Precede Proceed Model in Business

Applying the Precede-Proceed Model

Precede-Proceed Model

Precede-proceed model, like any other model, is used in public health. However, its primary principles connect to other community issues altogether. During the 20th century, when medical advances eliminated most infectious diseases, the leading causes of death and disability became chronic conditions such as stroke, diabetes, cancer, and heart diseases. Health maintenance then changed to prevent such conditions from disease treatment (Morgan et al. 2012). Moreover, most recently, due to active promotion of attitudes and behaviors, exercise, stress minimization, and exercise, span and quality of life have been improved.

Subsequently, Precede-proceed is one of the most detailed and widely used perspectives guiding population health intervention developments. Larry Green and Marshall Kreuter established this framework. Precede-proceed model is primarily used within the Western World, where it has been applied to multiple health issues. The precede-proceed model is also one of the oldest health education and planning initiatives frameworks (Binkley & Johnson, 2013). The framework is founded on the critical principle of participation, which stipulates that the enhancement of change is through the targeted audiences' active participation in identifying their health-related issues and aims in implementing and developing solutions. Consequently, applying the model's particular stage should encompass attempts to input from populations of priority intervention designed to help.

One of the unique features of the precede-proceed is its eight-stage planning that begins at the end, centralizing on health-associated outcomes of interest. After that, the model works backward to establish the kind of intervention combination strategies that can best attain such objectives. At this stage, planners of the population health widen their understanding of the community where they work by carrying out several data collection activities like interviews with focus groups, key opinion leaders, and community members, as well as surveys and gathering data through observation (Binkley & Johnson, 2013). Community, as used in this instance, refers to a group or a geographical area with shared values, norms, and characteristics.

Phase 2: Epidemiological, Behavioural, and Environmental Assessment

Epidemiological Assessment. Parents with mild to severe intellectual and developmental disabilities were placed within institutions or homes with well-staffed dental and medical facilities and workers with advanced training. However, there has been a success in placing parents in smaller community residences and removing them from the institutions. However, even though such initiatives improved parents' general health, their access to dental health care has become limited or unavailable, and their oral health has been affected.

Medicaid ensures most parents with intellectual and developmental disabilities. However, most dentists do not recognize Medicaid for treating special needs patients. As a result, the parents' oral health is affected by their inability to properly floss their teeth and the absence of semiannually preventive dental treatment. Since parents exhibit diverse uncooperative behaviors and some developed physical impairments due to old age, providing oral care becomes challenging (Binkley & Johnson, 2013). Moreover, most parents usually ignore the posterior teeth while cleaning and focus only on the anterior teeth, putting the posterior oropharyngeal area at risk for infection and colonization with bacteria.

Parents are also prone to swallowing disorders, exposing them to more risk of respiratory and aspiration infections, significant mortality, and morbidity caused amongst the population. Like patients in intensive care units and parents in nursing homes, pathogenic bacteria can colonize parents' oropharyngeal area.

Besides, even though there is a need to enhance social initiatives focusing on several dentists treating parents, parents must take care of their oral hygiene (Binkley & Johnson, 2013). Therefore, theoretical strategies and interventions that address parents' behavioral abilities in giving oral health support may minimize differences and improve the parents' quality of life and health.

Behavioral Assessment. Parents with intellectual and developmental disabilities have cognitive, physical, and behavioral disabilities that negatively impact their ability to carry out their oral hygiene. Besides, parents with a mild disability who can do their oral hygiene regularly fail to prioritize brushing their teeth and are unaware of how to perform such practices optimally. Parents with moderate to severe disabilities may partially be able to carry out their oral hygiene; however, they frequently need supervision or assistance by care providers to properly clean their teeth.

Like parents of very young children, caregivers also have a critical role in shaping parents' behavior with intellectual disability disorders, with a mental age below that of a 5-year-old child (Binkley & Johnson, 2013). Generally, parents with disabilities do not attain good oral health independently. Nevertheless, according to Shaw and colleagues, if parents with intellectual disability disorders are encouraged, motivated, and supervised by caregivers, their oral hygiene is enhanced.

Environmental Assessment. Group homes' physical environment is usually not conducive to oral hygiene activities. Tools usually available for oral hygiene are over-the-counter toothbrushes that are likely inadequate in addressing residents' disabilities. Moreover, research findings show no procedures or policies to guide oral hygiene or oral health practices (Grant et al. 2004). The enaction of procedures and policies relating to oral health by institutions that manage group homes would give all the caregivers expectations and guidelines for their performance.

