L11 Community Health Education: Theories, Models, and Principles

Suggest the importance of community Health (7)

• Promotes disease prevention

• Enhances quality of life

• Reduces healthcare costs

• Addresses health disparities

• Empowers individuals and communities

• Strengthens social connections

• Supports sustainable development

which level of prevention does the following context refers to ?

• To prevent the onset of diseases and health conditions through education, behavior change, and environmental modifications.

• By providing information and resources, community health education empowers individuals to adopt healthy behaviors and reduce their risk of developing preventable illnesses.

Primary Prevention

• target healthy individual

• to reduce incidence

which level of prevention does the following context refers to ?

• Early detection and prompt intervention to mitigate the impact of diseases.

• Screening, self- examinations, and diagnostic tests to identify diseases in their early stages

Secondary prevention

which level of prevention does the following context refers to ?

• To minimize the negative consequences of existing diseases and prevent complications.

• Treatment plans, make lifestyle modification for better health outcomes

• Reduce burden of chronic disease

Tertiary prevention

• target sb alr have the disease

Which level of health behaviour does the following Context refers to ?

• Focuses on individual characteristics that influence behavior, such as: knowledge, attitudes, beliefs, motivation, self-concept, past experiences, skills, and intentions

Intrapersonal level

Which level of health behaviour does the following Context refers to ?

• Examines social influence and relationships

• Explores support systems, family, friends, and peers

• How social interactions impact an individuals’ behavior

Interpersonal level

Which level of health behaviour does the following Context refers to ?

• Focuses on the broader context in which individual behavior occurs

• Recognizes that behavior is affected by and interacts with multiple levels of influence, including the physical environment, community, institutional structures, and policy systems

• Broader ontext

Ecological, structural, ad systemic levels

List the types of behaviour change theories at intrapersonal level (4)

1. Health Belief Model (HBM)

2. Theory of Planned Behavior (TPB)

3. Stages of Change Model/Transtheoretical Model (TTM)

4. Information-Motivation-Behavioral Skills Model (IMB)

Suggest the core concepts (4) and purpose of Health Belief Model

1. Perceived susceptibility

2. Perceived severity

3. Perceived benefits

4. Perceived barriers

Purpose:

• Explains and predicts individual changes in health behaviors

• Emphasizes the role of personal beliefs in decision-making processes

Suggest examples of modifying factors that can affect the core concepts of the Health Belief Model

• Demographic, structural and psychosocial factors that may moderate relationships between health beliefs and health behaviors

  • class, gender, age, personality, peer group pressure…

Example

• Cancer is more prevalent among older people, a person’s age may moderate the relationship between perceived threat and cancer screening behavior.

Suggest the core concepts of Theory of Planned Behaviour (3)

Attitude: Personal evaluation of the behavior (favorable or unfavorable)

• What do I think?

Subjective Norm: Belief about whether key people approve or disapprove of the behavior

• What do other think?

Perceived Behavioral Control: Belief in one's own ability to perform the behavior

• Can I do it?

These three factors lead to an intention: your desire to perform the behavior.

What does the following intervention examples aims at changing which elements (core concepts) of Theory of Planned Behaviour ?

• Educational campaigns to inform individuals about the benefits of xxxxx…

• Communication strategies: Sharing testimonials 感言, using using persuasive messages, and presenting factual information about the effectiveness of xxxxx…

Attitude

• Individuals’ attitudes

What does the following intervention examples aims at changing which elements (core concepts) of Theory of Planned Behaviour ?

• Peer education programs, involvement of influential community leaders, or social marketing to make condom use more socially acceptable and expected.

Subjective Norm

• Social presses individuals feel concerning whether they should or not perform a behavior

What does the following intervention examples aims at changing which elements (core concepts) of Theory of Planned Behaviour ?

• Ensuring that condoms are readily available and affordable,

• Offering demonstrations on how to use condoms correctly, and

• Addressing myths and misconceptions that may make individuals feel that condom use is not within their control.

Perceived Behavioural Control

• Perception of the ease or difficulty of performing the behaviour

What does the following intervention examples aims at changing which elements (core concepts) of Theory of Planned Behaviour ?

• Using commitment devices, such as pledges or goal setting

Behavioural Intention

• Motivational factor that represents the likelihood of an individual engaging in a behavior

Suggest the core concepts of Stages of Change Model / Transtheoretical Model (TTM)

1. Pre-contemplation

2. Contemplation

3. Preparation (determination)

4. Action

5. Maintenance

Which stage does the following context refers to in the Stages of Change Model / Transtheoretical Model (TTM) ?

• people do not intend to take action in the foreseeable future (defined as within the next 6 months). People are often unaware that their behavior is problematic or produces negative consequences.

