Social and Behavioral Approaches to Public Health PUBH 6007 Test #1

Trans-theoretical Model (TTM)

describes an individuals' motivation and readiness to change a behavior.
Behavior change is a process, not an event

Pre-contemplation includes

Consciousness Raising, Dramatic Relief, Environmental Re-Evaluation.

Contemplation includes

Self Re-Evaluation

Preparation includes

Social Liberation and Self Liberation

Action includes

Helping Relationships, Counter Conditioning, Reinforcement management

Maintenance includes

Stimulus Control

RE-AIM Framework

Reach, Effectiveness, Adoption, Implementation, Maintenance
Developed to help make research findings more generalizable by encouraging scientists and evaluators to balance internal and external validity when developing and testing interventions.

The goal of the RE-AIM Framework was to

Produce programs and policies with a higher likelihood for uptake and sustainability in typical community or clinical settings

REACH (of RE-AIM)

Individual level measure of participation.
Refers to percentage and risk characteristics if persons who receive or are affected by a policy or program.
Measured by comparing records or program participants and complete sample information for a defined population.
Concerns characteristics of participants

EFFICACY (of RE-AIM)

Has 2 issues:
Importance of assessing both positive and negative consequences of programs (critical to determine benefits but also to be certain that harm does not outweigh benefits).
The need to include behavioral, quality of life, and participant satisfaction outcomes as well as physiological endpoints (behavioral outcomes should be assessed for participants, staff, and payers and purchasers who support intervention).

ADOPTION (of RE-AIM)

Proportion and representatives of settings or programs.
There are common temporal patterns in the type and percentage of settings that will adopt an innovative change.
Typically, assessed by direct observation or structured interviews or surveys.

IMPLEMENTATION (of RE-AIM)

The extent to which a program is delivered as intended.

MAINTENANCE (of RE-AIM)

Long-term maintenance of behavior change.
Extent to which innovations become a relatively stable, enduring part of the behavioral repertoire of an individual.
Extent to which a health promotion practice or policy becomes routine and part of the everyday culture and norms of an organization.

what is self efficacy

the idea of self-efficacy as a key element in how people change behavior moves beyond the mechanistic conditioning process of change.

PRECEDE evaluation tasks

specifying measurable objectives and baselines

PROCEED evaluation tasks

monitoring and continuous quality improvement

Phase 1 of Precede-Proceed

social assessment

Phase 2 of Precede-Proceed

epidemiological assessment

Phase 3 of Precede-Proceed

educational and ecological assessment

Phase 4 of Precede-Proceed

administrative and policy assessment and intervention alignment

Phase 5 of Precede-Proceed

implementation

Phase 6 of Precede-Proceed

process evaluation

Phase 7 of Precede-Proceed

impact evaluation

Constructs of TTM

Pre-contemplation, contemplation, preparation, action, maintenance

Phase 8 of Precede-Proceed

outcome evaluation

What is a SMART goal?

Specific, Measurable, Achievable, Relevant/Realistic, Time-specific

What are the SMART goal objectives?

Educational, Behavioral, and Health

Educational Objective:

Change in specific attitudes, knowledge, beliefs, expected to result from intervention
Increases likelihood of achieving the behavioral objectives

Behavioral Objectives:

Change in specific practices or actions (behaviors) expected to result from the intervention: adopting a new behavior, changing an existing behavior, cessation of an unhealthy behavior.
Increases likelihood of achieving the health objective

Health Objectives:

The change in health related status or outcome expected to result from the intervention.
Should be big picture and of public health significance.
Decrease morbidity or mortality, reduce incidence or prevalence, improve health status

What is a logic model

A systematic and visual way to present and share your understanding of the relationships among your resources to operate your program, the activities you plan, and the changes or results you hope to achieve.

Why are logic models important?

Defines the program rationale, clarifies stakeholders' implicit program theories, articulates program rationale, helps identify specific interventions, helps identify unintended effects, focuses the evaluation on critical areas, supports the rationale and planning for scale up, required by most funders.

Health Belief Model (HBM)

model for explaining how beliefs may influence behaviors

Health Belief Model constructs

Perceived susceptibility, perceived severity, perceived benefits, perceived barriers, cues to action, self efficacy

Perceived Susceptibility

Likelihood one will get disease or condition

Perceived severity

beliefs about gravity of contracting disease/illness

Perceived benefits

perceived benefits about available actions to reduce threat

Perceived barriers

belief about the 'costs' of advised health action

Cues to Action

strategies to activate readiness

Self Efficacy

confidence in one's ability to take action

Measurement of HBM Constructs:

1. Construct definitions need to be consistent with HBM theory conceptualized
2. Measures need to be specific to behavior being addressed and relevant to population
3. Measure full range of factors that may influence behavior for content validity
4. Multiple items for each scale reduces measurement error
5. Validity and reliability measures need to be reexamined with each study

Theory of Reasoned Action

Asserts the most important determinant of behavior is BEHAVIORAL INTENTION
Focuses on cognitive factors (beliefs/values) that determine motivation (behavioral intention)

Theory of Planned Behavior

Adds perceived behavioral control over behaviors taking into account situations where one may not have complete volition over behavior.
Perceived behavioral control is independent of behavioral intention

Precaution Adoption Process Model (PAPM)

Attempts to explain how people decide to take action; specifically looking at the mental state and how people respond/cope to discreet stressors.
How people translate that decision to act

Stages of PAPM

Unaware of Issue, Unengaged by Issue, Deciding About Acting, Decided Not to Act or Decided to Act, Acting, Maintenance

what are the social cognitive theory constructs?

Reciprocal determinism, environment, observational learning, behavioral capability, reinforcement, outcome expectations, outcome expectancies, self-efficacy, self-control of performance, and managing emotional arousal.

Reciprocal Determinism

The idea that there is an interactive loop between individuals and an environment

Environment

Factors external to a person - social, or physical - which all together comprise the situation with which a person interacts

Observational Learning

Key early construct. Learning by observing the positivity or negative reinforcements that happen to someone else

Behavioral capability

Distinguishes between learning and performance. A person must know what the behavior is (knowledge) and how to perform it (skill).

Reinforcement

The idea that a reward (positive reinforcement) increases the likelihood that the behavior will be repeated, and negative reinforcement does the opposite.

Outcome expectations

The anticipation that certain actions will result in outcomes/reactions. It is what a person learns related to behavior.

Outcome expectancies

Closely related to Outcome Expectations, but focusing on the value a person places on certain outcomes.

Self-Efficacy

Refers to the confidence a person feels about performing a behavior, and about overcoming the obstacles to performing it.

Self-control of performance

The idea of monitoring one's behavior within a social environment. Includes idea of self-assessment against a goal, self-rewards.

Managing emotional arousal

Said to inhibit learning, so its management is part of learning.

Individual (internal)

A person's sense of self-efficacy about a new behavior, behavioral capabilities, managing emotions, outcome expectancies, etc.

Environmental (external)

The social/physical environment surrounding individuals, including the modeling behavior of others, reinforcement, and other factors.

Reciprocal Determinism

An individual interacts with an environment, receives a response from the environment, adjusts behavior, interacts again, etc.

What is the Social Cognitive Theory

Principle of reinforcement to include observation of consequences; an individual's interaction with an environment.