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Course Home > Assessing > P.E.R. Factors > P.E.R. Assessment Steps

In This Module:

Extent of the Problem

Behavioral Factors

Environmental Factors

P.E.R. Factors

The Big Picture


The P.E.R. Assessment - Part I


Definitions of P.E.R. Factors


P.E.R. Assessment Steps


The P.E.R. Assessment - Part II


Course Project - Part 3 - Assessing P.E.R. Factors


Discuss Your Assessment

Module 2 Wrap-Up

P.E.R. Assessment Steps

The main steps in conducting a P.E.R. assessment are summarized below. You may want to print this out for future reference. (Printer-friendly version)

  1. Identify factors influencing the behavior or environmental characteristic of interest. Brainstorm a list using what you know from research and experience in the community.

  2. Sort them into predisposing, enabling, and reinforcing factors. Note that some of the enabling factors may be the same as environmental factors.

  3. Prioritize the factors, both between and within categories, based on:

    1. Importance—Judge importance based on the prevalence of a factor (how common it is), immediacy (how urgent it is), and necessity of the factor for the behavioral or environmental change. In an ecological approach, enabling factors tend to be the most important because they generally have greater impact on the behavior of the target audience. Predisposing and reinforcing factors generally have less impact, but may be necessary and supportive of the desired behavioral or environmental change.

    2. Changeability—Sometimes the most important factors are beyond your ability to change. Choose factors on which you have some hope of making an impact. For example, you might not be able to change national nutrition standards for school lunches, but you may be able to affect local school district policy.

  4. Set objectives that address each of your top-ranked P.E.R. factors.These objectives will be the focus of your action plan.

  5. If your priority enabling factor is a complex environmental condition, then you may need to repeat the P.E.R. assessment on this top-ranked enabling factor to understand and prioritize the underlying causes. This higher level P.E.R. analysis will assess the factors that predispose, enable, and reinforce this situation.

For more information and resources, go to Tools for You and More Info for this course on the Cornell NutritionWorks website at

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

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