309 1
According to the Chronic Care Model, the three major spheres important for chronic care management are...
(1) the community, (2) the health care system, and (3) provider organizations
Early Public Health Efforts
-Eqypt -India; 4,000 years ago, signs of sanitation (keeping water clean) -Oldest health-related documents •Smith Papyri (1600 B.C.) - surgical techniques• Code of Hammurabi - laws pertaining to health practices (physician fees)
Early Medicine (Greek)
1st to put emphasis on disease prevention with a balance among physical (athletics), mental (philosophy), and spiritual (theology) •Asclepius - god of medicine -Hygeia - power to prevent disease; more prominent -Panacea - ability to treat disease•Terms hygiene and panacea trace to these daughters •Caduceus - staff and serpent of the physician, was a symbol of the temples of Asclepius •*Hippocrates* (460-377 B.C.) •Theory of disease causation•Distinguished between endemic & epidemic diseases•The first epidemiologist & father of medicine
Medical Democratization
A strong belief in the colonies was that health and medicine should be in the hands of everyone, not a select elite. •Self-help style books were beginning to be published in London but became a hugely popularized concept in America.
Theory of Reasoned Action/Theory of Planned Behavior.
Action (TRA) postulates that attitudes and beliefs are related to health behavior. However, unlike the HBM, the TRA also includes the concept of subjective norms, -marks a shift from the exclusive focus on attitudes and beliefs and examines these constructs in a broader social context. -Behavior refers to performing the desired action. -Behavioral intentions represent a person's likelihood to engage in the behavior -Attitude toward the behavior is one's belief about the target behavior. -Subjective norms are the pressure one feels from others to engage in the behavior Perceived behavioral control is one's belief regarding how much power one has over the enactment of the behavior
Virtue Ethics
Considers virtues as fundamental to ethical life ex: Making decisions in light of those favored virtues
SOCIAL CHANGE PHILOSOPHY
Emphasizes creating social, economic, & political change that benefits health of individuals & groups.
DECISION-MAKING PHILOSOPHY
Emphasizes critical thinking & lifelong learning. uses roleplay as examples
Making Ethical Decisions
Ethical decision making •Requires practitioner to make choices when the circumstances involve conflicting principles •Requires people to rely on their values, principles, and ethical thinking •Should begin before any ethical problem surfaces •Importance of moral sensitivity •Be aware of the context in which an ethical decision is made •Consider •Place, time, identity, social relationships, the ideal, the concrete, seriousness
True or False: The Structural Model of Health Behavior delineates factors outside the individual's control that may be modified to promote healthy behaviors.
FALSE the Information Processing Paradigm delineates factors outside the individual's control that may be modified to promote healthy behaviors.
True or False: Social Cognitive Theory is a value expectancy theory.
False
Health Behavior
Individual preferences change •Context matters •Plate size Default options influence our behaviors •We can use these to promote positive health behaviors •Can cost more to be healthy in the present but more costly to be unhealthy in the long run •Multi-level approaches needed
Planning models
PRECEDE-PROCEED , MAPP
levels of prevention (3)
Primary: prevent/promotion Secondary: screen-early detection Tertiary: treat- to prevent further deterioration, rehab
Importance of Theory to Health Promotion
Research indicates that interventions that apply theoretical principles to their design are more effective than those that do not •Theories help us understand behaviors and the process by which behavior change occurs •Theories describe how and why attitudes, beliefs, social, and environmental influences affect our health behavior •Theories identify potential targets of change
What is Philosophy?
Statement summarizing the attitudes, principles, beliefs, and valuesheld by an individual or group. •How you act is a reflection of your philosophy •Corporate slogans and mission statements are often used to convey philosophies •Many quotes by famous people actually are philosophy statements- Loren Bensley Philosophy reflects your values and beliefs, which determine your purpose for being Provides bridge between theory and practice• Helps answer the "whys" of health promotion
True or False: Health behavior theories in Western cultures place more value on the individual compared to societies that hold more collectivistic views.
TRUE
Utilitarian Ethics
The greatest good for the greatest number of people ex: Make a decision on what benefits the majority
The TTM can be used to explain or predict changes in health behavior. T/F?
True
Basic Principles
Value of Life - First & most basic principle •Goodness (or rightness) - Subdivided into two related principles •nonmaleficence - First duty is to do no harm •beneficence (or benevolence) - Doing good; actions that provide for the greater good of the community •Justice (or fairness) - just in distributing goodness & badness; subdivided into two area •procedural justice - fair procedures followed distributive justice - allocation of resources Honesty •At the heart of any moral relationship is communication; telling the truth. •Autonomy (or individual freedom)•People must have the freedom to choose their own way of being ethical within the framework of the other principles.
Competing Views of Illness
With some advancements in science, this period was characterized by a great widening of views on illness.
