Module 5 PROCEDE PROCEED Model Assignment

Chapter 13 PRECEDE-PROCEED Model “He who has health, has hope; and he who has hope, has everything” ~ Thomas Carlyle PRECEDE-PROCEED • PRECEDE-PROCEED Model (PPM) – a structure for applying theories so the most appropriate intervention strategies can be identified and implemented • Not considered a theory, but rather a planning model or conceptual framework for practice • One of the most widely used program planning frameworks • Unlike other theories, PPM does not attempt to predict or explain the relationship among factors thought to be associated with an outcome of interest PRECEDE-PROCEED PRECEDE P = predisposing R = reinforcing E = enabling C = constructs E = educational/ecological D = diagnosis E = evaluation PROCEED P = policy R = regulatory O = organizational C = constructs E = educational E = environmental D = development PRECEDE-PROCEED PRECEDE-PROCEED • The PPM contains 8 Phases: • Phase 1: Social Assessment • Phase 2: Epidemiological Assessment • Phase 3: Educational and Ecological Assessment • Phase 4: Administrative and Policy Assessment and Intervention Alignment • Phase 5: Implementation • Phase 6: Process Evaluation • Phase 7: Impact Evaluation • Phase 8: Outcome Evaluation PRECEDE-PROCEED PRECEDE-PROCEED • Phase 1 – Social Assessment: Identify social problems that impact quality of life, health care, and priorities of individuals or populations • Primary Data – information collected first-hand • Planners expand understanding of the community by conducting multiple data collection activities, such as interviews with key opinion leaders, focus groups with members of the community, observations, and surveys • Example: unemployment, absenteeism, crime, crowding, overall population health PRECEDE-PROCEED • Phase 2 – Epidemiological Assessment: determine health issues associated with quality of life • Secondary Data – data which have previously been collected by other researchers, such as vital statistics, state and national health surveys, medical and administrative records • Subgroups may be characterized by age, gender, ethnicity, occupation, education, income, family structure, geographical location, etc. • Example: morbidity, mortality, risk factors, disability, longevity, intensity, incidence, prevalence PRECEDE-PROCEED • Phase 2 – Epidemiological Assessment: • Behavioral determinants of health exist on three levels: • Physical – behaviors which contribute to the presence and severity of health problems (smoking, poor nutrition, and sedentary lifestyle) • Social – behaviors of individuals who can influence the actions of the person at risk (parents, spouses, or friends) • Environmental – external factors beyond the control of the individual (policies and law makers) PRECEDE-PROCEED • Phase 2 – Epidemiological Assessment: • Prioritization Matrix – a tool which program planners utilize to help prioritize the physical, social, and environmental determinants PRECEDE-PROCEED • Phase 3 – Educational & Ecological Assessment: Predisposing, reinforcing, and enabling factors all influence the likelihood that health behavior change will occur • Predisposing Factors: Antecedents to behavior that provide the rationale or motivation for the behavior (knowledge, attitudes, existing skills, values, beliefs) • Reinforcing Factors: Reward or incentive for the persistence or repetition of the behavior (attitudes and beliefs of others, social support, peer influence, vicarious reinforcement) • Module 5 PROCEDE PROCEED Model Assignment

Enabling Factors: Antecedents to behavioral or environmental change that allow motivation or policy to be realized (resources, programs, services, accessibility, skills) PRECEDE-PROCEED • Phase 4 – Administrative & Policy Assessment & Intervention Alignment: Policies, resources, and circumstances prevailing that could facilitate or hinder program implementation • The resources needed to launch and sustain the program • The organizational barriers that effect implementation • Policies that support the program or need to be changed PRECEDE-PROCEED • Phase 5 – Implementation: • The act of converting planning, goals, and objectives into action through administrative structure, management activities, policies, procedures, regulations, and organizational actions of new programs • When a program planner reaches this phase, the program should be finalized and ready to be put into action PRECEDE-PROCEED • Phase 6 – Process Evaluation: An evaluation designed to document the degree to which replicable program procedures were implemented with fidelity by trained staff according to a written plan • How well and how much of the assessment and intervention procedures were provided, to whom, when, and by whom? • The extent to which the program was implemented according to the set protocol • Appropriateness of content, methods, materials, media, instruments PRECEDE-PROCEED • Phase 7 – Impact Evaluation: • The extent of change in the predisposing, reinforcing, and enabling factors in addition to the behavioral and environmental factors • An evaluation designed to produce qualitative and quantitative data and insight during the early developmental phase of an intervention, including the assessment of: • Immediate (1-hour to 1-week) or short-term (1-week to 6-months) cognitive, psychosocial, psychomotor (skill), and/or behavioral impact of an intervention for a well-defined population at risk PRECEDE-PROCEED • Phase 8 – Outcome Evaluation: • The effectiveness of the program and whether the program reached its goals and objectives • An evaluation using an experimental or quasiexperimental design to document program feasibility, efficacy, or effectiveness, and costeffectiveness or cost-benefit in producing longterm changes (ex: 1 to 10 years) in the incidence or prevalence of a morbidity or mortality rate or other health status indicator for a clinically diagnosed medial condition among a well-defined population at high risk Application of the PRECEDE-PROCEED Model • Compass Strategy – concerned with the early detection and treatment of mental disorders among adolescents • Phase 1 & 2 – researchers utilized focus groups of adolescents and parents who were affected by mental health disorders to generate appropriate media messages to stress the importance of early detection and treatment • Phase 3 & 4 – predisposing, reinforcing, and enabling factors were identified; resources and policies were analyzed to determine the success of the Compass Strategy Application of the PRECEDE-PROCEED Model • Compass Strategy – concerned with the early detection and treatment of mental disorders among adolescents • Phase 5 – Compass Strategy was implemented over a three-year period; a media campaign evolved from the first four phases of the PPM • Phase 6, 7, & 8 – Process evaluation used a 65-item survey; impact evaluation used telephone interviews; and outcome evaluation was used to determine the overall success of the mental disorder social media campaign PRECEDE-PROCEED Summary • • • PRECEDE-PROCEED Model (PPM) is one of the most widely used program planning models in health promotion programs PPM contains 8 Phases – (1) Social Assessment; (2) Epidemiological Assessment; (3) Educational and Ecological Assessment; (4) Administrative and Policy Assessment and Intervention Alignment; (5) Implementation; (6) Process Evaluation; (7) Module 5 PROCEDE PROCEED Model Assignment

