What is PRECEDE-PROCEED?

Why use PRECEDE-PROCEED?

How do you use PRECEDE-PROCEED?
If you were a contractor setting out to build a wood-frame house, you wouldnt just pick up
whatever wood you found lying around and begin. Youd consult first with the owner,
and start with an idea of the house she wanted its size, its shape, its features. Youd
want a picture of the finished house, and a floor plan as well, with some notes on
measurements and materials. Youd plan the construction with her, and set out a
process for getting it done. And youd do all this before you ever picked up a tool,
because otherwise the process would be hit-or-miss: she wouldnt get the house she
wanted, and your time would be wasted.
The same is true if youre developing an intervention to address a health or community issue.
It makes no sense to pick an issue at random, and to use whatever service happens to be
available to try to address it. You have to consult with the community, understand and
analyze community information, your own and others observation, and the context of
the issue to create an intervention that will actually bring about the changes the
community wants and needs.
In the first section of this Developing a Logic Model or Theory of Change, we introduced the
need for a process for doing health and community work. In this section, well look at
PRECEDE-PROCEED, the first of several specific models that may prove helpful to you in
carrying out your own work. Well examine other models in subsequent sections of this
chapter. Then in the last section, well examine some ways in which elements of various
models can be combined to respond to your particular situation.

What is PRECEDE-PROCEED?
Like most of the other models well examine in this chapter, PRECEDE-PROCEED was
developed for use in public health. Its basic principles, however, transfer to other
community issues as well. As a result, well treat it as a model not just for health
intervention, but for community intervention in general. And in fact, PRECEDE/
PROCEED focuses on the community as the wellspring of health promotion.
In the latter half of the 20th Century, as medical advances eliminated many infectious
diseases, the leading causes of disability and death in the developed world changed to
chronic conditions heart disease, stroke, cancer, diabetes. The focus of health
maintenance, therefore, shifted from the treatment of disease to the prevention of
these conditions, and, more recently, to the active promotion of behaviors and attitudes
proper diet, exercise, and reduction of stress, for instance that in themselves do
much to maintain health and improve the length and quality of life.
Behind PRECEDE-PROCEED lie some assumptions about the prevention of illness and
promotion of health, and, by extension, about other community issues as well. These
include:
Since the health-promoting behaviors and activities that individuals engage in are almost
always voluntary, carrying out health promotion has to involve those whose behavior or
actions you want to change. PRECEDE-PROCEED should be a participatory process,
involving all stakeholders those affected by the issue or condition in question from
the beginning.

Health is, by its very nature, a community issue. It is influenced by community attitudes,
shaped by the community environment (physical, social, political, and economic), and
colored by community history.
Health is an integral part of a larger context, probably most clearly defined as quality of life,
and its within that context that it must be considered. It is only one of many factors that
make life better or worse for individuals and the community as a whole. It therefore
influences, and is influenced by, much more than seems directly connected to it.
AIDS has changed the way many people in the US view and practice sex, for instance. In some
other countries, it has affected the whole social structure because of the number of
orphans it has created, and its impact on the workforce. By the same token, youth
violence changes the views and actions of many people who are at no risk of being its
victims, and may put a community at an economic disadvantage by making it less
attractive to new business or industry. Almost any other issue could serve equally well
as an example of the broad reach of community problems (or assets, for that matter).
Finally, health is more than physical well-being, or than the absence of disease, illness, or
injury. It is a constellation of factors economic, social, political, ecological, and physical
that add up to healthy, high-quality lives for individuals and communities.
This broad perspective on health extends to other community issues. We can define the health
of a community as its fitness in many areas, of which citizens physical health is only one.
Indications of a communitys overall health include how well it:
Contributes to the stability of families
Nurtures and supports children
Fosters lifelong learning
Provides meaningful work for its citizens
Invites involvement in the democratic process
Cares for those who need help
Protects and sustains the natural environment
Encourages the arts
Values and encourages racial and cultural diversity
Works to promote and maintain safety and physical well-being for its members
(see Healthy Cities/Healthy Communities, for a longer discussion of this concept.)
PRECEDE and PROCEED are acronyms (words in which each letter is the first letter of a word).
PRECEDE stands for Predisposing, Reinforcing, and Enabling Constructs in
Educational/Environmental Diagnosis and Evaluation. As its name implies, it represents
the process that precedes, or leads up to, an intervention.
PROCEED spells out Policy, Regulatory, and Organizational Constructs in Educational and
Environmental Development, and, true to its name as well, describes how to proceed
with the intervention itself.
PRECEDE has four phases, which well explore in greater detail later in the section:
Phase 1: Identifying the ultimate desired result.
Phase 2: Identifying and setting priorities among health or community issues and their
behavioral and environmental determinants that stand in the way of achieving that
result, or conditions that have to be attained to achieve that result; and identifying the
behaviors, lifestyles, and/or environmental factors that affect those issues or conditions.

