The Cdcynergy Model Can Be Distinguished From the Other Models by Its Focus on Communications.

Larn how to develop a coherent plan that addresses necessary issues and actions using the Precede-Keep model.

• What is PRECEDE-Go along?

• Why use PRECEDE-Continue?

• How practise you use PRECEDE-PROCEED?

If y'all were a contractor setting out to build a woods-frame house, you lot wouldn't merely pick up whatever wood you establish lying around and begin. Y'all'd consult first with the owner, and start with an idea of the house she wanted – its size, its shape, its features. You lot'd desire a picture of the finished house, and a floor programme as well, with some notes on measurements and materials. You'd program the construction with her, and set out a process for getting information technology done. And you lot'd exercise all this before you always picked up a tool, because otherwise the process would exist hit-or-miss: she wouldn't get the house she wanted, and your fourth dimension would be wasted.

The same is true if you're developing an intervention to accost a health or customs issue. It makes no sense to pick an issue at random, and to utilize whatsoever service happens to be bachelor to try to address information technology. You take to consult with the customs, understand and analyze customs information, your ain and others' observation, and the context of the upshot to create an intervention that will actually bring about the changes the community wants and needs.

In the first section of this chapter, nosotros introduced the need for a process for doing health and customs piece of work. In this section, we'll look at PRECEDE-PROCEED, the first of several specific models that may prove helpful to yous in carrying out your own work. We'll examine other models in subsequent sections of this chapter. Then in the concluding section, nosotros'll examine some ways in which elements of various models tin exist combined to respond to your particular situation.

What is PRECEDE-Continue?

Like most of the other models we'll examine in this affiliate, PRECEDE-Keep was developed for employ in public wellness. Its basic principles, however, transfer to other community issues as well. As a result, nosotros'll treat it as a model non simply for wellness intervention, but for community intervention in general. And in fact, PRECEDE/ Go along focuses on the community every bit the wellspring of health promotion.

In the latter half of the 20th Century, as medical advances eliminated many infectious diseases, the leading causes of disability and death in the developed globe changed to chronic conditions – heart disease, stroke, cancer, diabetes. The focus of health maintenance, therefore, shifted from the treatment of affliction to the prevention of these conditions, and, more recently, to the active promotion of behaviors and attitudes – proper diet, exercise, and reduction of stress, for instance – that in themselves do much to maintain health and improve the length and quality of life.

Behind PRECEDE-Go on lie some assumptions nigh the prevention of illness and promotion of health, and, by extension, about other community problems as well. These include:

• Since the health-promoting behaviors and activities that individuals engage in are almost always voluntary, carrying out health promotion has to involve those whose behavior or actions you want to change. PRECEDE-Go on should exist a participatory process, involving all stakeholders – those affected past the upshot or condition in question – from the beginning.
• Health is, by its very nature, a community issue. It is influenced by community attitudes, shaped by the customs environment (concrete, social, political, and economic), and colored by community history.
• Health is an integral function of a larger context, probably most clearly divers as quality of life, and information technology'south within that context that it must be considered. It is but i of many factors that make life improve or worse for individuals and the customs as a whole. Information technology therefore influences, and is influenced by, much more than than seems straight connected to it.

AIDS has changed the way many people in the Us view and practice sex, for case. In some other countries, it has affected the whole social construction because of the number of orphans it has created, and its impact on the workforce. By the same token, youth violence changes the views and deportment of many people who are at no risk of being its victims, and may put a customs at an economic disadvantage past making it less attractive to new business or industry. Near whatever other issue could serve as well equally an instance of the broad reach of customs issues (or avails, for that matter).

• Finally, health is more than physical well-beingness, or than the absence of disease, affliction, or injury. Information technology is a constellation of factors – economic, social, political, ecological, and concrete – that add up to healthy, loftier-quality lives for individuals and communities.

