Phases and Methods

Phases and Methods of the PRECEDE-PROCEED Model

Phase 1 - Social Assessment, Participatory Planning, and Situational Analysis

Community organizing theories and principles are relevant.

  • Community Organization: Community groups are helped to identify common problems or goals, mobilize resources, and develop and implement strategies for reaching those goals (Minkler and Wallerstein, 2002).
  • Community Mobilization: Community members define prevention needs (problem identification, needs assessment, program design) and obtain community program support (Treno and Holder, 1997).

Planners expand their understanding of the community with the following methods.

  • Social Assessment: The application of objective and subjective sources of information designed to expand the mutual understanding of people regarding their aspirations for the common good (Green and Kreuter, 2005, p.31).
  • Concept Mapping: A structured group activity where participant generated ideas are subjected to quantitative analysis resulting in cluster maps. Final agreement is reached those maps that best reflect the participants' views.

Phase 2 - Epidemiological Assessment, Behavioral Determinants, and Environmental Determinants

Epidemiological Assessment

  • Identifies the health problems, issues, or aspirations upon which the program will focus.
  • Uncovers the behavioral and environmental factors most likely to influence the identified priority health issues.
  • Translates priorities into measurable objectives for the program being developed (Green and Kreuter, 2005).

Behavioral Determinants

  • Behaviors or lifestyles that contribute to the occurrence and severity of a health problem.
  • The behavior of others who can directly affect the behavior of the individuals at risk.
  • The action of decision makers whose decisions affect the social or physical environment that influences the individuals at risk.

Environmental Determinants

Those social and physical factors external to the individual, often beyond his or her personal control, that can be modified to support the behavior or influence the health outcome.

At this phase in the program planning process, community organizing theories and principles are still relevant, as are interpersonal and individual theories of behavior change such as Social Cognitive Theory.

Phase 3 - Educational and Ecological Assessment

Planners identify the following factors that influence the likelihood that behavioral and environmental change will occur.

  • Predisposing Factors: "antecedents to behavior that provide the rationale or motivation for the behavior".
  • Reinforcing Factors: "factors following a behavior that provide continuing reward or incentive for the persistence or repetition of the behavior".
  • Enabling Factors: "antecedents to behavioral or environmental change that allow a motivation or environmental policy to be realized".

All three levels of change theories can be useful at this stage.

  • Individual-level theories- most appropriate to address predisposing factors.
  • Interpersonal-level theories - most appropriate for reinforcing factors; suggest indirect communication channels and methods.
  • Community-level theories - most appropriate for enabling factors; suggest environmental changes and methods such as grassroots organizing and advocacy (Clark and McLeroy, 1995).

Phase 4 - Administrative and Policy Assessment and Intervention Alignment

The planner selects and aligns the program's components with priority determinants of change previously identified to discover resources, organizational barriers and facilitators, and policies needed for implementation and sustainability.

The planner must look at macro and micro levels of alignment between the assessment of determinants and the selection of interventions (Green and Kreuter, 2005, p.196)

  • Macro level - Consider the organizational and environmental systems that can affect the desired outcomes.
  • Micro level - Focus on individual, peer, family, and others who can influence the intended audience's health behaviors more directly.

Methods for building a comprehensive program (Simons-Morton, Greene, and Gottlieb, 1995; D'Onofrio, 2001):

  • Matching the ecological levels to broad program components.
  • Mapping specific interventions based on theory and prior research and practice to specific predisposing, enabling, and reinforcing factors.
  • Pooling prior interventions and community-preferred interventions that might have less evidence to support them.
  • Patching those interventions to fill gaps in the evidence-based best practices.

The mapping of interventions to predisposing, reinforcing, and enabling factors is mainly influenced by community-level theories.

Phases 5 to 8 - Implementation and Evaluation

Data collection plans should be in place for evaluating the process, impact, and outcome of the program.

  • Process Evaluation: determines the extent to which the program was implemented according to protocol.
  • Impact Evaluation: assesses change in predisposing, reinforcing, and enabling factors, as well as in the behavioral and environmental factors.
  • Outcome Evaluation: determines the effect of the program on health and quality of life indicators.