PRECEDE/ PROCEED

muji-s@fkm.unair.ac.id
mujisulistyowati@gmail.com
 KERANGKA PRECEDE/ PROCEED
LAWRENCE GREEN
PRECEDE (Predisposing, Reinforcing and Enabling Constructs in Educational Diagnosis and Evaluation)

Phase 5 Phase 4 Phase 3 Phase 2 Phase 1

Administrative Educational and Behavioral and Epidemiological Social
and Policy Organizational Environment Diagnosis Diagnosis
Diagnosis Diagnosis Diagnosis
Predisposing
HEALTH Factors
PROMOTION

Health
Behavior
Education Reinforcing
Factors and Lifestyle

Quality
Health
Policy and
Regulation of Life
Organization Enabling
Factors Environment

Phase 8 Phase 9
Phase 6 Phase 7
Implementation Impact Outcome
Process Evaluation
Evaluation Evaluation

PROCEED (Policy, Regulation, Organization, Construct in Education, Environment Development)

 Overview
• P-P framework originated in the 1970s
• To enhance the quality of health education interventions
by offering practitioners a systematic planning process
• P-P model is a nine-phase process that begins with the
proposition that health behaviors are complex,
multidimensional, and influenced by a variety of factors
• P-P model is not considered a behavioral theory per se, it
is a conceptual framework for practice, or planning
model
• The planning process in P-P emphasized on the principle
of participation
Bersambung…
• The principle of participation states that
success in achieving change is enhanced by
the active participation of member of the
target audience in defining their own high-
priority problems and goals and in developing
and implementing solutions (Green & Kreuter,
1991; Minkler, 1990; Freudenberg & others,
1995)
• It means : at each phase, efforts should be
made to include the target audience in all
aspects of program planning, implementation
and evaluation
DIAGNOSIS SOSIAL
 Definisi

• Assessing Quality of Life Concerns

Social Needs Assessment/ Social reconnaissance
• The process of determining people’s perceptions
of their own needs or quality of life, and their
aspirations for the common good, through broad
participation and the application of multiple
information-gathering activities designed to
expand understanding of the community.
• Community participation merupakan konsep
dasar dalam social diagnosis, dan telah
menjadi prinsip dasar dalam upaya promosi
kesehatan dan pengembangan masyarakat
• multiple information-gathering, berarti bahwa
diagnosis sosial dilakukan dengan
mengumpulkan beberapa indikator dan data
yang berasal dari berbagai sumber
• expand understanding, berarti adanya
perhatian dari lintas bidang :sosial, ekonomi,
budaya dan lingkungan
 Hubungan antara “Health” dan
“Social Problems” :

• A Reciprocal Relationship
Social policy/
Social service interventions

Health Social Conditions

Quality of Life

Health Policy
Health Interventions
 “Quality of Life”

• Dapatkah “Quality of Life” diukur ?

• Pendekatan yang dipakai :
– Objective assessment/ Social Indicators :
• Unemployment rates; air quality; housing, etc
– Subjective assessments :
• Menggunakan informasi yang didapat dari masyarakat/
populasi
• Keuntungan : sudut pandang masalah/ situasi dari
masyarakat
• Cara : survey.
 Identifikasi
• Beberapa strategi untuk mengidentifikasi
masalah sosial :
– Studi literature
– Key informant interviews
– Community forums
– Nominal Group Process
– The Delphi Method
– The Continuum Approach
– Data Publik
– Focus Group discusion (FGD)
• To conduct an effective social diagnosis : one
must apply the principle of participation and
ensure the active involvement of the people
who will be affected by the program being
planned.
 Indikator Dx Sosial
• Kesejahteraan
• Kemiskinan
• Angka Melek Huruf
• Tingkat Pengangguran
• Tingkat kriminalitas
• Tingkat pendidikan
• Pendapatan/ pekerjaan
• Saluran komunikasi
• Budaya (yang dianut dan masih diterapkan)`
 DIAGNOSIS
EPIDEMIOLOGI
 Tujuan Dx Epidemiologi
• Mengidentifikasi masalah kesehatan yang
penting untuk dipecahkan, secara obyektif
• faktor perilaku dan lingkungan apa yang
mempengaruhi terjadinya masalah kesehatan
tersebut
ASSESSING THE IMPORTANCE OF HEALTH
PROBLEMS
• It helps to establish the relative importance of
various health problems in the target population
as a whole and in population subgroups
• It provides a basis for setting program priorities
among the various health problems and
subgroups
• It aids in the allocation of responsibilities among
collaborating professionals, agencies and
departments
• The purpose is to identify the known risk factors
for the priority health problems
 Two Approaches in
Epidemiological Diagnosis :
 REDUCTIONIST APPROACH
– Works from a broad social problem toward an
assessment of the health components that contribute
causally to that problem
– The reductionist approach can be used in
epidemiological assessment when the social problem
has been identified, but the causes of the problem
have not been clearly delineated.
 EXPANSIONIST APPROACH
– Starts from a specified health problem and works to
the larger social context within which that particular
problem occur
 go to.. Behavioral &
Environmental diagnosis

Three ways that behavior can influence health :

1. through physical and social environmental
causes
2. through health care (environmental) causes
3. directly
 Langkah dalam melakukan diagnosis Epidemiologi

DIAGNOSIS DIAGNOSIS EPIDEMIOLOGI

SOSIAL :
Pendekatan
Keadaan
Reduksi :
perumahan
• gizi buruk
jelek
• penyakit infeksi
• diare

Pendekatan Health Problem

Ekspansi:
Diare, terjadi pada Prioritas
sasaran dengan masalah
karakteristik sosial kesehatan
yang bagaimana ? dengan variabel
• Kelompok usia sosial
• Pendidikan
• Penghasilan
• lokasi Health Objective:
Who ?
What ?
How much ?
By when ?
 Pustaka :
• Green & Kreuter, 1991, Health Promotion Planning :
An Educational and Environmental Approach, 2nd
Ed., Mayfield Publishing Company, page: 44-82