PRECEDING METHOD

According to Green and Kreuter (1980), the PRECEDE Method is a way of assessing the Health
Education needs of a community.

It is a planning model used in health education, through which a series of factors that influence the
adoption, maintenance and/or cessation of a behavior are analyzed.

Meaning of PRECEDE

It is an English acronym that means

P Predisposing Predisposition
R Reinforcing Reinforcement
E Enabling Qualification
C Causes Causes
E Education Education
D Diagnosis Diagnosis
Evaluation Assessment
Predispose, reinforce and causes that
make educational diagnosis and
evaluation possible.

Uses of the PRECEDE Method

This model is used to analyze:
 Social problems
 health problems
 Behavioral factors

Stages (phases) of the PRECEDE Method

PLANNING: PRECEDING METHOD.

Planning model designed by Lawrence Green and Marshall Kreuter for health education and
health promotion programs.
It is based on the principle that most behavioral changes are voluntary in nature.
This principle is reflected in the systematic planning process that attempts to empower individuals
with: understanding, motivation and skills to actively participate in solving community problems in
order to improve the quality of life.
It has been used successfully in health promotion and health education programs. It takes into
account the determining factors of health and serves as a guide in the planning of health
promotion and health education programs and interventions, facilitating planning, implementation
and comprehensive evaluation of programs, as well as the development of policies and legislation.

The model emphasizes that health and behaviors are determined by multiple factors and that
multisectoral and multidisciplinary actions are essential to achieve behavioral changes.

DETERMINATION OF EDUCATIONAL NEEDS

No doctor would prescribe a drug without first carrying out a diagnostic approach. However,
frequently, the doctor or nurse gives some advice without making an adequate diagnosis of the
factors that affect the specific behavior of the patient or his or her family.

The educational diagnosis identifies the patient's needs, that is, those factors on which it is
necessary to act to modify them. Determining learning needs can be done using different tools.
The choice of the most appropriate one is based on reliability and validity criteria, and some type
of questionnaire can be used, more or less structured, either self-administered or as a guide for
the interview with the patient. An effective instrument for carrying out behavioral diagnosis is the
PRECEDE model, which has, with it, identified a series of fundamental factors that are the so-
called predisposing factors (knowledge, attitudes, beliefs and perceptions of the patient),
facilitators (abilities, skills , human resources around the patient) and reinforcement.

The important thing is that the tool ensures the collection of valid data, that is, that it reports the
person's true learning needs. Therefore, asking the asthmatic about his knowledge, beliefs and
attitudes is an effective method, and direct observation of his behaviors makes it possible to better
evaluate learning needs. On many occasions, the information obtained after a simple conversation
can be used to focus the educational intervention and to determine which factors are important
and necessary to be assessed.

The analysis stage will allow for clear and detailed information on all the elements that come into
play when developing educational material, allowing development adjusted to real needs and
conditions. The product of this stage must be a written document.
 Needs analysis : You must know what the needs of the possible users of the material are,
analyze the causes of the problem and the possible solutions, to determine if it is justifiable
to develop the material. From this analysis, a prioritized list of problems to be solved must
be obtained.
 Audience analysis : For the solution to fit well with the target population, you must know
the essential aspects that characterize them, such as age range, education, prior
knowledge on the subject, special physical or cognitive needs, and everything. which can
provide greater knowledge of potential users.
 Environment Analysis: It is important to take into account the environment in which the
material will be worked on, whether it is within an institution and within a curriculum or as an
extracurricular activity, whether it is for individual and autonomous use by the student,
whether This will determine many things about the material.
 Content analysis: Once the topic is known, a bibliographic and documentary review will be
carried out in order to obtain the possible direct sources of the information and all the
supporting material, it will also serve to delimit the content to work on.

System analysis: If it is a computerized material, it is important to consider the system in
 which it will be viewed, and see what options will be provided to the user to achieve greater
coverage.

PREPARATION OF THE PROGRAM COMPONENTS.

This model is extremely practical, since several studies show that changes in behavior last longer
when people have actively participated in them and decision-making about the change is made
throughout the process. In this process, individuals make healthy decisions through changing their
behavior and through changing policies that influence their behaviors.
The model has seven stages, the first five of diagnosis and the remaining of execution and
evaluation, not necessarily sequential:

1. Social diagnosis of the needs, desires and perceptions of adolescents,

2. Epidemiological diagnosis of the situation and the most frequent health problems;
3. Diagnosis of behaviors and the environment;
4. Diagnosis of the conditions of the behaviors that predispose, reinforce, facilitate
and affect behavior.

