Chapter 5-7
The decision to adopt is said to be influenced by
3 types of knowledge
The 3 types of knowledge
Awareness knowledge (innovation exists) Procedural knowledge (how to use) Principles knowledge (understanding how the innovation works)
SCT: Triadic Reciprocity
Behavior Environmental Factors Personal Factors If one thing changes, it's going to affect the others
Organizational and Systems Change
Health promotion, disease prevention, and health care are all accomplished primarily through organizations (agencies, hospitals, programs) and systems (healthcare systems, policy coordination system)
SNT Steps
Centrality versus marginality of individuals in the network 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
CDC/WHO Relationship
Close relationships that may increase the risk of experiencing violence as a victim or perpetrator (peers, partners, family) 1. What relationships may increase the risk of violence as a victim or perpetrator a. If you're at the bar and your friends leave you b. Boyfriend/girlfriend who beats you
community mobilization
Collective action by groups and community members to increase awareness about the problem, advocate for policy change, and engage in many other kinds of activities designed to do something about the environmental conditions
why do we mobilize?
Complex issues, need the community to solve and get other perspectives Community will know if it will work where they live
Stages of Change
Create awareness and interest Change attitudes and conditions Motivate people to want to change their behavior Empower people to act Prevent backsliding
steps in organizational change
Create shared vision Communication Empower Institutionalize and reward Evaluate
CDC/ WHO Societal
broad societal factors that help create a climate in which violence is encouraged or inhibited (social and cultural norms, and the health, economic, educational, and social policies that help to maintain economic or social inequities between groups in society)
Communication patterns in the network (network linkages)
How does information circulate through the network? Is it viewed equally coming from anyone in the network, or do some members have more credibility?
Healthy People 2020
Increase social marketing in health promotion and disease prevention Increase proportion of quality, health related websites Increase individuals access to the internet Increase proportion of persons who use electronic devices
Who are the targets of change
Individual Group Organization Environment
Implementation
Refers to initial use of the practice or technology Program focus is often on improving the self-efficacy and skills of those who have adopted the behavior or technology A linkage agent can help facilitate the process
Critique 2 of SCT
SCT has gone through a number of evolutions. As it evolved, the emphasis moved from a behaviorist variant to its current focus on self-efficacy, yet all components ever included in the theory are still "hanging around" It retained earlier constructs
Critique of SCT
SCT is very complex, and because it includes so many constructs that are said to be related to behavior, it can be viewed as less of a theory than a generally related "grab bag"
Critique 1 of SNT
SNT is a limited theory and approach. It is primarily useful for small or defined group interventions
SCT Individual Characteristics
Self Efficacy Behavioral Capability Expectations Expectancies Self Control Emotional Coping
Examples of Community Mobilization Efforts:
The labor movement Civil rights HIV/AIDS activism Anti-abortion movement
Shannon Weaver Model Critique
This is very technical description that does not take into account: Context or setting of the communication Relationships between sender and receiver The meaning attached to the channel The process of encoding and decoding itself, which is a meaning-making act
Innovation Development
This refers to the development of the innovation itself—planning, formative research, and testing
Defining the Problem
Who Where When Why What
Critique 1 CSHP
With so many interacting levels and processes, how can you tell where the causal chain leading to (health) behavior lies?
DOI Critique 3
Works better for adoption of behaviors versus cessation or prevention of behaviors
vicarious learning
a person learns by observing the behavior of others and the consequences of that behavior
emotional coping
a person's ability to deal with emotions involved in a behavior change
Individual ("internal") characteristics
a person's sense of self-efficacy about the new behavior, their confidence that they can do it and overcome obstacles (barriers) to doing it a. Behavioral capability their level of knowledge and skill as they relate to the new behavior b. The person's expectations and expectancies bout what will happen if they make the change and if tat expected outcome is good or likely to be rewarded c. Their level of self-control in terms of making change d. Their emotional coping ability, to deal with the emotions involved in the behavior change
Self Efficacy
a persons confidence that he or she can preform a behavior
who invented the SCT?
albert bandura
The Exosystem
the social system level surrounds the first two systems. An individual child does not interact with this system, but the child's development is affected by this system (includes the workplace, social services, and health services that have an effect on the child's well-being—political system, government) Ex. Would be decisions the school board makes; parent's workplace that may not let the parent off work when the child is sick
situation
the social/physical environment in which the behavior takes place, and a person's perception of those factors
Bronfernbrenner
used to explain childhood behavior AKA ecological systems theory/ bioecological systems theory
streams of influence are the
various potential contributing factors to behavior are said to operate across the causal levels
expectations
what a person thinks will happen if he or she makes a behavior change
healthy school environment
what's in vending machines, are there school stores, for parties is there regulation about what can be served
expectancies
whether a person thinks the expected outcome is good or likely to be rewarded
social marketing helps customize
your message to those targeted audiences
social marketing helps you reach
your target audience
social marketing helps create
greater and longer-lasting behavior change
self control
how much control a person has over making a change
Defining the community
how will you do this? Is it a geographic community? Subpopulation?
