CPH – Social and Behavioral Sciences

Acculturation
A gradual process through which an individual adopts the behavioral norms, attitudes and beliefs of a culture other than his own
Adherence
Closely following or sticking to a plan or protocol. In the context of health promotion, we use the term adherence to refer to individuals taking their medications as prescribed (i.e. adherence to antiretroviral therapy) or following program protocols (i.e. sticking to a diet and exercise plan). In the context of health promotion, adherence can also refer to following the implementation protocol when delivering a health promotion program, conducting interviews, etc.
Asset mapping
A component of community capacity assessment and community development that involves conducting an inventory of individual, group and community resources, often physically designating them on a geographical map. A capacity assessment offers an alternative to a needs-based approach to community health and “is a measure of actual and potential individual, group and community resources that can be inherent and/or brought to bear for health maintenance and enhancement.” 25 Once assets are “mapped,” efforts are directed at mobilizing, strengthening and supplementing them while working to achieve a common vision.
Behavioral capability
An individual’s knowledge and skills related to a specific health behavior. In order for an individual to engage in a particular behavior, that individual must first know what the behavior is and how to successfully perform it. Behavioral capability is a key construct of the Social Cognitive Theory.
Behavioral factors
The patterns of behavior of individuals and groups that protect or put them at risk for a given health or social problem
Behavioral intention
Mental state in which the individual expects to take a specified action at some time in the future
Behavioral objective
Statement of desired outcome that indicates who is to demonstrate how much of what action by when .”
Behavioral risk
Typically modifiable behavior, like smoking or lack of physical activity, which puts an individual at risk for a negative health outcome
Best practices
Recommendations for an intervention, based on a critical review of multiple research and evaluation studies that substantiate the efficacy of the intervention in the populations and circumstances in which the studies were done, if not its effectiveness in other populations and situations where it might be implemented
Change agent
In the context of Diffusion of Innovations, a change agent is “an individual who influences clients’ innovation-decisions in a direction deemed desirable by a change agency.” The change agent’s functions are often to develop a perceived need for change, facilitate information-exchange, identify a client’s problems, develop a client’s intentions to change, motivate the movement from intentions to action, support long-term adoption of the change, and help the client achieve self-reliance.
Coalition
Group of organizations or representatives of groups within a community joined to pursue a common objective
Co-morbidity
Having more than one illness or condition that compromises quality of life at the same time
Communication theories
In the context of public health, communication theories are meant to describe how communication processes impact health behavior change and how communication strategies can be used strategically to motivate behavior change. Although there are a number of communication theories and concepts, four that are particularly relevant to public health include the knowledge gap, agenda setting, cultivation studies, and risk communication . The knowledge gap refers to the fact that individuals with more formal education tend to be more knowledgeable about many issues when compared to those with less formal education; therefore, “an increasing flow of information into a social system is more likely to benefit groups of higher socioeconomic status than those of lower SES,” thereby contributing to health disparities and other inequities. Knowledge gaps can be modified by content and channel factors, social conflict and mobilization, community structure, and individual motivational factors. Agenda-setting refers to the ability of the mass media to influence public opinion and priorities, particularly in relation to politics and policymaking. Cultivation studies investigate “the impact the mass media have on our perceptions of reality.”
Community
Specific group of people, often living in a defined geographical area, who share a common culture, values and norms, are arranged in a social structure according to relationships which the community has developed over a period of time. Members of a community gain their personal and social identity by sharing common beliefs, values and norms which have been developed by the community in the past and may be modified in the future. They exhibit some awareness of their identity as a group, and share common needs and a commitment to meeting them
Community-based interventions
Programs designed to focus on healthful changes in either subgroups or localized populations
Community-based participatory research (CBPR)
Collaborative process that equitably involves all partners in the research process and recognizes the unique strengths that each brings. CBPR begins with a research topic of importance to the community with the aim of combining knowledge and action for social change to improve community health and eliminate health disparities
Community capacity
Combined assets that influence a community’s commitment, resources, and skills used to solve problems and strengthen the quality of life for its citizens
Community organization
Set of procedures and processes by which a population and its institutions mobilize and coordinate resources to solve a mutual problem or to pursue mutual goals
Consciousness raising
Process of “learning new facts, ideas and tips that support the healthy behavior change.” Efforts to increase awareness about the causes and consequences of a disease or unhealthy behavior during a media campaign would be considered consciousness raising. Consciousness raising is a process of change included in the Transtheoretical model that is most appropriate for individuals in the earliest stages of change (precontemplation and contemplation).
Cues to action
Strategies to activate one’s readiness” to engage in a particular behavior or activity. A cue to action can be either an internal or external stimulus that motivates a person to act. Cues to action is a key construct in the Health Belief Model.
Cultural competence
Design, implementation, and evaluation process that accounts for special issues of select population groups (ethnic and racial, linguistic) as well as differing educational levels and physical abilities
Decisional balance
Relative weight an individual places on the perceived pros and cons of changing or engaging in a certain behavior. Typically, the pros of change need to outweigh the cons of change before an individual will be ready to take action and maintain a behavior change. Decisional balance is a key construct in the Transtheoretical model.
Determinants of health
Range of personal, social, economic and environmental factors which determine the health status of individuals or populations
Diffusion of innovations (DOIs)
Community-level theory that attempts to describe the rate and process of the adoption of new ideas and behaviors in a specific population or between populations. An innovation is defined as “an idea, practice or object that is perceived as new by an individual or other unit of adoption,” while diffusion is defined as “the process by which an innovation is communicated through certain channels over time among the members of a social system.” The process of diffusion occurs over the course of five stages: innovation development, dissemination, adoption, implementation, and maintenance. The adoption stage requires that an individual: 1) has knowledge of the innovation (has an awareness that the innovation exists, knowledge of how to use the innovation and how it works); 2) goes through a process of persuasion or attitude development, in which the individual discusses the innovation with others and forms a favorable or negative attitude toward it; 3) decides to adopt the innovation; 4) implements, or begins to use the innovation; and 5) goes through a process of confirmation, in which the individual integrates the innovation into his life and recommends it to others. In general, not everyone adopts an innovation at the same time. Diffusion of Innovations categorizes individuals into five groups, based on when they adopt an innovation: innovators are the first to adopt, followed by early adopters , then early majority adopters , followed by late majority adopters and finally laggards . The process of adoption in a population over time, as described by DOI, roughly follows a standard normal distribution: early majority adopters and late majority adopters are within one standard deviation of the mean; early adopters and laggards are within two standard deviations; and innovators are within three standard deviations of the mean. There are certain attributes of an innovation that determine the speed and extent of its diffusion. These attributes include: the relative advantage of the innovation over existing alternatives; its compatibility with the intended audience; its complexity , or ease of use; its trialability , or whether or not someone can try the innovation before deciding whether or not to adopt it; the observability or measurability of its results; its likely impact on social relations ; its reversibility ; its communicability , or how easily and clearly it can be understood; the time required to adopt the innovation; the level of risk or uncertainty associated with its adoption; the level of commitment required to use the innovation effectively; and the modifiability of the innovation over time.
Early adopters
Those in the population who accept a new idea or practice soon after the innovators (but before the middle majority), and who tend to be opinion leaders for the middle majority
Ecological approaches/levels
Recognize the multiple levels of influence on and the varying nature of determinants of health. They view health behavior as both affected by and affecting the physical and social environment (reciprocal determinism). They move beyond a “victim blaming,” individual-level approach to health promotion, emphasizing the use of multiple strategies to impact determinants of health, partnerships between multiple sectors to enhance health promotion efforts, and targeting change at multiple levels of intervention. The levels of an ecological approach in health promotion include intrapersonal factors, interpersonal processes and primary groups, institutional factors, community factors, and public policy.
Empowerment
Social action process that promotes participation of people, organizations and communities in gaining control over their lives in their community and larger society. With this perspective, empowerment is not characterized as achieving power to dominate others, but rather power to act with others to affect change.” 6 “In health promotion, empowerment is a process through which people gain greater control over decisions and actions affecting their health
Environment/environmental factors
Factors that influence an individual’s behavior but are physically external to the individual. The environment/environmental factors are explicitly important in social ecological approaches to health education and health promotion, as well as in Social Cognitive Theory.
Ethics in health promotion and health promotion research
Ethical principles in health education and health promotion practice and research are similar to those outlined in the Belmont Report and earlier ethical codes and include principles of respect for persons, beneficence, and justice. In health promotion practice and research, these ethical principles call for informed consent and voluntary participation, a commitment to preserve participant privacy, equitable inclusion in programs and research, a protection of vulnerable populations, and careful efforts to maximize benefits and minimize risks for participants. A unified code of ethics for the health education profession was adopted in 1999, outlining each health educator’s responsibilities to the public, to the profession, to employers, in delivering health education, in conducting research and evaluation, and in professional preparation. The code of ethics is available at www.cnheo.org.
Evaluation
Comparison of an object of interest against a standard of acceptability.” In health education and health promotion, evaluation is typically thought about in three distinct phases: formative, process and summative
Evidence-based practice
Program decisions or intervention selections made on the strength of data from the community concerning needs and data from previously tested interventions or programs concerning their effectiveness, sometimes using theory in the absence of data on the specific alignment of interventions and population needs
Feedback
Information provided to individuals based on their individual characteristics or based on comparisons with others. Major types of feedback, in the context of health communication and communication technology, include personal feedback, normative feedback, and ipsative (or iterative) feedback
Personal feedback
Refers to the information that respondents obtain about the answers they have provided
Normative feedback
Refers to the information respondents obtain when comparing their responses with the responses of another group
Ipsative (iterative) feedback
Refers to a comparison between a person’s most recent status and that found at previous assessments
Focus group
Carefully planned series of discussions designed to obtain perceptions on a defined area of interest in a permissive, nonthreatening environment
Formative evaluation
Any combination of measurements obtained and judgments made before or during the implementation of materials, methods, activities or programs to discover, predict, control, ensure, or improve the quality of performance or delivery.” This can include the combination of needs assessment, pilot testing, process evaluation, etc.
Formative research
Assesses the nature of the problem, the needs of the target audience, and the implementation process to inform and improve program design. Formative research is conducted both prior to and during program development to adapt the program to audience needs
Common methods of formative research
Literature reviews, reviews of existing programs, and surveys, interviews, and focus group discussions with members of the target audience.”
Gatekeeper
Individual who formally or informally controls aspects of a community and/or access to a priority population. Gatekeepers are typically very knowledgeable of a community and how it functions. In community health, gaining the cooperation of the community gatekeeper(s) can improve the feasibility, quality and acceptability of community interventions and programs
Hardiness
Positive coping influence characterized by “high levels of perceived control, commitment to succeed, and a propensity to see stressful life events as challenging.” Challenging, in the context of hardiness, reflects an individual’s ability to view stressful situations and experiences as an opportunity for growth and development and not as a threat. Hardy individuals are less likely to experience illness as a result of stressful events
Harm reduction
Intermediate approach to behavior change that emphasizes adopting a lower risk alternative to a high risk behavior when an individual is either unwilling or unable to stop the high risk behavior. Needle exchange programs that facilitate the use of sterile injection equipment in order to reduce the transmission of HIV among injection drug-users are an example of harm reduction.
