The PRECEDE–PROCEED model is a cost–benefit evaluation framework proposed in 1974 by Lawrence W. Green that can help health program planners, policy makers and other evaluators, analyze situations and design health programs efficiently. It provides a comprehensive structure for assessing health and quality of life needs, and for designing, implementing and evaluating health promotion and other public health programs to meet those needs. One purpose and guiding principle of the PRECEDE–PROCEED model is to direct initial attention to outcomes, rather than inputs. It guides planners through a process that starts with desired outcomes and then works backwards in the causal chain to identify a mix of strategies for achieving those objectives. A fundamental assumption of the model is the active participation of its intended audience — that is, that the participants ("consumers") will take an active part in defining their own problems, has establishing their goals and developing their solutions. In this framework, health behavior is regarded as being influenced by both individual and environmental factors, and hence has two distinct parts. First is an "educational diagnosis" – PRECEDE, an acronym for Predisposing, Reinforcing and Enabling Constructs in Educational Diagnosis and Evaluation. Second is an "ecological diagnosis" – PROCEED, for Policy, Regulatory, and Organizational Constructs in Educational and Environmental Development. The model is multidimensional and is founded in the social/behavioral sciences, epidemiology, administration, and education. The systematic use of the framework in a series of clinical and field trials confirmed the utility and predictive validity of the model as a planning tool.
Brief history and purpose The PRECEDE framework was first developed and introduced in the 1970s by Green and colleagues. PRECEDE is based on the premise that, just as a medical diagnosis precedes a treatment plan, an educational diagnosis of the problem is very essential before developing and implementing the intervention plan. Predisposing factors include knowledge, attitudes, beliefs, personal preferences, existing skills, and self-efficacy towards the desired behavior change. Reinforcing factors include factors that reward or reinforce the desired behavior change, including social support, economic rewards, and changing social norms. Enabling factors are skills or physical factors such as availability and accessibility of resources, or services that facilitate achievement of motivation to change behavior. The model has led to more than 1000 published studies, applications and commentaries on the model in the professional and scientific literature. In the early 1990s the National Center for Chronic Disease Prevention and Health Promotion at the Centers for Disease Control and Prevention (CDC, US Department of Health and Human Services) gave additional national prominence to the PRECEDE model. Dr. Marshall Kreuter, Director of the Division of Chronic Disease Control and Community Intervention and his staff adapted and incorporated PRECEDE within a model planning process offered, with federal technical assistance, to state and local health departments to plan and evaluate health promotion programs (with their coalitions). The CDC model was called PATCH, for Planned Approach to Community Health. The relevance of this initiative to the application of PRECEDE, and the inspiration for some of the extensions of the (PATCH) model to incorporate PROCEED dimensions was detailed in a special issue of the Journal of Health Education in 1992. In 1991, "PROCEED" was added to the framework in consideration of the growing recognition of the expansion of health education to encompass policy, regulatory and related ecological/environmental factors, in determining health and health behaviors. As health-related behaviors, such as smoking and excessive use of alcohol, increased or became more resistant to change, so did the recognition that these behaviors are influenced by factors such as the media, politics, and businesses, which are outside the direct control of the individuals. Hence more "ecological" methods were needed to identify and influence these environmental and social determinants of health behaviors. With the emergence of and rapid growth in the field of genetics, the PRECEDE–PROCEED model was revised, in 2005, to include and address the growing knowledge in this field.
Description The PRECEDE–PROCEED planning model consists of four planning phases, one implementation phase, and three evaluation phases.
Phase 1 – Social diagnosis The first stage in the program planning phase deals with identifying and evaluating the social problems that affect the quality of life of a population of interest. Social assessment is the "application, through broad participation, of multiple sources of information, both objective and subjective, designed to expand the mutual understanding of people regarding their aspirations for the common good". During this stage, the program planners try to gain an understanding of the social problems that affect the quality of life of the community and its members, their strengths, weaknesses, and resources; and their readiness to change. This is done through various activities such as developing a planning committee, holding community forums, and conducting focus groups, surveys, and/or interviews. These activities will engage the beneficiaries in the planning process and planners will be able to see the issues just as the community sees them.
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