CPH - Social and Behavioral Sciences

Population-based

" Community health methods that are used to help change behavior in groups of people." Population-based approaches use a defined community or population as their organizing principle for preventive action over individuals, and they focus on addressing population-level processes that influence health. Population-based approaches include policy development and advocacy, organizational change, community development and empowerment.

Community-based participatory research (CBPR)

"A collaborative process that equitably involves all partners in the research process and recognizes the unique strengths that each brings. CBPR begins with a research topic of importance to the community with the aim of combining knowledge and action for social change to improve community health and eliminate health disparities."

Health status

"A description and/or measurement of the health of an individual or population at a particular point in time against identifiable standards, usually by reference to health indicators."

Motivational interviewing

"A directive, client-centered counseling style for eliciting behavior change by helping clients to explore and resolve ambivalence ." Motivational interviewing emphasizes drawing out an individual's internal motivations to change; allowing an individual to express and resolve her own ambivalence towards a behavior; and avoiding direct persuasion, confrontation and argumentation. The individual is viewed as the expert, while the primary role of the interviewer is to facilitate the individual's expression of goals and the discovery of an acceptable resolution to the ambivalence. In theory, an individual's ambivalence is the principle barrier to behavior change.

Coalition

"A group of organizations or representatives of groups within a community joined to pursue a common objective."

Behavioral intention

"A mental state in which the individual expects to take a specified action at some time in the future."

Relapse prevention

"A self-control program designed to help individuals to anticipate and cope with the problem of relapse in the habit-changing process." According to the Relapse Prevention Model, which is based on social-cognitive psychology, relapse is influenced by both immediate determinants and covert antecedents to high-risk situations. Immediate determinants of relapse include high-risk situations, coping skills, outcome expectancies, and the abstinence violation effect (the individual's emotional response to an initial lapse and what he attributes that lapse to). Covert antecedents to high-risk situations—lifestyle factors (i.e. stress and lifestyle imbalance) or cognitive factors such as cravings and urges—can increase the likelihood of relapse by increasing an individual's exposure to high-risk situations and/or by decreasing the individual's motivations to resist a lapse in behavior. The Relapse Prevention model outlines various intervention strategies for identifying, preventing, or avoiding the determinants and antecedent causes.

Theory

"A set of interrelated constructs, definitions, and propositions that presents a systematic view of events or situations by specifying relations among variables in order to explain and predict the events or situations."

Empowerment

"A social action process that promotes participation of people, organizations and communities in gaining control over their lives in their community and larger society. With this perspective, empowerment is not characterized as achieving power to dominate others, but rather power to act with others to affect change." "In health promotion, empowerment is a process through which people gain greater control over decisions and actions affecting their health."

Community

"A specific group of people, often living in a defined geographical area, who share a common culture, values and norms, are arranged in a social structure according to relationships which the community has developed over a period of time. Members of a community gain their personal and social identity by sharing common beliefs, values and norms which have been developed by the community in the past and may be modified in the future. They exhibit some awareness of their identity as a group, and share common needs and a commitment to meeting them."

Behavioral objective

"A statement of desired outcome that indicates who is to demonstrate how much of what action by when ."

Social ecology framework

"An approach to health education that goes beyond individual behavior change to examine and modify the social, political, and economic factors impacting health behavior decisions." The social ecological framework (see also ecological approach/levels) recognizes the individual, interpersonal, community, organizational and policy-level influences on health.

Outcome expectations (Perceived outcomes expectations)

"Anticipatory outcomes of a behavior," or what an individual perceives is the likely result of engaging in a specific behavior. Outcome expectations develop from previous experience, through observing others, hearing about specific behaviors or situations from others, or from emotional or physical responses to a behavior. Outcome expectations are a construct of the Social Cognitive Theory.

Formative evaluation

"Any combination of measurements obtained and judgments made before or during the implementation of materials, methods, activities or programs to discover, predict, control, ensure, or improve the quality of performance or delivery." This can include the combination of needs assessment, pilot testing, process evaluation, etc.

Process evaluation

"Any combination of measurements obtained during the implementation of program activities to control, assure, or improve the quality of performance or delivery."

Formative research

"Assesses the nature of the problem, the needs of the target audience, and the implementation process to inform and improve program design. Formative research is conducted both prior to and during program development to adapt the program to audience needs. Common methods include literature reviews, reviews of existing programs, and surveys, interviews, and focus group discussions with members of the target audience."

Outcome evaluation

"Assessment of the effects of a program on the ultimate objectives, including changes in health and social benefits or quality of life."

Community capacity

"Combined assets that influence a community's commitment, resources, and skills used to solve problems and strengthen the quality of life for its citizens."

Risk communication

"Engaging communities in discussions about environmental and other health risks and about approaches to deal with them. Risk communication also includes individual counseling about genetic risks and consequent choices."

