Vocabulary

• Predisposing

Making someone more susceptible or inclined to a particular condition or behavior; creating a predisposition.

• Diabetes

A chronic medical condition characterized by elevated levels of blood sugar, resulting from either insufficient insulin production or the body's ineffective use of insulin.

• Desserts

weet dishes typically served at the end of a meal; often containing sugars, fruits, or other sweet ingredients.

• Sedentary

Involving or characterized by a lack of physical activity; a lifestyle that includes sitting or lying down for extended periods.

• Psychosocial

Relating to the interplay between psychological and social factors, including the influence of social relationships on mental health.

• Participatory

Involving active participation or involvement.

• Agencies

Organizations or entities that perform specific functions or provide services, often with a particular mandate or purpose.

• Coalition

An alliance or partnership formed by groups, organizations, or individuals working together towards a common goal or objective.

• Mobilize

Prepare and organize for movement or action.

• Marketing

Advertisement or promotion of a good or service, shaping public opinion to change behavior, especially buying and selling.

As shown in this infographic, health planning starts as indicated on the left with a health issue of concern. The first step is to understand the target population. Using the ecological perspective, all of the various levels of influence need to be considered, along with all predisposing, enabling and reinforcing factors. Then planners can determine the theory or model with the best fit for the health issue of concern. This will help as they develop interventions to solve the health problem.

CASE STUDY EXAMPLE FOLLOWING THE INFOGRAPHIC:

People of SpringVillage are concerned with increasing rates of diabetes. Public Health professionals meet with concerned citizens to discuss the problems.

1. They first need to understand the target population at different levels.

• • Intrapersonal: individuals are unaware of the seriousness of diabetes
  • Interpersonal: residents like to share high sugar and high fat desserts
  • Community: the local senior center sponsors movie nights where snacks and heavy desserts are served every day.

2. Consider factors that have led to the current problem.

• • Predisposing factors: many people do not understand diabetes.
  • Enabling factors: rich desserts and sedentary lives are the norm.
  • Reinforcing factors: social pressure encourages the same habits.

3. Find a theory that will best frame a solution.

• • Health Belief Model is one option; it can help them consider their perceived susceptibility and barriers.
  • Stages of Change (transtheoretical) Model is another option; it can show what stage they are in and whether they are ready for change.
  • Best fit: Social Cognitive Theory (SCT) because many of their issues revolve around their social setting.

4. Develop interventions for solutions. Using the SCT, they will look at:

• • Reciprocal Determinism: individuals who have high risk for diabetes are affected by the social setting (environment) and their food and activity behaviors.
  • Behavioral capability: they first need to learn better diabetes self-management through effective health education.
  • Self-efficacy: setting small goals and celebrating successes will help build their confidence to change.
  • Observational learning: health educators can bring healthy vegetable snacks and fruit desserts to show examples of better food choices.
  • Reinforcements: they find social settings rewarding so they can plan fun physical activity nights and celebrate healthier lifestyles.

Levels of Influence

Theories may be applied at any of these levels, according to the Ecological Perspective:

1. Individual (intrapersonal), the most basic theories in health promotion practice. Individuals are the target audience for health education materials. Intrapersonal factors include knowledge, attitudes, beliefs, motivation, self-concept, developmental history, past experience, and skills. The most common intrapersonal theories are:

• • Health Belief Model
  • Stages of Change
  • Theory of Planned Behavior
  • Precaution Adoption Process Model

2. Interpersonal (social). Theories at the interpersonal level assume individuals are influenced by a social environment. The opinions, behavior, and support of other people influence their feelings and behavior, and the individual has a reciprocal effect on others. The social environment also impacts health.

• • The main interpersonal theory we cover is the Social Cognitive Theory (SCT), one of the most frequently used theories. It explores the reciprocal interactions of people and their environments, and the psychosocial determinants of health behavior.

3. Institutional. This includes the healthcare system, universities, businesses, schools, and employers.
4. Community. Examples of theories with strategies for intervening at the community level:

• • Community Organization and Other Participatory Models emphasize community-driven approaches to assessing and solving health and social problems.
  • Diffusion of Innovations Theory addresses how new ideas, products, and social practices spread within an organization, community, or society, or from one society to another.
  • Communication Theory describes how different types of communication affect health behavior.

