PRECEDE–PROCEED model
The PRECEDE–PROCEED model is a comprehensive framework used by healthcare professionals to design, implement, and evaluate public health programs. Developed by Lawrence W. Green and his colleagues in the 1970s and refined in the 1980s, this model emphasizes understanding community health issues before devising solutions. PRECEDE stands for Predisposing, Reinforcing, and Enabling Constructs in Educational Diagnosis and Evaluation, focusing on assessing the factors contributing to health problems, such as social circumstances and epidemiological data.
In contrast, PROCEED—Policy, Regulatory, and Organizational Constructs in Educational and Environmental Development—concerns the implementation and evaluation of health initiatives. The model encourages community participation, recognizing that involving those affected enhances program cooperation and effectiveness. Additionally, it acknowledges the importance of environmental influences on health behaviors. Ultimately, the model aims to facilitate positive health changes through ethically designed programs that respect individual choice, ensuring that interventions promote well-being without coercive measures. The PRECEDE–PROCEED model serves as a valuable tool for addressing public health challenges in diverse communities.
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PRECEDE–PROCEED model
The PRECEDE-PROCEED model is a strategy used by healthcare professionals to form, implement, and evaluate a plan for public health programs. The words are an acronym built from the first letters of the words in the purpose of each part of the process. The model helps guide healthcare professionals in developing programs that are ethical, practical, and successful. It allows health professionals to create initiatives that involve individuals in making improvements in their own health while achieving larger goals for the health of the overall community.
Background
The model originated in the work of American public health specialist Lawrence W. Green in the 1960s and 1970s. Working with a number of colleagues in the health field, Green developed the idea of "diagnosing" problems in public health. Just as physicians diagnose a patient before developing a treatment plan, Green suggested that medical professionals should examine a community health problem and determine its cause before developing a solution. In 1974, he proposed the PRECEDE model. The name was taken from the first letter of the purpose of the process: Predisposing, Reinforcing, and Enabling Constructs in Educational Diagnosis and Evaluation.
During the 1980s, Green and several colleagues continued to work to refine the model. Toward the end of the decade, Green and his colleague Marshall Kreuter introduced a revised version, the PRECEDE-PROCEED model. PROCEED stood for Policy, Regulatory, and Organizational Constructs in Educational and Environmental Development. The new model was based on the researchers' combined experience with federal health programs and those in large health organizations such as the Kaiser Family Foundation. The model was further refined without changing the name in 2005 and again in 2022 to address new developments in healthcare. The 2022 edition included three new authors—Andrea Gielen, Judith Ottoson, and Darleen Peterson—with new chapters concerning public health planning, health implementation, and evaluation changes.
Overview
Green, Kreuter, and their colleagues developed the model as a way to guide those developing public health plans. Their aim was to help community health planners focus on the goal as they worked through the process to uncover the causes of the problem and what is needed to overcome it. The model helps the planners consider all the potential elements between determining what the problem is and the intended outcome once it is solved.
There are two key principles involved in the model. The first is the principle of participation. Green and his colleagues believed it was important that those who were supposed to be helped by whatever program was being developed were involved in the process. This idea was borrowed from social and educational sciences, and is considered important for getting cooperation from those expected to benefit from the new program. The second principle is taking into account the role environmental factors, such as social circumstances, inequities, politics, and media, play in the health of a community.
The PRECEDE portion of the model deals with assessing the community factors that led to the problem the planners are trying to resolve. The factors include social assessment, epidemiological assessment, ecological assessment, appropriate interventions to achieve the outcome, and implementation of these interventions. The planners assess the social problems facing the people affected by the problem and determine what would be needed to fix those social issues. They identify the epidemiological factors, such as the prevalence of a disease, how widespread it is, and how to control it. They then determine what results they want in relation to these factors. They also determine what in the environment is contributing to the health issue and what could be done to correct or change these factors. In the original model, implementation was the final step.