The microsystem
includes the relationships and structures with which a child has the most direct, immediate contact (family, school, neighborhood, daycare, primary school) Has daily impact on the child
The CDC/WHO model organizes contributing factors in the following domains
individual relationship community societal
Flay's Theory of Triadic Influence influences (TTI)
individual behavior
Targeting
process of developing campaigns closely tailored to the needs, attitudes, beliefs, and behaviors of specific market segments
what is the key principle of social learning theory?
learning by observation, or vicarious learning
Marketing segmentation
refers to the segmentation of a target population into meaningful subgroups so that messages and campaigns can be appropriately channeled
The mesosystem
relationships and structures that provide the connections between components of a child's microsystem (connections between a child's teacher and parents; among an organization like the YMCA, parents, and the neighborhood; among faith organizations, families, and neighborhoods) Neighborhood or community that surround the child "connective tissue"
sociogram
map of social relations surrounding individual A sociogram is a charting of the inter-relationships within a group. Its purpose is to discover group structure: i.e., the basic "network" of friendship patterns and sub-group organization. The relations of any one child to the group as a whole are another type of information which can be derived from a sociogram
Communications Channel is the
medium through which you transmit information
Cultural-environmental influences
multiple sociocultural and macroeconomic factors that contribute to attitudes about specific behaviors
Why do some resist change?
nobody likes change
reinforcement
positive or negative responses to a person's behavior
SLT grew to include other constructs related to an individual's interaction with an environment. This concept was
self efficacy
The key to SNT
specific or unique characteristics of individuals are not so important to the theory because the focus is on relationships between and among individuals, and
Product attributes
that are said to be important determinants of the speed and extent of diffusion
reciprocal determinism
the interactive process where a person makes a change based on individual characteristics and social/environmental cues, receives a response, makes adjustment to his or her behavior and so on
Human communication is almost unique among all organisms in that is
symbolic
Emphasis on Dissemination
1. Active knowledge transfer from the resource system to the user system 2. Involves the identification of communication channels and dissemination channels 3. Process by which the innovation is communicated
Diffusion of Innovations (DOI)
1. Approaches in health promotion have roots in rural sociology 2. Addresses the gap between introduction of a new technology or behavior and the actual adoption of the behavior by a large community or group
Commercial Marketing vs Social Marketing
1. Commercial marketing change behavior for benefit of the marketer 2. Social marketing change behavior for the benefit of the individual, or society
Eight Components of CSHP
1. Comprehensive school health education 2. Physical education 3. School health services 4. School nutrition services 5. School counseling, psychological, and social services 6. Healthy school environment 7. School-site health promotion for staff 8. Family and community involvement in school health
Public health Approach Steps
1. Define the Problem 2. Identify the risk and protective factors 3. Develop and test prevention strategy 4. Assure Widespread Adoption
UNICEF Adolescent Well Being Framework
1. Health status, knowledge, and skills 2. Subjective well-being (a person's perception of how they are doing and their future prospects 3. Supportive environment for identity and equity (related to gender identity, ethnic identity, etc.) 4. Protective environment (legal protections, enforcement to prevent abuse and exploitation) 5. Educational opportunity and performance 6. Access to supportive services and relationships (includes services and social support relationships) 7. Socioeconomic opportunity (actual opportunities and the perception of opportunities) 8. Participation (in community, society)
Steps of Implementing Social marketing campaign
1. Identifying behaviors you want to change 2. Identify your audience 3. Identify and reduce barriers 4. Pretest your ideas 5. Publicize actions and benefits 6. Assess your results
The Four P's
1. Product: What is the behavior or technology you are offering? 2. Price: For the target population, what are the costs involved in adopting a behavior or using a technology? What is the cost of adoption? 3. Place: How do you distribute or make the behavior or technology easily available to the target population? Where is the product available? 4. Promotion: How do you promote or make the target population aware of the previous 3 elements?
