Kines 501 Final Exam

Formulation of Program Theory

Articulate and evaluate the conceptualization of health problems

Casual Model

- What causes the health problem?

- Necessary for the development of any interventions

Predisposing Factors

things that facilitate or hinder likelihood of a given behavior (knowledge, attitude, belief, values)

Reinforcing FactorsEE

rewards & feedback received from others regarding a given behavior (attitudes and support of influential people, economic rewards, social norms)

Enabling Factors

conditions that help/hinder doing a given behavior ( availability of resources, accessibility of services, laws and policies)

9 phases of PRECEDE-PROCEED framework

- social assessment

- epidemiologic assessment

- behavioral & environmental assessment

- educational & ecological assessment

- administrative policy

- implementation

- process evaluation

- impact evaluation

- outcome evaluation

Intervention Model

- the mechanism by which the intervention will influence the problem

- focus on changing modifiable factors in the casual model

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Mediational Model Structure

- intervention to mediator to outcome

Logic Model

- graphic depiction of key program elements

- tells story of program in a condensed format

Components of Logic model

- inputs, activities, outputs, impact (short term), impact (long term), outcomes

Components of Logic model

Components of Logic model

- inputs, activities, outputs, impact (short term), impact (long term), outcomes

Logic Model: Inputs

resources needed for program activities (staff funding, partners, settings)

Logic Model: Impact (short term)

program mediators (knowledge changes that result in activities and outputs)

Logic Model: Impact (long term)

behavioral and health effects of intervention

Outcomes

longer term health outcomes (goals)

Why create a logic model

- promotes collaboration among stakeholders to develop agreement on program theory and outcomes

- convenient visual representation of a program

- aids in developing evaluation questions and measures

- often required by funders

5 common elements to health promotion program planning

- assessing needs

- setting goals and objectives

- developing interventions

- implementing interventions

- evaluating results

Primary prevention

preventing from ever having a health problem

Secondary prevention

preventing from a severe case (catching them in the early phase)

Tertiary prevention

already a well established health problem

Role of planning frameworks

- integrate behavioral and social science theories

- develop interventions to prevent and control health problems

- a tool to help partners focus on goals and understand them

- an action guide to streamline efforts

- an evaluation guide for measuring progress and success

Examples of Planning Models

- PRECEDE PROCEDE

- RE-AIM

- Mobilizing for Action Through Planning and Partnerships

- Intervention Mapping

PRECEDE-PROCEED

framework for identifying strategies to address factors linked to outcomes of interest

- begin with desired outcomes

- work backwards to identify factors influencing success

- plan with target community

PRECEDE-PROCEED Assumptions

- behavior and behavior change must be enabled

- behavior and behavior change must be reinforced

PRECEDE-PROCEED Step: Social Assessment

PRECEDE-PROCEED Step: Epidemiological Assessment

Identifies health problems for program focus

PRECEDE-PROCEED Step: Behavioral & environmental assessment

Identifies predisposing, reinforcing, enabling factors that impact behavioral and environmental targets

PRECEDE-PROCEED Step: Intervention Alignment and Administrative& policy assessment

Selects & aligns program components with priority determinants of change, identifies resources, organizational barriers and policies for implementing and sustaining program

Designing the intervention

What are key aspects of promising approaches that are/have been used in practice

Best Practices

interventions that have been proven effective in multiple settings and populations

Best Experiences

the prior experiences of other practitioners communities, states, or national programs in addressing the same issues. Come from prior or existing programs

Best Processes

Proven methods and strategies used to assess the population and local situation to select appropriate interventions

SMART Research Questions

Specific, Measurable, Attainable, Realistic, Time-Bound

Needs & Assets Assessments

Systematic Process to:

- define the health problem characterize within a specific population and context

- identify needs and resources

- compile evidence to inform development of intervention tailored to population

- identify both the good and band

Identifying Stakeholders

Those who are relevant to a future health promotion effort because they: may be affected, have potential to influence, have key insight

Who to involve in your intervention?

- state and community partners

- support and intermediary org

- funders

- those affected (community members)

Why involve community members?

- provides direct experience

- realistic about their needs and priorities

Why promote diverse partcipation?

- better represent the community

- gain different opinions

- bring more experience and capacity to the table

- new collaborations and partnerships

Community Assets

anything that can be used to improve the quality of community life. Could be schools, influential people, etc

Why identify community assets?

- foundation for community improvement

- external resources may not be available

- improvement efforts are more effective and longer lasting when community members dedicate their time to changes they desire

- when efforts are planned on the strengths, people are more likely to feel positive about them

Asset Mapping

A community asset is anything that can be used to improve the quality of community life

What is a Needs Assessment?

collection of information on both current health status and ideal health status of a group or community

What three levels of ecological model does need assessment reflect?

- Intrapersonal

- Interpersonal

- Community

Results of a needs assessment can be used to...

- help advocate for health resources

- establish a baseline against which to gauge the effectiveness of the program

Photovoice

an activity in which participants are asked to represent their communities or express their points of view by taking pictures of scenes that highlight research themes

What are the three main goals of photovoice?

