HK 366 Final Exam Study Exam
HK 366 Final Exam Study Exam HK 366
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Final Exam Study Guide Packet Know the three basic parts of most planning models e g assessment 0 Assessment looking at the health problem and its causalsupporting factors 0 Development of an intervention health promotion program based on the assessment targeting selected factors identified in the assessment and utilizing appropriate theory to guide intervention components 0 Evaluation looking at the intervention to determine if it has been implemented as planned and if it has actually affected the factors to which it was connected Understand the role assessment plays in health promotion interventionprogram develop and implementation 0 Must assess the situation and the target factors in order to develop an appropriate intervention or program Recognize 2 planning models e g PRECEDEPROCEED model 0 PrecedeProceed Model a process of assessment and planning before putting a program in place followed by implementation and evaluation of the program 0 The Risk and Protective Factors Planning Model Be able to identify the key difference between the PRECEDEPROCEED model and the Risk and Protective Factor Planning Model 0 Risk and Protective Factors Model is a theorybased planning model that focuses on certain health risk behaviors as the targets of change 0 Lays out a set of risk factors that are said to be precursors to or predictors of risky behavior by young people Know the five PRECEDE planning phases that describe assessment activities For each phase be able to describe the phase sources of info and what each phase tells you review charts in Powerpoint slides 0 Phase 1 Social Assessment and Situational Analysis I What is it assessment of quality of life and social factors surrounding one or more health problems ranking or positioning the health problems in context I Sources of info employment rates availability of health care services education crime housing parksrecreation facilities etc I What this tells you from an ecological perspective provides an overview of the connection between health and other factors as well as potential social or quality of life outcomes for the program may also give you an indication of the importance placed on a particular health issue in the community 0 Phase 2 Epidemiological Assessment I What is it assessment of prevalenceincidence of a health condition any comorbid conditions and affected populations specific focus on health issues to be targeted I Sources of info local surveillance data from public health sources schools emergency rooms and police I What this tells you the nature and extent of a health problem or problems patterns and trends and the affected populations 0 Phase 3 Behavioral and Environmental Assessment I What is it assessment of the behavioral and environmental risk factors contributing to the health conditions you want to address as identified in the epidemiological data I Sources of info local surveys focus groups or other data from public health sources schools community groups or work related sources environmental risk data from environmental agencies public health agencies or organizations I What this tells you behaviors and environmental conditions that you may need to target in an intervention in order to address the identified health problems 0 Phase 4 Educational and Ecological Assessment I What is it predisposing factors attitudes knowledge beliefs values perceptions genetic predisposition etc enabling factors skills resources and barriers that help or hinder the desired behavior reinforcing factors others attitudes towards the desired behavior rewards I Sources of info local surveys focus groups local research or specialized data data collected for the assessment by the interventionist I What this tells you factors that inform motivate or lead to the behavioralenvironmental risk factors may need to target these in order to in uence those risk factors 0 Phase 5 Administrative and Policy Assessment I What is it assessment of administrative organizational and political resources available to support the development and implementation of a health promotion program I Sources of info key community leaders and sources focus groups surveys of the nonprofit sector colleges and universities I What this tells you the practical details about putting a program into action 0 Phase 6 Implementation I What is it use all of the info you have gathered to put your program into place I PROCEED 0 Phase 789 Three Types of Evaluation I Process evaluation an assessment of a program implementation 0 Sources of info involves tracking records such as sign in sheets hiring records staff training records how many materials were developed and distributed and how many educational sessions were conducted etc I What this tells you did you do what you said you were going to do I Outcome evaluation an assessment of the short term 13 years impacts of a program 0 Sources of info need to collect info about the factors they expect to change in the short term the collect the same data at one or more points after the intervention takes place to measure the change pre and post data I What this tells you often refers to changes to knowledge policies and practices community awareness and systems the kinds of changes that are related to what was identified in phase 3 and 4 I Impact evaluation an assessment of the long term effects of your