PRECEDEPROCEED: - PowerPoint PPT Presentation

Title: PRECEDEPROCEED:


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PRECEDE/PROCEED

• Comprehensive Planning Model
• Green Kreuter

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Objectives

• Describe how the use of the PRECEDE model
  improves the planners ability to tailor health
  education programs to community-specific needs.
• Identify four benefits community partnerships
  contributes to health education programs

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Source http//www.lgreen.net/precede.htm
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Factors That Affect the Health of a Community
Physical Factors
Social/Cultural factors
Health of The Community
Community organization
Individual behaviors
Source McKenzie, Pinger, Kotecki (2006)
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Knights of the Round Table for Community
Assessment Capacities

• Tribal council
• Elders
• Law Enforcement
• Health Care providers
• Educator
• Politicians
• Leaders of activist groups
• Business leaders
• Clergy
• Chamber of Commerce members
• Health service organizations

Gatekeepers Formal Informal
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How do we approach a community?
What you see is not what you get!
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Culture
Past - Present Culture changes everyday
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Navigational Tool?
Cultural Competency
Who's more diverse?
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Diversity
External Internal
Gender
Race
region of origin
SES
Color
Ethnicity
politics
Ability
language
resident status
sexual orientation
Class
Experience
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What is it that I need to get to?
Communities are Social Networks

• People have come together and have a shared
  vision.
• 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.
• These activities help to clarify the first phase
  in the model and move the group into the second
  phase.

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Step 1 Social Assessment
Quality of Life Subjectively defined problems of
individuals or communities

• Illegitimacy
• Welfare
• Unemployment
• Absenteeism
• Crowding

• Alienation
• Hostility
• Discrimination
• Riots
• Crime

Health
Photovoice
Quality of Life
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PhotoVoice

• Take photos of community as they perceive it
• Select most significant photos
• Explain meaning of selected photos
• Themes, issues, or theories emerge and are
  identified

• Community Partnerships
• Cannot exist without relationships
• Complements and supports community

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Step 2 Epidemiological Assessment
(Core functions of public health)

• Monitors trends and changes
• Provides basis for setting program priorities
• Limited by budget, time, and resources
• Background of team players

Relevant Data

• Vital Indicators
• Morbidity
• Mortality
• Fertility
• Disability
• Dimensions
• Incidence
• Prevalence
• Distribution
• Intensity
• Duration

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Nominal Group Process for Community

• List three items of highest priority on an index
  card
• Collect cards and ensure anonymity
• Add rankings on a flip chart

• 1 ranking 3 points
• 2 ranking 2 points
• 3 ranking 1 point

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Goals Objectives

• Whose health is the focus of the program?
• What health benefit will be achieved?
• How much of that benefit is to be achieved?
• When will it be achieved?

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Step 3 Behavioral Environmental Assessment

• Step 1
• List all possible risk factors associated with
  the problem.
• Conduct a thorough literature review.

• Step 2
• Two columns
• 1) behavioral factors personal actions and
  behaviors of others
• 2) environmental factors physical and social
  (income, location, insurance, access to health
  care)

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Step 3 Behavioral Environmental Assessment
Winnowing Down

• Step 3
• Identify criteria to shorten the list. Talk with
  experts and community personnel to determine
  which to eliminate. (Important and Changeable)
• Step 4
• Determine prevalence of the behavior or how
  frequently the environmental factor is involved.
  (Data to support)

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Step 3 Behavioral Environmental Assessment

• Determine if there is sufficient evidence whether
  the factor contributes to the problem.
• Each factor should be classified as important or
  not as important
• Step 5
• Determine changeability.
• Group process in conjunction with literature
  review should allow classification of low or high
  likelihood of change.

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Step 3 Behavioral Environmental Assessment

• Step 6
• Create an importance and changeability matrix.

Importance
X
Low
High
Changeability
X
High
Low
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Changeability Matrix
More Important
Less Important
More Changeable
Less Change able
Behavioral Objectives created from Quads 1 and 2
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Step 3 Behavioral Environmental Assessment

• Step 7
• Set SMART 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 Ecological Assessment
Factors from Behavioral and Environmental
conditions can be grouped into 3 types of risk
factors

• Predisposing Risk 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 Educational Ecological Assessment

• Reinforcing Risk Factors
• Actions by others that reward or deter a given
  behavior.
• 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 Educational Ecological Assessment

• Enabling Factors
• Conditions of the environment that facilitate
  actions.
• (Factors that assist in promoting the chosen
  action.)
• Educational resources, supportive policies,
  changes, skill development, environmental

• At the end of this phase, SMART objectives should
  be written 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
• Step Three
• Identification of barriers. Financial, goal
  conflict, amount of change necessary, group and
  staff commitment

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Step 5 Administrative and Policy Assessment

• 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?

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Step 5 Administrative and Policy Assessment

• 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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Summary of PRECEDE

• Enables program planners and communities to find
  common ground
• Social assessment
• Understanding of perceived needs
• Epidemiological, behavioral and educational
  assessments
• Documents actual needs
• Starting points are where these needs intersect

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Summary of PRECEDE

• Administrative and policy assessments
• Defines parameters an intervention can operate

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Four benefits

• Provides structure to identify desired outcomes
• Evaluation built into planning process
• Promotes development of tailored change
  strategies
• Helps communities to identify the most important
  issues and the most changeable

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PROCEED EvaluationFirst, Throughout, Last,
Recycling

• Process
• Did the program get implemented as planned?
• Impact
• Measures short-term effect on target populations
  (knowledge, skills, behavior)
• Outcome
• Measures of health or quality of life

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References

• Glanz, K., Rimer, B. Lewis, F. (2002). Health
  behavior and health education Theory, research,
  and practice (3rd ed.) San Francisco
  Jossey-Bass.
• McKenzie, J.F., Pingers, R.R., Kotecki, J.
  (2006). An introduction to community health (5th
  ed.) Boston Jones and Bartlett.
• Precede/Proceed Retrieved March 18, 2007 from
  http//www.lgreen.net/precede.htm