Phase 3: Identifying the predisposing, enabling, and reinforcing factors that can affect the
behaviors, attitudes, and environmental factors given priority in Phase 2.
Phase 4: Identifying the administrative and policy factors that influence what can be
implemented.
Another premise behind PRECEDE-PROCEED is that a change process should focus initially on
the outcome, not on the activity. (Many organizations set out to create community
change without stopping to consider either what effect their actions are likely to have,
or whether the change theyre aiming at is one the community wants and needs.)
PRECEDEs four phases, therefore, move logically backward from the desired result, to
where and how you might intervene to bring about that result, to the administrative and
policy issues that need to be addressed in order to mount that intervention successfully.
All of these phases can be thought of as formative.
PROCEED has four phases (also to be discussed in more detail later) that cover the actual
implementation of the intervention and the careful evaluation of it, working back to the
original starting point the ultimate desired outcome of the process.
Phase 5: Implementation the design and actual conducting of the intervention.
Phase 6: Process evaluation. Are you actually doing the things you planned to do?
Phase 7: Impact evaluation. Is the intervention having the desired impact on the target
population?
Phase 8: Outcome evaluation. Is the intervention leading to the outcome (the desired result)
that was envisioned in Phase 1?
A word about logic models: Although most formal models, like PRECEDE-PROCEED present
themselves as the way to structure an intervention or other activity, the word logic
implies that you should carefully consider your own situation as well as the model. If
there are reasons why a particular part of a model might not work for you, its
reasonable (logical) to change it. While PRECEDE-PROCEED presents a structure that
could conceivably work well (and has worked well) in a variety of situations, its still
important to think about whether all parts of it will work for you.
A flow chart of the model (see Fig. 1), developed by its originators, shows a circular process. It
starts (on the upper right) with a community demographic and quality-of-life survey, and
goes counterclockwise through PRECEDEs four phases that explain how to conceive and
plan an effective intervention. PROCEED then picks up with the intervention itself
(described here as a health program), and works back through the first five phases,
evaluating the success of the intervention at addressing each one (The process
evaluation in Phase 6 looks at whether the intervention addressed the concerns of
Phase 3 as planned. The impact evaluation of Phase 7 examines the impact of the
intervention on the behaviors or environmental factors identified in Phase 2. And the
Outcome evaluation of Phase 9 explores whether the intervention has had the desired
quality of life outcome identified in Phases 1 and 2). Eventually, the process arrives back
at the beginning, either having achieved the desired quality of life outcome, or to start
over again, incorporating the lessons of the first try. The arrows in the flow chart
demonstrate the effects of each phases issues on the next one to the right. Since youre
working backwards from the ultimate outcome, effects move to the right. If the chart
was demonstrating the direction of analysis, the arrows would point in the opposite
direction.

Figure 1. Generic representation of the Precede-Proceed Model. From L. Green and M. Kreuter. (2005). Health Promotion Planning: An Educational and
Ecological Approach (4 th Ed.). Mountain View , CA : Mayfield Publishers.

The PRECEDE-PROCEED model applies a medical perspective to public health, even though its
focus is health promotion, rather than treatment of disease. Just as a medical diagnosis
precedes treatment, the model assumes that a far-reaching diagnosis should precede a
public health intervention. A diagnosis suggests a treatment (an intervention), which is
closely monitored for process (Is the patient getting the treatment prescribed?), impact
(Is the treatment having the hoped-for impact on the symptoms?), and outcome (Does
the treatment cure the patient, or have the desired effect on her overall health?). A
premise of the model is that a diagnosis should start with the desired end result and
work backwards to determine what needs to be done to bring about that result.
Another basic premise of the model is that the purpose of a health program and by
extension, the purpose of any proactive type of community intervention is to improve
the quality of life for individuals and their community, and that the two are largely
inseparable. Thus, any intervention should be community-based, and should look at the
needs of the community, even if the intervention is aimed at a more specific target
group.
A final premise of any community-based model for intervention is that planning and
implementing a community intervention calls for a joint effort among (health and other)
professionals and organizations, policy makers, community officials, community leaders,
and community members at large, including members of the target population. In order
to ensure accurate information and community support, all elements of the community
should be involved in the process from the beginning.

Why use PRECEDE-PROCEED?

First, there are good reasons for using some kind of logic model or theoretical framework for
any intervention:
It provides a structure within which to plan your work, so that youre not simply grasping at
straws. As a result, youre more likely to develop a coherent plan that addresses the
necessary issues.
Most models give you either a guide or a foundation for critical analysis of the issues at hand.
That doesnt guarantee that your analysis will be complete or accurate, but it
significantly increases the chances. (See Analyzing Community Problems and Solutions,
for more on logical analysis.)
This is not to say that you have to use a logic model. There are other ways to approach
developing an intervention, many of them outlined in the Community Tool Box (Ch. 8,
17, 18, 19). The advantage of PRECEDE-PROCEED and similar models is that they tell you
exactly what to do: you follow directions, and you have a procedure for developing an
intervention. The disadvantage of these models is that they tell you exactly what to do:
if some part of the model isnt appropriate for your setting or your circumstances, youll
have to realize that, and change it to fit, or risk a problem.PRECEDE-PROCEED now offers
a flow chart or algorithm to facilitate decisions for skipping some steps or phases,
thereby tailoring the model to different local situations.
Usually, the originators of the model will tell you that you have to follow it exactly. In fact,
thats rarely the case. If you like the model, you can be sure to include all its elements,
but you can still change some of them, change the timing, even change the order to
better match the needs of your community. You might also find yourself taking some

