PRECEDE-PROCEED模式

簡介及應用成員：金怡晨、黃亞陽、丁子堯、王政和PRECEDE-PROCEED模式1980年，以美國LawrenceW.Green教授為首提出的，所以又稱格林模式。PRECEDE-PROCEED模式不僅僅是行為理論模型，更為健康促進的規劃設計、執行及評價提供一個連續的步驟或階段。是當代健康教育領域最有代表性、應用最廣泛的過程模式。3行為理論/需求診斷健康干預PRECEDE-PROCEED模式可分為兩個階段：4行為理論PRECEDE-PROCEED模式分析程序上：從結果入手，以演繹的方法進行分析思考；在設計干預方案前對產生結果的重要影響因素作出診斷。模式結構上：考慮了影響健康的多重因素，幫助規劃制定者把這些因素作為重點干預的目標，同時產生特定的規劃目標和評價標準。PRECEDE-PROCEED模式特點：傾向因素強化因素促成因素6行為生活方式環境傾向因素強化因素促成因素PRECEDE-PROCEED中的行為理論傾向因素〔前置因素〕：是指能促進或阻礙人們行為改變動機的因素包括知識、態度、信念、價值觀等傾向因素〔PredisposingFactors〕以母乳喂養為例產婦關于母乳喂養益處的知識有效喂養的技能母乳喂養的態度自我效能促成因素〔EnablingFactors〕強化因素：是指目標人群在行為改變后所獲得的各種正向或負向反響，這種反響可以是來自他人的、也可以是來自自身的，其作用結果可能使得行為維持、開展或減弱。包括社會支持、同伴贊許、親屬肯定與鼓勵、實質性獎勵、自己對行為后果的感受強化因素〔ReinforcingFactors〕PRECEDE-PROCEED模式實施過程〔簡要〕PRECEDE-PROCEED模式實施過程〔簡要〕PRECEDE-PROCEED模式實施過程〔簡要〕健康領域使用最為廣泛、評估最為全面的模式之一，也是社區健康促進和公共衛生干預的有效模式干預對象包括健康者和疾病患者研究方向包括疾病護理、疾病預防、健康保健和健康需求評估等PRECEDE-PROCEED模式的應用PRECEDE-PROCEED模式的應用——研究方向應用實例〔一〕格林模式在社區高血壓患者健康教育中的應用紀誠鄭昊姚桐姜巖石研究目的和對象研究目的：研究格林模式在社區高血壓患者健康教育中的應用效果研究對象：某社區高血壓患者120人，應用格林模式進行健康教育。在應用格林模式前，對教育對象進行高血壓知識達標率、高血壓健康教育的支持率、衛生活動參與率和高血壓控制穩定率等調查研究方法具體實施流程圖研究方法1.社會診斷通過GQOLI-74生活質量評價表，了解患者的生活、學習、工作、社會環境等根本情況2.流行病學診斷進行健康調查，了解既往病史、家族病史、教育對象高血壓到達幾級并了解其身體健康狀況3.行為與環境診斷吸煙、長期飲酒、睡眠缺乏、肥胖等研究方法研究方法7.健康教育過程評價通過隨訪和調查問卷的方式，及時了解教育對象及其家人的反響意見和建議，找出存在的問題并對原方案進行調整8.健康教育效果評價通過隨訪和調查問卷的方式，對教育對象進行高血壓知識達標率、高血壓健康教育的支持率、衛生活動參與率、高血壓控制穩定率和不良習慣轉變率等調查9.健康教育的結果評價教育結束后，對照方案進行隨訪，了解教育對象的長、短期目標的完成情況，并根據情況隨時修改目標，應用CQOLI-74生活質量評價進行評估應用實例〔二〕ApplicationofthePRECEDE-PROCEEDPlanningModelinDesigninganOralHealthStrategyCatherineJ.BinkleyandKnowltonW.JohnsonJTheoryPractDentPublicHealthBackgroundAlthoughthepoororalhealthofadultswithintellectualanddevelopmentaldisabilities(IDD)constitutesasignificanthealthdisparityintheUnitedStates.Fewinterventionstodatehaveproducedlastingresults.Moreover,thereisminimalapplicationofplanningmodelstoinformanddesignatheory-basedstrategythathasthepotentialtobeeffectiveandsustainableinthispopulation.MethodsThePRECEDE-PROCEEDplanningmodelisbeingusedtodesignandevaluateanoralhealthstrategyforadultswithIDD.ThePRECEDEcomponentinvolvesassessingsocial,epidemiological,behavioral,environmental,educational,andecologicalfactorsthatinformedthedevelopmentofaninterventionwithunderlyingsocialcognitivetheoryassumptions.ThePROCEEDcomponentconsistsofpilot-testingandevaluatingtheimplementationofthestrategy,itsimpactonmediatorsandoutcomesofthepopulationunderstudy.PRECEDEPlanningModelComponentPhase1SocialAssessmentThePRECEDEportionoftheModelbeginswithdiagnosticactivitiesthatidentifydesirableoutcomesorgoalsoftheinterventionorask,“Whatcanbeachieved?〞Theseactivitiesdeterminedtheprimaryordistaloutcomesoftheoralhealthstrategyfortheindividualwithdisabilities.Phase2-Epidemiological,Behavioral,andEnvironmentalAssessmentWesearchedtheliteratureandaskedquestionsoftheselectedcommunityleadersandhealthcarestaffnotedaboveaboutwhatproblemsorissuesaffecttheoralhealth-relatedqualityoflifeforpersonswithIDD?