According to World Health Organization (WHO) 2005, health promotion program is the process of enabling people to increase control over their health. The program under review will enter the PRECEDE model at phase one (social diagnosis phase) as it involves determination of the social problems, the needs, and thus the quality of life of the individuals in need of developing or adopting healthy lifestyles. Then it will go into phase 2 (epidemiological diagnosis), which involves identifying the health or other issues (e.g. prevalence of obesity, incidences of unhealthy lifestyles, etc) that most clearly influence the outcome the community seeks. In phase 3 involving behavioral and environmental diagnosis, the behaviors and lifestyles and/or environmental factors will be identified and changed to affect the health or other issues identified in phase 2, and determine which of them are most likely to be changeable. In the PRECEDE model, behavioral factors play a crucial role in some of the leading causes of death in the modern lifestyles such as, chronic diseases, heart disease, cancer, and stroke (Mc Ginnis & Foege, 1993). The behaviors associated with health problem include: use of tobacco, firearms, reckless driving without safety belts, irresponsible sexual behavior, illicit use of drugs, lack of physical exercises and dietary behavior. Maintaining an unhealthy diet for instance is a behavior that may expose one to cardiovascular disease, (O’Connor-Fleming & Parker, 2003). The PRECEDE health promotion model’s interventions seek to turn people away from risky behaviors and direct them toward healthful behaviors, such as following a rich diet (Issel, 2008).
Environmental factors are also associated with the health problems for modern lifestyles as outlined in the PRECEDE model within the context of the program under review. A change in one’s behavior may be easier if certain aspects of the environment around him/her are supportive of that change, (Bunton et al. 2005). The environmental factors include: availability of referral services and health centers that provide public health initiatives, policy initiatives, existence and enforcement of legislation or laws such as a ban on smoking in public places, increasing levies on alcohol and cigarettes, making nicotine replacement therapy and other smoking cessation aids available and relatively low cost, availability of healthful products and alternatives to unhealthful behaviors. For example, availability of facilities like swimming pools, gymnasiums, parks and recreational centers in addition to security in their neighborhoods will encourage people to go out regularly for exercises in modern lifestyles. Environmental factors that may not be supportive of health problems include such things as lack of gyms and sports facilities, living and working with those who smoke, lack of health care providers and user fees for recreation centers and other sports facilities. All these are PRECEDE model strategies of manipulating the environment so as to achieve the desired results of better health for the modern world, (Green & Kreuter, 1999). In the PRECEDE model, the predisposing, enabling, and reinforcing factors which can either enhance or prevent the changes in the pertinent phase 3 behavioral and environmental factors are identified in phase 4 (i.e., the educational and organizational diagnosis phase). Predisposing factors can provide the reason or motivation that can lead to a specific behavior. They include knowledge, attitudes, cultural practices or beliefs, which can make individuals to easily change and adopt healthy lifestyles (i.e., regular exercises, eating healthy foods, quitting smoking, etc, which are specific to the health program under review). Enabling factors give individuals the ability to act out of their own free will and hence allow the realization of motivations. These enabling factors include, available resources (gyms and sports ware), supportive policies (by-laws and legislations prohibiting smoking and promoting safety on roads and working environments), assistance (by lifestyle managers), and services (by health care providers, or through health facilities, etc) in the context of the program under review. Reinforcing factors such as social or peer support, praise, reassurance, etc, will “reinforce an already started behavior by providing continuing incentives and rewards which can lead to persistence and repetition of behaviors” (Green, 1974). As reviewed by the PRECEDE model and explained in this article, the program effectively addresses the factors responsible for unhealthy lifestyles in the modern world as the model seems to serve the communities well as a diagnostic planning tool. The inclusion of policy, regulatory, and organizational dimensions of educational and environmental development in the communities through the PRECEDE model offers more robust programs with greater potential to change community. The steps outlined in the PRECEDE model are geared toward encouraging individuals and communities to embrace healthy behavior. The model emphasizes the fact that any meaningful change in behavior is a long process and that people are motivated differently hence their readiness to change is also different. In my opinion therefore, the PRECEDE health promotion model effectively addresses the factors responsible for health problems.
References
Bunton, R., Nettleton, S., & Burrows, R. (Eds.) (2005). The Sociology of Health Promotion: Critical Analyses of Consumption, Lifestyle, and Risk. New York: Routledge.
Green, L. W., and Kreuter, M. W. (1999). Health Promotion Planning: An Ecological and Environmental Approach, 3rd ed. Mountain View, CA: Mayfield Publishing Co.
Green, L. W. (1974). “Toward Cost-Benefit Evaluations of Health Education: Some Concepts, Methods, and Examples.” Health Education Monographs 2 (Supp.1):34–64.
Issel, L. M. (2008) “Health Program Planning and Evaluation: A Practical, Systematic Approach for Community” Jones & Bartlett Publishers.
McGinnis, J., and Foege, W. (1993). “Actual Causes of Death in the United States.” Journal of the American Medical Association 270:2207–2212.
O’Connor-Fleming, M. L., & Parker, E. (2003). Health Promotion: Principles and Practice in the Australian Context /. Crows Nest, N.S.W.: Allen & Unwin.
World Health Organization, (2005). Participants at the 6th Global Conference on Health Promotion. The Bangkok Charter for health promotion in a globalized world. Geneva, Switzerland: World Health Organization. Web.