Opinion leaders

"Individuals who are well respected in a community and can accurately represent the views of the priority population." They are typically demographically similar to the priority population, knowledgeable about community issues and concerns, early adopters of innovations, and capable of persuading others to engage in a particular behavior.

Stakeholders

"People who have an investment or a stake in the outcome of a program and therefore have reasons to be interested in the evaluation of the program."

Social norms

"Perceived social patterns of and expectations for behavior."

Evidence-based practice

"Program decisions or intervention selections made on the strength of data from the community concerning needs and data from previously tested interventions or programs concerning their effectiveness, sometimes using theory in the absence of data on the specific alignment of interventions and population needs."

Community-based interventions

"Programs designed to focus on healthful changes in either subgroups or localized populations."

Best practices

"Recommendations for an intervention, based on a critical review of multiple research and evaluation studies that substantiate the efficacy of the intervention in the populations and circumstances in which the studies were done, if not its effectiveness in other populations and situations where it might be implemented."

Social capital

"Social capital represents the degree of social cohesion which exists in communities. It refers to the processes between people which establish networks , norms, and social trust, and facilitate coordination and co-operation for mutual benefit." Social capital is "usually characterized by four interrelated constructs: trust, cooperation, civic engagement, and reciprocity."

Risk behavior

"Specific forms of behavior which are proven to be associated with increased susceptibility to a specific disease or ill-health."

Cues to action

"Strategies to activate one's readiness" to engage in a particular behavior or activity. A cue to action can be either an internal or external stimulus that motivates a person to act. Cues to action is a key construct in the Health Belief Model.

Policy advocacy

"The actions or endeavors individuals or groups engage in in order to alter public opinion in favor or in opposition to a certain policy."

Social marketing

"The application of commercial marketing technologies to the analysis, planning, execution, and evaluation of programs designed to influence the voluntary behavior of target audiences in order to improve their personal welfare and that of their society." Social marketing emphasizes the 4 P's of product, price, place and promotion.

Summative evaluation

"The application of design, measurement and analysis methods to the assessment of outcomes of a program or specific interventions within a program." Outcome and impact evaluation are collectively referred to as summative evaluation.

Impact evaluation

"The assessment of program effects on intermediate objectives including changes in predisposing, enabling, and reinforcing factors, behavioral and environmental changes, and possibly health and social outcomes."

Evaluation

"The comparison of an object of interest against a standard of acceptability." In health education and health promotion, evaluation is typically thought about in three distinct phases: formative, process and summative.

Processes of change

"The covert and overt activities that people use to progress through the stages" 1 of change in the transtheoretical model (TTM). There are ten processes of change that have been identified in conjunction with the development of the TTM: consciousness raising, dramatic relief, self-reevaluation, environmental reevaluation, self-liberation, helping relationships, counter-conditioning, contingency management, stimulus control, and social liberation. Different processes of change are used by individuals in different stages of change to progress towards action and maintenance. In the early stages, people tend to rely more on the cognitive, affective and evaluative processes (consciousness raising, dramatic relief, environmental reevaluation and self-reevaluation) while in the later stages the emphasized processes of change focus on making commitments, seeking support, contingency planning and other behavioral processes (counter-conditioning, helping relationship, stimulus control, reinforcement management).

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."

Cultural competence

"The design, implementation, and evaluation process that accounts for special issues of select population groups (ethnic and racial, linguistic) as well as differing educational levels and physical abilities."

Reciprocal determinism

"The dynamic interaction of the person, behavior, and the environment in which the behavior is performed." In other words, the concept of reciprocal determinism emphasizes that health behaviors and individuals are not only influenced by the physical and social context in which they exist, but also that such individuals and their behavior influences the environment. Reciprocal determinism is a key construct of the Social Cognitive Theory and in ecological approaches to health promotion.

Sustainability

"The maintenance and institutionalization of a program or its outcomes."

Behavioral factors

"The patterns of behavior of individuals and groups that protect or put them at risk for a given health or social problem."

Quality of life

"The perception of individuals or groups that their needs are being satisfied and that they are not being denied opportunities to achieve happiness and fulfillment."

Resilience

"The process of adapting well in the face of adversity, trauma, tragedy, threats, or even significant sources of stress—such as family and relationship problems, serious health problems, or workplace and financial stressors. It means 'bouncing back' from difficult experiences."

Needs assessment

"The process of determining, analyzing and prioritizing needs, and in turn, identifying and implementing solution strategies to resolve high priority needs." A needs assessment is meant to assist program planners in identifying a priority population, their specific needs, subgroups of the population with the greatest needs, the most significant problems facing the priority populations and subgroups, what is currently being done and/or what has been done in the past to effectively address their needs, etc. Needs assessment is generally viewed as the first step in health promotion program planning and depends on both secondary and primary data collection gathered through a variety of qualitative and quantitative methods.

