PRECEDE-PROCEED Model

Transcript PRECEDE-PROCEED Model

PRECEDE-PROCEED: Down the Yellow-Brick Road to Optimal Planning, Implementation and Evaluation

Lawrence W. Green University of California at San Francisco and Judith M. Ottoson San Francisco State University NW Chapter of Society for Public Health Education Seattle, May 30, 2013

• • • • •

Some Challenges of Planning Programs in Public Health

Health behavior & environmental change are driven by more than knowledge, beliefs, and attitudes ( “motivation”) Health behavior & environmental changes usually must be sustained over long periods to achieve health benefits Communications must be supported by policies and programs , regulations and organization Must adapt programs to different populations and settings, with sensitivity to their differences In summary: the challenges require more than merely importing and imparting information, knowledge, or even wisdom…

PRECEDE-PROCEED Model

• • • • • • •

P

redisposing,

R

einforcing, &

E

nabling

C

onstructs in

E

ducational/Ecological

D

iagnosis &

E

valuation • • • • • • •

P

olicy,

R

egulatory &

O

rganizational

C

onstructs in

E

ducational &

E

nvironmental

D

evelopment Green & Kreuter,

Health Program Planning, 4 th ed.,

NY, London: McGraw-Hill, 2005.

For bibliography of >1000 published applications, go to www.lgreen.net

Prototype of Causal Models and Intervention Models

Problem Theory: Causes (X)>->->->->->Effects Action Theory Causal Theory :

Intervention Models: INPUTS

(

educational, X ?

OUTPUTS (behavioral change, health, organizational quality of life, economic, etc.) development)

Different models interpret the content of “ X?

” according to different theories (or assumptions) about causation and control (mediating variables).

Green & Kreuter,

Health Program Planning, 4 th ed.,

NY, London: McGraw-Hill, 2005.

Examples of Causal Theories on Which PRECEDE-PROCEED

•

is Based

Psychological theories : X includes a behavior, and its antecedents such as attitudes, beliefs, values, perceptions, and other cognitive variables • Socio-cultural theories : X includes social norms, networks, diffusion, organizational functioning, and inter-organizational exchange & coalitions. • Economic theories : X includes consumer behavior and organizational response to consumer demand; governmental subsidies or incentives, taxes.

• Pathophysiological theories : X includes organisms or environmental exposure processes.

Planning & Evaluation Phases

Phase 4a Intervention Alignment Phase 3 Educational & Ecological assessment Predisposing Phase 2 Epidemiological, Behavioral and Environmental Assessment Phase 1 Social and Quality of Life Assessment



Precede Evaluation tasks:

Specifying measurable objectives and baselines.

Genetics Health Program

Phase 4b Administrative & Policy Assessment

Educational strategies Policy regulation organization Reinforcing Enabling Behavior Environment Health Quality of life



Proceed Evaluation Tasks:

Monitoring & Continuous Quality Improvement

Input Process Output Short-term impact Longer-term health outcome Short-term social impact Long-term social impact Phase 5 Implementation Phase 6 Process evaluation Phases 7-8 Impact and outcome evaluation

Phases 2-4 of PRECEDE. Phase 4: Intervention Alignment, Administrative And Policy Assessment Phase 3: Educational and Ecological Assessment

Phase 2: Epidemio logical & Behavioral Assessment

Matching and Mapping Predisposing Communications with Evidence, Theory & Policy

Direct Communications Knowledge, Attitudes Beliefs Cultural Values Perceptions

Communications: Reinforcing Health education, Training, Political, Media advocacy

Indirect Communi cations Influence from parents, teachers, employers, peers, etc.

Genetics and Human Biology Behavior and Lifestyle Policy, Regulation, Organization Enabling

Availability of resources Accessibility Skills, Restrictions Ecosystem

Environment

Phases 3-4. Intervention Planning 2c. Select Intervention Approaches

Policy Advocacy

2b. Select Channels and Mediators

Community Leaders

2a. Select Intervention Objectives

Healthful policies

Phases 1-2. Select Health, Environmental & Behavioral Goals Phases 4-5:. Dissemination

Community Development

& Implementation

Community Organization Community Norm Shapers Organization Decision-Makers Healthful Communities Healthful Organizations To Influence Individuals

6. Conduct Process Evaluation

Individuals at Risk Healthful behavior

7. Conduct Impact Evaluation 8. Conduct Outcome Evaluation Phases 6-8. Evaluation

*Adapted from Simons-Morton B, Greene W, & Gottlieb N.

Introduction to Health Education & Health Promotion,

2 nd ed. Waveland Press, 1995, p.154.

Health Status

From Planning to Implementation & Evaluation

Chapter 5

Phase 3 Planning PRECEDE Phases 4+ Intervention Alignment Administrative & Policy Diagnosis Predisposing Communications: Health Education Training Media Advocacy Reinforcing Behavior & Lifestyle Policy Regulation Organization PROCEED

Enabling Environment

Evaluation: Process………...Impact……Outcome-->

ALIGNING INTERVENTIONS WITH EVIDENCE, THEORY, EXPERIENCE, POLICY, IMPLEMENTATION AND FORMATIVE EVALUATION

Chapter 5: TURNING THE CORNER FROM PRECEDE to PROCEED Green & Kreuter, Health Program Planning: An Educational and Ecological Approach. 4 Publishing Co., 1984.

th ed. NY: McGraw-Hill, 2005; and building on Green & Lewis, Measurement & Evaluation in Health Education and Health Promotion. Palo Alto: Mayfield

Best Practices vs. Best Processes

• •

Best practices

efficacy

are interventions recommended on the basis of systematic reviews of evidence from controlled studies that substantiate their in the situations in which they were tested, but not necessarily their

effectiveness

in other populations and circumstances.

