PRECEDE/PROCEED Model used in Health Care

Database: Ovid MEDLINE(R) <1946 to October Week 4 2014>, PsycINFO <1806 to October
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1 (precede adj proceed).mp. [mp=ti, ab, ot, nm, hw, kf, px, rx, ui, tc, id, tm, sh, tn, dm, mf, dv,
kw] (362)
2 1 and survey.mp. [mp=ti, ab, ot, nm, hw, kf, px, rx, ui, an, tc, id, tm, sh, tn, dm, mf, dv, kw]
(63)

Bailey, P. H., et al. (1994). "A heart health survey at the worksite: the first step to
effective programming." AAOHN Journal 42(1): 9-14.
1. Cardiovascular disease is the number one killer in Canada, accounting for 42%
of all deaths. 2. Workplace policy and health promotion programs can have a
significant impact on modifiable risk factors associated with the development of
heart disease. 3. This article describes the results of a worksite cardiovascular risk
behavior screening of 652 mining employees in Sudbury, Ontario. 4. The
theoretical framework for this study is based on the PRECEDE-PROCEED
model: to reach the ultimate outcome, improved quality of life changes must be
made at both the individual as well as the environmental (workplace) level
(Green, 1991).

Bakken, S., et al. (2009). "Barriers, enablers, and incentives for research participation: a
report from the Ambulatory Care Research Network (ACRN)." Journal of the American
Board of Family Medicine: JABFM 22(4): 436-445.
BACKGROUND: Supported by a supplement to our Clinical and Translational
Science Award, we studied the feasibility of implementing clinical research in
Northern Manhattan community practices that primarily serve Hispanic patients.
METHODS: We applied a mixed-methods approach (surveys, focus groups, interviews)
based on the PRECEDE-PROCEED model to determine the level of interest in
clinical research among community clinicians (both practice-based research
network [PBRN] members and non-PBRN members), the perceived barriers that
hamper participation in clinical research, and the perceived facilitators for
conducting research in such practices.
RESULTS: Survey and qualitative data indicated strong interest in clinical research
among current and potential PBRN members if it was relevant to improving
quality of care in their practice or community. They also identified important
perceived barriers (lack of time, inadequate training in research methods, lack of
collaborators and support staff, institutional review board hurdles, and community
distrust of research) and the necessary requirements for overcoming barriers to
conducting research in busy clinical settings, which included collaborators,
mentors, research support staff, and a trusting patient-clinician relationship.
CONCLUSION: It is feasible to conduct clinical research studies in urban community
medical practices if the topics are relevant to the community and appropriate
enabling structures and processes are put into place.

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Bian, H. and C. L. Smith (2006). "Development of a questionnaire to assess dentists'
knowledge, opinion, education resources, physician cooperation, and clinical practice
regarding obstructive sleep apnea (OSAQ-D)." Sleep & Breathing 10(2): 76-82.
This report describes the construction of a questionnaire to assess dentists'
knowledge, opinion, education resources, clinical practice, and physician
cooperation regarding obstructive sleep apnea (OSA) based on the PRECEDE-
PROCEED model. The scale development included such steps as generating an
item pool, expert review of initial item pool, pilot test, and final test. After the
expert review, a total of 78 items made up the pilot test instrument including five
demographic (age, year graduated from dental school, gender, years in practice
dentistry, and membership of the Academy of Dental Sleep Medicine), 22
knowledge, 15 opinion, 11 education resources, 10 physician cooperation, and 15
clinical practice questions. The pilot test samples were third or fourth year dental
school students and dentists from the University of Florida. Nineteen dentists and
26 students returned the survey. Based on the results of item analysis and content
review, a total of 70 questions were remained for the final test. The final
questionnaire was mailed to 450 dentists who were randomly selected from a list
of 10,838 dentists with a Florida license and also delivered to 65 dental school
students and postgraduates of the University of Florida. A total of 163 participants
including 112 dentists and 51 students and postgraduates responded. The average
age was 42.87 years, and most of them are males (77.8%). Only one dentist was a
current member of the Academy of Dental Sleep Medicine. The item analysis was
performed for five scales. 8 items with poor item difficulty, lower item
discrimination, or having big effect on the item consistency were removed from
the instrument, and 62 questions were kept for the further evaluation. The
reliability coefficient alpha of knowledge, opinion, education resources, physician
cooperation, and clinical practice scales was 0.77, 0.86, 0.67, 0.75, and 0.86,
respectively. According to the standard from DeVellis (Scale development: theory
and applications, Sage, Thousand Oaks, 2003), they were acceptable, or
respectable, or even very good.

Bonner, A., et al. (2007). "A student-led demonstration project on fall prevention in a
long-term care facility." Geriatric Nursing 28(5): 312-318.
Falls are a frequent and serious problem facing people aged 65 and older. The
incidence of falls increases with greater numbers of intrinsic and extrinsic risk
factors and can be reduced by risk modification and targeted interventions. Falls
account for 70% of accidental deaths in persons aged 75 and older. Mortality due
to falls is significantly higher for older adults living in extended care facilities
versus those living in the community. Our objective was to evaluate the
effectiveness of a fall prevention training program in a long-term care setting. A
single-group repeated-measure design was used, guided by the Precede-Proceed
framework. A comprehensive review of the literature and a concept analysis
guided the development of testing and educational materials for all nursing and
ancillary facility staff. Preliminary testing provided baseline data on knowledge
related to fall prevention. Pre- and posttests, a fall prevention newsletter, and
informational brochures were distributed to nursing staff and ancillary personnel

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 at training sessions. Certified nursing assistant (CNA) champions were identified
and given peer leadership training. "Quick Tips" fall prevention badges were also
distributed to staff. Graduate students led interdisciplinary environmental rounds
weekly, and new falls were reviewed on a daily basis by the interdisciplinary
team. A 60-day posttest evaluated retention of fall prevention knowledge. Fall
rates at baseline and for 2 months after the intervention were compared.
Preliminary survey data revealed fall prevention learning opportunities, with a
pretest mean score of 86.78%. Qualitative data were coded and revealed specific
learning gaps in intrinsic, extrinsic, and organizational causes of falls. The 60-day
posttest mean score was 90.69%; a paired t test (t score = -1.050; P = .057)
suggested that learning may have taken place; however, differences in scores did
not reach statistical significance. The fall rate before training was 16.1%; 30-day
posttraining fall rate was 12.3%, and 60-day postintervention fall rate was 9%.
Based on the program results, the model was expanded from long-term care to the
university hospital system and outpatient clinics in the same community. The
collaboration between a school of nursing and 1 long-term care facility led to the
adoption of a significant quality improvement program that was subsequently
extended to a local hospital and clinic system. Student-led projects designed to
teach community service learning can be meaningful and can lead to changes in
patient safety and quality of care.