Match the examples with the appropriate health belief model. My mother keeps reminding me to go to the doctor. a. cues to action b. perceived severity c. self-efficacy d. perceived benefits e. perceived susceptibility f. perceived barriers
a. cues to action
4. Fill in the blank: _________ is a top-down process that begins with models and worldviews and works down to understanding specific applications. a. Inductive reasoning b. Deductive reasoning c. Probabilistic reasoning d. Observational reasoning
b. Deductive reasoning
10. Which of the below is NOT a type of behavioral consequence? a. Positive reinforcement b. Negative attitude c. Negative reinforcement d. Punishment
b. Negative attitude
the final 16% of a social system population to accept an innovation are called the: a. late majority b. laggards c. late minority d. innovators
b. laggards laggards is our word, you can can say lagga
2. A primary goal of health education outlined in the WHO 1998 definition includes improving: a. Patient costs b. Ecological health c. Health literacy d. Community involvement
c. Health literacy
9. Which acronym refers to national HIV/AIDS-control campaigns? a. ABC b. PSA c. K-A-B
c. K-A-B
social support
considers the positive role of relationships in health outcomes. -Emotional support is showing love, compassion, and care. It incorporates behaviors like listening and physical affection. Emotional support is the most fundamental type of social support, and most of the other supportive behaviors contain aspects of emotional support. -Appraisal support is facilitating social comparison, providing personal evaluation, and giving honest feedback. -Informational support is providing helpful, relevant facts. -Instrumental support is offering tangible help like money for a gym membership or a ride to the physician's office.
3. Which is a dimension proposed by the authors to add to the K-A-B approach? a. Costs b. Choices c. Expectations d. Consequences
d. Consequences
Which of the following is not a type of social support? a. Informational support b. Emotional support c. Appraisal support d. Personal support e. Instrumental support
d. Personal support
Match the examples with the appropriate health belief model. If I follow my exercise schedule, I will reduce my risk of a heart attack, and I will also have more energy. a. cues to action b. perceived severity c. self-efficacy d. perceived benefits e. perceived susceptibility f. perceived barriers
d. perceived benefits
Social Ecological Framework (SEF)
describes different levels that influence behavior but does not necessarily explain the specific constructs and how these interact.
The Marketing Mix is represented by the four Ps. Which of the following is not one of the Ps? a. Price b. Product c. Place d. Promotion e. Position
e. Position
Match the examples with the appropriate health belief model. I am in great health, so I don't have to worry about having a heart attack. a. cues to action b. perceived severity c. self-efficacy d. perceived benefits e. perceived susceptibility f. perceived barriers
e. perceived susceptibility
Community Level Theories
explain behavior by looking at the social systems in which people live including the: -Policies -Rules and Regulations -Laws These include the Information Processing Paradigm and Social Marketing.
Match the examples with the appropriate health belief model. My doctor asked me to go in for some lab work, but the past couple months have been crazy. It can wait. a. cues to action b. perceived severity c. self-efficacy d. perceived benefits e. perceived susceptibility f. perceived barriers
f. perceived barriers
Ottawa Charter
five priority action areas for health promotion: (1) building public health policy, (2) creating supportive environments, (3) strengthening community action, (4) developing personal skills, and (5) reorienting health services.
COGNITIVE-BASED PHILOSOPHY
focuses on the acquisition of content & information, increase in knowledge for decision making.
Structural Model of Health Behavior
health interventions have two main targets. Either they target factors individuals can control (like attitudes or beliefs about exercise) or factors individuals cannot control (like park availability). -Availability. Availability is how accessible products are that promote or inhibit health. -Physical structures are the attributes of products, neighborhoods, and all other environmental objects that promote or inhibit healthy behavior. -Social structures are policies and laws that promote or inhibit healthy behavior. -Media and cultural messages are communications from television, radio, Internet, and cultural groups that promote or inhibit healthy behavior. Although these messages may target individuals, they also change social norms. Structural interventions are ideal for achieving population-level changes. However, in a healthy population, a structural intervention may be less effective
K-A-B-C approach
knowledge-attitude-behavior-consequence approach assumes that either on an individual level or via mass communication, changing knowledge and attitudes may result in risk factor reduction and other forms of behavior change. Consequences following behavior either reinforce or prevent further instances of that same behavior growing in importance, as by introspection, people can arrive themselves at a healthy decision
social ecological frame more, identity which theory is at which lvl
look over review slides after you study quizlet
western vs traditional values vs universalism
much of the research and writing produced about health promotion consists of the work of North American, European, and other "Western" academics and officials. This derives not from a lack of interest among researchers and practitioners in nonWestern countries nor in their potential for enormous contributions to the field but instead from the reality of the wealth of nations, which in turn defines their ability to afford support for these efforts.
endemic
occurs regular in a pop as a matter of course think regular endemic life in mhw
pandemic
outbreak over wide geographic area such as continent
Positivism
philosophy of science that holds that objective empirical verification is the only manner through which we can establish scientific validity. 'Verification' means that two or more individuals must be able to see, hear or otherwise objectively sense the same phenomenon in the same way. It is thus the opposite of introspection and subjectivity. only anything observable is of interest.
patient education
process of improving patients' knowledge and skills with the purpose of influencing specific attitudes and behaviors required to maintain or improve health
What is health behavior?
refers to the actions of individuals, groups, and organizations, as well as the determinants, correlates, and consequences, of these actions—which include social change, policy development and implementation, improved coping skills, and enhanced quality of life. Those personal attributes such as beliefs: •expectations, motives, values, perceptions, and other cognitive elements; •personality characteristics, including affective and emotional states and traits; and •overt behavior patterns, actions, and habits that relate to health maintenance, to health restoration, and to health improvement
What is theory?
set of interrelated concepts, definitions, and propositions that present a systematic view of events or situations by specifying relations among variables in order to explain and predict the events of the situations
inductive reasoning
specific to general quantitative research?
