BPK 340 - lec 2

entry points

where to focus health promotion efforts

issues

• from monitoring/surveys

• epidemiology

• CVD, diabetes, HI/AIDs etc

• most focus at the individual level

populations

• target at risk

settings

• where people live and engage

reciprocal causation

theory that ones’ behavior both influences and is influenced by personal-individual factors and the surrounding environment and that the environment is influenced by the individuals in it

settings based health promotion

places, location where the health promotion happens

captured audience

• individually focused health promotion

• education, mass media, skill development

• stress reduction, lifting techniques, nutrition programs

structure and culture redesign

• indiidual is powerless

• ex. ecological model of health promotion

1. individuals and structures interacting creating complexity

2. focus on changing the whole system to be more health enhancing

Models

a way of looking at a system or thing

• a framework to guide a process

Theory vs model

theory = blueprint of why change happens

model = toolkit for how to apply it

theory

an integrated set of propositions that serves as an explanation for a phenomenon

• introduced after a phenomenon has already revealed a systematic set of uniformities

a systematic arrangement of fundamental principles that provide a basis for explaining certain happenings of life

• theory of planned behavior

• social cognitive theory

health promotion theory

purpose: explains why and how people behave in certain health-related ways

nature: based on tested principles, evidence and research

focus: identifies the mechanisms influencing behavior (eg, beliefs, motivation, environment

ex. social cognitive theory - explains behavior change through interactions b/w personal factors, environment, and behavior

theory of planned behavior

Behavior is driven by intentions

intentions shapped by

• attitude toward behavior

• subjective norms (social pressure)

• perceived behavioral control (confidence in ability)

suggest that likelihood of an individual engaging in a health behavior is influenced by their intention to perform the behavior, which is shaped by attitudes, subjective norms, and perceived behavioral control

• only psychological variables influence health behaviors

• perceptions and beliefs of others can influence behavior

• interventions include mass communication designed to change attitudes

social cognitive theory

• learning happens by observing, imitating and modeling others

• behavior is shaped by personal factors actions and the environment (reciprocal determinism)

• cognitive processes, self-regulation, and self- efficacy are key to learning and behavior change

argues that our knowledge, beliefs are influenced by observing what other do and what we see ( media)

• learning through observation

• knowledge and beliefs are shaped by watching other ( media)

• we copy behaviors if we think they are rewarded

• we avoid behaviors if we think they are punished

model

a subclass of a theory

• provides a plan for investigating and or addressing a phenomenon

• does not attempt to explain the processes underlying learning, but only to represent them

• provides the vehicle for applying the theories

health belief model

transtheoretical model

health promotion model

purpose: provides a structured framework for appying theories in real-world health promotion

nature: often combines multiple theories or concepts into a practical plan

focus: organizes ideas into avisual or conceptual tool to guide interventions

ex. PRECEDE-PROCEED model - a comprehensive planning framework for designing, implementing and evaluating health promotion programs

health belief model

psychological variables influence health behaviors

interventions are knowledge based programs which include health education and risk appraisal

transtheoretical model

• stages of change model - outlines the steps through which people progress as they make changes

• primarily psychological

• some of the processes of change include social and physical environmental factors

• staged-matched cognitive behavioral modification

precontemplators

contemplators

action

maintenance

termination

models of behavior change

not meant to compete

different ways of looking at how people change

all models have strength and weaknesses

• no single model captures all factors

• each offers insight to guide interventions

• criticism: individual models can be too simplistic (reductionist)

ecological model of health

health and wellbeing are affected by a dynamic interaction among biology, behavior and the environment

• This interaction changes over the life course of individuals, families, and communities

• accounts for the social, cultural and economic factors that affect health behavior

main focus is on how environment shapes behavior

• Multiple levels of influence on a specific behavior

ex. mask wearing

Interpersonal level

friends, family, social network

organizational level

workplace, school

community level

cultural values, norms; built environment

public policy

public service to enforce safety for everyone; mandatory

ecological model

attempt to understand how the individual interacts with their environment and shoes opportunities for influence

PHAC

public health agency of canada

• part of the federal health portfolio

• focus on protecting agains threats to public health, preventing and reducing diseases and injury, and promoting health, wellbeing and equity

mision: improve the health of all people and communities in canada by addressing public health priorities through science, innovation, service delivery and collaborative action

vision: health, wellbeing and equity for all ppl and communities in canada

• promote health

• prevent and control chronic diseases and injuries

• prevent and control infectious diseases

• prepare for and respond to public health emergencies

• strengthen public health collaboration b/w governmetns

• facilitate national approaches to public health policy and planning

• apply international research and development to canada’s public health programs

