DB
Social Ecological Model Health Behavior
Where to begin…
What are some of the main issues impacting public health?
How do we begin to understand all of the things that impact these issues?
Social Ecological Model
Personal factors
Knowledge; beliefs
Attitudes; motivation
Experience
Expectations
Skills
Physiology affecting energy balance
Appetite & satiety mechanisms
Metabolic rate; energy balance set-point
Intrauterine & early life “programming”
Biology affecting RFs & disease
Genetic predisposition
Neuronal regulation
Cellular processes
Adipose tissue metabolism
Lipoprotein & glucose regulation
Simons-Morton DG, unpublished, 2005
Diet and physical
activity behaviors
Obesity
CVD risk factors
CVD
Environmental, societal, health-care factors
SES; Social and cultural norms
Home, school, & workplace environments
Media; advertising
Food composition; portion size; cost
Built environment; PA/PE programs
HC provider advice, counseling, & treatment
Obesity: Consequences and Influences
4
Individuals
Organizations
(schools, worksites, healthcare providers)
Communities
Family
Broader Physical & Social Environments
Individual are influence by their social & physical environments
5
Example of SEM Logic Model
CDC Social Ecological Model
What is consistent with each slide?
Broad view with multiple connections
Nothing stands on its own
Change in one should result in change in other sections.
What is SEM?
Framework for conceptualizing
Allows one to consider individual and environmental factors
Examines how factors impact health and health-related behaviors
Components of the Social Ecology Model
Intrapersonal
Interpersonal
Institutional/Organizational
Community
Policy/Population
Intrapersonal
Factors within the individual.
Values
Beliefs
Attitudes
Skills
Genetics
Interpersonal
Factors that impact on behavior through social exchanges.
Family and friends
Social support
Social norms
Social networks
Institutional
Places where groups of people come together.
There is generally a common reason for gathering.
Informal rules
Formal rules
Environmental regulation
Community
Place where individuals from different institutions come together for social governance.
Defined subjectively.
Defined legally.
Common purpose.
Frequently some geographical identity.
Policies
Legal or socially upheld codes of conduct. They can be:
Informal
Formal
Individual
Group
Institutional
Community
Benefits of SEM
Health behaviors and problems are complex
Many factors impact health and health behavior
These factors interact with one another
Must look at issues from a multiple-level view if change is to be made
Complexity of human behavior
Intricacy of environments
Physical
Social
Benefits of SEM Cont.
Why should we focus on factors outside the individual?
Victim blaming
Underlying determinants of health and health behavior
Understand where impact and improvements may be made
Utilization of SEM
Problem analysis/needs assessment
Intervention design/conceptualization
Evaluation
Problem Analysis
Determine the problem determinants
What factors influence the problem at each level
Individual
Interpersonal
Organizational
Community
Policy/Population
Example
Factors/ determinants impacting teen pregnancy
Individual
Lack of knowledge and skills to prevent pregnancy
Interpersonal
Most teenagers engage in sexual activity
Institutional/ Organizational
Schools only able to teach abstinence only education
Community
Community perceptions about sexuality education
Population/Policy
Lack of support for education and access to contraception
Conceptualization/Intervention Design
Identify and shape solutions
Focus on identified goals and objectives
Based on theory
Incorporate a design team from multiple disciplines
Target factors on multiple levels
Broad scoped
Interventions
Individual Level
What is the focus of change?
What factors should be addressed?
Interpersonal
What is the focus of change?
What factors should be addressed?
Institutional
What is the focus of change?
What factors should be addressed?
Community/Organizational
What is the focus of change?
What factors should be addressed?
Policy/Population
What is the focus of change?
What factors should be addressed?
Potential Limitations of SEM
Interventions need to recognize all five domains as factors that can all modify change in a meaningful manner.
Problem - dose -response relationship
How much is needed in each domain?
Problem - with inadequate resources, what do you focus on?
Evaluation
Social norms
Policy Change
Example: Obesity Prevention Program
You are planning a needs assessment.
According to SEM you should obtain info on: intrapersonal attributes, interpersonal factors, institutional characteristics, community characteristics and policies that exist in all of the above domains.
Example cont’d
BUT where do you go from here?
According to SEM you should try and impact all four levels and also address policies within these levels where possible.
The model gives a lot of room for creativity.
The drawback is that there is very little formal structure to draw from.
SEM and Public Health
One must assume that many negative health behaviors have many factors that are driving the behavior.
We need a method to assist us with conceptualization about all of the information
Social Ecology Model is a good way to condense and review what has been done.
Just organize the information under the SEM headings.
SEM and Public Health Cont
You are now in a position to focus on the area of greatest need or the area of greatest interest. This can now be done with the full recognition of this area as part of the problem or solution.
This allows you to deal with better understanding of the limitations of your work which will probably not deal with all five parts of the social ecology model.