Chapter 5: Social, Cultural, and Environmental Theories (Part 1)

market segmentation

segmentation of a target population into meaningful subgroups so that messages and campaigns can be appropriately channeled.

SOCIAL MARKETING

- Approach to health communication and behavior change that incorporates principles of marketing to achieve health aims. Treating the behavior as a product that you are trying to market. Potential consumers (target population) are understood as thinking about health behavior change in the same way they would think about other product choices. - Goal is to have people voluntarily adopt the health behavior or tech because they come to view the behavior as in their interest. To promote voluntary adoption the choice of behavior being offered has to be presented as attractive in its cost and benefits. - Similar to the DOI and HBM. Introduced in the 1960 to 70s by Kotler and Zaltman. Used with respect to HIV/AIDS and reproductive health. - Principles of social marketing the four p's. - Need to come up with a way to phrase a message and a dissemination plan to get the message out through various media (interpersonal and print). Go through multiple channels and repeated or sequenced messages. - Market segmentation and targeting

Things to Think About/Critiques DOI and SM

- Assessing the effect of SM campaign may be difficult because if a behavior change s the goal, tracking exposure to the campaign for those exposed and assessing the degree to which behaviors/attitudes have changed is not always easy. SM campaigns seek to introduce a technology as the behavior change (use of condoms for STI prevention). This is easier to track because it is more tangible and observable.

Network Qualities in Assessing the Role of Network on Health Behavior

- Centrality versus marginality of individuals in the network: Degree to which an individual has interactions with many people in the network OR plays an important role in network activities. - Reciprocity of relationships: Are relations one-way or two-way? - Complexity or intensity of relationships in the network: Is the network mostly one-way? Multiplex? Do all people have relations with many alters, making a complex and dense pattern of interaction? - Homogeneity or diversity of people in the network: IS there diversity of types of members? - Subgroups, cliques, and linkages: Concentration if interaction among some members? What is the nature of the? Are any members linked to other social networks? - Communication patterns in the network: How does information circulate? Viewed equally coming from anyone in the network OR do others have more credibility?

SOCIAL NETWORK THEORY (SNT)

- Implications range from sociological and health-related applications to communications, political opinion, esoteric mathematical and systems theory application and others. Surfaced in 1950s with study on Norwegian villages. - Explains behavior as specific or unique characteristics of individuals are not important because the focus is on relationships between and among individuals and how the nature of those relationships influences behavior and beliefs (relationships refers to set of relationships that an individual participates in - family, work networks, and any other social group). - Important role in whether someone acts in a way that is risky or good for their health - what information someone is exposed to about health and what kinds of social support person has available. - Requires research on the social networks of interest (related to the health issue). Seeks to identify people in the network (actors) and the kinds of ties and linkages that exist between those people. Look at the people in the network, frequency of interaction, types of interactions, differences in relational roles, and groups or cliques in the larger network. Information gives information on social influences, channels of communication, and channels of influence. - Networks common in health research and interventions: ego-centered network and full-relational network. - Role on networks and health behavior: HEALTH RISKS or SUPPORTIVE roles that plays in promoting health behaviors among its members.

What are We Talking About?

- Individual theories talk about internal factors. Social/environmental theories talk about external factors. - SCT talks about focuses more on social networks and groups.

SOCIAL PROCESS THEORIES AND APPROACHES: DIFFUSION OF INNOVATIONS AND SOCIAL MARKETING origin and basic elements

- Less theory driven, more of a description of a process for how behavior tends to change in groups.

SOCIAL COGNITIVE THEORY, FORMERLY KNOWN AS SOCIAL LEARNING THEORY origin and basic elements

- Most well known and productive of these kinds of theories because its specific focus on the interaction between individuals and their immediate environment. - SCT began as a theoretical offshoot of behaviorism. Albert Bandura (1960) proposed that operant conditioning worked when the reinforcement was directed toward other people. Rewards and punishments does not have to specifically happen to the person - Johnny raises his hand in class when he sees that his teacher rewards other who do that). Social Learning Theory (SLT) - learning by observation learning or vicarious learning. - Expanded approach when added self-efficacy, this gives individuals a role in their own process change (beyond conditioning process of behaviorism). Referred to agency. Added reciprocal determinism - where behavior is part of a cycle that includes individuals and their social and physical environments. Bandura renamed and position it is a theory that addresses individuals consciously operating within an environment. - Changing a behavior is a function of individual (internal) characteristics, environmental (external) factors. - Relationship are being investigated and role of these factors are better understood than others.

Principles of SOCIAL MARKETING

- Product: The behavior or technology you are offering and its benefits. Identify the most important benefits of the product among the target population. - Price: For the target population, the costs involved in adopting a behavior or using technology. Understand the cost perceived by the target population is a research task. - Place: How you distribute or make the behavior or tech easily available to the target population. Issue of access and availability. - Promotion: How you promote or make the target population aware of the previous three elements.