Adoption
1. See a lot of parallels between the TTP and PAPM. 2. Adoption refers to the "uptake" of the behavior or technology by the intended audience
Developing and testing prevention strategies
1. using data from counties, survey and focus groups 2. what does it mean to use an evidence based activities approach 3. how do you test your strategies? 4. Dissemination
Communication Theory
1. what is communication 2. processes involved in communication 3. key components of communication
Maintenance
1After individuals begin to engage in a new behavior or use a technology the first time, the next step is to keep that pattern going. The focus is on sustainability( keeping adoption of the behavior) a. Could refer to the institutionalization of a behavior or technology b. How do you influence others to do it as well. c. Institutionalization is another aspect of maintenance
Behavioral Capability
A person's level of knowledge and skill in relation to a behavior
Shannon Weaver Model
A sender encodes a message. The message is the content, the information. Encoding means to package the message in text or symbols of some kind. The sender transmits the message through a channel or medium, such as a telephone, email or speech During the transmission, the message may encounter noise, which essentially means interference The message then goes to a receiver, who interprets or decodes the information so it can be used. The receiver may transmit feedback, or a reaction to the sender
School Health Services
Access to nurses, people to help support students
Social Marketing
Applies principles of marketing to social and health communications This is a specific kind of approach to health communications and behavior change in groups or populations that incorporates principles of marketing to achieve health aims
Homogeneity or diversity of people in the network (geographic density/dispersion)
Are all members family? Where are they all located?
Reciprocity of Relationships
Are relations one-way or two-way?
Subgroups, cliques, and linkages
Are there concentrations of interaction among some members of the group? What is the nature of these?
Organizational Change
Assessing and improving group dynamics Encouraging shared goals and missions ID organizational impediments to change and unfreeze the system to make changes Involve the system in identifying and implementing change
Critiques of Health Communication
Assessing impact Blurred lines Access to health technology Rapid growth of technology
Social Marketing Critique 3
Assessing the effect of a social marketing campaign may be difficult because, if a behavior change is the goal, tracking exposure to the campaign for those exposed and assessing the degree to which behaviors, or at least attitudes, have changed is not always easy.
School counseling, psychological, and social services
Do schools have programs for bullying and access to counselors
Social Marketing Critique 1
Doesn't take into account a person's resources or social support to adopt the new behavior
Flay's Theory of Triadic Influence Level 2 of causation
Causally distal or predisposing (family relationships, social capital, community laws or policies)
Flay's Theory of Triadic Influence Level 1 of causation
Causally proximal or immediate (intentions or skills)
Key Issues in the mobilizing communities
Defining the community Assessing, and working with the community's capacity for mobilizing Understanding the community agenda and selecting the right issue
DOI Critique 2
Did not originate in Public Health
who should be involved in mobilization
Everyone: local orgs, families, stakeholders
Family and community involvement in school health
Getting the families and community involved in the health of the students, staff, making sure they have the right services
Understanding the community agenda and selecting the right issue
Health problem may or may not be at the top of the list of priorities for a given community
DOI Steps
Innovation Development Emphasis on Dissemination Adoption Implementation Maintenance
DOI Adopter Categories
Innovators willing to take a risk, like new ideas, eager to try new behavior Early adopters still need to see in instructor manual to know what's going to happen, but they will get there Early majority followers, but willing to be one of the first ones after seeing other people seeing some results Late majority they want to see everyone else who's done it, then they adopt it Laggards the last ones to adopt the innovation
The macrosystem
Integrated with, the nature of the other system levels (includes cultural values, customs,—these affect the level below Beliefs, family values, etc. Could have multiple effects on the other levels (ex. Culturally-based gender and parent roles)
Complexity or intensity of relationships in the network
Is it a network mostly composed of one-way relations?? Or is it primarily multiplex relationships? Do all people in the network have relations with several alters, making a very complex or dense patter of interactions?
