How does the Precede-Proceed Model provide a structure for assessing health and quality-of-life needs?

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Karyth Cara eNotes educator| Certified Educator

The Precede-Proceed model of health planning and evaluation, developed for the public health sector by a prestigious team led by Lawrence W. Green, is a model that is aimed at preventing disease thereby increasing an individual's overall health and quality of life (QOL) and that incorporates social, cultural and individual factors that affect the outcome of a person's overall health and incidence of disease.

[T]wo fundamental propositions are emphasized: (1) health and health risks are caused by multiple factors and (2) because health and health risks are determined by multiple factors, efforts to effect behavioral, environmental, and social change must be multidimensional or multisectoral, and participatory. (Lawrence W. Green, "The Precede-Proceed Model of Health Program Planning & Evaluation")

The Precede-Proceed model provides a structure for assessing health and quality-of-life needs by "designing, implementing, and evaluating health promotion and other public health programs to meet those needs" (Green, Encyclopedia of Public Health, Gale). "PRECEDE" is actually an acronym that stands for Predisposing, Reinforcing, and Enabling Constructs in Educational Diagnosis and Evaluation. Diagnosis and evaluation are incorporated functions within Precede; it outlines a means for accurately diagnosing and planning (diagnostic planning) a process to be used to development a targeted and focused public health program for a targeted community.

"PROCEED" is also an acronym for Policy, Regulatory, and Organizational Constructs in Educational and Environmental Development. The social and cultural features of education and environment are incorporated functions within Proceed; it facilitates the programs designed as a result of the Precede process by guiding the implementation and evaluation of those Precede programs. While Precede works backward from the desired end result, attained through the diagnostic process, to the beginning point (the point(s) that preceded the end result) of the assessment process, Proceed works forward to implement the designed plan and to evaluate its effectiveness.

PRECEDE’s five phases move logically backward from the desired result to where and how you might intervene to bring about that result, to the administrative and policy issues that need addressing in order to mount an intervention successfully.

PROCEED has four phases that cover the actual implementation of the intervention and the careful evaluation of it, working forward to the original starting point, which is the ultimate desired result of the process. (University of Kansas, Community Tool Box, "Other Models for Promoting Community Health and Development" Sec 2)

Precede's five phase or steps:

  • Phase one requires determining the health and quality of life ["self-reported measures of physical and mental health" (Center for Disease Control and Prevention)] needs, the social problems, and/or the cultural needs of a given population.
  • Phase two requires identifying all determinants of health [the internal or external factors that "affect the health of individuals and communities" (World Health Organization)] of these problems and needs.
  • Determinants of Health.
    • Biology and genetics. Examples: sex and age (internal)
    • Individual behavior. Examples: alcohol use, injection drug use (needles), unprotected sex, and smoking (internal)
    • Social environment. Examples:  discrimination, income, and gender (external)
    • Physical environment. Examples: where a person lives and crowding conditions (external)
    • Health services. Examples: Access to quality health care and having or not having health insurance (external) (Center for Disease Control and Prevention)
  • Phase three requires analyzing the determinants of health for the behavioral determinants (internal factors of behavioral choices) and environmental determinants (external factors of local environment) of the health problems (quality of life is defined as physical and mental health).
  • Phase four requires identifying the individual determining factors that predispose to, reinforce, and enable behaviors and lifestyles (i.e., choice within environments).
  • Phase five ascertains interventions--health promotion intervention, health education intervention and/or policy-related intervention--best suited to encouraging needed changes (1) in behaviors or environments and (2) in factors supporting the behaviors and environments (behavioral reactions to environments result in lifestyles).