Research ethics
subset of professional ethics •"Comprises principles and standards that, along with underlying values, guide appropriate conduct relevant to research decisions" •Voluntary participation is the foundation of research ethics
Individual-Level theories
the Health Belief Model, the Transtheoretical Model, and the Theory of Reasoned Action/Theory of Planned Behavior.
health promotion principles
the population as a whole in context
health promotion
the process of enabling people to increase control over, and to improve, their health science and art of helping ppl change their lifestyle to move toward a state of optimal health -getting ppl involved in their own health care -recognition of lifestyle diseases and major causes of illness and death -*strengthening community participation*
Health Belief Model (HBM)
theorizes that health-related behavior change depends on having sufficient motivation, a belief of a perceived health threat, and belief that the intended behavior will reduce the perceived threat
"Risk-Reduction" approach
through patient education or community heart health promotion, the typical participants evidenced some sort of risks that would need to be reduced in order for them to achieve optimal health. takes those at high risk and moves them back down to normal
epidemic
unexpected large number of cases of an illness, health-related behavior, or other health-related event
Chronic Care Model
(CCM) emerged out of a need to provide a better quality of health care for patients with a chronic health conditions (1) the community, (2) the health care system, and (3) provider organizations -Community resources and policies are the first "essential element" in the CCM. -The health care organization includes the organization's values, policies, training, and orientation toward patients. -Self-management support involves teaching patients with a chronic disease how to care for themselves. -Delivery system design refers to creating an ideal division of labor. -Decision support means having a set of clear practice guidelines for the treatment and management of chronic diseases. -Clinical information systems refer to the organization of patient medical records. complex, requires system changes, expensive
Social Cognitive Theory
(SCT) frames health behavior as a dynamic relationship among the person, the behavior, and the environment. -Reciprocal determinism refers to the dynamic relationship among the self, behaviors, and the environment, both social and physical. Specifically, all three factors influence and are influenced by each other. -Environment is any factor outside the self. -Situation is how you perceive the environment. -Observational learning maintains that you often learn by seeing others model the behavior and receiving a positive consequence as a result of its enactment. -Behavioral capability is your knowledge and skill to enact the desired behavior. -Outcome expectations are what you think will happen as a result of enacting the behavior. -reinforcement -Outcome expectancies are how much you value the particular outcome. -Emotional arousal management refers to how you address and cope with the negative or positive emotions surrounding the performance of a behavior.
the Transtheoretical Model (STAGES OF CHANGE)
(TTM) frames health behavior as progressing through a series of stages and offers direction on how to promote behavior change in these various stages. precontemplation, contemplation, preparation, action, maintenance, termination -Decisional balance is the perception of the relative benefits and disadvantages of performing the behavior -Self-efficacy is how confident one feels in successfully making and maintaining a change. The 10 processes include -consciousness raising, using new info to become more aware of the problem -dramatic relief, emotional reaction to problem behavior -self-reevaluation,is conceptualizing the self with the problem behavior and without the problem behavior and then differentiating between these two possible identities to make a decision about which type of person to be. -environmental reevaluation, assessing how the behavior impacts others and society both mental and emotionally -social liberation, changing social norms to promote healthy behaviors. -helping relationships, emphasizes the role of trusting, nurturing relationships in promoting change. -counterconditioning, replacement, rather than changing behavior- replaces unhealthy behavior with a healthy one -contingency management, frames behavior change as motivated through reinforcements for healthy behavior. -stimulus control, use of cues or prompts to promote healthy behaviors and counter engagement in unhealthy behaviors. -self-liberation, the belief that change is possible and the person has a personal commitment to follow through with the change. The first five are considered experiential and the latter five are considered behavioral. One critique of the TTM is that it is not suited to complex behaviors like exercise because an individual may be simultaneously at different stages, which is not accounted for by the model. Some authors argue that the TTM oversimplifies complex behavior by artificially forcing it into stages
Social-Ecological Framework
*Individual-level factors* include personal opinions, beliefs, and attitudes that influence behavior. An example of an individual-level factor would be a person's enjoyment of physical activity. *Interpersonal-level factors* are influences that derive from interactions with others. These include not only how family, friends, and peers think about a behavior but whether they engage in the behavior as well. *Organizational-level factors *are the values, policies, and routines of particular institutions and groups. An example of an organizational-level factor would be physicians at a certain hospital being required to refer obese patients to a free exercise program. application of Social-Ecological Framework -lives. Social environmental factors include factors like social norms that are held by a particular community; for example, in some racial/ethnic communities, doing exercise for fun is not part of the culture. Perceived environment, an aspect of physical environment, incorporates factors such as perceived safety and attractiveness of the environment (e.g., is your neighborhood known for its gang activity and thus not conducive for walking?). Behavior settings, also an aspect of the physical environment, include factors such as the design and layout of the neighborhood and school environments (e.g., are you exposed to graffiti or do you see trees when you walk from home to school?). Lastly, the policy environment includes factors such as health care policy, zoning codes, and park policies. Sallis and colleagues argue that the best way to encourage an active lifestyle is to target as many levels of influence as possible by adopting a multilevel, multidisciplinary approach to promoting physical activity.