Predisposing factors include the adolescent's knowledge, attitudes, beliefs, values and
perceptions that facilitate or limit the change process. Reinforcing factors are the rewards and
feedback that the participant receives from the people around him, once a behavior has been
adopted, (such as classmates, friends, family, media, teachers, health personnel, etc.).
Favoring factors are those that make possible or facilitate the desired change, such as social
skills (resistance to peer pressure, social competence, being a determined person, with
problem and stress management skills), available resources (access to services, laws, plans
and programs) and/or barriers that can favor the desired behavior and limit the undesired
(legislation, culture);

5. Diagnosis of the administrative and political environment that evaluates organizational capacity
management and resources available for the development and implementation of programs,
and that can influence the factors of the desired behavior. The following phases are execution
and evaluation.
The Precede-Proceed Model emphasizes the basic idea that health and behaviors are
determined by multiple factors and that multisectoral and multidisciplinary actions are essential
to achieve the expected behavior change.

EXECUTION: SELECTION AND TRAINING OF STAFF

Personnel Selection : An Execution, Coordination and Administration Unit will be required to
provide logistical and technical support to the executing agencies. For the most part, these
personnel will come from the entities in charge of coordinating the Plan. However, if additional
personnel are required, they must be selected and hired during this stage. The hiring of
specialized personnel for monitoring, follow-up, evaluation and reorientation of activities should
also be considered.

Personnel Training: Training as a systematic process must become a significant factor within the
level of education, capable of raising awareness and updating with innovative strategies and the
use of relevant tools that allow it to focus its management towards achieving changes and
innovations, to ensure the success of the educational process.

T he t raining it self consists of:

1) explain and demonstrate the correct way to perform the task;
2) help t he participant perform first under supervision;
 3) t hen allow the participant to perform alone;
4) evaluat e performance
5) t rain part icipants based on the evaluation results. These steps may have t o
be repeat ed several times before a participant correctly grasps what to do.
W hen t he part icipant has assimilated the material, he can
6) st rengt hen your knowledge by training another person.

T here is a big difference between explaining to participants how to do a task and

successf ully t ransmitting theoretical and practical knowledge.

During st af f t raining, it is necessary:

1) const ant ly evaluate the level of understanding;
2) adapt t he level of training to the participants;
3) present a limited number of concepts at a time;
4) separat e learning tasks into several simple concepts;
5) involve all participants (so that everyone actively participates, not just
observes an individual's demonstration); As in any circumstance related to
learning, part icipants will feel bett er if the supervisor or trainer is kind and
shows pat ience. Honest, deserved praise also helps.

During t raining, explanations and demonstrations are very important , but

part icipant s remember information better when they apply it. Unfortunately, t his
st ep is of t en eliminated because it takes up time. And also because observing a
part icipant who does the task with difficulty requires patience. In the early
st ages, pract ical methods yield better results than theoretical ones.
E xplanat ions should be brief and simple. When showing a video, it is necessary
t o encourage participants to ask and answer questions. In this way,
underst anding of the material presented is checked.

Acquisition of equipment and materials .

“A health system based on EpS must have a planning system that allows it to provide resources
appropriate to health needs. In turn, these resources must be determined by an analysis of the
health situation that is based on information from the community level. Resources must have
inputs (for example, facilities, personnel, equipment, supplies and medications) and with the
necessary budget to provide high-quality comprehensive, preventive and curative care.

To establish the necessary resources for care at the first level, we start from the following
premises:
 First-level care has to respond to the majority of the health problems of the population
served, so its professionals must develop a broad profile and be the basis of the health
system.
 The resources must be in accordance with the functions and activities to be carried out by
the area team as a whole, which will be delimited by the needs and demands of the
population.
The diversification of skills, technical excellence, the acquisition of skills and knowledge, in
addition to the results obtained, must be incorporated into the remuneration and incentive
systems.

Educational resources : brochures, posters, brochures, murals, use of media: press, radio,
television, Internet.
The media well and reasonably used in the field of health education contribute to increasing the
level of
Raising awareness of the population about a certain health problem, and creating a current of
opinion favorable to health and the promotion of healthy lifestyles People, equipment, materials
and infrastructure required to develop the proposed contents.

Health education means and aids:

The means that exist to carry out health education are:
 Verbal (talks, conferences)
 Writings (books, magazines)
 Visuals (photographs, graphics)
 Mixed (audiovisual)

The most frequently used medium is verbal because it establishes a direct relationship with the
individual or group.
The effectiveness of teaching methods and the verbal medium increases considerably with the
use of WORD AIDS or audiovisual aids.

