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PRACTICE EXAM QUESTIONS :1. Explain what a systemic approach is to solving a health problem?
2. There is a discussion about the determinants of fast food consumption. Which framework is
better discuss the EnrG framework and the RAA model
3. Explain if you see children having fun while playing actively outside which model you can explain
the best and why?
4. Explain in which cases you prefer qualitative research above quantitative research?
5. Why bother with interactions and moderation when trying to understand health behavior? It is
much more important to put effort in studying main effects of determinants ?
,PRECEDE-PROCEED MODEL
Precede: predisposing, reinforcing, and enabling constructs in educational/ecological diagnosis and evaluation
Proceed: policy, regulatory, and organizational constructs in educational and environmental development
- Main purpose of the model is not to predict or explain the relationships among factors thought to be
associated with the outcome, but to provide a structure for applying theories and concepts
systematically in the planning and evaluating of health behaviour change programs.
Step 1 = Phase 1 + 2: Identifying the problem (Social assessment): There are a lot of young people with CVD
due the smoking. (Ask yourself: What is the problem? Why is it a problem, whose problem is it? and What is
causing the problem?)
Step 2 = Phase 2: Identifying the genetical/behavioral/environmental influences. (Epidemiological assessment)
For genetics, behavior and environment you look at what is related to the health problem in question (thus
CVD)
- Which genetics, behavior and environmental factors are important?
- Which genetics, behavior and environmental factors are changeable?
- Which genetics, behavior and environmental factors will we target?
- Which objectives will we set
o (smart, specific, measurable, attainable, relevant, timely)
, o (For environment e.g.: so e.g.: Tobacco and e-cigarette sales by gas stations and convenience
stores should be reduced by 50% within 3 years after program implementation.)
Step 3 = Phase 3: Identifying the determinants of the behavior. (Educational and ecological assessment)
- Predisposing factors include a person’s or population’s knowledge, attitudes, beliefs, values, and
perceptions that facilitate or hinder motivation for change.
o Knowledge about the topic
o Attitude towards the behavior
o Cultural and social norms
- Reinforcing factors are the rewards or satisfactions received and the feedback an individual receives
from influential significant others following the adoption of a behavior.
o Social support from family, friends etc.
- Enabling factors are those skills, resources, or barriers that can help or hinder the desired behavioral
and environmental changes needed to achieve the desired health outcome.
o How many gyms are in the neighbourhood
o Are people getting education about healthy habits because then individuals can make
informed choices
Here you could use socio-cognitive models like EPPM or SDT for individual level.
Step 4 = Phase 4: Developing interventions and policy measures (Health program and policy development). For
this step you need to think of interventions that influence determinants of EPPM or SDT. (You look at
intervention, implementation and behavior strategies)
Step 5 = Phase 5-8
- Phase 5: implementation. → The planner prepares for implementation by developing the necessary
training, materials, and resources to support program delivery.
- Phase 6-8: process, impact, and outcome evaluation.
- The planner develops data collection plans to conduct process, impact, and outcome evaluations,
respectively.
o Process evaluation = determines the extent to which the program was implemented
according to protocol.
o Impact evaluation = assesses change in predisposing, reinforcing, and enabling factors, as
well as in the behavioral and environmental factors.
o Outcome evaluation = determines the effect of the program on health and quality-of-life
indicators.
→ The measurable objectives that are written in each phase of precede-proceed serve as
milestones against which accomplishments are evaluated.
The hallmarks of the precede-proceed model include: its flexibility, scalability, evidence based process and
evaluability and commitment to the principle of participant.
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