University Nursing Assignment: Oral Health Program Evaluation

This nursing assignment focuses on developing and evaluating an oral health program for adults with intellectual and developmental disabilities (IDD) using the PRECEDE-PROCEED model. The assignment begins with a detailed application of the PRECEDE-PROCEED model, outlining the phases of social, epidemiological, ecological, administrative, and policy assessments. It emphasizes the importance of these assessments in understanding the oral health needs of the IDD population, identifying predisposing, enabling, and reinforcing factors, and addressing policy and organizational concerns. The report then transitions to the PROCEED component, detailing program implementation, process evaluation, impact evaluation, and outcome evaluation. The assignment further explores the model's contribution to intervention development, behavior change, and program delivery, highlighting its adaptability and importance in health promotion. The paper also examines the sustainability of health promotion programs, citing examples of program failures and the factors that influence program success. Finally, the assignment draws parallels between the PRECEDE-PROCEED model and the CDC evaluation framework, demonstrating the model's relevance and applicability in real-world health promotion scenarios.

Running head: NURSING ASSIGNMENT
Nursing assignment
Name of the Student
Name of the University
Author note

PHASE 4
Policy assessment
Oral Health
America. Policy State
ment and Healthy
People 2020
HEALTH
PROGRAM
Educational
strategies
Policy
regulation
organization
PHASE 5
Implementation
Behaviour
management
techniques
PHASE 3
Ecological Assessment
predisposing, enabling and reinforcing
factors
Predisposing factors
Feeding problems, swallowing disease and
poor functional status
Reinforcing
Coaching, Rewards
Enabling
Dietary supervision,
monitoring, availability of
oral hygiene products
PHASE 6
Process evaluation
Fidelity, dosage and participants’ reaction
PHASE 2
Epidemiological assessment
National health surveys, vital oral health statistics
among IDD adults, genetic factors
Genetics
Behaviour
Oral health
practices
Environment
Lack of calming
atmosphere and
oral hygiene
devices
PHASE 1
Social assessment
Survey and questionnaire,
individual interviews, focused
group interviews and
organizational forums
Health
Oral
health
status
Quality
Oral health
status
PHASE 7
Impact evaluation
Effectiveness of oral health program with
respect to program objectives, predisposing,
reinforcing and enabling factors
PHASE 8
Outcome of evaluation
Oral health strategy assessment
PRECEDE
PROCEED
Running head: NURSING ASSIGNMENT

Running head: NURSING ASSIGNMENT
Answer one
PRECEDE-PROCEED model provides a comprehensive structure for the assessment of
health needs of a population for the planning, implementation and evaluation of oral health
promotion program. PRECEDE is used for structuring of plan for the targeted intellectual and
developmental disabilities (IDD) adult population focused on their oral health. PROCEED model
can be used for the implementation and evaluation of the oral promotion program from Binkly’s
strategy. 1
PRECEDE- Planning component
Phase 1: Social assessment: In this phase, gerontology nurses would undertake the
determination of perception of IDD adult population regarding oral hygiene needs and overall
effect of social problems on their quality of life. The nurses would undertake the social needs
through literature review, survey and questionnaire, individual interviews, focused group
interviews and organizational forums for data collection (both objective and subjective). This
phase helps in making the planners aware of the oral health issue that community sees. 1-2
Phase 2: Epidemiological, behavioural and environmental assessment: This phase deals with
the determination and focusing on IDD adults with oral unhygienic health related to community
health needs. The primary or secondary data for epidemiological data collection comprises of
national health surveys, vital oral health statistics among IDD adults, genetic factors in
understanding IDD oral health problems and counselling them. 1-3
There is poor communication, uncontrolled movements, lack of manual dexterity make it
difficult for the IDD adults to maintain oral hygiene. The common behaviours like brushing is
also difficult to maintain for them.
The lack of calming atmosphere and oral hygiene devices are the factors that contribute
to poor oral hygiene among IDD adults.
Phase 3: Ecological and educational diagnosis: This phase focuses on selected factors like
predisposing, enabling and reinforcing as if these factors are modified, it can bring about
behaviour change among IDD adults.
In IDD adults, the predisposing factors for poor oral hygiene are feeding problems,
swallowing disease and poor functional status that contribute to poor oral hygiene among them.
The self-efficacy like oral health hygiene practices and adaptive environmental usage are also
predisposing factors. Reinforcing factors include use of rewards or any sort of reinforcement
that can be used for behaviour change. Coaching can also be reinforced where dental health
coaches motivate IDD adults to undertake tooth brushing and mouth washing. The enabling
factors include the dietary supervision, monitoring, availability of oral hygiene products and
resources that can facilitate achievement of behaviour change. 1-3

