The effect of educational intervention based on the PRECEDE-PROCEED model on self-care behaviors and quality of life of hypertensive patients.

Background: To prevent the harmful consequences of hypertension and enhance the quality of life of hypertensive patients, the use of educational models is highly suggested. Therefore, the present study was designed to determine the effect of education based on the PRECEDE-PROCEED on self-care behaviors and the quality of life of hypertensive patients in Kazeroon city, Iran, in 2023. Methods: A total of 120 hypertensive individuals who were referred to Kazeroon city health centers participated in the current quasi-experimental study. The participants were divided into two experimental and control groups using a random sampling technique (60 participants in each group). The self-care behaviors questionnaire, the quality of life questionnaire, and a questionnaire based on the PRECEDE-PROCEED model were used as the data acquisition techniques. Both groups completed the questionnaires before and 2 months after the intervention. The educational program included a six-session, 50-60 min training program using three different teaching methods (speaking, Q&A, group discussion, and peer training) in health facilities. The data were examined using paired t, independent t, and chi-square statistical tests after being entered into the SPSS 24 statistical program. Results: Following the intervention, the experimental group showed significantly higher values in quality of life, knowledge, attitude, enabling and reinforcing factors, and self-care behaviors compared to the control group (p < 0.001 for all comparisons). The experimental group also exhibited a significant reduction in systolic blood pressure measures compared to the control group (p < 0.001). Conclusion: In the present study, education based on the PRECEDE-PROCEED model and focusing on blood pressure self-care behavior in patients with hypertension led to a decrease in their systolic blood pressure measures and improved their quality of life.

Developing Knowledge of Autism in Majority World Countries: Examples of Bolivia and Paraguay.

Bolivia and Paraguay are Majority World countries, which are defined as areas within which most of the world's population live, natural resources and landmass are located, but are often economically poor. Minority world countries, such as, the United States, have a smaller percentage of the world's population, but often a greater share of the world's wealth. Many Majority World countries, such as Bolivia and Paraguay, have not collected prevalence data on autism and assessments and interventions for persons are quite limited, if they are available at all. Persons with autism in Bolivia and Paraguay are at most underserved and the majority are unserved. This article reviews topological, demographic, and economic/political factors affecting the identification and provisions of services for autistic children and the current health and educational status for autistic persons in Bolivia and Paraguay. Descriptions of the efforts of outside consultants to assist parents and professional within those countries to gain information and develop assessment and intervention programs for autistic children are described. Attention is given to methodologies employed by United States consultants to ensure the implementation of culturally responsive practices. Consultants employed skilled dialogue when interviewing parents and professionals in Bolivia and Paraguay to understand their perspectives so as to guide content of trainings. The PRECEDE-PROCEED framework was employed to develop a culturally-responsive approach to assessment and intervention.

Applying the PRECEDE-PROCEED model to develop MommaConnect: a digital healthcare platform for addressing postpartum depression and improving infant well-being.

The PRECEDE-PROCEED model is a comprehensive planning and theoretical framework that incorporates epidemiological, environmental, behavioral, and social factors systematically to design, implement, and evaluate health promotion programs. As such, PRECEDE-PROCEED is a highly effective tool for addressing complex and significant public health concerns like postpartum depression (PPD). PPD negatively impacts mothers and their infants, with studies showing that approximately one in eight mothers experience PPD, leading to adverse effects on maternal functioning and infant development. However, access to specialized evidence-based treatment remains significantly limited due to barriers including social determinants of health. This paper explores the application of the PRECEDE-PROCEED model as a planning and theoretical framework for the design and development of MommaConnect, an innovative digital healthcare platform aimed at reducing PPD symptoms and improving maternal-infant interaction while overcoming barriers to treatment. Key components of the MommaConnect design and development process are mapped onto the steps of the PRECEDE-PROCEED model. MommaConnect features are aligned with specific stages of the model, from assessing, predisposing, enabling, and reinforcing factors to designing, implementing, and evaluating the intervention. By leveraging this model, MommaConnect represents a promising innovative approach to address PPD to improve maternal functioning and infant health in a digitally-enabled era. This paper underscores the importance of utilizing a framework like the PRECEDE-PROCEED model in the design and development of innovative healthcare solutions.

