培訓(xùn)資料-格林模式健康評估

PRECEDE-PROCEED模式

簡介及應(yīng)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(jìn)的規(guī)劃設(shè)計(jì)、執(zhí)行及評價(jià)提供一個(gè)連續(xù)的步驟或階段。是當(dāng)代健康教育領(lǐng)域最有代表性、應(yīng)用最廣泛的過程模式。3行為理論/需求診斷健康干預(yù)PRECEDE-PROCEED模式可分為兩個(gè)階段：4行為理論P(yáng)RECEDE-PROCEED模式分析程序上：從結(jié)果入手，以演繹的方法進(jìn)行分析思考；在設(shè)計(jì)干預(yù)方案前對產(chǎn)生結(jié)果的重要影響因素作出診斷。模式結(jié)構(gòu)上：考慮了影響健康的多重因素，幫助規(guī)劃制定者把這些因素作為重點(diǎn)干預(yù)的目標(biāo)，同時(shí)產(chǎn)生特定的規(guī)劃目標(biāo)和評價(jià)標(biāo)準(zhǔn)。PRECEDE-PROCEED模式特點(diǎn)：傾向因素強(qiáng)化因素促成因素6行為生活方式環(huán)境傾向因素強(qiáng)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(jìn)或阻礙人們行為改變動機(jī)的因素包括知識、態(tài)度、信念、價(jià)值觀等傾向因素〔PredisposingFactors〕以母乳喂養(yǎng)為例產(chǎn)婦關(guān)于母乳喂養(yǎng)益處的知識有效喂養(yǎng)的技能母乳喂養(yǎng)的態(tài)度自我效能促成因素〔EnablingFactors〕強(qiáng)化因素：是指目標(biāo)人群在行為改變后所獲得的各種正向或負(fù)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(jié)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(shí)質(zhì)性獎勵、自己對行為后果的感受強(qiáng)化因素〔ReinforcingFactors〕PRECEDE-PROCEED模式實(shí)施過程〔簡要〕PRECEDE-PROCEED模式實(shí)施過程〔簡要〕PRECEDE-PROCEED模式實(shí)施過程〔簡要〕健康領(lǐng)域使用最為廣泛、評估最為全面的模式之一，也是社區(qū)健康促進(jìn)和公共衛(wèi)生干預(yù)的有效模式干預(yù)對象包括健康者和疾病患者研究方向包括疾病護(hù)理、疾病預(yù)防、健康保健和健康需求評估等PRECEDE-PROCEED模式的應(yīng)用PRECEDE-PROCEED模式的應(yīng)用——研究方向應(yīng)用實(shí)例〔一〕格林模式在社區(qū)高血壓患者健康教育中的應(yīng)用紀(jì)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(qū)高血壓患者健康教育中的應(yīng)用效果研究對象：某社區(qū)高血壓患者120人，應(yīng)用格林模式進(jìn)行健康教育。在應(yīng)用格林模式前，對教育對象進(jìn)行高血壓知識達(dá)標(biāo)率、高血壓健康教育的支持率、衛(wèi)生活動參與率和高血壓控制穩(wěn)定率等調(diào)查研究方法具體實(shí)施流程圖研究方法1.社會診斷通過GQOLI-74生活質(zhì)量評價(jià)表，了解患者的生活、學(xué)習(xí)、工作、社會環(huán)境等根本情況2.流行病學(xué)診斷進(jìn)行健康調(diào)查，了解既往病史、家族病史、教育對象高血壓到達(dá)幾級并了解其身體健康狀況3.行為與環(huán)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(jià)通過隨訪和調(diào)查問卷的方式，及時(shí)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(jìn)行調(diào)整8.健康教育效果評價(jià)通過隨訪和調(diào)查問卷的方式，對教育對象進(jìn)行高血壓知識達(dá)標(biāo)率、高血壓健康教育的支持率、衛(wèi)生活動參與率、高血壓控制穩(wěn)定率和不良習(xí)慣轉(zhuǎn)變率等調(diào)查9.健康教育的結(jié)果評價(jià)教育結(jié)束后，對照方案進(jìn)行隨訪，了解教育對象的長、短期目標(biāo)的完成情況，并根據(jù)情況隨時(shí)修改目標(biāo)，應(yīng)用CQOLI-74生活質(zhì)量評價(jià)進(jìn)行評估應(yīng)用實(shí)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(diào)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