Week 6: models & theories for health promotion and disease

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Why are models and theories important?

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1

Why are models and theories important?

  • similar to narrowing focus of a research paper - direction about INTENT of a paper

  • models and theories enable program planners to give structure & organization & understanding to the program process and purpose

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2

Theories

  • think question mark

  • help us understand what influences health

  • why are people not engaging in certain health behaviours

  • how are peoples behaviours influenced

  • what factors should/ shouldn't be considered

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3

Models

  • provide a vehicle for applying theories

  • serve as a framework/ map

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4

How do theories and models work together?

Theories provide insights & directions eg.

  • students do readings to get better grades

  • dogs doing tricks

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5

Crash course video: operant and classical conditioning

What school of psychological thought did Pavlov's work start?

Behaviourist

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6

What is a neutral stimulus in classical conditioning?

the ringing sound - bell

  • the neutral stimulus eventually becomes the conditioned stimulus

  • eg. Jim's computer tone

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7

What does the neutral stimulus become in the after-conditioning phase of CC?

Conditioned stimulus

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8

T/F: Operant conditioning is a type of associative learning

True

  • along with Watsons little Albert experiments

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9

Who is the champion (founder) of operant conditioning?

Skinner

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What is a 'shaper' in operant conditioning?

shaping behaviour by pushing a lever to get a treat

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11

T/F: Negative reinforcement means the same as punishment in OC

False

  • Punishment decreases behaviour

  • Neg reinforcement removes the punishment event to increase behaviour

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12

Classical/Pavlovian conditioning

  • pairing new stimulus with natural stimulus to produce natural response

  • all responses are reflexes eg. natural stimulus: smell of fresh fries = salivation neutral stimulus: doorbell conditioned response: salivation when the doorbell sound occurs

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Operant / Skinner conditioning

  • modify behaviour by manipulating consequences of behaviour

  • thru shaping we learn to modify our behaviour

  • consequences shape the continuation/ termination of behaviour eg.

  • target behaviour: wearing a seatbelt

  • principles widely used in behaviour for healthy behaviour change

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Combination theories (theories that use op and classical conditioning)

  • Stimulus response (SR)

  • social cognitive theory

  • the theory of reasoned action (TRA)

  • theory of planned behaviour (TPB)

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15

T/F: the health belief model can be used to explain and predict behaviour:

True

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16

In the HBM, do cues to action mean the same thing as triggers?

cues to action serve as a trigger for behaviour seeing a media campaign or receiving advice = cue to action

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17

What are 3 health issues that have been studied using the HBM?

gestational diabetes -> risk factor for type 2 diabetes and the women's perceived threat

increase toothbrushing - keep on brushing sent texts to participants weekly

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18

4 key constructs in the health belief model

Perceived susceptibility Perceived severity perceived benefits perceived barriers

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19

Perceived susceptibility

  • opinion of your chance of getting a particular condition eg. how likely is it that you will develop osteoporosis?

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Perceived severity

opinion of how serious the condition would be eg. Would osteoporosis be a mild inconvenience or severe?

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Perceived benefits

Opinion of how effective the advised action would be eg. physical activity and vitamin B promotes bone health, therefore preventing osteoporosis - How effective would doing those things be?

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Perceived barriers

Opinion of cost or drawbacks of the advised action eg. don't like/ have time to exercise or cant afford healthy food

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Perceived threat

the higher the perceived threat, the higher the likelihood of engaging in health protective behaviour is higher

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24

2 most well known Combo models

HBM and Transtheoretical model

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T/F: The stages in the Transtheoretical model are non linear

True

  • more likely to be cyclical

  • its a journey

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26

The 5 stages of the TM

Pre contemplation contemplation preparation action maintenance

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Precontemplation

"not ready"

  • unlikely to engage in healthy behaviour in the near future

  • encouraged to think about the pos/neg of their current behaviour

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Contemplation

"getting ready"

  • has intentions to change

  • appreciate the positives of adopting the action and is beginning to think about change

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Preparation

"ready to engage in action"

  • gradual steps

  • tells family and friends they will do the behaviour

  • has a plan of action

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action

"initiated action"

  • often takes time to get here

  • need to keep working hard to keep the action in the life

  • commitment

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Maintenance

changed and sustained behaviour

  • encouraged to share and seek support from healthy people

  • important to challenge themselves

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Decisional Balance

do the positives outweigh the negatives?

