Week 6: models & theories for health promotion and disease

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

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

Models

- provide a vehicle for applying theories
- serve as a framework/ map

How do theories and models work together?

Theories provide insights & directions
eg.
- students do readings to get better grades
- dogs doing tricks

Crash course video: operant and classical conditioning

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

Behaviourist

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

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

Conditioned stimulus

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

True
- along with Watsons little Albert experiments

Who is the champion (founder) of operant conditioning?

Skinner

What is a 'shaper' in operant conditioning?

shaping behaviour by pushing a lever to get a treat

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

False
- Punishment decreases behaviour
- Neg reinforcement removes the punishment event to increase behaviour

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

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

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)

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

True

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

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

4 key constructs in the health belief model

Perceived susceptibility
Perceived severity
perceived benefits
perceived barriers

Perceived susceptibility

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

Perceived severity

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

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?

Perceived barriers

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

Perceived threat

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

2 most well known Combo models

HBM and Transtheoretical model

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

True
- more likely to be cyclical
- its a journey

The 5 stages of the TM

Pre contemplation
contemplation
preparation
action
maintenance

Precontemplation

"not ready"
- unlikely to engage in healthy behaviour in the near future
- encouraged to think about the pos/neg of their current behaviour

Contemplation

"getting ready"
- has intentions to change
- appreciate the positives of adopting the action and is beginning to think about change

Preparation

"ready to engage in action"
- gradual steps
- tells family and friends they will do the behaviour
- has a plan of action

action

"initiated action"
- often takes time to get here
- need to keep working hard to keep the action in the life
- commitment

Maintenance

changed and __**sustained**__ behaviour

* encouraged to share and seek support from healthy people
* important to challenge themselves

Decisional Balance

do the positives outweigh the negatives?

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

5 steps of the Generalized Model

1. Needs assessment
2. Setting goals and objectives
3. developing interventions
4. Implementing Interventions
5. Evaluating results

Needs assessment

- collecting and analyzing data
- the 1st step of planning and evaluation
- sets priorities with stakeholders

Setting Goals and objectives

what will be accomplished
- discussed with stakeholders
- must be SMART

developing interventions

- how the Goals and objectives will be achieved
- will you use already existing programs or develop your own?

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

Evaluating results

improving quality and determining effectiveness

PATCH acronym

Planned Approach to Community Health

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

APEX-PH model

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

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

MAP IT 5 phases

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

The 3 F's of program planning

Fluidity
Flexibility
Functionality

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

flexibility

planning is adapted to the needs of stakeholders
- planning gets modified as the process unfolds

Functionality

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

PRECEDE acronym

Predisposing
Reinforcing
Enabling
Constructs in
Educational/ Ecological
Diagnosis and
Evaluation

PROCEDE acronym

Policy
Regulatory
Organizational
Constructs in
Educational and
Environmental
Development

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

Social Assessment and situational analysis

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

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

educational and ecological assessment

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

3 categories of an educational and ecological assessment

- predisposing (values, beliefs)
- reinforcing (access to healthcare)
- enabling (types of feedback)

(1st 3 steps of PRECEDE)

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

Implementation

planners select interventions and strategies to begin implementation

Process/ Impact/ outcome evaluation

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

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

SWOT analysis

Strengths, weaknesses, opportunities, threats analysis

Healthy communities

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

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

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

Healthy plan it 6 steps

1. priority setting
2. establishing goals
3. outcome objectives
4. strategy
5. evaluation
6. budget