Determinants of health

"The range of personal, social, economic and environmental factors which determine the health status of individuals or populations."

Community organization

"The set of procedures and processes by which a population and its institutions mobilize and coordinate resources to solve a mutual problem or to pursue mutual goals."

Tailoring

"The use of information about individuals to shape the message or other qualities of a communication or other intervention so that it has the best possible fit with the factors predisposing, enabling, and reinforcing that person's behavior."

Social network

"The web of social relationships that surround individuals." Social network structures can be described both in terms of dyadic characteristics and characteristics of the network as a while. Dyadic characteristics include reciprocity, intensity, and complexity in interpersonal relationships. Network characteristics include levels of homogeneity, geographic dispersion, and density.

Early adopters

"Those in the population who accept a new idea or practice soon after the innovators (but before the middle majority), and who tend to be opinion leaders for the middle majority."

Mission statement

A brief statement that defines the purpose and focus and sometimes the vision and values of an organization or program. Typically, all program planning, program activities, partnerships, etc. should be made to reflect to the mission statement to ensure that they are in line with the overall purpose and goals of the program or organization.

Diffusion of innovations (DOIs)

A community-level theory that attempts to describe the rate and process of the adoption of new ideas and behaviors in a specific population or between populations. An innovation is defined as "an idea, practice or object that is perceived as new by an individual or other unit of adoption," while diffusion is defined as "the process by which an innovation is communicated through certain channels over time among the members of a social system." The process of diffusion occurs over the course of five stages: innovation development, dissemination, adoption, implementation, and maintenance. The adoption stage requires that an individual: 1) has knowledge of the innovation (has an awareness that the innovation exists, knowledge of how to use the innovation and how it works); 2) goes through a process of persuasion or attitude development, in which the individual discusses the innovation with others and forms a favorable or negative attitude toward it; 3) decides to adopt the innovation; 4) implements, or begins to use the innovation; and 5) goes through a process of confirmation, in which the individual integrates the innovation into his life and recommends it to others. In general, not everyone adopts an innovation at the same time. Diffusion of Innovations categorizes individuals into five groups, based on when they adopt an innovation: innovators are the first to adopt, followed by early adopters , then early majority adopters , followed by late majority adopters and finally laggards . The process of adoption in a population over time, as described by DOI, roughly follows a standard normal distribution: early majority adopters and late majority adopters are within one standard deviation of the mean; early adopters and laggards are within two standard deviations; and innovators are within three standard deviations of the mean. There are certain attributes of an innovation that determine the speed and extent of its diffusion. These attributes include: the relative advantage of the innovation over existing alternatives; its compatibility with the intended audience; its complexity , or ease of use; its trialability , or whether or not someone can try the innovation before deciding whether or not to adopt it; the observability or measurability of its results; its likely impact on social relations ; its reversibility ; its communicability , or how easily and clearly it can be understood; the time required to adopt the innovation; the level of risk or uncertainty associated with its adoption; the level of commitment required to use the innovation effectively; and the modifiability of the innovation over time.

Asset mapping

A component of community capacity assessment and community development that involves conducting an inventory of individual, group and community resources, often physically designating them on a geographical map. A capacity assessment offers an alternative to a needs based approach to community health and "is a measure of actual and potential individual, group and community resources that can be inherent and/or brought to bear for health maintenance and enhancement." Once assets are "mapped," efforts are directed at mobilizing, strengthening and supplementing them while working to achieve a common vision.

Voucher

A coupon or document that can be exchanged for a service, incentive or something else as decided by the distributor. Vouchers are used in health promotion to encourage individuals to participate in programs, to link individuals to and to coordinate services between program partners, as incentives, etc.

Mediating factors

A factor that partially or completely explains the relationship between a predictor and a behavior or outcome. A mediating factor is independently related to the outcome of interest and to the predictor of interest, thereby acting as a link between the two. For example, in the Theory of Reasoned Action, a person's behavioral intention acts as a mediating factor between his attitude and subjective norms and his behavior.

Focus group

A focus group study is a carefully planned series of discussions designed to obtain perceptions on a defined area of interest in a permissive, nonthreatening environment.

Information-motivation-behavior (IMB)

A general model that holds that information, motivation, and behavioral skills are the primary determinants of health-related behaviors. Individuals who are well informed, highly motivated, and who have the necessary behavioral skills are more likely to engage in a specific health-related behavior. The specific types of information, motivational strategies and behavioral skills necessary to lead to behavior change are expected to vary between subpopulations and between behaviors. Behaviorally relevant information is considered "a necessary but not a sufficient condition" for risk reduction behavior. In general even a well-informed and behaviorally skilled individual must be highly motivated in order to engage in a specific health-promoting behavior and to maintain it over time.

