Preparation of model health education plan, PRECEDE-PROCEED.pptx

Preparation of model health
education plan, PRECEDE-
PROCEED Model, including
sustainable planning
Presenter
Jagat Prasad Upadhyay
Muskan Pudasainee
MPH 2nd Semester
School of Health and Allied Science
(SHAS)
11/11/2023 PREDEDE- PROCEED Model 1

Presentation Outline
• Introduction
• PRECEDE-PROCEED Model (Theory)
• PRECEDE-PROCEED Model (Health Education Program Planning)

Health Education
• Health education is a process of educating people about health.
• Communication activity aimed at enhancing positive health and preventing or
diminishing ill-health in individuals and groups through influencing the
beliefs, attitudes and behaviors of those with power and of the community at
large
-(Downie, Fyfe, and Tannahill, 1994)
• Health education comprises consciously constructed opportunities for
learning involving some form of communication designed to improve health
literacy, including improving knowledge, and developing life skills that are
conducive to individual and community health.
-(WHO, 1998)

PRECEDE-PROCEED Model
• The PRECEDE-PROCEED model is a comprehensive structure for
assessing health needs for designing, implementing and evaluating
health education, 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.
• Given by, Lawrence W. Green, Marshall Krueter
• For PRECEDE, (Approx. 1968 – 1974)
• For PROCEED, (Late 1980s)

PRECEDE
• P = Predisposing,
• R = Reinforcing,
• E = Enabling,
• C = Causes in,
• E = Educational,
• D = Diagnosis, and
• E = Evaluation
PROCEED
• P = Policy,
• R = Regulatory,
• O = Organizational,
• C = Constructs in,
• E = Educational, and
• E = Environmental
• D = Development

PRECEDE
• Look at present outcomes of health habits and quality of life of the
target population
• Ask “WHY?” rather than “HOW?”
• First portion of the model
• Diagnostic phase
• Built on the belief that there is a need to engage in
multidimensional diagnoses to more effectively determine factors
that may influence health status in the community

PROCEED
• Goes beyond educational interventions to the political, managerial,
and economic actions necessary to make social system
environments more conducive to healthful lifestyles and a more
complete state of physical, mental and social well-being for all.

PRECEDE (Diagnostic Part)
• Phase 1- Social Diagnosis
• Phase 2- Epidemiological Diagnosis
• Phase 3- Behavioral & Environmental Diagnosis
• Phase 4- Educational Diagnosis
• Phase 5- Administrative & Policy Diagnosis

PROCEED (Implementing and Evaluating Part)
• Phase 6- Implementation
• Phase 7- Process Evaluation
• Phase 8- Impact Evaluation
• Phase 9- Outcome Evaluation

Phase 1: Social Diagnosis
• Determine people’s perceptions of their own needs and quality of
life.
• Important because of reciprocal relationship between health and
quality of life
• Links between social problems & specific health problems used to
develop focus for health education
• Methodology for social diagnosis:
Interviews, Focus group discussions, RRA (rapid rural appraisal),
Participatory rural appraisal (PRA), Observation – participatory &
non-participatory, Surveys, Literature Review etc

Phase 2-Epidemiological Diagnosis
• Identify which health problems are most important to the
population or community that are associated with the quality of
life
• Identify specific health problems and non-health factors which are
associated with a poor quality of life
• Answer “What health problems are important (measured
objectively, rather than subjectively)?”
• Establish the relationships between health problems and quality
of life
• Establish dimensions for measuring health problems – indicators
for morbidity, mortality, & disability
• Set priorities within health problems and within target population.

Phase 3- Behavioral & Environmental
Diagnosis
• Seek to identify behavioral and environmental factors contribute
to the health problems of the interest
• Focuses on systematic identification of health practices and other
factors which seem to be linked to health problems defined in
Phase 2
• Includes non-behavioral causes (personal and environmental
factors) that can contribute to health problems, but are not
controlled by behavior

Phase 3- Behavioral & Environmental
Diagnosis
• Behavioral factors are those behaviors or lifestyle of the
individuals at risk that contribute to the occurrence and severity
of the health problem
• Environmental factors
• Are 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
• Modified environmental factors usually requires strategies other than
education

Phase 4- Educational Diagnosis
• This phase identifies those antecedent and reinforcing factors that
initiate and sustain the change process
• Three types of factors are identified:
• Predisposing factors
• Enabling factors
• Reinforcing factors

• Predisposing factors are the factors that provide the rationale or
motivation for a behavior.
• Knowledge
• Attitudes
• Beliefs
• Values
• Perceived needs and abilities

• Reinforcing factors are those elements that appear subsequent to
the behavior and that provide continuing reward or incentive for
the behavior to become persistent
• Social support - reward, or punishment
• Peer influence
• Significant others’ support

• Enabling factors are those that enable (allows) motivation to be
realized; can affect behavior directly or indirectly through a
conducive environmental
• Programs, services, and resources necessary for behavioral
change
• Accessibility, availability, skills

Phase 5- Administrative and Policy Diagnosis
• Focuses on administrative and organizational concerns which
must be addressed prior to program implementation
• Includes identification of policies, assessment of resources(time,
people, funding), concerned organization and coordination with
others that could facilitate or hinder program implementation