Effect of oral health education on improving knowledge, attitude, practice, and oral health status of patients with liver cancer: A quasi-experimental study.

PURPOSE: To evaluate the effectiveness of the PRECEDE-PROCEED model (PPM) in helping patients with liver cancer be aware of their knowledge, skills, and abilities in self-oral health behaviors and improve their oral health status. METHODS: This is a quasi-experimental study of 90 patients with liver cancer assigned to an oral health education or a control group. The intervention group was educated with the PRECEDE-PROCEED model. A brief oral scale and the knowledge, attitude, and practice oral health questionnaire were employed to measure the oral health status and cognitive behavioral ability to seek oral health in patients. RESULTS: Among 102 eligible patients, 90 (88.23%) agreed to participate in the present study and were divided to intervention (n = 45) or control (n = 45) groups. After the intervention and one month after discharge, the oral health scores of patients in the Intervention group were lower than those of the control group (P < 0.05). In addition, after the intervention and one month after discharge, the patients in the test group had higher scores on knowledge, beliefs, and behaviors of oral health than the control group (P < 0.05). One month after discharge, the mean knowledge and skills scores were significantly higher in the intervention group than in the control group. CONCLUSIONS: Our findings suggest that oral health education may be a useful health intervention for patients with liver cancer. It may also improve the knowledge and beliefs of liver cancer patients seeking oral health. Larger long-term investigations are necessary to provide more support for these preliminary conclusions.

The Family and Pregnancy Pop-Up Village: Developing a one-stop shop of services to reduce pregnancy care-related inequities in San Francisco.

INTRODUCTION: Centering affected individuals and forming equitable institutional-community partnerships are necessary to meaningfully transform care delivery systems. We describe our use of the PRECEDE-PROCEED framework to design, plan, and implement a novel care delivery system to address perinatal inequities in San Francisco. METHODS: Community engagement (PRECEDE phases 1-2) informed the "Pregnancy Village" prototype, which would unite key organizations to deliver valuable services alongside one another, as a recurring "one-stop-shop" community-based event, delivered in an uplifting, celebratory, and healing environment. Semi-structured interviews with key partners identified participation facilitators and barriers (PRECEDE phases 3-4) and findings informed our implementation roadmap. We measured feasibility through the number of events successfully produced and attended, and organizational engagement through meeting attendance and surveys. RESULTS: The goals of Pregnancy Village resonated with key partners. Most organizations identified resource constraints and other participation barriers; all committed to the requested 12-month pilot. During its first year, 10 pilot events were held with consistent organizational participation and high provider engagement. CONCLUSION: Through deep engagement and equitable partnerships between community and institutional stakeholders, novel systems of care delivery can be implemented to better meet comprehensive community needs.

Development of a HIV Prevention Program to Promote Condom Use Among Iranian Female Sex Workers: Application of An Intervention Mapping Approach.