Health belief model (HBM)
Individual-level, value-expectancy health behavior theory developed in the 1950s by social psychologists in the U.S. Public Health Service in efforts to explain why people did not seek preventive health and screening services. The theory was first used in relation to a free Tuberculosis screening program, but has since been applied to numerous health behaviors. The HMB maintains that an individual will engage in behavior to prevent, screen for or control disease or negative health outcomes if they 1) perceive themselves to be at risk for that disease; 2) believe that the disease has potentially serious consequences; 3) believe that a recommended (and available) behavior is effective in reducing their risk for or the consequences of the disease; and 4) believe that the perceived barriers or costs of engaging in that behavior are fewer than the perceived benefits. Internal or external cues to action can motivate a person to take action. Self-efficacy was added as a construct to the HBM in the late 1980s.
Health disparities
Differences in the incidence, prevalence, mortality, burden of diseases or other adverse health conditions that exist among specific groups within the general population. “A chain of events signified by a difference in: (1) environment, (2) access to, utilization of, and quality of care, (3) health status, or (4) a particular health outcome that deserves scrutiny.”
Health literacy
Degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions
Health Insurance Portability and Accountability Act (HIPAA)
A statute passed in 1996 in efforts to improve the efficiency of healthcare delivery by mandating and standardizing the electronic exchange of health information and to provide Federal protections to preserve the privacy of protected, individually identifiable health information. Under HIPAA’s Privacy Rule, which has been effective since April, 2003, an individual has the right to see and correct his health records, to know how information from those health records is being used and shared, and to deny permission for those health records to be used for certain purposes. In many cases, an individual must provide written permission for certain individuals or groups to be able to received information from his personal health records, unless that information is needed to provide continuity of care or is required to be reported for public health surveillance purposes
Health status
Description and/or measurement of the health of an individual or population at a particular point in time against identifiable standards, usually by reference to health indicators
Impact evaluation
Assessment of program effects on intermediate objectives including changes in predisposing, enabling, and reinforcing factors, behavioral and environmental changes, and possibly health and social outcomes
Information-motivation-behavior (IMB)
General model that holds that information, motivation, and behavioral skills are the primary determinants of health-related behaviors. Individuals who are well informed, highly motivated, and who have the necessary behavioral skills are more likely to engage in a specific health-related behavior. The specific types of information, motivational strategies and behavioral skills necessary to lead to behavior change are expected to vary between subpopulations and between behaviors. Behaviorally relevant information is considered “a necessary but not a sufficient condition” for risk reduction behavior. In general even a well-informed and behaviorally skilled individual must be highly motivated in order to engage in a specific health-promoting behavior and to maintain it over time.
Institutionalization
Involves “permanently” incorporating program activities into the routines and structure of an organization or community in order to maximize the long-term benefits of your program and to ensure its sustainability following staffing changes, the termination of formal activities and/or grant funding, etc.
Intervention mapping
Program planning framework intended to facilitate the development of theory- and evidence-based health promotion programs. Following a thorough review of the literature and an appropriate needs assessment, the process of intervention mapping includes five steps: “1) creating matrices of proximal program objectives from performance objectives and determinants of behavior and environmental conditions; 2) selecting theory-based intervention methods and practical strategies; 3) designing and organizing programs; 4) specifying adoption and implementation plans; and 5) generating an evaluation plan.” In step one, a list of performance objectives are generated that define the desired behavioral and environmental outcomes of the program; personal (internal) and external determinants of the behavioral and environmental outcomes are specified; if determinants vary by sub-population, the target population is differentiated; and, finally, performance objectives and determinants are linked in a matrix format, often by level (i.e. individual vs. organizational) and by sub-population, if applicable. Each cell in the resulting matrices will contain either a learning objective (linking a performance objective with a personal determinant) or a change objective (linking a performance objective with an external determinant) that defines what individuals need to learn or what changes need to take place in the environment as a result of the program. In step 2, a list of theoretical intervention methods (i.e. community planning) and a list of possible strategies for delivering those methods (i.e. community forums or meetings) are developed, based on the identified proximal objectives. In step 3, the selected strategies are operationalized into deliverable program components and delivery mechanisms (i.e. channel selection), and program materials are developed and pre-tested. During step 4, a “linkage system” between program users and developers is created so that the program can be modified to meet the needs of the users; adoption and implementation performance objectives are developed; determinants of adoption and implementation are specified; and an implementation plan is developed. Finally, step 5 involves developing an evaluation model, including a plan for process evaluation.
Intervention message
Program-specific message delivered to an individual or group that is designed to increase awareness of a health problem, motivate behavior change, address perceived barriers to engaging in a health behavior, or something else related to the goals and objectives of the program. Theory-based and tailored intervention messages are typically the most effective.
Lay health advisor (or lay health worker or community health worker)
Member of the target community that is trained to administer health promotion messages and program activities. Lay health advisors are often used to overcome language barriers, to enhance the cultural relevance of health promotion programs, to facilitate access to and understanding of a community among program planners, to help connect members of the target population with services, etc.
Levels of prevention (primary, secondary, tertiary)
Reflect the different points of prevention and intervention in health education and health promotion
Locus of control
Generalized belief that circumstances and rewards are under one’s own (internal locus of control) or others’ control (external locus of control).
Mediating factors
Factor that partially or completely explains the relationship between a predictor and a behavior or outcome. A mediating factor is independently related to the outcome of interest and to the predictor of interest, thereby acting as a link between the two. For example, in the Theory of Reasoned Action, a person’s behavioral intention acts as a mediating factor between his attitude and subjective norms and his behavior.
Mission statement
Brief statement that defines the purpose and focus and sometimes the vision and values of an organization or program. Typically, all program planning, program activities, partnerships, etc. should be made to reflect to the mission statement to ensure that they are in line with the overall purpose and goals of the program or organization.
Mixed methods
Strategic and systematic combination of qualitative and quantitative research methods. The combination of methods often works to overcome the limitations of quantitative or qualitative methods used in isolation, to improve the validity of findings, and/or to provide a more comprehensive understanding of a problem or phenomenon.
Motivational interviewing
Directive, client-centered counseling style for eliciting behavior change by helping clients to explore and resolve ambivalence .” 17 Motivational interviewing emphasizes drawing out an individual’s internal motivations to change; allowing an individual to express and resolve her own ambivalence towards a behavior; and avoiding direct persuasion, confrontation and argumentation. The individual is viewed as the expert, while the primary role of the interviewer is to facilitate the individual’s expression of goals and the discovery of an acceptable resolution to the ambivalence. In theory, an individual’s ambivalence is the principle barrier to behavior change.
National health objectives
U.S. Department of Health and Human Services has coordinated a process to develop a set of national health objectives to direct public health efforts each decade since 1980, starting with the publication of Promoting Health/Preventing Disease: Objectives for the Nation. The current set of national health objectives is contained in Healthy People 2010: Understanding and Improving Health . Healthy People 2010 contains 467 national health objectives that cover 28 primary focus areas.
Needs assessment
Process of determining, analyzing and prioritizing needs, and in turn, identifying and implementing solution strategies to resolve high priority needs.” 8 A needs assessment is meant to assist program planners in identifying a priority population, their specific needs, subgroups of the population with the greatest needs, the most significant problems facing the priority populations and subgroups, what is currently being done and/or what has been done in the past to effectively address their needs, etc. Needs assessment is generally viewed as the first step in health promotion program planning and depends on both secondary and primary data collection gathered through a variety of qualitative and quantitative methods.
Normative beliefs
Reflect individuals’ beliefs about whether important referent individuals, or people whose opinion they value, approve or disapprove of a particular behavior. Normative beliefs, along with an individual’s motivation to comply with the opinions and values of the referent individuals, form a person’s subjective norms. Normative beliefs and subjective norms are constructs of the Theory of Reasoned Action/Theory of Planned Behavior.
Opinion leaders
Individuals who are well respected in a community and can accurately represent the views of the priority population.” They are typically demographically similar to the priority population, knowledgeable about community issues and concerns, early adopters of innovations, and capable of persuading others to engage in a particular behavior.
Organizational change
Process through which organizations “innovate new goals, programs, technologies, and ideas” in order to improve organizational efficiency and effectiveness
Seven Stages of the Stage Theory of Organizational Change
1) Sensing unsatisfied demands on the system; 2) search for possible responses; 3) evaluation of alternatives; 4) decision to adopt a course of action; 5) initiation of action within the system; 6) implementation of the change; and 7) institutionalization of the change
Outcome evaluation
Assessment of the effects of a program on the ultimate objectives, including changes in health and social benefits or quality of life
Outcome expectations
Anticipatory outcomes of a behavior,” or what an individual perceives is the likely result of engaging in a specific behavior. Outcome expectations develop from previous experience, through observing others, hearing about specific behaviors or situations from others, or from emotional or physical responses to a behavior. Outcome expectations are a construct of the Social Cognitive Theory.
Perceived barriers
Individual’s beliefs about the negative consequences of or challenges associated with engaging in a particular health behavior. Perceived barriers can be physical, emotional, psychological, economic, etc. Typically, the perceived benefits of a behavior must outweigh the perceived barriers for a person to adopt that behavior. “Perceived barriers” is a key construct of the Health Belief Model.
Perceived benefits
Individual’s beliefs about the efficacy of a particular behavior in reducing the perceived threat associated with a particular disease or outcome. An individual would not be expected to adopt a specific health behavior without believing it would effectively reduce his perceived threat of disease. “Perceived benefits” is a key construct of the Health Belief Model.
Perceived Response efficacy
Belief whether the recommended action is effective in preventing or reducing risk for a health problem. It is important to note that ether low perceptions of self (self efficacy), or low perceptions of the recommended action (response efficacy) may lead to maladaptive behavior. For example, people may not feel confident that they can reduce their intake of fried foods (self efficacy) or they may not feel confident that reducing their intake of fried foods will lower their risk of heart attack (response efficacy). The implication for prevention is to ensure that health education supports both the belief in one’s ability to change lifestyle behaviors as well as the belief that lifestyle changes are effective in reducing risks.
Perceived self-efficacy
Individual’s beliefs about and confidence in his ability to perform a certain behavior or take action. Self-efficacy influences what behaviors we choose to perform, the amount of effort we expend on performing those behaviors, how long we persist in performing a behavior, and how we feel about particular behaviors. Self-efficacy is developed through direct or vicarious experience, verbal or social persuasion, and physiological reactions/feedback. Perceived self-efficacy is a concept common to many theories of Health Behavior, but is most directly related to Social Cognitive Theory.
Perceived severity
Individual’s beliefs about how serious a disease or its physical and social consequences are. “Perceived severity” is a key construct of the Health Belief Model.
Perceived susceptibility
Individual’s beliefs about how vulnerable, or at risk, he or she is to getting a particular disease or of being affected by a particular health outcome. “Perceived susceptibility” is a key construct of the Health Belief Model.
Perceived threat
Combination of perceived severity and perceived susceptibility. An individual’s beliefs about his perceived susceptibility to a disease and the perceived severity of that disease combine to form his overall beliefs about the level of threat that disease poses for him.
Pilot testing
Implementing a program or program components on a smaller scale, in a setting similar to where the program will be fully implemented and with a population similar to the planned target population. Pilot testing allows program planners to identify and correct problems with the intervention strategies before they are fully implemented.
Policy advocacy
Actions or endeavors individuals or groups engage in in order to alter public opinion in favor or in opposition to a certain policy.”
Population-based
Community health methods that are used to help change behavior in groups of people.” Population-based approaches use a defined community or population as their organizing principle for preventive action over individuals, and they focus on addressing population-level processes that influence health. Population-based approaches include policy development and advocacy, organizational change, community development and empowerment.