Castellanos, D. C. and K. Abrahamsen (2014). "Using the PRECEDE-PROCEED model

to assess dietary needs in the Hispanic population in northeastern Pennsylvania."
Hispanic Health Care International 12(1): 43-53.
Research shows that as Hispanic immigrants spend more time in the United States
and/or become more assimilated to the U.S. culture their diet begins to mimic that
of a Western diet. A dietary needs assessment was conducted in the target
population of low income, first-generation Hispanics in the greater Scranton, PA,
area to identify nutrition problems and inform culturally appropriate nutrition
intervention development. The PRECEDE-PROCEED model was used to guide
the assessment. Interviews with key informants and a focus group as well as
demographic and dietary-related questionnaires were completed with the target
population to identify health and nutrition needs in the community and factors
regarding dietary behaviors. Behavioral and environmental objectives were
developed and led to a culturally tailored nutrition intervention. (PsycINFO
Database Record (c) 2014 APA, all rights reserved) (journal abstract).

Chen, C. C., et al. (2014). "An evaluation of healthcare information on the Internet: the
case of colorectal cancer prevention." International Journal of Environmental Research &
Public Health [Electronic Resource] 11(1): 1058-1075.
Health information, provided through the Internet, has recently received attention
from consumers and healthcare providers as an efficient method of motivating
people to get screened for colorectal cancer (CRC). In this study, the primary
purpose was to investigate the extent to which consumers were better educated
about CRC screening information because of the information available on the
Internet. Another purpose was to identify how better-informed consumers, with

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 reliable and trustworthy health information, were enabled to make sound
decisions regarding CRC screening. The data used in this study was taken from
the 2003 Health Information National Trends Survey. People aged 55 and older
were classified based on their compliance with recommended CRC screening. The
study applied the PRECEDE-PROCEED model to evaluate the effects of health
information taken from the Internet regarding CRC screening. The credibility and
reliance of cancer related information on the Internet was significantly associated
with patient compliance to be screened for CRC. Experience and knowledge of
Internet use had a significant impact on the utilization of CRC screening. This
analysis suggests that the design and publishing websites concerning CRC should
emphasize credibility and reliance. Websites providing information about CRC
must also contain the most current information so that people are able to make
educated decisions about CRC screening.

Chen, C. C., et al. (2011). "Improving children's healthcare through state health insurance
programs: an emerging need." Health Policy 99(1): 72-82.
OBJECTIVES: State Children's Health Insurance Program (SCHIP) in the USA
plays a critical role in healthcare service utilization. This study assesses children's
needs for healthcare services among the variations of SCHIP.
METHODS: This study applies the PRECEDE-PROCEED behavioral model to analyze
the behavior of children with healthcare needs and unmet healthcare needs by
using the National Survey of Children with Special Healthcare Needs of the USA.
RESULTS: Children who were previously under a Medicaid program are apt to enroll in
SCHIP programs. SCHIP children with healthcare needs are more likely than
comparable non-SCHIP children to use hospital outpatient departments instead of
using doctors' offices and health centers. Children under the SCHIP single and
SCHIP combination programs are more likely to use doctors' offices and health
centers than those in the Medicaid expansion program. SCHIP combination or
SCHIP Medicaid expansion states are significantly less likely to have unmet
healthcare needs than children in SCHIP single states.
CONCLUSIONS: Medicaid has a significant impact on the SCHIP program. There is a
substitution of healthcare service facilities between hospital outpatient
departments and either the doctors' offices or health centers. Copyright 2010
Elsevier Ireland Ltd. All rights reserved.

Coburn, C. L. and P. C. Weismuller (2012). "Asian motivators for health promotion."

Journal of Transcultural Nursing 23(2): 205-214.
Change in health behaviors requires motivation on the part of the individual. The
aim of this article is to compare elements of the motivation process across
cultures. A secondary aim is to determine whether a Western model of behavior
change for health promotion, such as the PRECEDE-PROCEED model, can be
applied to Asian populations. An integrative review and critical analysis of
research literature was done by reviewing 20 studies with observational survey
design and 6 integrative literature reviews. Findings show that the motivation
process is similar for Eastern and Western cultures, but the motivators are

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 different. The findings identify 10 motivators, congruent with Asian culture, that
would allow the PRECEDE-PROCEED model to be used in Asian settings.

Cole, R. E. and T. Horacek (2009). "Applying precede-proceed to develop an intuitive

eating nondieting approach to weight management pilot program." Journal of Nutrition
Education & Behavior 41(2): 120-126.
OBJECTIVE: To describe the use of a consolidated version of the PRECEDE-
PROCEED participatory program planning model to collaboratively design an
intuitive eating program with Fort Drum military spouses tailored to their
readiness to reject the dieting mentality and make healthful lifestyle
modifications.
DESIGN: A consolidated version of PRECEDE-PROCEED guided demographic,
epidemiological, behavioral, organizational, and administrative diagnosis through
survey research. Focus groups composed of planning/steering committee
members diagnosed environmental, organizational, administrative. and policy
considerations. Objectives were set for each phase to assist with program
tailoring.
SETTING: Recruitment at Fort Drum Army Installation, NY, summer 2004.
PARTICIPANTS: Ninety-one military health beneficiaries aged 20-65 years of age
completed the pilot-tested survey packet.
PHENOMENON OF INTEREST: The survey assessed quality of life issues, Diet
Mentality, Healthy Eating Index, and Intuitive Eating Stages of Change scores,
and desired program mix.
ANALYSIS: Mean and mode of survey responses and scores.
RESULTS: A 10-week "My Body Knows When" intuitive eating program was tailored to
increase attendance, reduce barriers, and increase successful rejection of a dieting
mentality.
CONCLUSIONS AND IMPLICATIONS: A consolidated version of PRECEDE-
PROCEED efficiently guided participatory planning to tailor this program.

