title: PRECEDE-PROCEED model modification in community-based oral health promotion by using the linear structural relations programme.
abstract: OBJECTIVE
  The PRECEDE-PROCEED (P-P) model is a framework for designing health education/promotion programmes. While the P-P model has been used to design community-based oral health programmes, outcome assessments of the model are seldom reported. The aim of the present study was to explore whether pathways in the P-P model accurately reflect the current status of environmental/behavioural assessment in a Japanese community and to examine whether using the linear structural relations (LISREL) programme would improve the model.
  
  
  METHODS
  In a community health centre in Japan, a questionnaire with 29 items regarding oral health was distributed to 824 mothers with 3-year-old children. The items were compiled into eight variables that were tested using the LISREL programme. Goodness-of-fit index (GFI), adjusted goodness-of-fit index (AGFI) and root mean square error of approximation (RMSEA) were statistically analysed before and after P-P model modification.
  
  
  RESULTS
  The GFI, AGFI and RMSEA were 0.913, 0.776 and 0.161 before, and 0.975, 0.939 and 0.075 after P-P model modification, respectively. Indirect effects on the quality of life from the predisposing, reinforcing and enabling factors became stronger than those in the initial P-P model. The overall fit of the modified P-P model was significantly better than that of the P-P model without modification, which did not accurately reflect the status of environmental/behavioural assessment in the community.
  
  
  CONCLUSIONS
  The modified P-P model reflected the current status of environmental/behavioural assessment in the community. Health education models should be tested rigorously to ensure that they fit the reality of people's behaviour.
authors.affiliation: Hiroshima University, Hiroshima, Japan. makotokawa@hiroshima-u.ac.jp
authors.forename: Makoto
authors.initials: M
authors.lastname: Kawamura
authors.forename: Takashi
authors.initials: T
authors.lastname: Komabayashi
authors.forename: Hisako
authors.initials: H
authors.lastname: Sasahara
authors.forename: Mitsugi
authors.initials: M
authors.lastname: Okada
authors.forename: Norihiro
authors.initials: N
authors.lastname: Taguchi
authors.forename: Tetsuji
authors.initials: T
authors.lastname: Ogawa
mesh_terms: D000328:Adult; D001294:Attitude to Health; D002675:Child, Preschool; D003742:Dental Devices, Home Care; D005246:Feedback; D005260:Female; D015438:Health Behavior; D006267:Health Education, Dental; D007722:Health Knowledge, Attitudes, Practice; D006293:Health Promotion; D006801:Humans; D007564:Japan; D008297:Male; D017145:Models, Educational; D009042:Motivation; D009909:Oral Health; D017063:Outcome Assessment, Health Care; D015397:Program Evaluation; D011788:Quality of Life; D011795:Surveys and Questionnaires; D014099:Toothbrushing