Phase 5- Administrative and Policy Diagnosis
• Administrative Diagnosis
• Analysis of policies, resources and circumstances prevailing
organizational situations that could hinder or facilitate the
development of the health program
• Policy Diagnosis
• Assesses the compatibility of your program goals/objectives with
those of the organization and its administration

Phase 6- Implementation of the Program
• Planned activities and strategies are carried out with the target population
• Includes development of implementation timetable, organization and
coordination with others
Strategies of implementing health education programme:-
1. Building commitment
2. Training of health education workers
3. Mobilizing and utilizing resources
4. Organizing Community
5. Monitoring the programme
6. Supervision of HE programme
7. Recording and reporting

Phase 7- Process Evaluation
• Determine the extent to which the program was implemented
according to protocol (Overall program)

Phase 8- Impact Evaluation
• Assesses change in predisposing, reinforcing and enabling factors,
as well as in the behavioral and environmental factors (Program
Impact)

Phase 9- Outcome Evaluation
• Outcome evaluation determines the effect of the program on
health and quality of life.

Planning, Implementation, and evaluation of health
education program on Diabetes Mellitus by using
PRECEDE-PROCEED model on Dhangadi Sub-
Metropolitan city, ward no:6, Matiyari, Kailali

Introduction
• Diabetes mellitus refers to a group of diseases that affect how the
body uses blood sugar (glucose).. More commonly referred to as
“diabetes”
Type 1 DM (Insulin-dependent DM / childhood-onset diabetes)
• Type 1 DM characterized by beta cell destruction caused by an
autoimmune process, usually leading to absolute insulin deficiency
• it is usually seen in individuals<30 years of age

Introduction
Type 2 DM (Non-insulin dependent DM / Adult-onset diabetes)
• It is characterized by insulin resistance in peripheral tissue and an insulin
secretory defect of the beta cell.
• It is Most common form of diabetes mellitus and mainly occurs in the middle-
aged and elderly
• It accounts for 90-95% of all cases of diabetes.
Prediabetes. Blood glucose levels are higher than what’s considered normal,
but not high enough to qualify as diabetes.
Gestational diabetes. Gestational diabetes is a type of diabetes that can
develop during pregnancy in women who don't already have diabetes

Risk Factors
Type 1
• Family history: Having a
parent, brother, or sister
with type 1 diabetes.
• Age: You can get type 1
diabetes at any age, but it
usually develops in children,
teens, or young adults.
Type 2
• Have prediabetes.
• Are overweight.
• Are 45 years or older.
• Have a parent, brother, or
sister with type 2 diabetes.
• Are physically inactive

Preventive Measures

Diabetes around the world in 2021
Sources: International Diabetes Federation Diabetes Atlas, 2021

Southeast Asia Scenario
• 1 in 11 adults (90 million) are living with diabetes.
• The number of adults with diabetes is expected to reach 113
million by 2030 and 151 million by 2045.
• Over 1 in 2 adults living with diabetes are undiagnosed.
• 747,000 deaths caused by diabetes in 2021.
• USD 10 billion spent on diabetes in 2021.

Prevalence of diabetes in the WHO South-East
Asia Region
Country Adults with diabetes (20–79 y),
1,000s
Diabetes prevalence (20–79 y) ( %)
Bangladesh 13136.3 12.5
Bhutan 44.8 8.8
India 74194.7 8.3
Maldives 27.0 6.7
Nepal 1133.5 7.2
Srilanka 1417.6 9.8

National Scenario
• Diabetes mellitus is one of the leading cause of death in Nepal.
• According to the latest WHO data published in 2017 Diabetes Mellitus
Deaths in Nepal reached 6,482 or 3.97% of total deaths.
• Prevalence of diabetes was 7.2 percent among adults (20-70)yrs (IDF 2021),
a recent nationwide survey shows a prevalence of Diabetes Mellitus as 8.5%
(men: 4.6% and women: 2.7%) among 15-69 years population (STEPS
Survey 2013); however some sources indicated higher prevalence of about
11 percent in certain areas.
Source: Nepal health profile , Multi-sectoral Action Plan on the Prevention and Control of NCD in Nepal 2014-2020

Phase I: Social Diagnosis
• Literacy rate = 65%
• 12% people are physically inactive,
• Unemployment rate is 15%
• Poor living condition
• Low income
11/11/2023
PREDEDE- PROCEED Model
Note:- All Data are Imaginary
36

Phase II – Epidemiological Diagnosis
• Burden of Disease:-
• Prevalence of DM :- 55%
• High in male than female
• % of smoker & alcohol drinker are more than 50.
• More than 20% of the population are overweight.
• It is common in physically inactive, overweight, smoker, alcohol
consumption etc.
Note:- All Data are Imaginary

Phase III: Behavioral and Environmental
Diagnosis
Behavioral:-
• Habit of living luxurious lifestyle.
• Ignorance of Personal Health.
• Increase consumption of junk food.
• Habit of Smoking & drinking alcohol
Environmental:-
• Area for physical exercise.