This broad perspective on health extends to other community issues. We tin can define the health of a community equally its fitness in many areas, of which citizens' concrete health is just one. Indications of a customs's overall wellness include how well it:

• Contributes to the stability of families
• Nurtures and supports children
• Fosters lifelong learning
• Provides meaningful piece of work for its citizens
• Invites involvement in the democratic procedure
• Cares for those who need assist
• Protects and sustains the natural environs
• Encourages the arts
• Values and encourages racial and cultural diversity
• Works to promote and maintain safety and physical well-existence for its members

PRECEDE and PROCEED are acronyms (words in which each alphabetic character is the first letter of a word). PRECEDE stands for Predisposing, Reinforcing, and Enabling Constructs in Educational/Environmental Diagnosis and Evaluation. As its name implies, information technology represents the process that precedes, or leads up to, an intervention.

PROCEED spells out Policy, Regulatory, and Organizational Constructs in Educational and Environmental Development, and, true to its name also, describes how to continue with the intervention itself.

PRECEDE has iv phases, which nosotros'll explore in greater detail later in the section:

• Phase 1: Identifying the ultimate desired result.
• Phase 2: Identifying and setting priorities among health or customs issues and their behavioral and environmental determinants that stand up in the manner of achieving that effect, or conditions that accept to be attained to achieve that result; and identifying the behaviors, lifestyles, and/or environmental factors that touch those bug or conditions.
• Phase 3: Identifying the predisposing, enabling, and reinforcing factors that tin touch on the behaviors, attitudes, and environmental factors given priority in Phase ii.
• Phase 4: Identifying the authoritative and policy factors that influence what can be implemented.

Another premise behind PRECEDE-Proceed is that a change process should focus initially on the result, non on the activity. (Many organizations prepare out to create community modify without stopping to consider either what effect their actions are likely to have, or whether the change they're aiming at is ane the community wants and needs.) PRECEDE'south four phases, therefore, motion logically backward from the desired event, to where and how you might intervene to bring almost that effect, to the authoritative and policy issues that demand to be addressed in order to mount that intervention successfully. All of these phases can be thought of as formative.

PROCEED has 4 phases (besides to be discussed in more than detail after) that encompass the actual implementation of the intervention and the careful evaluation of information technology, working dorsum to the original starting indicate – the ultimate desired outcome of the procedure.

• Stage 5: Implementation – the design and bodily conducting of the intervention.
• Phase 6: Process evaluation. Are you actually doing the things you planned to do?
• Phase 7: Impact evaluation. Is the intervention having the desired impact on the target population?
• Phase 8: Outcome evaluation. Is the intervention leading to the outcome (the desired result) that was envisioned in Phase ane?

A discussion nearly logic models: Although most formal models, like PRECEDE-PROCEED present themselves as the manner to structure an intervention or other activity, the give-and-take "logic" implies that you should carefully consider your ain situation as well as the model. If in that location are reasons why a particular part of a model might not work for you, it's reasonable (logical) to alter information technology. While PRECEDE-PROCEED presents a structure that could conceivably work well (and has worked well) in a variety of situations, it'south still of import to remember about whether all parts of it will work for you.

A period chart of the model (see Fig. 1), developed by its originators, shows a circular process. It starts (on the upper right) with a customs demographic and quality-of-life survey, and goes counterclockwise through PRECEDE's four phases that explain how to conceive and plan an effective intervention. Continue and then picks up with the intervention itself (described here equally a health program), and works dorsum through the start five phases, evaluating the success of the intervention at addressing each one (The process evaluation in Phase 6 looks at whether the intervention addressed the concerns of Stage 3 as planned. The touch evaluation of Phase 7 examines the bear on of the intervention on the behaviors or ecology factors identified in Phase two. And the Result evaluation of Phase 9 explores whether the intervention has had the desired quality of life outcome identified in Phases 1 and 2). Eventually, the procedure arrives dorsum at the beginning, either having achieved the desired quality of life outcome, or to start over again, incorporating the lessons of the offset endeavour. The arrows in the flow chart demonstrate the effects of each stage'due south problems on the side by side ane to the right. Since you're working backwards from the ultimate outcome, effects move to the correct. If the chart was demonstrating the direction of analysis, the arrows would point in the opposite direction.

Figure one. Generic representation of the Precede-Go along Model. From Fifty. Green and Yard. Kreuter. (2005). Health Promotion Planning: An Educational and Ecological Approach (four th Ed.). Mount View , CA : Mayfield Publishers.