Locus of control

A generalized belief that circumstances and rewards are under one's own (internal locus of control) or others' control (external locus of control).

Acculturation

A gradual process through which an individual adopts the behavioral norms, attitudes, and beliefs of a culture other than his own.

Subpopulation

A group, or subset, of people within a population that share a common characteristic. Subpopulations within intended audiences are often defined in order to facilitate understanding of the group and to be able to better tailor messages to fit their needs and behaviors.

Social cognitive theory (SCT)

A health behavior theory that describes the reciprocal influence and dynamic interaction between an individual's personal factors, the environment, and specific health behaviors. Major constructs of the SCT include environments , situations (an individual's cognitive perceptions of the environment that may affect his behavior), behavioral capability , outcome expectations , outcome expectancies (the value an individual places on an expected outcome), self-regulation (ability to engage in goal-directed behavior), observational learning, reinforcements, perceived self-efficacy , emotional coping responses, and reciprocal determinism . The SCT maintains that personal factors within individuals—their behavioral capability, self-efficacy, outcome expectations and expectancies, coping mechanisms, and self control—are key determinants of behavior and both influence and are influenced by the environment. The environment is important partially because it provides models for and opportunities for observational learning and reinforcement, increasing the likelihood that certain behaviors are performed. Based on the concept of reciprocal determinism any change in the person, environment or behavior results in a situational change, necessitating a reevaluation of the interaction between the three.

Lay health advisor (or lay health worker or community health worker)

A member of the target community that is trained to administer health promotion messages and program activities. Lay health advisors are often used to overcome language barriers, to enhance the cultural relevance of health promotion programs, to facilitate access to and understanding of a community among program planners, to help connect members of the target population with services, etc.

Transtheoretical model of change (TTM)

A model of individual health behavior that integrates processes of change and theoretical principles from multiple leading theories across several disciplines. The TTM is a stage-based model that takes into account an individual's readiness to change and views behavior change as a process that occurs over time and not as a finite event. Intervention messages and strategies are based on appropriate processes of change and are developed and matched to an individual's readiness to change. There are five main stages of change (see stages of change) and ten processes of change (see processes of change) that have been empirically linked in the TTM. In addition to the concepts of stages and processes of change, the TTM also asserts that, in order for an individual to take action and maintain a behavior change, that person must perceive that the benefits, or pros, of change outweigh the cons (decisional balance ). Situational self-efficacy —the confidence one feels in his or her ability to resist relapsing and engaging in an unhealthy or high-risk behavior in specific, tempting situations—is the final key construct of the TTM.

Hardiness

A positive coping influence characterized by "high levels of perceived control, commitment to succeed, and a propensity to see stressful life events as challenging." Challenging, in the context of hardiness, reflects an individual's ability to view stressful situations and experiences as an opportunity for growth and development and not as a threat. Hardy individuals are less likely to experience illness as a result of stressful events.

Consciousness raising

A process of "learning new facts, ideas and tips that support the healthy behavior change." Efforts to increase awareness about the causes and consequences of a disease or unhealthy behavior during a media campaign would be considered consciousness raising. Consciousness raising is a process of change included in the Transtheoretical model that is most appropriate for individuals in the earliest stages of change (precontemplation and contemplation).

Intervention mapping

A program planning framework intended to facilitate the development of theory- and evidencebased health promotion programs. Following a thorough review of the literature and an appropriate needs assessment, the process of intervention mapping includes five steps: "1) creating matrices of proximal program objectives from performance objectives and determinants of behavior and environmental conditions; 2) selecting theory-based intervention methods and practical strategies; 3) designing and organizing programs; 4) specifying adoption and implementation plans; and 5) generating an evaluation plan." In step one, a list of performance objectives are generated that define the desired behavioral and environmental outcomes of the program; personal (internal) and external determinants of the behavioral and environmental outcomes are specified; if determinants vary by sub-population, the target population is differentiated; and, finally, performance objectives and determinants are linked in a matrix format, often by level (i.e. individual vs. organizational) and by sub-population, if applicable. Each cell in the resulting matrices will contain either a learning objective (linking a performance objective with a personal determinant) or a change objective (linking a performance objective with an external determinant) that defines what individuals need to learn or what changes need to take place in the environment as a result of the program. In step 2, a list of theoretical intervention methods (i.e. community planning) and a list of possible strategies for delivering those methods (i.e. community forums or meetings) are developed, based on the identified proximal objectives. In step 3, the selected strategies are operationalized into deliverable program components and delivery mechanisms (i.e. channel selection), and program materials are developed and pre-tested. During step 4, a "linkage system" between program users and developers is created so that the program can be modified to meet the needs of the users; adoption and implementation performance objectives are developed; determinants of adoption and implementation are specified; and an implementation plan is developed. Finally, step 5 involves developing an evaluation model, including a plan for process evaluation.

