MHD504 1 CASE

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MHD504 _ Module 1 - Background

Health Promotion: The Role of Theory and the Ecological Perspective

Required Reading

Stacey, F. G., James, E. L., Chapman, K., Courneya, K. S., & Lubans, D. R. (2015). A systematic review and meta-analysis of social cognitive theory-based physical activity and/or nutrition behavior change interventions for cancer survivors.Journal of Cancer Survivorship, 9(2), 305-338. Available in the Trident Online Library.

Lee, R. E., Medina, A. V., Mama, S. K., Reese-Smith, J. Y., O'Connor, D. P., Brosnan, M., ... & Estabrooks, P. A. (2011). Health is power: an ecological, theory-based health intervention for women of color. Contemporary clinical trials, 32(6), 916-923. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3185198/

U.S. Department of Health and Human Services. (n.d.). Theory at a glance: A guide for health promotion practice. Retrieved from https://www.sbccimplementationkits.org/demandrmnch/wp-content/uploads/2014/02/Theory-at-a-Glance-A-Guide-For-Health-Promotion-Practice.pdf

Optional Reading

Healthy People 2020. Retrieved from https://www.healthypeople.gov/2020/tools-resources/Evidence-Based-Resources

Optional Resources

Purdue Online Writing Lab. (2018). General format. Retrieved from https://owl.purdue.edu/owl/research_and_citation/apa_style/apa_formatting_and_style_guide/general_format.html

Purdue Online Writing Lab. (2018). In-text citations: The basics. Retrieved from https://owl.purdue.edu/owl/research_and_citation/apa_style/apa_formatting_and_style_guide/in_text_citations_the_basics.html

Purdue Online Writing Lab. (2018). Reference list: Basic rules. Retrieved from https://owl.purdue.edu/owl/research_and_citation/apa_style/apa_formatting_and_style_guide/reference_list_basic_rules.html

Module 1 - Home

Health Promotion: The Role of Theory and the Ecological Perspective

Modular Learning Outcomes

Upon successful completion of this module, the student will be able to satisfy the following outcomes:

· Case

· Describe the Ecological Perspective in Health Promotion.

· Identify the role of behavior and the environment.

· Identify the main theories and theoretical models used in Health Promotion, their focus, and key concepts.

· SLP

· Use the scholarly literature to identify a health problem for a specific population, and discuss the magnitude and social determinants of the problem from a public health perspective.

· Discussion

· Discuss the role of theory in Health Promotion.

Module Overview

The United States Department of Health and Human Services defines health promotion as any combination of health education and related organizational, political, and economic interventions designed to facilitate behavioral and environmental adaptations that will improve or protect health.

The World Health Organization (WHO) defines health promotion as "the process of enabling people to increase control over, and to improve their health".

Health promotion represents a comprehensive social and political process. It not only embraces actions directed at strengthening the skills and capabilities of individuals, but also action directed towards changing social, environmental, and economic conditions so as to alleviate their impact on public and individual health.

People's lifestyles and the conditions in which they live and work strongly influence their health, well-being and longevity. Poor conditions lead to poorer health. An unhealthy environment and unhealthy behavior have direct harmful effects, but the worries and insecurities of daily life and the lack of supportive environments also have an influence.

Examples of social determinants are:

· Income

· Education

· Occupation

· Family structure

· Access to transport

· Stress

· Sanitation

· Exposure to hazards

· Social support

· Racial discrimination

· Access to resources linked to health.

The Ecological Perspective

Health behavior is affected by multiple factors. Sometimes health promotion program planners design programs that assume that only one factor will influence the reduction of a high-risk behavior, or the maintenance of a low-risk behavior.

The ecological perspective on health promotion programs, as proposed by McLeroy, Bibeau, Steckler and Glanz (1988), encourages us to look at health promotion programs from a contextual perspective. This model purports that there are multiple levels or factors that influence health behavior. An ecological perspective has implications to both explain health behavior and design related health promotion interventions.

As a means to explain health behavior, the ecological approach forces one to look for the cause of a health issue or problem from multiple perspectives. For example, eating behavior may be a function of personal knowledge and attitudes about food (intrapersonal). But, it could also be influenced by peer pressure (interpersonal), healthy food choices in company vending machines (institutional), an ample supply of fresh fruits and vegetables in local groceries (community) and the availability of free or reduced-price lunch in schools (public policy).