PRECEDE-PROCEED framework
Most well-known health program planning model. In PRECEDE-PROCEED a program planner begins by identifying the desired outcome of the program and working backwards to discover strategies for reaching that outcome. PRECEDE stands for p redisposing, r einforcing and e nabling c onstructs in e ducational/ecological d iagnosis and e valuation, and includes various stages of assessment and planning. PROCEED stands for p olicy, r egulatory, and o rganizational c onstructs in e ducational and e nvironmental d evelopment and deals mainly with program implementation and evaluation.
9 Phases of PRECEDE-PROCEED
Phase 1, social assessment and situational analysis, involves engaging the target population to identify general indicators of quality of life. Phase 2, epidemiological assessment, includes identifying specific health goals or problems that contribute to or interact with the social goals or problems identified in phase 1. Phase 3, behavioral and environmental assessment, involves identifying and prioritizing behavioral and environmental determinants of the specific health problems identified in phase 2. Phase 4, educational and ecological assessment, includes identifying and prioritizing predisposing, reinforcing and enabling factors that are related to the behavioral and environmental determinants. ” Predisposing factors include a person’s or population’s knowledge, attitudes, beliefs, values and perceptions that facilitate or hinder motivation for change.” Reinforcing factors are “the rewards received and the feedback the learner receives from others following adoption of a behavior.” ” Enabling factors are those skills, resources or barriers that can help or hinder the desired behavioral changes as well as environmental changes.” Phase 5, intervention alignment and administrative and policy assessment, involves “intervention matching, mapping, and patching” to determine which program components and activities are needed to target the factors identified in the previous stages and determining whether or not the program has the policy, organizational and administrative capacity to do them. In phase 6, implementation occurs. Phase 7 includes process evaluation, phase 8 includes impact evaluation, and phase 9 includes outcome evaluation.
Predictors
Characteristics or variables that predict or otherwise help to explain a particular behavioral, health or other outcome
Primary data
Data gathered directly by the individual using it to answer a specified research question or to gather information on a specific population or health problem. This includes data collected first-hand through survey research, focus groups, interviews, etc.
Primary prevention
Refers to preventive measures that are intended to prevent or put off the onset of injury or disease. Vaccinations, abstinence, and exercise are examples of primary prevention.
Process evaluation
Any combination of measurements obtained during the implementation of program activities to control, assure, or improve the quality of performance or delivery
Processes of change
Covert and overt activities that people use to progress through the stages” of change in the transtheoretical model (TTM). There are ten processes of change that have been identified in conjunction with the development of the TTM: consciousness raising, dramatic relief, self-reevaluation, environmental reevaluation, self-liberation, helping relationships, counter-conditioning, contingency management, stimulus control, and social liberation. Different processes of change are used by individuals in different stages of change to progress towards action and maintenance. In the early stages, people tend to rely more on the cognitive, affective and evaluative processes (consciousness raising, dramatic relief, environmental reevaluation and self-reevaluation) while in the later stages the emphasized processes of change focus on making commitments, seeking support, contingency planning and other behavioral processes (counter-conditioning, helping relationship, stimulus control, reinforcement management).
Protective factors
Factors that decrease the likelihood of negative health outcomes and risk behaviors
Psychosocial determinants
Determinants of health that reflect the interaction between the social environment and an individual’s development, beliefs and behaviors. Psychosocial factors are thought to not only mediate the effects of social and structural factors on individual health outcomes, but also to be influenced by the social structures and contexts in which they develop. Coping skills or social support following a stressful experience are examples of psychosocial determinants.
Qualitative research
Utilizes methods that results in the collection of non-numeric data that are not highly categorized or defined prior to data collection. Open-ended surveys, focus groups, in-depth interviews, observational and case studies typically result in qualitative data.
Quality of life
Perception of individuals or groups that their needs are being satisfied and that they are not being denied opportunities to achieve happiness and fulfillment
Quantitative research
Utilizes methods that result in the collection of numerical and typically predefined data. Statistical methods are employed to analyze and interpret quantitative data. Closed-ended surveys are an example of quantitative research.
Quasi-experimental design
Research design that does not use randomization in assigning units (individuals) to conditions or treatments. Quasi-experiments depend on self-selection or administrator selection to assign individuals to conditions but they are otherwise structurally similar to a randomized experimental design.
Reciprocal determinism
Dynamic interaction of the person, behavior, and the environment in which the behavior is performed.” In other words, the concept of reciprocal determinism emphasizes that health behaviors and individuals are not only influenced by the physical and social context in which they exist, but also that such individuals and their behavior influences the environment. Reciprocal determinism is a key construct of the Social Cognitive Theory and in ecological approaches to health promotion.
Relapse prevention
Self-control program designed to help individuals to anticipate and cope with the problem of relapse in the habit-changing process.” According to the Relapse Prevention Model, which is based on social-cognitive psychology, relapse is influenced by both immediate determinants and covert antecedents to high-risk situations. Immediate determinants of relapse include high-risk situations, coping skills, outcome expectancies, and the abstinence violation effect (the individual’s emotional response to an initial lapse and what he attributes that lapse to). Covert antecedents to high-risk situations—lifestyle factors (i.e. stress and lifestyle imbalance) or cognitive factors such as cravings and urges—can increase the likelihood of relapse by increasing an individual’s exposure to high-risk situations and/or by decreasing the individual’s motivations to resist a lapse in behavior. The Relapse Prevention model outlines various intervention strategies for identifying, preventing, or avoiding the determinants and antecedent causes.
Resilience
Process of adapting well in the face of adversity, trauma, tragedy, threats, or even significant sources of stress—such as family and relationship problems, serious health problems, or workplace and financial stressors. It means ‘bouncing back’ from difficult experiences
Perceived Response efficacy
Belief whether the recommended action is effective in preventing or reducing risk for a health problem. It is important to note that ether low perceptions of self (self efficacy), or low perceptions of the recommended action (response efficacy) may lead to maladaptive behavior. For example, people may not feel confident that they can reduce their intake of fried foods (self efficacy) or they may not feel confident that reducing their intake of fried foods will lower their risk of heart attack (response efficacy). The implication for prevention is to ensure that health education supports both the belief in one’s ability to change lifestyle behaviors as well as the belief that lifestyle changes are effective in reducing risks.
Risk behavior
Specific forms of behavior which are proven to be associated with increased susceptibility to a specific disease or ill-health
Risk communication
Engaging communities in discussions about environmental and other health risks and about approaches to deal with them. Risk communication also includes individual counseling about genetic risks and consequent choices
Screening behavior
Seeking diagnostic (screening) tests to check for the presence of disease or precursors to disease, typically prior to the development of outward signs and symptoms. Screenings, as a form of secondary prevention, facilitate early diagnosis of disease and often improve disease outcomes
Secondary data
Pre-existing data collected by somebody other than the individual using it. Secondary data is often used in conducting needs assessments and/or to supplement primary data.
Secondary prevention
Preventive measures that are directed at the early diagnosis and treatment of injuries and diseases to limit disability and prevent the development of complications and more serious disease. Screening tests and self-exams for breast cancer are examples of secondary prevention strategies.
Self-management
Process of taking an active responsibility for and control over managing and monitoring one’s health, including managing chronic diseases and disability
Self-report (data)
Generated by having respondents report about themselves. Self-report data are common in sociaorgal and behavioral sciences, but their validity is often questioned because of potential bias
Social capital
Degree of social cohesion which exists in communities. It refers to the processes between people which establish networks , norms, and social trust, and facilitate co-ordination and co-operation for mutual benefit.” Social capital is “usually characterized by four interrelated constructs: trust, cooperation, civic engagement, and reciprocity.
Social cognitive theory (SCT)
Health behavior theory that describes the reciprocal influence and dynamic interaction between an individual’s personal factors, the environment, and specific health behaviors. Major constructs of the SCT include environments , situations (an individual’s cognitive perceptions of the environment that may affect his behavior), behavioral capability , outcome expectations , outcome expectancies (the value an individual places on an expected outcome), self-regulation (ability to engage in goal-directed behavior), observational learning, reinforcements, perceived self-efficacy , emotional coping responses, and reciprocal determinism . The SCT maintains that personal factors within individuals—their behavioral capability, self-efficacy, outcome expectations and expectancies, coping mechanisms, and self control—are key determinants of behavior and both influence and are influenced by the environment. The environment is important partially because it provides models for and opportunities for observational learning and reinforcement, increasing the likelihood that certain behaviors are performed. Based on the concept of reciprocal determinism any change in the person, environment or behavior results in a situational change, necessitating a reevaluation of the interaction between the three.
Social ecology
Study of the influence of the social context on behavior, including institutional and cultural variables
Social ecology framework
Approach to health education that goes beyond individual behavior change to examine and modify the social, political, and economic factors impacting health behavior decisions.” The social ecological framework (see also ecological approach/levels) recognizes the individual, interpersonal, community, organizational and policy-level influences on health.
Social marketing
Application of commercial marketing technologies to the analysis, planning, execution, and evaluation of programs designed to influence the voluntary behavior of target audiences in order to improve their personal welfare and that of their society.” 4 Social marketing emphasizes the 4 P’s of product, price, place and promotion.
Social network
Web of social relationships that surround individuals.” Social network structures can be described both in terms of dyadic characteristics and characteristics of the network as a while. Dyadic characteristics include reciprocity, intensity, and complexity in interpersonal relationships. Network characteristics include levels of homogeneity, geographic dispersion, and density.
Social norms
Perceived social patterns of and expectations for behavior
Socioeconomic factors
Social and economic characteristics like education, income, and occupation that influence an individual’s ability to function or “compete” in society. Socioeconomic factors are often correlated with an individual’s health status.
Stages of change
Temporal progression towards behavior change that individuals go through over time. The stages of change are part of the Transtheoretical model, in which five stages of change are defined: precontemplation (no intention to take action in the next six months); contemplation (thinking about taking action in the next six months); preparation (intending to take action in the next month and has taken some behavioral steps toward change); action (has adopted behavior change for less than six months); and maintenance (has adopted behavior change for longer than six months). Although there is technically a sixth stage of change—termination (no longer tempted to engage in old behavior and has complete self-efficacy)—defined for use in the Transtheoretical model, very few people seem to reach this stage.
Stakeholders
People who have an investment or a stake in the outcome of a program and therefore have reasons to be interested in the evaluation of the program
Stereotyping
Making generalizations or assumptions about an individual based on a characteristic or attribute that individual shares with a larger group
Stress and coping
Stress is the experience of psychological or emotional distress in response to an event or experience. Stress can produce physiological changes in the body that may be associated with illness and disease. Coping consists of “an individual’s ongoing efforts to manage specific external and internal demands that are appraised as taxing or exceeding personal resources
Structural intervention
Focuses on influencing or changing the social, political, physical or economic environment to facilitate healthy behaviors or behavior change in large groups of people.
Subjective norm
Individual’s “belief about whether most people approve or disapprove” of a particular behavior. Subjective norms directly influence a person’s intentions to engage or not engage in that behavior. Subjective norm is a key construct of the Theory of Reasoned Action/Theory of Planned Behavior
Subpopulation
Group, or subset, of people within a population that share a common characteristic. Subpopulations within intended audiences are often defined in order to facilitate understanding of the group and to be able to better tailor messages to fit their needs and behaviors
Summative evaluation
Application of design, measurement and analysis methods to the assessment of outcomes of a program or specific interventions within a program.” Outcome and impact evaluation are collectively referred to as summative evaluation
Sustainability
Maintenance and institutionalization of a program or its outcomes
Tailoring
Use of information about individuals to shape the message or other qualities of a communication or other intervention so that it has the best possible fit with the factors predisposing, enabling, and reinforcing that person’s behavior
Target group/intended audience
Primary population expected to receive/benefit from a specific health promotion program’s messages, activities and interventions. Typically the target group is the group of people most at risk or most affected by a specific health problem.
