THE PRECEDE-PROCEDE

MODEL

L.W. GREEN

Muhammad Azinar
Peminatan Promosi Kesehatan dan Ilmu Perilaku
Jur. IKM – FIK Universitas Negeri Semarang
PRECEDE (Predisposing, Reinforcing, and Enabling Constracts in Educational/Environmental
Diagnosis and Evaluation)
Phase 5 Phase 4 Phase 3 Phase 2 Phase 1
Administrative educational and Behavioral and Epidemiological Social
and policy organizational environmental diagnosis diagnosis
diagnosis diagnosis diagnosis

HEALTH PREDISPOSING
PROMOTION FACTORS

HEALTH REINFORCING BEHAVIOR &

EDUCATION FACTORS LIFE STYLE

HEALTH QUALITY
OF LIFE
POLICY
REGULATION
ORGANIZATION ENABLING
FACTORS ENVIRONMENT

Phase 6 Phase 7 Phase 8 Phase 9

Implementation Process evaluation Impact evaluation Outcome evaluation

PROCEDE (Policy, Regulatory, and Organizatinal Constructs in Educational/Environmental Development)

 Phase 3 Phase 2 Phase 1
Behavioral and Epidemiological Social
environmental diagnosis diagnosis
diagnosis

BEHAVIOR &
LIFE STYLE
HEALTH QUALITY
OF LIFE
ENVIRONMENT
Behavioral Environmental Vital Social
Indicators: Indicators: Indicators: Dimensions: Indicators:
Distribution Absenteeism Hostility
Compliance Economic Disability
Duration Achievement Illigitimacy
Consumption Physical
patterns Services Discomfort Functional Aesthetics
level Allienation Performance
Coping Social
Incidence Comfort Riots
Preventive Fertility
Dimensions: Intensity Crime Self-esteem
actions Fitness
Prevalence Crowding Unemploy-
Self-care Access Morbidity
ment
Utilization Affordability Mortality
Discrimination Votes
Equity
Dimensions: Happiness Welfare
Physiological
Frequency risk factors
Persistence
Promptness Relationships, indicators, and dimensions of factors that
Quality
Range
might be identified in phases 1,2, & 3
 Phase 5 Phase 4
Administrative and policy educational and
diagnosis organizational diagnosis

Direct PREDISPOSING FACTORS:

communication to Knowledge
public, patients, Beliefs
students, Values
employees Attitudes
HEALTH Perceptions
PROMOTION

Indirect REINFORCING FACTORS:

communication Attitudes and behavior of
through staff BEHAVIOR
family, peers, teachers, (actions) of
HEALTH training,
supervision, employers, health providers, individuals,
EDUCATION
consultation, community leader, decision groups, or
feedback makers, etc. communities

Training : ENABLING FACTORS:

Community Availability of resources
POLICY organization Accessibility
ENVIRONMENT
REGULATION Referrals
ORGANIZATION Rules or laws,
Skills
1. PREDISPOSING FACTORS • Relate to the motivation of an
individual or group to act.
2. ENABLING FACTORS
• As the “personal” preferences
3. REINFORCING FACTORS that an individual or group
brings to a behavioral choice.
• Include : knowledge, attitudes,
beliefs, values, perceived
needs, and abilities.
• Include the cognitive and
affective dimensions of
knowing, feeling, believing,
valueing, and having self
confidence or a sense of
efficacy.
1. PREDISPOSING FACTORS • Conditions of the
2. ENABLING FACTORS environment, facilitate the
3. REINFORCING FACTORS performance of an action by
individuals or organizations;
• Included are:
- the availability,accessibility,
and affordability of health care
and community resources.
- conditions of living that act
as barriers to action, such as
availability of transportation.
- new skills that a person,
organization, or community
needs to carry out a
behavioral or environmental
change.
1. PREDISPOSING FACTORS • Are those consequences of
2. ENABLING FACTORS action that determine whether
3. REINFORCING FACTORS the actor receives positive (or
negative) feedback and is
supported socially after it
occurs.
• Include:
- social support, peer
influences, and advice and
feedback by health-care
providers.
- physical consequences of
behavior.
- social benefits, physical
benefits, economic benefits,
imagined or vicarious
rewards (self respect).
- punishments.
Relationship between health and quality of live

Malnutrition
Alcoholism
Anemia
Parasites
Mental illnes
Adolescent
Health
pregnancy
Problems
Social Problems or
Quality of Live Concern:
POVERTY
Environmental
Problems
Underemployment
Poor education
Social disintegration
Overpopulation
Geography
Transportation
 Examples of behavior and environmental factors
influencing health

WORKER BEHAVIOR
Personal protective equipment
Personal hygiene
Medical screening HEALTH OUTCOME:
Attendance at training Occupational lung disorders CORPORATE
meetings Musculoskeletal disorders OUTCOMES:
Occupational cancer Sick leave (cuti sakit)
Fractures, amputations, Absenteeism
traumatic death Property damage and
Noise-induced disability claims from
WORKPLACE hearing loss high accident rates
ENVIRONMENT Dermatological problems
Engineering controls Psycological disorders
Administrative controls
Clearing practices
Signs/warnings/postings
Industrial monitoring/testing
 Examples of Predisposing, Enabling, and
Reinforcing Factors Influencing Behavioral Problem
INFLUENCING FACTORS BEHAVIORAL PROBLEM
PREDISPOSING FACTORS
Knowledge about safety practices
Attitude toward safety performance
Perceived susceptibility to an injury
Control over own safety on job
Perception of risk taking on the job
Saliency of health

ENABLING FACTORS
Exposure to safety training Worker’s
Instructions at initial employment
Availability of appropriate and safe equipment safety
Exposure to safety meetings practices
Work pace

REINFORCING FACTORS
Top management’s attitude toward safety and
safety practices
Top management’s enforcement measures of
safe work conditions and practices
Foremen’s safety enforcement and safety
practices
Union’s attitude toward safety practices
Co-worker’s attitude toward safety practices
Safety climate of the site
 Beginning at the end
INPUTS X? OUTPUTS
(educational, (health, quality
organizational, of life)
economic, etc.)

• The PRECEDE framework directs initial attention to outputs rather

than inputs.
• It encourages asking ‘why’ before ‘how’.
• Begin with the desired final outcome and determine what causes it-
that is, what must precede that outcome (X ?).
• The factors important to an outcome must be diagnosed before the
intervention is designed.
 PREDISPOSING

BEHAVIOR
HEALTH

ENABLING REINFORCING

Reference : L.W Green, Marshal W. Kreuter, Health Promotion Planning: An

Educational and Environmental Approach, Mountain View, Mayfield
Publishing Company, 2nd Edition, 1991.

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