Poorly controlled type 2 diabetes mellitus has been positively associated with periodontal disease, which is characterized by loss of connective tissue and bone support, ultimately leading to tooth loss (Hu, Wallace, & Tesh, 2010; Mohamed et al., 2013). This paper demonstrates how the Precede-Proceed Model can be used to address the risk factors associated with diabetes in the community.
Using the Precede-Proceed to Address the Issue
The Precede-Proceed Model has two distinct elements, with the former representing predisposing, reinforcing and enabling constructs in educational diagnosis and evaluation, and the latter representing policy, regulatory and organizational constructs (Tramm, McCarthy, & Yates, 2012). Overall, the model has eight segments, with the Precede section comprising three distinct phases (social assessment, epidemiological assessment, and educational and ecological assessment) and the Proceed section comprising the remaining five segments (administrative and policy assessment and intervention alignment, implementation, process evaluation, impact evaluation, and outcome evaluation).
Drawing from this description, the model can be used in an initiative aimed at addressing the high incidence of diabetes in the community, particularly in terms of assessing the ecological factors that influence the onset of the disease. Using the model, the ecological factors associated with a high incidence of diabetes within the community can be categorized using three parameters. The first parameter will assess the predisposing factors, described as individual-level factors that provide the rationale or motivation for specific health behaviors such as lack of physical activity, obesity, poor dietary habits, poor nutrition, and low quality of life (Tramm et al., 2012).
The second parameter will assess the enabling factors to health, which include how the community is exposed to new skills and knowledge related to diabetes prevention, the resources and assets available at the community level to combat diabetes and associated diseases, and the barriers that exist at the community level to hinder optimal behavior performance or environmental change. The last parameter will evaluate the reinforcing factors to health, which include the rewards and feedback associated with the performance of health behaviors that contribute to the reduction of diabetes at the interpersonal and individual levels; that is, how community members are rewarded for internalizing positive health behaviors. The causal theory of organizational change can be used to identify the determinants of a particular intervention outcome assessed through the Precede-Proceed model, while the action theory can be used to explain how the various interventions aimed at reducing diabetes in the community will influence the determinants and outcomes (Mohamed at al., 2013).
Developing Partnerships and Target Organizations
It is important to partner with the local health department, other state and local agencies dealing with diabetes, private health organizations within the community, and non-governmental organizations operating in the community to share information and guard against duplication of efforts aimed at reducing type 2 diabetes within the community. Type 2 diabetes is known to affect adults, hence the need to target church-based organizations, community-based organizations, health institutions, and community-based social support organizations in efforts aimed at reducing the high prevalence of the disease within the community.
Using the Model to Plan Interventions
The etiology of type 2 diabetes is associated with “lifestyle factors such as high fat and sugar intake, physical inactivity and obesity” (Mohamed et al., 2013, p. 1). As described above, the Precede-Proceed Model can be used to assess these individual-level factors and help stakeholders to prioritize the observed needs according to the results of the assessment. The model can be used to identify administrative and financial policies to address the individual-level risk factors for diabetes described above, education skills and ecology required for successful prevention of diabetes, and various desirable outcomes that should be targeted by the health promotion initiative. Identifying the ecological factors involved will ensure the inclusion of protective factors that act to reduce the likelihood of diabetes in the community.
Overall, it can be concluded that the Precede-Proceed Model is effective in not only assessing individual and ecological factors associated with diabetes but also in planning interventions that aim to address the factors.
Hu, J., Wallace, D.C., & Tesh, A.S. (2010). Physical activity, obesity, nutritional health and quality of life in low-income Hispanic adults with diabetes. Journal of Community Health Nursing, 27(3), 70-83.
Mohamed, H.G., Idris, S.B., Ahmed, M.F., Boe, O.E., Mustafa, K., Ibrahim, S.O., & Astrom, A.N. (2013). Association between oral health status and type 2 diabetes mellitus among Sudanese adults: A matched case-control study. PLoS ONE, 8(12), 1-9.
Tramm, TR., McCarthy, A., & Yates, P. (2012). Using the Precede-Proceed Model of health program planning in breast cancer nursing research. Journal of Advanced Nursing, 68(8), 1870-1880.