health promo midterm #2

Model vs. Theory

theory - Help us understand what influences health
Why are people (not) engaging in certain health behaviors?
How are people's behaviors influenced?
What factors should be considered when evaluating program 's focus?

model - Provide a vehicle for applying theories— framework / map

how do models and theories work together in HP programs?

theories provide insight and direction, models then give steps to initiate change

Behaviorism

science focuses on observable behaviors and not unobservable internal mental processes

Associative learning

when a subject links certain events, behavior, or stimuli together in the process of conditioning

Pavlov classical conditioning dog experiment

Neutral stimulus (bell) - is paired with the unconditioned stimulus (smell of food) until association between the 2 are made --> stage called acquisition
Neutral stimulus then becomes a conditioned stimulus

Classical conditioning

type of learning in which one learns to link 2 or more stimuli and anticipate events

Watson - little albert experiment

Paired rat with scary noise = fear of rat
--> a form of classical conditioning

Operant conditioning

behavior is strengthened if followed by a reinforcer or diminished if followed by a punisher

Positive reinforcement

when presented after a response it strengthens the response

Negative reinforcement

removed after a response, strengthens the response

Combination theories

Stimulus Response ( SR) Theory
Social Cognitive Theory/ Social Learning Theory
Theory of Reasoned Action (TRA)
Theory of Planned Behavior (TPB)

Health Belief Model

our perceptions are associated with particular actions that determine our behavior

4 key constructs in the health belief model

Perceived susceptibility
Perceived benefits
Perceived severity
Perceived barriers

perceived susceptibility

opinions of your chance of getting condition

perceived benefits

opinion on how effective the advised action will be

perceived severity

opinion of how serious the condition would be

perceived barriers

opinions of the costs of the action advised

what factors can affect these 4 constructs?

all of these perceptions are affected by modifying factors = Age, ethnicity, socioeconomic status, etc.

Perceived susceptibility + perceived severity = ?

perception of threat
- If perceived threat is high, the likelihood of engaging in the health protected behavior is higher than it would be if perception of threat is low
- Creating realistic perceptions of threat in the target population --> educational materials, fear appeals

Perceived benefits + perceived barriers = ?

determines response
- Evaluate pros and cons, do benefits outweigh costs
- HP aims to ensure benefits of the behavior are clearly communicated and relevant for the target population

cues to action

factors that activate "readiness to change"
ex; Reminder from clinic, seeing campaign, receiving advice from doctor, feeling ill

self-efficacy

Belief that one can successful perform a behavior, even in hard/stressful situations

why is self efficacy important in HP?

Important in initiating and maintaining behavior change

Keep on brushing project

sent motivational text messages to participants once per week for a 10 week time period
New Zealand, 18-24 age, encourage to brush teeth
51% brushed teeth 2x or more a day - before study
After study - increased to 73%
Conclusion - motivational text messages increased tooth brushing
--> health belief model applied

Transtheoretical model of behavior change

helps understand different stages in process of ready to change, to persisting with the behavior

are the stages of this transtheoretical model linear?

Stages are not always linear, but cyclical - people do not always maintain behavior and move backwards

Stages of Transtheoretical Model

precontemplation, contemplation, preparation, action, maintenance

precontemplation stage

not ready, unlikely to engage in healthy behavior
- for around 6 months
- encouraged to weigh pros and cons of change, may be defensive

contemplation stage

'getting ready'
Has intention to engage in health behavior within next few months, but could last up to 2 years
Appreciate positives of changing behavior
May put off behavior
Has the thought, but unlikely to act

preperation stage

ready to engage in action within next 30 days
Takes gradual steps
Small exercise, but not enough to make significant change

action stage

action is ready to be initiated
Initiated behavior changes
Need to keep working to keep the behavior in routine
Useful to learn techniques to enhance commitment
Doing well

maintenance stage

changed and sustained behavior
Share experiences and seek support
Important to have awareness that some situations can cause person to get into old habits

Precede - Proceed Model

8 step framework for HP programming
Pre-pro work in tandem --> providing continuous series of steps in planning, implementation and evaluation of HP programs
Led to think first inductively, then deductively - start with desired ends and work back to original causes, ex; heart disease