Best processes

are methods such as those of PRECEDE and the matching of evidence-based interventions to align and adapt them to the needs of a particular population and setting. Green & Kreuter,

Health Program Planning: An Educational and Ecological Approach.

4th ed. NY: McGraw-Hill, 2005.

Emergence of a Sedentary Society

2.3

1.8

Millions of Person-Miles in Automobiles, 1970-1990

1.4

60% of kids walked to school in 1970. 13% do now

800 k-calories/day decrease in 20 years

7:04

3000

6:07 5:06

2200 Hours of TV Viewed Daily 1960-1992

58%

Percent of Workforce in Sedentary Occupations, 1950-1996

36% 45% 1970 1990

Source: Schroeder, 2003

Change in Per Capita Cigarette Consumption

California & Massachusetts vs Other 48 States, 1984-1996 -10 -15 -20 -25 5 0 -5 Other 48 States California Massachusetts 1984-1988 1990-1992 1992-1996

http://www.cdc.gov/tobacco

The Adaptation Process

The Adaptation Guide, CDC, Div of HIV/AIDS Prevention., 2010. www.cdc.gov/hiv/topics/evaluation/health_depts/guidance/strat handbook/chapter4.htm

Sources & Uses of Evidence & Theory in Population-Based Planning & Evaluation Models* Evidence from community or population 1. Assess Needs & Capacities of Population Evidence from Etiologic Research 4. Evaluate Program Reconsider X 2. Assess Causes (X) & Resources Program Evidence & Effectiveness Studies, and use of Theory 3. Design & Implement Program Evidence from Efficacy Studies, and Use of Theory to Fill Gaps

*Green & Kreuter,

Health Program Planning.

4th ed. NY: McGraw-Hill, 2005, Fig. 5-1.

PROGRAM EVALUATION STANDARDS

Yarbrough, D.B., Shulha, L.J., Hopson, R.K., and Caruthers, F.W. (2011). The program evaluation standards: A guide for evaluators and evaluation users (3 rd ed.). Thousand Oaks, CA: Sage. http://www.jcsee.org

http://www.jcsee.org/program-evaluation-standards/program-evaluation-standards-statements

Public Health Core Functions and Essential Services

Community Tool Box http://ctb.ku.edu

Evaluation is…...

… the

systematic assessment

of the

operation outcomes

and/or of a

program or policy

, compared to a set of explicit or implicit

standards

as a means of contributing to the

improvement

of the program or policy Weiss, p4

The Program Evaluation Standards

• • • Key features – Standards identify and define evaluation quality – Guide evaluators and evaluation users in pursuit of evaluation quality – “laws” vs voluntary, consensus Revised 2011 – Clarifications – Now fifth standard of evaluation accountability Trade-offs among standards

•

The Program Evaluation Standards

Utility -- The utility standards support high quality evaluation use through attention to all aspects of an evaluation

•

Feasibility - The feasibility standards encourage evaluation to be effective and efficient.

•

Propriety -- The propriety standards are intended to ensure that an evaluation will be proper, fair, legal, right, acceptable, and just.

•

Accuracy -- Accuracy is the truthfulness of evaluation representations, propositions, and findings, which is achieved through sound theory, methods, designs, and reasoning.

•

Evaluation Accountabilit (metaevaluation) y -- Documenting and improving evaluation accountability requires similar efforts to those required for program accountability, i.e., an evaluation of the evaluation

• • • • • • • •

Utility Standards

The utility standards support high quality evaluation use through attention to all aspects of an evaluation

: Evaluator credibility

: Attention to stakeholders

: Negotiated purposes

: Explicit values

: Relevant information

: Meaningful processes & products

: Timely & appropriate communicating & reporting

: Concern for consequences and influence

Feasibility Standards

The feasibility standards are intended to ensures that an evaluation will be realistic, prudent, diplomatic, and frugal •

: Project management •

: Practical procedures • •

F3 F4

: : Contextual viability Resource use

Propriety Standards

The propriety standards are intended to ensure that an evaluation will be conducted legally, ethically, and with due regard for the welfare of those involved in the evaluation, as well as those affected by its results •

: Responsive & inclusive orientation • •

P2: P3:

Formal agreements Human rights & respect • • • •

P4 P5: P6 P7:

Clarity and fairness Transparency & disclosure Conflicts of interest Fiscal responsibility

Accuracy Standards

…intended to ensure that an evaluation will reveal and convey technically adequate information about the features that determine worth or merit of the program being evaluated. • • • • • • • •

: Justified conclusions and decisions

A2:

Valid information

: Reliable information

: Explicit program & context descriptions

: Information management

: Sound design & analysis

: Explicit evaluation reasoning

: Communication & reporting

Evaluation Accountability Standards

Accountability refers to the responsible use of resources to produce value. In program evaluation, this requires an evaluation of the evaluation. • • •

E1:

Evaluation documentation

E2: E3:

Internal metaevaluation External metaevaluation

Trade offs Among Standards

• • • • Utility vs accuracy Accuracy vs Feasibility Feasibility vs utility Propriety vs nothing

Evaluation Standards: So What?

• Power of knowing what counts as “good” evaluation • Know where to find standards:

ww.jcsee.org

• Rationale for explaining evaluation trade offs • Accountability