This document discusses several conceptual models used in community health: - The Precede-Proceed Model is an 8-phase model for planning, implementing, and evaluating public health programs by first assessing needs and then implementing and evaluating an intervention. - The Donabedian Model examines health care quality using three concepts: structure, process, and outcomes to evaluate how structure influences processes and outcomes. - The Health Belief Model suggests individuals' health-related actions depend on their perceptions of susceptibility, severity, benefits, and barriers of diseases or health behaviors. It includes six constructs related to risk perceptions and decision-making.

1. CONCEPTUAL MODELS IN
COMMUNITY HEALTH
BY
MARIA NJOKI THIONG’O
SHS/BSN/5345-2/2022

2. OBJECTIVES
1. Understand what a Conceptual Model is
2. Describe the Precede-Proceed Model
3. Describe the Donabedian Model
4. Describe the Health Belief System Model

3. WHAT IS A CONCEPTUAL MODEL?
•Abstract, psychological representations of how tasks
should be carried out.
•Representation of a system that uses concepts and ideas
to form said representation.
•Way to describe physical or social aspects of the world in
an abstract way.

4. PRECEDE-PROCEED
MODEL

5. PRECEDE-PROCEED MODEL
•Developed for use in public health but its basic principles
transfer to other community issues too.
•Not only a model for health intervention but for community
health in general.
•Focus: Community is a wellspring of health promotion.
•Latter half of 20th Century
•Medical advances shifted focus from treatment of diseases to
prevention of illness and recently, to the active promotion of healthy
behaviors and attitudes

6. PRECEDE-PROCEED MODEL
•It is a comprehensive structure for:
•Assessing health needs,
•Designing, Implementing & Evaluating health promotion and other
public health programs to meet those needs.
•PRECEDE: provides the structure for planning a targeted and
focused public health program.
•PROCEED: provides the structure for implementing and
evaluating the public health program.

7. PRECEDE-PROCEED MODEL:
PRECEDE
•Stands for: Predisposing, Reinforcing, and Enabling Constructs
in Educational Diagnosis and Evaluation.
•Involves assessment of various community factors. Has 4
Phases:
•Phase1-Social Assessment: Determine the social problems and
needs of a given population and identify desired results.
•Phase2-Epidemiological assessment: Identify the health
determinants of the identified problems and set priorities and
goals.
•Phase 3-Ecological assessment: Analyze behavioral and
environmental determinants that predispose, reinforce, and enable
the behaviors and lifestyles identified.

8. PRECEDE CONTD.
• Phase 4-Identify administrative and policy factors that
influence implementation and match appropriate interventions
that encourage desired and expected changes.
•Implementation of interventions

9. PRECEDE-PROCEED MODEL:
PROCEED
•Stands for Policy, Regulatory, and Organizational
Constructs in Educational and Environmental Development.
•Involves the identification of desired outcomes and
program implementation. Also has 4 Phases:
•Phase 5-Implementation: Design intervention, assess the
availability of resources, and implement the program.
•Phase 6-Process Evaluation: Determine if the program is
reaching the targeted population and achieving desired goals.
•Phase 7-Impact Evaluation: Evaluate the change in behavior.

10. PROCEED CONTD.
•Phase 8-Outcome Evaluation: Identify if there is a decrease in
the incidence or prevalence of the identified negative behavior
or an increase in identified positive behavior.

12. DONABEDIAN MODEL

13. DONABEDIAN MODEL
•Developed by Dr. Avedis Donabedian in the year 1966.
•Provides a framework for examining health services and
evaluating the quality of health care.
•It has 3 components:
• STRUCTURE
• PROCESS
• OUTCOMES
• BALANCING-additional component.
•Donabedian believed that structure measures have an effect on
process measures and in turn impact outcome measures.
• These 3 form the basis for what is needed for an effective suite of measures.
• Patient + structure + process = outcome.

14. DONABEDIAN MODEL: STRUCTURE
MEASURES
•These are otherwise known as input measures.
•Reflect the attributes of the service/provider such as staff-to-patient
ratios and operating times of the service.
Examples:
•How staff is trained and educated.
•Treatment protocols and procedures health facilities utilize.

15. DONABEDIAN MODEL: PROCESS
MEASURES
•Reflect on the way systems and processes work to deliver the
desired outcome.
Examples:
•Length of time a patient waits for a senior clinical review
•A patient receives certain standards of care or not
•If staff wash their hands
•Recording of incidents and acting on the findings
•Whether patients are kept informed of the delays when waiting for an
appointment.

