Revisiting Precede–Proceed: A leading model for ecological and ethical health promotion

Abstract

Background: The Precede–Proceed model has provided moral and practical guidance for the fields of health education and health promotion since Lawrence Green first developed Precede in 1974 and Green and Kreuter added Proceed in 1991. Precede–Proceed today remains the most comprehensive and one of the most used approaches to promoting health. Objective: A decade after the most recent edition of the model was published in 2005, this paper examines the model’s theoretical underpinnings, history, and influence on the field of health promotion. Although the limited evidence for effectiveness of this and other models is discussed briefly, this review focuses on the socio-ecological and ethical implications of the model. Approach: Theory and literature review. Results: Precede–Proceed has promoted public health and health promotion practice in five ethically and practically important ways: (1) by advancing the ecological perspective on health that, today, has come to dominate public health practice; (2) by remaining population-centred, rather than focusing on individuals; (3) by demanding democratic and participatory approaches to health promotion; (4) by setting quality of life, rather than behaviour change or even health, as the goal for health promotion; and (5) by being deeply grounded in practice. Conclusion: Precede–Proceed guides practitioners in bridging health promotion goals of enabling people to control and improve their own health with larger public health goals of creating the conditions where people can be healthy. It also provides an ethical guide to promoting health in democratic and participatory ways.