Phase IV: Educational and Organizational
Diagnosis
Predisposing Factors:-
• 65% of People have lack of knowledge on Diabetes Mellitus.
• 60% of people don’t know about the risk factor of DM.
• Only 30% of the total population have known about the Preventive
measures of DM.

Phase IV: Educational and Organizational
Diagnosis
Reinforcing Factors:-
• Food culture of the family
• High advertisement and social marketing of Junk food.
• Peer Influence
Enabling Factors:-
• Easy availability of junk food

Phase V: Administrative and Policy
Diagnosis
• Multi-sectoral Action Plan on the Prevention and Control of NCD in
Nepal 2014-2020
• Non Communicable Diseases Risk Factors: STEPS Survey Nepal
2019
• PEN Package
• WHO guidelines related to NCDs

Goal and Objectives
Goal:- Promoting healthy lifestyle through social behavior change
communication for the prevention and control of Diabetes Mellitus

Goal and Objectives……
Objectives:-
By the end of this programmes
• 80% of participant will be able to know the DM.
• 80% of the participant will be able to list 3-4 risk factor of DM.
• At least 50% of Participants will know about the effect of high intake of fat, salt,
sugar and carbohydrate.
• 70% of the participant will be able to list at least 3-4 Preventive measures of
DM
• 60% of the participant will know about the importance of physical activity in
preventing DM

Content to be Taught
• Introduction of DM
• Risk factor of DM
• About junk food & its health impact.
• Preventive measure of DM
-Daily requirements of fat, salt, sugar and Carbohydrate
- Physical Activity & its importance.

Target group
• 30 participant of the Dhangadhi sub-metropolitan city ward no. 6,
Matiyari & age between 20-60 years.

Methods and Media
Methods
• Mini-Lecture/lecture
• Short Film/Documentary
• Role play
Media
• Pamphlets
• Projector
• Laptop
• Posters

Resources
• Health educator:- MPH 2nd semester students and health
coordinator of health section
• IEC materials will be managed from Health office/Health
section/health facilities.
• Laptop and documentary/film will be managed by Ourselves.
• Required Money will be managed by Ourselves.
• Hall:- Bhairav higher secondary school, matiyari
• Materials:- Projector will be managed from School

Detail Plan of Action
• Health Education programme will be conducted for 1 day
Detailed Plan of action

Phase VI: Implementation of the Program
Strategies of implementing health education programme:-
1. Building commitment
2. Training of health education workers
3. Mobilizing and utilizing resources
4. Organizing Community
5. Monitoring the programme
6. Supervision of HE programme
7. Recording and reporting

Building commitment
• Local political leaders, Teachers group, Mothers group, Youth club, FCHVs etc.
should be committed to cooperate for the success of the health education
programme.
• The group of Health education provider should be committed to motivate all
active group participant to motivate for the cooperation for the success of the
health education programme
• The group of health education provider should be committed to provide
quality education to the participant.

Training of Health Education Workers
• Health Educator must be trained to provide quality health
education.

Mobilizing and Utilizing Resources
• Resource must be adequate before the conduction of health education
program (such as human, money, materials & time).
• Proper mobilization of these resources must be done for effective result.
• Maximize the use of locally available resources for effective result.

Organizing Community
• Involve of the participant as a volunteer during the conduction of the
program; for role play, registration etc.
• A committee Organize for monitoring, evaluation and follow-up of the
program.

Monitoring the programme
• To check whether the programme is going on as planned or not
monitoring will be done.
• Regular checking of the programme is done by the help of
organized committee and by health educator themselves.
• It will be done by-
• Interviewing the concerned person
• Suggesting on problems if any

Supervision of HE programme
• For the supervision of the program, there will be a Supervising
Committee consisting four MPH 2nd Semester student. The
supervising committee will provide:-
 Guidance
 Direction
 Suggestion
 Feedback
• The use of close questionnaire, observation checklist.

Recording and reporting
• Recording and reporting of each event should be done by MPH 2nd
Semester students.

Evaluation
• Process Evaluation
• Impact Evaluation
• Outcome Evaluation

Phase VII: Process Evaluation
Evaluation of
• Goal
• Objectives
• Detail plan of action
• Materials
• Methods & Media
• Resource person
• Health education program as a whole
Evaluation tools/techniques:- Observation-checklist

Phase VIII: Impact Evaluation
Short term impact evaluation:-
• Assessment of knowledge of all participant through Pretest and
post test evaluation.
• Tools for evaluation
• Questionnaire
-pre test, post-test

Phase VIII: Impact Evaluation cont. …
Long term impact evaluation:-
• Dietary habit of participants.
• Physical exercise of the participants
• Attitude of people on diabetes mellitus.
• Tools for evaluation:-
• Observation
• Record review for health seeking behaviour

Phase IX: Outcome evaluation
• Prevalence of DM
• Mortality due to DM
• Tools for evaluation:-
• Secondary Data review

References
• Prevalence of diabetes mellitus and associated risk factors in Nepal:
findings from a nationwide population-based survey
• Nepal Burden of Disease 2019: A Country Report based on the
2019 Global Burden of Disease study

THANK YOU!

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