Tertiary prevention
Preventive measures directed at rehabilitating, training and educating an individual who has already reached a point of disability, impairment or dependency. Tertiary prevention is the final level of prevention and includes measures such as disease management education for diabetics or for individuals who are recovering from a heart attack.
Theoretical construct
Building blocks or primary elements of a theory that have been developed or adopted for use in that particular theory. Constructs are understood only within the context of the theories they are associated with. For example, perceived susceptibility, perceived severity, and perceived barriers are constructs of the Health Belief Model.
Theory
Set of interrelated constructs, definitions, and propositions that presents a systematic view of events or situations by specifying relations among variables in order to explain and predict the events or situations
Theory of planned behavior (TPB)
Extension of the Theory of Reasoned Action that takes into consideration an individual’s perceived control over engaging in a particular behavior, in addition to his attitudes towards and subjective norms surrounding that behavior. Perceived behavioral control was added in efforts to account for factors beyond the individual’s control that potentially influence his behavioral intentions and, ultimately, behavior. People may expend more energy and try harder to perform a behavior when they perceive that they have high behavioral control, or are capable and have sufficient resources to engage in that behavior and overcome any barriers. Perceived behavioral control is a function of control beliefs (beliefs about the presence or absence of resources and barriers to performing a behavior) and perceived power (beliefs about the influence of each perceived resource or barrier on the difficulty of engaging in the behavior).
Theory of reasoned action (TRA)
Most important determinant of a behavior is an individual’s behavioral intention , or “perceived likelihood of performing the behavior.” An individual’s behavioral intention is influenced directly by that person’s attitude toward the behavior and subjective norms . Attitude toward a behavior is a function of a person’s behavioral beliefs (beliefs about the likely outcomes and attributes of a particular behavior) and his evaluation of behavioral outcomes (the value that he places on the likely outcomes and attributes). Again, subjective norms are formed by a person’s normative beliefs and motivations to comply .
Transtheoretical model of change (TTM)
Model of individual health behavior that integrates processes of change and theoretical principles from multiple leading theories across several disciplines. The TTM is a stage-based model that takes into account an individual’s readiness to change and views behavior change as a process that occurs over time and not as a finite event. Intervention messages and strategies are based on appropriate processes of change and are developed and matched to an individual’s readiness to change. There are five main stages of change (see stages of change) and ten processes of change (see processes of change) that have been empirically linked in the TTM. In addition to the concepts of stages and processes of change, the TTM also asserts that, in order for an individual to take action and maintain a behavior change, that person must perceive that the benefits, or pros, of change outweigh the cons ( decisional balance ). Situational self-efficacy —the confidence one feels in his or her ability to resist relapsing and engaging in an unhealthy or high-risk behavior in specific, tempting situations—is the final key construct of the TTM.
Voucher
Coupon or document that can be exchanged for a service, incentive or something else as decided by the distributor. Vouchers are used in health promotion to encourage individuals to participate in programs, to link individuals to and to coordinate services between program partners, as incentives, etc.
Over the past century, the global pattern of disease has shifted away from infectious disease towards chronic disease, with chronic disease now accounting for _____% of deaths worldwide.
Over the past century, the global pattern of disease has shifted away from infectious disease towards chronic disease, with chronic disease now accounting for 60% of deaths worldwide.
_______ ________ and ______ are the two leading causes of death worldwide
Heart disease and stroke are the two leading causes of death worldwide
T/F: 80% of all chronic disease deaths occur in developing countries.
True
80% of all chronic disease deaths occur in developing countries.
T/F: Disparities in chronic disease exist worldwide, with disadvantaged populations experiencing a disproportionate burden of morbidity, disability, and death.
True
Disparities in chronic disease exist worldwide, with disadvantaged populations experiencing a disproportionate burden of morbidity, disability, and death.
In the United States, chronic disease now accounts for ______% of deaths, a substantial proportion of morbidity, and more than ______% of national health care costs.
In the United States, chronic disease now accounts for 70% of deaths, a substantial proportion of morbidity, and more than 75% of national health care costs.
What are the major determinants of early and unnecessary death?
Behavioral risk factors, including tobacco use, poor diet and physical inactivity, and excess alcohol consumption, are the major determinants of early and unnecessary death.
T/F: preventable death remains a major public health challenge of the 21st century, largely due to limited use of a broad, sustained, multi-level approach directed at individuals, social relationships, and organizational and community environments.
True
preventable death remains a major public health challenge of the 21st century, largely due to limited use of a broad, sustained, multi-level approach directed at individuals, social relationships, and organizational and community environments.
SOCIAL AND BEHAVIORAL SCIENCES IN PUBLIC HEALTH – Domain: Social and Behavioral Determinants of Health
– Leading Causes of Preventable Death
– Health Disparities and Inequities
– Social and Behavioral Epidemiology
– The Social Ecological Model
SOCIAL AND BEHAVIORAL SCIENCES IN PUBLIC HEALTH – Domain: Prevention Theory, Science & Practice
– Theories and Models of Change
– Health Promotion and Disease Prevention
– Evidence-based Prevention Programs and Policies
– Community Health Practice
SOCIAL AND BEHAVIORAL SCIENCES IN PUBLIC HEALTH – Domain: Program Planning and Evaluation
– Ethical Issues in Planning and Evaluation
– Planning Models
– Evaluation Methods
– Scaling Up Programs and Sustainability
The five leading causes of death include:
The five leading causes of death include heart disease, cancer, stroke, chronic lower respiratory diseases, and unintentional injuries.
The leading risk factors for preventable deaths worldwide are:
The leading risk factors for preventable deaths worldwide are hypertension, tobacco use, high blood glucose, physical inactivity, and obesity.
In the US, tobacco use, poor diet and physical inactivity, and excess alcohol use account for nearly _____% of all early and unnecessary deaths.
In the US, tobacco use, poor diet and physical inactivity, and excess alcohol use account for nearly 40% of all early and unnecessary deaths.
What is the National Vital Statistics System (NVSS)?
The National Vital Statistics System (NVSS) is the major source of mortality data in the US, and may be used to track the leading causes of death over time.
What are Health disparities?
Health disparities are differences in the incidence rate, prevalence rate, disability rate, or mortality rate between groups. Most disparities affect specific groups in the population that are in a position of social or economic disadvantage related to discrimination or exclusion because of gender, age, race or ethnicity, education or income, geographic location, disability, or sexual orientation.
What are health inequities?
When disparities in health are due to systematic injustices, such as segregation and unequal treatment, the differences are termed health inequities.
The leading health inequities in the US include:
The leading health inequities in the US include heart disease, cancer, diabetes, HIV/AIDS, infant mortality, asthma, and mental health. Inequities present not only as differential health status, but differential access to needed medical procedures and access to quality medical care.
Racism is conceptualized into three dimensions:
Racism is conceptualized into three dimensions: (1) Internalized Racism – Acceptance of negative messages about worth by race; (2) Personally-mediated Racism – Differential assumptions about abilities and intentions by race; (3) Institutionalized Racism – Differential access to benefits and opportunities because of race.
What does the World Health Organization report “Closing the Gap in a Generation: Health Equity Through Action on the Social Determinants of Health,” highlight?
The World Health Organization report “Closing the Gap in a Generation: Health Equity Through Action on the Social Determinants of Health,” highlights that social injustice and human rights issues are the key contributors to health inequities worldwide. The opportunities and challenges in the social context of individuals across income levels influence their health, with low-income populations in poorer health than middle-income populations, and middle-income populations in poorer health than high-income populations. The decline in health at lower relative incomes, termed the “social gradient,” is seen both within countries and between countries. It is important to note that the social gradient exists in high-income countries as well; when the benefits of wealth or economic growth are not distributed equitably, health inequities persist.
There are a number of social forces that produce health inequities including:
There are a number of social forces that produce health inequities including: (1) Socioeconomic Status (2) Social Capital (3) Collective Efficacy
Some key strategies that may contribute to eliminating health disparities include:
Some key strategies that may contribute to eliminating health disparities include: (1) increased access to services for all through financing mechanisms, organizational changes, and removal of legal and transportation barriers; (2) culturally and linguistically competent programs; (3) improved patient-provider communication; (4) programs to eliminate provider discrimination; and (5) increased minority representation among the health care workforce.
Major data sources for monitoring health disparities over time include:
Major data sources for monitoring health disparities over time include the National Health Interview Survey (NHIS), the Behavioral Risk Factor Surveillance System (BRFSS), the National Health and Nutrition Examination Survey (NHANES), the National Vital Statistics System (NVSS), and administrative data (Medicare, Medicaid, and hospital discharge data).
Social epidemiology
Social epidemiology investigates social, economic, and environmental causal and contributing factors to explain the distribution of disease.
Behavioral epidemiology
Behavioral epidemiology investigates lifestyle factors to explain the distribution of disease.
Social and behavioral epidemiology have identified a number of determinants of disease including:
Social and behavioral epidemiology have identified a number of determinants of disease including social class, housing, employment, environmental pollutants, access to health care, access to healthy foods, built environment, stress, social support, social capital, social cohesion, tobacco use, lack of physical exercise, poor diet, excess alcohol use, drug use, failure to use seat belts, and failure to follow preventive guidelines.
What is the Behavioral Risk Factor Surveillance System (BRFSS) and what kind of data does it collect?
The Behavioral Risk Factor Surveillance System (BRFSS) is a state-based telephone survey established by the Centers for Disease Control (CDC) in 1984, collecting data on health risk factors (i.e., percent of population smoking, percent of population overweight), protective factors (i.e., percent of population wearing seat belts, percent of population with flu vaccination, percent of women receiving mammograms), access to care (i.e., percent of population with health insurance, percent of population with access to a primary care provider), and health conditions, diseases, and status (i.e., percent of population with hypertension, percent of population with diabetes, percent of population with poor health).
social ecological perspective
The social ecological perspective asserts that health is a complex phenomenon that cannot be understood from a single level of influence.
social ecological model
The social ecological model is a framework of determinants of health across multiple levels of influence. In the social ecological model, environments influence individuals, and individuals influence their environments. Determinants may include risk factors, which place an individual at increased risk for a negative health outcome, and protective factors, which decrease the likelihood of negative consequences from exposure to risk.
The Social Ecological Model – Levels of influence
(1) Individual level influences include biology, knowledge, attitudes, beliefs, self-efficacy, and skills. (2) Interpersonal level influences include role modeling, social support, and social norms through relationships with families, friends, and peers. (3) Organizational level influences are rules, regulations and policies and norms of institutions such as schools and workplaces. (4) Community level influences include relationships among organizations, informal community networks, and community norms. (5) Societal level influences are macro-level factors such as religious or cultural belief systems, societal norms, economic or social policies, and national, state, and local laws.
The Social Ecological Model – Core Principles
Core principles in the social ecological perspective include: (1) Multiple factors operate at multiple levels to influence health behavior; (2) Influences interact across levels; (3) Multi-level interventions are more effective than interventions at a single level; and (4) Interventions are most powerful when they address specific behaviors.
The Social Ecological Model – Models of Help-Seeking and Health Services Use
Models of help-seeking and health services use inform the process linking determinants with health outcomes, and highlight the diversity in populations that must be understood and addressed in order to have culturally competent practitioners and service delivery systems.
