GROUP 1

PRECEDE-PROCEED MODEL

Developed by Dr. Lawrence W. Green and colleagues, the PRECEDE-PROCEED Model

provides a model for community assessment, health education, planning, and evaluation. When
applied in public health, this model focuses on health promotion rather than disease prevention.
PRECEDE-PROCEED is community-based and participatory, based on the assumption that
changes that promote health (and other community issues) are mostly voluntary, hence
requiring participation from people who need to change as well as others who may influence or
be influenced by them.

PRECEDE, which stands for predisposing, reinforcing, and enabling constructs in

education diagnosis and evaluation, is used for community diagnosis. PROCEED, an acronym
for policy, regulatory, and organizational constructs in educational and environmental
development, is a model for implementing and evaluating health programs based on
PRECEDE.

Figure 1. Generic Representation of the PRECEDE-PROCEED Model. From L. Green

and M. Kreuter. (2005). Health Promotion Planning: An Educational and Ecological Approach
(4th ed.). Mountain View, Ca: Mayfield Publishers.
Case Scenario

In a small community in San Miguel, Manila with a population of about 20,000 residents
and 4,300 households, the local authorities are planning to reinforce a mandatory COVID-19
vaccination to achieve ‘herd immunity’, also known as ‘population immunity’. The barangay
officials conducted a survey among the residents who fit the criteria for vaccination, wherein the
results showed that 30% of the residents ages 18 and above do not want to get vaccinated.
15% of the residents are still undecided, while the remaining 55% agreed to get vaccinated. The
majority of those who do not want to get vaccinated belong to the persons with comorbidities
and senior citizens demographic. While those who are still undecided stated that they either do
not believe in the effects of the vaccine or they prefer a different brand of vaccine than what
their barangay is offering.

Figure 1.1. PRECEDE-PROCEED Model for Health Promotion, Planning, and Implementation
for COVID-19 Vaccination in San Miguel, Manila.
PHASE 1: Social Diagnosis

Lack of Herd Immunity in the community of San Miguel, Manila may need programs that
work on a large-scale to educate the residents on the importance of vaccines. The lack of
education about vaccines are the obstacles that are hindering the Herd immunity to be achieved
in the community. The desired result is the reduction of transmission and infection of the
COVID-19 virus through Herd immunity by encouraging the residents to get vaccinated.

The population aggregates consist of the following:

Age Criteria Percentage

18 years and above Fit for vaccination 72%

17 to 13 years old Age does not qualify for vaccine age 13%
requirement

12 to 6 years old Age does not qualify for vaccine age 14%
requirement

*18 years and above Not recommended for vaccine due to 1%

underlying conditions or allergies
Table 1. Social Diagnosis (Demographic for Vaccination of San Miguel Residents).

Majority of the community population is eligible for vaccination. Age range of 18 years
old and above comprise 72% of the community which is equivalent to 14,400 residents. 13% or
2,600 are teenagers below 18 years old. 14% or 2,800 residents are ages 12 to 6. While, 200
residents or the remaining 1% belong to ages 18 and above but due to certain underlying health
conditions, they are not recommended to be vaccinated.

The barangay officials conducted a survey to determine the number of residents who are
willing and not willing to get vaccinated, as well as their reason for declining and other concerns.
The survey results showed that out of the 14,400 eligible candidates for the vaccination
program, 55% or 7,920 agreed to get vaccinated no matter what the brand of the vaccine is.
While, 30% or 4,320 residents do not want to get vaccinated because they fear the effects of the
vaccine since they are mostly persons with comorbidities and senior citizens. 15% or 2,160
residents are those who answered that they are still undecided whether or not to get vaccinated
because of their fear of the vaccine, and they prefer a different brand of vaccine.
 Figure 2. Social Diagnosis (Survey results regarding the mandatory community vaccination).