Phase 1 - social assessment and situational analysis

Begin with consideration of quality of life
Involve people who will be targeted, target population --> Needs assessment
Acquire subjectively defined problems and priorities of individuals or communities
Indicator ex; absenteeism, aesthetics, crime, alienation, unemployment, self-esteem etc

Phase 2: Epidemiological Assessment

Task is to match info from phase 1 and 2
Rank concerns in order of importance --> sometime based on reality, ex; how much funding, can we afford to target this concern
Consider valid indicators - morbidity, fertility, mortality and their dimensions - strength of problem/need to fix

example of why phase 2 is necessary

sick building syndrome - social assessment identifies an important issue, but epidemiological assessment finds no relevance of this issue, go back and implement health education rather than an intervention

Incidence

new cases in a group in a certain time period

Prevelance

existing cases in a group at designated time period

examples of indicators and dimensions

environment:
counselling services = indicators
accessibility = dimension

genetics:
breast cancer = indicator
predisposed for it, and poor diet = dimensions

relationship between importance and changeability

Phase 3: Educational and Ecological Assessment

3 groups - predisposing factors, enabling factors, reinforcing factors

pre-disposing factors

knowledge, attitudes, beliefs, values, perceptions that facilitate motivation for change
Genetics, and early childhood experiences that created the basis for our motivation to change
Ex; predisposing factors influencing likelihood for one to be physically active - parents heavily valued physical activity

enabling factors

skills, resources, barriers that can help of hinder desired behavior changes
Created by society forces or systems
Factors that make change possible

reinforcing factors

rewards and feedback
Encourage or discourage behavior continuation
Produce lifestyles which influence enviro - via consumer demand, cumulative actions, political advocacy

Phase 4 - Admin and Policy Assessment

Assess of organizational and administrative capabilities and resources for program intervention
Assess limitations

Phase 5-8: Implementation and Evaluation

Make up the proceed portion of the model

Stimulus Response Theory

Combines Pavlov classical conditional with operant conditioning
Behavior based on stimulus, response, and reinforcement
Which part reps classical conditioning - behavior frequency determined by consequences
Consequences determining behavior come from either reinforcement or punishment --> individuals can learn from either one or both

positive punishment

add something to unpleasant to decrease behavior, ex; speeding ticket

Negative punishment

removing a positive reinforcer

social cognitive theory

Reinforcement + expectation = behavior
Ex; Presents + will get present = answer question
Consequence, belief about consequence, behavior

Expectancy

ones beliefs and perceptions that a specific consequence will follow a specific action --> based on past experience, cultural norms and beliefs
Ex; partner forgiveness - If you bring your partner flowers, they will forgive you for a mistake they made

Incentives

reactions from external world regarding our behavior/behavior change

which theory is considered they 'most complete theory' applied to HP?

Social cognitive theory --> addresses both underlying determinants of health behavior and methods of promoting change

behavioral capacity

'knowing' of a behavior
ex; aerobic exercise --> intended behavior is to increase aerobic exercise, must know effects of this exercise and how to perform it properly

barriers to behavioral capacity

low education

Expectancies

Our behaviors are attached to values - the values added to expectations, likelihood of behavior
Ex; exercise - value having more endurance which comes with exercise

5 ways to increase self efficacy

Task mastery - completing something, I've done it before I can do it again, pulling from own experiences of success
Vicarious experiences - watching other people complete, if they can do it I can too
Verbal persuasion - someone talking you through completing a task, helpful feedback, encouragement
Imagery - imagining ourselves doing something, form of motivation
Emotional arousal - how are we feeling, interpreting it accurately, helps us think about a situation positively

Self-control/ self-regulation

control over behavior through monitoring and adjusting
Reinforcement is essential

3 types of reinforcement

direct reinforcement, vicarious reinforcement, self-reinforcement

direct reinforcement

rewards that immediately follow a given behavior
ex; child is praised when using manners

vicarious reinforcement

toddler learning to use manners because they saw their siblings getting praised for it

self-management reinforcement

judgement of our behavior to our own personal standards

reciprocal determinism

Interaction between individual and the situation they are in - interaction among person, behavior, and environment
Ex; significant number of nonsmokers - an individual who smokes in an environment full of nonsmokers is discouraged to smoke