• The PRECEDE-PROCEED model applies a medical perspective to public health, even though its focus is health promotion, rather than treatment of disease. Just as a medical diagnosis precedes treatment, the model assumes that a far-reaching diagnosis should precede a public wellness intervention. A diagnosis suggests a treatment (an intervention), which is closely monitored for process (Is the patient getting the treatment prescribed?), impact (Is the treatment having the hoped-for impact on the symptoms?), and result (Does the handling cure the patient, or have the desired event on her overall wellness?). A premise of the model is that a diagnosis should get-go with the desired end result and work backwards to decide what needs to be washed to bring about that result.
• Another basic premise of the model is that the purpose of a health program – and by extension, the purpose of whatever proactive type of community intervention – is to meliorate the quality of life for individuals and their community, and that the two are largely inseparable. Thus, any intervention should be community-based, and should await at the needs of the community, even if the intervention is aimed at a more than specific target group.
• A final premise of whatever community-based model for intervention is that planning and implementing a community intervention calls for a joint try amidst (health and other) professionals and organizations, policy makers, community officials, customs leaders, and community members at big, including members of the target population. In gild to ensure accurate information and community support, all elements of the community should be involved in the process from the get-go.

Why use PRECEDE-Continue?

First, in that location are good reasons for using some kind of logic model or theoretical framework for any intervention:

• It provides a structure inside which to plan your work, then that you're not merely grasping at straws. As a effect, you're more probable to develop a coherent program that addresses the necessary issues.
• Most models give you lot either a guide or a foundation for disquisitional analysis of the problems at manus. That doesn't guarantee that your analysis will exist complete or accurate, but information technology significantly increases the chances. (See Analyzing Community Issues and Solutions, for more than on logical analysis.)

This is not to say that yous have to apply a logic model. In that location are other ways to approach developing an intervention, many of them outlined in the Customs Tool Box. The reward of PRECEDE-Continue and like models is that they tell you exactly what to do: you follow directions, and you have a process for developing an intervention. The disadvantage of these models is that they tell you exactly what to exercise: if some function of the model isn't advisable for your setting or your circumstances, you lot'll have to realize that, and change it to fit, or risk a trouble. PRECEDE-Continue now offers a period nautical chart or algorithm to facilitate decisions for skipping some steps or phases, thereby tailoring the model to different local situations.

Ordinarily, the originators of the model will tell y'all that you have to follow it exactly. In fact, that's rarely the case. If y'all like the model, yous can be sure to include all its elements, but you tin can notwithstanding change some of them, change the timing, even change the lodge to improve match the needs of your community. You might likewise find yourself taking some pieces of one model and grafting them on to another, or reinterpreting a model in calorie-free of a particular theoretical framework.

Over and above the use of logic models in general, there are some proficient reasons for using PRECEDE-PROCEED specifically:

• PRECEDE-PROCEED provides a template for the procedure of conceiving, planning, implementing, and evaluating a community intervention.
• PRECEDE-PROCEED is structured as a participatory model, to comprise the ideas and help of the customs. That means that its employ will provide you with more, and more than accurate, data about the issues in question, and with a better agreement of their history and context in the community.
• Community involvement is also a ways of building community ownership of the intervention, leading to more customs support and a greater chance of success.
• PRECEDE-Proceed considers the ways in which administrative and policy guidelines can limit or shape an intervention, an area of planning too oft ignored.
• PRECEDE-PROCEED incorporates evaluation of the process, the intervention itself, and the final outcome. That allows the intervention to exist monitored and adapted to answer to community needs and changes in the situation, and checks that its accomplishments actually pb to the projected goal.
• Although PRECEDE-Go on sets out a strict process, it says much less nearly content. Information technology leaves plenty of leeway for adapting your intervention'due south design and methods to the state of affairs, the needs of the customs, etc.

Although these are good reasons to use PRECEDE-PROCEED, they are besides good reasons to use some of the other models in this chapter. This is the reason we are presenting several – so that you tin decide which amongst them, if whatever, makes the most sense to you, and would be best for your circumstances and customs. PRECEDE-PROCEED's greatest strength may be its comprehensive and rigorous structure – it covers all the bases.