pieces of one model and grafting them on to another, or reinterpreting a model in light
of a particular theoretical framework.
Over and above the use of logic models in general, there are some good reasons for using
PRECEDE-PROCEED specifically:
PRECEDE-PROCEED provides a template for the process of conceiving, planning, implementing,
and evaluating a community intervention.
PRECEDE-PROCEED is structured as a participatory model, to incorporate the ideas and help of
the community. That means that its use will provide you with more, and more accurate,
information about the issues in question, and with a better understanding of their
history and context in the community.
Community involvement is also a means of building community ownership of the intervention,
leading to more community support and a greater chance of success.
PRECEDE-PROCEED considers the ways in which administrative and policy guidelines can limit
or shape an intervention, an area of planning too often ignored.
PRECEDE-PROCEED incorporates evaluation of the process, the intervention itself, and the final
outcome. That allows the intervention to be monitored and adjusted to respond to
community needs and changes in the situation, and checks that its accomplishments
actually lead to the projected goal.
Although PRECEDE-PROCEED sets out a strict process, it says much less about content. It leaves
plenty of leeway for adapting your interventions design and methods to the situation,
the needs of the community, etc.
Although these are good reasons to use PRECEDE-PROCEED, they are also good reasons to use
some of the other models in this chapter. This is the reason we are presenting several
so that you can decide which among them, if any, makes the most sense to you, and
would be best for your circumstances and community. PRECEDE-PROCEEDs greatest
strength may be its comprehensive and rigorous structure it covers all the bases.

How do you use PRECEDE-PROCEED?

Logic models dont really mean much unless you actually use them in the community. Once
youve decided that PRECEDE-PROCEED provides a good model for your intervention,
how do you translate it into action? Well look at each of the nine phases of the model
with that question in mind.
PRECEDE: Doing the groundwork. PRECEDE starts by determining the desired outcome for the
community, and then works back to what has to be done to obtain that outcome. Each
phase moves one step closer to the actual intervention.
Our presentation of the model assumes that, although it was developed for use in public
health, it can be used by activists or organizations concerned with any issues that affect
the quality of life in a community, as seen in some of the 950 published applications.
Phase 1: Defining the ultimate outcome. The focus here is on what the community wants and
needs, which may seem unrelated to the issue you plan to focus on. What outcome does
the community find most important? Eliminating or reducing a particular problem
(homelessness)? Addressing an issue (race)? >Improving or maintaining certain aspects
of the quality of life (environmental protection?) Improving the quality of life in general
(increasing or creating recreational and cultural opportunities)?

This phase starts with the collection of demographic data, which is then presented to the
community to help citizens decide on priorities. The way to determine what citizens
want for their community is to ask them. There are a number of options here, which can
be used individually or in combination, including:
Community surveys
Focus groups
Phone interviews
Face-to-face interviews
Questionnaires in public places
Rather than just asking them for their opinions about what would improve the community, its
far more powerful to involve community members in the whole process from the
beginning, including them in all phases of the PRECEDE-PROCEED model. While actual
applications of the model often tend to be top-down, it is likely to work better if the
community has significant input and decision-making power from the beginning. (See
Participatory Approaches to Planning Community Interventions.)
Phase 2: Identifying the issue. In Phase 2 of PRECEDE, you look for the issues and factors that
might cause or influence the outcome youve identified in Phase 1 (including supports
for and barriers to achieving it), and select those that are most important, and that can
be influenced by an intervention. (One of the causes of community poverty, for instance,
may be the global economy, a factor you probably cant have much effect on. As
important as the global economy might be, youd have to change conditions locally to
have any real impact.)
Its important to analyze these issues carefully, and to make sure that youve chosen the right
ones. What would the elimination of a particular factor make possible, for instance, that
isnt possible already? How does a particular issue create a barrier to the desired
outcome? What else do these issues affect, besides the desired outcome?
Which are the issues with the most drastic effects? And how do you define the most drastic
effects? Are they economic? Social? Physical?
An industry responsible for pollution that actually or potentially causes health problems may
also be the local economic mainstay. Even if the industry has the best of intentions, it
may be unable to afford to clean up its operation. The town may be faced with the
choice of either losing the jobs and tax base that the industry provides, or continuing to
live with a health hazard. Whats more important here, and how do you decide what to
focus on? (And is there an answer that isnt either-or ?)
This kind of situation is by no means universal...but it isnt particularly unusual, either. It may
be helpful once again to read Analyzing Community Problems and Solutions, Thinking
Critically, and Addressing Social Determinants of Health and Development.
In some cases, the issues you choose to focus on may be directly related to the outcome
youre seeking building more affordable housing as a way to address homelessness, for
instance. In others, you may be trying to affect factors that have just as great an impact
on the outcome, but seem further removed from it e.g., addressing safe streets by
providing parenting courses and other services for at-risk families.
Once again, involving stakeholders and other community members here is likely to get you the
best information possible about which issues to emphasize, and to keep you from
making mistakes based on ignorance of the communitys history or of the relationships
among community members.

