 Assesses the immediate effect of the program on target behaviors
Administrative Assessment and their predisposing, enabling and reinforcing antecedents or on
 Analysis of the policies, resources and circumstances prevailing in influential environmental factors
the organizational situation that could facilitate or hinder the Example:
development of the health promotion program  Impact Evaluation Effects Of STD Educational Efforts
 Resources Needed o Percentage of students able to recognize STDs, express
o Time intentions to use preventive measures
o Personnel
o Increase in self referrals and referral of sexual contacts for
o Budget
STD screening and treatment at an earlier stage; increase in
 Available Resources
knowledge and practice of behaviors that decrease risk of STD
 Factors Influencing Implementation
contact.
 Assess the compatibility of the program goals/objectives with those
of the organization and its administration
PHASE 9: OUTCOME EVALUATION
Policy Assessment  Object of interest are those health status and quality of life
 Analysis of policies, regulations and organizations that prevent indicators (mortality, morbidity, unemployment, homelessness)
changes in the enabling factors because they involved legal, Example:
political, or environmental conditions  Outcome Evaluation Effects Of STD Educational Efforts
 Assessment of Organizational Mission, Policies and Regulations o Improve health status: By 2003, reported gonorrhea
 Assessment of Political Forces incidence should be reduced to a rate of 280 cases/100,000
 Assessment of barriers to implementation o By 2003, reported incidence of pelvic inflammatory disease
should be reduced to a rate of 60 cases per 100,000 women
Health Education
For evaluation:
PROCESS IMPLEMENTATION
IMPACT BEHAVIORS
OUTCOME HEALTH STATUS AND QOL

LET’S GO BATCH 2019! 100% PROMOTION! #2019KAKAYANIN

#ROADTOCLERKSHIP

4 of 4 [3A Transers]
 4.07
April 6, 2018
PRECEDE-PROCEED MODEL
Dr. Eufemia Collao
Department of Family and Community Medicine
APPENDIX

Fig 1. PRECEDE-PROCEED MODEL

5 of 4 [3A Transers]