Impact Evaluation; (8) Outcome Evaluation PRECEDE-PROCEED Model (PPM) is a cost-benefit evaluation framework that helps health program planners, policy makers, and other evaluators analyze situations and design health programs efficiently Chapter 15 Design, Sampling, and Evaluation “Research is to see what everybody else has seen, and to think what nobody else has thought” ~ Albert Szent-Gyorgyi Research Design • The primary purpose of conducting research is to develop new knowledge • The best and most powerful means of generating new facts is through the use of scientific experimentation • Research performed using experimental methods attempt to minimize threats to internal and external validity and other extraneous variables or biases that may contaminate the study Research Design • Extraneous Variables – Contaminants controlled for by using random assignment • Example: ethnicity, sex, age, fitness level, health status, race, and socioeconomic status • Cause-and-Effect Relationship – Determined using experimental methods in that one factor demonstrates a predictable influence on another • Experimental research is the most robust way for researchers to determine if there is a true cause-and-effect relationship between two (or more) variables Research Design • Research Design – Overall plan for the study • • Selected before the study is conducted Determines relationships between the independent and dependent variables • Provides structure and determines the statistical analyses used to test the hypotheses • Allows the researcher to conduct the program while minimizing extraneous variables and bias • Selection depends on many factors: • Purpose of the study • Threats to validity controlled by the researcher • Resources • Time • Accessibility to participants Research Design • Research Design – Three categories: • Experimental Design • Quasi-Experimental Design • Nonexperimental Design • Measurements used in evaluation designs can be collected at three different times: • After the intervention • Both before and after the intervention • Several times before, during, and after the intervention Experimental Design • Experimental Design – Involves random assignment of participants to experimental and control groups and the measurement of both groups • Allows for the greatest control over the factors that may influence the results • Minimizes threats to validity to the greatest extent possible and produces the most robust evidence of program effectiveness • Common experimental designs in health education include: • • • Posttest-Only Design Pretest-Posttest Design Time Series Design Experimental Design • Posttest-Only Design • • Posttest only design is based on the randomization of participants into either an experimental or control group, introducing the independent variable to the experimental group, and then testing for the differences of treatment and no treatment Pretest-Posttest Design • • Pretest-posttest design differs from the posttest only design due to the addition of a pretest The use of a pretest allows the researcher to assure that both the treatment and control groups are similar and provides a baseline measurement Experimental Design • Time Series Design • • • Used to examine differences in program effects over time In an experimental time series design, several measurements are taken over time both before and after the program for both treatment and control groups This process helps to identify other factors that may account for change between the pretest and posttest measurements, and is useful for measuring delayed effects of a program Quasi-Experimental Design • Quasi-Experimental Design • • • Involves the use of experimental and control groups; however, there is no random assignment to the groups These designs result in interpretable and supportive evidence of program effectiveness Premise of a quasi-experimental design is to investigate the participant in a real-world setting, introduce the independent variable, and then measure its effect Quasi-Experimental Design • Pretest-Posttest Design • • • Quasi-experimental pretest-posttest design is one of the more common types of research designs found in health promotion programs Used when the treatment or control group cannot be formed by random assignment Time Series Design • A quasi-experimental time series design is the same as an experimental time series design, only there is no randomization of participants to groups Quasi-Experimental Design • Repeated Measures Design • The experimental group is exposed to more than one level of the independent variable • Module 5 PROCEDE PROCEED Model Assignment

