GREENS PRECEDE

-PROCEED MODEL
 Lawrence W. Green
- is best known by health
Born:United States of America
Education:
University of California, Berkeley
Books:
Measurement and Evaluation in Heal
th Education and Health Promotion
,more
education researchers as the
originator of the PRECEDE
Model and co-developer of the
PRECEDE-PROCEEDModel,
which has been used throughout
the world to guide health
program intervention design,
implementation, and evaluation
and has led tomore than 1000
published studies, applications
and commentaries on the model
in the professional and scientific
literature.

INTRODUCTION
Precede-ProceedModel of health program planning and evaluation
builds on more than 40 years of work byDr. Lawrence W. Greenand
colleagues at Berkeley, Johns Hopkins, the U.S. Public Health Service,
the University of Texas, the Kaiser Family Foundation, the University of
British Columbia, Health 2000, Macro International, and Emory
University.

The PrecedeProceed model has provided moral and practical guidance

for the fields of health education and health promotion since Lawrence
Green first developed Precede in 1974 and Green and Kreuter added
Proceed in 1991. PrecedeProceed today remains the most
comprehensive and one of the most used approaches to promoting health

Precede- Proceed model is not considered a behavioral theory per

se, it is a conceptual framework for practice, or planning model
INTRODUCTION
The PRECEDE-PROCEED Model is used both for
delivery programs in practice settings and when
conducting behavior change interventions.

The model offers a framework within which

individual level theories, community level
theories, interpersonal communication,
interactive technologies media campaigns and
grass roots organizing can be utilized
INTRODUCTION
The PRECEDE-PROCEED model is a tool for designing,
implementing, and evaluating health behavior change programs .

The PRECEDE-PROCEED model 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.

PRECEDE-PROCEED provides a logic model that can serve as

the basis for an individual, one-time intervention or a decades-
long community development program or project. Although
designed for health programs, its adaptable to other community
issues as well. As with many models, its meant to be a guide, not
a prescription.
PURPOSE
Lawrence Greens process for planning effective health
education programs was intended to overcome criticisms of
health education as arbitrary, negative ("Don't smoke")
and ineffective (1). The combined PRECEDE-PROCEED
model of health education was developed over a 20 year
period starting in 1968. It systematically guides the
development and evaluation of a health education program
and reorients health education from focusing on inputs
(what is being taught) to outcomes (the change that is
being sought). Those who plan health education should
begin from the desired outcome and work backward to
identify the factors that precede it, and then proceed
systematically to design ways to modify these factors.
PURPOSE
The purpose of the PRECEDE/PROCEED model is
to direct initial attention to outcomes rather than
inputs. This forces planners to begin the planning
from the outcome point of view. In other words, you
as a program planner begin with the desired outcome
and work backwards to determine what causes it,
what precedes the outcome. Intervention is targeted
at the preceding factors that result in the outcome.
The planning process outline in the model rests
on two principles:

The principle of participation, which states that

success in achieving change is enhanced by the
active participation of members of the target
audience in defining their own high-priority
problems and goals and in developing and
implementing solutions. This principle is derived
from the community development root theories and
the empowerment education model exemplified by
Freire.
The important role of the environmental factors as
determinants of health and health behavior such as
media, industry, politics, and social inequities
WHY USE PRECEDE/PROCEED
A logic model provides a procedural structure for constructing
an intervention.

A logic model provides a framework for critical analysis.

PRECEDE/PROCEED is participatory, thus assuring

community involvement.

Community involvement leads to community buy-in.

PRECEDE/PROCEED incorporates a multi-level evaluation,

which means you have the chance to constantly monitor and
adjust your evaluation.

The model allows leeway to adapt the content and methods of

the intervention to your particular needs and circumstances.
PRECEDE
PRECEDE based on the premise
Predisposing that just as a medical diagnosis
precedes a treatment, so should an
Reinforcing educational diagnosis precede an
Enabling intervention plan.

Constructs In Criticism was that there was too

much emphasis on implementing
Educational /
programs and too little on designing
Environmental interventions to strategically meet
Diagnosis
needs.

Evaluation
5 PHASES OF PRECEDE
PHASE 1 - SOCIAL DIAGNOSIS
The focus of this phase is to identify and evaluate the social problems which
impact the quality of life of a target population. This requires program
planners to gain an understanding of the social problems which affects the
quality of life of the patient, consumer, student, or community, as those
populations see those problems. This followed by the establishment of a link
between these problems and specific health problems which may become the
focus of health education. The link is essential in life and, in turn, how the
quality of life affects social problems.