Biggest Trend in Health Promotion
A call for all our activities and programs to be EVIDENCE-BASED
Application of the Socio-Ecologic Framework
Breast and Cervical Cancer Screening (CDC,2013) •Individual: education to increase knowledge •Interpersonal: family, friend, peer influences •Community: working with coalitions to promote screening •Organizational: worksite policies to support preventative care •Policy levels: Insurance mandates for screening
Ethical Issues in HP
Ethical issues interface with all aspects of our professional lives Obligations of professions & professionals (Bayles, 1989) •Obligations & availability of services •Obligations between professionals and clients •Obligations to third parties •Obligations between professionals and employers •Obligations to the profession Ethical dilemmas (Penland & Beyrer, 1981) •Must be an issue (a controversy); two sides •Must involve a question of right and wrong
Renaissance
Characterized by gradual rebirth of thinking about the world and humankind in a more naturalistic and holistic fashion •Science reemerged as legitimate field of inquiry, numerous scientific advancements •Disease and plague still ravaged Europe, medical care was rudimentary •Royalty suffered from many health problems just as commoners did •Disposal of human waste and severe uncleanliness were common problems •Health boards formed in Italy
Parts of a Theory
Concept - primary elements of theories (Glanz et al., 2008) Construct - the main concepts of a theory. The elements of the theory used to describe, explain, and predict behavior. Variable - the operational (practical use) form of a construct; (Rimer & Glanz, 2005, p. 4); how a construct will be measured (Glanz et al., 2008). Model - presents and explains relationships between constructs.
Conceptual models
Constructs are the main concepts of a theory (National Cancer Institute, 2005). They are the elements of the theory used to describe, explain, and predict behavior. For example, the constructs of the Health Belief Model include perceived susceptibility, perceived severity, perceived benefits, perceived barriers, cues to action, and self-efficacy. A model presents and explains relationships between constructs. For example, the Health Belief Model explains how attitudes and beliefs influence behavior. In contrast, a framework provides a way of viewing the behavior but does not explain relationships between constructs. For example, the Social Ecological Framework (SEF) describes different levels that influence behavior but does not necessarily explain the specific constructs and how these interact. When distinguishing among theory, model, and framework, it is helpful to think of the term "theory" as the most all-encompassing of the three. Models and frameworks can exist within theories, the former by outlining a specific set of constructs and how they are related to a behavior, while the latter by providing a general idea of what influences behavior.
Theoretical foundations of health promotion.
Constructs are the main concepts of a theory (National Cancer Institute, 2005). They are the elements of the theory used to describe, explain, and predict behavior. For example, the constructs of the Health Belief Model include perceived susceptibility, perceived severity, perceived benefits, perceived barriers, cues to action, and self-efficacy. A model presents and explains relationships between constructs. For example, the Health Belief Model explains how attitudes and beliefs influence behavior. In contrast, a framework provides a way of viewing the behavior but does not explain relationships between constructs. For example, the Social Ecological Framework (SEF) describes different levels that influence behavior but does not necessarily explain the specific constructs and how these interact. When distinguishing among theory, model, and framework, it is helpful to think of the term "theory" as the most all-encompassing of the three. Models and frameworks can exist within theories, the former by outlining a specific set of constructs and how they are related to a behavior, while the latter by providing a general idea of what influences behavior.
Application of Theory to Health Promotion
Example: planning a health promotion intervention to increase physical activity among preteen girls •Consider what factors are influential to increasing the target behavior •Consider aspects of the target population •Theory needs to fit the sociocultural characteristics of the target population and be consistent with the behavior in question
Mobilizing for Action through Planning and Partnerships (MAPP) (NACCHO, 2001)
Designed to provide communities for a framework for improving health •Blends the strengths of other planning models Six phases •Phase 1: organizing for success and partnership development •Phase 2: visioning •Phase 3: conducting the four MAPP assessments: CTSA, LPHSA, CHSA, and FCA •Phase 4: identify strategic issues •Phase 5: formulate goals and strategies •Phase 6: the action cycle
The Socio-Ecologic Framework
Explores the impact of multiple levels of influence on behavior •Individual-level factors: personal opinions, beliefs, and attitudes •Interpersonal-level factors: how peers, family, and friends think about/engage in a behavior •Organizational-level factors: values, policies and routines of institutions and groups •Community-level factors: those that affect populations •Policy-level: national, state, local laws
Anyone is ready to make changes in health behavior T/F?
False everyone is at different stages
According to the TTM, the progression through stages of change must be linear. T/F?
False everyone is at different stages at different points and can even to backwards.
True or False: The Jakarta Declaration provides the most-cited definition of health promotion.
False the most widely used was presented by the World Health Organization (WHO) in its Ottawa Charter for Health Promotion in 1986
True or False: In science, "positivism" refers to the emphasis on health rather than on illness.
False, focuses on the observable?
ECLECTIC HEALTH EDUCATION/PROMOTION PHILOSOPHY
Focuses on an adapting approach that is appropriate for setting.
FREEING/FUNCTIONING PHILOSOPHY
Focuses on freeing people to make best health decision for them based on their needs and interests-not necessarily on interests of society.
BEHAVIOR CHANGE PHILOSOPHY
Focuses on modifying unhealthy habits.
