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...

…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.

Summary of the Precede-Proceed Model and its application

The study used informal discussion with chosen community leaders, working with parents with intellectual disability disorders, and a literature review.

Phase 1 - Social Assessment

The activities established the primary outcomes of oral health strategy for parents with disabilities.

Phase 2 - Epidemiological, Behavioural, and Environmental Assessment

The phase established environmental, behavioral, and epidemiological factors that could have affected the quality of life and oral health of parents with intellectual disability disorder (Binkley & Johnson, 2013).

Phase 3 - Educational and Ecological Assessment

This phase determined aspects that, if altered, would probably lead to behavior change and maintain this change process.

Phase 4 - Intervention Alignment and Administrative and Policy Assessment

This phase considers Contextual factors like caregiver oral health status, group home environmental characteristics, and demographics associated with influence strategy.

Phase 5 - Pilot Study

Even though this study failed to embrace pilot study inclusion as critical to the PRECEDE-PROCEED planning model, it is believed to be a vital phase. The lessons and results obtained are critical in revising its evaluation study.

Phase 6 - Implementation

This phase illustrates the implementation of the oral health strategy in an efficacy study.

Phases 7 and 8 - Process and Outcome Evaluation

The efficacy study is a cluster randomized control trial…