We used an Intervention Mapping Approach (IMA) to derive multi-level HIV prevention strategies aiming to develop an HIV prevention intervention program among female sex workers (FSWs). We also aimed at pilot testing the effects of the IMA-based "HIV Prevention and Awareness Program (HIV-PAP)" on safe sex behaviors and its determinants among FSWs in Tabriz, Iran. To develop HIV-PAP, we conducted the six-step process of IMA. At Step 1, in a cross-sectional study, 140 FSWs were face-to-face interviewed. At Step 2, the program matrix was provided based on the importance and variability for identifying priority factors. At Steps 3 and 4, the methods and strategies for behavioral change were selected, and the HIV-PAP program components and materials were developed. At Steps 5 and 6, evaluation (as a pilot testing with Static-Group Comparison design) was conducted applying a pre-experimental study, in which 30 FSWs were assigned to intervention (n = 15) and control (n = 15) groups. The intervention group participated in a two-month long program, and one month later, the initial questionnaires were completed by both groups. The respondents (M age: 33.4 years, SD: 9.7) acquired low score (less than 50%) in negotiating for condom use (49.8%) only, and moderate scores (50-65%) in perceived social support (61.6%) and knowledge (60.5%). Adjusted for other variables, the factors (R2 = 32.0%) associated with safe sex behaviors among FSWs were predisposing factors [self-efficacy (ß = 0.331), perceived norms (ß = 0.945), and perceived barriers (ß = 0.258)], condom use negotiation (ß = 1.386), and environmental factors (ß = 0.333). Our IM-based framework had an adequate fit index (χ2 = 130.8, CFI = 0.78). Looking for inter-group comparison after intervention, we found significant mean difference (MD) for knowledge (MD: 2.18; 95% Confidence Interval (CI) - .38 to 4.74, p < 0.05), self-efficacy to use condom (MD: 6.71; 95% CI - 1.85 to 9.29, p < 0.05), perceived risk (MD: 2.03; 95% CI 0.58, to 3.49, p < 0.05), perceived social support (MD: 4.64; 95% CI - 5.37 to 11.31, p < 0.01), and safe sexual behaviors (MD: 7.75; 95% CI - 4.19 to 9.71, p < 0.05). The HIV-PAP showed effectiveness in promoting safe sexual behaviors and their determinants among FSWs. Healthcare providers should better understand the determinants of safe sexual behaviors among FSWs in the settings with legal prohibitions for sex work. In such communities, they should try to either develop or adapt such stage-specific interventions, within which promoting the above-mentioned factors is the core priorities of the program.

A community based intervention to modify preventive behaviors of cutaneous leishmaniasis in children: a randomized controlled trial based on PRECEDE PROCEED model.

OBJECTIVES: Iran ranks among the top six countries globally with a significant incidence of Cutaneous Leishmaniasis (CL). Using planning models is one community-based intervention to promote preventive behaviors. The purpose of our study was to evaluate the effectiveness of the PRECEDE-PROCEED model (PPM) in modifying preventive behaviors related to CL in children through mother training in a community intervention. METHODS: A randomized controlled trial based on the PPM model was conducted on 168 mothers (intervention (n = 84) and control group (n = 84) with 10 years old children in the rural areas of Iran. Mothers from 7 village areas were randomly allocated to the intervention (2 village) and control groups (5 village). The intervention group received a program comprising eight 90-minute training sessions and environmental interventions. In this study, we utilized the PPM as a framework to design the questionnaires on Leishmaniosis prevention behavior. Participants in both groups completed the questionnaires at baseline (before the intervention), immediately after the intervention, and at the 2-month follow-up. Analysis of the data was conducted utilizing SPSS20, with statistical significance set at p < 0.05. RESULTS: Compared to the control group, the intervention group showed significant increases in knowledge, enabling factors, reinforcing factors, attitude, and preventive behaviors related to Cutaneous Leishmaniasis over time from baseline to follow-up (P < 0.001). No significant differences (P > 0.05) were observed in the alterations of the PPM construct, knowledge, and preventive behaviors within the control group from pre-intervention to follow-up. CONCLUSIONS: Community (education and environmental) intervention based on PPM is feasible and acceptable to modify preventive behaviors of Cutaneous Leishmaniasis in children by increasing a mother's knowledge and attitude as well as changing enabling and reinforcing factors. TRIAL REGISTRATION: IRCT20160619028529N8.

Factors Influencing the Implementation of a Fall Prevention Exercise Program for Community-Dwelling Older Adults: A Qualitative Study Guided by the PRECEDE-PROCEED Model.

