Kine 3645
Targeting or Tailoring? Maximizing Resources to Create Effective Health Communications
Healthcare marketers meet the needs of consumers when developing campaigns to sell health services (can be costly and interests vary) Marketers should turn to social marketing for insight on maximizing resources to reach potential consumers Competing against high volume advertisers means creating quality messages that influence the targeted audience for health communication campaigns Customizing messages to a particular audience maximizes strength and influence Two methods to customize health messages: - Message Targeting: customizes messages to shared characteristics of population subgroups (lifestyles, emerging careers) - Message Tailoring: fits messages to individual characteristics (personality) Psychographics/ matched messages are strategies for targeting/ tailoring messages Message Targeting and Psychographics Message targeting involves defining a subgroup of a population based on common characteristics and providing information consistent with them (if members have enough similar characteristics, the same message will influence them) Knowledge of group's characteristics allows message developers to allocate campaign resources economically and strategically by targeting their relevant audience Variables to segment audiences range from age, gender, income, behaviour, etc. The needs, wants and interests of consumers are not always taken into account by these variables and business methods are done as convenient for them Due to the substantial variability among individuals with the same diseases for example, marketing campaigns targeted towards this subgroup will be unsuccessful - Example: If two people have SCI, but in different areas, their health care and assistive device needs are different, thus requiring different marking campaigns Psychographics uses psychosocial variables (lifestyle, attitude, opinions, personality) beyond one-dimensional variables (age, gender) to describe consumers In marketing campaigns, psychographics are used to measure psychological variables of targeted audience to identify individuals who will be most receptive to their ads The theory underlying psychographics is that understanding why individuals make certain choices is effective in developing marketing campaigns The importance of audience segmentation as a tool to reach needy members of population is important - changing one health behaviour may result in a lifestyle change Psychographics is a good fit for guiding health communication practices Using variables such as lifestyle, attitudes and opinions to increase regular mammography screening, researchers identified two segments of the population representing the majority of women not getting breast exams: women not aware that annual screening was necessary and those who were aware Extant health behaviour communication can be used to find/ serve relevant subgroups Example: if the goal of a marketing campaign is to encourage women in a community to get screened for breast cancer, it's important to know key barriers preventing them from mammograms such as choice of hospital and such Campaign resources are economical when segments are identified systematically First, to create a meaningful population subgroup, you should communicate with community reps or even directly interact with people to determine things about them Second, organization should develop materials for each segment, rather than using one generic message, they should develop multiple materials to target groups with similar beliefs/ attitudes Message Tailoring and Matched Messages Customizes health communication messages - process that fits the message to the individual to meet needs, rather than targeting group criteria (must assess individual) This approach is motivated by a theory that describes how individual process and respond to information in persuasive messages Elaboration Likelihood Model: individual are most persuaded by personally relevant messages because they pay more attention and process the information better Personalization is the most basic approach to tailoring, which involves identifying and incorporating into messages, the characteristics of someone (name, age) Other approaches assess and integrate into messages, more detailed information for the individual - one way is by matching messages to ways people process health info - Social Intelligence Theory: variations in info processing styles differentiate individuals more than personality traits o Tailoring messages to information processing styles tend to be based on more static psychological characteristics o Messages tailored to a constant characteristics doesn't no need modification as those that might change over time 4 Information Processing Styles: coping style, need for cognition, health locus of control and regulatory focus - Experiments done on these showed that messages matched to one's information processing style were more persuasive in affecting behavioural change than mismatched messages Effective strategy is costly if you need detailed communication, individualized assessment, content, etc. Tailoring messages (to a specific diseases) requires screening tools or surveys to identify cognitive and behavioural factors that make messages relevant to the consumer Targeting or Tailoring? Maximizing Resources To target or tailor depends on factors (available resources, size of target audience, behaviour) - tailoring messages of an individual results in increase in costs Health communicators must find a balance between message specificity and proportion of audience that responds to the message To predict the level of specificity that a message needs to influence behaviour, you need to identify needs of the intended audience To tailor or target messages can be determined by identifying variables that predict behaviour change (knowledge, beliefs, norms) If there is low behaviour determinant variability, targeting is most appropriate Best method for creating messages is to use a combination of tailoring and targeting (ideal communication strategy for message effectiveness and resource efficiency) Goodness of fit-- reflects how well the content of targeted messages, taken from composite group characteristics maps on the content of tailored messages from traits - The challenge is to determine which variables will result in good-fitting messages and whether a targeted message results in outcomes to individual tailor messages It may be possible to use targeted messages that are culturally relevant to produce the same behavioural outcomes as tailored messages
RE-AIM: Adoption
"Concerns the participation rate and whether the setting is representative of the larger population" Raingruber Concerns the percentage and representativeness of organizations or setting that will conduct a given program. Factors to look for: -Political/Cultural Fit ( ex. workplace support intervention? most likely not) -Cost -Level of Resources & Expertise Required -Similarity to Current Practices
Maladaptive Fear Control Action
"Denial" I'm not at risk for getting cancer, it won't happen to me "Defensive avoidance" This is just too scary, I'm simply not going to think about it "Reactance" They're just trying to manipulate me, I'm going to ignore them
RE-AIM: Efficacy
"Efficacious programs produce positive outcomes with few unintended consequences." Raingruber Impact of an intervention on specified outcomes -Both Negative & Positive Factors to look for: Intended results Did the intervention work? -Weight -Smoking Cessation -Exercise -Flossing
RE-AIM: Maintenance
"Focuses on the long-term utilization of the given health behaviour. Also refers to whether a health promotion program is sustainable." Raingruber Operates at both the individual and setting level How well behaviour change holds in the long term -Individual -Setting Factors to look for: -Long term studies -Aspects that predict maintenance
RE-AIM: Reach
"Reach is a measure of how many people can be influenced by a health promotion program" Raingruber Participation rate among those approached "participation rate vital" Representativeness of participants Factors to look for: -Size & Characteristics of potential audience -Barriers to Participation >Social and Environmental Context ( ex. a smartphone intervention has old age barriers ->>>>because old people will be a context because they will have most likely have no smartphone) >Necessary Referrals >Transportation >Inconvenience
RE-AIM: Implementation
"Whether the health promotion program was implemented as intended" Raingruber Intervention Integrity Quality & Consistency of the Delivery Factors to look for: -Different organizations adopting in different ways -Changes made to the intervention
Combination of targeting and tailoring?
