health behavior
rah1234sPRECEDE-PROCEED
Health Behavior
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Overview
PRECEDE
Developed by Green et al 1970s
Predisposing, reinforcing and enabling constructs in educational/environmental diagnosis and evaluation
Educational diagnosis should precede a intervention plan
Counter emphasis on implementation without proper planning
PROCEED
Developed in 1991
Policy, regulatory, and organizational constructs in educational and environmental development
Recognize environmental factors impact on health
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PRECEDE-PROCEED Planning Model
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Step1: Social Assessment
People have come together and have a “shared vision”
Felt needs are identified
A specific health problem has been identified and some preliminary measurable health objective has been stated.
Some activities have commenced to initiate a needs assessment and learning about the problem.
Focus groups
Key informant interviews
These activities help to clarify the first phase in the model and move the group into the second phase.
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Step 2: Epidemiological Assessment
Data
Often secondary sources
Collection
Sources
Comparisons
Set priorities and prepare to write goals and objectives
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Step 3: Behavioral and Environmental Assessment
List all possible risk factors associated with the problem. This should incorporate a thorough literature review.
Break into two lists - one titled behavioral with the other titled environmental.
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Step 3 (con’t)
Identify criteria to shorten the list. Talk with experts and community personnel to determine which ones to eliminate
Determine prevalence of the behavior or how frequently the environmental factor is involved.
Determine if there is sufficient evidence whether the factor contributes to the problem
Each factor should be classified as important or not as important
Determine changeability.
Group process in conjunction with literature review should allow classification of low or high likelihood of change.
Create an importance and changeability matrix.
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Step 3 cont.
Set objectives on the important and changeable factors.
Who is expected to change?
What is expected to change?
How much will change?
When will it change?
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Step 4: Educational and Ecological Assessment
Predisposing Factors
cognitive and affective attributes
knowledge, self-efficacy, locus of control, attitudes, beliefs, perceptions
these provide a rationale or motivation to perform a given behavior
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Step 4 cont
Reinforcing Factors
Social support and the role it plays in rewarding or supporting a given behavior
Parents, family members, co-workers, peers, friends, health care providers, supervisors, can also include influential media.
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Step 4 cont.
Enabling Factors
Factors that assist in promoting the chosen action.
Educational resources, supportive policies, changes, skill development environmental
“At the end of this phase, there should be specific objectives stated for each of the three factors”
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Step 5: Administrative and Policy Assessment
Step One
Plan for time utilization and personnel needs.
Gantt Charts should be used to outline both areas.
Step Two
Assessment of Available Resources
Material needs (educational, computer, paper, curriculum etc), building needs, training or re-training of personnel. Etc.
Step Three
Identification of barriers. Financial, goal conflict, amount of change necessary, group and staff commitment etc.
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Policy Diagnosis
Step One
Assess policies, regulations, organization
Determine - loyalty of personnel
are your goals consistent within the organization?
do you have the flexibility to do new things?
is there flexibility for the administrators to determine policy implementation?
Step Two
Assessment of politics
Who within the organization and outside of the organization want this to succeed?
A plan for maximizing involvement of those who can help.
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Steps 6-9: Implementation and Evaluation
Step 6; Implementation
Programs are like a child, it needs room to breathe, to experiment, to adapt to new circumstances and people“
Checklists - process evaluation begins.
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Step 7; Process Evaluation
Are you doing what you said that you would do?
Are you following the Gantt charts as set out in the original document?
If there are changes, how have these been documented?
Methods - interviews, focus groups, paper trail. Discussions center on predisposing, reinforcing, and enabling factors.
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Step 8; Impact Evaluation
There should be measurable changes as set out by the objectives derived in phase 3. Planning should have defined how these changes would be measured. Generally, paper and pencil measures, measures of observation, records etc.
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Step 9; Outcome Evaluation
Are you achieving the program’s goals? Is there a reduction in CVD, perhaps a type of cancer, STD’s, illegal use of substances etc. Etc.
Usually done by examining the bottom line after a few years of programming.
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