Health Promotion Planning:

PRECEDE PROCEED Model

 Green and Kreuter (1980, 1991)

P redisposing P olicy
R einforcing and R egulatory and
E nabling O rganizational
C onstructs in C onstructs in
E ducational E ducational and
D iagnosis and E nvironmental
E valuation D evelopment
 PRECEDE

Based on the premise that an educational diagnosis

should precede an intervention plan

Criticism: too focused on implementation and too little

on designing interventions to strategically meet the
needs
 PROCEED

Added in 1991 to address the environmental factors as

determinants to health and health behavior

Lifestyle (Environment) – recognition of impact,

behaviors are sometimes influenced outside the
individual
 Other developments

 In 2005, the model was revised to reflect the

growing interest in ecological and participatory
approaches

 Recognition of genetic factors

 New version

 Streamlined, more efficient model

 Merges two phases: epidemiological assessment and

the behavioral + environmental assessment

 What has stayed is the fundamental principle of

partcipation
PRECEDE
Phase 5 Phase 4 Phase 3 Phase 2 Phase 1
Administrative Educational and Behavioral and Epidemiological Social
and Policy Ecological Environmental Assessment Assessment
Assessment Assessment Assessment

Predisposing
Factors
HEALTH
PROMOTION
Health Reinforcing Behavior
Education Factors and Lifestyle

Health Quality
Policy of Life
Regulation Enabling
Factors Environment
Organization

Phase 6 Phase 7 Phase 8 Phase 9

Implementation Process Impact Outcome
Evaluation Evaluation Evaluation
PROCEED Green and Kreuter, 1991
Lgreen.net
Source: Community Toolbox, University of Kansas
PRECEDE
Phase 5 Phase 4 Phase 3 Phase 2 Phase 1
Administrative Educational and Behavioral and Epidemiological Social
and Policy Ecological Environmental Assessment Assessment
Assessment Assessment Assessment

Predisposing
Factors
HEALTH
PROMOTION
Health Reinforcing Behavior
Education Factors and Lifestyle

Health Quality
Policy of life
Regulation Enabling
Factors Environment
Organization

Phase 6 Phase 7 Phase 8 Phase 9

Implementation Process Impact Outcome
Evaluation Evaluation Evaluation
PROCEED Green and Kreuter, 1991
 SOCIAL ASSESSMENT

 Assessment in both objective and subjective terms

of high-priority problems or aspirations for the
common good, defined for a population by
economic and social indicators and by individuals in
terms of their quality of life

 Defining the ultimate outcome

 Guide Questions

 Describe the demographic characteristics of a

population whose quality of life you would like to
measure

 Gather information about social problems and

perceived quality of life of your target
 Quality of Life
Subjectively defined problems and
priorities of individuals or communities

Social Indicators:
Absenteeism Happiness
Achievement Hostility
Aesthetics Illegitimacy
Alienation Performance
Comfort Riots
Crime Self-esteem
Crowding Unemployment
Discrimination Votes
Welfare
PRECEDE
Phase 5 Phase 4 Phase 3 Phase 2 Phase 1
Administrative Educational and Behavioral and Epidemiological Social
and Policy Ecological Environmental Assessment Assessment
Assessment Assessment Assessment

Predisposing
Factors
HEALTH
PROMOTION
Health Reinforcing Behavior
Education Factors and Lifestyle

Quality
Policy Health of Life
Regulation Enabling
Factors Environment
Organization

Phase 6 Phase 7 Phase 8 Phase 9

Implementation Process Impact Outcome
Evaluation Evaluation Evaluation
PROCEED Green and Kreuter, 1991
 EPIDEMIOLOGICAL
ASSESSMENT

 Delineation of the extent, distribution, and causes of

a health problem in a defined population
 Guide Questions

 Which problem has the greatest impact in

terms of death, disease, disability etc?
 Which problems are the most susceptible to
intervention?
 Which problem is not being addressed by
other agencies in the community?
 Which problem, when appropriately
addressed, has the greatest potential yield?
 Are any of the problems highly ranked as a
national/community priority?
 Health

Vital Indicators:
Disability
Discomfort
Fertility
Fitness
Morbidity
Mortality
Physiological risk factors
 Health

Vital Indicators: Dimensions:

Disability Distribution
Discomfort Duration
Fertility Functional level
Fitness Incidence
Morbidity Intensity
Mortality Longevity
Physiological risk factors Prevalence
 Steps

 1. Set priorities among prevailing health problems

 2. Identify risk factors

 3. Develop health objectives

 Health Status Objective
To reduce neonatal tetanus to less than one case per
1,000 livebirths in all provinces, cities and municipalities by
2020
PRECEDE
Phase 5 Phase 4 Phase 3 Phase 2 Phase 1
Administrative Educational and Behavioral and Epidemiological Social
and Policy Ecological Environmental Assessment Assessment
Assessment Assessment Assessment