ex. pants tailored to size 32 but targeted to everyone
GL- Conclusion The implementation of a goal setting and action planning protocol in fitness testing in elementary school physical education class may:
- significantly increase student's physical activity -self-efficacy -significantly increase fitness scores
purpose of proceed -proceed model and re-aim
- useful in evaluating health promotion programs. -helpful to researchers who are trying to measure the effectiveness of a health promotion program and also to practitioners who are designing interventions. a planning model that came designed as a way to teach students about health promotion. It was also created as a planning, intervention, and evaluation framework. The goal of the PPM is to identify the most effective way to promote change by conducting local needs assessments and program evaluations. The model was based on epidemiology, social-cognitive psychology, education, and management principles -The PPM is based on the assumption that interventions will be effective if they (1) come from the community, (2) are planned thoroughly, (3) are based on data, (4) include interventions the community sees as feasible, (5) include multiple strategies woven into a cohesive program, and (6) rely on feedback and progress evaluation.
obesity and obese percentages in Canada
-"Adolescents do NOT outgrow overweight and obesity, rather weight gain is generally continued into adulthood. If we extrapolate this trend to 2040 then we can expect approximately 70% of adults over 40 years to be overweight and obese." Statistics Canada -in the youngest age group you can see there is little change in the overall levels of overweight but an increase in obesity that was virtually non-existent in 1978... other age groups more than double percentage of overweight What's going on??? What's driving this trend??? - lazy to cook - processed foods - screen/ sedentary time - etc.
comprehensive school health in Canada notes implementation
-In 1985, the Ottawa Charter for Health Promotion provided the framework for CSH, which is currently implemented in over 43 countries around the world Canadian schools differ so a standard protocol for implementation of CSH is therefore not feasible. . They necessitate tailoring to the needs of individual school communities
How might health literacy and health numeracy be linked to what we know about health disparities? Why might medical statistics be ineffective for changing risk perceptions?
-affect midstream - skills to find health related problems. ex. no idea how to find a chiropractor because have no health literacy. > make stats understandable to all to increase effectiveness for changing risk perceptions because can understand stats of health and definitions. because if not > medical statistics be ineffective for changing risk perceptions because people are like wtf is diabetes because they have no literacy
3-healthy school policies
-can be as simple as a classroom teacher deciding to no longer use candy as a reward for good behaviour -These policies strongly support HEAL behaviours, but to date few investments have been made to determine the effectiveness of the HEAL policies.
Denial city!
Awareness/education Optimistic bias for our kids? Parents have optimistic bias > think kids are active at school so don't think kids need PA at home Example: PLAY-ON data Bassett-Gunter and Leatherdale, 2014 2363 students and parents Grades 1 -4 Boys and girls 69% less active Parents 53% more active
organized sport and physical activity participation grade
B-
GL Mechanisms Causing The Effects: Fitness Scores
Fitness scores may have improved due to increased motivation, caused by goal-setting
Raingruber evaluation theories: Nightingale s Environmental Theory (1859)
Florence Nightingale is credited with being the first nurse theorist. She proposed Environmental Theory, which aimed to restore the client to their optimal state of health. She asserted that the client s environment could be used to facilitate his or her recovery and that the nurse was responsible for helping configure the environment such that it supported recovery. Pure air, clean water, sufficient food, efficient drainage, cleanliness, and light were considered necessary for a healthy environment. A quiet, noise-free environment with adequate warmth during cold periods was also considered to be a priority (Nightingale, 1859). The practice of environmental configuration, based on client needs is still practiced today
Health Risk Information
Gain/loss-framed messages are often preceded by health risk information
Negative Effects? high or low risk messages
Gainforth & Latimer (2011) Women read either a high or low risk message about the HPV vaccine. look at the use of "ONLY" in high risk
GL Increasing Self-Efficacy
Goal Setting Action Planning Instruction Reinforcement
Guest Presentation
Goal setting and action planning interventions in youth physical education: An approach to increase self-efficacy.
A Social Ecological Approach to Youth Health Promotion
Grounded in the Ottawa Charter for Health Promotion, which highlighted "supportive environments for health" and stated that "health is created and lived by people within the settings of their everyday life; where they learn, work, play and love. WHO, 1986
Medical Statistics: Considerations
HEALTH LITERACY!!!
Why does risk matter?
Health Belief Model (Protection Motivation Theory) Optimistic Bias Modifiable (Individual level approach)
protection motivation theory: caution 1:
Be Careful! efficacy and level of fear Strong fear appeals with low-efficacy messages produce greatest levels of defensive responses > maladaptive Strong fear appeals with high efficacy messages produce the greatest behavior change.
Qualitative Analyses of parents
Borra et al., 2003 Parents need to learn how to talk about eating and exercise habits with their children -positive and encouraging ways Positive, realistic approaches to getting fit: -answers to questions -ideas for physical games and activities -attainable goals and small steps to -healthful eating -healthful meal, snack, and recipe suggestions -incentive ideas for getting kids active -referral services for local support groups. Parents and children need to work together
school grade: on physical activity
C+
Evaluating CSH
CSH is in its infancy. Where clinical evidence tends to be universal and biological in nature, evidence for population health interventions is context specific and consequently in continued need of replication CSH is a promising approach to promoting HEAL. Rigorous evaluations of CSH are urgently needed to provide a stronger evidence base of the benefits of CSH for learning, self-esteem and disease prevention. This evidence will help justify devoting more school time to promote HEAL and more resources for CSH, to the benefit of both learning and health.
Two modes of processing message tailoring
Central route >thorough scrutinizing Peripheral route > superficial evaluation, cues
Peripheral Strategies
Colors, images, fonts, declarative statements
Know Your Numbers Program
Community based program targeting blood pressure and stroke risk factors Goal: change knowledge of risk factors and health promotion behaviours 59817 participants over 3 years Baseline and Follow-Up data collected by survey from 510 participants FOUND: Improved knowledge for health risk information Participants took "Health Promotion Action"
Linguistic Strategies
Culturally appropriate language
active transport grade
D-
sedentary grade
D-
How are we doing in Canada??
D- in overall physical activity
Optimistic bias & physical activity?
