The Underlying Theories of Precede-Proceed Model Understanding Causal Assumptions and Intervention Assumptions

Prototype of Causal Models and Intervention Models Problem Theory: Causes->->->->->->->Effects INPUTS (educational, organizational economic, etc.) OUTPUTS (health, quality of life, develop-ment) X ? Most models for planning contain an implicit or an explicit set of assumptions about causation. Unfortunately, these assumptions are too often implicit, so we are left to guess what factor X involves. Is it just behavior, or is it just environment, or is it some combination of lifestyle, environment and health services... Different models interpret the content of “X?” according to different theories (or assumptions) about causation and control. 10

Examples of Causal Theories on Which PRECEDE-PROCEED is Based Psychological theories in which X includes behavior, and its antecedents such as attitudes, beliefs, perceptions, and other cognitive variables Sociological theories in which X includes organizational functioning and interorganizational exchange and coalitions. Economic theories in which X includes consumer behavior and organizational response to consumer demand. Pathophysiological theories in which X includes organisms or environmental exposure processes.

Action Theory and Program Theory Use Causal Theories to Link Intervention and Outcomes Action Theory and Program Theory Use Causal Theories to Link Interventions & Outcomes Intervention Variable Ca usa l Variable Outcome Variable Action Theory Program Theory Success Success *Action Theory and Conceptual Theory Intervention Evaluation Model. Chen 1990. p. 200

Mediating and Moderating Variables Mediator Intervention Outcome Variable Variable Mediator Moderator

Prototype of the Resource-Based Planning Approach* 1. Select Resource or Service to be Studied 4. Evaluate Use of the Resource or Service 2. Assess Demand for the Resource or Service 3. Increase Resource or Increase Demand *A procedural model, as distinct from a causal model. 11

Strengthening Population-based, Diagnostic Planning Approaches* Participatory Research 1. Assess Needs, Assets of Population 2. Assess Causes, Set Priorities & Objectives 4. Evaluate Program Reassess causes Redesign 3. Design and Implement Program *Green & Kreuter, Health Promotion Planning, 3rd ed., Mayfield, 1999.

*Green & Kreuter, Health Promotion Planning, 3rd ed., 1999. Surveillance, Planning and Evaluating for Policy and Action: PRECEDE-PROCEED MODEL* Health education Policy regulation organization Public Phase 5 Administrative & policy assessment Predisposing Reinforcing Enabling Phase 4 Educational & ecological assessment Behavior Environment Phase 3 Behavioral & environmental assessment Health Phase 2 Epidemiological assessment Quality of life Phase 1 Social assessment Phase 6 Implementation Phase 7 Process evaluation Phase 8 Impact evaluation Phase 9 Outcome evaluation Input Process Output Short-term impact Longer-term health outcome Short-term social impact Long-term social impact *Green & Kreuter, Health Promotion Planning, 3rd ed., 1999.