Professional ethics•
Focuses on the "actions that are right and wrong in the workplace and are of public matter" •Professional ethics guide individual behavior in the work setting •Professional socialization - coming to an understanding of what behaviors are appropriate in a professional role
School Health
Horace Mann -called for mandatory hygiene programs that would help students understand their bodies and the relationship between their behaviors and health Other national movements •National Tuberculosis Association introduced the "Modern Health Crusade" as a device for promoting the health of school children •Sally Lucas Jean responsible for changing the name from hygiene education to health education, emphasizing healthy living and health behavior rather than physiology and hygiene World War I provided impetus for widespread acceptance of school health education as its own discipline •Many men were rejected from the draft due to physical deficiencies that could have been prevented by school health education Professional organizations emerged and expanded during the 1900s to focus on school health World War II turned national focus to physical fitness and health due to degeneration of the health of young American men and the large number unfit to serve in the military Coordinated school health program (CSHP) •CDC recommends placing curriculum emphasis on six key adolescent risk behaviors: alcohol and drug use, behaviors that contribute to unintentional injuries and violence, tobacco use, unhealthy dietary behaviors, inadequate physical activity, and sexual risk behaviors
Health behavior change..
Is hard •Set realistic expectations •Lifelong implications •Smoking increases nursing home admittance by 40%• Failure often occurs due to focus on negative factors instead of specific positive goals •And a practical method to achieve •Relapses will occur NEED A PLAN•Will need a change in the environments that lead to the behavior
Deontological Ethics
Judges based on whether practices are consistent with certain duties ex: Identify one's duty and acting accordingly
The 1800s (Public Health Emerging)
Overcrowding in cities, caused many public health problems - smallpox, cholera, typhoid, and tuberculosis reached high endemic levels •1842, Chadwick's Report on an Inquiry into the Sanitary Conditions of the Laboring Populations of Great Britain Advancements in microbiology and bacteriology •1849, Snow removes pump handle in London •1862, Pasteur proposes germ theory •1875-1900, bacteriological period of public health
PRECEDE-PROCEED
PRECEDE-PROCEED (Green & Kreuter, 1991) Best known & often used model, Developers: Larry W. Green & Marshall W. Kreuter •PRECEDE—predisposing, reinforcing, and enabling constructs in educational / ecological diagnosis & evaluation •Phase I: Social assessment •Phase II: Epidemiological assessment •Phase III: Educational and ecological assessment •Pahe IV: Intervention alignment and administrative and policy assessment •PROCEED—policy, regulatory, and organizational constructs in educational & environmental development •Phase V: Implementation •Phase VI: Process evaluation •Phase VII: Impact evaluation •Phase VIII: Outcome evaluation
Recent Events
Patient Protection & Affordable Care Act •Focuses on prevention and prevention services by removing cost barriers. •Encourages worksite wellness programs, evidence-based community prevention and wellness programs, and provides support for school-based health centers. Younger generations have a strong focus on positive health behaviors. More awareness of health issues and tools to address them. A lot of health information out there (double edged sword)
Health Philosophies
Philosophy of symmetry - health has physical, emotional, spiritual, and social components, each one as important as the other. •Holistic philosophy - the mind and body distinction disappear, yielding a whole unified being. •Wellness - always a positive quality that enables a person to strive to reach an optimum state of health in all dimensions (spiritual, physical, intellectual, emotional, social, environmental)
Middle Ages
Political & social unrest; many health advances lost •With collapse of the Roman Empire, there was much political and social unrest •Many public health problems resulted from overcrowding •Little emphasis on cleanliness or hygiene Religious beliefs impacted health - belief that disease was caused by sin or disobeying God Characterized by great epidemics (overcrowding) -Leprosy, bubonic plague -Concept of disease contagion became more universally accepted -Syphilis - last major epidemic disease of this period -Other epidemics: smallpox, diphtheria, measles, influenza, tuberculosis, and anthrax
6. Short answer: How is a Population Attributable Risk different than a high-risk approach to improving public health?
Population attributable risk percent (PAR%), gives the percent of cases in the total population that can be attributed to the risk factor. high risk prevention strategies aim to identify individuals or groups who are likely to have an increased incidence of a disease, based on the presence of modifiable risk factors known to be causal for the disease (e.g., high blood pressure) The high-risk strategy is generally implemented to decrease risk or course of disease among those with the greatest potential burden, while the population strategy seeks to maximize the number of individuals reached by an intervention, with less concern for the differential risk that individuals face in developing disease.
Health Behavior Categories (3)
Preventive Health Behavior •Action taken in an asymptomatic state for the purpose of preventing or detecting disease Illness Behavior •Action taken to define the state of health and find a suitable remedy Sick-role behavior •Action taken to get well (receiving treatment). Some loss of function.
Early Medicine
Priests served as physicians (bloodletting) •Also, Barbers(tooth extractions) Egyptians (3000-1500 B.C.) •Primitive medicine due in part to priest-physicians •Known for personal cleanliness Hebrews (around 1500 B.C.) •Extended the Egyptian hygienic thought •Formulated probably the world's first hygienic code in the biblical book of Leviticus
Ensuring Ethical Behavior
Professionals act unethically for specific reasons Profession can put into place procedures that help to ensure ethical behavior by all •Selective admissions into academic programs •Retention standards for students in academic programs •Graduation from an academic program •Completion of internships •Becoming credentialed •Continuing education unit or update of credentials Once individuals have been admitted to the profession •Expected to behave according to professional norms •Code of ethics •Considered the professional norm •Principal function is to "organize in a systematic way basic ethical standards, rules, and principles of professional conduct" (Pritchard, 2006) •Professions should have a means to discipline individuals that violate the code of ethics Ensuring ethical behavior in the health education/promotion profession •Health education/promotion has unclear standards for admission into the profession The profession of health education/promotion has a code of ethics •Society for Public Health Education (1976) •Association of the Advancement of Health Education (1994) [now know as the American Association of Health Education] •Current code of ethics is recognized by the Coalition of National Health Education Organizations [CNHEO]
special considerations
Public health researchers may need to take into account characteristics of the target population when considering a theory. When considering which theories should inform health promotion research and practice, researchers and practitioners need to consider the types and amount of resources available to them, including organizational partners, as well as personnel and material resources. The application of some theories/frameworks may require more resources compared to others.