The Social Ecological Model – Model of Help-Seeking
This model includes: (1) Health behaviors – actions to promote health, prevent disease, or detect disease at early stages such as diet, exercise, and immunizations, and on-time screenings; (2) Illness behaviors – help-seeking and self-care actions in response to suspected or actual illness, including ignoring symptoms, self-help, medical care, and alternative medical care; (3) Sick role behaviors – actions in response to diagnosed illness; and (4) Disease management behaviors – actions in response to medical advice, such as adherence to treatment.
The Social Ecological Model – Socio-Behavioral Model of Health Services Use
This model predicts the use of health services with three major types of variables: (1) Predisposing variables – demographic characteristics, coping strategies, and health beliefs; (2) Enabling variables – personal and household resources, availability of community resources, and access to resources through transportation, financing, language, and literacy; and (3) Need – self perceived health status or clinician-rated health status.
theory
A theory is a set of interrelated concepts, definitions and propositions that presents a systematic view of events or situations.
Concepts
Concepts are major components of theory.
Constructs
Constructs are concepts that have been developed or adapted for use in a particular theory.
Variables
Variables are operationally-defined, measurable forms of constructs.
Models
Models are a set of theories that have been combined to explain a specific problem.
The most useful theories are:
The most useful theories are internally consistent, parsimonious, plausible, pragmatic, and ecologically valid.
Theories and models of change guide the development of interventions by:
Theories and models of change guide the development of interventions by identifying factors within individuals, in relationships among individuals, and in organizations and communities that are related to changes in the health behavior and health status of individuals and populations.
Intrapersonal theories and examples of common ones
Intrapersonal theories of change are used to understand and change individual health behaviors. These theories focus on factors within the individual that influence health behavior, including beliefs, attitudes, and readiness to change. Major intrapersonal theories and models include the Health Belief Model, the Theory of Reasoned Action/Theory of Planned Behavior, and the Transtheoretical Model.
The Health Belief Model
The Health Belief Model focuses on individual beliefs as determinants of behavior. The basic premise is that health behavior is determined by perception of the threat of a health problem, and appraisal of the recommended behavior for preventing or controlling the problem.
Major constructs of the health belief model:
Major constructs include: (1) Perceived Susceptibility, belief about the chances of experiencing a risk of getting a condition or disease; (2) Perceived Severity, belief about how serious a condition and its related consequences are; (3) Perceived Benefits, belief in the efficacy of the advised action to reduce the risk of seriousness of impact; (4) Perceived Barriers, belief about the tangible and psychological costs of the advised action; (5) Cues to Action, strategies to activate an individual’s readiness to perform the advised action; and (6) Self-efficacy, confidence in one’s ability to perform the advised action.
Theory of Reasoned Action/Theory of Planned Behavior
These two theories focus on individual attitudes as determinants of behavior. The basic premise is that behavioral intentions are the best predictors of behavior, and behavioral intentions are directly influenced by the attitude about performing the behavior and the subjective norm, the belief whether important others approve or disapprove of the behavior.
Major constructs of the Theory of Reasoned Action/Theory of Planned Behavior
Major constructs include: (1) Behavioral Intention, the intent to enact the behavior; (2) Attitude, the evaluation of the behavior; and (3) Subjective Norm, the perceived expectation to perform the behavior from others. The Theory of Planned Behavior expands the Theory of Reasoned Action by adding a construct of Perceived Behavioral Control over performance of the behaviors.
Transtheoretical Model –
The Transtheoretical Model focuses on an individual’s readiness to change as a determinant of behavior. The basic premise is that behavior change is a process, individuals differ in their readiness to change, and intervention strategies must be tailored for each stage of readiness to change.
6 stages of the Transtheoretical Model
The model consists of six stages: (1) Precontemplation, no intention to act; (2) Contemplation, intention to act sometime in the future; (3) Preparation, intention to act in the near future with some steps towards action; (4) Action, behavior change for less than 6 months; (5) Maintenance, behavior change for more than 6 months; and (6) Termination, no temptation to relapse. Moving successfully through the stages requires Decisional Balance, weighing the benefits of changing versus the costs of changing, and Self-efficacy, the perceived ability to engage in healthy behavior.
Theories of Change Focusing on Relationships and examples
Interpersonal theories of change are used to understand and change interpersonal interactions related to health behaviors and health status. These theories focus on factors in the individual’s social relationships that influence health, including learning processes, relationships between individuals, and coping strategies. Major interpersonal theories and models include Social Cognitive Theory, Social Support/Social Networks, Stress and Coping, and Social Influence.
Social Cognitive Theory –
Social Cognitive Theory focuses on learning processes as a determinant of health. The basic premise is that individuals learn both from their own experiences and vicariously, by watching the behaviors and the attendant behavioral consequences of others. A key feature of this theory is reciprocal determinism, in which behavior, interpersonal factors, and environmental events interact as determinants of each other.
Major Concepts of Social Cognitive Theory –
Major concepts include: (1) Environment, social environmental factors and physical environmental factors; (2) Outcome Expectations, beliefs about outcomes of behaviors; (3) Outcome Expectancies, perceived value of the outcomes; (4) Self-control, regulation of performance; (5) Behavioral Capability, knowledge and skills to perform the behavior; (6) Self-efficacy, confidence to perform the behavior and sustain the behavior change; and (7) Emotional Coping Response, the strategies to deal with emotional stimuli.
Social Cognitive Theory – two major methods of behavior change include:
The two major methods of behavior change include: (1) Observational Learning, learning to perform new behaviors by observing others’ actions and the outcomes of others’ behavior; and (2) Reinforcement, responses to an individual’s behavior that increase or decrease the chances of recurrence.
Social Support/Social Networks –
ocial Support Theory and Social Network Theory focus on relationships between individuals and how the nature of these relationships influences beliefs and behaviors.
Social Support/Social Networks – The four types of social support include:
The four types of social support include: (1) Emotional Support, empathy and caring; (2) Instrumental Support, tangible aid; (3) Informational Support, advice and information; and (4) Appraisal Support, information for self-evaluation, such as constructive feedback.
A social network is comprised of the relationships surrounding an individual and includes six critical components:
A social network is comprised of the relationships surrounding an individual and includes six critical components: (1) Centrality vs. Marginality, the degree of interaction; (2) Reciprocity of Relationships, whether relationships are one-way or two-way; (3) Complexity of Relationships, whether relationships are dense or primarily one-way; (4) Homogeneity/Diversity, the level of difference among individuals within a network; (5) Subgroups, Linkages, and Cliques, the level of concentration of interaction; and (6) Communication Patterns, the credibility of communication and how information is circulated throughout the network.
Stress and Coping Theory
Stress and Coping Theory focuses on coping strategies as determinants of health. Stressful experiences are constructed as person-environmental transactions, where the impact of an external stressor is mediated by the individual’s appraisal of the stressor and the psychological, social, and cultural resources at his/her disposal.
Stress and Coping Theory – The five types of stressors:
(1) Ambient Environment, continuous conditions in the physical environment; (2) Major Life Events, discrete events that occurs and disrupt the individual’s normal activities; (3) Daily Hassles, ongoing minor situations or events that irritate or distress an individual; (4) Chronic Strains, challenges that an individual experiences over time such as poverty, discrimination, or unemployment; and (5) Cataclysmic Events, sudden physical environmental disasters.
Stress and Coping Theory – Major constructs include:
Major constructs include: (1) Primary Appraisal, evaluation of the significance of a stressful event; (2) Secondary Appraisal, evaluation of ability to control the stressful event through coping; (3) Coping Efforts, strategies used to mediate a stressful event; (4) Problem management, strategies used to change a stressful situation; and (5) Emotional Regulation, strategies used to change thoughts or feelings about a stressful event.
Social Influence –
Social influence is a process directed at behavior change through communication as part of formal (doctor-patient) and informal (parent-child) interpersonal relationships. Behavior change may occur from interactions with others who are similar, others who are esteemed/ valued, and others who are considered expert. The amount of change is a function of the number of influencers, the closeness of the influencers to the individual, and the salience of the influencers.
Motivational interviewing
Motivational interviewing is a formal social influence process through which individuals identify, explore, and resolve ambivalence about changing unhealthy behaviors, such as tobacco use, poor diet, and sedentary lifestyle.
Theories of Change Focusing on Organizations and Communities and some common examples
Organizational and community theories of change are used to understand and change the role organizations and communities play in supporting or inhibiting behavior change. These theories focus on factors in organizations and communities that influence health, including organizational policies and practices; community organization and community building; production and exchange of information; and widespread dissemination of innovations. Major organizational and community theories and models include Organizational Change Theory, Community Organization Theory, Communication Theory, and Diffusion of Innovations.
Organizational Change Theory –
Organizational Change Theory focuses on organizational policies and practices as determinants of health. There are two major approaches to organizational change: a stage approach, and an organizational development approach.
Organizational Change Theory – a stage approach
The basic premise of the stage approach is that organizations go through a set of stages as they engage in a change process, including awareness of a problem, initiating action to solve the problem, implementing changes, and institutionalizing changes.
Organizational Change Theory – organizational development
The basic premise of organizational development is that factors related to organizational functioning must be identified and changed. The Organizational Development process consists of four stages: (1) Assessing and improving group dynamics within the organization; (2) Encouraging shared goals; (3) Identifying organizational barriers to change; (4) Identifying and implementing new organizational policies and practices.
Community Organization Theory –
Community Organization Theory focuses on community organization and community building as determinants of health, and involves a process in which community groups identify problems, mobilize resources, and design and implement strategies to reach common goals.
Community Organization Theory – Major Models
Major models include: (1) Locality Development, primarily a process-oriented model that uses consensus and cooperation to build a sense of community and community capacity; (2) Social Planning, primarily a task-oriented model that uses rational-empirical problem solving with the help of an outside expert to solve immediate problems; and (3) Social Action, a confrontational, conflict-oriented model that seeks to change imbalances of power by redistributing power and resources.
Community Organization Theory – Major concepts
Major concepts include: (1) Empowerment, a social action process to create community mastery over community problems; (2) Critical consciousness, awareness of social, economic, and political factors that contribute to community problems; (3) Community capacity, community ability to identify, mobilize, and address community problems; (4) Issue selection, community identifies immediate winnable changes; (5) Participation, the engagement of community members as partners in the change process; and (6) Relevance, a community agenda based on community-defined needs and resources.
Communication Theory –
Communication Theory focuses on the production and exchange of information as a determinant of health. Communication theory uses media and communications to provide information, influence behavior change, and influence what individuals are concerned about. The most common forms of communication in public health are interpersonal and mass communication. The processes involved in communication include encoding, transmission, reception (decoding) and synthesis of information and meaning. Communication theory is an important tool for addressing health literacy, cultural competency, and limited English proficiency in populations. New communication strategies include internet-based health information, online support groups, telephone-delivered interventions, and interactive health games.
Communication Theory – A number of factors can affect the communication process including:
A number of factors can affect the communication process including: (1) Context of the communication; (2) Relationship between sender and receiver; (3) Meaning attached to the channel (i.e., newspaper, TV, interpersonal communication); and (4) Process of encoding and decoding.
Diffusion of Innovation –
Diffusion of Innovation theory focuses on the widespread dissemination of successful innovations as a determinant of health. The process of dissemination includes: (1) Innovation Development, the development of the innovation; (2) Dissemination, the process to communicate about the innovation; (3) Adoption, the “uptake” of the innovation by the target population; (4) Implementation, the regular use of the innovation; and (5) Maintenance, a focus on sustainability and institutionalization of the behavior.