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Phase 4: Administrative and policy assessment: This phase focuses on organizational and
administrative concerns that include development of budgets, timeline through Gantt chart,
resources assessment and coordination with community and other organizations. The types of
personnel like dentists, dental nurses, dental health practitioners and support staff for carrying
out the health promotion program. Booklets, educational materials, lecture room, pamphlets,
projector and printers, counselling clinic, organizational budget and oral health supplies like
toothbrushes, toothpaste, dental brushes and mouthwash solutions.
Oral Health America. Policy Statement and Healthy People 2020 objective of oral health
can help to assess the organizational goals and administration. The policy would help to evaluate
that program goals are working in accordance with rules, regulations and mission of oral health
promotion program that are needed for sustainability of implemented program. 1-3
Barriers are also identified to behaviour change like attitudes of IDD adults, commitment,
motivation, capability, difficulty using a brush, inability to rinse, complexity and familiarity of
program along with adequate funding and space. There might also be dysphagia as they have a
tendency to gag or choke while tooth brushing.
PROCEED- implementation and evaluation component
Phase 5: Program implementation: For successful implementation of oral health hygiene
strategy, capacity-building promotion is required for training skills and supervising of oral
hygiene practices for IDD adults. Behaviour management techniques like motivating IDD adults
to perform tooth brushing, flossing and mouth washing after having food. Specially designed
oral hygiene aids can be given to IDD patients as they lack the ability to perform brushing. This
training can be given to dental hygienists, caregivers and gerontological nurses through 20
minutes DVD power point presentation demonstrating behavioural management techniques and
oral hygiene practices.
Phase 6: Process evaluation: In this phase, the evaluation of health promotion program is done
through fidelity, dosage and participants’ reaction. The amount of intervention exposure of
dosage or oral health promotion, extent of implementation of intervention as designed and
appraisal of interventions by participants on usefulness or intervention quality (participant
reaction). 1-2
Phase 7: Impact evaluation: The performance of educators and participants can be evaluated
for impact and effectiveness of oral health program with respect to program objectives,
predisposing, reinforcing and enabling factors.
Phase 8: Outcome evaluation: This can be done through oral health strategy assessment as it
has direct effects on outcomes and mechanisms of behaviour change.

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Answer two
The main contribution of this model in the case study is that it guides the exact way to
develop an intervention for oral health promotion. Every assessment step contributes by
outlining what exactly needs to be done offering an algorithm or flow chart for oral health
strategy. This model also contributes to conducting behaviour change, implement oral hygiene
interventions and delivery of oral health promotion program among IDD patients. In the case
study, it was observed that IDD patients are unable to maintain oral health hygiene due to
feeding and swallowing issues, dysphagia, lack of motivation and low self-esteem. Therefore,
this model is helpful in achieving oral health hygiene and behaviour change among IDD adults
through their active participation. 3
Not every phase in the model is important for health promotion. As mentioned above that
this model is an exact guide that tells what to do by following directions, therefore model
application can vary accordingly. If this model is not suitable in a particular setting or there is
risk, resistant to change, few steps can be skipped and tailoring of model can be done suitable to
different local settings. In addition, the social, epidemiological, environmental, behavioural,
ecological and educational assessments are important phases as it helps to plan the interventions
for behaviour change and health promotion. 3-4
In case of application of this model to any other health issue, the adaption of health
promotion program depends on the population type and setting. There are different factors that
play a role in health issues and therefore, this model need to be tailored according to the
behavioural, social, epidemiological, administrative, policy factors and sensitive to these

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differences. The model varies in a way where it must be tailored for individual approaches
scalable to population approaches at multiple points of intervention.
Answer three
The MTCP program was launched with an aim to change the policies of smoking in the
community and motivate individuals to quit smoking with provision of tobacco treatment
services. The discontinuation of funding was the main reason for the sustainability of this
program. Due to the nation-wide recession, there was defunding and termination of this program
led to a major health challenge.5
In the second paper, Body Project was launched with a hope of eating disorder
prevention. However, the mater-level clinicians who were the prime mental health providers in
the project have limited experiences in delivering interventions. Moreover, there were time
constraints and lack of experience with manualized format that made clinicians leave the project
and as a result, there was high turnover. These barriers failed to provide sustainability to the
program. 6
In the above two cases, funding, time and lack of experience of clinicians led to the
failure of the both projects. For the Body Project, the clinicians should have been provided with
more time so that they would have not felt rushed and took time to adapt to the changes like
conducting more group interviews and recommend others about the program. Although, the
clinicians lacked knowledge about project, they valued the intervention aspects. Therefore, it was
important to take constructive feedback from them that would have facilitated the delivery of
intervention with training for effective time management. As there was limited staff time, there
was high clinical turnover, therefore clinical training on time management and dissemination