Dharamsi, S., et al. (2009). "Oral care for frail elders: knowledge, attitudes, and practices
of long-term care staff." Journal of Dental Education 73(5): 581-588.
The University of British Columbia Geriatric Dentistry Program (GDP) offers
dental services and provides a comprehensive in-service education program for
nursing and residential care-aide (RCA) staff in the provision of daily mouth care
for elders in various long-term care (LTC) facilities in Vancouver. This study
examined the general impact of the education initiative at one LTC site. A survey
(N=90), semi-structured open-ended interviews (N=26), and product audits were
conducted to 1) examine the impact of the GDP education initiative on the level
of knowledge, attitudes, and practices of RCAs and nursing staff regarding the
provision of daily mouth care; 2) identify the enablers and barriers that influenced
the provision of daily mouth care practices, policies, and protocols using the
PRECEDE-PROCEED model of health promotion research; and 3) assess the
self-perceptions of RCAs and nursing staff members regarding their oral health. A
knowledge gap was evident in some key areas pertaining to prevention of dental
diseases. Twenty-five percent of residents were missing toothbrushes and

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 toothpaste for daily mouth care. Residents who exhibit resistance to mouth care
tended not to receive regular care, while issues such as time, increased workload,
limited staff, and the lack of an accountability structure are disenabling factors for
provision of daily mouth care. Results suggest that the impact of educational
interventions is affected by the quality of in-service education, an absence of
identified predisposing, reinforcing, and enabling factors, and a strong
commitment among LTC staff to the provision of daily mouth care for frail elders.

Fujii, C., et al. (2004). "An attempt to prevent lifestyle-related diseases of schoolchildren
in collaboration with parents, schools and communities. [Japanese]." [Nippon koshu eisei
zasshi] Japanese journal of public health 51(9): 790-797.
PURPOSE: The authors focused on preventing lifestyle-related diseases among
schoolchildren on the basis of health surveys with blood examinations and
questionnaires on lifestyle in collaboration with parents, YOGO teachers, and
public health nurses. The present study purposed to evaluate this approach using
the PRECEDE-PROCEED Model. METHOD: The authors inquired of
schoolchildren's parents their awareness of their children's health through health
surveys of their children. Additionally, changes in the role of YOGO teachers and
public health nurses before and after our attempt were assessed. The significance
and problems with our approach were then evaluated based on the PRECEDE-
PROCEED Model. RESULTS: Based on the PRECEDE-PROCEED Model, it
was clarified that, for prevention of lifestyle-related diseases among
schoolchildren, health surveys with blood examinations and questionnaires on
lifestyle increased parents' interest in their children's health. On the basis of the
results of health examinations, the role of YOGO teachers changed from leading
figure for general health education to supporters of health promotion for
individuals, with provision of health education classes in schools for this purpose.
The role of public health nurses also changed from providing health education at
the request of schools to supporting families to improve their lifestyle, including
that of their children. CONCLUSIONS: In collaboration with children's parents,
YOGO teachers and public health nurses, the present approach to prevent
lifestyle-related diseases of schoolchildren on the basis of health surveys has
advantages for increasing interest in schoolchildren's health, and should be useful
for health promotion.

Hislop, T. G., et al. (2003). "Facilitators and barriers to cervical cancer screening among
Chinese Canadian women." Canadian Journal of Public Health. Revue Canadienne de
Sante Publique 94(1): 68-73.
BACKGROUND: Chinese Canadian women have higher cervical cancer
incidence, and lower Pap testing, rates than the general Canadian population.
Predisposing, enabling and reinforcing factors associated with ever having a Pap
test, and having a recent Pap test within the last 2 years, were assessed in Chinese
women in British Columbia using the PRECEDE-PROCEED model.
METHOD: Chinese women (n=512) between the ages of 20 and 79 years and residing in
Greater Vancouver were interviewed about Pap testing, health care, traditional
health beliefs, acculturation and sociodemographic characteristics. Two analyses

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 were done, comparing women who had ever and never had a Pap test, and
comparing women who had and had not received a recent Pap test. Focus groups
and qualitative interviews ensured cultural sensitivity in the survey questionnaire.
RESULTS: Seventy-six percent reported ever having a Pap test and 57% reported having
a Pap test within the last 2 years. Traditional health beliefs were not associated
with ever or recent Pap testing. However, belief that Pap testing prevented cancer
and general knowledge about the Pap test were associated with screening.
Concern about pain/discomfort with the test, availability of time, culturally
sensitive health care services and recommendation for Pap testing by a physician
were also associated with screening. Factors differed for ever, and recently,
having a Pap test.
INTERPRETATION: Pap testing is less common among Chinese Canadian women.
Continuing education about Pap testing is recommended for physicians serving
underscreened Chinese women. Culturally and linguistically appropriate
educational materials are needed for the Chinese community.

Jones, S. C. and R. J. Donovan (2004). "Does theory inform practice in health promotion
in Australia?" Health Education Research 19(1): 1-14.
In recent years, there have been numerous papers discussing the importance of
improving the link between health promotion researchers and practitioners.
Several reviews have been undertaken to determine the extent to which health
promotion research is disseminated to, and utilized by, practitioners in the
development and implementation of health promotion programs. These studies
have generally been limited to reviews of literature rather than directly gathering
data from practitioners. This paper reports on a survey of Australian health
promotion practitioners undertaken to investigate the extent to which they are
aware of, understand and utilize the major health promotion theories and models
derived from research in the areas of psychology and communication. We found
that none of the theories or models included in this study-the 'standard' theories
and models taught in health promotion courses, and included in the leading
textbooks-were used by more than 50% of practitioners in their work. The only
models being used by more than one-third of the practitioners were PRECEDE-
PROCEED and the Transtheoretical (Stages of Change) Model. The paper
concludes with possible explanations for the low level of utilization of theories
and models, and suggestions for increasing their usage based on information
sources accessed by these practitioners.