Phases 1 and 2 are where you develop the long-term goals for your intervention. They tell you
what your ultimate desired outcome should be, and what the issue(s) or associated
factors may be that influence it. Those are the things youre ultimately aiming to change.
Most of the factors influencing the issues or outcomes can be classified as behavioral, lifestyle,
or environmental.
The behavior referred to here is a specific, observable, often measurable and usually
customary action. Some behaviors put people or communities at more or less risk for
health or other problems.
Needle-sharing is a behavior that puts heroin addicts at high risk for hepatitis and AIDS.
Consistent studying usually lessens the risk of school failure for a student.
If littering is a common individual behavior, it may have community consequences that range
from the aesthetic (piles of trash creating an unattractive scene) to health (breeding of
mosquitoes in garbage-strewn lots, water pollution, etc.) to the economic (businesses
unwilling to locate in the community because of its physical condition). It may also have
social consequences, with neighborhood conditions affecting residents self-image, and
leading eventually to a breakdown of civic responsibility.
A lifestyle is a collection of related behaviors that go together to form a pattern of living. Some
lifestyles may put people and communities at risk of health and other problems.
An example of a high-risk lifestyle that is often mentioned in the popular media is one that
includes very little exercise, a diet high in calories and saturated fats, and lots of stress.
Such a lifestyle can lead to heart attack, stroke, cardiovascular disease, and other
problems associated with obesity, including diabetes.
A lifestyle that involves gang membership and regular participation in violent acts has both
individual consequences (the constant risk of serious injury or death, an arrest record,
detachment from others humanity) and consequences for the community (people
afraid to use the streets, reduced economic activity, scarce resources spent on extra law
enforcement, etc).
The environment of a particular issue or problem can refer to the natural, physical
environment the character and condition of the water, air, open space, plants, and
wildlife, as well as the design and condition of built-up areas. But it can also refer to the
social environment (influence of family and peers; community attitudes about gender
roles, race, childrearing, work, etc.), the political environment (policies and laws, such as
anti-smoking ordinances, that regulate behavior or lifestyle; the attitudes of those in
power toward certain groups or issues), and the economic environment (the availability
of decent-wage jobs, affordable housing, and health insurance; the community tax base;
global economic conditions).
In general, behaviors, lifestyles, and environmental factors are what an intervention sets out to
change. The changes in these areas in turn affect the crucial issues, and lead to the
achievement of the final outcome that was identified in Phase 1 of the model.
So how do you choose which behaviors, lifestyles, or environmental factors to focus on? Thats
where analysis comes in. What are people doing or what are the factors in the
environment that lead to, maintain, or prevent the issue or condition you want to
change? Using critical thinking (see Thinking Critically ) and the But why? technique
(see Defining and Analyzing the Problem ), you should be able to narrow it down to a
handful. The criteria for choosing a particular target for your intervention are: (a) Is the
potential target an important enough factor to have a real effect on the issue, and thus

on the quality of life in the community? and (b) Is it likely that the potential target can
actually be changed by an intervention that you have the resources to mount?
A classic example of community change through behavior change is that of reducing the
incidence of lung cancer and heart disease in a community by convincing smokers to
change their behavior i.e. quit. Fewer smokers mean less secondhand smoke, less time
lost from work because of smoke breaks and smoking-related illnesses, fewer low-birthweight babies, fewer children with asthma and other respiratory ailments, and lower
health insurance costs. Altogether, changing smokers behavior adds up to an
improvement in the overall quality of life for the community.
Changing smokers behavior fits both criteria described above. It has a profound effect on the
issue and on the general quality of life; and it is often responsive to change, because of
many smokers desire to quit, general knowledge about the dangers of smoking, the cost
of tobacco products, community support, and already-existing strategies and smokingcessation groups that can be incorporated relatively cheaply into an intervention.
Phase 3: Examining the factors that influence behavior, lifestyle, and responses to
environment. Here, you identify the factors that will create the behavior and
environmental changes youve decided on in Phase 2. (For more on behavior change,
see Promoting Behavior Changes by Making It Easier and More Rewarding: Benefits and
Costs.)
The terms healthful behavior and risky behavior below refer not only to physical health,
but to any behavior thats advantageous or harmful to the individual and/or the
community, and is likely to have a significant effect on their quality of life.
Predisposing factors are intellectual and emotional givens that tend to make individuals
more or less likely to adopt healthful or risky behaviors or lifestyles or to approve of or
accept particular environmental conditions. Some of these factors can often be
influenced by educational interventions. They include:
Knowledge. Youre more likely, for instance, to avoid sunburn if you know it can lead to skin
cancer than if you dont.
Attitudes. People who have spent their youth as athletes often come to see regular exercise as
an integral part of life, as necessary and obvious as regular meals.
Beliefs. These can be mistaken understandings believing that anything low in fat is also low in
calories or closely held beliefs based on religion or culture the Bible says Spare the
rod and spoil the child, so its important to physically punish your children for mistakes
or misdeeds.
Values. A value system that renounces violence would make a parent less likely to beat a child,
or to be physically abusive to a spouse or other family member.
Confidence. Many people fail to change risky behavior simply because they dont feel capable
of doing so.
Enabling factors are those internal and external conditions directly related to the issue that
help people adopt and maintain healthy or unhealthy behaviors and lifestyles, or to
embrace or reject particular environmental conditions. Among them are:
Availability of resources. People with mental health problems, for instance, are much more
likely to get help if services are readily available.
Accessibility of services. Services do no good if they have waiting lists that run into years, or
arent physically accessible to those who need them. (For more on availability and