program the kinds of effects that might happen in several years or more 0 Sources of info collect info about the factors they think will change before the intervention is given then follow up at intervals over a long time period with the same collection of information I What this tells you did the intervention affect the health problem or issue that was the ultimate target 6 Know the four PROCEED phases including program implementation and evaluation 0 Phase 6 implementation 0 Phase 7 process evaluation 0 Phase 8 outcome evaluation 0 Phase 9 impact evaluation 7 Be able to define and recognize examples of risk factors e g poor family function poverty crime 0 Risk factors conditions or habits that make a person more likely to develop a disease I Individual biologicalpsychological dispositions attitudes values knowledge skills problem behaviors I Peer norms activities attachment to specific groups I Family family function management bonding abuseviolence I School bonding to schoolclimate policy performance I Community bonding norms resources poverty level crime awarenessmobilization I Societyenvironment norms policysanctions 8 Be able to define and recognize examples of protective factors e g prosocial individuals groups 0 Protective factors conditions or attributes that when present mitigate or eliminate risk of developing a disease I Individual gender intelligence temperament I Social bonding attachmentcommitment to positive prosocial individuals groups I Health beliefsclear standards for behavior in families schools and communities 9 Understand the need for evaluation 0 Why evaluate I Accountability responding to public need to show that costresources invested in a program had an effect I Learning and improvement evaluation data can help determine what is working and what is not I Theory test the validity of a theory that is incorporated in an intervention or to test effectiveness of a specific program model I Efficiency to assess what it costs for the program to achieve its goals I Describe a logic model its components and understand 0 Logic model is I Picture of the health program what is put into the program what is being carried out and what it is trying to achieve I Clarifies the strategy underlying the program I Builds common understanding especially about the relationship between actions and results I Communicates what a program is and is not about I Forms a basis for evaluation 0 Components I Problem goal health problem to be addressed I Inputs resources and staff I Outputs activities to address problems I Short term outcomes of activities change in attitudes skill changes change in regulations I Long term impacts permanent behavior change change in health status 11 Describe and recognize examples of evaluation designs e g historical record keeping approach 0 Historical recordkeeping approach track project activities and client participation 0 Qualitative approach assess what project participants and staff have experienced in terms of change 0 Periodic inventorytime series at specified time intervals beginning with a baseline program data are tabulated and surveys are completed to check progress towards program goals no comparison group 0 Benchmarking assess program and participant impact data against come comparable benchmark standard 0 Quasiexperimental design identify a community or population sample similar to your intervention sample but one that doesn39t receive the intervention and collect pre and post test or time series data from both intervention and comparison groups to assess any differences attributed to the intervention 0 Classic experimental design randomly assign some individual sin the target population to the intervention or to serve as controls collect pre and post test or time series data from both groups to assess any differences attributable to the intervention 12 Describe and recognize examples of confounds e g maturation confound O Confounds unplanned occurrences or situations that may affect an intervention and interfere with a claim that only the intervention caused a particular change 0 Examples History during course of intervention something happens among or to the intervention or control groupscommunities that is not connected to the experiment leading to a change highly publicized event such as a famous film star dies of HIVAIDS Maturation during the intervention some changes could occur such as behavior or attitude just because participants gain life experience Testing some changes from baseline to followup data could just be the result of people becoming more familiar with the evaluation surveys or questions Regression to the mean when participants have characteristics or behaviors that are already extreme these factors may change during the course of the intervention just because they were so extreme to start with ex extreme poverty or highrisk behavior pre and post test score may show improvement just because they can39t get any worse Selection bias when participants are not a representative sample Mortality or attrition when participants leave an intervention or research experiment over time your responses are only coming from those who stayed so might not be representative Diffusion of treatment when you can39t prevent the control group from getting some or all of the intervention 13 Understand key issues with respect to implementing health promotion programs in school and workplace settings 0 Schools Intensity and effects of a