Decreased motivation to engage in health-protective behaviours such as physical activity
Targeting vs. Tailoring
Depends on Behaviour Targeting best for "easy" one-time behaviours if awareness is determined > target that constuct Tailoring best for complex on-going behaviours Depends on Goodness-of-fit of messages Depends on determinants of behaviour Variability among audience? Example; Breast cancer screening awareness Tailoring more resources - To tailor or target messages can be determined by identifying variables that predict behaviour change (knowledge, beliefs, norms) - If there is low behaviour determinant variability, targeting is most appropriate Combination of targeting and tailoring? Impact = Reach x Efficacy
Our Girls Aren't Guinea Pigs August 27, 2007
Described the HPV Vaccine as risky not factual but changed perception of risk to readers which led to not getting vaccinated because they believed the fake facts and this led to behavior change
Sociocultural Strategies
Discuss within broader social context Identify, recognize, reinforce, and "build-in" cultural values
Constituent-involving strategies
Draw directly on the experiences of the target group
Smoking Cessation Campaigns
Effective if: The are accompanied by messages emphasizing that quitting is possible Advise the reader where to get help. EFFICACY IS IMPORTANT images more important than words > because visuals more likely to target emotions ( affective) ex. Could I exchange this pack of cigarettes with a warning about lung cancer, for one with a warning about premature birth? Because lung attacks their perceived vulnerability and severity as oppose to birth which doesn't affect a MAN.
Efficacy vs. Effectiveness Trials
Efficacy: Use motivated, "homogeneous" participants with minimal or no complications or co-morbidities Complex and intensive Research staff following a standardized protocol homogenous= specific group of people ex.18-24 men hence how effective will efficacy be due to using specific parameters of people in real world setting Effectiveness: Intended to represent typical setting conditions It is hoped that the intervention will be maintained, assuming there are positive results
A Model for Healthy School Communities comprehesive school area article HEAL - health eating and active living
Healthy School Communities grey area- what we need to do: teaching and learning physical and social environment policy evidence community partnerships and services blue area- how can we achieve this and do it Sustainability -policy and evidence whole school approach -policy and community partnerships and services access plan and learn - community partnerships and services and teaching and learning health and education synergy -teaching and learning and physical and social environment policy champion and team -physical and social environment policy and evidence
Best Approach to Youth Health Promotion?
Healthy School Communities Approach AND Parent Social Support Interventions HSCA + PSSI = best
Medical Stats Considerations: "Ensure understanding"
Ensure understanding 1. Use multiple formats 2. Use a common denominator 3. Use a meaningful time frame 4. Use frequencies rather than percentages
The Importance of Evaluations
Ensuring that health promotion practice is evaluated! Ensuring that research reaches health promotion practice is important! It is a two-way street! There are many different theories and terms
Message targeting
Message targeting customizes messages to shared characteristics of population subgroups Demographic factors mothers Children Cultural group Lifestyle factors recent college graduates in emerging careers physically active retirees living in the suburbs
What about physical activity? Latimer, Brawley & Bassett, 2010
N = 12 Tailored > control group in >50% of studies Exposure! Exposure! Exposure! Cautious recommendations... What about tailoring beyond TTM?
Elaboration Likelihood Model by: Caciopo and Petty Personally relevant information more persuasive
Personally relevant information more persuasive Present information in a way that is consistent with recipients' characteristics Tailor to psychological constructs that differentiate how people process information? Tailored messages >relevant > central route
Longitudinal Results: Physical Activity
Physical Activity per week increased
Tailored Messages: Stage of Change
Pre-contemplation Contemplation Preparation Action Maintenance
What is Message Tailoring?
Presenting information in a manner that suits the "individual characteristics" of the message recipient Fits messages to individual characteristics, such as personality factors or theoretical determinants of behaviour E.g., information processing style, stage of change, self-efficacy, perceived susceptibility Increases the salience and impact of the message on behaviour
Conclusion from MS study
RISK INFORMATION IMPORTANT!! -Perceived risk -Protection Motivation Theory -PA intentions -PA Message Framed did not matter following risk information
Medical Events & Narratives
TV shows and books, anecdotes: Medical Narratives are medical events that can be used as teachable moments! First or third person Elaborate on example of an event and provide characters and plot "Grey's Anatomy" Celebrity Narratives Should contain information about: -The causes and consequences of illness and treatment seeking behaviour -Available treatment options and their consequences for the individual
Tailoring
Tailoring is directed at individuals not groups Tailoring is based on known (i.e., measured) differences that exist between individuals
How to Boost Parent Social Support?
Target Attitudes toward Social Support -Make more enjoyable for parents -Help parents with self-regulation to reduce sense of time burden Target Perceived Behavioural Control -Improved accessibility and programming -Reduce barriers e.g., cost, travel -Help parents with self-regulation (Planning, monitoring, goal-setting etc.)
CREATING RISK PERCEPTIONS
Targeting perceived vulnerability and severity: Medical Statistics Medical Results Medical Events New technology
message tailoring article: psychographics
are strategies for targeting/ tailoring messages -uses psychosocial variables (lifestyle, attitude, opinions, personality) beyond one-dimensional variables (age, gender) to describe consumers -In marketing campaigns, psychographics are used to measure psychological variables of targeted audience to identify individuals who will be most receptive to their ads - The theory underlying psychographics is that understanding why individuals make certain choices is effective in developing marketing campaigns
four types of information processing
coping style -blunters -moniters need for cognition -high in need -low in need health locus of control -internal -external regulatory focus -promoters -preveneters
message tailoring article: 4 Information Processing Styles:
coping style, need for cognition, health locus of control and regulatory focus - Experiments done on these showed that messages matched to one's information processing style were more persuasive in affecting behavioural change than mismatched messages Effective strategy is costly if you need detailed communication, individualized assessment, content, etc. Tailoring messages (to a specific diseases) requires screening tools or surveys to identify cognitive and behavioural factors that make messages relevant to the consumer
apple schools results
dietary intake decreased heavily in 2 years from 2100 to under Alberta average of 1900 fruit and vegetable consumption per day skyrocketed up while provincial average went down.
GL Solving the Problem
It is important that PA is promoted during this time period as the development of health behaviours begins in childhood. >Determinants of PA >Effective Interventions
Quantitative Analysis Rhodes et al., 2013
KEY FACTORS -ATTITUDES CHILD PA -ATTITUDES PARENT SOCIAL SUPPORT -PERCEIVED CONTROL OVER SUPPORT ************ATTITUDE PARENT SOCIAL SUPPORT MOST IMPORTANT FACTOR ***********
GL Fitness Testing
An understanding of your own fitness level and capabilities is a key part of Physical Literacy. In Canada Fitness Testing has been deemed "discouraging to those who need it the most."