The PROCEED portion of the model was added later. It is focused on identifying what planners want to happen, implementing the program, and then determining if it has had the desired effect. Factors considered in this portion of the model include implementation, process evaluation, impact evaluation, and outcome evaluation. Those responsible for the program determine a process to be followed and what resources will be needed. After the program is launched, the planners monitor its success. They look at whether the program is actually reaching the people it was intended to help and if the outcomes are what they expected. They look to see if people have changed their health behaviors as a result of the program, and they look for a related increase in a desirable behavior or decrease in an undesirable behavior.
For example, a group of health professionals have determined that childhood obesity is an increasing problem in their area. Using the PRECEDE-PROCEED model, they determine that their ultimate goal is to see a decreasing trend in the number of children who were obese in a twelve-month period. Having identified the problem and the intended outcome, the planners now set about determining what is needed to achieve that goal.
Knowing that the program will be more successful if they engage the participants, they talk to the children and their parents and discover that several important factors affect the children's weight. They discover that a lack of access to fresh foods, a lack of safe outdoor playing spaces, and low incomes mean that children are eating too many unhealthy foods and not getting enough exercise. The solution the planners come up with includes arranging for fresh fruit and vegetables to be distributed to the children in school to take home. Health officials arrange cooking lessons to expose the children and their parents to these "new" foods. The group also arranges to reclaim some vacant lots, one to be a community garden for the people to grow produce and one to create a new play space. For several months, the researchers observe and record how many people participate in each activity. After a year, they compare the children's weight and determine if the goal has been reached.
Although medical professionals and community health officials may implement the PRECEDE-PROCEED model, it is acknowledged that any changes in health must be entered into voluntarily by the participants. The process, therefore, includes and addresses the moral and ethical issues of forcing health changes on people. While programs can be designed and implemented to encourage health, it is only used to force health changes in situations in which the common good requires overriding the individual's right to choose their own health behaviors. For instance, in the childhood obesity example above, the program designers would create opportunities for parents to give fresh food to their children and a place for them to play, but would not impose consequences on those who do not participate fully or choose not to participate at all.
Bibliography
Kreuter, Marshall W., et al. Community Health Promotion Ideas That Work. Jones & Bartlett Publishers, 2003.
Mohamed, Rabeaa Abd Rabo, and Samia E. Khaton. "The Effect of an Educational Intervention Based on the PRECEDE-PROCEED Model on Knowledge, Behaviors and Attitudes of Adolescent Students Regarding Drug Abuse and Addiction." IOSR Journal of Nursing and Health Science, vol. 6, no. 4, July–Aug. 2017, pp. 14–27.
"Phases and Methods of the PRECEDE-PROCEED Model." Health Behavior and Health Education, www.med.upenn.edu/hbhe4/part5-ch18-phases-and-methods.shtml. Accessed 23 Dec. 2024.
Phillips, Jane L., et al. "Developing Targeted Health Service Interventions Using the PRECEDE-PROCEED Model: Two Australian Case Studies." Nursing and Research in Practice, 17 July 2012, doi.org/10.1155/2012/279431. Accessed 23 Dec. 2024.
Porter, Christine M. “Revisiting Precede–Proceed: A Leading Model for Ecological and Ethical Health Promotion.” Health Education Journal, vol. 75, no. 6, 2016, pp. 753–64, doi.org/10.1177/0017896915619645. Accessed 23 Dec. 2024.
"Precede/Proceed." Community Toolbox, University of Kansas, ctb.ku.edu/en/table-contents/overview/other-models-promoting-community-health-and-development/preceder-proceder/main. Accessed 23 Dec. 2024.
"The PRECEDE-PROCEED Model Origins and Evolution." Lawrence Green, www.lgreen.net/precede-proceed. Accessed 23 Dec. 2024.
"The PRECEDE-PROCEED Model 2022 Edition." Lawrence Green, www.lgreen.net/precede-proceed-2022-edition. Accessed 23 Dec. 2024.
"PRECEDE/PROCEED." Rural Health Information Hub, www.ruralhealthinfo.org/community-health/health-promotion/2/program-models/precede-proceed. Accessed 23 Dec. 2024.