True or False: Structural cohesion refers to the number, length, and strength of relationships between people.
TRUE Structural cohesion frames social proximity in "terms of the number, length, and strength of the paths that connect actors in networks". For example, a best friend of 15 years would likely have more paths of influence of a longer duration with more strength per path than an acquaintance from college
Using Theory
Theories provide direction and organizes knowledge Theories can help in planning, implementing, and evaluating programs •Indicates reasons why people are not behaving in healthy ways •Identifies information needed for intervention development •Provides a conceptual framework •Gives insight for delivery •Identifies measurements needed for evaluation •Help provide focus and infuses ethics and social justice into practice Programs based upon sound theory more likely to succeed
True or False: One application of theory to our health promotion research and practice is to build scientific evidence.
True? Clinical practice generates research questions and knowledge for theory. Research guides our practice and build knowledge through theory development. Theory guides research and improve practice
True or False: An individual or intrapersonal factor within the Social Ecological Framework includes how our family treats us.
True? Interpersonal-level factors are influences that derive from interactions with others. These include not only how family, friends, and peers think about a behavior but whether they engage in the behavior as well. An example of an interpersonallevel factor would be how often a friend goes to exercise class with you. If you have the support of your friend, whether in the form of encouragement or driving you to the gym, you may be more likely to attend the exercise class.
health education
a combination of PLANNED learning experiences based on theories that provide groups the opportunity to acquire the info and skills needed to make informed health decisions knowledge-attitude-behavior health education is a part of health promotion -healthier to take the stairs than elevator, making stairs accessible
Diffusion of Innovation theory
a theory that identifies stages of dissemination and types of adopters of new technology and other changes, including behavioral change. examines how new ideas spread in a social system. -Relative advantage is how much the new idea, or innovation, is superior to the current idea. -Compatibility is the consistency between the innovation and current processes. -Complexity is how difficult the innovation is to understand or accomplish. -Trialability is how much one can "experiment" with the innovation before fully adopting it. -Observability is how much others can perceive the effects of the innovation The steps progress as follows: knowledge about the innovation leads to attitude change about the innovation. Attitudes about the innovation lead to an acceptance or rejection of the innovation. The decision to accept or reject the innovation leads to implementation (or not) of the innovation. Implementation of the innovation leads to confirmation or disconfirmation
What construct was added to the Theory of Reasoned Action when it was modified to the Theory of Planned Behavior? a. Perceived behavioral control b. Perceived environment c. Perceived attitude d. Perceived norms e. Perceived adoption
a. Perceived behavioral control
7. Which theoretical construct demonstrates the current emphasis on the individual in health behavior theories? a. Self-efficacy b. Outcome expectations c. Social environment d. Decisional balance e. All of the above f. a, b, & d g. a, c, & d
a. Self-efficacy -Decisional balance is the perception of the relative benefits and disadvantages of performing the behavior -Self-efficacy is how confident one feels in successfully making and maintaining a change. NOT B OR C, THOSE ARE INTERPERSONAL
Match the examples with the appropriate health belief model. My brother just had hear surgery a. cues to action b. perceived severity c. self-efficacy d. perceived benefits e. perceived susceptibility f. perceived barriers
a. cues to action
Match the examples with the appropriate health belief model. A stroke can be serious. You can lose movement on one side of your body and have difficulty keeping your balance for months afterwards. a. cues to action b. perceived severity c. self-efficacy d. perceived benefits e. perceived susceptibility f. perceived barriers
b. perceived severity
the Health Belief Model
beliefs and knowledge about a health behavior and its consequences affect whether the behavior is enacted. -Perceived susceptibility is the belief that one is likely to contract a particular disease, condition, or negative health outcome. Perceived susceptibility is a person's subjective belief about risk rather than an objective measure. -Perceived severity is a person's belief in the negative consequences of contracting the disease, condition, or negative health outcome. It can include both negative health outcomes and negative personal or social outcomes -Perceived benefits of taking action interact with perceived susceptibility and perceived severity. Specifically, if a person views a particular action as reducing susceptibility or severity, the individual will view the action as beneficial. -Perceived barriers are obstacles to performing the recommended health behavior. -Cues to action are "triggers" for the proposed health behavior. -Self-efficacy, within the context of health behavior, is one's perceived confidence in performing a specific health behavior One critique of the HBM is that it does not present specific guidelines for health promotion interventions. Another critique is that the HBM highlights the cognitive decision-making process and assumes that "people decide what to do based on the extent to which they expect their choices will produce results they value"
Which of the following is not a central construct in the Health Belief Model? a. Perceived benefits b. Perceived barriers c. Perceived outcomes d. Perceived severity e. Perceived susceptibility
c. Perceived outcomes It includes -Perceived susceptibility -Perceived severity -Perceived benefits -Perceived barriers -Cues to action -Self-efficacy
Social cognitive theory primarily emphasizes: a. A person's opinion of health b. Pros and cons of changing behavior c. education d. the relationship of an individual and their surrounding environment
d. the relationship of an individual and their surrounding environment
Origin of Ethics
dates back to 470-399 B.C. Ethos and Mores - both mean character •Ethics - the science of how choices are made •Morality - the activity of making choices and of deciding, judging, justifying, and defending those actions People use terms such as good, right, bad, and wrong when referring to ethical judgments about human behaviors
Information Processing Paradigm
delineates how certain factors impact persuasion Input variables include the source, message, channel, receiver, and target -exposure, attention, liking, comprehension, related cognitions, skill acquisition, how, accept, retain, retrieve (from memory), consolidation -then use info to make descions and behave accordingly loss of interest is a problem
deductive reasoning
general to specific top-down reasoning in which a conclusion is reached by stating a general principle and then applying that principle to a specific case (The sun rises every morning; therefore, the sun will rise on Tuesday morning.)