It is necessary to make a diagnosis to be able to carry out an evaluation of the existing

situation (practical behaviors, knowledge, social beliefs and other beliefs that motivate certain
behaviors, environmental factors that influence behaviors, etc.) and to then establish some
objectives. realistic behavior change, highlighting the obstacles identified during the diagnosis
phase.

Selection of participants:

1.- Propose between six and twelve people to participate, notifying them at least one or two days
in advance. However, in certain circumstances, people may prefer that the focus group be held at
that time. We can then take advantage of this opportunity as long as we have previously prepared
the interview guide.

2.- Try to bring together the participants based on one or more homogeneity criteria (example:
sex, age, socio-professional category, etc.), depending on the topic to be discussed, to allow free
and interactive participation. It is advisable to compensate in some way the participants who
dedicate their time to us.

3.- Do not forget to notify some people of the focus group, if necessary (for example: notify the
head of the village

Recruitment of participants.
There are three sections to transmit a health education message:
- Information to the masses.
- Group education.
- Individual advice.

Information to the masses : through the media (television, radio...)

It transmits a health message that can be reaffirmed with repetition and if done over a long
period can produce a change in behavior. This begins a task without ensuring that it is
modified, then it is not health education.
 Group education : changes in attitudes and behaviors are better achieved and the three
levels of consciousness are better reached. The communication process is facilitated by the
personal relationship between the educator and those educated.

Individual advice: the educational content is personalized to the maximum. It requires

knowledge of the individual and particular situation and a greater dedication of time.

Individual or group differences:

The educator faces a wide variety of characteristics: Cultural, Economic, Educational,
Ages, Interests.

Conducting teaching sessions.

The functions of the nursing staff in the EpS are aimed at achieving health promotion,
prevention, recovery and rehabilitation of diseases, in a way that places the services within
the reach of the individual, the family and the community. community, to meet health
demands throughout the life cycle.

Group or collective education is a series of scheduled sessions, aimed at a group of patients,

users or groups, with the aim of improving their abilities to address a certain health problem or
topic. Interventions aimed at community groups are also included to increase their awareness of
social, political and environmental factors that influence health.

The work methodology in group education has improved greatly in recent years. From an
approach of education equal to information, which we could synthesize in the talk model, we are
moving towards a model of active and participatory education, which includes different educational
sessions, in which not only cognitive results, but also skills are sought and achieved. practices.

This means developing more reflections, attitudes and skills to deepen a role of facilitation, help
and support. To achieve this, some basic attitudes are useful (congruence, acceptance, positive
evaluation or esteem for other people and empathy) and other more specific ones that are related
to a tolerant, rather than defensive, climate.

Useful skills also include some more general and some more specific. Among the former, the
following stand out: empathic understanding, active listening, assertiveness, interpersonal
communication, emotional self-control, conflict management and negotiation.

Among the latter, we could highlight: summarizing and returning issues, helping to think, leading
meetings, positive reinforcement, leading groups, managing discussions and different types of
educational techniques, resources and materials. The attitudes and skills of the educator, as well
as the techniques used, must adapt to the dynamics and stages of evolution of the group
(insecurity, exposure, confrontation, belonging).

It must be taken into account that the use of an active and participatory methodology throughout
the educational process provides continuous information about the needs, demands, problems,
motivations, interests and behaviors of the group and related factors. The situation analysis is,
therefore, being reworked day by day and the programming must be flexible enough to adapt to
the needs of the group at all times.

Selection and development of teaching aids

The teaching aids are the material resources (blackboard, sheets, overhead projector, etc.) that
the educator uses to facilitate the student's better understanding of the contents of the program.
Due to the strategic function played by the teaching aids, they must be subordinated to the
proposed objectives.

The key characteristics presented by the EPS programs evaluated as effective with respect to the
methodology are:
 That incorporate active learning methods.
 That they are directed towards social influences and that of the mass media.
 That reinforce individual values and group norms.
 That promote the development of skills (socially, fundamentally).
An especially effective strategy is peer group work. Its main advantages are:
 Greater adaptation of content and strategies.
 Greater motivation and credit of information.
Adolescents place much greater value on information obtained in the group than on information
provided from above. The student must come to make the learning activity his or her own, and the
educator must play the role of facilitator of learning. In this sense, we must always try to use
participatory methods:
 That enhance:
o The acquisition of social skills.
o Competence in communication.
o Conflict resolution.
 What affects:
o In responsibility.
o In self-esteem.
o In making decisions.
 That facilitate:
o The practice of learned skills.
In this sense, the WHO (1983) said: If we approach health education from a participatory model,
and adapted to needs, the population will acquire responsibility in their learning and this will not be
focused on knowledge, but also on knowing how to do.