Intervention message

A program-specific message delivered to an individual or group that is designed to increase awareness of a health problem, motivate behavior change, address perceived barriers to engaging in a health behavior, or something else related to the goals and objectives of the program. Theory-based and tailored intervention messages are typically the most effective.

Health Insurance Portability and Accountability Act (HIPAA)

A statute passed in 1996 in efforts to improve the efficiency of healthcare delivery by mandating and standardizing the electronic exchange of health information and to provide Federal protections to preserve the privacy of protected, individually identifiable health information. Under HIPAA's Privacy Rule, which has been effective since April, 2003, an individual has the right to see and correct his health records, to know how information from those health records is being used and shared, and to deny permission for those health records to be used for certain purposes. In many cases, an individual must provide written permission for certain individuals or groups to be able to received information from his personal health records, unless that information is needed to provide continuity of care or is required to be reported for public health surveillance purposes.

Behavioral risk

A typically modifiable behavior, like smoking or lack of physical activity, which puts an individual at risk for a negative health outcome.

Theory of reasoned action (TRA)

According to the Theory of Reasoned Action, the most important determinant of a behavior is an individual's behavioral intention , or "perceived likelihood of performing the behavior." An individual's behavioral intention is influenced directly by that person's attitude toward the behavior and subjective norms . Attitude toward a behavior is a function of a person's behavioral beliefs (beliefs about the likely outcomes and attributes of a particular behavior) and his evaluation of behavioral outcomes (the value that he places on the likely outcomes and attributes). Again, subjective norms are formed by a person's normative beliefs and motivations to comply .

Theory of planned behavior (TPB)

An extension of the Theory of Reasoned Action that takes into consideration an individual's perceived control over engaging in a particular behavior, in addition to his attitudes towards and subjective norms surrounding that behavior. Perceived behavioral control was added in efforts to account for factors beyond the individual's control that potentially influence his behavioral intentions and, ultimately, behavior. People may expend more energy and try harder to perform a behavior when they perceive that they have high behavioral control, or are capable and have sufficient resources to engage in that behavior and overcome any barriers. Perceived behavioral control is a function of control beliefs (beliefs about the presence or absence of resources and barriers to performing a behavior) and perceived power (beliefs about the influence of each perceived resource or barrier on the difficulty of engaging in the behavior).

Gatekeeper

An individual who formally or informally controls aspects of a community and/or access to a priority population. Gatekeepers are typically very knowledgeable of a community and how it functions. In community health, gaining the cooperation of the community gatekeeper(s) can improve the feasibility, quality and acceptability of community interventions and programs.

Subjective norm

An individual's "belief about whether most people approve or disapprove" of a particular behavior. Subjective norms directly influence a person's intentions to engage or not engage in that behavior. Subjective norm is a key construct of the Theory of Reasoned Action/Theory of Planned Behavior. (See also normative beliefs).

Perceived self-efficacy

An individual's beliefs about and confidence in his ability to perform a certain behavior or take action. Self-efficacy influences what behaviors we choose to perform, the amount of effort we expend on performing those behaviors, how long we persist in performing a behavior, and how we feel about particular behaviors. Self-efficacy is developed through direct or vicarious experience, verbal or social persuasion, and physiological reactions/feedback. Perceived self-efficacy is a concept common to many theories of Health Behavior, but is most directly related to Social Cognitive Theory.

Perceived severity

An individual's beliefs about how serious a disease or its physical and social consequences are. "Perceived severity" is a key construct of the Health Belief Model.

Perceived susceptibility

An individual's beliefs about how vulnerable, or at risk, he or she is to getting a particular disease or of being affected by a particular health outcome. "Perceived susceptibility" is a key construct of the Health Belief Model.

Perceived benefits

An individual's beliefs about the efficacy of a particular behavior in reducing the perceived threat associated with a particular disease or outcome. An individual would not be expected to adopt a specific health behavior without believing it would effectively reduce his perceived threat of disease. "Perceived benefits" is a key construct of the Health Belief Model.

Perceived barriers

An individual's beliefs about the negative consequences of or challenges associated with engaging in a particular health behavior. Perceived barriers can be physical, emotional, psychological, economic, etc. Typically, the perceived benefits of a behavior must outweigh the perceived barriers for a person to adopt that behavior. "Perceived barriers" is a key construct of the Health Belief Model.

Behavioral capability

An individual's knowledge and skills related to a specific health behavior. In order for an individual to engage in a particular behavior, that individual must first know what the behavior is and how to successfully perform it. Behavioral capability is a key construct of the Social Cognitive Theory.

