Using the PRECEDE-PROCEED Model and Service-Learning to Teach Health Promotion and Wellness: An Innovative Approach for Physical Therapist Professional Education

Abstract

BACKGROUND AND PURPOSEPhysical therapists (PTs), along with other health care professionals, have been charged with the task of preventing chronic disease and premature morbidity, in addition to their traditional roles. The American Physical Therapy Association (APTA) recently adopted a bold new vision for the profession: Transforming society by optimizing movement to improve the human experience.1^1) The APTA Code of Ethics instructs PTs to reduce health disparities and health care inequities, improve access to health care services, and address the health, wellness, and preventive health care needs of people.2^2) The Commission on Accreditation in Physical Therapy Education (CAPTE) Evaluative Criteria CC-5.50 to 5.52 describe Practice Management Expectations which require professional physical therapy programs to include content related to prevention, health promotion, fitness, and wellness.3 These guiding documents clearly indicate that PTs have a role to play in prevention, and professional physical therapy programs have a responsibility to provide training in this area of practice. The profession's role in this arena was further reinforced with the recent APTA House of Delegates passing of 4 separate but related motions: RC 11-15, Health Priorities for Populations and Individuals; RC 12-15, The Role of the Physical Therapist in Diet and Nutrition; RC 13-15, The Association's Role in Advocacy for Prevention, Wellness, Fitness, Health Promotion, and Management of Disease and Disability; and RC 14-15, Physical Therapists' Role in Prevention, Wellness, Fitness, Health Promotion, and Management of Disease and Disability.4It has been stated that the use of planning models in public health may produce more effective interventions since it forces planners to address multiple areas of influence that impact health behavior change.5 The purpose of this paper is to describe the use of an established public health planning model to teach service-learning as part of the community health and wellness curricular content to entry-level Doctor of Physical Therapy (DPT) students.METHODS/MODEL DESCRIPTION AND EVALUATIONThe PRECEED-PROCEED ModelThe PRECEDE-PROCEED model is a tool for designing, implementing, and evaluating health behavior change programs. Whenever a problem affecting a target population is identified, health professionals can use this model to help guide the process of developing a solution. The cornerstone of the model is the premise that for a health promotion program to be successful, it must use a process that engages the active participation of the intended population.The PRECEDE-PROCEED model is divided into 2 components: PRECEDE (Phases 1-4) provides the formative process that leads to an intervention, and PROCEED (Phases 5-8) describes how to proceed with the intervention and evaluation (Figure l).6 The acronym PRECEDE (predisposing, reinforcing, and enabling constructs in educational diagnosis and evaluation) describes a detailed approach of problem diagnosis and project planning. The second part of the model continues with 4 additional phases as part of PROCEED (policy, regulatory, and organizational constructs in educational and en- vironmental development), which guide the implementation and evaluation of the program objectives and intervention that were designed in the PRECEDE phases.The PRECEDE-PROCEED model of health program planning and evaluation was developed by Lawrence Green and Marshall Kreuter in an effort to improve effectiveness of community health programs.'' One published study found that of 10 planning models studied, the PRECEDE-PROCEED model was considered to be the most useful for both research and practice.8 The model is utilized extensively among public health professionals. There have been over 960 published studies which apply various aspects of the model addressing an array of public health concerns.7 For example, it has been used in the implementation of church-based heart health promotion programs for older adults,9 as guidance for a faith-based healthy eating program,10 for development of a rheumatoid arthritis education program,11 and for establishment of an ergonomics training program to prevent work-related musculoskeletal disorders within supermarket cashiers. …