accessibility of services, see Developing and Increasing Access to Health and Community
Services.)
Community and/or government laws, policies, priority, and commitment to the issue.
Government laws and policies can both force changes in behavior or environment, and
underline the importance of those changes. (See Changing Policies, particularly
Overview of Tactics for Changing Policies see also Principles of Advocacy and Responding
to Counterattacks, which also deal with policy change, especially Conducting a Direct
Action Campaign, and Media Advocacy.)
Issue-related skills. People who start out with a work ethic and an understanding of the
workplace, for instance, are apt to benefit from job placement programs.
Reinforcing factors, are the people and community attitudes that support or make difficult
adopting healthy behaviors or fostering healthy environmental conditions. These are
largely the attitudes of influential people: family, peers, teachers, employers, health or
human service providers, the media, community leaders, and politicians and other
decision makers. An intervention might aim at these people and groups because of
their influence in order to most effectively reach the real target group.
Phases 2 and 3 comprise the part of the model where the real planning of an intervention has
to take place. What are you trying to change, and what are the factors that will help to
bring that change about? Answering these questions should bring you to an
understanding of whom and what an intervention should target, who best might
conduct the intervention, and what it should look like in order to hit its targets
effectively.
Phase 4: Identifying best practices and other sources of guidance for intervention design, as
well as administrative, regulation, and policy issues that can influence the
implementation of the program or intervention. Phase 4 helps you look at organizational
issues that might have an impact on your actual intervention. It factors in the effects on
the intervention of your internal administrative structure and policies, as well as
external policies and regulations (from funders, public agencies, and others).
Design issues: Matching, mapping, pooling, and patching. or Selecting, designing, blending,
and supporting interventions.
The discussion of the ways in which organizational issues, particularly internal ones, interact
with a proposed intervention is one that all too often never takes place. For that reason,
Phase 4 is particularly important. Such a discussion can avoid mismatches between an
organization and its proposed intervention (a strictly hierarchical organization
attempting to implement an intervention meant to empower a group with no voice, for
instance), or to alert an organization to an internal or external regulation or policy that
needs to be changed or circumvented for an intervention to proceed as planned.
Administrative issues include organizational structure, procedures, and culture; and the
availability of resources necessary for the intervention.
The organizational structure may be hierarchical, democratic, collaborative, or some
combination, and may be more or less rigid or flexible within each of those categories. It
should be appropriate to the design of the intervention (e.g., allowing for staff decisions
in the field in a gang outreach program), and flexible enough to make adjustments when
necessary.
Organizational procedures are the ways in which the organization actually carries out its work.
In order for an intervention to be successful, those procedures have to focus on its
goals, rather than on internal convenience or traditional methods. An intake procedure,

for instance, should be designed to be as easy and un-embarrassing for participants as

possible otherwise it can be a barrier to participation.
The organizational culture. Organizations are social groups that develop cultures of their own.
Those cultures often dictate, among other things, how staff members interact with one
another, how program participants are treated, and how the organization views its work
and its mission. (Is it just a job, or is it Gods work?) They also usually determine the fit
between an organization and an intervention.
The resources available for the intervention include not only money although thats certainly
important but time, personnel, skills, and space. Now is the time to pinpoint any gaps
in resources beforehand, and work to close them. Thus, finding funding and/or the right
staff people may be a good part of this phase.
Policy and regulatory issues have to do with the rules and restrictions both internal and
external that can affect an intervention, and their levels of flexibility and enforcement.
Internal policies:
Staff members. Organizational policy may treat staff as employees who take orders, as
colleagues who contribute to the work of the organization, or as collaborators who
jointly own it. The amount of freedom they have to exercise their creativity and to take
initiative probably depends on that policy, which may be unstated.
Participants. Does organizational policy see participants as clients that the organization is
doing something to or for, or as partners in a change effort? Does it treat participants
respectfully, as equals, or does it condescend or act authoritative?
How does the organization treat relationships among participants and staff? In some
organizations, they may be friendly; in others, strictly professional. (Romantic or sexual
relationships raise some ethical questions, and probably need to be considered
separately. See Professional ethics below.)
Specific practices, methods, or programs. Many organizations maintain policies that suggest or
mandate certain ways of carrying out their work.
Collaboration. Some non-profits make it a point of policy to collaborate as much as possible,
while others rarely, if ever, work with other organizations.
Professional ethics. Many organizations expect staff members to adhere to a code of
professional ethics either an internal one, or one set out by a professional association
that governs confidentiality, inappropriate relationships, abuse of position, reporting
(or non-reporting) of specific kinds of illegal behavior, etc. There may be organizational
regulations about these areas as well.
External policies and regulations that might affect an intervention can come in a variety of
forms:
Funders requirements. These may apply to the intervention itself, or they may place
restrictions on anything the organization can do, even those areas such as, perhaps,
this intervention that arent funded directly by the funder in question.
Oversight agency regulations. The organization may be subject to the authority of a state or
federal agency whose regulations affect the intervention.
State or federal laws, or local ordinances
Unstated community policies. Certain actions may simply be unacceptable to the majority of
the community, to coalition partners, etc.