- enable people to record and reflect their communities strength and concerns

- to promote critical dialogue and knowledge about important issues through large and small group discussions of photographs

- to reach policymakers

Steps to conduct a photo voice

- conceptualize the problem

- devise initial themes

- conduct photovoice training

- take pictures

- facilitate group discussion

- select photographs

- codify issues, themes, and theories

- present findings to stakeholders/target audience

Four phases of community needs assessment

Phase 1: Gather preliminary data and generate assessment questions

Phase 2: collect community data

Phase 3: analyze data and interpret results

Phase 4: prioritize needs, identify assets, and make recommendations

Phase 1: Gather preliminary data and generate assessment questions

- gather basic community information

- observe and take notes

- talk to people

Phase 2: collect community data

- assemble secondary data

- gather primary data

- identify gaps in knowledge

Phase 3: analyze data and interpret results

- analyze the data

- compare perceived and actual needs

- compare your community to others

Phase 4: prioritize needs, identify assets, and make recommendations

- prioritize needs

- validate prioritized needs

- create an asset map

- submit findings and recommendations

What is theory?

Where do theories come from?

theories come from repeated observations of some happening

Three parts of a theory

- concepts

- constructs

- variables

Theory concept

- is the idea which theory is formed

- concepts come from factors that influence health behavior such as beliefs, relationships, and social structures

Theory Constructs

- ways in which the concept is used in the theory

- Constructs: mastery experiences, vicarious learning, verbal persuasion, physical and emotional state

Variables

identify the ways the concept is measured

Models

mix of concepts from a number of theories used together

Characteristics of theory

- general

- testable

- abstract

- replicable

- supported

- logical and meaningful

- efficient

Characteristics of Conceptual Models

- specific

- testable

- specific-variables

-replicable

- supported

- logical and meaningful

- efficient

Steps in Choosing a Theory

1. identify the health issue and the intervention population

2. gather info about the health issue

3. identify possible causes for the health issue

4. identify the level of interaction for the possible causes of the issue

5. identify the theory that best matches the level and causes

Types of Relationships: Antecedent

background factors that precede expected relationships

Types of Relationships: Mediating

variables that come between predictor and outcome variables

Types of Relationships: Confounding

variables that related to both outcome and predictor variable

Types of Relationships: Modifying

the relationship between the predictor and outcome is influenced by a third variable

Self-Efficacy Theory

individuals are more likely to engage in activities for which they have high self-efficacy and less likely to engage in those they do not

People with strong self-efficacy...

- see difficult tasks as challenges to be mastered

- set goals and maintain strong commitment to attaining them

- approach difficult situations with confidence

- are less prone to depression and stress

People who doubt their ability...

- see difficult tasks as threats and avoid them

- give up the face of failure

- quickly lose faith in their ability

- are more prone to depression and stress

Ways to change self-efficacy

- mastery experiences

- vicarious experiences

- verbal persuasion

- somatic and emotional states

Mastery Experiences

successfully doing something is a mastery experience that increases self-efficacy

- trying different things

- over-coming obstacles

- practicing things that do not come easily

Vicarious Experiences

learning by watching someone similar to yourself be successful is a vicarious experience that increases self-efficacy

conversely, watching the person fail threatens self-efficacy

Verbal or Social Persuasion

encouragement by others that increases self-efficacy

Somatic or Emotional State

occurs when someone thinks about doing something can increase or decrease self-efficacy

Logic Model: Activities

key events or actions performed by program and its staff

Logic Model: outputs

direct products of activities (# of people reached, satisfaction, materials, distributed)

Health Belief Model

Used to understand and predict health behaviors

Health Belief Model: Perceived Susceptibility

beliefs about the changes of getting a condition

Health Belief Model: Perceived Severity

beliefs about a seriousness of a condition and its consequences

Health Belief Model: Perceived Benefits

beliefs about the effectiveness of taking action to reduce risk of seriousness

Health Belief Model: Perceived barriers

beliefs about the material and psychological costs of taking action

Health Belief Model: Cues to action

factors that activate readiness to change (reminders)

Health Belief Model: Self-Efficacy

Confidence in ones ability to take action

Where does the HBM fit within the Ecological Model?

Intrapersonal

Strengths of Health Belief Model

- tailored to individual needs

- used to predict or explain health behaviors

- intuitive conceptualization and modifiable constructs

- perceived barriers strongest predictor of health behavior

Limitations of HBM

- little known about relationship between constructs

- cues to action not adequately researched

- effects of each construct small

Transtheoretical Model

- health behavior change is a process that goes through a series over time

- people who need to change the most are often not ready to change their behavior

Stages of Change: Precontemplation

has no intention of taking action within the next six months

Stages of Change: Contemplation

intends to take action in the next six months

Stages of Change: Preparation

intends to take action within the next 30 days and has taken some steps in that direction

Stages of Change: Action

has changed behavior for less than 6 months

Stages of Change: Maintenance

has changed behavior for more than 6 months

Stages of Change: Termination

zero temptation to regress and 100% self efficacy

Self-liberation

belief that one can change and the commitment and re-commitment to act on that belief

Social liberation

increase healthy social opportunities or alternatives

Where does the TTM fit within the ecological model?

Intrapersonal??

TTM Strengths

-Applied and effective with a large number of health problems

- Can be used in a range of settings

- Supported by both theoretical and applied studies

TTM Limitations

- Applicability to children and adolescents is unclear

- Applied more often to risk reduction than to risk prevention

- Difficult to recruit individuals in precontemplation stage

- Poor retention rates

Social Cognitive Theory

Recognizing that behavior is influenced by the environment and personal factors. All interact with another