developmental stage with respect to the youth involved in an intervention where social pressures the process of forming and identity and affiliating with social groups and biological changes all affect what you may be trying to achieve The politics of implementing social and health programs in schools The greatly increased demand on schools to act in a much broader social capacity Competing priorities and scarce resources 0 Workplace Employee reluctance to mix personal health issues with a work context Differences between wellness programs and specific workplace cultures that might include social norms and messages related to success such as working very hard not complaining and not revealing personal information at work No time I No incentives to take advantage of the programs 14 Understand the kinds of social and behavioral theories that could be applicable to school based health programs 0 Theories focusing on individual knowledge and attitudes like HBM and TPB O Theories addressing the interaction between an individual and the environment including observational learning developing skills and selfefficacy SCT O Theories and approaches focusing on the mobilization of communities and organizations 0 Theories and approaches that address the role and structure of the built environment in health behavior 15 Understand the kinds of social and behavioral theories that could be applicable to workbased health programs 0 See school program question 16 Define globalization and be able to describe the broader implications of globalization for public health 0 Globalization population mobility and movements of information resources and of environments have all done much to reduce the distinction between international and domestic 0 Broader implications I Increasing complexity in terms of ensuring workplace health and safety across globalized operations I Increasing complexity in terms of ensuring the safety of food and medical products which are exported and imported from a wide range of countries and regions and often transshipped via intermediate destinations I Increasing complexity in terms of ensuring environmental responsibility where facilities and production are segmented and located in different countries under different regulations and conditions I Much more rapid routes of transmission for infectious disease around the globe I Much more rapid avenues for communication and dissemination 17 Understand key components in the overall ecology of global health that program planners must take into consideration when developing health promotion programs in a global setting e g environmental risks system capacity and infrastructure etc 0 Environmental risks presence of diseases carried or vectored in a particular location via contaminated water insects pollution climatic factors that cause food shortages or famine 0 System capacity and infrastructure presence of absence of adequate health care services planning or prevention functions 0 Socioeconomic conditions nature of the economy and its relationship to the global economic system and the impact of this context on social factors which in turn affect health conditions and system capacity 0 Political conditions the presence of instability or con ict or at worst armed con ict and civil war such conditions are devastating for health and for the ability of health systems to function 0 Social patterns and cultural traditions impact health and health behavior by social stratification by class raceethnicity caste designations or any other grouping and determines the kinds of health care people have access to 19 20 Describe and recognize examples of groups of people who are considered at high risk or vulnerable e g migrant workers runaway youth etc 0 Migrant workers who do not speak English and have limited or no access to health care 0 Youth from highcrime communities and histories of family dysfunction 0 Rural populations with few sources of employment lack of income low educational levels and limited access to health care 0 Runaway youth and youth who drop out of school Adults returning from prison 0 Urban highpoverty communities with few income sources other than illegal or street economic activity 0 People involved in the sex trade or heavy drug use 0 People from historically excluded or marginalized communities e g sexual minorities 21 Describe what is meant by a harm reduction approach 0 Meets people where they are focusing on the reduction of key health impacts 0 resulting from behavior while not being judgmental about the person as a whole 0 Is effective in reducing for example HIV transmission among injection drug users and between injection users and sexual partners 0 The basic idea behind harm reduction is that many highrisk individual have multiple problems and difficult situation in their lives and they may not be able to change all of these things at least in the short term 0 Harm reduction focuses on specific behaviors that pose the greatest public health threat while in the short term not judging or focusing on other behaviors the person may engage in that are also risky or unhealthy Final Exam Readings 0 Edberg chapters 8 101213 14 FINAL EXAM STUDY GUIDE EXAM 1 MATERIAL 1 Understand rationale for focusing on health behaviors in public health and health promotion a There has been a huge shift in the past 100 years from infectious disease to chronic diseases b This is mainly caused by people39s behaviors and choices c This is