The PRECEDE-PROCEED model is probably one of the most talked about in public health.  One of the reasons being that it’s a comprehensive model for developing public health education programs.  There are a lot of arrows showing the relationship between items within a phase and between phases. The model title is actually an acronym which stands for:


  • Predisposing
  • Reinforcing
  • Enabling
  • Constructs
  • In Educational
  • Diagnosis
  • and Evaluation


  • Policy
  • Regulatory
  • and Organizational
  • Constructs
  • in Educational
  • and Environmental
  • Development


Dr. Lawrence Green developed the first iteration of this model in 1974.  It was based off of a cost-benefit analysis.   Then he applies it to public health programs.  It starts off with where the health and quality of life is now for whom you want to make improvements.  It moves through to creating education programs and policy.  Then it moved back through the phases focusing on evaluating the entire process with the outcome being better health and higher quality of life.

Why use a business concept for public health education programs?  Public health programs are typically government run.  Several programs have grant money tied to them.  How grant money is used is an important part of having a grant.  It would be prudent for the public health education program to use the grant money that provided the highest benefit for the cost.

This model looks like a complicated process, but it really isn’t.  You assess the quality of life of the group you wish to provide the health education program to.  This is something we do every day if we have contact with the public.  The next step is to assess their health.  This is where epidemiological evidence is used.  Then there’s an assessment of personal behaviors and the environmental factors that influence these behaviors.  After the behavioral assessment is completed, then a more in-depth assessment of the factors that reinforce, predispose, or enable the current behavior.  Finally after all of this assessment, the policies and programs are written.  The rest is evaluation.  Did we ultimately improve the quality of life of the group by the program/policy we created?

That sounds like a lot, but if you want a program that works each step is important.  In terms of determining culture, it may be assessed during the environmental influence assessment and the factor assessment, but I can’t say for sure.  If there isn’t a focus on culture, because culture influences a lot of how a person protects their own health, it may be an afterthought.  Cultural influences on health behavior should be a part of every program assessment.  I would propose adding a cultural assessment to phase three.  This would ensure it’s specifically addressed.