• People in this stage often underestimate the pros of changing behavior and place too much emphasis on the cons of changing behavior.

Pre-contemplation

Which stage does the following context refers to in the Stages of Change Model / Transtheoretical Model (TTM) ?

• people are intending to start the healthy behavior in the foreseeable future (defined as within the next 6 months).

• People recognize that their behavior may be problematic, and a more thoughtful and practical consideration of the pros and cons of changing the behavior takes place, with equal emphasis placed on both. Even with this recognition, people may still feel ambivalent 矛盾的 toward changing their behavior.
  

Contemplation

Which stage does the following context refers to in the Stages of Change Model / Transtheoretical Model (TTM) ?

• people are ready to take action within the next 30 days. People start to take small steps toward the behavior change, and they believe changing their behavior can lead to a healthier life.

Preparation

Which stage does the following context refers to in the Stages of Change Model / Transtheoretical Model (TTM) ?

• people have recently changed their behavior (defined as within the last 6 months) and intend to keep moving forward with that behavior change. People may exhibit this by modifying their problem behavior or acquiring new healthy behaviors.

Action

Which stage does the following context refers to in the Stages of Change Model / Transtheoretical Model (TTM) ?

• people have sustained their behavior change for a while (defined as more than 6 months) and intend to maintain the behavior change going forward. People in this stage work to prevent relapse to earlier stages.

Maintenence

(Termination - No longer tempted to lapse into old behavior)

What is the core concepts of Information-Motivation-Behavioral Skills Model ?

1. Information = Knowledge about the behavior and its consequences

2. Motivation = Personal attitudes towards the behavior and perceived social support

3. Behavioral skills = competencies and self-efficacy an individual has to carry out a specific behavior

   • CRITICAL COMPONENT that it determine an individual’s ability to successfully apply information and motivation to perform a behavior, e.g.

     • Practical skills: e.g. correct use of condom, measuing blood glucose level

     • Decision-Making skills: e.g. choosing healthy foods

In the example of Promoting breastfeeding in the community,

which core concepts does the following intervention targeting on in the Information-Motivation-Behavioral Skills Model ?

• Provide accurate, evidence-based information about the benefits of breastfeeding for both infants and mothers.

• Address common myths and misconceptions about breastfeeding

• Educational sessions by expert in covering the basics of breastfeeding

Information

In the example of Promoting breastfeeding in the community,

which core concepts does the following intervention targeting on in the Information-Motivation-Behavioral Skills Model ?

• Emphasizing the health benefits, emotional bonds, and the economic advantages

• Create social campaigns that normalize breastfeeding in public and within the community. Use support groups, social media, and community events to celebrate and encourage breastfeeding as a standard practice.

• Provide incentives for breastfeeding, such as employer support, maternity leave policies that facilitate breastfeeding, and recognition programs for "breastfeeding-friendly" public places.

(Personal & Social) Motivation

In the example of Promoting breastfeeding in the community,

which core concepts does the following intervention targeting on in the Information-Motivation-Behavioral Skills Model ?

• Offer hands-on breastfeeding classes that teach various holds, how to latch the baby onto the breast, and how to recognize signs of a good latch and sufficient milk intake.

• Teach strategies for common breastfeeding challenges, such as dealing with engorgement, sore nipples, or low milk supply. (problem-solving)

• Establish breastfeeding support groups led by trained professionals

Behavioral skills

List examples of theories that address behavior change at the interpersonal level (5) Also state the purpose of these theories

1. Social Network Theory

2. Social Norms Theory:

3. Social Support Theory

4. Social Comparison Theory

5. Diffusion of Innovations Theory

Purpose:

• These theories suggest that people are influenced by the behaviors, norms, attitudes, and support of those around them. Ultimately, affect our health.

Which theory does the following description refers to ?

• Individuals influence each other’s behaviors through observing others (modeling); by access to information, material resources, and emotional support; and by social norms.

Social network theory

Which theory does the following description refers to ?

• Individuals learn not only from their own experiences, but also by observing and imitating others’ actions and behaviors (and the rewards and repercussions of those actions).

Social Learning Theory (SLT)

Which theory does the following description refers to ?

• individuals not only look at the behaviors of others as a guide, they also compare their own behaviors to those of others, such that an individual’s behavior is based on comparisons made with others, including the reference groups.

Social Comparison Theory

Which theory does the following description refers to ?

• It refers to how new behaviors, ideas, programs, and innovations diffuse through social systems. Within a social system, some individuals (innovators, or opinion leaders) are the first to adopt a new behavior, and their adoption has a strong influence on others adopting the behavior.

Diffusion of Innovations Theory (DIT)

Which theory does the following description refers to ?