In a repeated measures design, participants have repeated measures gathered from them • Thus, participants serve as their own control group, which makes this a fairly sound research design • This design works best when there is little interaction among the levels of the independent variable and little time in between data collection measurements Nonexperimental Design • Nonexperimental Design • • • • • Involves the use of a treatment group, but does not use a control group or randomization Classified as experimental designs only because there is a manipulation of an independent variable Weakest degree of experimental control over the factors affecting the validity of the results Nonexperimental designs offer poor control and it is difficult to draw any meaningful conclusions about a cause-and-effect relationship between variables It is imperative that researchers avoid using nonexperimental research designs Nonexperimental Design • • Pretest-Posttest Design • • Used when participants cannot be assigned to groups, as no comparison group can be identified or it is not warranted This type of research are of limited significance, as changes in the participants could be due to other events and not due to results of the program Time Series Design • A single experimental group serves as its own control and is assessed on a dependent variable several times over a specified period of time • Establishes a baseline for the variable of interest • Examples: Stress, hormone levels, sleeping patterns, nutritional habits, medication use, etc. Nonexperimental Design • Static Group Comparison Design • No randomization of participants into groups • This is the only factor that makes it different from the posttest only experimental design • The experimental group receives the independent variable and is compared with an nonequivalent control group on the dependent variable • One-Shot Design • • • • Least acceptable of all the experimental designs The experimental group receives a treatment and is tested on its effect on the dependent variable The results of the treatment are compared against what the researcher “expected to occur” if the treatment was not given Based on previous knowledge and/or observation of the participants on the part of the researcher Sampling • • • • Census – Data from all target participants • Example: An entire school district Sample – Data from only some participants • Example: One school in the district Sampling Unit – Elements considered for selection as part of a chosen sample Sampling – Chosen from the target population of interest • • Using a sample rather than an entire population saves researchers both time and money Appropriate sample size is determined by how many individuals are needed for the researchers to feel confident valid conclusions can be drawn from the data Sampling • One of the most critical determinants of external validity, which is the ability to generalize study findings to the population of individuals who possess similar characteristics as those represented in the study sample Sampling • The correct selection of a sample is critical to the success of any program evaluation • Example: Does the information gained from the sample reflect the knowledge, attitudes, and behaviors of the survey population? • Sampling bias can be minimized by selecting the appropriate sampling procedures • Sampling procedures are categorized into: • Probability Samples • Nonprobability Samples Probability Sample • • • Probability Sample • Random selection increases the chance the study sample is representative of the survey population Random Sampling – An unbiased procedure by which all members of a population have an equal chance of being selected, and all samples of a given size have the same chance of being selected Probability Sample – Random selection is employed, and every individual in the survey population has an equal chance or probability of being selected Probability Sample • • • Simple Random Sample – Individuals, elements, or scores are selected from a population in such a way that each sample of size N has an equal chance of being selected • Sampling Frame – List of all sampling units in the survey population Systematic Sample – Every nth person is sampled Cluster Sample – A naturally occurring heterogeneous group Probability Sample • Stratified Random Sample – Utilized when researchers want certain groups to be represented in a sample • • Proportional Stratified Random Sample – Proportions in the sample represent the survey population • Example: Sample of 100 – selection of 60 small, 35 medium, and 5 large health clubs Nonproportional Stratified Random Sample – Equal representation from different strata within the survey population • Example: Sample of 200 – selection of 50 students from all ranks of freshman, sophomores, juniors, and seniors Nonprobability Sample • Nonprobability Sample – Sample in which all individuals in the survey population do not have an equal chance or probability of being selected • Utilized when a probability sample is not needed or cannot be obtained, due to lack of resources or being unable to identify or contact all those in the survey population • Cannot be generalized to the total survey population • Module 5 PROCEDE PROCEED Model Assignment

Some form of bias occurs in nonprobability samples, as those who are not included in the sample may differ in some way from those who are included in the study • Common types of nonprobability samples include: • Convenience Sampling • Purposive Sampling Nonprobability Sample • Convenience Sample – Selected as is accessible and relatively representative of the population of interest • • Examines the relationships among variables Purposive Sample – Selected in a deliberative and non-random fashion based on the purpose of the study • Involves studying the entire population of a specific group (College Professors at Florida Atlantic University) or a subset of a population (Tenured College Professors at Florida Atlantic University) Evaluation of Research • Evaluation – A process of reflection whereby the value of certain actions in relation to projects, programs, or policies are assessed against a standard of acceptability • Without the evaluation of a program, researchers cannot be certain of its impact and whether or not it was successful in achieving its targeted objectives and goals • Two main methods for categorizing evaluations: • Formative Evaluation (Process Evaluation) • Summative Evaluation (Impact Evaluation and Outcome Evaluation) • Evaluation of Research Formative Evaluation – Any combination of measurements obtained and judgments made before or during the implementation of materials, methods, activities, or programs to control, assure or improve the quality of performance or delivery • Designed to produce data and information used to improve a health promotion program during the developmental phase and document the feasibility of program implementation • Considered a method for judging the worth of a program while activities are being developed • Often used in pretesting or pilot testing an intervention program Evaluation of Research • Process Evaluation – Any combination of measurements obtained during the implementation of program activities to control, assure, or improve the quality of performance or delivery • Considered to be a type of formative evaluation • Measures the extent to which an intervention was delivered or implemented as intended • Designed to assess how much of …