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The Precede-Proceed Model            The Precede-Proceed model is a model of behavior change that is commonly used in health promotions projects (Green and Krueter, 1999).

The model was developed by Lawrence Green & Marshall Kreuter and is now “widely accepted as the ‘gold standard’ for designing, implementing and evaluating micro and macro level preventive interventions, the goal of which is to systematically reduce the occurrence of conditions that compromise well-being” (Myers, 2003).            For decades, practitioners in various professions have struggled to organize their planning, delivery and evaluation of health or educational programs. In order to address this problem, the Precede model was created. The Precede-Proceed model that is known today started only as a single Precede model. The Precede model was developed around 1968 to 1974 while Proceed was only added in the late 1980’s. The Precede is a model for the process of systematic development and evaluation of health education programs. An appropriate health education is considered to be the intervention (treatment) for a properly diagnosed problem in a target population. It considered a multidimensional model that is founded in the behavioral/social sciences, epidemiology, administration and education (Green and Krueter, 1991).

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In the late 1980s, the Proceed was added to the model. It was founded on L. Green’s experience with Marshall Krueter in various positions with the Kaiser Family Foundation and the federal government. It was added to the framework in acknowledgment of the growing need for health promotion interventions that go beyond traditional educational approaches to changing detrimental behaviors. The main purpose of the Precede-Proceed model is to focus primary attention to results rather than inputs (Green and Krueter, 1991).

            PRECEDE is an acronym for Predisposing, Reinforcing, Enabling, Causes in, Educational Diagnosis and Evaluation. This stage is divided into 5 phases:Phase 1 – Social DiagnosisPhase 2 – Epidemiological DiagnosisPhase 3 – Behavioral ; Environmental DiagnosisPhase 4 – Education ; Organizational DiagnosisPhase 5 – Administrative ; Policy DiagnosisThe first phase focuses on the assessment of social problems which affect the quality of life in a community. In the second phase, an examination of the health issues that affect the quality of life   is conducted. Then in phase 3, health practices related to behavior and the lifestyle are examined.

   Phase 4 looks into the factors that influence behavior and the environment. Finally,  phase 5  identifies the administrative and organizational concerns which must be addressed prior to program implementation are examined (Green and Krueter, 1991).            The Proceed is the second stage of the model.

PROCEED is an acronym for Policy, Regulatory, Organizational Constructs in Educational and Environmental Development. It is divided into 4 phases:Phase 6 – ImplementationPhase 7 – Process EvaluationPhase 8 – Impact EvaluationPhase 9 – Outcome Evaluation            Among the important concepts within the model are two principles on which the whole planning process is grounded. The first principle is the principle of participation. It states that  “success in achieving change is enhanced by the active participation of members of the target audience in defining their own high-priority problems and goals and in developing and implementing solutions” ( Green and Krueter, 1991).

The second principle is about the importance of environmental factors as determinants of health and health behavior such as industry, media, social inequities and politics (Green and Krueter, 1991).            There are 3 concepts that are defined under the phase 4 of the Precede stage. These concepts classifies the factors that affect behavior (Green and Krueter, 1991).Predisposing Factors – any characteristics of a person or population that motivates behavior prior to the occurrence of that behavior.

These are knowledge, attitudes, beliefs, and values.Enablers – characteristic of the environment that facilitate action and any skill or resource required to attain specific behavior. These are accessibility, availability, skills, and laws.

Reinforces – rewards or punishments following or anticipated as a consequence of a behavior. They serve to strengthen the motivation for behavior. These are family, friends, colleagues and teachers.

The Precede-Proceed model is parallel and essential to the nursing process. This can be observed in a study conducted by Florence Parent, Gérard Kahombo, Josué Bapitani, et al. regarding the level of training of secondary-level nurses in the Democratic Republic of the Congo (DRC). They have discovered that “a systemic approach that is based on the Precede-Proceed model of analysis, led to a better understanding of the educational determinants and of the factors favorable to a better match between training in health sciences and the expected competences of the health professionals” (Parent, et al., 2004).            The model has been applied to various health care domains.

It is related to Partnership’s work because its primary theme is that health programs must be community-based in order to be effective (Jandorf, et al., 2006). The model encourages and facilitates a more comprehensive and systematic planning of public health programs. The model is used to design health programs in a certain community. A component of the model that usually applied to community health care the administration of surveys to a target population. It is utilized to assess the demographic characteristics of a community.

This is can be applied in cancer prevention and detection programs. The Precede-Proceed model is also used to evaluate project outcomes or long-term effects of an intervention.  The categories covered in this type of evaluation are quality-of-life indicators, health status, morbidity, mortality, and social indicators (Gahimer, 1999).

A health program’s long-term impact on the community can be evaluated so that necessary changes can be made in the future.            “The health and well-being of a community are affected by the social milieu within which people live. Thus, with community partnership, the focus of interventions is shifting from individuals to people” (Abdullatif, 2000). It is an approach that addresses the social factors such as poverty, inequality and discrimination and their relationship to the overall well-being of the community. It aims to understand how society and different forms of social organization influence health and well-being. The community partnership is a “learning by doing” process since individuals, communities and sectors such as the health sector learn how to evaluate real life situations together. Each component of the partnership learns how to recognize their individual needs and problems, and then they work together to solve them (Abdullatif, 2000). “The process brings confidence in tackling further problems, whether acute or chronic.

Sectors learn how to work closely with communities and ‘people’, to take part in true dialogue which then translates into sustainable action” (Abdullatif, 2000).ReferencesGreen, L. ; Kreuter, M. (1991). Health Promotion Planning.

2nd Edition. Mountain View:             Mayfield Publishing Co.Green, L. W. and M.W. Krueter (1999). Health Promotion Planning: An Educational and   Ecological Approach, 3rd Edition.

Mountain View: Mayfield Publishing Company.Myers, V.L. (2003).

Planning and Evaluating Faith-based Interventions: A Framework to Close     the Theory-Practice Divide. Retrieved December 18, 2007 from Religion and Social             Policy Database.Prent, F., Kahombo, G., Bapitani, J., Garant, M., Coppieters, Y.

, Leveque, A., et al. (2004). A      model for analysis, systemic planning and strategic synthesis for health science teaching     in the Democratic Republic of the Congo: a vision for action. Retrieved December 18,    2007 from Human Resources for health Database.

Jandorf, L., Fatone, A., Borker, P.V., Levin, M., Esmond, W., Brenner, B.

, et al. (2006). Creating             Alliances to Improve Cancer Preventionand Detection Among Urban Medically    UnderservedMinority Groups. Supplement to Cancer, 107, 2043-2051.Gahimer, J. ; Morris, D.M.

(1999). Community health education: evolving opportunities for             physical therapists. Physical Therapy Education. Retrieved December 18, 2007 from    Database.Abdullatif, A. (2000).

Partnership of the community in support of health for all. Eastern           Mediterranean Health Journal, 6, 775-787.

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