Introduction
It is necessary to carefully plan the path to the intended results to achieve the goal. One of the famous and influential models for developing, implementing, and evaluating different health programs is the PRECEDE-PROCEED approach, founded by Green and supplemented by Kreuter. This model consists of such stages as social diagnosis, epidemiological diagnosis, behavioral and environmental diagnosis, educational and ecological diagnosis, administrative and policy assessment, implementation, process evaluation, impact evaluation, and outcome evaluation. The PRECEDE-PROCEED approach plays a significant role in health promotion and allows creating of long-term programs with clear aims and realizing them.
The Epidemiological Phase, Its Importance, and Data Sources
The epidemiological phase of the model aims to identify significant health issues that are the most important for the community or particular groups. Moreover, it indicates environmental and behavioral factors which have a specific impact on primary health problems of society. One of the tasks of this phase is also setting priorities and goals, the primary characteristic of which is objectivity. Sometimes, if the goals are too optimistic, they will hardly be achieved. For instance, it makes no sense to strive to completely eradicate cases of certain diseases from which people have been suffering for decades or centuries in five years. Therefore, the goals should be adequate, measurable, time-limited, and carefully planned. For example, it is possible to set such a goal: “By the year 2030, the number of children, living in this region and suffering from scoliosis should be decreased by 15%”. The goal can also consist of several small tasks or aims. Thus, the epidemiological phase means the precise determination of the health problems and behavioral and environmental factors contributing to these problems and setting objective goals to promote health.
Since studying the current state of the problem from different aspects is necessary to solve it in the future, the epidemiological phase is realized due to data on health conditions and its analysis. The developers utilize data on population health issues in the whole country, in a specific region, and at the local level, as well as statistics of morbidity and mortality and community surveys. This stage often relies on data from the National Health Information Centers and Medicine Databases. The epidemiological phase strives to answer the questions related to the importance of the problem, possible ways to solve it, the role of behavioral factors, and environmental causes of the health issue. It also tries to understand the potential yield of successfully addressing the issue and whether other agencies attempt to solve it. Therefore, by analyzing existing data, the epidemiological phase answers the questions that contribute to the correct setting of goals, the achievement of which will strengthen the nation’s health.
Types of Evaluation in the Approach
As a result, each program must be evaluated to see if the goal has been achieved. The evaluators strive to answer the questions of whether the planned actions were taken, whether these actions have the desired impact, and whether they lead to the main goal set in the initial phases. There are three main types of evaluation in the PRECEDE-PROCEED model: process evaluation, impact evaluation, and outcome evaluation. The first type tries to evaluate the process of the program’s implementation. It determines whether the program has been realized according to the plan. The second type evaluates the program’s effectiveness and ascertains if the influence of behavioral and environmental factors has changed. Its task is also to define the changes in predisposing (traits contributing to personal motivation), reinforcing (reaction of others), and enabling factors. The third type of evaluation determines whether the program has positively impacted the target group’s health and quality of life. Thus, all kinds of assessments measure the program’s strength and effectiveness, showing if it has managed to achieve the goal and make the life of society better.
Key Assumptions, Benefits, and Real-life Examples of Using the Approach
The model assumes that strengthening health should begin not with a diagnosis and an attempt to cure a person but with the determination of the desired result and work back to the original reason. One of the critical assumptions of the approach is the inseparability of health promotion with an improvement in the quality of life in general. The model also implies the need to participate in the program from beginning to end for developers and members of society, including representatives of the target group. As for the advantages of this model, it consists of many phases, the precise execution of tasks which allows the implementation of almost any plan. Using this model, developers will reach out to the community, which means they will be able to look at the situation from the inside, acquire more information about the problem, and get help from customers. Since the model includes not only the phases of development but also the evaluation of the process, it lets us adjust and improve the program.
Although this approach was introduced relatively recently, there have been many programs based on it. Last year, for instance, a group of German researchers (Bammann, Recke, Albrecht, Stalling, and Doerwald) used the PRECEDE-PROCEED model to promote outdoor physical activity in older people. In 2019, it was utilized by Garcia, Gatdula, and Bonilla to determine factors influencing childhood obesity among Hispanics/Latinos in the USA and decrease their impact. Thus, this approach is widely accepted in different parts of the world.
The Theory of Triadic Influence
The theory of triadic influence is a theory of health behavior that integrates many other approaches. It includes three main streams of influence: cultural-environmental influences, social or interpersonal influences, and intrapersonal influences. Broad sociocultural factors (impact of politics, mass media, religion, law, access to knowledge) belong to the first stream. The second type includes relationships with other people, level of attachment to them, susceptibility to the behavior of others, the desire to please someone, and attitude to social values and beliefs. Intrapersonal factors consist of self-control, the ability to cope with negative influences, and genetic predispositions. All these streams are closely connected because the decision cannot be determined by only one factor. In addition, the factors of one stream may overlap with the aspects of another; the elements of one stream can fall under the impact of another. For instance, interpersonal bonding that belongs to social influences also relates to intrapersonal ones, while social competence (interpersonal factor) relates to social and cultural-environmental influences. Thus, this theory accounts for the mechanisms of making a decision (for example, acquiring an addiction), explaining them with influencing factors of three types.
Conclusion
The PRECEDE-PROCEED model is a framework that consists of several phases and allows the development, implementing, and evaluation of different health programs. This approach assumes that every program should be carried out not only by developers but also by the members of society. Its primary tasks include setting objective goals (epidemiological phase), achieving them, and assessing progress (evaluation phase). Due to this model, researchers have developed many programs that promote the health of society and improve the quality of life.