Purpose: Multiple falls preventions exercise programs have been rolled out globally, however, few studies have explored the factors necessary for their implementation. This study aimed to investigate the factors influencing the implementation of "Steady Feet" (SF), a 12-week community fall prevention exercise intervention, for older adults living in Singapore. Material and Methods: This study utilized purposive sampling to recruit two participant groups: (i) older adults who declined or withdrew from the program and (ii) providers of the program (eg, instructors). We conducted 22 semi-structured interviews, recordings were transcribed and translated, followed by thematic analysis. Data collection and analysis were informed by the PRECEDE-PROCEED framework, focusing on predisposing, enabling, and reinforcing factors. Results: Findings revealed two predisposing, four enabling, and two reinforcing themes. Predisposing themes encompassed (i) knowledge, attitudes, and practices of older adults towards exercises and falls prevention, and (ii) perceptions and attitudes of providers towards SF. Both older adults and providers identified several enabling elements in implementing SF, emphasizing the significance of (i) accessibility, availability, and affordability. Providers highlighted (ii) tools and structural support for continual engagement, (iii) minimizing variations in capabilities through a competency development program, and (iv) fostering synergistic partnerships. Positive reinforcement included (i) the role of providers in engaging and promoting participation, (ii) family support, social networks, and (iii) incentives for older adults. Conversely, both groups highlighted negative reinforcements, including (iv) communication issues and (v) repetitive exercises, while providers specifically identified (vi) labor constraints as a deterrent for implementation. Conclusion: Findings indicate that effective implementation necessitates a multifaceted approach. Promoting participation involves engaging instructors, emphasizing social bonds and family involvement, offering incentives, and providing subsidized or free classes. A competency development program proved effective in reducing variations in providers' capabilities. Strengthening community partnerships, with management support, was crucial for ensuring the availability and accessibility of falls prevention programs.

Investigating the effect of education based on PRECEDE-PROCEED model on the preventive behaviors of musculoskeletal disorders in a group of nurses.

Background: One of the most important occupational complications that could occur in nurses is musculoskeletal disorders. In this study, we designed an educational intervention based on the PRECEDE-PROCEED model to investigate its effects on a group of nurses on preventive behaviors of musculoskeletal disorders. Methods: A total of 120 nurses working in Izeh City, Iran, participated in this semi-experimental study. The sampling was performed through a convenient sampling method, and the participants were randomly assigned to the experimental and control groups (60 participants for each group). Both groups filled out a questionnaire based on the PRECEDE-PROCEED model before and 2 months after the educational program as part of the data collection process. The data were examined using a paired t-test, an independent t-test, and a chi-square test after being entered into SPSS version 24. Results: According to the findings, prior to the intervention, there was no difference between the two groups in terms of their knowledge (p = 0.221), attitude (p = 0.136), enabling factors (p = 0.325), reinforcing factors (p = 0.548), self-efficacy (0.421), and behavior (0.257) levels. However, following the intervention, a substantial rise was witnessed in the experimental group in each of the mentioned variables (p = 0.001). Conclusion: In the current study, education based on the PRECEDE-PROCEED model led to the improvement of knowledge, attitude, enabling and reinforcing factors, self-efficacy, and finally preventive behaviors with musculoskeletal disorders in the participants. Considering the importance of the role of health education in promoting behaviors related to musculoskeletal disorders in nurses and the importance of observing related behaviors in preventing long-term complications, the necessity of education in a wider dimension and with different tools is felt more and more in society. Therefore, longer interventions with this aim could be carried out on nurses and other healthcare personnel.

Self-management of Diabetes for Empty Nest Older Adults: A Randomized Controlled Trial.

BACKGROUND: Despite much evidence showing the effectiveness of structured self-management education for diabetes, poor glycemic control remains a challenge among empty nest older adults. OBJECTIVE: We explored the effect of a health education intervention based on the PRECEDE-PROCEED model on the self-management of empty nest older adults with type 2 diabetes in Lanzhou, China. METHODS: We conducted a 2-armed, randomized controlled trial using a multistage sampling method. A total of 100 patients were randomly assigned to receive either community nurse-led diabetes education based on the PRECEDE-PROCEED model or general community diabetes education. Self-management scores and blood glucose were compared at baseline and at 3 and 6 months after the intervention. RESULTS: Analyses were conducted on the 98 patients completing follow-up. In the experimental group, diabetes self-management knowledge (t = 7.578, P < .001), self-management attitude (t = 9.155, P < .001), self-management behavior (t = 7.809, P < .001), and overall self-management scores (t = 7.626, P < .001) improved, with hemoglobin A1c (t = -2.825, P = .006), fasting plasma glucose (t = -3.100, P = .003), 2-hour postprandial blood glucose (t = -3.812, P < .001), and diastolic blood pressure (t = -2.104, P = .038) decreasing compared with the control group at 6 months postintervention. CONCLUSIONS: This study demonstrated that education based on the PRECEDE-PROCEED model was more effective than general health education in improving diabetes self-management and glycemic control among empty nest older adults.