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through internet-based approaches would have been an active way and helpful in program
sustainability. In the tobacco program, funding is the main issue where it was fruitful to select
affordable services that would have grant funding. Re-location of funding, adjustment of staff
patterns, assigning of resources for creation of demand for services and adjusting to existing
funding would have been useful for the program sustainability.
Answer Four
The evaluation steps outlined in CDC framework comprises of evaluation of process and
outcomes. In process evaluation, the examination of activities, its conduction, progress and
sufficient inputs for the activities are done. This step is important for distinguishing a poor
program from good one focusing on access, staff competency, dosage and transfer of
accountability. Moreover, the outcome evaluation or effectiveness is done through assessing of
progress of program outcomes. The changes in the attitudes of people, protective factors,
environment and trends in mortality and morbidity greatly evaluate a health promotion program.
The PRECEDE-PROCEED model greatly resembles the CDC evaluation framework for health
promotion program. 7
The process and impact evaluation of promoting preventive behaviours of domestic
violence among girls and women was conducted through this model. There is close resemblance
of both evaluation processes as the preventive behaviour of domestic violence program was done
through evaluation of process, educational objectives and program components like methods,
program staff, activities and materials used. 8
Community-based youth fitness and nutrition summer camp was also evaluated by
PRECEDE-PROCEED model. In implementation step, the supporting organizations, program

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length, activity duration, frequency and participants grouping was done. The outcome and impact
evaluation was addressed through analysis of actual data like efficiency, effectiveness and effort
consideration. The designing of program and achievement of desired outcomes with minimum
use of resources was measured for program effectiveness using this model. 9
Both the programs show similarity with CDC evaluation framework for health promotion
as the model used in both programs aligns with the framework.
When the evaluation step is compared to my own experiences, I believe that the
PRECEDE-PROCEED model used for the oral health promotion is appropriate. The evaluation
steps outlined in CDC is similar to my chosen model and greatly helpful in measuring the
effectiveness of oral promotion program for IDD adults.

Running head: NURSING ASSIGNMENT
References
1. Binkley C, Johnson K. Application of the PRECEDE-PROCEED Planning Model in
Designing an Oral Health Strategy. J Theory Pract Dent Public Health. 2013;1(3).
2. Aldiabat K. Developing Smoking Cessation Program for Older Canadian People: An
Application of Precede-Proceed Model. American Journal of Nursing Science.
2013;2(3):33. doi:10.11648/j.ajns.20130203.13.
3. Popoola T, Mchunu G. Application of PRECEDE-PROCEED model to tackle problems
identified with diarrhoea burden among under-5s in Botswana. Int J Nurs Pract.
2015;21:67-70. doi:10.1111/ijn.12328.
4. Devleesschauwer B, Aryal A, Joshi D et al. Epidemiology of Taenia solium in Nepal: is it
influenced by the social characteristics of the population and the presence of Taenia
asiatica?. Tropical Medicine & International Health. 2012;17(8):1019-1022.
doi:10.1111/j.1365-3156.2012.03017.x.
5. LaPelle N, Zapka J, Ockene J. Sustainability of Public Health Programs: The Example of
Tobacco Treatment Services in Massachusetts. Am J Public Health. 2006;96(8):1363-
1369. doi:10.2105/ajph.2005.067124.
6. Rohde P, Shaw H, Butryn M, Stice E. Assessing program sustainability in an eating
disorder prevention effectiveness trial delivered by college clinicians. Behav Res Ther.
2015;72:1-8. doi:10.1016/j.brat.2015.06.009.

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7. Cdcgov. 2011.Introduction to Program Evaluation for Public Health Programs: A Self-
Study Guide. Available at: https://www.cdc.gov/eval/guide/cdcevalmanual.pdf. Accessed
March 6, 2018.
8. Soleiman Ekhtiari Y, Shojaeizadeh D, Rahimi Foroushani A, Ghofranipour F, Ahmadi B.
The Effect of an intervention based on the PRECEDE- PROCEED Model on preventive
behaviors of domestic violence among Iranian high school girls. Iran Red Crescent Med
J. 2013;15(1). doi:10.5812/ircmj.3517.
9. Scholarworksuvmedu. 2016. Application of the precede-proceed model in the evaluation
of a community based youth fitness and nutrition summer camp program. . Available at:
https://scholarworks.uvm.edu/cgi/viewcontent.cgi?
referer=&httpsredir=1&article=1646&context=graddis. Accessed March 6, 2018.