Cornell NutritionWorks -- Preventing Childhood Obesity: An Ecological Approach

Printable View: Definitions of P.E.R. Factors

The predisposing, enabling, and reinforcing (P.E.R.) assessment is a tool to help you identify particular factors to target for creating behavioral and environmental changes you have prioritized. Each of these three categories of factors is defined below, with examples related to a specific behavior (consuming large portions).

Definitions of P.E.R. Factors

Predisposing Factors	Enabling Factors	Reinforcing Factors
Circumstances and situations existing before a given behavior occurs that provide the rationale or motivation for that behavior. They include knowledge, attitudes, beliefs, values, and self-efficacy.	Skills, resources, and barriers that help or hinder a given behavioral or environmental change. They include availability and accessibility of resources; laws, rules, regulations, and policies; and skills of individuals.	Feedback, positive or negative, that follows a particular behavior. These factors include the attitudes of others; the individual's physical or emotional changes and feelings after the behavior; economic impacts; ads and mass media; and perceived social acceptance of the behavior.

P.E.R. Factors Related to Consuming Large Portions

Predisposing Factors Examples	Enabling Factors Examples	Reinforcing Factors Examples
Knowledge: People don't know portions are a lot bigger than what people need to eat.	Availability: Fast food restaurants offer larger portion sizes for not much more money.	Attitudes of others: Large portion sizes are accepted as the norm.
Attitudes: People like getting served big portions.	Accessibility: People have the money to buy larger portions.	Physical feelings: People can feel uncomfortably full when eating more than they need.
Beliefs: People believe it's bad to waste food.	Policies: Some restaurants have a policy of charging extra for sharing a meal.	Economic impacts: For not much more money, people get a lot more food.
Values: People value getting more for their money	Skills of individuals: It's easy to supersize an order.	Mass media: Ads encourage people to choose the larger sizes.
Self-efficacy: People are not confident that they can leave part of a portion uneaten.		Perceived social acceptance: Restaurants offer certificates and recognition for those who can eat huge amounts.

Reference: Green LW, Kreuter MW. Health Program Planning: An Educational and Ecological Approach, 4th ed. New York, NY: McGraw-Hill; 2005


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