Factors influencing home health care providers' performance of oral health care for older people: A qualitative study.

AIM: To examine factors that affect the performance of oral health care (OHC) for older people receiving nursing care at home. BACKGROUND: Oral health is often neglected by health care providers caring for older people. Research shows that health care providers' provision of OHC may be influenced by various factors (barriers and facilitators). When this research was conducted, health care providers from home healthcare services (HHCS) and nursing homes were grouped together despite setting differences; therefore, this study focuses on the performance of OHC by home health care providers (HHCPs) as a single group. DESIGN: Explorative design with a qualitative approach. METHODS: The managers of four HHCS units recruited 17 HHCPs to participate in focus group interviews. One interview was conducted per unit, and there were four to five participants in each interview. The analysis of interviews was based on theoretical thematic analysis and the PRECEDE constructs in the PRECEDE-PROCEED model. Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines were used in reporting this study. FINDINGS: The analysis resulted in two themes with predisposing factors (HHCPs' professional responsibilities, older people's attitude), five themes with enabling factors (knowledge and skills, older people/carer trust, available time, available equipment and collaboration with public dental service (PDS)), and two themes with reinforcing factors (routines and OHC focus on the workplace) that affect the provision of OHC. The factors were categorised as individual, organisational and collaboration factors. CONCLUSIONS: In addition to individual factors found in previous studies, factors related to the organisation of services and communication between HHCPs and PDS seem to affect HHCPs' provision of OHC for adults receiving HHCS. IMPLICATIONS FOR PRACTICE: This study provides in-depth knowledge that can contribute to increasing HHCPs' provision of OHC and thereby prevent oral and dental disease among older people receiving HHCS.

Use of the PRECEDE-PROCEED Model to Pilot an Occupational Physical Activity Intervention: Tailored Through a Community Partnership.

BACKGROUND: Healthcare and social assistance workers are at increased risk for obesity. This industry has limited access to workplace health promotion resources and reports low rates of physical activity programs for workers. METHODS: This article describes the application of the PRECEDE-PROCEED Model (PPM) to plan, implement, and evaluate a pilot physical activity intervention, Project Move, tailored to promote occupational physical activity and reduce sedentary behaviors among female workers. Actions taken by the community-based participatory research partnership assisted in the identification of the predisposing, reinforcing, and enabling factors that influenced the physical activity behaviors of female workers. The resources and capacities of the partnership were leveraged to implement and evaluate the pilot intervention. FINDINGS: After the 12-week intervention, the participants' daily average steps while at work met the recommended minimum 7,000 steps/day, and the time spent sitting decreased along with positive changes in health-related psychosocial measures. CONCLUSIONS/APPLICATION TO PRACTICE: The PPM represents a feasible approach for community-based participatory partnerships to create a tailored intervention to address the occupational physical activity and sedentary behaviors of at-risk female healthcare and social assistance workforce.

Application of implementation science framework to develop and adopt regulatory science in different national regulatory authorities.

