Impact of PRECEDE–PROCEED Model Audits in Cancer Screening Programs in Lombardy Region: Supporting Equity and Quality Improvement

Abstract

Background: Health disparities related to socio-economic factors impact access to preventive health interventions. The PRECEDE–PROCEED model, a multidimensional approach to health promotion, has been adapted to optimise cancer screening programs in Lombardy, Italy, addressing these disparities. Methods: This study evaluated the application of systemic audits based on the PRECEDE–PROCEED model across Lombardy cancer screening programs. A systematic region-wide audit was performed in 2019, and follow-up audits were performed in 2022–2023. Data were collected using structured analysis methodologies, including epidemiological, behavioural, and organisational assessments. Results: The 2019 audit showed strengths in participation and quality standards but identified challenges in cervical cancer screening coverage and waiting times for assessments. Improvements plans included the digitisation of processes and stakeholder engagement. The 2022–2023 audits reported increased coverage for breast and colorectal screenings, but a slight decline in participation rates and examination coverage. Organisational improvements were noted, yet gaps in training and equity-targeted actions remained. Conclusion: The PRECEDE–PROCEED model audits led to notable improvements in the quality and equity of cancer screening programs in Lombardy. Sustained focus on digital integration, continuous re-training, and targeted equity interventions is essential for further progress.

Keywords

• PRECEDE–PROCEED model
• cancer screening
• audit
• Lombardy region
• equity
• quality improvement