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33

The Generalized Model

Teaches basic principles of planning and evaluation emphasized in most planning models

  • best and most universal model, therefore textbook recommends promoting it

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5 steps of the Generalized Model

  1. Needs assessment

  2. Setting goals and objectives

  3. developing interventions

  4. Implementing Interventions

  5. Evaluating results

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Needs assessment

  • collecting and analyzing data

  • the 1st step of planning and evaluation

  • sets priorities with stakeholders

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Setting Goals and objectives

what will be accomplished

  • discussed with stakeholders

  • must be SMART

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developing interventions

  • how the Goals and objectives will be achieved

  • will you use already existing programs or develop your own?

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Implementing interventions

putting the interventions/ programs into action implementation = program management this stage also focuses on marketing and communication

  • some processes may need to be modified

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Evaluating results

improving quality and determining effectiveness

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40

PATCH acronym

Planned Approach to Community Health

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PATCH model 5 phases

  1. Mobilizing the community

  2. Collecting + Organizing data

  3. Choosing health priorities and target groups

  4. Choosing and conducting Interventions

  5. Evaluating the PATCH process and interventions

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42

APEX-PH model

does basically the same thing as PATCH and both models do the same thing as the generalized model

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MAPP model + 6 phases

MAPP replaced APEX-PH

  1. Organizing for success and partnership

  2. Visioning

  3. Four MAPP assessments

  4. Identify strategic issues

  5. formulate goals and strategies

  6. Action cycle

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MAP IT 5 phases

M: mobilize A: Asses P: plan I: Implement T: track

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45

The 3 F's of program planning

Fluidity Flexibility Functionality

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Fluidity

steps in the planning process are sequential, they build on one another eg. A planner cannot develop goals and objectives until a needs assessment has taken place

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flexibility

planning is adapted to the needs of stakeholders

  • planning gets modified as the process unfolds

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Functionality

the outcome of planning = improved health conditions not the production of a program plan itself

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PRECEDE acronym

Predisposing Reinforcing Enabling Constructs in Educational/ Ecological Diagnosis and Evaluation

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PROCEDE acronym

Policy Regulatory Organizational Constructs in Educational and Environmental Development

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51

The 8 phases of PRECEDE-PROCEED

PRECEDE Phase 1: Social Assessment and situational analysis Phase 2: Epidemiological assessment Phase 3: Educational and ecological assessment Phase 4: Intervention alignment and administrative policy assessment

*there is no distinct break in between phases, planners can b=move back and forth

PROCEED Phase 5: Implementation Phase 6: Process phase 7: impact Phase 8: Outcome evaluation

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Social Assessment and situational analysis

seeks to subjectively define quality of life (problems and priorities) of those in the priority population

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Epidemiological assessment

planners use data to identify and rank the health goals or problems that may contribute to or interact with problems identified in phase 1

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educational and ecological assessment

identifies and classifies various factors that have the potential to influence a given behaviour into 3 categories:

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55

3 categories of an educational and ecological assessment

  • predisposing (values, beliefs)

  • reinforcing (access to healthcare)

  • enabling (types of feedback)

(1st 3 steps of PRECEDE)

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Intervention alignment and administrative policy assessment

  • The intent of intervention alignment is to match appropriate strategies and interventions with projected changes and outcomes identified earlier

  • in APA, planners determine if they have the capabilities and resources to develop and implement the program

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Implementation

planners select interventions and strategies to begin implementation

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Process/ Impact/ outcome evaluation

phases 6,7,8 don't have to be used - depends on the evaluation requirements

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59

The SMART model 7 phases

phase 1: Preliminary planning phase 2: consumer analysis phase 3: market analysis phase 4: channel analysis phase 5: develop interventions, materials and pretest phase 6: implementation phase 7: Evaluation

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SWOT analysis

Strengths, weaknesses, opportunities, threats analysis

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Healthy communities

movement characterized by community ownership and empowerment, driven by the values, needs and participation of community members with consultation from health professionals

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The health communication model (National Cancer Institute - NCI) 4 phases

Phase 1: planning and strategy development Phase 2: Developing and pretesting concepts Phase 3: Implementing the program Phase 4: Assessing Effectiveness and making refinements

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63

Intervention mapping: 6 steps

  1. needs assessment

  2. matrices of change objectives

  3. theory based methods and practical applications

  4. program production

  5. adoption and implementation

  6. evaluation planning

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64

Healthy plan it 6 steps

  1. priority setting

  2. establishing goals

  3. outcome objectives

  4. strategy

  5. evaluation

  6. budget

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