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You used the Methods in Social Epidemiology text to complete the readings on the several factors that can influence health outcomes. A health outcome here refers to at
least two major categories: health, meaning being healthy; and ill, referring to disease.
Most public health programs are outcome-based programs, if there is no final product?outcome, or there is no result?improved health, decreased morbidity, disease?most
programs will not survive because funding is scarce for programs that do not work.
Let us look at the factors that influence health outcomes and see these factors as the background information that set the stage for an evaluation
In this context, complete the following:
? Start your discussion by identifying those factors that affect or influence health outcomes. You can use the reading on "Indicators of Socioeconomic
Position," pages 47?85 of the Methods in Social Epidemiology text for a list of these factors.
? Now that you have identified these factors, choose a hypothetical program that you want to evaluate; for example, teen pregnancy. First, list a series of social,
economic, and environmental?including cultural?factors that contribute, or favored, teen pregnancy. These factors represent the background factors.
? Now, as if you were preparing an evaluation report that is focused on the prevention of teen pregnancy, write the contributing factors listed above as the background
information of your evaluation. This is the first stage of your evaluation report.
You visited some websites to complete the readings about a theoretical model that is commonly used in program evaluation. This model is the PRECEDE-PROCEED model that
stands for Predisposing, Reinforcing, Enabling, Constructs for Educational Diagnosis Evaluation – Policy, Regulatory, Organizational Constructs for Educational
Environmental Development. Although this model can be used as a planning, implementing, and evaluation tool for health education and public health programs, we will
focus on the evaluation part of the model, and use it as the framework to organize the specific evaluation steps of a program evaluation.
1. Start your discussion by going back to your program on the prevention of teen pregnancy, used as an example in the previous discussion. And although, you may not be
able to identify all of the factors associated with teen pregnancy, start by listing the following:
? What are the predisposing factors that are associated with teen pregnancy?
? Identify factors. Although, many times the reinforcing and enabling factors tend to overlap or tend to be the same factors?for example, an enabling factor can also
at the same time be a reinforcing factor?it is recommended to identify them separately. So, to identify these factors ask yourself the following questions.
 What are the enabling factors for teen pregnancy?
 What are the reinforcing factors for teen pregnancy?
? Address these factors similarly: Constructs for Educational Diagnosis Evaluation and Policy, Regulatory Organizational Constructs for Educational Environmental
Development. Do not worry if you cannot identify or use the entire list of factors, but be sure that you identify as many as possible. Keep this list for the next
steps in this exercise.
2. Continue the preparation of this discussion by using the different steps of the PRECEDE-PROCEED model?in this model, steps are called Phases. Following our example
on teen pregnancy, what we can identify is as follows:
? Phase 1: Identify a problem: Teen pregnancy is a public health problem in the US, especially among minority teenagers.
? Phase 2: Epidemiological assessment: Ask yourself, "How serious is the problem of teen pregnancy in the US?". So, you present here the overall statistics.
For example, in 2009, the National Center for Health Statistics/CDC reported that the annual rate of teen pregnancies was 39.1 births per 1,000 teens aged 15?19. You
can also search for the rate by state. The purpose here in this phase is to support your statement with numbers, epidemiological data.
? Phase 3: Environmental assessment: and after this you continue with the rest of the phases until you arrive at Phase 9, the Outcome Evaluation, which is very
important part because you may have the goal to decrease the original number of 39 per 1,000 teens aged 15?19 teen pregnancies annually to at least 35 births per 1,000
teens aged 15?19. And, even though it seems a small decrease, it is important because this will mean that the problem is not rising, which we know is possible because
as per the National Center for Health Statistics/CDC, the numbers had decreased 8 percent as of April 2011.
Again, you do not have to go through, or use, all of the phases; you can identify only some of them, but you cannot omit Phase 1, 2, 7, and 9 because you need to
identify a problem, and then identify how to reduce, or at least keep stable, the original number.
3. Put together your work from number 1 and number 2 above, and draw the flow chart of the PRECEDE-PROCEED model. You need not write a description, the flow chart
should be self-explanatory.
4. The work that you have done is usually a tool for the planning, implementation, and evaluation of public health programs, and it has been used, as the readings for
this unit present, for several successful programs in the country.
5. Finally, comment on any difficulties that you identified in the use of the PRECEDE-PROCEED model.
Having learnt how to use the PRECEDE?PROCEED model in the previous discussion, it is now time to discuss how far you can go with a program evaluation. As a logical
conclusion, evaluations need to have a limit; there is no way that a program can be evaluated at all levels, at the same time.
What do we mean by scope here? Scope is the extent?it is like a landscape view of the process, from phase 1 to the end of phase 8 of the model. In program evaluation,
how much an evaluation should cover is an important skill. In this context, we will continue using our example on a program for the prevention of teen pregnancy in the
US, and we will use this program to develop the last part of the evaluation, focusing on the last three phases of the PRECEDE?PROCEED model?process, impact, and
outcome evaluation.
You may, at this point, want to review what was meant by process, impact, and outcome evaluation using questions to illustrate the content as follows:
? Process: Is the program serving the target group as planned?
? Impact: Has the program produced any changes among the target group?
? Outcome: Did the program accomplish its ultimate goal?
Complete the following to discuss the scope of a program evaluation.

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