Population Attributable Risk (PAR)
relatively healthy and unhealthy profiles that cannot be fully explained by aggregate individual risks. The amount of "extra" disease attributable to a particular risk factor in a particular population If the association is causal - this is the amount of disease (theoretically) we could prevent if we removed that particular risk factor from the population If we have interventions that targets high risk groups we use RD - high risk strategies If we go for a population based approach - PAR aids shifted from mostly the gay community to other places like subharhan africa
Social Influence
social influence can be positive or negative; in other words, social influences can promote or hinder both healthy and unhealthy behaviors. Knowing who these influential people are and how they influence behaviors can be used to design more effective interventions. -Social proximity is how close you are to someone else in your network. -Structural cohesion frames social proximity in "terms of the number, length, and strength of the paths that connect actors in networks". For example, a best friend of 15 years would likely have more paths of influence of a longer duration with more strength per path than an acquaintance from college. -Equivalence frames social proximity as similarity. Specifically, two people are equivalent if their social networks are similar. In its most narrow sense, equivalence would mean two people having the same friends, acquaintances, and family. Thus, the more social connections two people share, the more equivalent they are. vary person to person, difficult to study and compare
Age of Enlightenment (1700s)
•1700s were a period of revolution, industrialization, and growth of cities •Miasmas theory - belief that disease was formed in filth and that epidemics were caused by some type of poison that developed in the putrefaction process •Scientific advancements continued throughout this period •Health education/promotion had still not emerged as a profession •A lot learned from military medicine *Domestic Medicine* •Women expected to deal with illness in the family, keeping a stock of home remedies. •Oral tradition later recorded in home health cookbooks that were widely sold throughout Europe and the U.S. "Housekeeper/healthkeeper"
1900-Present
•1900-1920 - the reform phase of public health •First national voluntary agencies formed •1922 - founding of the Public Health Education & Health Promotion Section of the American Public Health Association •Concept of prevention beginning to take hold •"New Deal" expanded social programs including public health efforts•Efforts shifted from communicable diseases to the prevention of chronic diseases •Medicare and Medicaid bills passed, 1965 •Lalonde Report, 1974
Resistance to a Profession
•A "profession" implies a set of skills and experiences that are beyond the normal person (opposite to domestic medicine). •Establishing a profession of medicine encountered major resistance, despite having a model in England. ____ Ridding of the Quacks: A Standardized Education •Extensive, lab-based medical education had become the norm in Europe during the early 1900s, had not yet reached the U.S. •Medicine epitomized the very lax state of the university education system in general, and reform was widely known to be needed. •The most radical reform came in 1893 when Johns Hopkins started its medical program, the first to actually require a college degree to enter.
Major categories of issues (McLeroy et al., 1993)
•Assigning individual responsibility •Changing behavior vs. social environment •Use of public policy or coercive strategies •Overemphasizing behavior change •Overemphasizing the importance of health •Educating the public on the concept of risk •Underemphasizing professional behavior Ethical issues to be considered with community interventions •Confidentiality •Consent •Disclosure •Competence •Conflict of interest •Grossly unethical behavior •General ethical responsibilities
Mores
•Assumed organizational standards of good and bad, no need for formal expression •What is allowable and tolerable
Behavior change
•Behavioral factors main contributor to leading causes of death •Multiple levels and multiple interventions needed to initiate and maintain health behavior change •Evidence-based What if behavior changes but health status does not •What is the health status of interest?
Early medicine (romans)
•Built extensive and efficient aqueduct system •Developed an extensive system of underground sewers and public and private baths •First to build hospitals •Developed a system of private medical practice •Furthered the work of the Greeks in the study of anatomy and the practice of surgery
Ethics
•Critical analysis of morality •How values affect choice
Ethical Issues in Health
•End of Life •Treating the uninsured •Organ transplants •Quality of life •Death penalty •Treatment of prisoners •Non-compliant patients
Summary
•Ethical questions impact all aspects of life •Health promotion specialists are constantly being confronted with ethical dilemmas, thus must have a basic understanding of how to make an ethical decision •Principles to guide ethical behavior: value of life, goodness (nonmaleficence & beneficence), justice (procedural & distributive) truth telling, & individual freedom.
organizational level theories
•Examine how the physical and social structures of organizations influence health behaviors, and how they can be modified to promote health Chronic Care Model and the Diffusion of Innovation theory.