Role of Parents: social support
Social support Tangible social support is divided into two categories: -instrumental (e.g., purchasing equipment, payment of fees and transportation) -Conditional (e.g., doing activity with, watching/supervision). Intangible social support is divided into two categories: -Motivational (e.g., encouragement, praise) -Informational (e.g., discussing benefits).
NEW TECHNOLOGY
Sun Safety experiment: Long term health effects Vs Appearance-based effects Participants either shown UV Photos or Photoaging Information Video Conclusions: Appearance based - more effective beacuse ppl hate seeing themselves ugly -.. superficial UV photo and photoaging information are promising interventions for skin cancer prevention Long-term effects: less skin damage and darkening & increased sun protection behaviors. long term is less effective for young ppl cuz they think life is super long and dont care about the future however both are still effective for sun safety
GL Purpose
To investigate the effect of a fitness testing based goal setting and action planning intervention in youth physical education on PA self-efficacy, enjoyment & intentions, goal setting self-efficacy and fitness performance scores.
message tailoring article: 2 methods
Two methods to customize health messages: - Message Targeting: customizes messages to shared characteristics of population subgroups (lifestyles, emerging careers) - Message Tailoring: fits messages to individual characteristics (personality) Psychographics/ matched messages -are strategies for targeting/ tailoring messages -uses psychosocial variables (lifestyle, attitude, opinions, personality) beyond one-dimensional variables (age, gender) to describe consumers -In marketing campaigns, psychographics are used to measure psychological variables of targeted audience to identify individuals who will be most receptive to their ads - The theory underlying psychographics is that understanding why individuals make certain choices is effective in developing marketing campaigns Campaign resources are economical when segments are identified systematically
APPLE SCHOOLS : A Case Study for The Healthy School Community Approach
Two year (2008-2010) "Comprehensive School Health" Intervention Alberta Project Promoting active Living and healthy Eating APPLE Schools: Grade 5 students from 10 schools Control Schools Grade 5 students from 150 randomly selected schools
optimistic bias
Unrealistic optimism Common tendency regarding susceptibility or risk for disease "compared to other people of your age and sex, are your chances of getting the problem greater than, about the same, or less than theirs?" focuses on perceptions of susceptibility and risk. Weinstein (1984): people continued to practice unhealthy behaviours due to inaccurate perceptions of risk and susceptibility "unrealistic optimism" KEEP UNREALISTIC OPTIMISM IN MIND WHEN CREATING RISK PERCEPTIONS
How do we know if our programs are working??
Use of theories and models to evaluate Theories and models also useful for planning Many different theories and models -Diffusion of Innovation Theory -Precede-Proceed Model -*** RE-AIM framework *** -Many others!
RE-AIM Evaluation Framework
Used to refocus priorities for evaluation of interventions for public health Reach ind Efficacy ind Adoption setting Implementation setting Maintenance both
Evidential Strategies
Usually epidemiological data
Medical Statistics
Usually work to "convey perceived vulnerability". What types of medical statistics convey risk? 75% of Canadians will get HPV in their lifetime! 50% of Canadian adults are inactive! 28% of Canadian children are obese!
RE-AIM: Effectiveness vs. Efficacy
What is efficacy? How well does it work in an experimental setting? What is effectiveness? How well does it work in the real world?
SELF-EFFICACY
one's belief in one's ability to succeed in specific situations or accomplish a task I am confident that I can apply sunscreen effectively
protection motivation theory: caution 3:
optimistic bias
ms article: Longitudinal Results: Perceived Risk
percieved risk increased
2- social and physical environments
physical-A school that supports HEAL is often recognized as such when... one walks through the door and finds displays of HEAL-related messages, various activity spaces that will allow students to be active, welcoming spaces in which to eat snacks and lunches, and access to nutritious foods for all students social - . A school community that engages its students in the development of programs and provides equitable opportunities for all students will increase the sense of engagement in the learning environment and thus increase health example of social- Peer-led intramurals, student cooking classes
ATTITUDES SOCIAL SUPPORT
positives -Bond with child -Watch child improve/experience fun -Be physically active myself -Be a role model for my child negatives -Worry about my child -Unenjoyable due to demands/fatigue -Take time away from other commitments
ATTITUDES CHILD PA:
positives -health: physical and mental -Social -Fun -Normalcy -Motor skills development negatives -Centred out -Injury pain
What happens in response to fear appeals?
"fear": -an unpleasant emotion caused by the belief that someone or something is dangerous, likely to cause pain, or a threat you do something about it or pretend it doesn't exist.. -Adaptive Danger Control Action or Maladaptive Fear Control Action
Physical Activity Guidelines
#1 BENEFIT: ESTABLISH LIFELONG PHYSICAL ACTIVITY!!! benefits: - confidence, -fitness -motor skills -body weight -etc...
message tailoring article: Campaign resources are economical when segments are identified systematically
- First, to create a meaningful population subgroup, you should communicate with community reps or even directly interact with people to determine things about them - Second, organization should develop materials for each segment, rather than using one generic message, they should develop multiple materials to target groups with similar beliefs/ attitudes
PERCEPTIONS OF CONTROL OVER SOCIAL SUPPORTS
-Lack of accessible/accommodating programs -Lack of staff support for child -Limited choice of activities -Lack of equipment -Weather -Time -Cost -Travel far distance to activities -Tired/fatigue etc
What Health Behaviours Matter for Children and Youth?
-PHYSICAL ACTIVITY!!! -Sedentary behavior -Nutrition -Hygiene -Smoking -Drugs/alcohol -Safety (seatbelts/helmets) -Sleep!
