1、PRECEDE-PROCEED模式简介及应用,成员：金怡晨、黄亚阳、丁子尧、王政和,1,PRECEDE-PROCEED模式,1980年，以美国Lawrence W.Green教授为首提出的，所以又称格林模式。PRECEDE-PROCEED模式不仅仅是行为理论模型，更为健康促进的规划设计、执行及评价提供一个连续的步骤或阶段。是当代健康教育领域最有代表性、应用最广泛的过程模式。,2,PRECEDE阶段：(Predisposing, Reinforcing and Enabling Constructs in Educational/environmental Diagnosis and Evalu
2、ation) 指在教育/环境诊断和评价中的倾向因素，促成因素及强化因素。PROCEED 阶段：(Policy, Regulatory and Organizational Constructs in Educational and Environmental Development)指在执行教育和环境干预中运用政策、法规和组织的手段。,3,PRECEDE-PROCEED模式可分为两个阶段：,3,4,PRECEDE-PROCEED模式,4,分析程序上：从结果入手，以演绎的方法进行分析思考；在设计干预计划前对产生结果的重要影响因素作出诊断。模式结构上：考虑了影响健康的多重因素，帮助规划制定者把这些
3、因素作为重点干预的目标，同时产生特定的规划目标和评价标准。,PRECEDE-PROCEED模式特点：,5,倾向因素,强化因素,促成因素,6,PRECEDE-PROCEED中的行为理论,6,倾向因素（前置因素）：是指能促进或阻碍人们行为改变动机的因素包括知识、态度、信念、价值观等,倾向因素（Predisposing Factors）,以母乳喂养为例 产妇关于母乳喂养益处的知识 有效喂养的技能 母乳喂养的态度 自我效能,7,促成因素（实现因素）：是指促成或阻碍健康行为动机得以实现的因素包括实现健康行为所必须的技术、资源、服务、社会力量等（客观条件）,促成因素（Enabling Factors）,以
4、母乳喂养为例 围产期护理 产假政策 知识信息获取（社区/媒体/课堂） 配方奶粉的宣传,8,强化因素：是指目标人群在行为改变后所获得的各种正向或负向反馈，这种反馈可以是来自他人的、也可以是来自自身的，其作用结果可能使得行为维持、发展或减弱。包括社会支持、同伴赞许、亲属肯定与鼓励、实质性奖励、自己对行为后果的感受,强化因素（Reinforcing Factors）,以母乳喂养为例 围产期护理 产假政策 知识信息获取（社区/媒体/课堂） 配方奶粉的宣传,9,PRECEDE-PROCEED模式实施过程（简要）,10,PRECEDE阶段社会诊断（社区需求评估） 评估目标人群的生活质量并明确影响其生活质量
5、的健康问题 了解目标社区或对象人群的社会环境流行病学诊断 确定目标人群的主要健康问题行为诊断 区分行为与非行为因素/重要行为与不重要行为/高可变性行为与低可变性行为教育诊断 确认影响目标行为的倾向因素、促成因素和强化因素管理与政策诊断 组织评估和资源评估,PRECEDE-PROCEED模式实施过程（简要）,11,PROCEED阶段执行阶段/过程评价 通过健康教育和政策法规制定实施健康促进近期效果评价 影响行为生活方式的因素是否得到改变中期效果评价 行为与生活方式是否发生改变结局评价 生活质量是否得到改善（发病率）,PRECEDE-PROCEED模式实施过程（简要）,12,健康领域使用最为广泛、
6、评估最为全面的模式之一，也是社区健康促进和公共卫生干预的有效模式干预对象包括健康者和疾病患者研究方向包括疾病护理、疾病预防、健康保健和健康需求评估等,PRECEDE-PROCEED模式的应用,13,慢病管理 高血压 冠心病营养性疾病 缺铁性贫血 碘缺乏性疾病妇幼保健 剖宫产 口腔健康其他 职业防护 艾滋病 烟草控制等等,PRECEDE-PROCEED模式的应用研究方向,14,应用实例（一）,格林模式在社区高血压患者健康教育中的应用纪诚 郑昊 姚桐 姜岩石,15,研究目的和对象,研究目的：研究格林模式在社区高血压患者健康教育中的应用效果研究对象：某社区高血压患者120人， 应用格林模式进行健康教
7、育。在应用格林模式前，对教育对象进行高血压知识达标率、高血压健康教育的支持率、卫生活动参与率和高血压控制稳定率等调查,16,研究方法,具体实施流程图,17,研究方法,1.社会诊断通过GQOLI-74生活质量评价表，了解患者的生活、学习、工作、社会环境等基本情况2.流行病学诊断进行健康调查，了解既往病史、家族病史、教育对象高血压达到几级并了解其身体健康状况3.行为与环境诊断吸烟、长期饮酒、睡眠不足、肥胖等,18,研究方法,4.教育与组织诊断分析引起高血压的行为和生活方式的倾向因素、促成因素和强化因素，更确切地了解促进疾病生成的原因，更有针对性更有效地进行护理干预5.管理与政策诊断6.实施教育计划
8、根据各教育对象存在的不用银色，着重给予健康指导、制定计划,19,研究方法,7.健康教育过程评价通过随访和调查问卷的方式，及时了解教育对象及其家人的反馈意见和建议，找出存在的问题并对原计划进行调整8.健康教育效果评价通过随访和调查问卷的方式，对教育对象进行高血压知识达标率、高血压健康教育的支持率、卫生活动参与率、高血压控制稳定率和不良习惯转变率等调查9.健康教育的结果评价教育结束后，对照计划进行随访，了解教育对象的长、短期目标的完成情况，并根据情况随时修改目标，应用CQOLI-74生活质量评价进行评估,20,应用实例（二）,Application of the PRECEDE-PROCEED P
9、lanning Model in Designing an Oral Health StrategyCatherine J. Binkley and Knowlton W. JohnsonJ Theory Pract Dent Public Health,21,Background,Although the poor oral health of adults with intellectual and developmental disabilities (IDD) constitutes a significant health disparity in the United States
10、.Few interventions to date have produced lasting results. Moreover, there is minimal application of planning models to inform and design a theory-based strategy that has the potential to be effective and sustainable in this population.,22,Methods,The PRECEDE-PROCEED planning model is being used to d
11、esign and evaluate an oral health strategy for adults with IDD. The PRECEDE component involves assessing social, epidemiological, behavioral, environmental, educational, and ecological factors that informed the development of an intervention with underlying social cognitive theory assumptions. The P
12、ROCEED component consists of pilot-testing and evaluating the implementation of the strategy, its impact on mediators and outcomes of the population under study.,23,PRECEDE Planning Model Component,24,Phase 1 Social Assessment,The PRECEDE portion of the Model begins with diagnostic activities that i
13、dentify desirable outcomes or goals of the intervention or ask, “What can be achieved?” These activities determined the primary or distal outcomes of the oral health strategy for the individual with disabilities.,25,Phase 2 - Epidemiological, Behavioral, and Environmental Assessment,We searched the
14、literature and asked questions of the selected community leaders and healthcare staff noted above about what problems or issues affect the oral health-related quality of life for persons with IDD? - OR - What needs to change to achieve optimal oral health for these individuals? This phase determined