PROCEED: Implementing and evaluating the intervention .

Phase 5: Implementation. At this point, youve devised an intervention (largely in Phases 3 and
4), based on your analysis. Now, you have to carry it out. This phase Involves doing just
that setting up and implementing the intervention youve planned.
The final three phases take place as the intervention continues, and serve to help you monitor
and adjust your work to make it as effective as possible.
Phase 6: Process Evaluation. This phase isnt about results, but about procedure. The
evaluation here is of whether youre actually doing what you planned. If, for instance,
you proposed to offer mental health services three days a week in a rural area, are you
in fact offering those services?
Phase 7: Impact Evaluation. Here, you begin evaluating the initial success of your efforts. Is the
intervention having the desired effect on the behavioral or environmental factors that it
aimed at changing i.e., is it actually doing what you expected?
Phase 8: Outcome Evaluation. Is your intervention really working to bring about the outcome
the community identified in Phase 1? It may be completely successful in every other way
the process is exactly what you planned, and the expected changes made but its
results may have no effect on the larger issue. In that case, you may have to start the
process again, to see why the factors you focused on arent the right ones, and to
identify others that might work.
Some outcomes may not be apparent for years or decades. Lifestyle changes made by young
people to stave off heart disease and stroke, for instance, usually wont reveal their
health benefits until those people are well into middle age. If you know that an outcome
may not show itself for a long time, you may just have to be patient and continue to
monitor the process and impact of your intervention, with the belief that the eventual
outcome will become apparent in time.
Phases 6-8 call for formal evaluations of each phase, with controlled studies and detailed
findings, but most Community Tool Box users probably dont have the resources for
that, and shouldnt expect to do it. That doesnt mean you shouldnt evaluate, however.
Its a relatively simple matter, for instance, to keep records and to examine them to find out
whether your process was carried out as planned, or simply to look at what you are
doing to see whether it matches what you intended to do. The same is true for the other
stages of evaluation. Dont worry if you cant do a formal study...but dont let evaluation
go, either. Its an important part of the process. (Please see the Community Tool Box
chapters on evaluation, 36-39, especially Some Methods for Evaluating Comprehensive
Community Initiatives.)
Remember also that evaluation is ongoing throughout the work. It takes place while the
intervention is being implemented, not afterwards. The whole point of evaluation of
each phase of the model is to adjust or change what youre doing in that phase, if
necessary, to make it more effective.
At any point in the PROCEED continuum, you should be prepared to revisit your analysis. If you
find a gap between your planning and reality, or if you realize that your intervention
isnt achieving the results you aimed at, you should go back to the PRECEDE part of the
model, try to determine what needs to be changed, and adjust what youre doing
accordingly. The point of evaluation is not to see whether you pass some kind of test
its to make sure that your intervention brings about the outcome that the community
wanted or needed in the first place.
In Summary

PRECEDE-PROCEED provides a logic model that can serve as the basis for an individual, onetime intervention or a decades-long community development program or project.
Although designed for health programs, its adaptable to other community issues as
well. As with many models, its meant to be a guide, not a prescription.
PRECEDE-PROCEED is community-based and participatory, founded on the premise that
changes promoting health (and other community issues) are largely voluntary, and
therefore need the participation of those needing to change and others who might
influence them or be influenced by them.
A major reason to use PRECEDE-PROCEED is that it is a logic model. As a result, it will provide a
structure within which to plan your work, and organize both your thinking and your
actions, so that your intervention will be a carefully-planned, coherent whole, rather
than cobbled together. As a logic model, it also provides a guide for analyzing the issues
involved, and choosing both the most likely areas to address and the most likely avenues
to address them.
There are also reasons to use PRECEDE-PROCEED specifically. First, its a participatory model.
By involving the community, it will both bring more and better ideas about issues and
resolving them, and build community ownership of the intervention. Second, since it
includes multi-level (ecological) planning and evaluation, PRECEDE-PROCEED builds in
monitoring of the intervention, allowing for adjustment and greater effectiveness. And
finally, the model allows the freedom to adapt the structure to whatever content and
methods meet the needs of your community.
PRECEDE is the diagnostic portion of the model. It starts with the idea that the focus of change
must be on its desired outcome, and works backward from that outcome to construct an
intervention that will bring it about. It has four phases:
Phase 1: Social diagnosis determine what the community wants and needs to improve its
quality of life.
Phase 2: Epidemiological diagnosis determine the health problems or other issues that affect
the communitys quality of life. Include also the behavioral and environmental factors
that must change in order to address these problems or issues. Behavioral factors
include patterns of behavior that constitute lifestyles. In considering environmental
factors, you should include the physical, social, political, and economic environments.
Phases 1 and 2 identify the goals of the intervention.
Phase 3: Educational and organizational diagnosis determine what to do in order to change
the behavioral and environmental factors in Phase 3, taking into account predisposing
factors (knowledge, attitudes, beliefs, values, and confidence); enabling factors
(availability of resources, accessibility of services, government laws and policies, issuerelated skills), and reinforcing factors (largely the influence of significant others in the
social environment).
Phase 4: Designing programs or interventions and the support for them through administrative
and policy diagnosis determine (and address) the internal administrative and internal
and external policy factors that can affect the success of your intervention. The former
include organizational structure, procedures, culture, and resources; the latter
encompass both internal policies and funders requirements, oversight agency
regulations, state or federal laws, or local ordinances, and unstated community policies.
Phases 3 and 4 set the structure and targets for the planning and design of the intervention.
PROCEED is, in medical terms, the treatment portion of the model, and comprises the
implementation and evaluation of the intervention. It consists of four phases:

Phase 5: Implementation conduct the intervention.