Adaptive Danger Control Action
-Pay attention -Process message -Accept message -Take action -Seek help -Quit smoking
Schools can play an important role in increasing physical activity by:
-Providing instruction/skill development -Creating awareness/knowledge -Creating a supportive social network -Establishing a supportive physical environment -Enhancing motivation -Establishing and enforcing supportive policies
1- teaching and learning
-Schools are the vehicle in society for providing education and preparing students to become productive citizen - it is important that professional development be provided for those teachers who do not feel qualified or comfortable teaching health-related subject matter, such as nutrition and physical education, in order for them to contribute to good health education
GL- Limitations & Future Directions
-Small sample size -No control group -SE Scale not validated -Children's Physical Activity Self-Efficacy scales are not uniform across all studies -Short intervention period -No follow up to see if intervention had lasting impact
A Model for Healthy School Communities 4 pillars
-Teaching and Learning -social and physical environment -healthy school policies -partnerships and services
article: risky business by Rebecca gunter
-The effects of an individualized health-information intervention on health risk perceptions and leisure time physical activity among people with spinal cord injury. -measured bmi, wight glucose, triglycerides etc ...
proceed- procede 9 steps 1 2 3 4 5 6 to 9
1-conduct a social assessment in which community members and involved participants identify their own health promotion needs 2- an epidemiological assessment is conducted using vital statistics and state or national surveys to identify the health problems that have the largest impact on the given community 3- a behavioral and environment assessment is conducted to evaluate factors that contribute to the identified problem. These can be the lifestyles of individuals, environmental factors, or social influences. Each of the factors is ranked according to importance in terms of contributing to the selected health problem and is evaluated based on whether it can or cannot be changed. Those factors that are most important and most changeable are considered the priority targets 4-the antecedent, predisposing, reinforcing, and enabling factors are considered. -Predisposing factors ---are antecedents that provide rationale or motivation for the health behavior. -Reinforcing factors ---provide continuing reward and are things such as social support, peer influence, and vicarious reinforcement -enabling factors ---include services and resources and policies necessary for health. Measurable objectives are also developed in step four. 5-intervention strategies are devised and policies, resources, and circumstances within the organizational contexts that influence the intervention are considered. Barriers at this level, such as staff commitment and lack of space, need to be considered 6-9 In steps six to nine, process impact evaluations are established to assess the changes in predisposing, reinforcing, enabling, behavioral, and environmental factors that determine the likelihood that change will happen. Outcome evaluations are also identified. Participatory approaches to planning that encourage individual and community-level involvement are key aspects of the model
Weinstein: FOUR cognitive factors that contribute to unrealistic optimism:
1. Lack of personal experience with the problem 2. The belief that the problem is preventable by individual action 3. The belief that if the problem has not yet appeared, it will not appear in the future 4. The belief that the problem is infrequent.
rationale: for social ecological approach in schools
1. Schools can reach almost all children and adolescents. Rules out the inequities that some children face due to a lack of time, financial resources or parent support 2. Children spend most of their time at school: Nine months a year for a majority of their waking hours 3. Controlled environment where children can learn and practice 4. The school is an important social and physical environment for children 5. Skilled personnel are available; Teachers can provide opinion leadership, role modeling, reinforcement, and feedback 6. The physical facilities are built. 7. Schools also have built in effective lines of communication with parents.
GL The Intervention
1. consent 2. baseline measures 3. smart goals. 4. 6 week intervention 5. post test: questionaires 6. fintess testing was conducted
protection motivation theory: cautions:
1. efficacy and levels of fear 2. risk perceptions and factual information 3. unrealistic optimism
Key Findings of sedentary guidelines
15% of 3- to 4-year-olds in Canada meet the Canadian Sedentary Behaviour Guidelines for the Early Years During waking hours, 3- to 4-year-olds in Canada spend an average of 7.5 hours per day being sedentary 24% of 5- to 17-year-olds in Canada meet the Canadian Sedentary Behaviour Guidelines for Children and Youth During waking hours, 5- to 17-year-olds in Canada spend an average of 8.5 hours per day being sedentary (2012-13 CHMS, Statistics Canada).
Average daily time of screen related activities
7 hours boys 6 hours girls
Key Findings
70% of 3- to 4-year-olds in Canada meet the daily recommendation of at least 180 minutes of physical activity at any intensity. 9% of 5- to 17-year-olds in Canada meet the daily recommendation of at least 60 minutes of MVPA. 14% of 5- to 11-year-olds 5% of 12- to 17-year-olds This percentage has remained stable since the 2007-2009 when 7% of 5- to 17-year-olds met the daily recommendation. 2012-13 CHMS, Statistics Canada
What do parents know anyway?
=Parents may not recognize the detrimental health consequences of their children being overweight -When they do, may feel confused by the plethora of messages about strategies for addressing the problem -And we may be too darn tired to care (at the time)!!!
Which behaviour change intervention is better?
A. Carefully controlled intervention, similar participants, standardized protocol. B. Wide range of participants, various protocols, less controlled. results of A and B A. 20% of people increased their PA. B. 80% of people increased their PA. A is 20% vs 80 % in B more unrelated separate results A. 80% of participants add 15 minutes of physical activity each day. B. 20% of participants add 30 minutes of physical activity each day. HENCE: BOTH ARE good, none is better DEPENDS ON GOAL for example if your looking to add 30 min of exercise that B is better in tha second example THEREFORE *********************************GO FOR THE ONE WITH A "BETTER BANG FOR YOUR BUCK" ****************
Which RE-AIM element is the most important? Reach Efficacy Adoption Implementation Maintenance
ALL of them are important in their own way none are most important
What about parents of children with disabilities? Bassett-Gunter et al., In preparation
ATTITUDES CHILD PA -ATTITUDES PARENT SOCIAL SUPPORT -PERCEIVED CONTROL OVER SUPPORT
Comprehensive school health in canada
Abstract The Canadian education system is among the best in the world academically. In contrast, students' (children and youth) eating and activity levels are so poor that they have led to prevalence rates of overweight that are among the highest in the world. Given the enormous public health burden associated with poor nutrition and physical inactivity, Canada needs to address this health risk. Comprehensive school health (CSH) is a promising approach to promoting healthy eating and active living (HEAL). This article provides a review of CSH and discusses its four essential elements: 1) teaching and learning; 2) social and physical environments; 3) healthy school policy; and 4) partnerships and services. It also provides a common understanding of the implementation and broader benefits of CSH, which, in addition to health, include student learning and self-esteem. The article further discusses some complexities of a rigorous evaluation of CSH, which comprises proof of implementation, impact and positive outcome. Though such an evaluation has yet to be conducted, some studies did confirm successful implementation, and another study observed positive outcomes. Rigorous evaluation is urgently needed to provide a stronger evidence base of the benefits of CSH for learning, self-esteem and disease prevention. This evidence is essential to justify devoting more school time to promote HEAL and more resources to implement and support CSH to the benefit of both learning and health. Key words: Schools; Canada; public health; education; health promotion; health policy
From "best practice" to "next practice": the effectiveness of school-based health promotion in improving healthy eating and physical activity and preventing childhood obesity.