Diffusion of Innovation – Five factors influence whether an innovation will diffuse, and the rate of diffusion:
Five factors influence whether an innovation will diffuse, and the rate of diffusion: (1) individual characteristics of the prospective adopter; (2) environmental context of the innovation; (3) the change agent’s credibility, trust, and respect; (4) the quantity and quality of information and communication about the innovation; and (5) characteristics of the innovation, in terms of relative advantage (if the innovation is better than what currently exists), compatibility (if the innovation fits with the intended audience), complexity (if the innovation is easy to use), trialability (if the innovation can be tried before deciding to adopt it), and observability (if the results of the innovation are observable and measurable).
Health Promotion
Health Promotion is defined by the World Health Organization (WHO) as “the process of enabling people to increase control over their health and its determinants, and Health promotion activities focus on changing individual knowledge, attitudes, and skills, as well as enacting laws, policies, and regulations that address air and water quality, housing, food supply, income, and working conditions.
Prevention
Prevention is defined by WHO as “approaches and activities aimed at reducing the likelihood that a disease or disorder will affect an individual, interrupting or slowing the progress of the disorder, or reducing disability.” Prevention approaches may be categorized based on a continuum of disease or by population subgroup.
Prevention Categories Based on the Disease Continuum – (1) Primary Prevention Strategies
(1) Primary Prevention Strategies are delivered prior to the onset of disease in order to prevent the occurrence of disease. Examples of primary prevention include immunizations, safe drinking water and food system, adequate diet and physical activity, preventing youth access to tobacco, sunscreen and protective clothing, workplace safety regulations, and air bags.
Prevention Categories Based on the Disease Continuum – (2) Secondary Prevention Strategies
(2) Secondary Prevention Strategies are delivered at the earliest stages of disease to identify and detect disease and provide prompt treatment. Examples of secondary prevention include screening for cancers, heart disease, diabetes, lead exposure, TB, HIV, mental illness, and substance abuse.
Prevention Categories Based on the Disease Continuum – 3) Tertiary Prevention Strategies
3) Tertiary Prevention Strategies are delivered when the individual already has a disease in order to limit disability and complications, and reduce severity or progression of disease. Examples of tertiary prevention include retinal exams for diabetic retinopathy, stroke and post- heart attack rehabilitation programs, cancer survival programs, and hospice programs that ensure dignity and reduce suffering in terminal conditions.
Prevention Categories Based on Population Subgroup –
Prevention activities are targeted to different groups in the population: (1) Universal Prevention Strategies are delivered to the entire population in order to avert the onset of disease; (2) Selective Prevention Strategies are delivered to a subgroup in the population who are deemed “at risk” by belonging to a certain group or setting, regardless of their individual level of risk; and (3) Indicated Prevention Strategies are delivered to the individuals in the population who have risk factors or are exhibiting early signs of a disorder.
Multicultural Perspective and Prevention –
Culture is a set of learned and shared values, beliefs, attitudes, languages, behaviors, and customs of a group of people. Ethnicity is a classification of people based on national origin or culture, and race is a classification of people based on physical or biological characteristics. Cultural diversity refers to differences based on cultural, ethnic, or racial factors. Cultural diversity impacts beliefs about health, illness, and health care. A multicultural perspective takes cultural differences into account when developing a model of the determinants of health and when designing prevention strategies. Examples of multicultural prevention strategies include culturally tailored dietary guidelines, and partnering with churches to deliver prevention programs.
Harm Reduction Perspective and Prevention –
The harm reduction perspective is based on the assumption that banning certain substances is unrealistic, so the public health approach should focus on reducing the negative consequences of high-risk behaviors. Examples of harm reduction strategies include nicotine gum, designated driver programs, and needle exchange programs for intravenous drug users.
Examples of evidence-based primary prevention strategies directed at the four leading behavioral risk factors for preventable death include:
(1) Tobacco Use: Smoking cessation programs, school-based prevention curricula, minor access laws, cigarette excise taxes, and smoke free environments. (2) Physical Inactivity: Moderate amounts of low intensity physical activity, accessible stairwells and sidewalks, safe neighborhoods, and affordable facilities for exercise. (3) Poor Diet: Include more fruits and vegetables, increase grains and fiber-rich foods, decrease total fat and saturated fat, decrease salt and sugar, restaurants encourage healthy eating habits, and food manufacturers lower fat content of processed food. (4) Excess Alcohol Consumption: Alcohol reduction programs, school-based prevention curricula, minor access laws, increasing alcohol taxes, maintaining limits on days of sale, maintaining limits on hours of sale in bars, regulation of alcohol outlet density, sobriety checkpoints, and supervision in alcohol risk work environments.
Community Health Practice
WHO defines a community as “A social group determined by geographic boundaries and/or common values and interests, community members know and interact with one another, the community functions within a particular social structure, and the community creates norms, values, and social institutions.” Critical components of community health practice include identification of stakeholders, community mobilization, community assessment, and community-based participatory research.
Identification of Stakeholders –
Stakeholders include the program sponsor, and decision makers, organizations, and individuals that will be affected by the program. Critical stakeholders include: (1) Elected officials and their health policy advisors; (2) Legislators on health-related committees; (3) Program sponsors and funders; (4) Program Managers; (5) Program Staff; (6) Key health supporters as well as potential adversaries; (7) Representatives from a broad array of public and private agencies including public health, private health care organizations, mental health, substance abuse, environmental protection, criminal justice, social services, education, agriculture, transportation, and recreation; (8) Representatives from relevant health associations (American Heart Association, American Cancer Society, etc.); (9) Target groups and beneficiaries; and (10) Potential program adopters.
Community Mobilization –
Community mobilization involves a collective effort by groups and community members to increase awareness about a problem and advocate for change.
Community Mobilization – Key Steps
Key steps include: (1) Defining the community; (2) Assessing, and working with, the community’s capacity for mobilizing; and (3) Understanding the community agenda and selecting the right issue. Community mobilization leads to community empowerment, i.e., the community taking charge of the issue, defining what the goals are, and taking the necessary action.
Community Assessment –
Basic information for community needs assessment and surveillance includes morbidity and mortality data from the National Vital Statistics System; behavioral factors from the Behavioral Risk Factor Surveillance System; and social, economic, and environmental indicators from the Directory of Social Determinants of Health at the Local Level.
Community Assessment – The process of mapping community assets Identifies community capacity for addressing community needs, and includes the following steps:
The process of mapping community assets Identifies community capacity for addressing community needs, and includes the following steps: (1) Identify the skills, capacities, and experiences of community members and organizations that can help address the problem. This assessment should include the health care environment (hospitals, clinics, insurance companies, pharmacies), the food environment (produce markets, quick shops, fast food restaurants), the active living environment (sidewalks, parks, recreation center), community services (employment assistance, housing, transportation), other public institutions (schools, libraries), private businesses, nonprofit organizations, and community or neighborhood organizations, media representatives, community historians, and community informal leaders and role models. (2) Identify how the assets identified in step 1 can be used to address determinants of the problem; (3) Identify what assets are missing to address determinants of the problem.
Community-based Participatory Research –
Community-based Participatory Research (CBPR) is a collaborative approach to research that equitably involves all stakeholders in the process of defining the problem, identifying and implementing solutions, and evaluating outcomes. CBPR is founded on the principle that more comprehensive and participatory approaches are needed to address the complex set of multi-level determinants underlying major public health problems.
Community-based Participatory Research – The key principles include:
The key principles include: (1) Start with the community as the unit of assessment and change; (2) Build on community assets and resources in solving community problems; (3) Support equitable partnership with the community throughout the research process; (4) Build community capacity through the research process; (5) Use the social ecological model to understand determinants of community problems and to guide actions at multiple levels of influence; (5) Disseminate findings through multiple channels with sensitivity to cultural issues in communication and literacy; and (6) Balance research and action.
Ethical Issues in Planning and Evaluation – The Tuskegee Study –
The Tuskegee Syphilis Study involved poor African-American men in Macon County Alabama who were offered free treatment for “Bad Blood”, a euphemism for syphilis. 600 low-income African American males were recruited by government health workers and monitored for 40 years, while effective treatment was withheld from study participants who contracted syphilis. In 1972 a United States Public Health Service investigator expressed concerns about the morality of the experiment to an Associated Press reporter, and the publication of the story led to a class-action suit against the federal government, which was settled out of court in 1974.
Ethical Issues in Planning and Evaluation – The National Research Act and the Belmont Report –
The U.S. Congress passed the National Research Act in 1974, creating the National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research. The goal of the Commission was to identify the basic ethical principles guiding the conduct of research with human subjects. The Belmont Report summarizes the work of the Commission, including the boundaries between practice and research, basic ethical principles of respect for persons, beneficence, and justice, and informed consent, assessment of risks and benefits, and selection of subjects.
Institutional Review Board (IRB) –
An IRB is an administrative board that has the authority to approve, modify or disapprove research involving human subjects. IRBs are federally mandated to ensure that all research involving human subjects is conducted in accordance with federal regulations.
Healthy People National Health Objectives –
The US Department of Health and Human Services has developed science-based national public health objectives every 10 years since 1980, as part of the Healthy People Initiative. The goal of Healthy People is to increase quality and years of life and eliminate health disparities by providing a framework of public health priorities, measurable objectives and benchmarks, which can be used to guide local health planning and to aid in monitoring progress over time. Leading Health Indicators in Healthy People 2010 include physical activity, overweight and obesity, tobacco use, substance abuse, responsible sexual behavior, mental health, injury and violence, environmental quality, immunization, and access to health care.
PRECEDE-PROCEED –
PRECEDE-PROCEED is a community-oriented, participatory model for creating successful community health promotion interventions by identifying the desired outcome, identifying determinants of the outcome, and designing an intervention to reach the desired outcome.
The initial PRECEDE component has four phases:
The initial PRECEDE component has four phases:(1) Social Diagnosis, which involves asking the community what it wants and needs to improve community health and quality of life, resulting in identification of a community health outcome; (2) Epidemiological Diagnosis, which involves identifying the health behaviors, interpersonal factors, organizational factors, and community factors that influence the community-identified outcome, determining which risk factors are most significant and malleable, and developing program objectives; (3) Educational and Organizational Diagnosis, which involves identifying the predisposing, enabling, and reinforcing factors that may facilitate or impede changing the factors identified during Phase 2; and (4) Administrative and Policy Diagnosis, which involves identifying and modifying internal administrative issues and policies and external policies as needed to generate the funding and other resources for the intervention.
The PROCEED component adds on an additional four phases:
The PROCEED component adds on an additional four phases (5) Implementation, which involves starting up and conducting the intervention; (6) Process Evaluation, which involves a determination whether the intervention is proceeding as planned, with adjustments as needed; (7) Impact Evaluation, which involves a determination whether the intervention is changing the planned risk factors, with adjustments as needed; and (8) Outcome Evaluation, which involves a determination whether the intervention is producing the outcome identified in Phase 1, with adjustments as needed.
Social Marketing –
Social Marketing applies the principles of marketing to planning interventions at individual, interpersonal, organizational, community, and societal levels. The social marketing approach includes a focus on consumer wants and needs, awareness of competition, and audience segmentation. The goal is to influence “consumers” to “buy” a behavior change or health-related product/technology.
Social marketing campaigns are built around the “four Ps”:
Social marketing campaigns are built around the “four Ps” (1) Product, the behavior, program, technology; (2) Price, the cost of adoption; (3) Place, where the product available or promoted; and (4) Promotion, how to promote the first three “Ps” through persuasive strategies.
