A tool for planning successful interventions

To meet the challenge, we recommend the PRECEDE-PROCEED planning model (Green and Kreuter, 1999) for developing policy interventions. For this paper, we confine ourselves to an overview. This planning model meets the most of the demands derived from our conclusions. First, the big problem is cut into smaller pieces. Second, both internal and external factors can be taken into account. And third, behaviour is considered a complex of factors that need unravelling and need to be influenced by a combination of interventions.

Egmond et al. (2005) describes a 3-phase adaptation of the model to energy behaviour. In phase 1, a behavioural and contextual analysis is made: the role of habitual and reasoned behaviour in phase is assessed and the relevant contextual factors are assessed. In phase 2, the determinants of behaviour are analyzed. And in phase 3, instruments are chosen that match the determinants of behaviour. Green and Kreuter summarize their planning model with the slogan: “beginning at the end”, in other words, start with defining the desired goals and work backwards. See Figure 5 for an overview of the planning model.

Figure 5 PRECEDE - PROCEED (Modified from Green and Kreuter, 1999)

Phase 1. Diagnosing

This phase consists of two steps:
Step 1 defines the policy goals and the relevant behavioural and contextual change is established, related to a specific goal, e.g. the reduction of CO 2 by 20 % .
Step 2 establishes the most important behavioural and contextual change. Here, the behaviour of the target group is assessed, for example, if it is habitual behaviour or reasoned behaviour. Also, the changeability of the behaviour is established. Always start with the behaviour which has the greatest impact and is most easy to change.

Phase 2. Assessment of the determinants

In this phase, the determinants influencing the target group behaviour are determined. Green and Kreuter (1999) describe three general categories determinants that affect behaviour and environment. Each has a different influence on behaviour.
1. Predisposing factors motivate the behaviour;
2. Enabling factors facilitate the behaviour;
3. Reinforcing factors provide positive or negative feedback, and contribute to its persistence or repetition.

Behaviour can be explained as a function of the collective influence of these determinants.

1. Predisposing factors are especially internal antecedents to behaviour belonging to the individual person: they motivate the behaviour. The factors within this category that can be influenced include the cognitive and affective dimensions of knowing, feeling, believing, valuing, and having self-confidence or a sense of efficacy. Examples are awareness, knowledge, social norm, attitude self-efficacy and intention. Some predisposing factors cannot be easily influenced by policy instruments, for example socio-demographic variables such as income. These factors can, however, be used to segment the target group for marketing purposes.

2. Enabling factors are the external antecedents to behaviour belonging to the situation: they are conditions of the context and facilitate the performance or action of the individual person; they allow new behaviour to be realized, Two aspects of enabling factors must be taken into consideration: their availability and their accessibility.
Enabling factors relate to resources and new skills. Resources include external financial, technical and organizational resources. Examples are subsidies, engineering advice, specific advisors. New skills may have to be made available to realize the desired behaviour.

3. Reinforcing factors are those consequences of an action which provide positive or negative feedback, or support. Reinforcing factors include feedback of peers, advice and feedback by powerful and significant others (e.g. authorities offering stimulating subsidies and enforcing obligations). The feedback can be given in several ways: through social benefits, recognition, status, comparison with peers, financial rewards and reactions of customers.

This model gives a robust method to determine both internal and external factors (including feedback) that play a role in behavioural change. If the factors are established by surveying the target group, the ‘explaining power' of the specific determinants can be statistically established. This clarifies their relative importance of both internal and external factors.

Phase 3 choosing the appropriate instruments

In this phase, we choose instruments that match the determinants of behaviour—those that effectively alter the determinants.

Judicial instrument have their effect mainly on individual norm and values, and attitude. Furthermore, judicial instruments affect the factor ‘feedback of the authorities'. Covenants and agreements have a broader impact, and affect awareness, subjective norm and feedback of peers. Economic instruments have little effect on awareness, but mainly affect the enabling factor ‘financial resources'. They also affect attitude, because economic instruments positively influence decisions about investments. Communicative instruments have the broadest impact; they have effect on awareness, knowledge, attitude and self-efficacy, but not a big effect on individual norms and subjective norm. Furthermore, the communicative instruments have effect on a number of enabling factors: technical and organizational resources, and new skills. Benchmark and demonstration have clearly a reinforcing effect. In the instrument table (Figure 6), the active ingredients are reported in detail.

Based on the relative importance of the determinants the instrument table provides us the instruments which match these determinants in the best way. This allows us to formulate the intervention strategy. In most cases, determinants are influenced by more than one instrument, see figure 6, and therefore, we should choose ‘an instrument mix'; an effective intervention strategy is made up of various instruments. In the implementation phase, the model can be read from left to right: instruments will affect the determinants of behaviour; this, in turn, leads to a change in behaviour and, thereby, to achieving the goal.

Further reading

The scope of this paper does not allow describing the process of instrument development. Therefore, we recommend the book Planning health promotion programs (L. Kay Bartholomew, Guy S. Parcel, Gerjo Kok and Nell Gottlieb, 2006, Jossey Bass , San Fransisco). Although the scope of the book is health related, the approach is in essence the same.