Phase 6: Process evaluation determine whether the intervention is actually taking the actions
intended.
Phase 7: Impact evaluation determine whether the intervention is having the intended
effects on behaviors and/or environment.
Phase 8: Outcome evaluation determine whether the intervention ultimately brings about
the improvements in quality of life identified by the community as its desired outcome.
An unstated but important part of the model is that, at any point, your plan or intervention
can and should be revisited and revised, based on continued analysis and the results of
the various evaluations.
Print Resources
Gielen, Andrea Carlson, and Eileen M. McDonald. The PRECEDE-PROCEED Planning Model. In
Health Behavior and Health Education , edited by Karen Glanz, Frances M. Lewis, and
Barbara K. Rimer. San Francisco : Jossey-Bass, 1996.
Green, Lawrence W., and Marshall W. Kreuter. Health Promotion and Planning: An Educational
and Environmental Approach. (1999) (4th edition). Mountain View , CA : Mayfield
Publishing Co.
Online Resources
Using the Precede-Proceed Model is a short resource with visual examples of program
planning as well as case studies.
A Framework for Planning and Evaluation: Precede-Proceed Evolution and Application of the
Model by Lawrence W. Green and Judith M. Ottoson of Montreal, Quebec.
An explanation of the PRECEDE-PROCEED model from the Interdisciplinary Student
Community-Oriented Prevention.
The website of Lawrence Green, originator of the PRECEDE-PROCEED model and co-author of
the main text describing it. Includes a description of and ordering information for
EMPOWER software, developed as a teaching tool for the model.
Phase 1: Defining the ultimate outcome.
The first phase is to involve the community in prioritizing the issues on which they want to
focus. This involves collecting demographic data in the form of interviews,
questionnaires, and focus groups. The entire community can then be involved in using
those data to prioritize their outcomes.
Community Tool Box links related to Phase 1:
Assessing Community Needs and Resources
Developing a Plan for Identifying Local Needs and Resources
Understanding and Describing the Community
Conducting Public Forums and Listening Sessions
Conducting Focus Groups
Conducting Needs Assessment Surveys
Conducting Concerns Surveys
Conducting Interviews

Conducting Surveys
Qualitative Methods to Assess Community Issues
Leading a Community Dialogue on Building a Healthy Community
Creating and Using Community Report Cards
Phase 2: Identifying the issue.
In this phase, the community must involve all stakeholders in the process of identifying issues
related to the outcome and determining what to influence. It must be decided what
could prevent the desired outcome or aid in achieving it, which factors are the most
significant, and which can be influenced by intervention.
Community Tool Box links related to Phase 2:
Assessing Community Needs and Resources
Developing a Plan for Identifying Local Needs and Resources
Understanding and Describing the Community
Conducting Public Forums and Listening Sessions
Collecting Information About the Problem
Analyzing Community Problems
Conducting Focus Groups
Conducting Needs Assessment Surveys
Conducting Interviews
Conducting Surveys
Leading a Community Dialogue on Building a Healthy Community
Phase 3: Examining the factors that influence behavior, lifestyle, and responses to
environment.
Phase three involves deciding what factors to manipulate in order to create the changes
agreed upon in Phase 2. This requires analysis of the predisposing, enabling, and
reinforcing factors including the knowledge, beliefs and values of members of the
community, availability and accessibility of resources, and the attitudes of influential
people.
Community Tool Box links related to Phase 3:
Assessing Community Needs and Resources
Analyzing Community Problems
Conducting Focus Groups
Conducting Needs Assessment Surveys
Identifying Community Assets and Resources
Developing Baseline Measures of Behavior
Determining Service Utilization
Conducting Interviews
Conducting Surveys

SWOT Analysis: Strengths, Weaknesses, Opportunities, and Threats

Qualitative Methods to Assess Community Issues
Phase 4: Identifying "best practices" and other sources of guides to intervention design and
the administrative regulation, and policy issues that can influence the implementation of
the intervention.
In Phase four, an organization must consider its own structure, policies and history in order to
ensure that there are no internal factors that might act as barriers when trying to
implement changes. Issues that must be considered include the group's organizational
structures, procedures, culture and resources as well as policies regarding staff
members, participants, specific practices, community laws, and issues related skills.
Community Tool Box links related to Phase 4:
Assessing Community Needs and Resources
SWOT Analysis: Strengths, Weaknesses, Opportunities, and Threats
Administrative Issues
Developing an Organizational Structure for the Initiative
Organizational Structure: An Overview
Choosing a Group to Create and Run Your Initiative
Developing Multisector Task Forces or Action Committees for the Initiative
Developing an Ongoing Board of Directors
Welcoming and Training New Members to a Board of Directors
Maintaining a Board of Directors
Writing Bylaws
Understanding and Writing Contracts and Memoranda of Agreement
Hiring and Training Key Staff of Community Organizations
Developing a Plan for Staff Hiring, Orientation, and Training
Managing Finances
Planning and Writing an Annual Budget
Internal Policies
Hiring and Training Key Staff of Community Organizations
Developing Personnel Policies
Orienting Ideas in Leadership
Maintaining Ethical Leadership
External Policies and Regulations
Analyzing Community Problems and Solutions
An Introduction to the Problem Solving Process
Thinking Critically
Defining and Analyzing the Problem
Analyzing Root Causes of Problems: The "But Why?" Technique

