Vocabulary

• Cognitive

Relating to processes of thought, perception, and understanding; pertaining to mental activities such as learning and memory.

• Ecological

Pertaining to the interactions between organisms and their environment; related to the study of ecosystems and their components.

• Reciprocal

Involving mutual exchange or interaction; characterized by a two-way relationship or influence.

• Determinism

The philosophical or scientific concept that events, including human actions, are determined by previously existing causes or conditions, often without free will.

• Credible

Able to be believed; convincing and reliable.

• Sociocultural

Relating to the combination of social and cultural factors that influence human behavior and development.

• Interpersonal

Concerning relationships and interactions between individuals; pertaining to communication and connections between people.

• Peers

Someone of equal standing in the same group or community.

• Cholesterol

A fatty substance present in the cells of the body and in certain foods; high levels of cholesterol can contribute to cardiovascular diseases.

• Cafeteria

A large dining area with tables to eat at, where customers serve themselves or are served from a variety of dishes displayed along a counter.

• Ordinance

A law or regulation enacted by a local government, typically at the municipal level, to address specific issues or concerns within its jurisdiction.

1. Social Cognitive Theory

(U.S. Department of Health & Human Services et al., 2005) pg.19

Social Cognitive Theory (SCT) shows how personal factors (such as personal beliefs or personal cognitive factors), environmental factors (such as where you live), and human behavior (such as past experiences) exert influence upon each other. The fact that all three of these affect each other is called Reciprocal Determinism. As a person adopts new behaviors, this causes changes in both the environment and in the person. Behavior is not simply a product of the environment and the person, and the environment is not simply a product of the person and behavior, but all three are continuously affecting each other.

Important SCT concepts that influence health behavior:

1. Self-efficacy: Individuals with self-efficacy can change behaviors even when faced with obstacles. Many people confuse this concept with self-worth. Self-worth is the belief that one has value. Self-efficacy refers to one's belief in their ability to perform specific tasks. 
2. Outcome expectancies: If one expects the outcome to be a failure, they are not motivated to act or to persist through challenges.
3. Observational learning: Watching another person’s experience to see their outcome.

2. Best fit Health Interventions for Social Cognitive Theory

• Behavior modification

• • Description: techniques to replace unhealthy behaviors with desirable habits, such as positive or negative reinforcement that can increase self-efficacy

  • Examples:

• • • Reminders and encouraging messages to help someone stop smoking
    • Buying new clothes to reward yourself for losing weight
    • Providing recognition awards for days of sobriety in Alcoholics Anonymous

• Social activities

• • Description: health promotion in a socially supportive environment to reinforce healthy behaviors while providing companionship and decreasing social isolation

  • Examples:

• • • Line dancing and square dancing parties to encourage fun physical activity

    • Youth-Against-Tobacco clubs in high schools

    • Hiking and walking groups where members encourage each other

• Organizational cultural activities

• • Description: structured plans for health promoting events within a population’s traditional culture

  • Examples:

• • • The CDC provides funds for Tribal Practices for Wellness among Native Americans and Alaska Natives.
    • The Colombian government arranged for special burial ceremonies to accommodate cultural practices for Indigenous groups.
    • Many faith-based groups worked together with government agencies to respond to COVID-19 in ways that were culturally appropriate to each group.

3. Ecological Perspective

(U.S. Department of Health & Human Services et al., 2005) pg. 10

In addition to educating individuals about healthy practices, health promotion includes changing organizational behavior and the physical and social environment of communities. It also advocates for policies that support health, such as economic incentives. Therefore, health promotion operates on multiple levels. 

The ecological perspective looks at all levels of a health problem, and how people interact with their physical and sociocultural environments. 

Two key concepts show potential interventions for promoting health:

1. First, behavior both affects, and is affected by, multiple levels of influence;

• • intrapersonal or individual factors;
  • interpersonal factors;
  • institutional or organizational factors;
  • community factors; and
  • public policy factors.

2. Second, reciprocal causation means that individual behavior both shapes, and is shaped by, the social environment.

The first key concept, multiple levels of influence, is explained in Table 1.

Each level of influence can affect health behavior. An example of the levels can be seen if a woman delays getting a recommended mammogram, which may result from multiple factors.

• At the individual level, her inaction may be due to fears of finding out she has cancer.
• At the interpersonal level, her doctor may neglect to tell her that she should get the test, or she may have friends who say they do not believe it is important to get a mammogram.
• At the organizational level, it may be hard to schedule an appointment, because there is only a part-time radiologist at the clinic.
• At the policy level, she may lack insurance coverage, and thus be unable to afford the fee.

The second key concept of an ecological perspective, reciprocal causation, suggests that people both influence, and are influenced by, those around them.

Example: A man with high cholesterol can’t eat well because his company cafeteria doesn’t offer healthy food choices. He can try to change the environment by asking the cafeteria manager to add healthy items to the menu, or he can dine elsewhere. If he and others find a new place to eat, the cafeteria may change its menu to maintain lunch business. Therefore the cafeteria environment may make him change his eating habits, but his new habits may ultimately change the cafeteria as well.

An ecological perspective shows the advantages of multilevel interventions that combine behavioral and environmental components.

Example: Effective tobacco control programs often use multiple strategies to discourage smoking.

• Employee smoking cessation clinics have a stronger impact if the workplace has a no-smoking policy and the city has a clean indoor air ordinance.
• Adolescents are less likely to begin smoking if their peers disapprove of the habit and laws prohibiting tobacco sales to minors are strictly enforced.

Health promotion programs are more effective when planners consider multiple levels of influence on health problems. 

4. Best fit Health Interventions for Ecological Perspective

• Health Policy/Enforcement Strategies

• • Description: passing and enforcing laws that require behavior change by residents.

  • Examples:

• • • Indoor clean air laws that prohibit smoking
    • Taxes on soft drinks that decrease rates of purchasing
    • Seat belt and helmet laws that lower rates of vehicle injury and death

• Environmental Change Strategies

• • Description: improving the environment with health-producing elements and removing factors that are harmful to health

  • Examples:

• • • Establishing a network of community gardens
    • Improving air quality to decrease incidence of asthma
    • Providing sanitation and sewage systems

• Health-Related Community Service and Mobilization Strategies

• • Description: various community groups, including nonprofit agencies and businesses, form coalitions to collaborate on health improvement projects.

  • Examples:

• • • Community campaign to improve trails and bike paths
    • City-wide project to decrease drug overdose deaths
    • Intramural and after-school sports programs for youth recreation

References

U.S. Department of Health & Human Services, National Institutes of Health, & National Cancer Institute. (2005). Theory at a Glance: A guide for health promotion practice (2nd ed.). https://cancercontrol.cancer.gov/sites/default/files/2020-06/theory.pdf