King, K. M. (2009). "Predisposing, reinforcing, and enabling predictors of middle school

children's after-school physical activity participation." Dissertation Abstracts
International Section A: Humanities and Social Sciences 70(1-A): 105.
Overweight and obesity are serious health concerns facing American children
today. The number of children (2 to 19 year olds) who are overweight has
increased from 13.9% in 1999-2000, to 15.4% in 2001-2002, and 17.1% in 2003-
2004. The prevalence in overweight and obesity rates is increasing. Since it is
well documented that physical activity attenuates the overweight and obesity
crises, physical activity has been deemed as a leading health indicator for

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improving our nation's health, and is an effective approach to preventing and/or
reducing overweight and obesity. In a 2003 study, it was discovered that 72.3% of
middle school children participated in vigorous intensity physical activity at least
three days of the previous week and 33.6% participated in moderate intensity
physical activity at least five days the previous week. Yet, it is recommended that
middle school age children participate in at least 60 minutes of moderate to
vigorous intensity physical activity every day. The primary purpose of this study
was to determine if differences in after-school physical activity participation
existed among middle school children from different socioeconomic statuses
(SES). The secondary purpose was to identify which predisposing, reinforcing,
and enabling factors predicted after-school physical activity participation among
middle school children. The PRECEDE-PROCEED planning model was utilized
in a cross-sectional, descriptive, survey research design. The study sample
consisted of 158 middle school children (24.9% participation rate). The gender
breakdown of the sample was almost even, 81 females (51.3%) and 76 males
(48.1%). The socioeconomic status of the sample were 39.2% low SES and 58.9%
were not-low SES. Almost two-thirds of the children (60.8%) were physically
activity for one hour or more after-school each day. Somers' d tests revealed that
there was a significant difference (p = .035) in children's after-school physical
activity level and their socioeconomic status. Low SES children were more active
than not-low SES children. Ordinal logistic regression analysis revealed that of
the fourteen predisposing, reinforcing, and enabling factors that were tested,
physical activity self-efficacy (p = .03), attraction to physical activity (p = .01)
(predisposing factors), and access to sports equipment (p = .01) (enabling factor)
were statistically significant predictors of middle school children's after-school
physical activity level. Children who held a higher level of physical activity self-
efficacy were 3.4 times more likely to be physically active after school that
children with a lower level. Children who were attracted to physically active
games, sports, and activities were 3.48 times more likely to be physically active
after school that children with lower levels of physical activity attraction.
Children who felt that they had active toys, games, equipment, and supplies at
home were 2.46 times more likely to be physically active after school than
children who did not perceive adequate access to equipment. Middle school
children have approximately 61/2 hours of time after school each day to devote to
a variety of pursuits. Although almost two-thirds of children in this study met the
daily physical activity recommendation, research shows that as children grow
older, their physical activity levels decrease. Furthermore, most research also
shows that low socioeconomic status adults engage in less physical activity that
their not-low counterparts. Consequently, the area in which this study was
conducted was rural and poor Eastern Kentucky; health educators must
continually strive to cultivate children's physical activity behavior. This study also
found that the average time children devoted to watching television and playing
computer/video games was 3 hours and 43 minutes per day. (PsycINFO Database
Record (c) 2012 APA, all rights reserved).

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Kratzke, C., et al. (2010). "Training community health workers: factors that influence
mammography use." Journal of Community Health 35(6): 683-688.
The purpose of this study was to assess factors that influence mammography use
among volunteer community health workers (CHWs). Data trends indicate lower
mammography rates among minority and low-income women. Although CHW
interventions have been shown to promote mammography use among this
population, training strategies and the use of a comprehensive needs assessment
are lacking. Using a cross-sectional study design, data were collected via a mailed
survey. The dependent variable was mammography use within the past 2 years.
The independent variables were categorized according to the factors in the
PRECEDE-PROCEED model. Predisposing factors included susceptibility,
barriers, benefits, health motivation, self-efficacy, education, and age. Enabling
factors included income, health insurance, and regular source of care. Reinforcing
factors included physician recommendation to get a mammogram, social norms,
and family history of breast cancer. Self-reported data from a mailed survey were
obtained from a convenience sample of urban CHWS (N = 109) ages 40-73 with a
mean age of 55 (SD = 9.43). The sample included 90% African American and 8%
White women. Logistic regression results showed barriers to be predictive of
mammography use among CHWs controlling for age, self-efficacy, health
motivation, and social norms. The findings suggest CHW training focus on how
to identify and address barriers to increase the likelihood of mammography use
among CHWs. Future research is needed to identify cultural differences in
barriers for minority CHWs.

Linnan, L. A., et al. (2005). "Planning and the professional preparation of health
educators: implications for teaching, research, and practice." Health Promotion Practice
6(3): 308-319.
Planning skills are one of the seven essential responsibilities of health educators,
according to the National Commission of Health Education Credentialing
program; yet little information is available about who provides training in
planning, what type of training is offered, and what planning models are taught. A
survey of 253 accredited graduate and undergraduate health education programs
(response rate = 56%) was undertaken to gather information about planning and
the professional preparation of health educators. Results revealed that planning
instructors were primarily full-time, experienced, and about one half were CHES
certified. Overall, 88% (113/129) of respondents taught the PRECEDE-
PROCEED model, and 62% (81/131) taught the planned approach to community
health (PATCH) model. Few planning differences were found at the graduate and
undergraduate levels. Content analysis of 56 course syllabi revealed that 80%
(45/56) required students to complete a program plan proposal or document as the
culminating project for the course. Implications for teaching, research, and
practice are discussed.

Manfredi, C., et al. (2010). "Are racial differences in patient-physician cancer

communication and information explained by background, predisposing, and enabling
factors?" Journal of Health Communication 15(3): 272-292.

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 Research shows that African Americans tend to have poorer and less informative
patient-physician communication than Whites. We analyzed survey data from 248
African American and 244 White cancer patients to examine whether this
disadvantage could be explained by race variability on several other variables
commonly reported to affect communication. These variables were organized into
background, enabling, and predisposing factors, based on the Precede-Proceed
Model. Multivariate regressions were used to test whether race differences in
communication and information variables persisted after successively controlling
for background, enabling, and predisposing factors. African American patients
had higher interpersonal communication barriers than Whites, but this difference
did not persist after controlling for background factors. African Americans also
had higher unmet information needs and were less likely to receive the name of a
cancer expert. These differences persisted after controlling for all other factors.
Future research should focus on the informational disadvantages of African
American patients and how such disadvantages may affect cancer treatment
decisions.

Molloy, S. B. (2009). "HIV/AIDS knowledge in Nicaraguan students of nursing."