PHACs population health promotion model

ottawa charter, determinants of health and ecological model

• multiple point of entry to planning and implementation are essential - need for overall coordination of activity

assumptions

• health of individuals and groups are a combined result of their own health practices and the environment

• in order to enjoy optimal health, ppl need to meet their needs

• health care, health protection and disease prevention initiatives complement health promotion

precede/ proceed model

more speciic in the steps involved in creating a potential health promotion/public healthj intervention

• rpocess for doing health and community work

• focuses on the community

• participatory process

Precede model

Predisposing

Reinforcing

Enabling

Constructs in

Educational

Diagnosis

Evaluation model

• complex model

• emphasizes importance of careful planning

• uses a diagnostic approach

emphasizes

a. goal states desired

b. path to these goal states

c. supportive organization

Proceed model

Policy

Regulatory, and

Organizational Constructs in Educational and

Environmental Development

• includes more on evaluation of the program

Phase 1 - PP model

Social assessment and situational analysis

What quality of life issues concern the people to be served?

• problems, priorities

Phase 2 - PP model

Epidemiological assessment

Identify specific health problems linked to QOL issues in phase 1

• monitoring surveillance

• mortality, morbidity, disability

• genetics, behavior, environment

• prioritizing

Phase 3 - PP model

behavioural and lifestyle assessment and environment assessment

• identify specific health behaviours that need to be changed

• be aware of environmental factors that already influence these behaviours

• how do these influence factors in the next stage

Phase 4 - PP model

education and ecological assessment

• consider the predisposing, reinforcing and enabling factors that affect the factors from the previous stages

Predisposing factors - Phase 4a

• exert their effects prior to a behaviour occuring

• exist within the individual

• facilitate or hinder motivation for change

• ex. knowledge, attitudes, beliefs, values, confidence, demographic factors (hard to change), self efficacy, readiness for change, behavioral intentions

Enabling factors - Phase 4b

• barriers/opportunities created by society/people that make it easier or harder for a person or group to change

• make it possible for a motivation to be realized - enable people to act on their predisposition

include

• policies, law

• availability of resources

• cost of resources

• social support

• skills

Reinforcing factors - phase 4c

• providing feedback, facilitating adherence

• come into play after a behavior has begun

• contribute to persistence or extinction of the bhavior

include

• praise

• reassurance

• rewards

• punishment

• symptom relief

Phase 5 - PP model

Intervention alignment and administrative/policy assessment

• identify best practices for designing the intervention

• determine if capabilites and resources are available to develop and implement the program

• determine which policies, laws, admisitrative factors can posistvely or negatively affect implementation

phase 6 - PP model

implementation

• start the intervention according to the things you planned out during the precede stage

phase 7 - PP model

process evaluation

• monitor our implementation process to make sure we are doing what we said we were going to do in the Precede stage

• not about outcomes, about the process

Phase 8 - pp model

impact evaluation

• measure whether we are having the impact we set out to have

• Are ppl changing their behaviour?

• Has environment changed in the way we thought it would?

Phase 9 - outcome evaluation

we measure whether we are having a larger impact on the QOL factor we set out to improve in phase 1

ex. how is physical health better?

• if the larger issue takes years to develop then it may take years before we truly know if your intervention had an effect on this Phase 1 issue

determinants that can influence behavior change

• motivation

• attitudes

• norms

• self-efficacy

• locus of control

• barriers to change

motivation

the internal drive or desire to initiate and maintain health related behaviours in order to achieve specific goals or outcomes

attitudes

how people view the pros and cons of a behavior

• cons may be more relevant to those unmotivated to change, while pros are more important for those already ready to change

• emotional cons have been shown to be more powerful than rational cons

norms

shared expectation within a group or society about which health-related behaviors are acceptable, typical or desirable

norm = a pattern or trait taken to be typical in the behavior of a social group

• norms can be observed behaviorally

subjective norms

how we perceive what other think and what they defines as normal/acceptable

• a person’s belief about whether important people in their life think they should engage in a behavior

self-efficacy

an individual’s confidence in their ability to successfully perform a specific health-related behavior, even when faced with challenges or barriers

• the belief in one’s capacity to perform a specific task or reach a specific goal

affected by

• immediate goal vs long term goal

• feedback

how is self-efficacy improved

• mastery experiences

• modeling - comparing capabilities to others

• social persuasion

• modifying physiological states - stress, fatigue

locus of control

the extent to which a person believes their health s controlled by their own actions ( internal locus) vs by the outside dorces such as luck, fate, or powerful other ( external locus)

• you make things happen vs things happen to you

barriers to change in health promotion

individual - low knowledge, low confidence, negative beliefs

social - cultural norms, limited support, economic challenges

structural - poor resources access, transportation issues, system constraints