Generalized Model

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

5 Steps of the Generalized Model

Assessing Needs, Setting Goals and Objectives, Developing an Intervention, Implementing the Intervention, Ovulating the Results

assessing needs

collecting/analyzing data, determine priority in a population

Setting goals and objectives

what will be accomplished

Developing interventions

means by which goals or objectives are achieved

Implementing interventions

putting interventions into action

evaluating results

improve quality of interventions and determining effectiveness

PATCH model

Planned Approach to Community Health

Phases in PATCH model

1. mobilizing community
2.Collecting and organizing data
3.Choosing health priorities and target groups
4.Choosing and conducting interviews
5.Evaluating the PATCH process and interventions

similarities between PATCH and generalized

both conduct needs assessment's, both include interventions and evaluating them

APEX-PH Program

assessments protocol for excellence in public health
Designed specifically for local health departments to engage in planning and evaluation process

steps of the APEX-PH

1. Organizational capacity assessment (internal assessment of strengths)
2. Community process:
Collection and analysis of community health status
Collection and analysis of community opinion data
Development of an action plan with goals
3. Completing the cycle - implementation of plan

MAPP

mobilizing action through planning and partnerships
Replaced APEX

Steps of MAPP

organizing for success and partnership development, visioning, 4 MAPP assessments, identify strategic issues, formulate goals and strategies, action cycle

1. organizing for success and partnership development

assess whether program is timely, appropriate, possible
Work groups are created:
Core support team - prepares material for process
MAPP committee - composed of key sponsors, guide and oversee process
Community itself - provides input, representation about decision making

Visioning

guides community through a process that results in shared vision and common values
Vision for the 'future' with input from community and work groups

4 MAPP Assessments

Community themes and strengths assessment - community/consumer opinion
Local public health assessment
Community health status assessment - using epidemiological data
Forces of change assessment

Identify strategic issues

list of the most important issues facing the health of the community
Consider overlapping issues, which to prioritize first etc
Formulate goals and strategies

MAP-IT

made to help guide public health and HP planning efforts

Steps in MAP-IT

mobilize, assess, plan, implement, track

mobilize

mobilizing key individuals and organizations to work together to improve health of the community
Responsibilities are assigned - ex; developing educational/training programs

Assess

equivalent to needs assessment
Who is affected by health problems? What resources do we have to address issue? What resources are required to have meaningful impact?
State and local data collected and used

plan

involves developing goals and objectives, measures, baselines, and targets
What do we need to do to achieve our goals? How will we know when we reach our goal?

implement

put plan into action

track

equivalent to evaluation

2 significant challenges in planning

The preferences of stakeholders for a planning model or approach
Interpersonal conflicts among stakeholders

factors influencing which model to select for planning

Preferences of stakeholders / decision makers
How much time and funding
How many resources for data collection and analysis
Degree to which clients are actually involved as partners in the planning process or degree to which planning efforts will be will be consume oriented
Preferences of funding agency

3 Fs for program planning

Fluidity - steps in planning process are sequential, in order
Flexibility - planning is adapted to needs of the stakeholders, processes need to be adjusted with circumstances
Ex; influenza outbreak, requires rapid assessment and scan of environment that was accounted for
Functionality - outcome of planning is improved health conditions, not the production of the plan itself

Population-based approach

planning processes usually pertain to large population segments of even larger populations due to cost and other resources

Ecological Framework

helps planners better appreciate that families schools, employers social networks, organizations, communities and societies exert an influence on individuals and priority populations as they attempt to improve their health

SMART model

social marketing assessment and response tool

phases of the SMART model

preliminary planning, consumer analysis, market analysis, channel analysis, develop interventions material and protest, implementation, evaluation

Preliminary planning

identify a health problem and name it in terms of behavior
Develop general goals
Outline preliminary plans for evaluation
Project program costs

Consumer Analysis

segment and identify the priority population
Identify formative research methods
Identify consumer wants, needs, and preferences
Develop preliminary ideas for preferred interventions

market analysis

establish and define the market mix
Assess the market to identify competitors, allies, and partners

channel analysis

identify appropriate communication messages, strategies, and channels
Assess options for programs distribution
Identify communication roles for program partners
Determine how channels should be used

Develop interventions, materials, and protest

develop program interventions and materials using information collected in consumer, market, and channel analysis
Interpret the marketing mix into a strategy that represents exchange and societal good
Pretest and refine the program