HSCI 441 Dr. Robert Huff
Health Education & Health Promotion Planning
A Study Guide for Health Science 441
The Precede – Proceed Model (Green & Kreuter, 2005)
The Precede-Proceed model is a framework for planning, implementing and evaluating health education & health promotion programs in a variety of situations and settings. This study guide has been prepared to help the HSCI 441 student to make his or her way through the model as they attend the course and work on the development of their Senior Project which will take them to their graduation from the Health Education Program. This Study Guide will present the major phases of the model and ask the student to respond to questions in each of the phases that will help lead them to a real health issue/problem, a real target group living with the problem, in a real-world location somewhere in the Los Angeles or Ventura County area.
The Precede-Proceed model has eight phases that include the following:
- Phase 1: Social Assessment & Situational Analysis
- Phase 2: Epidemiological Assessment
- Phase 3: Ecological & Educational Diagnosis
- Phase 4: Administration & Policy Assessment & Intervention Alignment
- Phase 5: Implementation
- Phase 6: Process Evaluation
- Phase 7: Impact Evaluation
- Phase 8: Outcome Evaluation
PHASE 1: Social Assessment & Situational Analysis
This phase is concerned with Quality of Life and the health problems that impact on this within the community under study.
1. Purpose:
2. Methods:
The Windshield Survey:
- What community characteristics will you look for?
- How will you document what you see?
- How will you analyze the data you collect?
- How will you prioritize your findings?
SPA (Standard Planning Area), Census & Other Types of Data:
- What is the history of your community?
- How will you define your community’s boundaries?
- How will you define your community’s geographic features and why is this important to do?
- What demographic data will you collect? Where will you get this data? How will this data help you to
understand your community?
- What are the characteristics of the community’s health care system?
- What are the characteristics of the community’s social assistance system?
- What police, fire and other safety data and services are available in your community?
- Other community data (e.g. educational system, political system, etc.)?
Community Perceptions of its health issues and needs:
Key Informant Interviews:
- Who will you interview and why?
- What questions will you ask?
- How will you analyze the data you collect?
Central Location (Quick Intercept) Interviews:
- What areas of the community will you survey and why?
- How many community people will you intercept?
- What questions will you ask and why?
- How will you analyze your data?
Focus Groups:
- How many groups will you run?
- Who will you invite and how will you recruit them to participate?
- What questions will you ask?
- How will you analyze your data?
Community Forum:
- Do you need a community forum?
- If yes, how will you notify the community about it?
- What questions or issues will you address?
- How will you document community input?
Community-wide Survey:
- Do you have the resources to conduct this type of survey?
- How will you sample the community?
- What data will you collect?
- How will you format the instrument?
- Other methodological issues (e.g. analysis, reporting, etc.)?
Asset Mapping:
- What assets (human & organizational) do you have in your community to assist you in planning, implementation and
evaluation of a community health education/promotion program?
- Where are these assets located and how will you access them?
Situational Analysis (Social Diagnosis):
- How does the data collected from the steps above correlate/triangulate one to the other?
- What themes seem to have emerged from your data analysis (your health issues list)?
- How does literature research connect to the themes/issues you have identified?
- How will you identify your program planning priorities based on your data and problem list?
PHASE 2: Epidemiological Assessment
This phase will help the planner make final decisions regarding the issue and target group they will work with to design an
educational intervention to improve the health of the community and in turn, their quality of life.
Purpose:
The Five Epidemiological Questions:
1.
2.
3.
4.
5.
Classic Indicators of Health Problems (The Five D’s):
1.
2.
3.
4.
5.
Data Sources:
- Where will you go to collect epidemiological data to further highlight the health issues/themes in your community?
- What specific data will you collect?
- How will you know if the data you collect is significant within the framework of the themes you have elicited from your previous data?
- How does your epidemiological data compare to data from other communities in your target area, the county, state and national levels?
- Based on the data you have collected thus far, what specific health issue/problem will you target, who will you target and where will you target them?
Determinants/Factors that are Impacting on the Health Problem:
- What personal/individual behaviors are associated with the health problem you are dealing with?
- What environmental factors are contributing to the problem?
- What social factors are contributing to the problem?
- What, if any, physical factors are contributing to the problem?
- What biological factors are contributing to the problem?0
Relating Data to the Five Epidemiological Questions:
- How does your data help answer the epidemiological questions?
- How will the data help you define potential interventions?
The Behavioral Diagnosis:
1. Levels of Behavior:
- What proximal behaviors are contributing to the problem?
- What medial behaviors are contributing to the problem?
- What distal behaviors are contributing to the problem?
2. What level(s) of intervention will you emplay to solve the health problem you are dealing with?
- Intrapersonal
- Small group
- Community
- Organizational
- Policy and/or Legislative
3. Genetics:
- What role, if any, does genetics play in the health issue you are dealing with?
- If genetics is a factor, are there risk factors that are amenable to change that might help reduce the potential for reducing genetic risks?