Proceed's additional four phases or steps:

  • Phase six implements (puts into effect) the interventions identified in phase five.
  • Phase seven requires process evaluation of the implemented interventions.
  • Phase eight involves the impact of (the effect produced by) the interventions: impact evaluation requires evaluating the impact of the interventions on (1) the identified factors that support behavior and on (2) the behavior itself (evaluating the impact of intervention on both external behavioral support factors and internal choice-related behavior).
  • Phase nine, the last phase, comprises desired-results outcome evaluation, that is, phase nine determines the end-result effects of the interventions on the quality of life, i.e., health, and socio-cultural support factors of the population or community.

In actual practice, Precede and Proceed function in a continuous cycle. (1) Information gathered in Precede guides the development of program goals and objectives used in the implementation phase of Proceed. (2) This same information provides the criteria against which the success of the program is measured in the evaluation phase of Proceed. (3) The data gathered in the implementation and evaluation phases of Proceed clarify the relationships examined in Precede between the health or quality-of-life outcomes, the behaviors and environments that influence them, and the factors that result in the desired behavioral and environmental changes. (4) These data then suggest how programs may be modified to more closely reach their goals and targets (Green).

The cyclical mature of this model encourages more systematic and comprehensive planning of public health programs so that the programs match what the community identifies as its needs with the result that programs are participated in with goals and objectives more often reached. This model encourages recognition of differing goals, priorities and values in different communities of populations. As a result the real-world applications of the Precede-Proceed model have been myriad and varied. The model has been used to plan, design, implement, and/or evaluate programs for such diverse health and quality-of-life issues as breast, cervical, and prostate cancer screening; breast self-examination; cancer education; heart health; maternal and child health; injury prevention; weight control; increasing physical activity; tobacco control; alcohol and drug abuse; school-based nutrition; health education policy; and curriculum development and training for health care professionals (Green).

Source: Lawrence W. Green and Shawna L. Mercer. "Precede-Proceed Model." Encyclopedia of Public Health. Ed. Lester Breslow. Vol. 3. Gale Cengage, 2002.

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M.P. Ossa eNotes educator| Certified Educator

Precede-Proceed is a model for health planning, education, containment, and solutions that has been followed for over 40 years. It was proposed by Dr. Lawrence W. Green along with the US Public Health Service (USPHS) and other epidemiologists and experts in the field of health. In the beginning, the model was only called "Precede" and it was intended, like the name entails, to identify, predict, and prevent disease particularly those that are associated to specific living areas, conditions, preponderance, and other factors that are controllable if we get to understand them better.

Proceed was created to make the Precede model more universal, and to gather even wider range of environmental factors that abide by policies, specific community needs, and even international laws. Precede-Proceed is actually one of the most widely-taught models of preventive health at the world-wide level. This goes to show how influential and well-respected the methodology behind the model is.

The way in which the model provides a structure for assessing health and quality-of-life needs is by concisely explaining to the general public the exact behaviors and conditions that influence health. This follows the basic tenets of epidemiology, which are a) society and behavior,  b) education, and c) health administration. The idea is simple: since being healthy and being unhealthy are both conditions provoked by multiple environmental and genetic factors, all the efforts put forward to prevent and end disease should tap on these areas.

Precede-proceed first and foremost educates. Through the EMPOWER CD published by Jones and Bartlett, the basics of pandemics and epidemics are correlated to living conditions, behaviors, and available services.

The specific way in that it provides the structure is by phasing diagnoses and by carefully taking details of each and every area that is affected or potentially affected by diseases. The phases are:

  • Social - living conditions, support systems, and expansion of potential disease
  • Epidemiological- incidence of disease, tendency for pandemics
  • Behavioral/Environmental- what goes on where and why. How are behaviors affecting the environment and vice versa?
  • Educational/Organizational- what is being done at a community-national-international level to prevent  or cure. Are there plans put into place? Is there an emergency protocol?
  • Administrative/Policy-How is policy enforced? What happens when it is not enforced? What are rules and regulations put in place to prevent and control diseases? How is the public being educated overall?

Therefore, these pointers help society greatly by preparing the ground to avoid sudden onsets of disease in all kinds of community.