FORMULA USED:
● San Miguel, Manila with a total population of 20,000 residents. Out of the 14,400 eligible
residents for vaccination, only 7,920 agreed to participate in the vaccination program. To
calculate for the percentage:

● 4,320 residents out of 14,400, do not want to participate in the vaccination program:

● The remaining 2,160 residents out of the 14,400 were still undecided whether or not they
want to participate in the vaccination program.
PHASE 2: Epidemiological Diagnosis

‘Herd immunity’ or ‘population immunity’ needs to be achieved by San Miguel, Manila in

order to protect the community from an infectious or communicable disease brought about by
the COVID-19. Those who belong in the high-risks group which are medical frontliners, senior
citizens and persons with comorbidity are considered as a top priority in getting the vaccination.
Through vaccination, this will help in preventing the disease from spreading through any
population aggregates to reduce the number of cases and deaths.

After examining the community, the following are the identified factors that affect the
desired result:

Behavior Lifestyle Environmental

● Lack of knowledge ● Socioeconomic status ● Population density

● Noncompliance with the ● People with vices ● Confined and
health protocols enclosed spaces with
● Person’s trust in the poor ventilation
vaccine’s efficacy and
safety
● Fear
Table 2. Epidemiological Diagnosis of San Miguel Residents.

Due to the lack of knowledge and misinformation, the community became fearful of the
vaccine. The spread of the virus can also be increased due to noncompliance with the
community health protocols, hence hindering the community’s goal of ‘herd immunity’. Likewise,
the limited and enclosed space outside of the residents’ homes can facilitate the fast
transmission of disease (e.g. marketplace). People with unhealthy health habits, low
socioeconomic income, and vices are also at risk for developing health problems that may
complicate their ability to get vaccinated (e.g. certain medications, hypertension, cancer).

PHASE 3: Educational and Organizational Diagnosis

Predisposing factors refer to the people’s characteristics that motivate them toward
health-related behavior. Enabling factors refer to conditions in people and the environment that
facilitate or impede health related factors. Reinforcing factors refer to feedback given by support
persons or groups resulting from the performance of the health-related behavior.

The following are the factors identified to influence behavior, lifestyle, and responses to
the environment:

Predisposing Factors Enabling Factors Reinforcing Factors

● Misinformation from ● Low-income workers ● Dengvaxia

social media and ● No access to controversy plummets
 conspiracy theories information from vaccine confidence
● Fear of vaccine reliable sources ● Vaccine hesitant
side-effects prevent ● Insufficient families’ influence
them from working professionals in
● Does not feel the vaccination to
need for vaccination increase vaccine
acceptance
Table 3. Educational and Organizational Diagnosis of San Miguel Residents.

PHASE 4: Designing programs or interventions and the support for them through
administrative and policy diagnosis

The policy factors that can be implemented by the community:

a) Educate residents about the vaccine. Ask them if they are willing to talk and what
you can do to help them as their nurse. There is a lot of misinformation about
vaccines and disseminating accurate information is a must so that several people
would be encouraged to be vaccinated.
b) If they refuse the second time, and the barangay is still unable to achieve "herd
immunity," unvaccinated people will be prohibited from going outside until they
are vaccinated. For instance, visiting malls, other areas, and so forth.
c) Make vaccination sites easily accessible. Consider a vaccine program that goes
door-to-door or in-house vaccination. So that residents feel more secure and will
not be scared to go out. More people may be encouraged with a home-visit
vaccination program since it will be very convenient for them

PHASE 5: Implementation

A. Health Education

Lack of knowledge is one of the factors that hinders the residents from getting
vaccinated. Therefore, implementing a health education program to raise the residents'
awareness about the vaccines may persuade them to get vaccinated, as well as alleviate their
fears and correct any inaccurate information they may have received.