Predisposing
Factors
HEALTH
PROMOTION
Health Reinforcing Behavior
Education Factors and
Lifestyle
Quality
Policy Health of Life
Regulation Enabling
Factors Environment
Organization

Phase 6 Phase 7 Phase 8 Phase 9

Implementation Process Impact Outcome
Evaluation Evaluation Evaluation
PROCEED Green and Kreuter, 1991
BEHAVIORAL ASSESSMENT

 Systematic analysis of the specific health-related

actions that are linked to the identified health
problems which most likely affect or could effect a
health outcome
 Behavior

Indicators:
Compliance
Consumption patterns
Coping
Preventive actions
Self-care
Utilization
 Behavior

Indicators: Dimensions:
Compliance Frequency
Consumption patterns Persistence
Coping Promptness
Preventive actions Quality
Self-care Range
Utilization
 Behavioral Assessment
Step 1: Delineating the Behavioral and Nonbehavioral
Causes of the Health Problem

Step 2: Developing a Classification of Behaviors

 Preventive
 Treatment
 Behavioral Causes of Neonatal Tetanus
(-) Preventive Behavior:
 Non-submission of women 15-44 years old to tetanus
toxoid immunization
 Submission of infant to improper umbilical cord cutting
(+) Preventive Behavior:
 Proper cleaning of infant navel
(-) Treatment Behavior:
 Non-submission to early diagnosis and treatment of
neonatal tetanus
 Non-compliance to therapeutic regimen
 Behavioral Assessment
Step 3: Rating Behaviors in Terms of Importance

Step 4: Rating Behaviors’ Changeability

Step 5: Choosing Behavioral Targets

 Four Categories of Possible Action

More
changeable

Less
changeable
 Four Categories of Possible Action
More Less
important important

More
changeable

Less
changeable
 Four Categories of Possible Action
More Less
important important

High priority for

program focus
More
changeable (Quadrant 1)

Less
changeable
 Four Categories of Possible Action
More Less
important important

High priority for

program focus
More
changeable (Quadrant 1)

Priority for innovative

program; evaluation
Less
changeable
crucial
(Quadrant 2)
 Four Categories of Possible Action
More Less
important important

High priority for Low priority except to

program focus demonstrate change
for political purposes
More
changeable (Quadrant 1) (Quadrant 3)

Priority for innovative

program; evaluation
Less
changeable
crucial
(Quadrant 2)
 Four Categories of Possible Action
More Less
important important

High priority for Low priority except to

program focus demonstrate change
for political purposes
More
changeable (Quadrant 1) (Quadrant 3)

Priority for innovative No program

program; evaluation
Less
changeable
crucial
(Quadrant 2) (Quadrant 4)
Components of a Behavioral Objective

Who?

What?

How much?

When?
 Well-Stated Objectives
S pecific

M easurable

A ttainable

R ealistic

T ime-bound
 Well-Stated Objectives
S pecific R ealistic

M easurable U nderstandable

A ttainable M easurable

R ealistic B ehavioral

T ime-bound A chievable
 Behavioral Objectives
90% of pregnant women in Municipality Tagumpay will
submit to 5 doses of tetanus toxoid immunization by 2020
PRECEDE
Phase 5 Phase 4 Phase 3 Phase 2 Phase 1
Administrative Educational and Behavioral and Epidemiological Social
and Policy Ecological Environmental Assessment Assessment
Assessment Assessment Assessment

Predisposing
Factors
HEALTH
PROMOTION
Health Reinforcing Behavior
Education Factors and Lifestyle

Health Quality
Policy of Life
Regulation Enabling
Factors Environment
Organization

Phase 6 Phase 7 Phase 8 Phase 9

Implementation Process Impact Outcome
Evaluation Evaluation Evaluation
PROCEED Green and Kreuter, 1991
 ENVIRONMENTAL ASSESSMENT

 Systematic assessment of factors in the social and

physical environment that interact with the
behavior to produce health effects or quality of life
outcomes
 ENVIRONMENTAL ASSESSMENT

 Can concentrate attention on those aspects of the

environment that are
 More social than physical ( e.g., organizational and economic)
 Interactive with behavior in their impact on health
 Changeable by social action and health policy
 Environment

Indicators:
Economic
Physical
Services
Social
 Environment

Indicators: Dimensions:
Economic Access
Physical Affordability
Services Equity
Social
 Environmental Assessment
Step 1: List of environmental factors which affect the
health problem
Step 2: Identify which Environmental Causes of the Health
Problem are Changeable

Step 3: Rate Environmental Factors on Relative Importance

 Environmental Assessment
Step 4: Rate Environmental Factors on Changeability

Step 5: Choosing the Environmental Targets

Environmental Assessment

List of Environmental Factors

 Lack of TT2

 Inavailability of sterile equipment and supplies

needed in cutting umbilical cord
Environmental Objective

Sterile equipment and supplies will be made

available to the Tagumpay health center by 2020