Also, most caregivers are mandated to provide dinner or breakfast during the week and all meals over the weekend to the residents. Consequently, they are solely responsible for influencing what parents drink and eat while in care (Binkley & Johnson, 2013). Moreover, they also have the mandate to ensure that an appropriate diet is available to minimize tooth decay risks.

Phase 3-Educational and Ecological assessment

Predisposing Factors. Predisposing factors include outcome expectancies, behavioral capabilities, and self-efficacy. Studies have shown that giving caregivers training on how to provide oral hygiene to parents has a dismal effect on enhancing oral health. 

Enabling Factors. Enabling factors for parents with intellectual disability disorder that may impact mechanisms of enhancing oral health include capacity building, environmental adaptation, and planned action. Planned action has been found to impact the caregiver's behavior and is a critical construct of the Health Action Process Approach. Capacity building is strengthening, adapting, maintaining, and obtaining abilities to do things over time (Binkley & Johnson, 2013). The environmental adaptation uses tools of oral hygiene like unique toothbrush handles for the parents' minimal capability to grip or poor coordination, multi-surface brushes, mouth props, flavored toothpaste, dental floss alternatives, and powered brushes, which can also enhance caregivers' behavioral ability as well as the oral health of parents with intellectual disability disorder.

Reinforcing Factors. Reinforcing the desired behavior is an essential construct within a cognitive theory, and it promotes a behavior to be sustained and repeated. Monitoring oral health practices and components-coaching can impact behavioral capabilities, caregiver self-efficacy, environmental influences, and outcome expectancies (Binkley & Johnson, 2013). To research findings, ongoing coaching of residents and caregivers is vital for the parents' oral health strategic success (Grant et al. 2004). Other than coaching, a web-based monitoring system may enhance the capability to reinforce caregivers from time to time constructively.

Phase 4-Administration and policy assessment and Intervention Alignment

Health Education and Policy Regulation Factors. Contextual factors like caregiver oral health status, group home environmental characteristics, and demographics are associated with influence strategy. Consequently, such factors should be considered moderators of the strategy impacts and be statistically controlled in a randomized controlled study.

Also, based on administrative assessment, oral health strategy requires factors such as endorsement of institutions that give community services for the parents and behavioral contracts with the institutional directors to delineate the responsibilities and roles of the parents (Fickert & Ross, 2012). Moreover, the policy assessment established that for the success of oral health strategy, there is a requirement for the enaction of a monitoring policy by the institutions giving services to parents with intellectual disability disorder.

Phases 5–8 of the Proceed part of the model

The pilot study assesses the amount of intervention exposure of every strategy aspect, the degree to which every aspect is enacted as designed, and participants' reactions to strategy implementation over one month (Binkley & Johnson, 2013). Moreover, study outcomes are also assessed as preliminary results to guide final oral health strategy development.

Additionally, the oral health strategy will only be implemented upon receiving HIPPA authorization and informed written consent from the parents and caregivers with intellectual disability disorder. Also, there will be a negotiation of a behavioral contract with the caregivers to participate in the program to enhance the oral health of their residents.

To evaluate the impacts on the proximal results, the study plans to carry out a cluster randomized controlled trial that abruptly allocates group homes to experimental situations within the institutions. Outcomes will be evaluated at the beginning, after implementation, and as six months follow-up. Subsequently, the implementation of the control group will come first within nine months, with the implementation of the intervention group coming next over the same amount of time. This will minimize contamination between intervention and control group participants.

Further, outcome data will be obtained from outcome evaluation of parents with intellectual disability disorder nested within group homes (Binkley & Johnson, 2013). The study also intends to adopt three-level hierarchical linear model (HLM) random intercept regressions to answer the research question on the intervention's direct effects. This will evaluate whether there have been differential changes between control groups and intervention on intermediate, distal, or proximal outcomes (Vigild et al. 1993). Hierarchical non-linear modeling (HNLM) will be adopted for dichotomous outcomes.

Finally, the study intends to adopt a multilevel structural equation model procedure to establish whether social cognitive factors like caregiver self-efficacy mediate the relationship between distal outcome, intervention exposure, or intermediate outcome (Binkley & Johnson, 2013). Multilevel structural equation model solves for aspects at both parent with intellectual disability disorder and group home level, and constraints are put across model as the effects of random variability representation.