Dissertation Abstracts International: Section B: The Sciences and Engineering 70(6-B):
3432.
In Nicaragua, the combination of poverty, lack of education, early sexual activity,
drug use, high birthrate, and migration fuel the potential for the spread of
HIV/AIDS. Even though there has been increased awareness of HIV/AIDS within
Nicaragua, there has been fragmented countrywide effort to educate health
professionals, especially nurses who are the frontline of healthcare delivery, about
the disease. The purposes of this study were to assess HIV/AIDS knowledge in
Nicaraguan students of nursing and to make recommendations regarding the
future design of an HIV/AIDS educational program. Using an adaptation of Green
and Kreuter's PRECEDE-PROCEED (2005) model as the conceptual framework,
this descriptive study used a convenience sample of 290 Nicaraguan students of
nursing from the Universidad Politecnica de Nicaragua, (UPOLI), Polytechnic
University of Nicaragua School of Nursing, enrolled at the main campus in
Managua, and at three distance-learning regional campuses. To explore the
predisposing factor of HIV/AIDS knowledge, a culturally appropriate, true/false
HIV/AIDS knowledge survey was administered to participants in Spanish, along
with a second qualitative survey, which focused on enabling and reinforcing
factors. The participants were found to have fair HIV/AIDS knowledge based on
the percent correct on the true/false Survey 1 (mean=68.95%, SD=10.01). There
were no differences in the mean percent correct according to nursing program
type, and no correlation between age and percent correct. The mean percent
correct for the pilot study and different campuses were significantly different,
with the self-selected participants in the pilot study scoring higher. The mean
percent correct for participants who had cared for patients with HIV/AIDS was
significantly higher than for those who had not cared for patients with HIV/AIDS.
Even with fair knowledge, there were large gaps of basic HIV/AIDS information
in prevention, transmission, testing, treatment, universal precautions, and issues

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 directly related to Nicaragua. In the qualitative survey, the participants revealed a
lack of resources and a strong desire to learn more about HIV/AIDS. They listed
enabling and reinforcing factors that would help, hinder, encourage, or discourage
them from acquiring HIV/AIDS knowledge. Themes of the reflective paragraphs
were frustration, fear, sadness, helplessness, and moving forward. They wrote
about their future hopes and concerns about helping, professional nursing
responsibility, and ethical behavior. God, as a source of spiritual strength and
support, was also described. Based on the predisposing, enabling and reinforcing
factors, the investigator describes in the final chapter recommendations about a
future HIV/AIDS educational program for Nicaraguan students of nursing.
(PsycINFO Database Record (c) 2012 APA, all rights reserved).

Osuagwu, C. C. (2012). "Predictors of obesity in African American college students."

Dissertation Abstracts International: Section B: The Sciences and Engineering 72(10-B):
5924.
Obesity ranks as the second highest cause of death in the United States, due to its
numerous comorbidities, and data reveal that African Americans are at greatest
risk for this disease. The purpose of this study was to explore the multiple factors
that contribute to obesity in the African American population. Using a hybrid of
the PRECEDE-PROCEED and the vital renewal models, a mixed methods study
design that included 142 male and female African American college students, ages
18-26 years, was employed. A Likert-scaled survey for the quantitative phase and
a focus group interview for the qualitative arm were utilized. The survey
measured the constructs of attitude, culture, environment, exercise, food habits,
and knowledge. Descriptive, as well as multiple logistic regression analysis were
used to analyze associations among variables. Results showed that 40.1% of the
students were obese. Exercise, gender, culture, self-perception, and age
demonstrated strong association with obesity and were the most predictive factors
of obesity. Two focus group sessions were conducted with males and females,
respectively. The qualitative analysis revealed 6 major themes: attitude,
environment, money, culture, food habits, and stress. The study concluded that
multiple complex factors are responsible for persistent high rates of obesity in this
population, but cultural orientation and influence appear to be the most
challenging. Recommendations include campus-wide culturally specific
education, establishment of systems to support healthy food habits and exercise,
as well as programs and research on how to deal with the cultural factors. Social
change implications include policies and practices to improve health outcomes for
college students, especially in the African American college campuses.
(PsycINFO Database Record (c) 2012 APA, all rights reserved).

Ramey, S. L., et al. (2008). "Developing strategic interventions to reduce cardiovascular

disease risk among law enforcement officers: the art and science of data triangulation."
AAOHN Journal 56(2): 54-62.
The purpose of this study was to use data triangulation to inform interventions
targeted at reducing morbidity from cardiovascular disease (CVD) and associated
risk factors among law enforcement officers. Using the Precede-Proceed Health

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 Promotion Planning Model, survey data (n = 672) and focus group data (n = 8
groups) from the Milwaukee Police Department were analyzed. Narrative
transcripts disclosed that law enforcement officers encounter potential barriers
and motivators to a healthy lifestyle. Survey results indicated rates of overweight
(71.1% vs. 60.8%) and hypertension (27.4% vs. 17.6%) were significantly (p < or
= .001) higher among Milwaukee Police Department law enforcement officers
than the general population of Wisconsin (n = 2,855). The best predictor of CVD
was diabetes (p = .030). Occupational health nurses are uniquely positioned to
identify health risks, design appropriate interventions, and advocate for policy
changes that improve the health of those employed in law enforcement and other
high-risk professions.

Satia-Abouta, J., et al. (2002). "Psychosocial predictors of diet and acculturation in