16. DONABEDIAN MODEL: OUTCOME
MEASURES
•Reflect on the impact on the patient and demonstrate the end
result of your improvement work and whether it has ultimately
achieved the aim(s) set.
Examples:
•Outcome measures are reduced mortality
•Reduced length of stay
•Reduced hospital-acquired infections
•Reduced emergency admissions and improved patient
experience.

17. DONABEDIAN MODEL: BALANCING
MEASURES
•Reflect unintended and/or wider consequences of the change can be
positive or negative.
Examples:
•Recognizing these and attempting to measure them and/or reduce
their impact if necessary.
•Monitoring emergency re-admission rates following initiatives to
reduce the length of stay.

19. HEALTH BELIEF MODEL

20. HEALTH BELIEF MODEL
•Developed in the early 1950s by social scientists at the U.S.
Public Health Service:
• to understand the failure of people to adopt disease prevention strategies or
screening tests for the early detection of disease.
• later-for patients' responses to symptoms and compliance with medical
treatments.
•Suggests that a person's belief in a personal threat of an illness
or disease & a person's belief in the effectiveness of the
recommended health behavior/ action will predict the likelihood
the person will adopt the behavior.

21. HEALTH BELIEF MODEL
•Derives from psychological and behavioral theory with the
foundation that the two components of health-related behavior:
1. the desire to avoid illness, or conversely get well if already ill;
2. the belief that a specific health action will prevent, or cure, illness.
•Individual's course of action often depends on the person's
perceptions of the benefits and barriers related to health
behavior.

22. HEALTH BELIEF MODEL
• It has six constructs:
1. Perceived susceptibility:
• A person's subjective perception of the risk of acquiring an
illness or disease.
•There is wide variation in a person's feelings of personal
vulnerability to an illness or disease.

23. HEALTH BELIEF MODEL
2. Perceived severity:
•A person's feelings on the seriousness of contracting an illness
or disease (or leaving the illness or disease untreated).
•There is wide variation in a person's feelings of severity. Often
a person considers the medical consequences (e.g., death,
disability) and social consequences (e.g., family life, social
relationships) when evaluating the severity.

24. HEALTH BELIEF MODEL
3. Perceived benefits:
• A person's perception of the effectiveness of various actions
available to reduce the threat of illness or disease (or to cure
illness or disease).
•The course of action a person takes in preventing (or curing)
illness or disease relies on consideration and evaluation of both
perceived susceptibility.
•Perceived benefit, such that the person would accept the
recommended health action if it was perceived as beneficial.

25. HEALTH BELIEF MODEL
4. Perceived barriers:
•A person's feelings on the obstacles to performing a
recommended health action.
•There is wide variation in a person's feelings of barriers, or
impediments, which leads to a cost/benefit analysis.
•The person weighs the effectiveness of the actions against the
perceptions that they may be expensive, dangerous (e.g., side
effects), unpleasant (e.g., painful), time-consuming, or
inconvenient.

26. HEALTH BELIEF MODEL
5. Cue to action:
• Stimulus needed to trigger the decision-making process to
accept a recommended health action.
•Can be internal (e.g., chest pains, wheezing, etc.) or external
(e.g., advice from others, illness of family member, newspaper
article, etc.).

27. HEALTH BELIEF MODEL
6. Self-efficacy:
•The level of a person's confidence in his or her ability to
successfully perform a behavior.
•This construct was added to the model most recently in mid-
1980.
•Self-efficacy is a construct in many behavioral theories as it
directly relates to whether a person performs the desired
behavior

29. REFERENCES
• Community Tool Box https://ctb.ku.edu/en/table-
contents/overview/other-models-promoting-community-health-
and-development/preceder-proceder/main
•A Model for measuring quality care
https://www.med.unc.edu/ihqi/wp-
content/uploads/sites/463/2021/01/A-Model-for-Measuring-
Quality-Care-NHS-Improvement-brief.pdf
•Rural Health Information Hub
https://www.ruralhealthinfo.org/toolkits/health-
promotion/2/program-models/precede-
proceed#:~:text=The%20PRECEDE%2DPROCEED%20model%20is,and%
20focused%20public%20health%20program.