Ecological Perspective
Ecological View
"An understanding of health outcomes within an ecological framework"
Ecological Approach
"Developing strategies to influence multiple levels and determinants of health"
How to Apply Theory...
1) Identify goals and Objectives 2) Select theoretical framework 3) Connect theory and practice 4) Adapt or design evaluation tools
Basic Concepts of the Ecological Perspective
-There are multiple levels of influence: Cultural, family, societal, peer, institutional, and political -Each level can influence other levels (Reciprocal determinism) -Multiple factors, from each ecological level, influence health behavior -Multi-level interventions may be the most effective in public health -Multi-disciplinary groups most easily implement multi-level interventions -Ecological interventions are evaluated by measuring implementation outputs & overall impact at each level targeted -Political dynamics can limit ecological interventions
Ecological Model
-"A framework for the determinants of health" -Why people behave a certain way that impacts their health status
What is a Model
-A mixture of ideas or concepts taken from any number of theories and used together -Models help explain a specific problem in a particular setting -Not always as specific as theories
What is a Theory
-A set of interrelated constructs (concepts), definitions, and propositions used to understand events/situations -Systematic and Orderly -Evidence Based -Provides a framework for program and policy development -PH theory primarily from psychology and social psychology -Evidence <--> Theory
Social Ecological Models of Health Promotion
-Characterization of environment as having multiple physical, social and cultural dimensions -Health is influenced by environment and a variety of personal attributes; the same environment affects people differently -Many people in the same environment, whom are affected differently, but individual, family, groups all differ and influence their health behavior -The social ecological perspective is interdisciplinary, encompassing various scientific disciplines and levels of analysis
Brofenbrenner's Ecological Model Example: Addressing intimate partner violence
-Implementing school-based educational programs that promote egalitarian relationships and zero tolerance for violence (microsystem) -Implementing workplace policies that support court- ordered restraining orders (exosystem) -Enacting new laws/policies that punish behavior (macrosystem) -Promoting new social norms via media (macrosystem)
How Does the Ecological Model Influence Health Behaviors?
-Individual (intrapersonal) Factors= characteristics of the individual -Interpersonal Factors= relationships with others -Organizational (Institutional) Factors = characteristics of organization one belongs to (rules and regs) -Community Factors= sociocultural and structural (education, healthcare access, violence) -Public Policy/Societal= local/state legislation
Tommy and Ecological Model Example
-Individual Level= Educate him about the foods he eats -Interpersonal= After school programs -Organizational= Town sports clubs -Public Policy= Fix roads and get sidewalks & Reorganize school lunch programs -Community= Make parks in community
Ecological Model: Advantages
-Integrates behavioral change strategies with environmental enhancement strategies within a broad framework -Able to emphasize cross-level analyses of health problems and intervention strategies -Pays attention to dynamic interplay between personal and situational factors in health
Ecological Model: Disadvantages
-Requires integration of knowledge from several different disciplines. -Hard to make this possible, very challenging to address each level of intervention -Multilevel interventions can be complex, expensive, and impractical to implement. -Cannot target everything; requires one to identify key "leverage points" to target for intervention
Brofenbrenner's Ecological Model
Microsystem = Refers to the immediate environment in which a person is operating (e.g., family, classroom, peer group, neighborhood) Mesosystem = Refers to the interaction of two microsystem environments (e.g., family affecting an adolescent's peer group) Exosystem = Refers to aspects of the environment in which an individual is not directly involved, but is affected by (e.g., parents' workplace, community economy) Macrosystem = Refers to cultural values & expectations in which other systems function (e.g., laws, resources, cultural customs)
Social Ecology
Social ecology: "gives greater attention to the social, institutional, and cultural contexts of people-environment relations than did earlier versions, which focused more on biological processes and geographic environments"
Take Away Points
• Ecological approaches to community health integrate various theories of behavior change • The ecological approach, unlike the medical approach, avoids blaming the person and focuses on social and environmental determinants of behavior • The ecological perspective indicates that behavior is influenced by many factors at multiple social levels • Multi-level interventions are most effective in order to target each influential level
Socio-Ecological Perspective & STIs
• Individual Characteristics= Perception of risk for pregnancy and STIs, Confidence in condom use, Self-esteem, psychological distress, & depression • Family Characteristics= Perceived family support, Family connectedness & structure, Parent-adolescent communication, Perception of parental monitoring & influence • Relational Characteristics= Relationship control and length of relationship, Fear of condom negotiation and or believe of contraception responsibility, Perception of partners' sexual experience • Peer and Community Characteristics= Peer pressure to engage in sexual intercourse (increases with age) , Peer norms surrounding sexual behaviors & condom use • Societal Characteristics= Media influences (internet, entertainment), Sociological constructs of race and gender