Chapter 8- Ethics & Professionalism

Ethics

refers to the moral principles generally accepted as the proper way to conduct one’s self, which provide guidance for behaviors that may be classified as right or wrong

Professionalism

involves behaving in a manner consistent with best practices and ethical behavior, staying up to date in the field, and taking responsibility to further the health education profession

Adaptation

is making changes to health education messages, materials, or programs to make them more suitable for a population of interest

Cultural Competence

is a person’s ability to understand and respect attitudes and values of various cultures and to address these differences in planning, implementing, and evaluating health education and promotion programs

Cultural Humility

is an ongoing process of self-exploration for health education specialist in which they honor the beliefs, customs, culture, and values of the people with whom they work with in communities

Health Disparities

are differences in the incidence, prevalence, mortality, and or burden of disease that exist among specific population groups

Online database

refers to any systemically organized information accessible on the internet, which may be used by health education specialist to obtain health knowledge and or resources for the health education process. An online database may include text documents, citations, abstracts, images, audios, videos, and or Web links

Policies

are set of rules and objectives to guide activities

Professional Development Plan (PDP)

is a career document in which short-term, mid-term, and long-term goals and objectives for professional person are outlined

Social determinants of health (SDOH)

are factors that could lead to health inequities and influence an individuals or communities health. SDOH barriers to health include race or ethnic status, gender, mental health, disabilities, or location

Technical Assistance

is a dynamic, capacity-building process for designing or improving the quality, effectiveness, and efficiency of specific programs, research, services, products, or systems

A theory

is a set of interrelated concepts and definitions that present a systematic view of events and is used to describe a relationship among variables to explain or predict events

Workforce Development Plan (WDP)

is the same as PDP; however this plan is used for teams or organizations in an agency or system

The Code of Ethics for Health Education Profession (CNHEO) include the following articles:

1. Responsibility to the Public

2. Responsibility to the Profession

3. Responsibility to the Employers

4. Responsibility to the Delivery of Health Education/ Promotion

5. Responsibility in Research and Evaluation

6. Responsibility in Professional Preparation and Continuing Education

Six frequently used ethical frameworks that can be applied to planning programs, which includes needs assessment:

• autonomy: personal right to self-determination and choice

• Criticality: the worst-off benefit the most

• Egalitarian: all persons of equal value; minimize disparities

• Needs-based: equal opportunity to meet own needs, such as healthy life

• Resource sensitive: resources are scarce

• Utilitarian: the greatest good for the greatest number; the end justifies the means

Respect for persons

people have the right to make choices about participation in research and some people may not have the ability to self-determine participation in research and should be protected

Beneficence

research staff should do no harm and should maximize the benefits of the research and reduce any possible harms to participants

Justice

Address fairness in distribution of the benefits of the research and selection into research projects

Section 5 of the Code of Ethics for the Health Education Profession

A. HES ensure that participation in research is voluntary and based upon the informed consent of participants. They follow research designs and protocols approved by relevant institutional review committees and/or boards

B. HES respect and protect the privacy, rights, and dignity of research participants and honor commitments made to those participants

C. HES treat all information obtained from participants as confidential unless otherwise required by law and informed research participants of the disclosure requirements and procedures

D. HES take credit, including authorship, only for work they have preformed and give appropriate authorship, co-authorship, credit, or acknowledgement for the contributions of others

E. HES report the results of their research and evaluation objectively, accurately, and in a timely manner

F. HES promote and disseminate the results of their research through appropriate formats while foster the translation of research into practice

G. HES conducting research or evaluation sometimes will be required to obtain informed consent.

Informed consent

is designed to allow participants to choose what will or will not happen to them, and the informed consent is signed by participants to indicate their choice.

includes the following information:

• Nature and purpose of the program

• Any inherent risks or dangers associated with participation in the program

• Any possible discomfort that may be experienced from participation in the program

• Expected benefits of participation

• Alternative programs or procedures in which the same results would be accomplished

• Option of discontinuing participation at any time

Plagiarism

using other peoples words, thoughts, or results without offering them credit through appropriate citations

Fabrication

making up results and reporting them

Falsification

changing or omitting data or manipulating results or processes so that research is not truthfully presented

ethical guidelines to consider when working with organizations follow:

• do no harm to your client. HES should, in their actions and work with other organizations, protect clients and other stakeholders from harm

• keep client information private or confidential unless the client or law requests otherwise

• avoid conflicts of interests

• do not act in the official capacity as an advocate for the client

• do not go beyond your own expertise or qualifications

• respect others. Consultants should respect the opinions, values, and beliefs of others different from their own

• ensure that all participation in research and data collection is voluntary and includes informed consent

• represent accurately potential services and outcomes to their employers

• maintain competence in their field of practice

Technology-based ethical issues

Beneficence: program planners need to justify why the chosen technology modality is best for participants (not the health promoter)

Transparency: informed consent processes and information provided by both participants and health promoters must be clear and accurate

Equity: given health disparities data, special attention should be paid to whom has access to the technological modality