Methods used for social diagnosis may be one or more of the following:
Community Forums
Nominal Groups
Focus Groups
Surveys
Interviews
Central location intercept

 PHASE 2 - EPIDEMIOLOGICAL DIAGNOSIS

helps determine health issues associated with the quality of life. It helps
identify behavioral and environmental factors related to the quality of life
issues. The focus of this phase is to identify specific health problem and non
health factors which are associated with a poor quality of life. Describing
these health problems can: 1) help establish relationships between health
problems, other health conditions, and the quality of life; 2) lead to the setting
of priorities which will guide the focus of program development and resources
utilization; and 3) make possible the delineation of responsibilities between
involved professionals and organizations and agencies. These priorities are
defined as program objectives which define the target population (WHO), the
desired outcome (WHAT), and HOW MUCH benefit the target population
should benefit, and by WHEN that benefit should occur.
Examples of Epidemiological data:
vital statistics
years of potential life loss
Disability
Prevalence
morbidity
incidences
mortality
 Phase 3 - BEHAVIORAL AND ENVIRONMENTAL
DIAGNOSIS
This phase focuses on the systematic identification of health
practices and other factors which seem to be linked to health
problems defined in Phase 2. This includes non-behavioral
causes (personal and environmental factors) that can
contribute to health problems, but are not controlled by
behavior. These could include genetic predisposition, age,
gender, existing disease, climate, and workplace, the
adequacy of health care facilities, etc. Also assessed are the
behaviors which cause health problems in the target
population. Another important component of this phase is
the determination of the importance and relative
changeability of each behavioral cause. It is critical that a
behavioral diagnosis is completed for each health problem
identified on Phase 2. This will allow all the planners to
choose target behaviors which will become the focus of
specific educational interventions.
PHASE 3 - BEHAVIORAL AND ENVIRONMENTAL
DIAGNOSIS (CONT.)
Behavioral Diagnosis is the analysis of
behavioral links to the goals or problems that are
identified in the epidemiological or social
diagnosis.
Environmental Diagnosis is a parallel analysis
of factors in the social and physical environment
other than specific actions that could be linked to
behaviors.
The Behavioral Matrix
This helps to identify targets where the most
effective intervention measures can be applied.
 Phase 4 - EDUCATIONAL DIAGNOSIS
This phase assesses the causes of health behaviors which
were identified in Phase 3. Three kinds of causes are
identified - predisposing factors, enabling factors, and
reinforcing factors.
The critical element of this phase is the selection of the
factors which if modified, will be most likely to result in
behavior change. This selection process includes identifying
and sorting (positive and negative) these factors in
appropriate category, prioritizing factors among categories,
and prioritizing with categories. Prioritization of factors is
based on relative importance and changeabiltiy. Learning
objectives are then developed which focus on these selected
factors.
Pinpoints the factors that must be changed to initiate and
maintain behavioral change. It is during this phase that
specific intervention objectives are created and the
intervention itself will be implemented.
Educational and organizational
 Phase 4 - EDUCATIONAL DIAGNOSIS (cont.)

Predisposing Factors - any characteristics of a person or population that

motivates behavior prior to the occurrence of that behavior
knowledge
beliefs
values
attitudes
Enablers - characteristic of the environment that facilitate action and any

skill or resource required to attain specific behavior

accessibility
availability
skills
laws (local, state, federal)
Reinforces - rewards or punishments following or anticipated as a

consequence of a behavior. They serve to strengthen the motivation for

behavior.
family
peers
teacher.
 Phase 5 - ADMINISTRATIVE AND POLICY DIAGNOSIS
This phase focuses on the administrative and organizational
concerns which must be addresses prior to program
implementation. This includes the assessment of resources,
budget development and allocation, development of an
implementation timetable, organization or personnel within
programs, and coordination of the program with all other
departments, and institutional organizations and the
community.
Administrative Diagnosis - the analysis of policies,
resources and circumstances prevailing
organizational situations that could hinder or facilitate the
development of the health program.
Policy Diagnosis - to assess the compatibility of your
program goals and objectives with
those of the organization and its administration; does it fit
into the mission statements, rules
and regulations.
PROCEED

Policy PROCEED - was added in 1991

to recognize environmental
Regulatory factors as determinants of health
Organizational and health behavior.

Constructs Lifestyle (Environment)

recognition of impact, behaviors
Educational
sometimes being influenced
Environmental outside of the individual i.e.
media campaigns for health
Development medications.
4 PHASES OF PROCEED
Phase 6 - IMPLEMENTATION
Design intervention and assess availability of resources
and implement program.
Phase 7 - PROCESS EVALUATION is used to evaluate
the process by which the program is being implemented.
Phase 8 - IMPACT EVALUATION measures the
program effectiveness in terms of intermediate objectives
and changes in predisposing, enabling, and reinforcing
factors.
Phase 9 - OUTCOME EVALUATION measures change
in terms of overall objectives and changes in health and
social benefits or the quality of life. It takes a very long
time to get results and it may take years before an actual
change in the quality of life is seen
END