Chinese American and Chinese Canadian women." Ethnicity & Health 7(1): 21-39.
OBJECTIVE: To examine the influence of diet-related psychosocial constructs on
the dietary practices of Chinese populations living in North America.
DESIGN: Data are from a cross-sectional survey of 244 women of Chinese ethnicity
living in Seattle, WA, USA and Vancouver, BC, Canada. Using an interviewer-
administered questionnaire and PRECEDE/PROCEED as our model, we collected
information on diet-related psychosocial (predisposing, enabling, and reinforcing)
factors; consumption of foods reflecting Western and Chinese dietary practices;
and past and current consumption of fruits, vegetables and fat.
RESULTS: Participants generally believed that there were strong relationships between
diet and health, but only about a quarter were aware of nutrition information from
the government. Food cost, availability, and convenience did not appear to be
major concerns among these participants. Respondents' older relatives and
spouses tended to prefer a Chinese diet and also had a strong influence on the
household diet. Associations of the psychosocial factors with demographic
characteristics, adoption of Western dietary practices, and consumption of fruits
and vegetables were informative. For example, older, less educated respondents
considered it very important to eat a low fat, high fruit and vegetable diet; while
younger, more educated participants who were employed outside the home did
not think the Chinese diet is healthier than a typical Western diet (all p < 0.05).
Western acculturated respondents were more likely to believe in a relationship
between diet and cancer/heart disease and report that preparing Chinese meals is
inconvenient (p < 0.05). Respondents with in-family normative pressure to
maintain Chinese eating patterns ate more fruits and vegetables (4.4 vs 3.7
servings), while knowledge of nutrition information from the government was
associated with increased fruit and vegetable consumption after immigration (all p
< 0.05).
CONCLUSIONS: Chinese cultural beliefs play an important role in the dietary practices
of Chinese living in North America. Therefore, traditional health beliefs, as well
as socioeconomic and environmental factors related to diet should be incorporated
into the design and implementation of culturally appropriate health promotion
programs for Chinese immigrants.

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Sato, K. and M. Oda (2011). "Analysis of the factors that affect dental health behaviour
and attendance at scheduled dental check-ups using the PRECEDE-PROCEED Model."
Acta Medica Okayama 65(2): 71-80.
A questionnaire survey was administered to 317 parents who attended infant
health check-ups in City B, Okayama Prefecture between October, 2008 and
March, 2009. The questionnaire survey studied 7 factors based on the PRECEDE-
PROCEED Model. We analysed factors that affected oral health behaviour and
attendance at scheduled dental health check-ups. The survey containing 22 items
concerning matters such as 'QOL' and 'health problems' was posted to parents and
guardians in advance, and then collected on the day of the medical check-up. The
collected data was analysed using the t-test and Pearson's correlation coefficient,
following which we conducted a covariance structure analysis. The results
showed that dental health behaviour was directly affected by reinforcing factors,
and indirectly associated with enabling and predisposing factors influenced by
reinforcing factors. It was also shown that predisposing factors and oral health
behaviour were associated with attendance at scheduled oral health check-ups.
The results indicated that strengthening oral health education by sharing
knowledge that acts as predisposing factors and introducing adaptations of oral
health behaviour that that fit individual lives will lead to improved attendance at
scheduled dental health check-ups.

Takano, M., et al. (2005). "Behavior and lifestyle factors related to quality of life in junior
high school students." Environmental Health and Preventive Medicine 10(2): 94-102.
Objectives: To analyze actual conditions of the quality of life (QOL) in junior
high school students, we developed a questionnaire based on the PRECEDE-
PROCEED model, and we conducted a survey by using this questionnaire.
Methods: We conducted a workshop organized with 29 specialists on school
health and community health to develop the questionnaire. The QOL outcome was
assessed by the QOL Profile-Adolescent Version (QOLPAV). The subjects of the
questionnaire surveys were 1600 general students in four junior high schools. To
investigate a correlation between QOLPAV, behaviors and three enhancing
factors, two different multiple regression models were constructed. Results: The
question battery for QOLPAV was found to be a high value of Chronbach's alpha.
Among present subjects, 16.5% were categorized as " problematic" or "very
problematic" classified by QOLPAV scores. In the first multiple regression model,
significantly high odds ratios were obtained between the QOLPAV and 4
questions for behaviors, such as "studying with high motivation" (OR 1.64),
"getting along well with my friends" (2.72), "having things I am interested in"
(1.70), and "making my own decisions" (1.80). In the second model, significantly
high odds ratios were obtained commonly between the above 4 questions about
behaviors and 2 questions on enabling factors, such as "easy to understand
lessons" (1.32-1.71) and "speaking to friends easily" (1.30-3.22). Conclusions: 1)
We developed a questionnaire to analyze the actual condition of QOL in junior
high school students with sufficient validity and availability. 2) Among the
present subjects, 16.5% were found to be problematic QOLPAV. 3) Among the
factors of behaviors, those representing positive willing and high coping ability

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 with the elements of each school life contributed significantly to the QOLPAV.
And among enhancing factors, "enabling factors" and "reinforcing factors" were
stronger contributors to the behaviors strongly related to the QOLPAV than that of
"predisposing factors".

Taylor, V. M., et al. (1994). "Medical community involvement in a breast cancer

screening promotional project." Public Health Reports 109(4): 491-499.
The analysis, mobilization, and involvement of medical communities in two
counties targeted for intervention by the Washington State Community Breast
Cancer Screening Project is described. Principles of community organization were
applied to the health care sectors in the counties, and the PRECEDE-PROCEED
model was used as a conceptual framework for considering individual physician
behavior. Quantitative and qualitative medical community assessment methods
included a demographic study, a survey of primary care physicians, personal
interviews with physicians, and medical office staff focus groups. In both
intervention areas, physician planning groups selected, developed, and helped
implement intervention activities targeting the health care sectors. These activities
included informational mailings to physicians, training of medical office staff
members and clinical mammographers, and support for a reminder system. The
experience demonstrated that physicians practicing in medium-sized cities are
willing to be active in community disease prevention programs.

Tremblay, M., et al. (2001). "Physicians Taking Action Against Smoking: an intervention
program to optimize smoking cessation counselling by Montreal general practitioners."
CMAJ Canadian Medical Association Journal 165(5): 601-607.
In 1997 the Direction de la sante publique de Montreal-Centre initiated
"Physicians Taking Action Against Smoking," a 5-year intervention program to
improve the smoking cessation counselling practices of general practitioners
(GPs) in Montreal. Program development was guided by the precede-proceed
model. This model advocates identifying factors influencing the outcome, in this
case counselling practices. These factors are then used to determine the program
objectives, to develop and tailor program activities and to design the evaluation.
Program activities during the first 3 years included cessation counselling
workshops and conferences for GPs, publication of articles in professional interest
journals, publication of clinical guidelines for smoking cessation counselling and
dissemination of educational material for both GPs and smokers. The program
also supported activities encouraging smokers to ask their GPs to help them stop
smoking. Results from 2 cross-sectional surveys, conducted in 1998 and 2000, of
random samples of approximately 300 GPs suggest some improvements over time
in several counselling practices, including offering counselling to more patients
and discussing setting a quit date. More improvements were observed among
female than male GPs in both psychosocial factors related to counselling and
specific counselling practices. For example, improvements were noted among
female GPs in self-perceived ability to provide effective counselling and in the
belief that it is important to schedule specific appointments to help patients quit;
in addition, the perceived importance of several barriers to counselling decreased

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 among female GPs. A greater proportion of the female respondents to the 2000
survey offered written educational material than was the case in 1998, and a
greater proportion of the male GPs devoted more time to counselling in 2000 than
in 1998; however, among male GPs the proportion who discussed the pros and
cons of smoking with patients in the pre-contemplation stage declined between
1998 and 2000, as did the proportion who referred patients in the preparation
stage to community resources. Our experience suggests that an integrated, theory-
based program to improve physicians' counselling practices could be a key
component of a comprehensive strategy to reduce tobacco use.

