PRECEDE-PROCEED model is a step by step comprehensive guide which helps to assess health needs and design, implement and evaluate public health programs. PRECEDE (Predisposing, Reinforcing, and Enabling Constructs in Educational Diagnosis and Evaluation) outlines a diagnostic planning process to assist in the development of targeted public health programs. PROCEED (Policy, Regulatory, and Organizational Constructs in Educational and Environmental Development) guides the implementation and evaluation of the programs, which were designed using PRECEDE.
In my previous discussion I analyzed the needs assessment stage of a Womens NGO in Mexico for a project targeting public health education for young mothers. A more comprehensive study was done to assess the second hand smoking experience among young mothers and their children as part of the global project.
As far as the idea of second hand smoking emerged after the needs assessment was done for the overall project, it entered the PRECEDE at a later stage. This has to be assessed as a project within a project, which needed additional efforts to assess the specific needs, conduct supplementary actions in researching several issues, e.g. what are the second hand smoking habits, what is the percentage of smoking population, how many people smoke in a family in average, as well as research if there are cultural obstacles in implementing this project.
Thus, second hand smoking sub-project undergoes the first phase of PRECEDE it assesses the quality of life, social problems and the needs. The findings, as the Womens NGO representative told, helped that the health determinants of the problems and needs to be identified, i.e. they revealed that almost 90 non smokers, an enormous number of people, experience second hand smoking. The behavioral determinant linked the problem to the culture of smoking at home and the absolute unawareness of the harms that second hand smoking can have on people, especially women and children (including at prenatal period). The culture of smoking wherever the smoker prefers at home, while spending time with children is prevailing. The breakdown of this culture will be extremely difficult by the team. The unawareness is more stressed by unwillingness to learn and change behavior, as men and elders might consider this action as stepping down from their position in front of younger generation. If a child or a woman would ask them to stop smoking at their presence, it would sound like an assault to any smoker.
The final stage of PRECEDE model proved to be the most difficult one to design for the NGO, as it had to do with a number of cultural issues, unawareness and rejection of the harm as the effects of second hand smoking is not usually visible. From the other hand, the activities had to be carried out with both parties smokers and second hand smokers. The most complicated phase would be bringing the smokers into dialogue. Scientific findings in this field would be a powerful tool in fostering change of behavior however, it would happen only if the dialogue was established.
The educational plan was designed considering the above listed constraints and difficulties. There were formal and non formal phases of the education, from which non-formal part consisted in developing friendly relations and an occasional conversation about the dangers of smoking, especially the second hand smoking. The entire idea was to develop a sense of responsibility towards people who are affected by the smokers actions. The main stress was put on the rights of women and children to healthy lifestyle, as this layer was the most oppressed considering gender inequality and cultural attitudes.
The designed sketch of interventions was thoroughly planned and all the cultural and gender aspects were considered due to the fact that the NGO was well aware of the local environment. The strategy of the activities was developed in a way not to harm the family relations by this intervention. The reality was though, that the number of target people would be small due to the limited number of social workers to carry out individual activities with the smokers.
In my previous discussion I analyzed the needs assessment stage of a Womens NGO in Mexico for a project targeting public health education for young mothers. A more comprehensive study was done to assess the second hand smoking experience among young mothers and their children as part of the global project.
As far as the idea of second hand smoking emerged after the needs assessment was done for the overall project, it entered the PRECEDE at a later stage. This has to be assessed as a project within a project, which needed additional efforts to assess the specific needs, conduct supplementary actions in researching several issues, e.g. what are the second hand smoking habits, what is the percentage of smoking population, how many people smoke in a family in average, as well as research if there are cultural obstacles in implementing this project.
Thus, second hand smoking sub-project undergoes the first phase of PRECEDE it assesses the quality of life, social problems and the needs. The findings, as the Womens NGO representative told, helped that the health determinants of the problems and needs to be identified, i.e. they revealed that almost 90 non smokers, an enormous number of people, experience second hand smoking. The behavioral determinant linked the problem to the culture of smoking at home and the absolute unawareness of the harms that second hand smoking can have on people, especially women and children (including at prenatal period). The culture of smoking wherever the smoker prefers at home, while spending time with children is prevailing. The breakdown of this culture will be extremely difficult by the team. The unawareness is more stressed by unwillingness to learn and change behavior, as men and elders might consider this action as stepping down from their position in front of younger generation. If a child or a woman would ask them to stop smoking at their presence, it would sound like an assault to any smoker.
The final stage of PRECEDE model proved to be the most difficult one to design for the NGO, as it had to do with a number of cultural issues, unawareness and rejection of the harm as the effects of second hand smoking is not usually visible. From the other hand, the activities had to be carried out with both parties smokers and second hand smokers. The most complicated phase would be bringing the smokers into dialogue. Scientific findings in this field would be a powerful tool in fostering change of behavior however, it would happen only if the dialogue was established.
The educational plan was designed considering the above listed constraints and difficulties. There were formal and non formal phases of the education, from which non-formal part consisted in developing friendly relations and an occasional conversation about the dangers of smoking, especially the second hand smoking. The entire idea was to develop a sense of responsibility towards people who are affected by the smokers actions. The main stress was put on the rights of women and children to healthy lifestyle, as this layer was the most oppressed considering gender inequality and cultural attitudes.
The designed sketch of interventions was thoroughly planned and all the cultural and gender aspects were considered due to the fact that the NGO was well aware of the local environment. The strategy of the activities was developed in a way not to harm the family relations by this intervention. The reality was though, that the number of target people would be small due to the limited number of social workers to carry out individual activities with the smokers.
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