• Publicize information about the actual prevalence of healthy behaviors within the community to correct misperceptions.

• For example, if most individuals in a community do not smoke, making this information widely known can discourage smoking initiation.

Social Norms Theory

What is peer-led programme / approach ?

• An approach of interpersonal level health promotion

• It is grounded in the idea that individuals are more likely to be influenced by and learn from people who they perceive as similar to themselves, such as peers.

List the benefits of peer-led health promotion programs (5)

1. Relatability: Peers who lead the program may share similar age, social, cultural, or experiential backgrounds with the participants. This can make the health information provided more relevant and relatable.

2. Credibility: Information may be more credible 可信的 when it comes from a peer, as they are seen as equals and may be perceived as having no ulterior motives for promoting certain behaviors.

3. Communication: Peers may communicate more effectively with each other using language and examples that are culturally and socially relevant.

4. Empathy and Support: Peer leaders may better understand the challenges and concerns of their peers and offer more empathetic support.

5. Role Modeling: Peer leaders can serve as positive role models, demonstrating healthy behaviors within their social group.

What is Social capital ?

It refers to the networks of relationships among people who live and work in a particular society, enabling that society to function effectively.

Explain how does peer-led programs support the elements involved in Social Capital (5)

Trust: The level of confidence that people have in each other and in social institutions

• Strengthen trust within the community as participants often share similar backgrounds and experiences, fostering a sense of mutual understanding

Norms and Sanctions: usually unwritten rules about how to behave, and the sanctions 制裁, either positive or negative, that encourage adherence to these norms

• By working together towards common health goals, peer-led programs can enhance social cohesion 社會凝聚力 and a sense of belonging within the community.

Networks and Connections: such as family, friends, colleagues, or community groups, which can provide support and access to resources

• These programs create and expand social networks, providing individuals with connections that can be valuable for various forms of support

• The networks established through peer-led programs can facilitate the sharing of resources, including information, emotional support, and practical assistance.

Civic Engagement: participation of individuals in civic activities and organizations, which contributes to a sense of shared responsibility for community well-being

• Engaging peers in health promotion can lead to increased civic engagement as individuals become more involved in community activities and decision-making.

Collective Efficacy: shared belief in a group's ability to come together and effectively achieve objectives or exert control over their environment

• Peers taking leadership roles can empower both the leaders and participants, enhancing collective efficacy and the community's ability to address other issues.

Sustainability: Programs that build social capital are often more sustainable, as the community takes ownership of the health intervention, maintaining it beyond the initial implementation phase.

List the Behavior change theories that address ecological, structural, and systemic levels (2)

1. Socio-ecological Model (SEM)

2. Structural Violence Theory

Which theory does the following description refers to ?

• the interrelationships between individuals and the social, physical and policy environment.

Socio-ecological model

What are the levels involved in Socio-ecological model ?

1. Individual level

2. Interpersonal level

3. Organisational level

4. Community level

5. Policy level

Which levels does the following intervention refers to in Socio-ecological model ?

• Education and Awareness, campaigns, social media

• Behavior change motivation, incentives

• Skills development through training programs

Individual level

Which levels does the following intervention refers to in Socio-ecological model ?

• Social support groups

• Involving family and friends in education program

• Partner notification and communication

• e.g. find Keung To promotion

Interpersonal level

Which levels does the following intervention refers to in Socio-ecological model ?

• Healthcare provider training

• Clinics accessibility for screening

• Introduce mobile screening units or at-home testing kits to increase access.

Organisational level

Which levels does the following intervention refers to in Socio-ecological model ?

• Engage local organizations, clubs, and leaders to advocate for chlamydia screening.

• Organize community events

• Work with community health workers to conduct outreach in areas with low screening rates

• Partner with local businesses, schools, and religious institutions to disseminate information and offer on-site screening.

Community level

Which levels does the following intervention refers to in Socio-ecological model ?

• Advocate for policies that mandate and fund chlamydia screening programs.

• Work towards policies that protect the privacy and rights of individuals seeking screening.

• Insurance: Collaborate with insurers to cover chlamydia screening at low or no cost

• Cost: Seek funding for programs that provide free or subsidized screening for uninsured individuals

Policy level

Which theory does the following description refers to ?

• Systematic ways in which social structures harm or otherwise disadvantage individuals

• it's embedded in the political and economic organization of our social world

• it causes injury to people (typically, not direct violence, such as by a gun or physical assault, but rather indirect violence through social neglect or social inequalities)

Structural Violence Theory

• Structural violence is invisible in the sense that it's not the result of a specific action but is instead a feature of the social, economic, and political organization.