15、 epidemiological, behavioral, and environmental factors that may well have an impact on the oral health and quality of life of individuals with IDD. This phase contributed to the identification of the factors that an oral health strategy needs to impact (mediating outcomes) in order to achieve the p
16、rimary outcomes.,26,Phase 3 Educational and Ecological Assessment,This phase determined factors that, if modified, would be most likely to result in behavior change and to sustain this change process. These factors are generally classified as predisposing, enabling, and reinforcing factors “Predispo
17、sing factors are antecedents to behavior that provide the rationale or motivation for the behavior and include individuals existing skills and self-efficacy. “Enabling factors are antecedents to behavioral or environmental change that allow a motivation or environmental policy to be realized” and ma
18、y include new skills, services, resources, and programs. Reinforcing factors are those factors following a behavior that provide continuing reward or incentive for the persistence or repetition of the behavior” and they include social support, praise, and vicarious reinforcement.,27,Change theory(ie
19、s) for designing the intervention after this assessment includes individual, interpersonal, and community theories. Individual-level theories are best used to address predisposing factors. while interpersonal-level theories, such as social cognitive theory, address reinforcing factors well. communit
20、y-level theories are most appropriate for addressing enabling factors.,28,Phase 4 Intervention Alignment and Administrative and Policy Assessment,Phase 4a - Intervention Alignment(调整)This phase matched appropriate strategies and interventions with the projected changes and outcomes identified in pha
21、ses 1-3 . Using assessment results from phases 1-3, the oral health strategy presented in the results section emerged as our intervention of choice.,29,Phase 4b - Administrative and Policy Assessment:In this phase, resources, organizational barriers and facilitators, and policies that were needed fo
22、r the strategy or intervention implementation and sustainability were identified . The organizational and environmental systems that could affect the desired outcomes (enabling factors) were taken into account. The administrative diagnosis assessed resources, policies, budgetary needs, and organizat
23、ional situations that could hinder or facilitate the development and implementation of the strategy or program (25). The policy diagnosis assessed the compatibility of the oral health strategy with those of the organizations providing services to individuals with IDD.,30,PROCEED Planning Model Compo
24、nent,31,Phase 5 - Pilot Study,Although we did not recognize the inclusion of a pilot study as essential to the PRECEDE-PROCEED planning model, we believe that it is an important planning phase. These results and lessons learned are important to revising both the pilot oral health strategy and its ev
25、aluation for an efficacy study. To this end, we have provided a description of our in progress pilot study in the results section of this article.,32,Phase 6 - Implementation,This phase presents a description of the implementation of the oral health strategy in an efficacy study. Key roles in the im
26、plementation phase are highlighted.,33,Phases 7 and 8 Process and Outcome Evaluation,Our planned efficacy study is designed as a cluster randomized control trial that includes a process and outcome evaluation. The study of both the implementation process and outcome achievements is important. The im
27、plementation process assessment should address the amount of intervention exposure of the oral health strategy (dosage), extent to which an intervention is implemented as designed (fidelity), and participant appraisal of intervention quality or usefulness (participant reaction), all of which are dis
28、cussed in the evaluation literature.,34,In addition, we measured adequacy of implementation by recruiting an expert panel who has published implementation articles to assess the adequacy of our implementation. The outcome evaluation should be composed of an assessment of oral health strategy direct effects on outcomes, mediation of outcomes designated as mechanisms of change, and moderation of contextual factors. Our evaluation plans are highlighted in the results section of this article.,35,谢谢！,36,