Introduction: The purpose of developing and adopting regulatory science (RS) for drug regulatory authorities (DRAs) is to enhance regulatory capacity by advancing the scientific approach for the evaluation of health-related products. While many DRAs around the world advocate the concept of RS, the implementation approaches of RS vary according to local needs and have not been systemically examined. This study aimed to systematically identify the evidence about how RS was developed, adopted, and advanced by the selected DRAs, and analyzed and compared the implementation experiences of RS development under the guidance of an implementation science framework. Methods: Documentary analysis of government documents and a scoping literature review were conducted, and data analysis was performed under the guidance of the PRECEDE-PROCEED Model (PPM). DRAs in the United States, the European Union, Japan, and China had officially launched RS initiatives and were therefore selected as the target countries in this study. Results: There is no common consensus on the definition of RS among the DRAs. However, these DRAs shared the same goal of developing and adopting RS, which was used to develop new tools, standards, and guidelines that could improve the effectiveness and efficiency of the risk and benefit assessment of the regulated products. Each DRA had decided its own priority areas for RS development and thus set specific objectives that might be technology-based (e.g., toxicology and clinical evaluation), process-based (e.g., partnership with healthcare systems and high-quality review/consultation services), or product-based (e.g., drug-device combination products and innovative emerging technologies). To advance RS, considerable resources had been allocated for staff training, advancing information technology and laboratory infrastructure, and funding research projects. DRAs also took multifaceted approaches to expand scientific collaborations through public-private partnerships, research funding mechanisms, and innovation networks. Cross-DRA communications were also reinforced through horizon scanning systems and consortiums to better inform and assist the regulatory decision-making process. The output measurements might be scientific publications, funded projects, DRAs interactions, and evaluation methods and guidelines. Improved regulatory efficiency and transparency leading to benefits to public health, patient outcomes, and translation of drug research and development as the key primary outcomes of RS development were anticipated but not yet clearly defined. Conclusion: The application of the implementation science framework is useful for conceptualizing and planning the development and adoption of RS for evidence-based regulatory decision-making. Continuous commitment to the RS development and regular review of the RS goals by the decision-makers are important for DRAs to meet the ever-changing scientific challenges in their regulatory decision-making process.

The study protocol for the randomized controlled trial of the effects of a theory-based intervention on resilience, social capital, psychological wellbeing, and health-promoting lifestyle in healthcare workers.

BACKGROUND: The workplace has been identified as a key determinant of health status. There is evidence of innumerable health problems among employees, particularly healthcare workers. Against this background, a holistic-systemic approach together with a good theoretical framework is required to reflect on this issue, and to support the design of effective interventions to promote the health and wellbeing of the given population. The present study aims to evaluate the effectiveness of an educational intervention in improving resilience, social capital, psychological wellbeing, and health-promoting lifestyle in healthcare workers, utilizing the Social Cognitive Theory integrated into the PRECEDE-PROCEED model. METHODS: This randomized controlled trial will be performed on a large sample of the employees working in two healthcare centers in the city of Shiraz, Iran. The study will proceed with the healthcare workers of one city being given the educational intervention and the healthcare workers of the other city serving as a control group. Using a census method, all healthcare workers in the two cities will be informed of the trial and its purpose, and then invitations to join the study will be issued. The minimum sample size required has been calculated as 66 individuals in each healthcare centers. Recruitment to the trial will by systematic random sampling of eligible employees who submit an expression of interest in joining the trial, and subsequently give informed consent. Data will be collected through a self-administered survey instrument at three stages: at baseline, and both immediately and three months after the intervention. The experimental group members should participate in at least eight of the ten weekly educational sessions of the intervention and complete the surveys in the three stages. There is no educational intervention for the control group, and they simply experience some routine programs, and complete the surveys at the same three timepoints. DISCUSSION: The findings will provide evidence for the possible effectiveness of a theory-based educational intervention to improve resilience, social capital, psychological wellbeing, and health-promoting lifestyle among healthcare workers. If the educational intervention is found to be effective, then its protocol will be exploited in other organizations to boost resilience. Trial registration IRCT20220509054790N1.

An intervention design for promoting quality of life among patients with multiple sclerosis: a protocol with a planning approach for a mixed methods study.

BACKGROUND: Multiple sclerosis is a chronic progressive disease of the central nervous system that affects the patients' quality of life. The disease's complications reduce the quality of life in patients by creating physical, psychological, social and economic problems for the patient and his/her family and reducing the patient's individual and social functioning. The aim of the present study is designing, implementing and evaluating an intervention based on the PRECEDE-PROCEED model to promote the quality of life in people with multiple sclerosis. This paper summarizes the study protocol. METHODS: We will use the PRECEDE-PROCEED model for designing the study. In the first step, the factors affecting quality of life in people with multiple sclerosis will be determined by a qualitative study. In the second step, these factors will be prioritized based on their importance and variability, then behavioral and environmental factors of the most important priority will be identified. In the third step, the predisposing, enabling and reinforcing factors related to the identified priority will be determined by a qualitative directed content analysis. In the fourth step, a questionnaire will be designed and psychometric based on the results of the previous step. The fifth step will be about planning to implement the intervention. In the sixth step, the intervention will be implemented and its effectiveness will be evaluated by process, impact and outcome evaluations. DISCUSSION: The results of this study will provide information about patients' needs and concerns and thus will contribute to policymakers, government, community, health professionals and families to take the necessary measures to improve quality of life in these patients.

