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