Abstract BACKGROUND: In 2005, we reported on the success of Comprehensive School Health (CSH) in improving diets, activity levels, and body weights. The successful program was recognized as a "best practice" and has inspired the development of the Alberta Project Promoting active Living and healthy Eating (APPLE) Schools. The project includes 10 schools, most of which are located in socioeconomically disadvantaged areas. The present study examines the effectiveness of a CSH program adopted from a "best practice" example in another setting by evaluating temporal changes in diets, activity levels and body weight. METHODS: In 2008 and 2010, we surveyed grade 5 students from approximately 150 randomly selected schools from the Canadian province of Alberta and students from 10 APPLE Schools. Students completed the Harvard Youth/Adolescent Food Frequency Questionnaire, questions on physical activity, and had their height and weight measured. Multilevel regression methods were used to analyze changes in diets, activity levels, and body weight between 2008 and 2010. RESULTS: In 2010 relative to 2008, students attending APPLE Schools were eating more fruits and vegetables, consuming fewer calories, were more physically active and were less likely obese. These changes contrasted changes observed among students elsewhere in the province. CONCLUSIONS: These findings provide evidence on the effectiveness of CSH in improving health behaviors. They show that an example of "best practice" may lead to success in another setting. Herewith the study provides the evidence that investments for broader program implementation based on "best practice" are justified. Poor diets and inadequate physical activity acknowledged as main drivers for obesity epidemic
Risky business Rebecca Gunter
Abstract Background Individuals with spinal cord injury (SCI) are at an increased risk for inactivity-related diseases such as heart disease, type 2 diabetes, and obesity. According to protection motivation theory, perceptions of disease risk predict motivation to engage in health-protective behaviors such as leisure time physical activity (LTPA). Objective The purposes of this study were to (1) examine changes in perceived risk for disease following an individualized health information intervention and (2) examine changes in perceived risk for disease as a predictor of changes in LTPA. Methods Perceived risk for disease and LTPA were measured at baseline among 62 people with SCI. Objective disease risk information (e.g., waist circumference, BMI, blood glucose) was collected and individual risk information was mailed to each participant. Perceived risk for disease and LTPA were remeasured 1 and 2 weeks following receipt of individualized information, respectively. Results Changes in perceived risk of heart disease and obesity were dependent on objective risk status. There were no significant changes in perceived risk of diabetes. Changes in perceived risk of heart disease negatively predicted, while changes in perceived risk of diabetes positively predicted, changes in LTPA. Changes in obesity did not significantly predict changes in LTPA. Conclusions Among people with SCI, individual health-risk information can change perceptions of disease risk. Increased perceived risk of diabetes may motivate LTPA, while increased perceived risk of heart disease may encourage avoidance behavior regarding LTPA. Keywords • Physical activity; • Health risk perceptions; • Protection motivation theory; • Health information; • Spinal cord injury
guest lecture GL
Action Planning and Goal Setting in Youth Physical Education: An Approach to Increase Self-Efficacy by Hutchinson, J.W., Bassett-Gunter, R.L. Undergraduate Thesis
What Types of Activity Should we Promote to Children and Youth?
Active play most important
Message Targeting,Most widely applied messaging strategy. Why?
Adapted from advertising Divide consumers into market segments
Raingruber evaluation theories: Leninger s Transcultural Care Theory (1968)
After completing a doctoral degree in anthropology, Madeleine Leninger spent more than a year with the Gadsup people of New Guinea, during which time she began to work on her theory of cultural care. Leninger s theory focuses on the ways in which cultures and subcultures differ in terms of caring behaviors, nursing care, health beliefs, and behavioral patterns and how caregiver and care recipient roles differ according to culture. Leninger emphasized that a nurse must discern the cultural values and beliefs of a client or family before intervening. She stated that social, religious, political, and economic factors influence how care should be provided (Alexander et al., 1986). The major concepts of Leninger s theory are care, caring, culture, cultural values, cultural variations, and nursing
GL Self Efficacy Theory (SET):
An individuals belief in his/her ability to succeed in a particular situation or task determines his/her decision to engage in that behaviour
Key Points of risk perceptions
How you state risk information matters!! Make sure the information you provide can be understood! Be creative! Use new technologies! Present information in creative ways! Talk to people, find out their stories!
PERCEIVED VULNERABILITY
I am at low risk for skin cancer
Impact
Impact = Reach x Efficacy reach= how many people you can reach impact= how well your message works best message is highest combo of increased reach & increased efficacy so combo of tailor and target becase tailor = increased efficacy,decreased reach target= decreased efficacy. increase reach
Negative Effects? Can Framed Messages Mitigate the Effect?
In addition to risk information, women read either a gain or loss framed message about the HPV vaccine.
Evidence that Tailoring works
Noar et al., 2007 Meta-analysis Overall r = .07 Specific behaviors Screening, Prevention, Vaccination Mode of delivery: pamphlets & leaflets Dose: More is better Theoretical constructs Follow-up period
Raingruber evaluation theories: Nursing Models and Theories
Nursing Models and Theories There are a vast number of nursing theories. While only those that are most relevant to health promotion are summarized next, it is likely that other nursing theories have some applicability to health promotion as well. Nursing models and theories that focus on health promotion have been critiqued for focusing on person-level issues rather than group or community level concerns (Whitehead, 2001a). However, a number of nursing theories, including Nightingale s, have included a community-oriented perspective.
