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