How practice you use PRECEDE-Continue?

Logic models don't really mean much unless you actually use them in the community. Once you've decided that PRECEDE-PROCEED provides a expert model for your intervention, how do you translate it into action? We'll look at each of the nine phases of the model with that question in listen.

PRECEDE: Doing the background. PRECEDE starts by determining the desired outcome for the customs, and so works back to what has to be done to obtain that effect. Each phase moves one step closer to the actual intervention.

Our presentation of the model assumes that, although it was developed for utilize in public health, it can be used by activists or organizations concerned with whatever issues that touch the quality of life in a community, equally seen in some of the 950 published applications.

Phase 1: Defining the ultimate outcome. The focus here is on what the community wants and needs, which may seem unrelated to the issue you program to focus on. What event does the customs discover about important? Eliminating or reducing a particular problem (homelessness)? Addressing an consequence (race)? >Improving or maintaining certain aspects of the quality of life (ecology protection?) Improving the quality of life in general (increasing or creating recreational and cultural opportunities)?

This stage starts with the collection of demographic data, which is then presented to the community to help citizens decide on priorities. The way to determine what citizens want for their community is to ask them. There are a number of options here, which tin can be used individually or in combination, including:

• Community surveys
• Focus groups
• Phone interviews
• Face-to-face interviews
• Questionnaires in public places

Rather than only asking them for their opinions about what would improve the community, it's far more powerful to involve community members in the whole process from the beginning, including them in all phases of the PRECEDE-Keep model. While actual applications of the model often tend to be elevation-down, information technology is likely to work meliorate if the community has significant input and decision-making power from the commencement.

Stage 2: Identifying the issue. In Phase 2 of PRECEDE, you look for the issues and factors that might cause or influence the effect y'all've identified in Phase i (including supports for and barriers to achieving it), and select those that are most important, and that tin be influenced by an intervention. (One of the causes of community poverty, for instance, may be the global economy, a factor yous probably can't have much consequence on. As of import every bit the global economy might be, you'd accept to alter weather condition locally to have any real impact.)

Information technology'south of import to analyze these issues carefully, and to make sure that you've chosen the right ones. What would the elimination of a particular cistron brand possible, for instance, that isn't possible already? How does a item issue create a barrier to the desired outcome? What else practice these bug affect, also the desired consequence?

Which are the issues with the most drastic effects? And how do you define "the most desperate furnishings?" Are they economical? Social? Physical?

An industry responsible for pollution that really or potentially causes wellness problems may besides be the local economic mainstay. Fifty-fifty if the industry has the all-time of intentions, information technology may be unable to afford to clean up its operation. The town may be faced with the choice of either losing the jobs and tax base that the industry provides, or continuing to live with a health hazard. What's more important here, and how practise you lot decide what to focus on? (And is there an answer that isn't either-or ?)

This kind of situation is by no means universal...but it isn't particularly unusual, either.

In some cases, the issues you choose to focus on may be directly related to the outcome you're seeking – edifice more affordable housing as a way to accost homelessness, for instance. In others, you may exist trying to affect factors that have simply as smashing an impact on the outcome, simply seem further removed from it – e.g., addressing condom streets by providing parenting courses and other services for at-chance families.

Once once more, involving stakeholders and other customs members here is probable to get you the all-time information possible about which issues to emphasize, and to go on you from making mistakes based on ignorance of the community'due south history or of the relationships amongst community members.

Phases 1 and 2 are where you develop the long-term goals for your intervention. They tell you what your ultimate desired consequence should be, and what the effect(s) or associated factors may be that influence information technology. Those are the things you're ultimately aiming to alter.

Almost of the factors influencing the issues or outcomes tin be classified every bit behavioral, lifestyle, or environmental.

The behavior referred to here is a specific, observable, ofttimes measurable – and usually customary – action. Some behaviors put people or communities at more or less risk for health or other problems.

