Unit 4

Unit Lesson Study Guide

In Unit 4, we will continue to discuss health behavior and its association with factors that could influence such behaviors. These types of influences are referred to as multilevel factors of behaviors, and they typically fall into five main categories:

1. individual factors,

2. inter-personal factors,

3. organizational factors,

4. community factors, and

5. policy factors

Consider the following scenario:

A 50-year-old man may purposely postpone getting a prostate cancer test because he is scared of finding out that he may have prostate cancer. This is an example of an individual- level factor. However, we need to look into this further and consider the following: his inaction might also be influenced by his primary physician’s failure to actually recommend and insist that he would need to take the prostate test. Another factor might be the difficulty of scheduling an appointment due to either unavailable equipment or the unavailability of staff at his local clinic. Another limiting factor could be that the fee for the exam is so high he cannot afford it, and his insurance does not cover this type of procedure. Thus, all these interpersonal, organizational, and policy factors are influencing this man’s behavior to not complete the prostate test. Therefore, for health promotion practitioners, it is very important to be aware of all these factors so effective change strategies or interventions can be prescribed.

One of the multilevel theories that will be discussed is the Theory of Triadic Influence (TTI). TTI behaviors arise due to one’s current social situation, general cultural environment, and their personal characteristics. Any health-related behaviors are influenced by an individual’s decisions.

What would be some of the influences that would affect a person’s decision-making process? These influences could include:

 social pressures to engage in certain health-related behaviors,

 certain attitudes toward actually performing those health-related behaviors, and

 one’s beliefs in performing those health-related behaviors

Multilevel Theories

These influences could be further described as social, interpersonal, and attitude-related sources of influence. In addition to the three types of influence noted above, there are also some direct or indirect causes of influence.

These causes are categorized as

 ultimate (e.g., certain factors specific to one’s background and environment),

 distal (e.g., general knowledge and values), and

 proximal (e.g., one’s beliefs and attitudes).

When we refer to the ultimate category, we typically think of one’s family characteristics and parenting styles (whether an individual has elevated or decreased parenting expectations or supervision) as well as certain environmental influences and their own behavioral pattern, level of behavior control, and intelligence. Some examples of distal influences would be one’s emotional attachments and behavior shown to them by their siblings, parents, or spouse. Proximal influences include things such as approval of behaviors as shown by one’s parents, siblings, and spouses as well as one’s own beliefs and attitudes towards a certain behavior or behaviors.

Let’s now transition and discuss how certain health promotion practitioners use health promotion programs and methods.

Developing Health Promotion Programs

The following is a real-world example of how a health promotion would be developed.

A local health organization is concerned with the teenage smoking problem and wants to develop a successful and effective health promotion program/policy.

Step 1: This would trigger the first step of the development process: the need to clearly describe the problem. Certain promotional considerations include causes (smoking and second-hand smoke has a direct and serious effect on the health and well-being of teenagers) of the problem (teenage smoking), impact of the problem, and what the possible solutions would be.

Step 2: Next, we can move to our second phase: finding out whether the targeted local community is actually ready for the development of a health promotion program or policy. Here, we would try to assess and evaluate whether additional education related to teen smoking cessation would be necessary. Step 2 would also assess who from the targeted community and other organizations would actually support their efforts. What is the overall public view/opinion related to the problem, and who would actually be concerned and affected by the program?

Step 3: The third step would incorporate the development of goals, objectives, and a clear direction that would prompt the health promotion program to consider so they can move forward. The program would specifically focus on setting the concrete objectives. One of the common ways to do such a task would be to use the specific, measurable, assignable, realistic, and time-specific (SMART) objectives. Once there are clearly defined objectives and a clear direction, the program can then move to the fourth step.

Step 4: In the fourth step, the goal would be to identify the key decision makers. Some of these individuals could be the community’s political leaders, school organizations, healthcare partners (local community hospitals, clinics, etc.), parent organizations, local work organizations, and student-based organizations. Again, the key here is to identify whom the organization should work with and communicate with on how to successfully implement the program and policy.

Step 5: In this step, the focus is on building and creating actual support for the policy. The organization would need to find approaches for us to effectively communicate and persuade key decision makers who were previously identified. Techniques would include writing letters and producing mass media announcements, posters, or radio/Internet ads. There would also be face-to-face meetings with the community’s leaders. The key would be to build a strong and supportive coalition.

Step 6: In this step, we will develop and document the program as well as the policy and revise as needed based on the data gathered from the previous steps. Some of the components of the written document would include an executive summary describing the purpose of the program’s goals and objectives, specific procedures for actually promoting the program, and steps to monitor and evaluate the success of our program implementation.

Step 7: The next step would be to actually implement the program. Evaluation

Health Promotion Program

The next phase is to evaluate the health promotion program. This step provides an opportunity to modify and update the program based on the evaluation. As with development, an evaluation is a process, and there are a few specific phases. Typically, there are 10 steps that are part of the evaluation process.

Step 1: Clarify our health promotion program (assess and conclude whether the program has had clearly defined goals, strategies, and interventions).

Step 2: Engage the key stakeholders. During the review, we want to have a clear understanding of the stakeholders’ true interests, desires, and expectations regarding that program’s direction and goals.

Step 3: Diagnose/evaluate the resources. Evaluators need to know their resources in terms of money and proper staffing because, depending on the program they are evaluating, proper resources should be available and/or in place.

Step 4: Organize and select specific evaluation questions. Evaluators are usually trying to come up with specific questions that their evaluation is trying to address.

Step 5: Come up with the methods of measurement and certain procedures. We want to know what we will measure, when we will collect the data, how will we collect the data, who will collect the data, and who will use the data.

Step 6: Develop a strict work plan. Evaluators will identify specific roles and tasks that each of them will be conducting and involved in.

Step 7: Collect the necessary data (possibly by using some type of questionnaire).

Step 8: Process that data and analyze the results that are noted. We will we process the data we obtained in those questionnaires and will try to analyze the results.

Step 9: Interpret the results and draw conclusions (results will be interpreted and findings and recommendations will be presented).

Step 10: Take the necessary action or actions. Evaluators will engage the key decision makers and collaborate with them in order to think of ways to further improve the program.