The residents can be educated through dissemination of information in social media,

barangay announcements, and pamphlets about the vaccine and its benefits. COVID-19
vaccines are effective in protecting against severe diseases and death caused by current
circulating COVID-19 virus variants, especially the Delta variant. Inform the residents that they
may experience side effects as a result of the vaccine. These are common and will pass in a
few days. Getting vaccinated reduces their chances of becoming infected significantly. While it is
rare to contract COVID-19 after being vaccinated, if they do, they will be considerably less likely
to become seriously ill. All of the existing vaccines provide excellent protection against the
COVID-19 virus.
 B. Health Consultation

Since, some of the residents are persons with comorbidities and of the older age,
implementing a free consultation before getting vaccinated can help ease their worries and
provide answers for their queries. It is also recommended to have pre-immunization screening
to ensure whether a person is allowed to get vaccinated. This will also help avoid allergic
reactions from the vaccine and any adverse effects due to underlying health conditions.

C. Accessible vaccination centers

Considering that older adults are on the priority list of people who should be vaccinated,
accessible vaccination centers are one of the interventions that might help older adults to decide
to get vaccinated. Not only the older adults but also the people with disabilities. To ensure the
safety of the older adults and PWD. Vaccination centers and providers should ensure that they
are prepared to accommodate the needs of older adults and people with disabilities prior to and
after the vaccination.

D. Strengthening Community Health Guidelines

Educate and encourage the residents to always practice personal protective measures
like regular and proper hand washing, wearing of face masks and face shield, physical
distancing of at least 1 meter, and avoiding crowded places and limit time in enclosed spaces.
Advise them to cover coughs and sneezes, protect yourself and others from diseases, and to
not touch their mouth, nose, and eyes unless hands are properly sanitized. All of these will help
prevent the fast transmission and spreading of the virus, keeping the residents infection-free.

E. Healthy Lifestyle and Behavior

During the COVID-19 epidemic, eating a nutritious diet is critical. Our body's ability to
prevent, fight, and recover from infections is influenced by what we eat and drink. Encourage
the clients to make healthy choices, such as eating a variety of fruits and vegetables on a
regular basis, to improve your overall nutrition. Promote smoking cessation, decreased alcohol
intake, and cessation of other vices to keep the residents body and environment healthy. Advise
the clients as well to perform exercise and physical activities that can be done at home to keep
their bodies active and healthy.

PHASE 6: Process Evaluation

Implementations were conducted as planned. Problems were identified and modified

immediately to improve the vaccination program. The interventions such as the community
health education were conducted as planned. Dissemination of accurate information through
social media and pamphlets about the benefits of the vaccine were provided for the residents.
As well as free and accessible health consultation for those who have comorbidities that have
concerns about the possible relation of their underlying condition and the vaccine. The target
group aggregates were able to be informed and reappraise their misconceptions and false
information regarding the vaccines that will be administered to them.
PHASE 7: Impact Evaluation

Figure 3. Impact Evaluation (Survey results regarding the mandatory community vaccination
after the intervention were conducted as planned).

The overall population in San Miguel, Manila is 20,000 with 4,300 households. Before
the implementations, 55% agreed to be vaccinated, 30% did not want to get vaccinated, and
15% were undecided. After the interventions were conducted, the percentage of people who
wanted to be vaccinated and got vaccinated increased. According to WHO, to achieve herd
immunity in a community, 70% of the population should be vaccinated.

PHASE 8: Outcome Evaluation

The interventions that were implemented were able to produce the desired result of
having a “herd immunity” for the barangay in San Miguel, Manila. According to the Centers for
Disease Control and Prevention, herd immunity, or community immunity, occurs when a
sufficient proportion of a population is immune to an infectious disease through vaccination,
making transmission from person to person less likely. The process that was planned met the
expected changes such as the strengthened compliance towards the community health
protocols, and 70% of the total population of the community was able to get vaccinated, thus
achieving “herd community”. Some of the outcomes that involve lifestyle and behavioral
changes may take years or longer to manifest. For instances like this, continue to watch the
process and impact of the interventions in the hopes that it will manifest eventually.
BSN 301 COMMUNITY HEALTH NURSING 2
GROUP 1 MEMBERS:
Aure, Reine
Carlos, Juan
Elgar, Kraven Kim
Guinto, Kyla
Laurezo, Joshua Glenn
Marilag, Abbygail
Martinez, Denise
Rara, Vanessa Mae

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