• Needle-sharing is a behavior that puts heroin addicts at high take a chance for hepatitis and AIDS.
• Consistent studying usually lessens the risk of school failure for a educatee.
• If littering is a mutual individual beliefs, information technology may accept customs consequences that range from the aesthetic (piles of trash creating an unattractive scene) to wellness (breeding of mosquitoes in garbage-strewn lots, h2o pollution, etc.) to the economic (businesses unwilling to locate in the customs because of its physical condition). Information technology may likewise have social consequences, with neighborhood conditions affecting residents' self-paradigm, and leading eventually to a breakdown of borough responsibility.

A lifestyle is a collection of related behaviors that go together to class a design of living. Some lifestyles may put people and communities at risk of health and other problems.

• An example of a high-risk lifestyle that is often mentioned in the pop media is 1 that includes very little exercise, a diet loftier in calories and saturated fats, and lots of stress. Such a lifestyle can pb to heart set on, stroke, cardiovascular disease, and other problems associated with obesity, including diabetes.
• A lifestyle that involves gang membership and regular participation in tearing acts has both individual consequences (the constant gamble of serious injury or death, an abort record, disengagement from others' humanity) and consequences for the community (people afraid to apply the streets, reduced economic activity, scarce resources spent on extra law enforcement, etc).

The environment of a particular result or problem tin can refer to the natural, concrete environment – the character and condition of the h2o, air, open space, plants, and wildlife, also as the pattern and condition of built-upwards areas. Only it tin also refer to the social surround (influence of family and peers; community attitudes most gender roles, race, childrearing, piece of work, etc.), the political environment (policies and laws, such as anti-smoking ordinances, that regulate beliefs or lifestyle; the attitudes of those in power toward certain groups or issues), and the economic environment (the availability of decent-wage jobs, affordable housing, and health insurance; the customs tax base; global economic conditions).

In general, behaviors, lifestyles, and environmental factors are what an intervention sets out to change. The changes in these areas in turn affect the crucial issues, and lead to the achievement of the terminal outcome that was identified in Phase one of the model.

And then how do you lot choose which behaviors, lifestyles, or ecology factors to focus on? That'southward where analysis comes in. What are people doing – or what are the factors in the environs – that lead to, maintain, or forestall the outcome or condition y'all want to alter? Using critical thinking and the "But why?" technique, you should be able to narrow it downwards to a handful. The criteria for choosing a detail target for your intervention are: (a) Is the potential target an important enough factor to have a existent effect on the result, and thus on the quality of life in the community? and (b) Is it likely that the potential target can actually exist changed by an intervention that you have the resources to mount?

A classic example of community modify through beliefs alter is that of reducing the incidence of lung cancer and heart disease in a customs by disarming smokers to change their behavior – i.eastward. quit. Fewer smokers mean less secondhand smoke, less time lost from work because of smoke breaks and smoking-related illnesses, fewer low-nascence-weight babies, fewer children with asthma and other respiratory ailments, and lower health insurance costs. Altogether, irresolute smokers' behavior adds upwards to an improvement in the overall quality of life for the customs.

Irresolute smokers' behavior fits both criteria described in a higher place. It has a profound event on the result and on the general quality of life; and it is often responsive to modify, because of many smokers' desire to quit, general knowledge virtually the dangers of smoking, the toll of tobacco products, customs back up, and already-existing strategies and smoking-cessation groups that can exist incorporated relatively cheaply into an intervention.

Phase 3: Examining the factors that influence behavior, lifestyle, and responses to surround. Here, you lot identify the factors that volition create the beliefs and ecology changes you've decided on in Phase 2.

The terms "healthful beliefs" and "risky behavior" beneath refer not only to physical health, merely to any beliefs that's advantageous or harmful to the individual and/or the customs, and is likely to have a significant event on their quality of life.