communications process critique
It Is sometimes complicated and difficult to assess the effect of a communications effort because there are many levels of social impact
Adoption Movement Stages
Knowledge of innovation Persuasion or attitude development Decision (to adopt) Implementation Confirmation
Critique 2 CSHP
Like the chaos theory, a small change in one component within one level is likely to cause" reverberations" through multiple levels, and these reverberations in turn may produce outcomes that change the nature of the environment (at all levels) with which the individual was interacting in the first place
Physical education
Make sure that PE and recess aren't taken away
Planning for mobilization
Phase I: Planning for community mobilization, Needs assessment Phase II: Raising awareness Phase III: Building a coalition, One single vision Phase IV: Taking action Phase V: Monitor and evaluate
Comprehensive school health education
Picking school textbooks that relate to health
Health communication is used to improve
Population health outcomes Health care quality Health equity emerging issues
DOI Critique 1
Similar to SCT, DOI describes multiple constructs and processes embedded within processes
Assessing, and working with the community's capacity for mobilizing
Some communities have experience and even existing organizations, like task forces, through which action can be organized
Social Marketing Critique 2
Some social marketing campaigns (and DOI efforts) introduce a product as the behavior change (ex. Condom use)
There are parallels between DOI and
TTP and PAPM
school site health promotion for staff
Teachers who are designated to help improve health environment in schools
Social Marketing is summarized as
The Four P's
Centrality versus marginality of individuals in the network
The degree to which a given individual has interactions with man people in the network or plays an important role in network activities
Alteration Activities
Transfer of work tasks New techniques New technologies Change in behavior between provider and consumer
Flay's Theory of Triadic Influence Level 3 of causation
Underlying or ultimate causes of behavior (structural poverty, gender roles, cultural goals and values)
Critique 2 of SNT
Using SNT is labor intensive and can be difficult. Identifying networks and conducting interviews is time-consuming, and if you are looking for full relational data, confidentiality concerns can be barrier
SCT Environmental Factors
Vicarious Learning Situation Reinforcement Reciprocal Determinism
School Nutrition Services
What they provide in cafeteria (processed vs healthy)
Additional Attributes
a. Effect on social relations b. Reversibility c. Communicability d. Time e. Risk and uncertainty level can the innovation be adopted with minimal risk and uncertainty f. Commitment can the intervention be used effectively with only modest commitment? g. Modifiability can the innovation be modified and updated over time?
Uses of DOI
a. Use of Oral Rehydration Therapy (child health—prevents dehydration from diarrheal disease) b. Condom use for HIV/AIDS prevention
5 most cited product attributes
a. relative advantage: is innovation better than what it will replace? b. compatibility: does innovation fit with the intended audience? c. complexibility: is the innovation easy to use? d. trialability: Can the innovation be tried before making the decision to adopt? e. Observability: are the results of the innovation observable and easily measurable? Can it produce tangible results
why was self efficacy added
added as key element in how people change their behavior
setting the agenda aims to
affect the agenda of what people are concerned about to set the stage for or prompt action
Coordinated School Health Program (CSHP)
approach to school health that addresses eight components of a school-based ecology of health
Social Network Theory
broad area of theory whose implications range from sociological and health-related applications to communications, political opinion, esoteric mathematical and systems theory applications, and others
Reciprocal determinism is
behavior is part of a continuous interactive cycle that includes individuals and their social and physical environments
Both social marketing and general health communication efforts incorporate
behavioral theories
CDC/WHO Individual
biological and other personal actors that increase the likelihood of becoming a victim or perpetrator of violence (age, education, income, substance use or history of abuse) What personal factors increase likelihood of becoming a victim or perpetrator of violence
The idea that innovations are adopted in a staged process by
different category of adopters
Technology has affected how
fast people communicate, affects communications process
What is the goal of social marketing
influence "consumers" to "buy" a behavior change or health-related technology
Example of communications channel
internet, social media, mobile phones, tests, twitter, TV, newspaper, magazines Channels can also be more specific like Hispanic newspaper and college radio Channel selection is important because it is relevant to the meaning of the message and because the channel is better for reaching particular group
stream of influence: Intrapersonal influences
intrapersonal characteristics contributing to self-efficacy regarding specific behaviors that person's own behavior
what is the focus of SCT?
specific focus on the interaction between individuals and their immediate environment, which differentiates it from individual-oriented theories
CDC/WHO community
settings (schools, workplaces, neighborhoods) where social relationships occur, together with characteristics of these settings that create risks for becoming a victim or perpetrator of violence
Interpersonal/ social influences
social situation/context or microenvironment that contributes to social normative beliefs about specific behaviors Peer influence
Who adopted the CSHP model
the CDC, Division of Adolescent and School Health (DASH), and WHO
The Chronosystem
the factor of time added to the other system levels—the multiple systems, operating over time (ex. Lack of school resources for young children may change the relationship between those children and the other system components when the children are older) You think about the other levels happening over time (over the span of a lifetime, over the span of years) Used to reflect the evolving pattern of interaction as individuals develop and engage in different ways over time with the surrounding ecological layers
Environmental ("external") characteristics
the social/physical environment surrounding individuals (including modeling behavior of others) a. The behavior of others ("modeling") and the consequences of that behavior, which results in vicarious learning b. The situation in which the behavior takes place, and perceptions of that situation by individuals Reinforcements (negative and positive) that
DOI has similarities to
the stages of change models DOI theory posits a process of dissemination, which can't help but include a chronological element
proximal process
those that occur between an individual and his or her immediate environment
distal process
those that occur within that environment, eventually affecting the immediate or proximal interactions
Communication is a process of
transmitting, receiving, and processing information important for behavior