Common Elements Among Planning Models –
Planning models have the following features in common: (1) Community involvement and mobilization; (2) Needs assessment at community and organizational levels; (3) Selection of specific target audiences; (4) Development of specific, measurable, attainable and time-bound objectives and their indicators; (5) Action plan development and implementation; (6) Evaluation of program processes and outcomes; and (7) Institutionalization.
Evaluation Methods
Program evaluation is a systematic process using both qualitative and quantitative methods to answer questions about the nature of the problem the program is addressing, the program’s logic model, program processes, program outcomes, and program efficiency. Program evaluation helps to orient public health efforts towards outcomes, and encourages the use of scientific evidence to guide decisions about public health programs and policies.
Needs Assessment –
A needs assessment investigates the extent of the problem, the consequences of the problem, and subgroups of people or places affected by the problem.
Logic Model –
A logic model summarizes the program’s mechanism of change by identifying inputs, activities, outputs, and a trajectory of short-term, intermediate, and long-term outcomes.
Process Evaluation –
Process evaluation investigates the fidelity of program implementation (what program activities are delivered, who delivers program activities, and when and where activities are delivered), and investigates outputs such as number of people served.
Outcome Evaluation –
Outcome evaluation investigates the effect of the program on short-term outcomes, intermediate outcomes, and long-term outcomes. For example, short-term outcomes of a prevention program could include increased knowledge, improved attitudes and beliefs, and increased skills; intermediate outcomes could include behavior change; and long-term outcomes could include decreased rates of disease, disability, death, or disparity.
Efficiency Evaluation –
An efficiency evaluation compares the incremental cost of the program to its effects (cost-effectiveness analysis) or to monetized effects (cost-benefit analysis). Efficiency evaluations may also investigate several competing programs to determine whether alternative, less costly programs achieve the same results as more expensive programs.
RE-AIM –
The RE-AIM Model encourages program developers and evaluators to emphasize the external validity of a program, thus increasing the likelihood of translating an effective program to practice. The RE-AIM framework includes five components; (1) Reach of the program; (2) Effectiveness of the program; (3) Adoption by large number of diverse settings; (4) Implementation with fidelity; and (5) Maintenance through institutionalization or by becoming part of organizational policies and practices.
Centers for Disease Control (CDC) Evaluation Framework –
The CDC established a six-step framework for evaluating public health programs: (1) Engage Stakeholders. 2) Describe the Program. (3) Focus the Evaluation Design.(4) Gather Credible Evidence. (5) Justify Conclusions. (6) Ensure Use and Share Lessons Learned.
Methodological Issues – Designs:
Questions about complex events, patterns and processes of a program are best answered with qualitative designs such as case studies and focus groups. There are three quantitative designs for measuring program impact: (1) The single subject design measures outcomes before and after program implementation, and is appropriate for a preliminary investigation of a program. The before and after design will not allow the evaluator to conclude if the program caused the change in outcome, as alternative, plausible explanations for the results cannot be ruled out; (2) The quasi-experimental design compares outcomes for a group participating in a program to the outcomes for a similar group not receiving the program. The quasi-experimental design is appropriate when random assignment is not feasible or ethical; (3) The experimental design, or randomized prevention trial, compares outcomes for a group randomly assigned to participate in a program to the outcomes for a group randomly assigned to a control condition. The experimental design is the most rigorous evaluation of impact when there are no concerns about denial or delay of program services.
Methodological Issues – Descriptive/Exploratory Research:
The purpose of descriptive research is to document characteristics and conditions of individuals, groups, or settings. The purpose of exploratory research is to examine the relationships among characteristics and conditions of individuals, groups, or settings. Descriptive and exploratory research questions are typically addressed with qualitative designs (case studies, focus groups, ethnography) or quantitative non-experimental designs (cross-sectional, retrospective, and prospective).
Methodological Issues – Hypothesis Testing Research –
The purpose of hypothesis testing research is to define a hypothesis, operationalize the variables, and conduct a statistical test of the relationship among variables. Statistical tests of relationships between variables are based on the null hypothesis; if the appropriate test statistic is different enough (p<.05), the null hypothesis of no relationship between the variables is rejected.
Methodological Issues – Synergy Between Methodological Issues – Descriptive/Exploratory Research and Hypothesis Testing Research –
There is a synergy between descriptive/exploratory research and hypothesis testing research in that results from one type of study may inform the other (i.e., results from an exploratory study may generate a hypothesis for testing; rich details that underlie hypothesis testing study results may be revealed by an exploratory study).
Methodological Issues – Sampling Methods –
There are two major types of sampling methods: (1) Non-probability sampling methods use human judgment to select the sample. Non-probability samples are appropriate for qualitative designs exploring complex program patterns. (2) Probability sampling methods draw a sample from the defined population such that each element has a known probability of being selected. Probability samples are appropriate for quantitative designs, with cluster sampling being most useful in situations when the program covers a large geographic area.
Methodological Issues – Measurement Methods –
Data about program activities, outputs, and outcomes can be collected via interviews with program staff and participants, direct observations of the program, and content analysis of program records. Data collection methods should be reliable (consistency of measure) and valid (accuracy of measure). Widespread impact of a program may be measured by using the Behavioral Risk Factor Surveillance System (BRFSS) to examine trends in behaviors for a defined population before and after implementation of a program.
Methodological Issues – Analytic Methods –
Analysis of the effect of the program on outcomes should control for other variables related to the outcomes. Major multivariate techniques include regression or ANOVA for continuous outcomes, and logistic regression for categorical outcomes.
Methodological Issues – Internal Validity –
Program evaluation methods have internal validity when other alternative plausible explanations for the effect of the program on the outcome can be ruled out.
Methodological Issues – External Validity –
Program evaluation methods have external validity when the results can be generalized to other groups and settings.
Scaling Up –
Scaling up refers to increasing a program’s impact while maintaining the program’s quality. There are four categories of scaling up: (1) Quantitative, increasing the numbers of clients reached by a program. (2) Functional, expanding program breadth. (3) Political, increasing the organization’s ability to address barriers to effective program services; and (4) Organizational, improving the organization’s ability to continue to support the program in an effective and sustainable manner.
Strategies for Ensuring Program Sustainability –
Strategies include: (1) Build community and organizational capacity in management, advocacy, fundraising, and training; (2) Utilize simple, user-friendly materials and tools; (3) Involve community members in every step of the program; (4) Develop, implement, and institutionalize cost-recovery mechanisms; (5) Develop, implement and institutionalize quality assurance and self assessment tools; (6) Build on pre-existing structures; 97) Develop program leaders and “champions”; and (8) Encourage cross-community learning.
Many people do not attempt to decrease unhealthy behaviors such as overeating or smoking because they lack the confidence that they can successfully change. This is an example of:
(A) Perceived susceptibility
(B) Perceived severity
(C) Perceived self-efficacy
(D) Perceived response efficacy
Many people do not attempt to decrease unhealthy behaviors such as overeating or smoking because they lack the confidence that they can successfully change. This is an example of:
(C) Perceived self-efficacy
Perceived self-efficacy is a construct from social cognitive theory. It is defined as the level of confidence in one’s ability to undertake the recommended preventive behavior. Self-efficacy is situation specific, so a person can be very confident in some circumstances and not in others. Additional explanations of this concept are available in several general texts (e.g., Coriel, Glanz, Nutbeam).
The construct of normative beliefs is from which model/theory?
(A) Transtheoretical model
(B) Theory of reasoned action/planned behavior
(C) Social cognitive theory
(D) Social ecological model
The construct of normative beliefs is from which model/theory?
(B) Theory of reasoned action/planned behavior
The construct of normative beliefs comes from the theory of reasoned action/planned behavior. It is the belief about whether each referent (i.e., the people important to someone) approves or disapproves of the behavior. Additional explanations of this concept are available in several general texts (e.g., Coriel, Glanz, Nutbeam).
Which of the following do social cognitive theory and the social ecological model have in common?
(A) Both take into consideration factors that are within the individual and factors that operate outside the individual.
(B) Both focus primarily on environmental determinants of behavior that must be addressed at the policy level.
(C) Both come out of the value expectancy paradigm that associates behaviors with valued outcomes.
(D) Both originally were developed exclusively to explain unhealthy versus healthy behaviors.
Which of the following do social cognitive theory and the social ecological model have in common?
(A) Both take into consideration factors that are within the individual and factors that operate outside the individual.
Social cognitive theory and the social ecology model both consider factors that are within the individual and factors that operate outside the individual (the social and physical environments). See McLeroy, et al.
A population of rural women experiences a high rate of mortality related to breast cancer. Researchers at a local university implement a breast cancer screening intervention. This intervention is an example of:
(A) Tertiary prevention
(B) Advocacy
(C) Secondary prevention
(D) Primary prevention
A population of rural women experiences a high rate of mortality related to breast cancer. Researchers at a local university implement a breast cancer screening intervention. This intervention is an example of:
(C) Secondary prevention
Secondary prevention refers to actions taken to prevent recurrence of a previous condition or worsening of a current condition. For instance, taking part in a cardiac rehabilitation program is secondary prevention, to stop one having another heart attack.
All intervention messages (printed, computer-delivered, or Internet-based) must:
(A) Start with the most important information first
(B) Include graphics, pictures, and the like to attract people’s attention
(C) Be written at a reading level suitable to the target population
(D) Be no longer than four sentences so that the reader does not become bored
All intervention messages (printed, computer-delivered, or Internet-based) must:
(C) Be written at a reading level suitable to the target population
Scenario for Questions 6-9.
Franklin ‘s Grove is the county seat of Franklin County , a small rural county in the So utheast. On the basis of its demographic and economic profile, it was selected as a health improvement zone to receive Federal funds to implement programs to improve progress toward reaching the national health objectives. Communities receiving such funds are charged with identifying the most significant gaps between the current health status and national health objectives and with putting programs in place to narrow such gaps.
What is the first step to take to address the goals of the funding?
(A) Consult Healthy People 2010 to identify relevant objectives
(B) Convene a group of community leaders to decide how to spend the funds
(C) Convene a group of community citizens to decide how to spend the funds
(D) Consult an expert in community health to draw up a program plan
What is the first step to take to address the goals of the funding?
(A) Consult Healthy People 2010 to identify relevant objectives
The first step for implementing programs that could narrow the gaps between the current health status in the county and the national health objectives would be to consult Healthy People 2010, a national health promotion and disease prevention initiative to increase the quality and years of healthy life and to eliminate health disparities. This action identifies the actual national health objectives so that programs can be developed and implemented to achieve these specific goals locally
Scenario for Questions 6-9.
Franklin ‘s Grove is the county seat of Franklin County , a small rural county in the So utheast. On the basis of its demographic and economic profile, it was selected as a health improvement zone to receive Federal funds to implement programs to improve progress toward reaching the national health objectives. Communities receiving such funds are charged with identifying the most significant gaps between the current health status and national health objectives and with putting programs in place to narrow such gaps.
Using the PRECEDE framework, the county health department has conducted a social and health diagnosis. Some of the most severe quality-of-life problems were related to limb amputation and kidney failure. Prevalent health problems included diabetes, hypertension, and cardiovascular disease. Which of the following behavioral factors are most likely responsible for the above health and quality-of-life issues in Franklin ‘s Grove?
(A) Unprotected sex, early sexual initiation, use of drugs
(B) Sedentary lifestyle, high caloric consumption, low fiber intake
(C) Advanced age, low levels of education, history of racism
(D) Frequent tobacco, drug, and alcohol use
Using the PRECEDE framework, the county health department has conducted a social and health diagnosis. Some of the most severe quality-of-life problems were related to limb amputation and kidney failure. Prevalent health problems included diabetes, hypertension, and cardiovascular disease. Which of the following behavioral factors are most likely responsible for the above health and quality-of-life issues in Franklin ‘s Grove?