Predisposing factors are intellectual and emotional "givens" that tend to make individuals more or less likely to adopt healthful or risky behaviors or lifestyles or to approve of or have item environmental weather condition. Some of these factors can ofttimes exist influenced by educational interventions. They include:

• Knowledge. You're more likely, for instance, to avoid sunburn if you lot know it tin lead to skin cancer than if y'all don't.
• Attitudes. People who have spent their youth every bit athletes oft come to see regular do as an integral part of life, as necessary and obvious equally regular meals.
• Behavior. These can be mistaken understandings – believing that annihilation depression in fatty is also depression in calories – or closely held beliefs based on religion or culture – as the quondam saying goes, "Spare the rod and spoil the child," so it'due south important to physically punish your children for mistakes or misdeeds.
• Values. A value system that renounces violence would make a parent less likely to beat a child, or to be physically abusive to a spouse or other family member.
• Confidence. Many people neglect to change risky behavior only considering they don't feel capable of doing so.

Enabling factors are those internal and external conditions direct related to the effect that aid people adopt and maintain salubrious or unhealthy behaviors and lifestyles, or to cover or reject particular environmental conditions. Amidst them are:

• Availability of resources. People with mental wellness problems, for instance, are much more likely to get help if services are readily bachelor.
• Accessibility of services. Services practice no good if they have waiting lists that run into years, or aren't physically accessible to those who need them.
• Community and/or regime laws, policies, priority, and delivery to the issue. Government laws and policies can both strength changes in behavior or environment, and underline the importance of those changes.
• Issue-related skills. People who offset out with a work ethic and an understanding of the workplace, for example, are apt to benefit from task placement programs.

Reinforcing factors, are the people and community attitudes that support or make difficult adopting salubrious behaviors or fostering healthy environmental atmospheric condition. These are largely the attitudes of influential people: family, peers, teachers, employers, health or homo service providers, the media, community leaders, and politicians and other decision makers. An intervention might aim at these people and groups – because of their influence – in lodge to well-nigh finer reach the existent target group.

Phases 2 and 3 comprise the office of the model where the real planning of an intervention has to have place. What are y'all trying to modify, and what are the factors that will help to bring that change virtually? Answering these questions should bring y'all to an agreement of whom and what an intervention should target, who best might deport the intervention, and what it should look similar in order to hit its targets finer.

Stage four: Identifying "best practices" and other sources of guidance for intervention design, as well every bit administrative, regulation, and policy problems that tin can influence the implementation of the program or intervention. Phase 4 helps you lot look at organizational issues that might have an bear upon on your actual intervention. It factors in the furnishings on the intervention of your internal administrative structure and policies, besides equally external policies and regulations (from funders, public agencies, and others).

Design issues: "Matching, mapping, pooling, and patching." or "Selecting, designing, blending, and supporting interventions."

The word of the ways in which organizational bug, particularly internal ones, collaborate with a proposed intervention is one that all too often never takes identify. For that reason, Phase 4 is particularly important. Such a discussion tin avoid mismatches between an arrangement and its proposed intervention (a strictly hierarchical system attempting to implement an intervention meant to empower a group with no vox, for example), or to alert an organisation to an internal or external regulation or policy that needs to exist changed or circumvented for an intervention to proceed as planned.

Administrative problems include organizational structure, procedures, and culture; and the availability of resources necessary for the intervention.

• The organizational structure may be hierarchical, democratic, collaborative, or some combination, and may be more or less rigid or flexible within each of those categories. Information technology should be appropriate to the design of the intervention (due east.g., assuasive for staff decisions in the field in a gang outreach program), and flexible plenty to make adjustments when necessary.
• Organizational procedures are the means in which the organisation really carries out its work. In social club for an intervention to be successful, those procedures have to focus on its goals, rather than on internal convenience or traditional methods. An intake process, for instance, should be designed to be as like shooting fish in a barrel and un-embarrassing for participants as possible – otherwise it can be a barrier to participation.
• The organizational culture. Organizations are social groups that develop cultures of their own. Those cultures oft dictate, amongst other things, how staff members interact with ane another, how program participants are treated, and how the organization views its work and its mission. (Is it just a task, or is information technology God's work?) They also unremarkably determine the fit between an organization and an intervention.
• The resources available for the intervention include non only money – although that's certainly important – only time, personnel, skills, and space. At present is the fourth dimension to pinpoint whatever gaps in resources beforehand, and piece of work to close them. Thus, finding funding and/or the right staff people may be a good part of this phase.