Health belief model (HBM)

An individual-level, value-expectancy health behavior theory developed in the 1950s by social psychologists in the U.S. Public Health Service in efforts to explain why people did not seek preventive health and screening services. The theory was first used in relation to a free Tuberculosis screening program, but has since been applied to numerous health behaviors. The HMB maintains that an individual will engage in behavior to prevent, screen for or control disease or negative health outcomes if they 1) perceive themselves to be at risk for that disease; 2) believe that the disease has potentially serious consequences; 3) believe that a recommended (and available) behavior is effective in reducing their risk for or the consequences of the disease; and 4) believe that the perceived barriers or costs of engaging in that behavior are fewer than the perceived benefits. Internal or external cues to action can motivate a person to take action. Self-efficacy was added as a construct to the HBM in the late 1980s.

Harm reduction

An intermediate approach to behavior change that emphasizes adopting a lower risk alternative to a high risk behavior when an individual is either unwilling or unable to stop the high risk behavior. Needle exchange programs that facilitate the use of sterile injection equipment in order to reduce the transmission of HIV among injection drug-users are an example of harm reduction.

Structural intervention

An intervention that focuses on influencing or changing the social, political, physical or economic environment to facilitate healthy behaviors or behavior change in large groups of people.

Quasi-experimental design

Any research design that does not use randomization in assigning units (individuals) to conditions or treatments. Quasi-experiments depend on self-selection or administrator selection to assign individuals to conditions but they are otherwise structurally similar to a randomized experimental design.

Perceived Response efficacy

Belief whether the recommended action is effective in preventing or reducing risk for a health problem. It is important to note that ether low perceptions of self (self efficacy), or low perceptions of the recommended action (response efficacy) may lead to maladaptive behavior. For example, people may not feel confident that they can reduce their intake of fried foods (self efficacy) or they may not feel confident that reducing their intake of fried foods will lower their risk of heart attack (response efficacy). The implication for prevention is to ensure that health education supports both the belief in one's ability to change lifestyle behaviors as well as the belief that lifestyle changes are effective in reducing risks.

Predictors

Characteristics or variables that predict or otherwise help to explain a particular behavioral, health or other outcome.

Adherence

Closely following or sticking to a plan or protocol. In the context of health promotion, we use the term adherence to refer to individuals taking their medications as prescribed (i.e. adherence to antiretroviral therapy) or following program protocols (i.e. sticking to a diet and exercise plan). In the context of health promotion, adherence can also refer to following the implementation protocol when delivering a health promotion program, conducting interviews, etc.

Primary data

Data gathered directly by the individual using it to answer a specified research question or to gather information on a specific population or health problem. This includes data collected firsthand through survey research, focus groups, interviews, etc.

Self-report (data)

Data that are generated by having respondents report about themselves. Self-report data are common in sociaorgal and behavioral sciences, but their validity is often questioned because of potential bias.

Psychosocial determinants

Determinants of health that reflect the interaction between the social environment and an individual's development, beliefs and behaviors. Psychosocial factors are thought to not only mediate the effects of social and structural factors on individual health outcomes, but also to be influenced by the social structures and contexts in which they develop. Coping skills or social support following a stressful experience are examples of psychosocial determinants.

Health disparities

Differences in the incidence, prevalence, mortality, burden of diseases or other adverse health conditions that exist among specific groups within the general population. "A chain of events signified by a difference in: (1) environment, (2) access to, utilization of, and quality of care, (3) health status, or (4) a particular health outcome that deserves scrutiny."

Ecological approaches/levels

Ecological approaches recognize the multiple levels of influence on and the varying nature of determinants of health. They view health behavior as both affected by and affecting the physical and social environment (reciprocal determinism). They move beyond a "victim blaming," individual level approach to health promotion, emphasizing the use of multiple strategies to impact determinants of health, partnerships between multiple sectors to enhance health promotion efforts, and targeting change at multiple levels of intervention. The levels of an ecological approach in health promotion include intrapersonal factors, interpersonal processes and primary groups, institutional factors, community factors, and public policy.

Ethics in health promotion and health promotion research

Ethical principles in health education and health promotion practice and research are similar to those outlined in the Belmont Report and earlier ethical codes and include principles of respect for persons, beneficence, and justice. In health promotion practice and research, these ethical principles call for informed consent and voluntary participation, a commitment to preserve participant privacy, equitable inclusion in programs and research, a protection of vulnerable populations, and careful efforts to maximize benefits and minimize risks for participants. A unified code of ethics for the health education profession was adopted in 1999, outlining each health educator's responsibilities to the public, to the profession, to employers, in delivering health education, in conducting research and evaluation, and in professional preparation.

Protective factors

Factors that decrease the likelihood of negative health outcomes and risk behaviors.