The ecological approach also provides the program planner with a perspective that requires the design of multiple intervention strategies to effectively address a health promotion problem. To this end, the program planner could provide employees with information on stress and stress management (intrapersonal), establish peer stress support groups at the work site (interpersonal), provide a stress management room and physical activity programs for employees (institutional), provide referral to existing community-based programs and resources (community), and comply with related Occupational Safety and Health Administration (OSHA) policy (public policy) (Eddy et al, 2002).

Once you are familiar with some contemporary theories of health behavior, the challenge is to use these critical tools within a comprehensive planning process. Planning systems like Social Marketing and PRECEDE-PROCEED increase the odds of success by examining health and behavior at multiple levels. This ecological perspective emphasizes our two main options:

· Change people

· Change the environment

The most powerful approaches will use both of these options together. Both are essential for truly comprehensive programs. Note how the activities most directly tied to changing people are derived from individual-level theories. In contrast, activities aimed at changing the environment draw on community-level theories. In between is Social Learning Theory, which has at its core a focus on the reciprocal causation between individuals and their environments.

Theories and Models in Health Promotion

Planning Models are used for guiding the planner through the process of planning and evaluating the intervention. Many people responsible for health education planning had more or less predetermined what intervention they were going to employ. Additionally, sometimes there was no apparent reason for choosing either the health issue to be addressed or the target population to be reached. Many times, the practitioner selected interventions based on which techniques he or she was most comfortable applying, even though they may not have been the most appropriate. Contemporary health education and health promotion rely on the systematic and critical analysis of the priorities and presumed cause-effect relationships.

Public health and health promotion programs can help to improve health, reduce disease risks, manage chronic illnesses, and improve the well-being and self-sufficiency of individuals, families, organizations, and communities. But not all health promotion programs and initiatives are equally successful. The programs that are most likely to succeed are based on a clear understanding of the targeted health behaviors and their environmental context. They are developed and managed using strategic planning models, and are continually improved through meaningful evaluation. Theories of health behavior can play a critical role in all of these areas.

Theories can help us understand the nature of targeted health behaviors. They can explain the dynamics of the behavior, the processes for changing the behavior, and the effects of external influences on the behavior. Theories can help us identify the most suitable targets for programs, the methods for accomplishing change, and the outcomes for evaluation. Theories and models EXPLAIN behavior and suggest ways to achieve behavior CHANGE.

Many health workers find that they can achieve the greatest impact by combining more than one theory to address a problem. Theories are most effective if they are integrated within a comprehensive planning system. Such a system assigns a central role to research as input to determine the situation and needs of the population to be served, the resources available, and the progress and effectiveness of the program at various stages. Planning is a continuous process, in which new information is gathered to build or improve the program.

Theories can be combined within one level, or across levels of practice. For example, the Health Belief Model might provide the basis for a message encouraging women to obtain cervical cancer screening (Pap smears), and Consumer Information Processing might guide the design and format for providing information. When it comes to combining theories across levels of practice, you need only remember that the broader or larger levels (interpersonal, community) are composed of units at the more narrow levels (individual, intra-personal). Thus, a cancer control program using the locality development model of Community Organization theory could employ skill development strategies suggested by Social Learning theory. Further, those skill development strategies could be phased in, thus designed to help move a wide variety of community dwellers through the Stages of Change.

Although health behavior theories are critical tools, the health educator cannot substitute theory for planning or research. However, theories help us interpret problem situations and plan feasible interventions. Theory also plays an important role in program evaluation. Because it identifies the assumptions behind intervention strategies, it helps pinpoint intermediate steps that should be assessed in evaluation. These "mediating factors" help to clarify the reasons why programs achieve or fail to achieve our goals for success in changing behaviors or environments.

Module 1 - Outcomes

Health Promotion: The Role of Theory and the Ecological Perspective

· Module

· Define health promotion, and describe the action areas of health promotion, the Ecological Perspective, and the role of behavior and the environment in health promotion.

· Discuss the role of theory in Health Promotion, and identify the main theories and theoretical models used in Health Promotion, their focus and key concepts, as well as their application in planning, implementation, and evaluation.