Health Numeracy
One component of health literacy The ability to think about/interpret probabilities, fractions & rations (e.g., percentages)! Basic math skills for health-related activities -Scheduling -Dosing -Timing -Understanding information and acting upon doctor recommendations Consider the Implications
GL Physical Activity and Children
Only 9% of children are meeting the recommended PA guidelines
The Know Your Numbers (KYN) program 2008 to 2010: impact on knowledge and health promotion behavior among participants
Our primary hypothesis was that people who participate in a KYN program would improve their knowledge of risk factors and health conditions associated with hypertension within three-months of attending a KYN program. Conclusion from inside text : KYN program is a successful model for increasing knowledge about risk factors for high BP and the health conditions associated with hypertension, while also prompting participants to take action to modify their cardiovascular risk Abstract BACKGROUND: Since 2007, the National Stroke Foundation in Australia has undertaken a community-based 'Know Your Numbers' program on blood pressure and other stroke risk factors. AIMS: The aims of this study are to assess, in a sample of registrants participating in a three-month follow-up survey, retention of knowledge of risk factors and health conditions associated with hypertension, and whether those who were advised to see their doctor sought treatment or performed other health promotion actions. METHODS: Various organizations (mainly pharmacies) were recruited to offer a 'free' standardized blood pressure check and educational resources for one-week/year between 2008 and 2010. Data collection was done thru registration log and detailed questionnaires for a sample of registrants at baseline and three-months. Descriptive statistics were used for comparison of baseline and three-month data. RESULTS: There were 59 817 registrants over three-years. A total of 2044/2283 (90%) registrants completed a baseline survey (66% female, 50% aged >55 years); 43% had blood pressure ≥140/90 mmHg whereby 32% were unaware of their blood pressure status. Follow-up surveys were obtained from 510/805 (63%) baseline participants who provided consent. At three-months, improved knowledge was found for 9 of 11 risk factors for hypertension (e.g. lack of exercise baseline 73%; three-months 85%, P < 0•001). Knowledge for all the health conditions assessed that are associated with hypertension improved (e.g. stroke baseline 72%; three-months 87%, P < 0•001, heart attack baseline 69%; three-months 84%, P < 0•001). All respondents reported at least one health promotion action. Among 141/510 advised to visit their doctor, 114 (81%) did. CONCLUSION: Know Your Numbers is a successful health promotion program and encourages people to be reviewed by their doctor. KEYWORDS: cerebrovascular disease; health care; health promotion; hypertension; prevention; risk factors
Trost et al., 2003 on parental support in CANADA?
Overall, the level of parent support was low, with parents encouraging, providing transport, or performing physical activity with their child less than twice per week on average. Don't parents know PA is good for their kids?
GL Mechanisms Causing The Effects: Self- Efficacy
PA Self-Efficacy: scores may have improved due to the mastery experience provided by the program students draw upon past successes Goal Setting Self-Efficacy: may have improved due to the lesson and goal-setting experience this intervention provided
Raingruber evaluation theories: proceed precede
PRECEDE stands for Predisposing, Reinforcing, and Enabling Constructs in Educational/Environmental Diagnosis and Evaluation, while -The PRECEDE portion of the model focuses on identifying educational factors that influence change PROCEED stands for Policy, Regulatory, and Organizational Constructs in Educational and Environmental Development. -The PROCEED portion of the model was added in 1991 to acknowledge the importance that environmental, regulatory, policy, and organizational factors have in shaping health, and it focuses on identifying ecological factors that influence change.
Raingruber evaluation theories: Proceed - precede critiques
PRECEDE-PROCEED model is to describe proximal, intermediate, and distal outcomes associated with health promotion programs . It has been critiqued for being difficult to use; it is a highly structured, linear effect model, which at times has been implemented incorrectly because of its complexity
Parental Support
Parental support; Encourage Be active with kids Transportation Watch kids Tell kids PA good for them LEADS TO CHILD SELF-EFFICACY ->> increased child PA
GL methods
Participants: 3 classes (grade 5,6 and 7) 75 subjects Location: Barrie, Ontario Outcome Variables -PA Self-Efficacy ex. even when i feel sick -Goal Setting Self-Efficacy ex. even when the goals are hard to achieve -PA Intentions ex. in the next 6 weeks i will... -PA Enjoyment ex. i enjoy sports a lot -Fitness Performance Scores ex. beep test, shuttle run
MS ARTICLE: The effects of gain- versus loss-framed messages following health risk information on physical activity in individuals with multiple sclerosis
Participants: 262 participants (37 m; 214 f; 11 did not indicate; M age = 41.62; SD = 9.47) Eligibility criteria: MS Community-dwelling Physically able to do PA Not meeting PA guidelines for people with MS Information Materials: study presented either loss or gain framed messages to participants
4-partnerships and services
Partnerships can assist schools in -using community facilities and resources to provide more opportunities for HEAL-related activities for students. -It is the act of engagement of partners that allows the community to develop, become sustainable and increase its capacity to meet the needs of all its members The services aspect includes- health services that maybe vital to students with specific health needs or who require assistance. Allowing access to the school facilities after or before school hours increases not only community facility usage, it also engages health professionals in a meaningful way in the school community
Optimistic bias & risk for health problems
People with optimistic bias are thought to be at increased risk for health problems
Targeting Strategies
Peripheral Strategies Evidential Strategies Linguistic strategies Sociocultural Strategies Constituent-involving strategies
Research Gaps: in these studies and programs
Research is needed on factors at the student-, school-, and community-level that influence participation in physical activity at school. While we know something about the quantity of PE and physical activity participation at school and in childcare settings, we know little about the quality of those opportunities The ParticipACTION Report Card, 2015 What about Secondary Schools? Bassett-Gunter, R. L., Hobin, E., Yessis, J., Hanning, R. & Harrington, D. (2015-2018). Heart Healthy Schools? A Comprehensive Approach to Healthy Eating Among Secondary Schools. Heart and Stroke Foundation of Canada Grant in Aid. Submitted. What about children with disabilities? Martin Ginis, K. A., Latimer-Cheung, A. E., Connelly, C....Bassett-Gunter, R. L. et al. (2014-2021). Enhancing community participation in Canadians with physical disabilities: development, implementation and evaluation of a partnered strategy. Social Sciences and Humanities Research Council Partnership Grant.
"Breaking it down" on caution 2 of PMT
Risk perceptions can be used to promote behaviour change! Be careful: Always pair with high efficacy messages! Consider risk information about desired behaviours!
protection motivation theory: caution 2:
Risk perceptions of the desired behaviour can also affect health behaviour change! Make sure information is factual!
Role of Parents
Role models Gate-Keepers Intangible social support is divided into two categories: Motivational (e.g., encouragement, praise) Informational (e.g., discussing benefits). Smoking -Twelve-year-olds whose parents smoked were more than "two times" as likely to begin smoking cigarettes on a daily basis between the ages of 13 and 21 than were children whose parents didn't use tobacco -If a child's parents smoke they are "three times" more likely to smoke themselves. Physical activity Parent PA level is a predictor of youth PA levels Diet -Mixed evidence of parent-child diet association -Children and adolescents who share family meals 3 or more times per week are more likely to be in a normal weight range and have healthier dietary and eating patterns than those who share fewer than 3 family meals together. In addition, they are less likely to engage in disordered eating.
"School-Based" Ecological Model
SEM ANGELO COHEN OTTAWA CHARTER
rationale of schools continued
Schools have an influence on: -the lives of youth -their families -the community at large School-based health and physical education programs increase the likelihood that children and their families will commit to enjoyable, lifelong physical activity.