Environment/environmental factors

Factors that influence an individual's behavior but are physically external to the individual. The environment/environmental factors are explicitly important in social ecological approaches to health education and health promotion, as well as in Social Cognitive Theory.

Co-morbidity

Having more than one illness or condition that compromises quality of life at the same time.

Change agent

In the context of Diffusion of Innovations, a change agent is "an individual who influences clients' innovation-decisions in a direction deemed desirable by a change agency." The change agent's functions are often to develop a perceived need for change, facilitate information-exchange, identify a client's problems, develop a client's intentions to change, motivate the movement from intentions to action, support long-term adoption of the change, and help the client achieve self-reliance.

Communication theories

In the context of public health, communication theories are meant to describe how communication processes impact health behavior change and how communication strategies can be used strategically to motivate behavior change. Although there are a number of communication theories and concepts, four that are particularly relevant to public health include the knowledge gap, agenda setting, cultivation studies, and risk communication . The knowledge gap refers to the fact that individuals with more formal education tend to be more knowledgeable about many issues when compared to those with less formal education; therefore, "an increasing flow of information into a social system is more likely to benefit groups of higher socioeconomic status than those of lower SES," thereby contributing to health disparities and other inequities. Knowledge gaps can be modified by content and channel factors, social conflict and mobilization, community structure, and individual motivational factors. Agenda-setting refers to the ability of the mass media to influence public opinion and priorities, particularly in relation to politics and policy-making. Cultivation studies investigate "the impact the mass media have on our perceptions of reality."

Feedback

Information provided to individuals based on their individual characteristics or based on comparisons with others. Major types of feedback, in the context of health communication and communication technology, include personal feedback, normative feedback, and ipsative (or iterative) feedback. Personal feedback "refers to the information that respondents obtain about the answers they have provided." Normative feedback "refers to the information respondents obtain when comparing their responses with the responses of another group." Ipsative feedback "refers to a comparison between a person's most recent status and that found at previous assessments."

Institutionalization

Involves "permanently" incorporating program activities into the routines and structure of an organization or community in order to maximize the long-term benefits of your program and to ensure its sustainability following staffing changes, the termination of formal activities and/or grant funding, etc.

Pilot testing

Involves implementing a program or program components on a smaller scale, in a setting similar to where the program will be fully implemented and with a population similar to the planned target population. Pilot testing allows program planners to identify and correct problems with the intervention strategies before they are fully implemented.

Stereotyping

Making generalizations or assumptions about an individual based on a characteristic or attribute that individual shares with a larger group.

Secondary data

Pre-existing data collected by somebody other than the individual using it. Secondary data is often used in conducting needs assessments and/or to supplement primary data.

Tertiary prevention

Preventive measures directed at rehabilitating, training and educating an individual who has already reached a point of disability, impairment or dependency. Tertiary prevention is the final level of prevention and includes measures such as disease management education for diabetics or for individuals who are recovering from a heart attack.

Secondary prevention

Preventive measures that are directed at the early diagnosis and treatment of injuries and diseases to limit disability and prevent the development of complications and more serious disease. Screening tests and self-exams for breast cancer are examples of secondary prevention strategies.

Primary prevention

Refers to preventive measures that are intended to prevent or put off the onset of injury or disease. Vaccinations, abstinence, and exercise are examples of primary prevention.

Stages of change

Refers to the temporal progression towards behavior change that individuals go through over time. The stages of change are part of the Transtheoretical model, in which five stages of change are defined: precontemplation (no intention to take action in the next six months); contemplation (thinking about taking action in the next six months); preparation (intending to take action in the next month and has taken some behavioral steps toward change); action (has adopted behavior change for less than six months); and maintenance (has adopted behavior change for longer than six months). Although there is technically a sixth stage of change—termination (no longer tempted to engage in old behavior and has complete self-efficacy)—defined for use in the Transtheoretical model, very few people seem to reach this stage.

Normative beliefs

Reflect individuals' beliefs about whether important referent individuals, or people whose opinion they value, approve or disapprove of a particular behavior. Normative beliefs, along with and individual's motivation to comply with the opinions and values of the referent individuals, form a person's subjective norms. Normative beliefs and subjective norms are constructs of the Theory of Reasoned Action/Theory of Planned Behavior.

Levels of prevention (primary, secondary, tertiary)

Reflect the different points of prevention and intervention in health education and health promotion. See definitions for primary prevention, secondary prevention and tertiary prevention.

Screening behavior

Seeking diagnostic (screening) tests to check for the presence of disease or precursors to disease, typically prior to the development of outward signs and symptoms. Screenings, as a form of secondary prevention, facilitate early diagnosis of disease and often improve disease outcomes.