Walsh, J. R. (2013). "A community-based participatory research approach for weight

management among disadvantaged young adults." Dissertation Abstracts International:
Section B: The Sciences and Engineering 74(3-B(E)): No Pagination Specified.
The PRECEDE-PROCEED health program planning model was applied to
develop, implement, and evaluate a salient and sustainable weight management
intervention. A steering committee, composed of researchers, stakeholders, and
job training program young adults and staff, guided the research process. Multiple
research methods were used for the initial four phases and resulted in social,
epidemiological, behavioral, ecological, educational, and organizational diagnoses
as outlined in PRECEDE to inform the intervention. PROCEED was implemented
with disadvantaged young adults (n=165), 18-24 years, attending two job training
programs. One site was used to recruit control participants and the other site to
recruit treatment participants. A non-randomized, quasi-experimental test of the
intervention was conducted using anthropometric measures and online survey
instruments (i.e., eating and physical activity behavior and life satisfaction) at pre-
(baseline), post-(10 weeks) and follow-up (22 weeks). During the 22-week
intervention treatment participants met weekly over the first 10 weeks in
classroom sessions to view 20 online educational modules about healthful eating,
physical activity, and stress and time management. They received weekly nudges
based on their Stage of Change to promote fruit and vegetable intake, physical
activity and stress management and set goals for behavior change. Analyses
included Student's t-tests, repeated measures of analysis of variance, linear
regression modeling, and non-parametric tests. The treatment group was
dichotomized for analysis based on intervention use. At baseline, males were
overweight and females were obese, based on mean body mass index, and both
reported high fruit and vegetable intake (>5 cups/day), physical activity (>30
minutes daily), and satisfaction with life (>75% satisfied). Food self-regulation
was higher for the high use treatment group versus the control group
(multivariate-adjusted linear regression estimate of the difference in score 1.78,
95% CI: 0.23 to 3.33, p=0.025). There were trends of reduced emotional eating
and improved food self-instruction benefits for high use treatment group
compared to the control group. Further work is needed to enhance the
effectiveness of healthy weight management programs for disadvantaged young
adults. (PsycINFO Database Record (c) 2013 APA, all rights reserved).

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Watson, M. R., et al. (2001). "A community participatory oral health promotion program
in an inner-city Latino community." Journal of Public Health Dentistry 61(1): 34-41.
OBJECTIVES: This paper reports the planning, implementation, process
evaluation, and refinement of an oral health community participatory project in
Mount Pleasant, an inner-city Latino neighborhood of Washington, DC. The main
goal was to explore the feasibility of implementing such a project.
METHODS: The PRECEDE-PROCEED model was used to guide the planning and
process evaluation of this project, in conjunction with community organizational
methods. A steering committee, which met periodically, was formed to assist in
program planning, implementation, and evaluation. The needs assessment of the
community identified extensive dental health problems among children and
deficiencies in their parents' oral health knowledge, opinions, and practices. In
response, culturally appropriate health education and promotion activities were
planned and implemented in collaboration with local community organizations,
volunteers, and local practitioners. Process evaluation was used to provide
feedback into the refinement of the community approach, which included record
keeping and an inventory approach to activities completed and resources used.
The overall impact and usefulness of this program were assessed informally using
an anonymous open-ended questionnaire directed to members of the steering
committee, and an outreach survey using a convenience sample at a local Latino
health fair.
RESULTS: The implementation of such a community participatory approach was feasible
and useful for building upon existing local resources and addressing oral health
concerns in a community not reached by traditional dental care and health
promotion initiatives. Individuals in this community showed a substantial interest
in oral health matters and participated in a variety of oral health prevention
activities. The community approach adhered to community-based research
principles.

Weiss, D. N. (2011). "Managing asthma on college campuses: What is being done and
what is not being done?" Dissertation Abstracts International Section A: Humanities and
Social Sciences 71(10-A): 3547.
Asthma is an incurable disease that affects more than 22 million Americans
(Healthy People 2010). Asthma is among the top health problems on U.S. college
campuses today, affecting 12% of students (American College Health Association,
2006). Of these, 40% do not seek medical care (Carpentier, Mullin, & Van Pelt,
2007). The objectives of the study were to conduct a population-based survey to
determine: (a) health center staffing, allergy capability, and asthma action plans,
policies, and information; and (b) health center directors' attitudes and perceptions
about asthma. The study used the PRECEDE-PROCEED Planning Model (Green
& Kreuter, 1999) as the conceptual framework. The sample was 117 New York
State four-year colleges with at least 1,000 full-time undergraduate students. Data
were collected from health center directors by telephone survey in January 2010
using the measurement instrument, Managing Asthma on College Campuses
Survey, which was designed by the investigator and an Expert Panel. The 15-item
survey instrument included closed and open-ended questions and used

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 quantitative and qualitative methods. Asthma management was measured using a
13-item Asthma Scorecard Total Score, which was weighted using the Delphi
technique. There was a significant association between the predictor variables of
size, location, and affiliation, which together accounted for 20.4% of the variance,
and Asthma Scorecard Total Scores (F 7.328, df 4, p < .001). Small colleges had
significantly lower scores than did medium and large schools. Urban schools had
significantly lower scores than did nonurban schools. There was a significant
positive association (p < .05) between the respondent's satisfaction with asthma
services and the weighted Asthma Scorecard Total Score. Significant barriers
existed, including lack of understanding of chronic disease management, lack of
health insurance or inadequate coverage for medications, limited accessibility, and
lack of sufficient resources in terms of staff and equipment to deal with existing
volume of students. Standardization of asthma management at campus health
centers was the top improvement recommended by respondents. With a mean
weighted Asthma Scorecard Total Score of 14.23 out of a possible 25, it appeared
that, on average, there was not adequate asthma education and management in
New York State colleges. (PsycINFO Database Record (c) 2012 APA, all rights
reserved).