GL- Physical Activity and Self-Efficacy
Self-efficacy within children has been shown to be a strong predictor of physical activity "what people think, believe and feel affects how they behave"
PERCEIVED SEVERITY
Skin cancer is a serious disease to develop
Best Health Promotion Theory for Youth Health Promotion?
Social Ecological Approach to Youth Health Promotion
MEDICAL RESULTS: Cautions
Tests can have mixed results: Positive test Motivates behaviour change Maladaptive fear control Negative test Demotivation or amotivation Motivated to maintain health
GL Self-Efficacy in The Classroom
The 3 classroom teachers were provided with a lesson and instructional material on Self-Efficacy Theory. mastery- Successful experiences lead to greater feelings of self-efficacy. Vicarious experience: Observing someone else perform a task or handle a situation can help you to perform the same task by imitation Verbal persuasion: When other people encourage and convince you to perform a task, you tend to believe that you are more capable of performing the task. Constructive feedback is important in maintaining a sense of efficacy as it may help overcome self-doubt Physiological states: Moods, emotions, physical reactions, and stress levels may influence how you feel about your personal abilities. If you are extremely nervous, you may begin to doubt and develop a weak sense of self-efficacy
Health Literacy
The degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions
Raingruber evaluation theories: The RE-AIM Framework (1999)
The idea that a health promotion program should be efficacious (create a substantial amount of change) and reach a large number of people led to the development of the RE-AIM framework. RE-AIM stands for Reach, Efficacy or effectiveness, Adoption, Implementation, and Maintenance (Glasgow, Vogt, & Boles, 1999). Reach is a measure of how many people can be influenced by the health promotion program. Efficacious and effective programs produce positive outcomes along with few unintended consequences. Adoption focuses on the participation rate (number of people who engage in the health promotion behavior) and whether the setting is representative of a larger population. Implementation targets whether the health promotion program was employed as intended or whether, for example, multiple health educators presented content in different ways, making the outcome hard to evaluate. Maintenance focuses on the long-term utilization of the given health behavior. It also refers to whether a health promotion program is sustainable even if there is a change in available resources. The goal is not to have a health promotion program that is equally effective on all five dimensions; rather, these dimensions help to evaluate a program before it is adopted so that the characteristics that are most important in the given setting can be selected
GL Discussion
The positive results in this short intervention help to affirm the utility of SET and provides grounds for its potential usefulness within the education setting. This study aides to the dialogue surrounding the proper and effective use of fitness testing in PE.
toll of increased sedentary
The toll of this is enormous. Children growing up in the U.S., and soon Canada, are the first cohort in modern memory looking at a shorter life expectancy than their parents because of epidemic obesity and diabetes. Dr. David Katz, Yale University Medical School
GL Physical Education Class
There is evidence to suggest that PA interventions have benefited from incorporating SET into physical education (PE) programming. There is no current study to incorporate SET into the fitness testing model
Medical Results
What types of medical results could be used to target risk perceptions? Blood Tests E.g., cholesterol, blood sugar Genetic Tests E.g., breast cancer genetic mutations ???
What did they find?? in Gainforth & Latimer (2011) study or risk and framed messages
Women who received high-risk messages compared to the women who received low-risk information: -greater response cost -less motivated to be vaccinated hence perceived high risk > greater response & less motivated to be vaccinated because think vaccine is risky Deleterious effects of the media! Frame & Risk Information Interaction -Self-efficacy only Still need to look into techniques for mitigating the deleterious effects! gain and loss didn't affect results
Does the Healthy School Community Approach Work? benefits
YES -Fosters healthy lifestyle habits -Improved eating habits as students develop health habits through what they learn and through the health choices they can make in their school environment -Increased Fruit and Vegetables -Reduced Calorie Intake -More Active -Less likely to be overweight -Improved Academic Performance 30% less likely to fail provincial tests -Improved Mental Health Improved self-esteem Reduced Bullying
Increased Sedentary Behaviour A Key Contributor?
Yes screen time to 0-4: -Detrimental to cognitive and psychosocial development -Body composition over 2 hours per day of screen time in 5-17 detrimental to: Body composition Academic achievement Self-esteem Social behaviour
RE-AIM
a framework that is EASY TO UNDERSTAND and evaluate intervention Few health promotion interventions that have proven successful in well-controlled research are applied in settings. such as Tobacco, Dietary Change, Physical Activity, Alcohol Use, Depression interventions We need more demonstrations of how to effectively implement recommendations in typical setting and in locations serving "minority, low-income and rural populations facing health disparities" Glasgow et al., (2003)
RESPONSE EFFICACY
a person's beliefs as to whether the recommended action step will actually avoid the threat If I wear sunscreen, I will reduce my risk of skin cancer
GL- Results: Psychological
all improved
GL Results: Fitness Performance Scores
all improved also
goodness-of-fit
how well you can target a message to meet the need of the recipient -The challenge is to determine which variables will result in good-fitting messages and whether a targeted message results in outcomes to individual tailor messages - It may be possible to use targeted messages that are culturally relevant to produce the same behavioural outcomes as tailored messages
active play grade
incomplete
Day 2-5 Results: Physical Activity Intentions
increased Physical Activity Intentions
message tailoring article: Elaboration Likelihood Model
individual are most persuaded by personally relevant messages because they pay more attention and process the information better Personalization is the most basic approach to tailoring, which involves identifying and incorporating into messages, the characteristics of someone (name, age) Other approaches assess and integrate into messages, more detailed information for the individual - one way is by matching messages to ways people process health info
RE-AIM: Two Techniques
interactive technologies ( more effective and in-person counseling
APPLE SCHOOLS DATA
obesity rates went down as oppose to national and provincial rates going up and physical activity went up to match national average as oppose to no change in Alberta average
message tailoring article: - Social Intelligence Theory
variations in info processing styles differentiate individuals more than personality traits o Tailoring messages to information processing styles tend to be based on more static psychological characteristics o Messages tailored to a constant characteristics doesn't no need modification as those that might change over time
Results of article: risky business by Rebecca gunter
what i learned: Individualized Health Risk Information can change behaviour BUT: "Must include messages regarding physical activity and risk reduction!!!!" Individualized Health Risk Information + messages regarding physical activity and risk reduction ->>> change behaviour
Can we use medical results to change people's risk perceptions and behaviour?
yes if they have numeracy and literacy as well as personal medical results most effective
Can we apply a Settings/Social Ecological Approach with a Health Equity Lens?
yes in SCHrationaOOL as a setting for youth health promotion