Confidentiality: data security protocols must be employed to protect private participant data

Special populations: additional standards to verify participant identity must be employed and regulations for protecting special populations must be followed if participants are members of included categories

Negligence

is the failure to act in a careful or reasonable manner

Health Equity

is defined in Healthy People 2030 as achievement of the highest level of health for everyone

Health inequitites

are differences in health due to social, economic, and/ or environmental disadvantage or injustices

Factors that could lead to health inequities and influence an individuals health or community’s health are called social determinants of health

Social Determinants of Heath (SDOH)

can be barriers to health and include race or ethnic status, gender, mental health, disabilities, or location

Collection of data

collating or collection of social determinants of health data helps health education specialists to understand, investigate, and spread awareness about the causes of inequities. This data collection could include secondary data that are stratified on SDOH indicators and primary data collected through participatory methods (focus groups, community forums) from those experiencing inequities and primary data colelction

Advocacy

Educate or help advocate for support for a specific action or policy in communities. Could ensure the creation or policies, regulations, or rules that can impact behaviors and environmental conditions of all who reside in the community

Health Equity Checklist

Identify: Identify protective factors and health equities in a community and geographic region through community assessment, secondary data, and environmental surveys

Engage: Include presentation of populations affected by health issues. Engage the representatives in your leadership team or partnerships

Analyze: Select or design and implement interventions or strategies in which inequities are addressed

Review: Monitor and evaluate so that efforts to reduce health inequalities are successful. Conduct appropriate sub-analyses of data to assess differences in outcomes for populations due to your strategies or interventions

Theory

is a set of interrelated concepts, definitions and propositions that present a systematic view of events or situations by specifying relations among variables, in order to explain and predict the events or situations

• can be used to shape answers to the questions of why, what and how

  • can be used to help pinpoint what HES need to know before developing and organizing an intervention program

Theories and models are used to:

• identify targets for change in health promotion efforts

• select strategies for implementation based on known influences on behavior and design interventions,

• specify potential outcomes to be monitored, measured or compared in a program evaluation for an intervention

Intervention Mapping

Bartholomew and Collogues first introduced with Five steps:

1. program objectives

2. theory-based intervention methods and practical strategies

3. designing and organizing a program

4. adoption and implementation plans (sustainability)

5. program evaluation plans

6. needs assessment

This framework can be used to help HES plan and develop interventions (lifecycle from problem to cycle)

Mobilizing for Action through Planning and Partnerships (MAPP)

is a community-wide strategic planning framework for improving public health.

MAPP has 6 phased for community data collection

1. Phase One: organizing for success and partnership development

2. Phase Two: visioning: fathering collective vision of what the community should be

3. Phase Three: Conduct the 4 Assessments:

• Community Themes and Strengths Assessment: assessment of qualitative data on how communities perceive their health and quality of life

• Local Public Health System Assessment: measurement of how well the public health system partners collectively offer health services through the analysis of national public health performance standards

• Community Health Status Assessment: analyses of the health indicators about the population

• Forces of change: assessment of positive and negative external forces that impact health promotion

4. Phase Four: Identifying Strategic Issues: using gathered information from the 4 assessment to discern the strategic health and other issues that the community must address

5. Phase Five: Formulation of Goals and Strategies: Specifying goals and activities in a community health improvement plan

6. Phase Six: Action Cycle: Continuing with planning, implementation, and evaluation of the community plan

HES should identify both a planning model and an implementation model in this stage to

help identify the types of data that need to be collected to fully understand the complex influences on health

Transtheoretical Model (Individual Level)

often called the Stages of Change Model, many theories are incorporated, thus the term “transtheoretical”

Its planned interventions can be used to reach people where they are in their motivation for changing a particular behavior. This model has several major constructs: stages of change, processes of change, decisional balance, and self-efficacy. The Stages of Chance construct receives considerable attention due to its use in determining readiness to change. A person can be in any stage with any behavior and move back and forth through the stages depending on external factors affecting the individual

Transtheoretical Model: Prochaska and colleagues proposed that change is process, not an event, and that change occurs as people move through a series of stages to adopt a new behavior. The Stages are:

Precontemplation

Contemplation

Preparation

Action

Maintenance

Termination

Precontemplation

a person is not interested in addressing the problem; some people may be unaware of, or in denial about, the problem

Contemplation

person is aware there is a problem and intends to do something in the next six months

Preparation

person has taken steps and plans to address the problem in the next month

Action

person has taken action (change behavior) withing the past six months

Maintenance

person has maintained the behavior change for more than sic months

Termination

person has no temptation to return to the old behavior

Health Belief Model

is a popular behavior change model that has been extensively used to research over the years. Is an individual-level model to provide an understanding about why individuals did not act on information specific to prevention or disease detection

Health Belief Model: Six major constructs through to affect behavior change:

Perceived Susceptibility

Perceived Severity

Perceived Benefits

Perceived Barriers

Cues to Action

Self-Efficacy

Perceived Susceptibilty

there is risk for the disease

Perceived Severity

there are serious consequences to contracting/developing the disease

Perceived Benefits

there are benefits to taking action to prevent or control the disease

Perceived Barriers

there are consequences to taking action against the disease

Cues to Action

cues or triggers that encourage a person to take action

Self-efficacy

there is confidence in taking action against the disease

Theory of Reasoned Action (TRA)

TRA was developed by Icek Ajzen first to focus on relationships among attitudes, behaviors, and intentions

recognize behavioral intention as key in determining behavior and assume that behavior change is influenced by a persons attitude toward the outcome and the social or subjective norms of people important to the persons life

Theory of Planned Behavior (TPB)

TPB was built on the Theory of Reasoned Action with the behavior control construct added.

the construct of perceived behavioral control is added

HES should examine the individuals motivation to perform the behavior, determine what the individuals peers think of the behavior, and assess the difficulty the individual will have in performing the behavior

Social Cognitive Theory (SCT) by Albert Bandura (interpersonal level)

is that learning is an interaction between a person and his or her environment, cognitive processes, and behavior. Also known as Reciprocal Determinism

The several major construct associated with SCT are:

• Behavior capacity (knowledge and skills) : persons understanding of the information on health topic or behavior, and risks and benefits of performing a behavior & persons ability to do a behavior

• Outcomes expectation: persons judgment on the results of behavioral action

• Expectancies

• Reciprocal determinism

• Self-efficacy: persons confidence in his ability to do a behavior

• Observational learning: learning new information and behaviors by watching other do a behavior ]

• Social Support or reinforcement: encouragement and reinforcement a person gets from his or her networks of friends and relatives

Self-efficacy

a person confidence in performing a behavior and overcoming possible barriers to that behavior

Social Support

is the actual offering of support by other individuals in a persons life

• can take different forms, including tangible, informational, emotional and appraisal

• Tangible: offering material assistance (money, food)

• Emotional: provision of caring or comfort

• Informational: offering advice or information

• Appraisal: support of self-evaluation or assessment

Diffusion of Innovation Theory (Community Level)

is a community level theory that is used to describe the rate at which a new program or activity will spread throughout a group of people. People can fall into different categories of adopting change:

• Innovators: are the first to adopt the new idea or program

• Early Adopters: wait until after the innovators adopt

• Early Majority: adopt once the opinion leaders have done so

• Late Majority: adopt once the new idea or program becomes the norm

• Laggards: are the last to adopt or they may never adopt

In the theory, constructs related to the innovation are incorporated: they include relative advantage, compatibility, complexity, observability and trialability. HES integrate the idea into something already accepted in the community through communication

Community Organizing/ Mobilization

is a process in which community groups identify problems or goals for change, mobilize interna, and external resources, and deliver strategies to reach goals

Ecological Model

are focused on the interaction of the individual and the environment. Requires that HES be familiar with individual behavior change strategies as well as strategies to change the environment or physical surroundings.

Sallis and Owen proposed health behavior can be affected at five levels:

1. individual or intrapersonal

2. interpersonal

3. organizational

4. community

5. public policy

Evidence-based Public Health

refers top the application of observation, theory, and science-based experiments (evidence) to improve the health of populations

• these programs or policies are grounded in evidence that work from systemic reviews of articles on that intervention and their findings

Evidence- based Policies

Policy change to impact health status should include evidence that can be in two forms: quantitative (epidemiological or economic data, evaluation findings) or qualitative ( health experts testimonies, expert opinions, narrative accounts)

Culturally and linguistically appropriate services (CLAS)

are methods to improve the quality of services provided to all individuals

There are 15 CLAS standards that cover the topics of principle standard

1. Principle standard: offer effective, equitable, and respectful quality services and are that are responsive to diverse cultural beliefs and practices, preferred language and health literacy

2. governance and leadership: recruit, promote and support a workforce that is culturally or linguistically diverse and addresses the needs of the population of interest

3. communication and language assistance: offer easy to understand print and multimedia material for the population one serves

4. engagement, continuous improvement and accountability: conduct routine community analyses and develop programs or strategies that address diverse culture and language needs of the population. partner with community to develop culturally relevant programs or policies

According the the Prevention Institute (2004) the root causes of racial and ethnic disparities or inequities fall into four discrete yet often overlapping categories

1. individual and behavioral

2. societal

3. environmental

4. medical care

Bernal and Rodriguez designed a framework of eight overlapping dimensions for understanding and adapting planning for a new culture:

1. language

2. persons

3. metaphors

4. content

5. concepts

6. goals

7. methods

8. context

Technical Assistance (TA) us the provision of direct, hands on aid that builds capacity to complete with quality and prevention tasks. The focus is to

a) develop individual skills and the conditions to use the skills effectively

b) build effective organizations

c) strengthen interrelationships between organizations

d) create enabling environments for addressing health issues across social sectors

the provision of basic TA is to provide information and support in an episodic or short-term timeframe

TA methods can vary based on relationships and needs, some formats of TA include:

• one-on-one consultations

• coaching

• group-based capacity building

• informal and formal networking among colleagues of similar interests