Analyzing Social Determinants of Health and Development

Generating and Choosing Solutions
Putting Your Solution into Practice
Deciding Where to Start
Designing Community Interventions
Participatory Approaches to Planning Community Interventions
Identifying Targets and Agents of Change: Who Can Benefit and Who can Help
Using Community Sectors to Reach Targets and Agents of Change
Choosing and Adapting Community Interventions
Criteria for Choosing Promising Practices and Community Interventions
Understanding Risk and Protective Factors: Their Use in Selecting Potential Targets and
Promising Strategies for Interventions
Identifying Strategies and Tactics for Reducing Risks
Adapting Community Interventions for Different Cultures and Communities
Ethical Issues in Community Interventions
Phase 5: Implementing and evaluating the intervention
At this point, the interventions devised must be carried out. This phase involved setting up and
implementing the intervention as planned.
Community Tool Box links related to Phase 5:
Principles of Advocacy
Overview Getting an Advocacy Campaign Off the Ground
Survival Skills for Advocates
Understanding the Issue
Recognizing Allies
Identifying Opponents
Encouraging Involvement of Potential Opponents as well as Allies
Developing a Plan for Advocacy
Conducting Advocacy Research
How to Conduct Research: An Overview
Conducting Studies of the Issue
Gathering Data on Public Opinion
Studying the Opposition
Requesting Accountability
Demonstrating Economic Benefit or Harm
Documenting Complaints
Acting as a Watchdog

Organizing Audits of Consumer Services

Conducting Research to Influence Policy
Organizing Study Circles
Providing Encouragement and Education
Developing a Proposal for Change
Establishing Formal Communications and Requesting Participation
Providing Corrective Feedback
Reframing the Issue
Conducting a Direct Action Campaign
Writing Letters to Elected Officials
Writing Letters to the Editor
Criticizing Unfavorable Action
Filing a Complaint
Seeking Enforcement of Existing Laws or Policies
Using Personal Testimony
Lobbying Decisionmakers
Establishing Lines of Communication within the Opposition's Traditional Allies
Conducting a Petition Drive
General Rules for Organizing for Legislative Advocacy
Developing and Maintaining Ongoing Relationships with Legislators and Their Aides
Registering Voters
Conducting a Public Hearing
Organizing Public Demonstrations
Seeking a Negotiator, Mediator, or Fact-Finder
Initiating Legal Action
Organizing a Boycott
Organizing a Strike
Electronic Advocacy
Advocacy Over and For the Long Term/node/1185
Media Advocacy
Working with the Media
Making Friends with the Media
Creating News Stories the Media Wants
Using Paid Advertising
Meeting the Media
Changing the Media's Perspective on Community Issues

Responding to Counterattack
Overview of Opposition Tactics: Recognizing the Ten D's
How to Respond to Opposition Tactics
Phase 6: Process evaluation
In phase six, the organization must review the interventions underway to determine if the
procedures are being carried out as planned. It must be determined if the specific tasks
within the interventions are being carried out as intended.
Phase 7: Impact evaluation
In phase seven the effects of the interventions are reviewed. A basic analysis must be
conducted to ensure that the interventions are having the desired effect.
Phase 8: Outcome evaluation
Even in you are implementing everything you planned, you may still not be having an impact
on the larger issues. In phase eight the outcomes are examined to see if the direct
effects of the interventions being made are effecting the bottom line, or if a focus on
different factors is needed.
Community Tool Box links related to Phase 6, Phase 7, and Phase 8:
Introduction to Evaluation
A Framework for Program Evaluation: A Gateway to Tools
Intervention Research with Communities: A Gateway to Tools
Understanding Community Leadership, Evaluators, and Funders: What Are Their Interests?
Choosing Evaluators
Developing an Evaluation Plan
Some Operations in Evaluating Community Interventions
Information Gathering and Synthesis
Designing an Observational System
Developing and Testing a Prototype Intervention
Selecting an Appropriate Experimental Design
Collecting and Analyzing Data
Collecting and Using Archival Data
Some Methods for Evaluating Comprehensive Community Initiatives
Measuring Success: Evaluating Comprehensive Community Health Initiatives
Gathering Information: Monitoring Your Progress
Rating Community Goals
Rating Member Satisfaction
Constituent Survey of Outcomes: Ratings of Importance
Reaching Your Goals: The Goal Attainment Report
Behavioral Surveys
Conducting Interviews with Key Participants to Analyze Critical Events

Gathering and Using Community-Level Indicators

Community-Level Indicators: Some Examples
Using Evaluation to Understand and Improve the Initiative
Providing Feedback to Improve the Initiative
Communicating Information to Funders for Support and Accountability