Suggest examples of structural violence

• racism, sexism, heterosexism, classism, and xenophobia 仇外心理,

  • which can lead to discrimination in the labor market, education, health care, and the legal system.

What are the purpose of applying Structural Violence Theory ? (5)

• Help us understand the social determinants of health (L3)

  • socioeconomic status, education, the physical environment, employment, and social support networks, as well as access to health care

• Illuminates the root causes of health disparities observed in different population groups

  • e.g. Poverty & racism

• Supports the argument for health promotion policies that target the social determinants of health

  • e.g. advocating for better housing, education, and employment policies, which can, in turn, improve community health

• Empowering communities to take control over their health and environment, which help to identify and address the structural barriers to their health and well-being

• Suggest collaboration across different sectors, such as public health, education, housing, and labor to work more effectively to address the underlying structural causes of poor health.

What are the principles of community health education ? (5)

• Needs Assessment: Conducting a thorough assessment of community health needs as a foundation to inform program planning.

• Target Population: Identifying and understanding the characteristics and needs of the population you aim to educate.

• Culturally Appropriate Approaches: Recognizing and respecting cultural diversity to ensure effective communication and engagement, aim to address health disparities

• Collaboration and Partnerships: Working with community organizations, healthcare providers, and stakeholders to maximize impact.

• Evaluation and Feedback: Assessing the effectiveness of community health education programs and making adjustments as needed.

What are the sub-principle of the Principles of “Needs Assessment” in Community Health Education ? (5)

1. Systematic approach

2. Stakeholder engagement

3. Cultural sensitivity

4. Data-driven decision making

5. Ongoing evaluation

Which sub-principle does the following strategies in the Principles of “Needs Assessment” in Community Health Education refers to ?

• Use a variety of data collection methods, such as surveys, interviews, focus groups, and observation.

• Analyze data to identify health issues, risk factors, and community assets

Systematic approach

Which sub-principle does the following strategies in the Principles of “Needs Assessment” in Community Health Education refers to ?

• Engage community members, including individuals, groups, and organizations, throughout the needs assessment process.

• Seek input from diverse perspectives to ensure a comprehensive understanding of community needs.

• Foster collaboration and partnerships for shared decision-making.

Stakeholder engagement

Which sub-principle does the following strategies in the Principles of “Needs Assessment” in Community Health Education refers to ?

• Employ culturally sensitive data collection methods and communication strategies.

• Consider cultural beliefs, practices, and language preferences to ensure inclusivity

Cultural sensitivity

Which sub-principle does the following strategies in the Principles of “Needs Assessment” in Community Health Education refers to ?

• Use evidence-based data to inform program planning and resource allocation.

• Analyze and prioritize identified needs based on their prevalence, severity, and impact on the target population

• Data-driven decision making

Which sub-principle does the following strategies in the Principles of “Needs Assessment” in Community Health Education refers to ?

• Continuously monitor and evaluate the effectiveness of community health education interventions.

• Collect feedback from participants and stakeholders to assess program outcomes and impact.

• Use evaluation findings to refine and improve future needs assessments and program strategies.

Ongoing evaluation

What should we focus about in the principle of “Target population” in the community health education ? (2)

• Analyze demographics

• Consider health disparities: Determine if certain populations are disproportionately affected by specific health issues.

  • This information can help prioritize target populations that may require additional attention.

Suggest the sub-principle of “Culturally Appropriate Approaches” in Community Health Promotion / ie. how to attain this principle

• Understanding and acknowledging cultural diversity and its impact on health beliefs and behaviors.

• Avoiding stereotypes and biases to ensure respectful and inclusive practices.

• Involving community members and stakeholders in program planning, implementation, and evaluation.

• Seeking their input, insights, and active participation to ensure relevance and sustainability.

• Using culturally appropriate language, including bilingual materials and interpreters when needed.

• Ensuring clear and effective communication to overcome language barriers.

• Tailoring interventions to align with cultural norms, values, and traditions.

• Incorporating culturally relevant examples, visuals, and narratives to enhance engagement.

In the principle of “Collaboration and partnership” (with NGOs) in Community Health Promotion, suggest the role of NGOs

• Provide expertise and specialization

• Establish community engagement and trust

• Resources mobilization (funding, volunteers, materials)

In the principle of “Collaboration and partnership” (with NGOs) in Community Health Promotion, what are the benefits to collaborate with NGOs ?

• Their networks extend the reach and impact of health promotion programs.

• NGOs bring a diverse range of skills, experiences, and perspectives to the table. Their collaboration enhances the overall effectiveness and quality of health promotion initiatives.

• NGOs often have long-term commitments to the communities they serve.

• Collaboration with NGOs can help ensure the sustainability and continuity