(B) Sedentary lifestyle, high caloric consumption, low fiber intake
The behavioral factors associated with such diseases as diabetes, hypertension, and CV disease include sedentary lifestyle, high caloric consumption, and low fiber intake.
Scenario for Questions 6-9.
Franklin ‘s Grove is the county seat of Franklin County , a small rural county in the So utheast. On the basis of its demographic and economic profile, it was selected as a health improvement zone to receive Federal funds to implement programs to improve progress toward reaching the national health objectives. Communities receiving such funds are charged with identifying the most significant gaps between the current health status and national health objectives and with putting programs in place to narrow such gaps.
Given the factors presumed to be responsible for the major health problems in this scenario, what would be the best source for community planners to use to find data on how widespread each behavioral factor is at the state or local level?
(A) Healthy People 2010 midcourse review
(B) Behavioral Risk Factor Surveillance System (BRFSS)
(C) Community Guide to Preventive Services
(D) Morbidity and Mortality Weekly Report
Given the factors presumed to be responsible for the major health problems in this scenario, what would be the best source for community planners to use to find data on how widespread each behavioral factor is at the state or local level?
(B) Behavioral Risk Factor Surveillance System (BRFSS)
The Centers for Disease Control and Prevention (CDC) operates the Behavioral Risk Factor Surveillance System (BRFSS), a state-based system of health surveys that collects information on health risk behaviors, preventive health practices, and health care access, primarily related to chronic disease and injury. For many states, the BRFSS is the only available source of timely, accurate data on health-related behaviors.
Scenario for Questions 6-9.
Franklin ‘s Grove is the county seat of Franklin County , a small rural county in the So utheast. On the basis of its demographic and economic profile, it was selected as a health improvement zone to receive Federal funds to implement programs to improve progress toward reaching the national health objectives. Communities receiving such funds are charged with identifying the most significant gaps between the current health status and national health objectives and with putting programs in place to narrow such gaps.
The Franklin County health program planners intend to keep close track of the number of programs and activities offered, the number of adults and children who participate in each program or activity, and all feedback given by community members about the programs and activities. These actions would most appropriately fit into which of the following evaluation categories?
(A) Cost-effectiveness
(B) Impact
(C) Outcome
(D) Process
The Franklin County health program planners intend to keep close track of the number of programs and activities offered, the number of adults and children who participate in each program or activity, and all feedback given by community members about the programs and activities. These actions would most appropriately fit into which of the following evaluation categories?
(D) Process
When health programs track the number of programs, activities, and participants and also gather feedback from community members, these actions constitute process evaluation. See: Kettner PM, Moroney RK, and Martin LL. 2003. McKenzie JM and Smelter J. 2005.
Which term refers to a collective body of individuals identified by geography, common interests, concerns, characteristics, or values?
(A) Community
(B) Population
(C) Sample
(D) Group
Which term refers to a collective body of individuals identified by geography, common interests, concerns, characteristics, or values?
(A) Community
A “community” can be defined as “a collective body of individuals identified (or defined) by geography, common interests, concerns, certain characteristics, or values”.
Which of the following is defined as a community’s ability to define and solve its own problems?
(A) Social capital
(B) Community development
(C) Community organization
(D) Community capacity
Which of the following is defined as a community’s ability to define and solve its own problems?
(D) Community capacity
The more skills, assets, and strengths that a community has, the better prepared it is to achieve its goals (http://www.communitycapacity.org).
Biological, environmental, behavioral, organizational, political, and social factors that contribute to the health status of individuals, groups, and communities are commonly referred to as:
(A) Health behavior causal factors
(B) Social ecology factors
(C) Needs assessment factors
(D) Determinants of health
Biological, environmental, behavioral, organizational, political, and social factors that contribute to the health status of individuals, groups, and communities are commonly referred to as:
(D) Determinants of health
All biological, environmental, behavioral, organizational, and political, and social factors that contributes to health status for individuals, groups, communities and beyond, are all referred to as determinants of health.
An individual’s capacity to obtain, interpret, and understand basic health information and services and the individual’s competence to use such information and services in ways that enhance health are called:
(A) Medical informatics
(B) Health literacy
(C) Health education
(D) Patient education
An individual’s capacity to obtain, interpret, and understand basic health information and services and the individual’s competence to use such information and services in ways that enhance health are called:
(B) Health literacy
Health literacy includes the capability to read and comprehend the label on a prescription bottle and then to take the medicine exactly as prescribed.
Which of the following terms refers to a consumer-driven application of sales and promotional techniques to the analysis (including the review of background information and formative work), planning, implementation, and evaluation of programs designed to encourage positive health behaviors within intended audiences?
(A) Health communications
(B) Health promotion
(C) Focus group testing
(D) Social marketing
Which of the following terms refers to a consumer-driven application of sales and promotional techniques to the analysis (including the review of background information and formative work), planning, implementation, and evaluation of programs designed to encourage positive health behaviors within intended audiences?
(D) Social marketing
Which of the following terms from the social cognitive theory refers to the dynamic interaction among the person, environment, and behavior?
(A) Behavioral norms
(B) Reciprocal determinism
(C) Decisional balance
(D) Bidirectional dependence
Which of the following terms refers to the dynamic interaction among the person, environment, and behavior?
(B) Reciprocal determinism
Reciprocal determinism comes from social cognitive theory (SCT) and refers to the interrelationship between a person, her environment, and her behavior. In other words, behavior both influences, and is influenced by, the social and physical environment.
A community has high rates of HIV infection among injection drug users (IDUs). The community council decides to legalize needle exchange programs in an effort to provide clean syringes to prevent the sharing of contaminated needles in drug-using networks. This type of program is an example of:
(A) Harm reduction
(B) Policy advocacy
(C) Community organization
(D) Behavior change
A community has high rates of HIV infection among injection drug users (IDUs). The community council decides to legalize needle exchange programs in an effort to provide clean syringes to prevent the sharing of contaminated needles in drug-using networks. This type of program is an example of:
(A) Harm reduction
Harm reduction interventions are designed to encourage individuals to adopt a behavior that reduces risk when they are unable or unwilling to completely eliminate their behavioral risk (e.g., reducing the number of cigarettes smoked, but not totally quitting).
Theory is defined as:
(A) A branch of philosophy that deals with morality
(B) A tested set of hypotheses listed in order of importance
(C) A systematic relationship of constructs devised to analyze, predict, and otherwise explain the nature of behavior of a specified set of phenomena
(D) A verified fact that the majority does not believe to be true
Theory is defined as:
(C) A systematic relationship of constructs devised to analyze, predict, and otherwise explain the nature or behavior of a specified set of phenomena
Which of the following is not a construct from the Health Belief Model?
(A) Susceptibility
(B) Cues to action
(C) Decisional balance
(D) Barriers
Which of the following is not a construct from the Health Belief Model?
(C) Decisional balance
Susceptibility, cues-to-action and barriers are classic HBM constructs, going back to the initial formulations of this theory. On the other hand, decisional balance is often employed within stages of change theory, particularly in SOC’s Strong and Weak Principles.
Which of the following processes from the Transtheoretical Model refers to substituting healthy behaviors for unhealthy ones?
(A) Stimulus control
(B) Consciousness raising
(C) Reinforcement management
(D) Counter-conditioning
Which of the following processes from the Transtheoretical Model refers to substituting healthy behaviors for unhealthy ones?
(D) Counter-conditioning
Within the Transtheoretical Model, stage movement is accompanied by one or more processes of change. Counter-conditioning, that is substituting healthy behaviors for unhealthy ones, is active during action and maintenance.
Which of the following is the best example of a process evaluation for a program designed to decrease mortality from drinking and driving among high school youth?
(A) Document change in mortality associated with drinking and driving
(B) Document change in numbers of youth riding with impaired drivers
(C) Document about risks of riding with impaired drivers
(D) Document number of students who attend the school’s alcohol-free party
Which of the following is the best example of a process evaluation for a program designed to decrease mortality from drinking and driving among high school youth?
(D) Document number of students who attend the school’s alcohol-free party
Process evaluation is concerned with how the program is delivered. It deals with issues such as when program activities occur, where they occur, and who delivers them and how many people participate in those activities.
Which of the following most directly deals with the issue of internal validity in program evaluation design?
(A) Having a reliable and valid measurement instrument
(B) Having well-written process objective (s)
(C) Having a comparison group
(D) Ensuring generalizability of program effects
Which of the following most directly deals with the issue of internal validity in program evaluation design?
(C) Having a comparison group
Internal validity is defined as the extent to which an observed impact can be attributed to a planned intervention and not to other factors. In order to do that, we employ evaluation designs, where in most cases, except for the one group pretest and post-test design which is the weakest design-a comparison group is incorporated.
Which of the following is the best example of intrapersonal factors that affect an individual’s behavior as outlined by the Social Ecological Model ( McLeroy et al., 1988)?
(A) National laws and policies
(B) Informal social networks
(C) Personal knowledge or skills
(D) Community partnerships
Which of the following is the best example of intrapersonal factors that affect an individual’s behavior as outlined by the Social Ecological Model (McLeroy et al., 1988)?
(C) Personal knowledge or skills
Intrapersonal factors are defined as characteristics of the individual such as knowledge, attitudes, self-concept and skills.
Which of the following is not an example of a methodology used during a social assessment?
(A) Process evaluation
(B) Focus groups research
(C) Delphi method
(D) Survey administration
Which of the following is not an example of a methodology used during a social assessment?
(A) Process evaluation
Social assessment is the process of gathering information through multiple sources and through broad participation in order to enhance the understanding of people regarding their own quality of life and aspirations for the common good. Strategies to conduct social assessment include asset mapping, the nominal group process, the Delphi method, focus groups, surveys and public service data.
Which of the following is not a principle/key concept in community organization and community building practice?
(A) Critical consciousness and empowerment
(B) Critical allocation of resources and sharing among partners
(C) Principle of relevance or “start where the people are”
(D) Principle of participation
Which of the following is not a principle/key concept in community organization and community building practice?
(B) Critical allocation of resources and sharing among partners
Although there is no single model regarding community building there are several key concepts that affect and measure change at the community level. These are: critical consciousness and empowerment, community competence, the principles of participation and relevance, issue selection and measurement and evaluation of community organizing efforts.
When a person is healthy, without signs and symptoms of disease, illness, or injury, the level of prevention most appropriate would be:
(A) Primary prevention
(B) Secondary prevention
(C) Tertiary prevention
(D) No prevention level is needed
When a person is healthy, without signs and symptoms of disease, illness, or injury, the level of prevention most appropriate would be:
(A) primary prevention
Primary prevention includes preventive measures that forestall the onset of illness or injury during the prepathogenesis period.
In the planning process, the group being served is referred to as the:
(A) Pilot population
(B) Key informants
(C) General population
(D) Priority population
In the planning process, the group being served is referred to as the:
(D) Priority population
The priority population is the people for whom the program is intended.
The social marketing conceptual framework if known for its 4 P’s and competition. Which of the following is not one of the 4 P’s?
(A) Price
(B) Product
(C) Population
(D) Place
The social marketing conceptual framework if known for its 4 P’s and competition. Which of the following is not one of the 4 P’s?
(C) Population
The social marketing framework includes five key concepts: the product (behavior being promoted) and its competition; the price (social, emotional, and monetary costs exchange for the product’s benefits); place (where the exchange takes place and/or where the target behavior is practiced); and promotion (activities used to facilitate the exchange.)