4. Behavioral Risk Assessment:
- Literature review to look at behavioral risks associated with your health issue
- Create list of behavioral risks based on literature and any other assessment data you may have
- Rate behaviors on the basis of importance for change
- Rate behaviors on the basis of changeability (e.g. which behaviors have the most potential for change and which the least potential for change)
- Make a list of the behavioral risks most amenable to change
The Environmental Diagnosis:
1. Subcategories of Environmental Assessment:
- Economic (the social environment)
2. Environmental Risk Assessment:
- What are the potential environmental risks related to your health issue (literature review may be helpful here)?
- Rate the environmental risks on the basis of importance for change
- Rate the environmental risks on the basis of changeability
- Which environmental risks are most amenable to change?
NOTE: Refer to your readings for the matrix approach to rating behavioral and environmental risks.
At this point, the group should have their project focus (e.g. health issue, target group and location, and risk assessments)
PHASE 3: Ecological and Educational Diagnosis
Purpose:
Categories of Factors Affecting Individual and Collective Behaviors:
1. Predisposing Factors:
2. Enabling Factors:
3. Reinforcing Factors:
The Domains of Learning:
1. Cognitive (Knowledge):
2. Affective (Attitudes, Beliefs, Values, Emotions):
3. Behavioral (Overt Action):
The Educational-Behavioral Diagnosis:
- What is the target group’s current (old) knowledge that is supporting or promoting the behavior(s) you wish to change?
- What is the target group’s current (old) attitudes that are supporting or promoting the behaviors you wish to change?
- What are the current (old) behaviors that are supporting or promoting the behavior change(s) you are focused on changing?
These three questions help target the KAB of the target group and must be understood if you are to have any real chance of impacting the health problem(s) you are concerned about in your target community. The ecological piece of this is concerned with what is going on around the target group (the social, genetic, and environmental factors) that are supporting the KAB that you are seeking to address. The next three questions are concerned with what it is you want to do to promote change in your target group.
- What new knowledge do you want your target group to have as a result of your program?
- What new attitudes do you want your target group to have as a result of your program?
- What new behavior(s) do you want your target group to have as a result of your program?
Health Behavior Models Relevant to the Ecological Diagnosis:
1. The Health Belief Model:
2. The Transtheoretical Model:
3. Social Cognitive Theory:
4. Diffusion of Innovation:
The Target Group Specific Needs Assessment:
1. Purpose:
2. Considerations:
3. Objectives of the assessment:
4. Types of questions and formatting of questions:
5. Methodology of administration:
6. Analysis and reporting of data:
PHASE 4: Administrative & Policy Assessment & Intervention Alignment
Phase 4 of the Precede-Proceed model is focused on the health education intervention Action Plan. At this point you will have needed to have completed the following tasks:
1. Have a clearly defined health problem/issue, target group and general location in which your project will be implemented.
2. A clearly defined educational-behavioral diagnosis based on your target group specific needs assessment.
3. A clear focus on the level(s) of intervention your program will target.
Writing Measurable Objectives (Refer to your handout):
1. Purpose of Objectives:
2. The characteristics of a measurable objective:
3. The hierarchy of Objectives:
- Administrative Objective:
- Health Education Program Objective:
- Health Education Target Group Objectives for KAB
- Health Education Learner Objectives for KAB
Objectives define the purpose, direction, and evaluation methodologies that your program will use to carry out its intervention plan.
Resources & Constraints:
- What specific resources do you have available to you in order to carry out the intervention the group is planning?
- What specific constraints are blocking (real or potential) the groups efforts in carrying out the intervention the group is planning? How will you overcome these?
Methods & Activities:
There are two major categories of methods that need to be considered in carrying out an intervention plan:
1. Methods related to “How” you will get your target group to come to your educational program:
2. Methods related to “What” you will do with the target group when you get them to your program:
Both of these major categories will rely on specific activities that must be completed in order for the method to succeed. For example:
Marketing Activities:
Classroom/workshop Education Session:
The Gantt Chart:
Purpose:
Format:
The Program Budget:
Purpose:
Direct & Indirect Costs:
Budget Format:
Administrative & Policy Assessment:
- What is the mission of your agency and how does your program fit within that mission?
- How will/is your agency supporting the program you wish to implement?
- What administrative clearances will you need in order to implement your program?
- What mandates does your agency have with respect to the delivery of health care services and how does your program fit within these mandates?
- What policy or legislative issues might your agency have and how do these impact on the program you are seeking to implement?
- What, if any, modifications will you need to make in order to implement your program?
PHASE 5: Implementation
The Five Phases of Implementation:
1: Gaining acceptance for the program:
2. Specifying tasks and estimating resources:
3. Developing your marketing plan (the six “P’s”):
4. Establishing a system of program monitoring:
5. Putting your plan into action:
PHASE 6: Process Evaluation
Purpose:
Tools:
PHASE 7: Impact Evaluation
Purpose:
Tools:
PHASE 8: Outcome Evaluation
Purpose:
Tools:
Using your evaluation data to determine whether if you achieved your objectives at each level of the hierarchy:
Specific handouts were provided in the class and reviewed with examples for this most important task…please refer to these when preparing for the final examination!