5. Public Policy. Local ordinances, regulations, state and federal laws.

Cognitive-Behavioral theories are those at the individual and interpersonal levels, which have three concepts in common:

1. Behavior is mediated by cognitions; that is, what people know and think affects how they act.
2. Knowledge is necessary for, but not sufficient to produce, most behavior changes.
3. Perceptions, motivations, skills, and the social environment are key influences on behavior.

Community-level models offer multi-dimensional approaches to promote healthy behaviors. With these models they can change the social and physical environment to support positive behavior change.

Public health often focuses on initiatives serving communities and populations, not just individuals, to prevent and control disease. Community-level models explore how to mobilize community members and organizations.

Communities can be defined geographically or by shared interests or ethnic identity. When planning community-level interventions, it is critical to learn about the community’s culture and unique characteristics.

Comprehensive health promotion programs often use advocacy techniques at individual, social, and community levels. Tobacco control and smoking prevention programs are prominent examples of this. Local tobacco control programs can use this effective multi-level approach to reach four goals:

1. raising the priority of smoking as a health concern,
2. helping community members to change smoking behavior,
3. strengthening legal and economic deterrents to smoking, and
4. reinforcing social norms that discourage smoking.

Key elements of successful interventions

1. Designing interventions:

(World Health Organization, 1986)

The Ottawa Charter for Health Promotion states that health requires peace, shelter, education, food, income, a stable ecosystem, sustainable resources, social justice, and equity. To reach those goals, they recommend that health interventions include the following elements:

• Create supportive environments for people at home, at work, and in leisure.
• Strengthen community actions, using human and material resources from within the community, and increase public participation in health matters.
• Develop personal skills, providing health education and life skills, so individuals gain more control over their own health.
• Reorient health services so that healthcare institutions, individuals, and governments all work together for a healthier life.

2. Health Behavior Change Framework

(https://byui.instructure.com/courses/219892/files/98454602/download)

Eight Types of Interventions

(Smith et al., 2015)

• Health Communication Strategies

• • Description: presenting health messages, ranging from advertising for public awareness to complex social marketing. A key element in communicating health messages includes Health Literacy (see below). (Centers for Disease Control and Prevention, 2022)
  • Examples:

• • • Public service announcements about where to obtain COVID-19 vaccine.
    • Billboards reminding people to wear seatbelts.
    • Campaigns to prevent drug overdose deaths with Naloxone.

• Health Education Strategies

• • Description: nearly all health interventions include education, but education may not be enough to create behavior change. For a person who already has motivation to change, simply providing information can help improve health.
  • Examples:

• • • Telling mothers the benefits of breastfeeding.
    • Explaining the causes of diarrhea and how to avoid it.
    • Showing how to apply first-aid after an injury.

• 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: reducing the transmission of infections by cleaning sources of infection or illness
  • Examples:

• • • Vector control, clearing mosquito breeding areas.
    • 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.

• Behavior Modification Activities

• • Description: techniques to replace unhealthy behaviors with desirable habits, such as positive or negative reinforcement.
  • 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.

• 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. (Centers for Disease Control and Prevention, 2023a).
    • 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.

• 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.

Health Literacy

• Definition: the ability to find, understand, and use information and services to inform health-related decisions and actions. (Centers for Disease Control and Prevention, 2023b)
• Examples:

• • Vaccine information provided in the primary language of the client.
  • Graphics and diagrams provided to explain medical procedures when reading levels are low.
  • Interpreters provided in healthcare and health education settings.

Source: (U.S. Department of Health & Human Services et al., 2005)

References

Centers for Disease Control and Prevention. (2022, April 15). Health Communication Strategies and Resources. Centers for Disease Control and Prevention. https://npin.cdc.gov/pages/health-communication-strategies

Centers for Disease Control and Prevention. (2023a, January 27). Tribal Practices for Wellness in Indian Country (TPWIC). Centers for Disease Control and Prevention. https://www.cdc.gov/healthytribes/tribalpractices.htm

Centers for Disease Control and Prevention. (2023b, March 31). What Is Health Literacy? Centers for Disease Control and Prevention. https://www.cdc.gov/healthliteracy/learn/index.html

Smith, P., Morrow, R., & Ross, D. (Eds.). (2015). Chapter 2: Types of intervention and their development. Field Trials of Health Interventions: A Toolbox. 3rd Edition. https://www.ncbi.nlm.nih.gov/books/NBK305514/#chapter-2-div1-2

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

World Health Organization. (1986). The 1st International Conference on Health Promotion, Ottawa, 1986. World Health Organization. https://www.who.int/teams/health-promotion/enhanced-well-being/first-global-conference