Policy and regulatory bug have to exercise with the rules and restrictions – both internal and external – that tin can affect an intervention, and their levels of flexibility and enforcement.

Internal policies:

• Staff members. Organizational policy may treat staff as employees who accept orders, as colleagues who contribute to the work of the organization, or as collaborators who jointly own it. The corporeality of liberty they have to do their creativity and to accept initiative probably depends on that policy, which may be unstated.
• Participants. Does organizational policy see participants as "clients" that the arrangement is doing something to or for, or as partners in a change effort? Does information technology care for participants respectfully, as equals, or does it deign or act authoritative?

How does the arrangement treat relationships among participants and staff? In some organizations, they may be friendly; in others, strictly professional. (Romantic or sexual relationships heighten some ethical questions, and probably need to be considered separately. Run across "Professional ethics" beneath.)

• Specific practices, methods, or programs. Many organizations maintain policies that suggest or mandate sure ways of conveying out their work.
• Collaboration. Some non-profits make it a point of policy to interact every bit much as possible, while others rarely, if ever, piece of work with other organizations.
• Professional ideals. Many organizations wait staff members to adhere to a code of professional ideals – either an internal one, or ane set out past a professional association – that governs confidentiality, inappropriate relationships, abuse of position, reporting (or non-reporting) of specific kinds of illegal behavior, etc. There may be organizational regulations about these areas as well.

External policies and regulations that might affect an intervention tin can come in a variety of forms:

• Funders' requirements. These may utilize to the intervention itself, or they may identify restrictions on annihilation the organization can do, even those areas – such as, perhaps, this intervention – that aren't funded directly past the funder in question.
• Oversight agency regulations. The arrangement may exist subject to the authority of a state or federal agency whose regulations affect the intervention.
• State or federal laws, or local ordinances
• Unstated community policies. Sure actions may only be unacceptable to the majority of the community, to coalition partners, etc.

Go on: Implementing and evaluating the intervention .

Phase 5: Implementation. At this point, y'all've devised an intervention (largely in Phases 3 and 4), based on your analysis. Now, you take to carry it out. This stage Involves doing merely that – setting up and implementing the intervention y'all've planned.

The final three phases take place as the intervention continues, and serve to assist yous monitor and adjust your piece of work to get in as effective every bit possible.

Phase half dozen: Procedure Evaluation. This phase isn't virtually results, just about procedure. The evaluation here is of whether you're actually doing what you planned. If, for case, you lot proposed to offering mental health services three days a calendar week in a rural area, are yous in fact offering those services?

Stage 7: Impact Evaluation. Hither, you begin evaluating the initial success of your efforts. Is the intervention having the desired effect on the behavioral or environmental factors that it aimed at changing – i.e., is it really doing what you expected?

Phase eight: Outcome Evaluation. Is your intervention really working to bring about the effect the community identified in Phase one? It may be completely successful in every other mode – the process is exactly what you planned, and the expected changes made – just its results may have no event on the larger issue. In that case, you lot may take to first the process again, to see why the factors you focused on aren't the right ones, and to identify others that might piece of work.

Some outcomes may not be apparent for years or decades. Lifestyle changes fabricated by young people to stave off center disease and stroke, for instance, commonly won't reveal their health benefits until those people are well into middle age. If you know that an outcome may not prove itself for a long time, you may merely have to be patient and continue to monitor the process and impact of your intervention, with the belief that the eventual result volition become apparent in time.

Phases vi-8 phone call for formal evaluations of each phase, with controlled studies and detailed findings, but well-nigh Community Tool Box users probably don't have the resources for that, and shouldn't expect to do it. That doesn't mean you shouldn't evaluate, nevertheless.

Information technology's a relatively elementary matter, for instance, to go along records and to examine them to find out whether your procedure was carried out as planned, or simply to look at what y'all are doing to meet whether it matches what you intended to do. The same is true for the other stages of evaluation. Don't worry if you can't practise a formal report...but don't let evaluation get, either. It's an important part of the process.