A PRECEDE-PROCEED approach in the advocacy for computer-based education on correct medical certification of cause of death among physician-learners

Objective@#Mortality data is a critical input to public health decision-making and planning. Yet, about 36% of underlying causes of death reported by physicians in 2018 are considered garbage codes, not useful in analyzing public health and mortality (PSA, 2018). We used the PRECEDE-PROCEED approach to develop, implement, and report an advocacy and education Project to improve training on medical certification of cause of death (MCCOD) among senior medical students and interns. @*Methods@#An MCCOD Instructional Design and eLearning course was introduced and validated in 33 medical education institutions. Lessons enhanced these education materials and are proposed for nationwide adoption. In the middle of the COVID-19 pandemic, the Project fast-tracked the training of physician-learners on the correct cause of death reporting and certification.@*Results@#Awareness of correct MCCOD and its personal and public health value reached at least 4000 learners, over a hundred medical faculty, and all deans of medical colleges in the Philippines.@*Conclusion@#The PRECEDE-PROCEED Model provided a clear and practicable framework for the advocacy and education efforts to train senior medical students and interns on MCCOD. It can similarly guide other medical education innovations by defining predisposing, enabling, and reinforcing factors then considering these factors for intervention strategies, implementation, process evaluation, outcome evaluations, and impact evaluations.

An internet-based educational intervention for mothers targeting preschoolers' weight management promotion (PWMP): a pilot study.

BACKGROUND: The prevalence of overweight and obesity among children has raised public health concerns. This study aimed to design and evaluate a behaviour change intervention program to promote weight management among Tehranian preschoolers. METHODS: The PRECEDE-PROCEED model is one of the most popular models in health education used to develop and evaluate most educational interventions. In this one-group pre and post-pilot study, 13 mothers of preschoolers were recruited from preschools in Tehran (the capital of Iran), in August 2020. Mothers received a six-week educational intervention, including text messages and educational videos via WhatsApp, to increase their self-efficacy to overcome barriers changing their children's lifestyle. Mothers reported preschoolers' height and weight to assess Body Mass Index and filled out the Food Frequency Questionnaire, the Persian version of the children's health-related quality of life questionnaire, and demographic features. The "Children's physical activity and sedentary behaviors checklist," newly designed by the researchers, was also filled out by mothers. These behaviors were measured according to the minutes that children were involved in these activities in a day, and the days they spent in a week for them. All variables were measured at baseline, immediately after the intervention and three months later. Data analysis was performed using SPSS IBM statistics version 22. Friedman test was used to evaluate changes over time. RESULTS: The findings demonstrated that the mean BMI z-score stayed steady between baseline, immediately after the intervention and after three months (P = 0.60). Besides, after three months, the intervention programme led to a decrease in soft drink consumption (P = 0.001), and an increase in parental perception of their child's general health (P = 0.05), the parental concern regarding their child's emotional and physical health (P = 0.002) and minutes of physical activity per day (P = 0.02). However, fruit intake decreased (P = 0.01), and simple sugar, such as cube, increased (P = 0.03). CONCLUSION: Results from this study are promising but should be interpreted with caution and should be replicated on a larger scale and compared with a control group to evaluate whether effects are maintained in a larger sample.

Effect of the PRECEDE-PROCEED model on health programs: a systematic review and meta-analysis.