Social Network Theory
•Explains the web of social relationships that surround people **Key component - relationship between and among individuals and how those relationships influence beliefs and behaviors When assessing a network's role, considers - •Centrality vs. Marginality •Reciprocity of relationships •Complexity or intensity of relationships in the network •Homogeneity or diversity of people in the network •Subgroups, cliques, and linkages •Communication patterns in the network
Morals
•Formally expressed standards •Legitimize social structures
US Public Health History 1700s
•Health conditions in the U.S. were deplorable •Many immigrants, cities growing, overcrowding •Quarantine & environmental regulations used •1789, first life expectancy tables created •1780s & 90s, some cities formed local health boards
Summary
•Health promotion is a multidisciplinary profession & has evolved from the theory & practice of other disciplines. •Many of the theories & models used in health promotion also have evolved from these other disciplines. •There are many behavior change theories that can be categorized using the five levels (intrapersonal, interpersonal, institutional, community, & public policy) of the socio-ecological approach.
Population Health and Behavior Change
•Improving population health is dependent on individual health behavior change •Population level influences individual health behavior •Changing population health behaviors also require multiple levels but lean heavily on policy interventions •Important to have a guide to address health behaviors
Health Behaviors
•Lack of physical activity •Tobacco/e-cig use•Unhealthy diet •Binge drinking Important to not only study these behaviors but also have clear definitions for them •Physical activity can be defined in many ways Clearly defining the link between the health behavior and the health outcome still needs to be improved•Smoking is a health behavior clearly linked to a health outcome.
US Public Health History 1800s
•Little progress, still much disease •Conditions of overcrowding, poverty, and filth worsened •Shattuck's Report of the Sanitary Commission of Massachusetts •State Boards of Health - first established in 1869•First full-time county health departments formed •American Public Health Association founded •National Board of Health created by Congress in 1879, later discontinued
Summary
•Philosophymeans a statement summarizing the attitudes, principles, beliefs, & concepts held by an individual or a group. •Forming both a personal & an occupational philosophy requires reflection & the ability to identify the factors, principles, ideals, & influences that help shape your reality •The decision to use any philosophy involves understanding & accepting the foundation that helped create the philosophy •A sound philosophical foundation serves as a guidepost for many of the major decisions in life
Philosophy Development
•Process of developing a philosophy includes discussing and listing core beliefs and principles regarding health education. Drafting your own philosophy uses a similar process •Personal values and beliefs •What health means to you •Attributes of people you admire and trust •Results of health studies •Desired outcomes •Philosophy statements are not stable •Philosophy results from the sum of knowledge, experience, and principles.
5-R's
•Relevance •Risks •Rewards •Roadblocks •Repeat
Approaches to Health Behavior
•SMART Goal Setting• -Specific, Measurable, Attainable, Relevant, and Timely •Problem-solving barriers -Develop solutions •Self-monitoring •Small changes •Engage social network •Create feasible routines
Summary 2
•Shift from prevention to promotion •Modern advances in technology are increasing people's knowledge of their own health •These advances are both a gift and challenge for health promotion •Using principles of community-based research can be a good approach to address misinformation •Generational gaps will become a more crucial factor when designing health promotion programs.
Philosophy in Health Promotion Practice
•Sometimes health promotion specialists are called upon to educate those who hold different philosophies •Primary responsibility is to protect the health of the public •Health is not a moral issue, but the definition of health varies •Philosophical thought is important to the delivery of health education/promotion •Philosophies can serve to guide time commitments a professional chooses to emphasize •Well-reasoned philosophy plays an important role in a career path •Commitment to improved health
interpersonal-level theories
•Theories that "assume individuals exist within, and are influenced by, a social environment. The opinions, thoughts, behavior, advice, and support of people surrounding an individual influence his or her feelings and behavior, and the individual has a reciprocal effect on those people" (Rimer & Glanz, 2005, p. 19) •Describe how the relationships between people influence health behaviors Social Cognitive Theory, Social Support, and Social Influence, social network theory
Summary
•Today's concept of health education/promotion is relatively new dating back only to the mid-to late-1800s. •Since ancient times humans have been searching for ways to keep themselves healthy & free of disease. •Progress in preventing & treating disease is evident in the early civilizations. •By the mid-1850s conditions were ripe for the birth of public health in the U.S.; government health departments were created at all levels; school health education was budding. •Late 1800s professional organizations were created & voluntary agencies were formed; bacteriology phase of public health.
Social Marketing
•Uses principles of commercial marketing to craft and guide behavior change programs uses the principles of commercial marketing to craft and guide behavior change programs. promotes "social good" by encouraging health behavior change ---Exchange is the idea that self-interest, or the desire to maximize benefits and minimize costs, drives behavior. Unlike commercial marketing, social marketing is not promoting a consumer product; thus the rewards and costs in social marketing are often intangible. -Audience segmentation is dividing the target audience into groups based on certain characteristics, like behaviors, personal preferences, and values. -Competition has a distinct meaning in social marketing. In commercial marketing, competition is the company or product that may tempt consumers away from your company or product. -***Marketing mix, or the "four Ps," is a foundational concept in commercial marketing. The four Ps, which include product, price, place, and promotion, have been appropriated by social marketers to promote behavior change. Social marketing understands product as the benefits of performing the health behavior. For a program promoting walking, the product might be a trimmer figure and a healthier heart. -Consumer orientation is thinking like the consumer. -Continuous monitoring and revision includes evaluating the effectiveness of the promotion program at every stage. initial planning, formative research, developing a strategy, developing a program and pretesting, implementing, and monitoring/evaluating. One critique of social marketing is that it is mainly about advertising. Another critique of social marketing is that it does not account for the physical environment.