DIFFUSION OF INNOVATIONS

- Roots in rural sociology. Diffusion of cultural practices was a major feature of American anthropology. Set out by Everett M. Rogers in 1962. - Used to address diffusion of tech, communication, medical/health tech, and behaviors. Concern was looking at the process by which a behavior or technology makes its way into a population and is or is not adopted. Diffusion is the process by which an innovation is communicated through certain channels. Innovation is something that is new. - Process of dissemination (like stages has a chronological component): (a) innovation development - development of the innovation like planing, formative research, and testing. (b) dissemination - active knowledge transfer from the resource system to the user system and involves identifying communication channels and dissemination channels. (c) adoption - refers to the uptake of the behavior or technology by the intended audience. Requires a movement through stages: knowledge, persuasion or attitude development, decision, implementation, and confirmation. Decision to adopt influenced by three knowledges: awareness, procedural, and principle. (d) implementation - initial use of the practice or technology. Linkage agent (educator) can help. (e) maintenance - keep the pattern of using the behavior or tech. Focus on sustainability or institutionalization. - Idea that innovations are adopted in a staged process by different categories of adopters: early adopters, early majority adopters, late majority adopters, and laggards. - Diffusion context - refers to complex factors related to the social group/population targeted by the program and the program of innovation dissemination itself that may facilitate or hinder diffusion (ex. country with strict centralized control means that the flow of dissemination would have to be channeled through one gateway or portal. - Five most often cited attributes: relative advantage, compatibility, complexibility, trialability, and observability. - Others: effect on social relations, reversibility, communicability, time, risk and uncertainty level, commitment, modifiability (all related to the extent of barriers to adoption).

Things to Think About/Critiques on SNT

- SNT is a limited theory and approach. Useful in small or defined group interventions. - Labor intensive and cab be difficult. Identify networks and conducting interviews are time consuming. Confidently concerns when look for full relational data.

individual (internal) characteristics

- Self-efficacy: their confidence that they can do the behavior and overcome barriers. - Behavioral capability: level of knowledge or skill - Expectations: what will happen if they made the change - Expectancies: outcome is good or likely to be rewarded - Self-control - Emotional coping

Using SCT

- Social skills training in a group setting to gain behavioral capability of non risky behaviors that help establish goos relationships with peers and contribute to the goal of popularity that was important for her. Skills include communication, self-presentation, and leadership. Group format will allow to gain peer feedback and reinforcement. Skills will be rewarded and they gain self-efficacy. - To boost self-efficacy, each girl in the group will be assigned a task and take turns being the leader. - To affect perceptions (expectations and expectancies) about the risk behavior, an education component concerning the risks and outcomes that they were involved in. - Vicarious learning, each will be given a mentor and their mentee will be in activity that they are doing successfully, like theater. Mentor takes on the role of social model. - Conclusion: Skills and self-efficacy would give participants tools to achieve the same goal (peer approval) that motivated their risky behavior, but in less damaging directions. Spending time with a mentor who is successfully engaged in activities would give a learning opportunity and behavior examples that participants can learn from. Learn about the negative consequences of their previous risky behavior and might affect their perceptions about the value of that behavior.

environmental (external) factors

- Social/physical environment surrounding the individuals. - Modeling: the behavior of others and consequences of that behavior results in vicarious learning. - Situation: where the behavior takes place and perceptions of that situation by individuals - Reinforcements: negative or positive that are given in response to the behavior

Example of the SCT

- Theresa moves from a private to a public school (changing social environment). She has certain perceptions about the situation she is in and her behavior at the new school has not been positively reinforced. She does not feel she has the behavioral capabilities to win peer approval and is short on self-efficacy. Reaches HS and does vicarious learning and learns what behaviors she thinks will make girls popular (behaviors that result in positive reinforcement) Because the behaviors that she is participating now is not getting the desired effects, she has agency and forms a plan from what she learned through her vicarious learning. She decides she was a bad reputation, so she needs to drink, have sex, and be known for these things. She hasn't thought much of the consequences. Comes into conflict with her family (different environment) but she can't come up with a behavior pattern to resolve that situation. She sees this as a barrier to the social work she wants to enter in. - Her behavior (what she was doing) was formulated (cognitive process) because of the interaction between personal characteristics and perceptions, her behavior, and the environment she was in (including the social response she got for her behavior).

Things to Think About/Critiques SCT

1. SCT is complex and it includes so many constructs that are said to be related to behavior, it is viewed more of a grab bag. 2. Theory went through number of evolutions. Emphasis has move from a behaviorist variant to self-efficacy, yet all the other component are hanging around there.

full relational network

Includes reciprocal information from other members of the network. Information from all or a significant number of network members.

ego-centered network

Map of the social relations surrounding an individual called "ego" and other people are called "alters". Based on the perspective of the ego.

Using the SNT

Useful in health promotion as a strategy to use for limited or defined groups of people. Not a mass or large population intervention. - Research to identify the important characteristics of the network: For ego centered, identify one or more individuals where you believe a network is involved, interview them about their interactions with others and develop a map with relationship data. Full relational network means to interview all or significant number of people in the network. - Development of an interview that works with the network as a facilitator: Using networks to distribute information. Credibly desalinate through someone in that network OR work with individuals in the network with influence.

reciprocal determinism

a persons acts based on individual factors and social/environmental cues, receives a response from that environment, adjust behavior, acts again, and so on

targeting

process of developing campaigns that are closely tailored to the needs, attitudes, beliefs and behaviors of specific market segments.