BACKGROUND: The predisposing, reinforcing, and enabling constructs in educational diagnosis and evaluation policy, regulatory, and organizational constructs in educational and environmental development (PRECEDE-PROCEED) model has been used as a theoretical framework to guide health promotion strategies to prevent chronic diseases and improve the quality of life. However, there is a lack of evidence as to whether applying the PRECEDE-PROCEED model effectively improves health outcomes. This study aimed to systematically review intervention studies that applied the PRECEDE-PROCEED model and examine its effectiveness.  METHODS: In December 2020, seven databases were systematically searched. The quality of studies was assessed using the Mixed Methods Appraisal Tool. The outcome of interest for the meta-analysis was knowledge. RESULTS: In total, 26 studies were systematically reviewed. Most studies provided educational programs as the main intervention for various population groups. Symptom or disease management and health-related behavior promotion were the most common topics, and education was the most frequently used intervention method. The PRECEDE-PROCEED model was applied in the planning, implementation, and evaluation of the intervention programs. Eleven studies were included in the meta-analysis, which showed that interventions using the PRECEDE-PROCEED model significantly improved knowledge. CONCLUSIONS: This study indicated that individuals are more likely to engage in health-related behaviors with better knowledge. Thus, the PRECEDE-PROCEED model can be used as the theoretical framework for health promotion interventions across population groups, and these interventions are particularly effective with regard to knowledge improvement.

Promoting behavior-related low back health in nurses by in-person and social media interventions in the workplace.

BACKGROUND: Nurses are put at high risk of work-related low back pain due to the nature of their work. The aim of this study was to develop and evaluate intervention based on the PRECEDE-PROCEED Model on promoting behaviors of low back health via two educational approaches. METHODS: This study was a community randomized-controlled clinical trial. The educational content was developed with six modules: knowledge, attitude, self-efficacy, reinforcing factors, enabling factors, and behavior. Intervention was delivered by two modes: (1) in-person (n = 60) and (2) social media (n = 60). Data were evaluated by a self-designed questionnaire at baseline, 3, and 6 months. Baseline comparisons between groups were made with Mann-Whitney U Test and T-Test. Comparison of change scores between groups and two delivery types across the three time periods used the mixed between-within subject analysis of variance. RESULTS: A total of 120 nurses received the allocated intervention. All educational component scores increased at 3-months in both groups. At the 6-month follow-up scores increased for enabling factors and behavior in the intervention group, while in the control group all scores increased except for attitude. Based on Bonferroni Post hoc analysis social media was more effective in knowledge, self-efficacy, reinforcing factors, and behavior than the in-person intervention. CONCLUSION: An educational program for low back health based on the PRECEDE-PROCEED model proved effective at improving all components. However, social media was more successful than in-person in the maintenance of behavior over the long term. TRIAL REGISTRATION: IRCT20170313033054N2: 25-02-2018. https://www.irct.ir/trial/25598.

Community Stakeholders' Perceptions on Barriers and Facilitators to Food Security of Families with Children under Three Years before and during COVID-19.

Children living in food-insecure households have poorer overall health than children in food-secure households. While U.S. nutrition assistance programs provide resources, these cannot consistently offer age-appropriate nutritional foods for young children. This study aimed to determine community stakeholders' perceptions of the barriers and facilitators to obtaining adequate, high-quality, and age-appropriate foods for children ages 0-3 in Florida before and during COVID-19. Community stakeholders (n = 32) participated in a 60 min interview via Zoom using a semi-structured script based on the PRECEDE component of the PRECEDE-PROCEED model. Interviews were transcribed verbatim and coded by two researchers using a thematic analysis approach. Stakeholders' perceptions revealed a lack of awareness surrounding eligibility for assistance programs, a lack of knowledge regarding how to obtain resources and services, and stigma associated with receiving benefits. These remained significant barriers to obtaining healthful foods for households with young children before and during COVID-19. Nonetheless, barriers were exacerbated during the pandemic. Unemployment rates rose, intensifying these households' financial hardships and food insecurity levels. Likewise, stakeholders suggested the need for families to become more aware of federal assistance eligibility requirements and available opportunities via social media and referrals. Identifying risk factors associated with food insecurity can inform future interventions to safeguard young children's health and well-being.