Recall also that evaluation is ongoing throughout the piece of work. It takes place while the intervention is being implemented, non afterwards. The whole bespeak of evaluation of each phase of the model is to accommodate or change what y'all're doing in that phase, if necessary, to make it more effective.

At any point in the Keep continuum, you should be prepared to revisit your assay. If yous find a gap betwixt your planning and reality, or if y'all realize that your intervention isn't achieving the results you aimed at, you should go dorsum to the PRECEDE part of the model, try to decide what needs to be inverse, and adjust what you're doing appropriately. The point of evaluation is not to see whether you pass some kind of test – information technology's to make certain that your intervention brings almost the outcome that the community wanted or needed in the offset place.

In Summary

PRECEDE-PROCEED provides a logic model that tin serve every bit the basis for an individual, 1-time intervention or a decades-long community evolution plan or project. Although designed for health programs, it's adjustable to other community issues as well. As with many models, it'due south meant to be a guide, not a prescription.

PRECEDE-PROCEED is community-based and participatory, founded on the premise that changes promoting health (and other community bug) are largely voluntary, and therefore demand the participation of those needing to modify and others who might influence them or be influenced by them.

A major reason to utilise PRECEDE-Keep is that it is a logic model. As a consequence, it will provide a construction within which to plan your piece of work, and organize both your thinking and your actions, and then that your intervention will be a carefully-planned, coherent whole, rather than cobbled together. As a logic model, information technology also provides a guide for analyzing the issues involved, and choosing both the most probable areas to address and the most likely avenues to address them.

There are also reasons to use PRECEDE-PROCEED specifically. First, it'south a participatory model. By involving the community, it volition both bring more and better ideas near bug and resolving them, and build community ownership of the intervention. 2nd, since information technology includes multi-level (ecological) planning and evaluation, PRECEDE-Go along builds in monitoring of the intervention, allowing for adjustment and greater effectiveness. And finally, the model allows the freedom to arrange the structure to whatever content and methods come across the needs of your community.

PRECEDE is the diagnostic portion of the model. It starts with the idea that the focus of alter must be on its desired outcome, and works backward from that issue to construct an intervention that will bring it about. It has four phases:

Phase 1: Social diagnosis – determine what the community wants and needs to better its quality of life.

Phase 2: Epidemiological diagnosis – determine the wellness problems or other problems that affect the community's quality of life. Include also the behavioral and ecology factors that must change in society to address these problems or problems. Behavioral factors include patterns of beliefs that constitute lifestyles. In considering environmental factors, you should include the physical, social, political, and economic environments.

Phases 1 and ii identify the goals of the intervention.

Phase 3: Educational and organizational diagnosis – make up one's mind what to do in guild to change the behavioral and environmental factors in Phase 3, taking into account predisposing factors (knowledge, attitudes, behavior, values, and confidence); enabling factors (availability of resources, accessibility of services, government laws and policies, issue-related skills), and reinforcing factors (largely the influence of significant others in the social environment).

Stage 4: Designing programs or interventions and the support for them through administrative and policy diagnosis – make up one's mind (and address) the internal administrative and internal and external policy factors that can affect the success of your intervention. The quondam include organizational structure, procedures, culture, and resources; the latter encompass both internal policies and funders' requirements, oversight agency regulations, state or federal laws, or local ordinances, and unstated customs policies.

Phases 3 and 4 set the structure and targets for the planning and pattern of the intervention.

PROCEED is, in medical terms, the handling portion of the model, and comprises the implementation and evaluation of the intervention. It consists of four phases:

Phase 5: Implementation – carry the intervention.

Phase 6: Procedure evaluation – decide whether the intervention is actually taking the actions intended.

Phase 7: Bear upon evaluation – determine whether the intervention is having the intended furnishings on behaviors and/or environment.

Phase 8: Event evaluation – determine whether the intervention ultimately brings about the improvements in quality of life identified past the community equally its desired event.

An unstated but important part of the model is that, at any point, your program or intervention can and should be revisited and revised, based on connected assay and the results of the various evaluations.

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Source: https://ctb.ku.edu/en/table-contents/overview/other-models-promoting-community-health-and-development/preceder-proceder/main

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