Certain factors make people more likely than others to behave in ways or fail to behave in ways that prevent or proliferate social change barriers. According to the PRECEDE-PROCEED model, these factors are grouped into three categories: predisposing factors, reinforcing factors, and enabling factors.
Program planners that understand these factors are better able to develop programs that are targeted, effective, efficient, and deliver results. An excellent understanding of these factors will also help them identify the most appropriate theoretical framework for the programs they design and come up with interventions that make change happen.
Here are some thoughts to help you determine and differentiate between predisposing, reinforcing, and enabling factors.
Predisposing factors include knowledge, attitudes, beliefs, personal preferences, existing skills, and self-efficacy towards the desired behavior change. Consider these examples:
- Predisposing factors (to Obesity): e.g., insufficient knowledge about healthy food choices, low levels of physical activity, low self-esteem
- Predisposing factors (to Skin Cancer): Genetics, insufficient knowledge about risk factors associated with skin cancer, low self-esteem, preference for light skin, poor perception of risk e.t.c
Reinforcing factors include factors that reward or reinforce the desired behavior change, including social support, economic rewards, and changing social norms. Consider these examples:
- Reinforcing factors (for childhood obesity): media influence, family and societal eating culture, parenting style.
- Reinforcing factors (for skin cancer): Skin tanning culture, media influence/definition of beauty/rewards, peer pressure/accolade e.t.c
Enabling factors are skills or physical factors such as availability and accessibility of resources, or services that facilitate achievement of motivation to change behavior. Consider these examples:
- Enabling Factors (Childhood obesity): e.g., Poor availability of low-cost healthy food options, poor access to safe play areas and neighborhoods, poor socio-economic status of parents.
- Enabling factors (Skin Cancer): e.g., wide-spread low-cost skin tanning services/businesses, unshaded neighborhood pools, high cost/expensive sunscreens
How to Determine the PRE factors to focus on in a program design
- The key is to prioritize your PRR factors – since, in the real world, it is hardly impossible for a single program to address ass predisposing, re-enforcing, and enabling factors that influence a health outcome. The key is to identify all you can identify and then prioritize. That is, pick out the top vital barriers to accomplishing the desired result. During the needs assessment phase of program development, our conversation with the community/target population through physical interactions or secondary research should help us make a pick. These two resources will show you how to prioritize by applying Critical Thinking and asking the But Why question:
- Always remember that the predisposing, reinforcing, and enabling (PRR) factors you identify should speak to the “barriers” you identified earlier, and NOT the desired results. For example, if you identified a barrier to achieving the desired result of “a decrease in skin cancer prevalence…” – As “frequent exposure to ultraviolet rays”; a factor that predisposes people to frequent exposure to UT rays could be “inadequate knowledge about the negative effects of ultraviolet rays on the skin”; a reinforcing factor could be “skin tanning culture”, while an enabling factor could be “widely available low-cost skin tanning services”.
You will notice that the three factors identified in this example speak to the one barrier to desired results identified.
You turn… practice writing at least one predisposing, reinforcing and enabling factor to the barrier you identified earlier
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