Wiesner, C., et al. (2013). "Barriers for implementing the HPV-DNA test as a primary
cervical cancer-screening technique in a demonstrative area of Colombia. [Spanish]."
Revista Colombiana de Cancerologia 17(3): 93-102.
Objective: To identify the barriers for the implementation of a cervical cancer-
screening program based on human papillomavirus (HPV) testing in Colombia.
Methods: The Precede-Proceed model was applied in four municipalities of
Cundinamarca and two of Boyaca. Secondary and primary data were analyzed
from 74 institutional surveys, 18 focus groups (with community leaders and
health professionals), and 12 interviews (health authorities). Results: The most
relevant barriers were identified as follows: 1) Social barriers: in Duitama, the
municipality with a religious tradition, HPV infection is represented as a venereal
disease. 2) Epidemiological barrier: the absence of a register for definitive
diagnosis of pre-neoplasic lesions. 3) Behavioral barriers: Pap smear laboratories
are not centralized, some are not accredited and colposcopies are not
standardized. 4) Health professionals overestimate Pap smear sensitivity and they
are over worried about HPV infection among women younger than 30 years. 5)
Administrative barriers: positive screened women need to have an authorization
from Health Insurance Enterprises in order to access the diagnosis and treatment
of cervical lesions. Conclusions: Colombia presents barriers to the operation of an
organized screening program that make it difficult to achieve the expected
objectives with the technological change from the use of cytology to molecular
testing. 2013 Instituto Nacional de Cancerologia.

Wright, A., et al. (2006). "Development and evaluation of a youth mental health
community awareness campaign - The Compass Strategy." BMC Public Health 6: 215.
BACKGROUND: Early detection and treatment of mental disorders in
adolescents and young adults can lead to better health outcomes. Mental health

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 literacy is a key to early recognition and help seeking. Whilst a number of
population health initiatives have attempted to improve mental health literacy,
none to date have specifically targeted young people nor have they applied the
rigorous standards of population health models now accepted as best practice in
other health areas. This paper describes the outcomes from the application of a
health promotion model to the development, implementation and evaluation of a
community awareness campaign designed to improve mental health literacy and
early help seeking amongst young people.
METHOD: The Compass Strategy was implemented in the western metropolitan
Melbourne and Barwon regions of Victoria, Australia. The Precede-Proceed
Model guided the population assessment, campaign strategy development and
evaluation. The campaign included the use of multimedia, a website, and an
information telephone service. Multiple levels of evaluation were conducted. This
included a cross-sectional telephone survey of mental health literacy undertaken
before and after 14 months of the campaign using a quasi-experimental design.
Randomly selected independent samples of 600 young people aged 12-25 years
from the experimental region and another 600 from a comparison region were
interviewed at each time point. A series of binary logistic regression analyses
were used to measure the association between a range of campaign outcome
variables and the predictor variables of region and time.
RESULTS: The program was judged to have an impact on the following variables, as
indicated by significant region-by-time interaction effects (p < 0.05): awareness
of mental health campaigns, self-identified depression, help for depression sought
in the previous year, correct estimate of prevalence of mental health problems,
increased awareness of suicide risk, and a reduction in perceived barriers to help
seeking. These effects may be underestimated because media distribution error
resulted in a small amount of print material "leaking" into the comparison region.
CONCLUSION: We believe this is the first study to apply the rigorous standards of a
health promotion model including the use of a control region to a mental health
population intervention. The program achieved many of its aims despite the
relatively short duration and moderate intensity of the campaign.

Ye, Y. (2014). "The role of illness factors and patient satisfaction in using online health
support groups." Health Communication 29(4): 355-363.
Drawing on the behavioral model of health services use and the PRECEDE-
PROCEED model, this research explores various correlates of participation in
online health support groups based on the 2007 Health Information National
Trend Survey data. Results show that controlling for demographics, emotional
health and family cancer history were significant correlates, whereas perceived
general health status approached statistical significance, and personal cancer
history and cancer worry were not significant. Moreover, patient-provider
communication satisfaction approached statistical significance, and patient
satisfaction with received health care was not statistically significant. Theoretical
and practical implications of these results are discussed. (PsycINFO Database
Record (c) 2014 APA, all rights reserved) (journal abstract).

Page 18
Yum, C., et al. (2014). "Evaluation of a discharge medication bedside delivery program:
The patient perspective." Journal of the American Pharmacists Association 54 (2): e166.
Objective: A large community chain pharmacy located inside a clinic has
implemented a pilot program to deliver discharge medications to patients' bedside
upon discharge from a large urban hospital. The purpose of this program is to
provide patients immediate access to their discharge medications and avoid initial
and medication nonadherence related to medication non-availability. Utilizing the
PRECEDE-PROCEED planning model, this study aims to evaluate the pilot
bedside delivery program and identify ways to make the program more efficient
and effective and to maximize several patient outcomes. Methods: This study has
2 components. First, a retrospective descriptive analysis of patients enrolled in the
program from January 2013 to September 2013 will be conducted. The analysis
will examine patient demographics such as: age and sex, prescription insurance
status, number and type of medications brought to bedside, patient's residential
distance from hospital, and whether the patient received a follow-up phone call 48
to 72 hours post discharge. The second component involves a survey given to
patients enrolled within a 3-month period. At time of consent, patients will be
given a choice to receive the survey via telephone, Internet, or postal mail.
Patients will be contacted approximately 1 month post discharge and survey
questions will explore self-reported adherence to the medications received at
discharge, primary care provider follow-up, patient satisfaction and helpfulness
with the existing program, and exploration of unfulfilled medication needs at
discharge. Descriptive statistics will be used to analyze most patient survey items.
Thematic analysis will be used to analyze open-ended items from patient surveys.
Exploratory bivariate and multivariate analyses will be used to examine
relationships between program characteristics and patient outcome variables. All
data will be entered and analyzed using SPSS 21.0.

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