Socioeconomic factors

Social and economic characteristics like education, income, and occupation that influence an individual's ability to function or "compete" in society. Socioeconomic factors are often correlated with an individual's health status.

Stress and coping

Stress is the experience of psychological or emotional distress in response to an event or experience. Stress can produce physiological changes in the body that may be associated with illness and disease. Coping consists of "an individual's ongoing efforts to manage specific external and internal demands that are appraised as taxing or exceeding personal resources."

Social ecology

The "study of the influence of the social context on behavior, including institutional and cultural variables"

National health objectives

The U.S. Department of Health and Human Services has coordinated a process to develop a set of national health objectives to direct public health efforts each decade since 1980, starting with the publication of Promoting Health/Preventing Disease: Objectives for the Nation. The current set of national health objectives is contained in Healthy People 2010: Understanding and Improving Health . Healthy People 2010 contains 467 national health objectives that cover 28 primary focus areas.

Theoretical construct

The building blocks or primary elements of a theory that have been developed or adopted for use in that particular theory. Constructs are understood only within the context of the theories they are associated with. For example, perceived susceptibility, perceived severity, and perceived barriers are constructs of the Health Belief Model.

Perceived threat

The combination of perceived severity and perceived susceptibility. An individual's beliefs about his perceived susceptibility to a disease and the perceived severity of that disease combine to form his overall beliefs about the level of threat that disease poses for him.

PRECEDE-PROCEED framework

The most well-known health program planning model. In PRECEDE-PROCEED a program planner begins by identifying the desired outcome of the program and working backwards to discover strategies for reaching that outcome. PRECEDE stands for predisposing, reinforcing and enabling constructs in educational/ecological diagnosis and e valuation, and includes various stages of assessment and planning. PROCEED stands for policy, regulatory, and organizational constructs in educational and environmental development and deals mainly with program implementation and evaluation. PRECEDE-PROCEED has six main phases, followed by three phases of evaluation: Phase 1, social assessment and situational analysis, involves engaging the target population to identify general indicators of quality of life. Phase 2, epidemiological assessment, includes identifying specific health goals or problems that contribute to or interact with the social goals or problems identified in phase 1. Phase 3, behavioral and environmental assessment, involves identifying and prioritizing behavioral and environmental determinants of the specific health problems identified in phase 2. Phase 4, educational and ecological assessment, includes identifying and prioritizing predisposing, reinforcing and enabling factors that are related to the behavioral and environmental determinants. " Predisposing factors include a person's or population's knowledge, attitudes, beliefs, values and perceptions that facilitate or hinder motivation for change." Reinforcing factors are "the rewards received and the feedback the learner receives from others following adoption of a behavior." " Enabling factors are those skills, resources or barriers that can help or hinder the desired behavioral changes as well as environmental changes." Phase 5, intervention alignment and administrative and policy assessment, involves "intervention matching, mapping, and patching" to determine which program components and activities are needed to target the factors identified in the previous stages and determining whether or not the program has the policy, organizational and administrative capacity to do them. In phase 6, implementation occurs. Phase 7 includes process evaluation, phase 8 includes impact evaluation, and phase 9 includes outcome evaluation.

Target group/intended audience

The primary population expected to receive/benefit from a specific health promotion program's messages, activities and interventions. Typically the target group is the group of people most at risk or most affected by a specific health problem.

Self-management

The process of taking an active responsibility for and control over managing and monitoring one's health, including managing chronic diseases and disability.

Organizational change

The process through which organizations "innovate new goals, programs, technologies, and ideas" in order to improve organizational efficiency and effectiveness. The Stage Theory of Organizational Change is one theory that explains this process. The seven stages of the stage theory of organizational change are: 1) Sensing unsatisfied demands on the system; 2) search for possible responses; 3) evaluation of alternatives; 4) decision to adopt a course of action; 5) initiation of action within the system; 6) implementation of the change; and 7) institutionalization of the change.

Decisional balance

The relative weight an individual places on the perceived pros and cons of changing or engaging in a certain behavior. Typically, the pros of change need to outweigh the cons of change before an individual will be ready to take action and maintain a behavior change. Decisional balance is a key construct in the Transtheoretical model.

Mixed methods

The strategic and systematic combination of qualitative and quantitative research methods. The combination of methods often works to overcome the limitations of quantitative or qualitative methods used in isolation, to improve the validity of findings, and/or to provide a more comprehensive understanding of a problem or phenomenon.

Quantitative research

Utilizes methods that result in the collection of numerical and typically predefined data. Statistical methods are employed to analyze and interpret quantitative data. Closed-ended surveys are an example of quantitative research.

Qualitative research

Utilizes methods that results in the collection of non-numeric data that are not highly categorized or defined prior to data collection. Open-ended surveys, focus groups, in-depth interviews, observational and case studies typically result in qualitative data.