-OR-Whatneedstochangetoachieveoptimaloralhealthfortheseindividuals?Thisphasedeterminedepidemiological,behavioral,andenvironmentalfactorsthatmaywellhaveanimpactontheoralhealthandqualityoflifeofindividualswithIDD.Thisphasecontributedtotheidentificationofthefactorsthatanoralhealthstrategyneedstoimpact(mediatingoutcomes)inordertoachievetheprimaryoutcomes.Phase3EducationalandEcologicalAssessmentThisphasedeterminedfactorsthat,ifmodified,wouldbemostlikelytoresultinbehaviorchangeandtosustainthischangeprocess.Thesefactorsaregenerallyclassifiedaspredisposing,enabling,andreinforcingfactors“Predisposingfactorsareantecedentstobehaviorthatprovidetherationaleormotivationforthebehaviorandincludeindividuals’existingskillsandself-efficacy.“Enablingfactorsareantecedentstobehavioralorenvironmentalchangethatallowamotivationorenvironmentalpolicytoberealized〞andmayincludenewskills,services,resources,andprograms.Reinforcingfactorsarethosefactorsfollowingabehaviorthatprovidecontinuingrewardorincentiveforthepersistenceorrepetitionofthebehavior〞andtheyincludesocialsupport,praise,andvicariousreinforcement.Changetheory(ies)fordesigningtheinterventionafterthisassessmentincludesindividual,interpersonal,andcommunitytheories.Individual-leveltheoriesarebestusedtoaddresspredisposingfactors.whileinterpersonal-leveltheories,suchassocialcognitivetheory,addressreinforcingfactorswell.community-leveltheoriesaremostappropriateforaddressingenablingfactors.Phase4–InterventionAlignmentandAdministrativeandPolicyAssessmentPhase4a-InterventionAlignment(調整)Thisphasematchedappropriatestrategiesandinterventionswiththeprojectedchangesandoutcomesidentifiedinphases1-3.Usingassessmentresultsfromphases1-3,theoralhealthstrategypresentedintheresultssectionemergedasourinterventionofchoice.Phase4b-AdministrativeandPolicyAssessment:Inthisphase,resources,organizationalbarriersandfacilitators,andpoliciesthatwereneededforthestrategyorinterventionimplementationandsustainabilitywereidentified.Theorganizationalandenvironmentalsystemsthatcouldaffectthedesiredoutcomes(enablingfactors)weretakenintoaccount.Theadministrativediagnosisassessedresources,policies,budgetaryneeds,andorganizationalsituationsthatcouldhinderorfacilitatethedevelopmentandimplementationofthestrategyorprogram(25).ThepolicydiagnosisassessedthecompatibilityoftheoralhealthstrategywiththoseoftheorganizationsprovidingservicestoindividualswithIDD.PROCEEDPlanningModelComponentPhase5-PilotStudyAlthoughwedidnotrecognizetheinclusionofapilotstudyasessentialtothePRECEDE-PROCEEDplanningmodel,webelievethatitisanimportantplanningphase.Theseresultsandlessonslearnedareimportanttorevisingboththepilotoralhealthstrategyanditsevaluationforanefficacystudy.Tothisend,wehaveprovidedadescriptionofourinprogresspilotstudyintheresultssectionofthisarticle.Phase6-ImplementationThisphasepresentsadescriptionoftheimplementationoftheoralhealthstrategyinanefficacystudy.Keyrolesintheimplementationphasearehighlighted.Phases7and8ProcessandOutcomeEvaluationOurplannedefficacystudyisdesignedasaclusterrandomizedcontroltrialthatincludesaprocessandoutcomeevaluation.Thestudyofboththeimplementationprocessandoutcomeachievementsisimportant.Theimplementationproces