why it is so important to try to intervene within specific behaviors so that we can change to promote healthy new behaviors 2 Have a good understanding of the types of factors in uencing development of diseases and chronic conditions a Social determinants of health SDH conditions in which people are born grow live work and age i Genes and biology physical environment clinical care social and economic factors health behaviors 1 Biggest determinants of health are social and economic factors 40 and health behaviors 30 a VFquot quotF Q 139 F PHPP Career pressures Sedentary lifestyles High density population living Poor diet Crime Drugs Gangs Poverty Pollution Fear Stress Economic struggles 3 Understand trends in important diseases in US over past 100 years or so a Current leading causes of death in the US i Heart disease ii Cancer iii Chronic lower respiratory diseases iv Stroke b Diseases such as TB and pneumonia have drastically decreased over the past 100 years but diseases such as cancer and heart disease have drastically increased c A huge shift from infectious diseases to chronic diseases as leading causes of death d Many of the leading causes of death are caused by things that we have control OVCI i The diseases are affected by the choices that we make ii Individuals are largely in control of their own health problems 4 Be able to identify settings for health education and health promotion programs a Hospitals b Clinics c Schools d Fitness centers e Workplace 5 Understand dimensions along which target audiences can be defined e g sociodemographic characteristics etc a Sociodemographic characteristics age gender etc b Race and ethnicity c Life cycle stage d Disease or at risk status 6 Be able to define and recognize examples of health behaviors and things that are not health behaviors a Health behaviors actions of individuals groups organizations as well as their determinants correlates and consequences 7 Be able to define and recognize key attributes of theory e g abstract in nature a Theory set of interrelated concepts definitions and propositions that present systematic view of events or situations by specifying relations among variables in order to explain and predict the events or situations b Terminology i Concepts building blocks of theories ii Constructs concepts used in specific theories iii Variables operational forms of constructs define the way a construct is to be measured in a specific situation iv Models may draw on the number of theories to help understand problems in a specific setting or context aren39t always as specific as theories 8 Why is behavior theory important a They provide a general explanation of why people do or do not act to maintain their own health b Allows researchers to investigate why who what and how c Provide us a roadmap so that we can answer why who what and how 9 Three phases of health promotion during which theory is used e g planning a Implementing b Evaluating programs and interventions c Explaining behavior and suggest specific ways in which behavior change can be accomplished 10 Be able to recognize the three types of studies in which behavioral theories are used or tested e g measurement etc a Measurement testing theoretical constructs b Observational examining determinants of behaviors such as PA diet tobacco use c Intervention guiding strategy development 11 Be able to understand that there are multiple levels of in uence on health behaviors some of which may not be motivated or in uenced by health concerns For example health behavior may be in uenced by social or personal goals that have nothing to do with health a Social or personal goals Socioeconomic circumstances Environmental conditions Public policies and regulations Ecological Model i Two key points 1 Behavior is affected by and affects multiple levels of in uence 9906 a Individuals39 choices are thought to be in uenced by one39s previous experiences other people social norms and environments at work schools communities etc 2 Possibility of reciprocal causation a Environmental factors affect individuals and groups but they can also in uence their environment to regulate their own behavior ii Multiple interventions or strategies at multiple levels are often needed to initiate and sustain behavior change iii If many factors shape and motivate behavior as it relates to health we can say that for any given health issue that there is an ecology of behavior iv Behavioral ecology might include factors 1 Close to individual intrapersonal 2 Related to social groups interpersonal 3 Related to community society and culture physical environment v For each of the ecological levels there are theories that correspond 12 Be able to understand how to apply social ecologicalecological models to obesity physical activity and violence and recognize examples of factors that might affect these outcomes at the individual social and environmental levels a Obesity example i Individual factors I genetics food preferences attitudes and beliefs knowledge about risk ii Social factors I interpersonal processes social relationships social status and connection to diet iii Cultural factors I shared beliefs or values related to food images of ideal body social role of eating iv Environmental factors I encourage overconsumption of food discourage physical activity availabilitycost of healthy food or exercise options 13 Be able to define recognize examples of conceptual models and be able to distinguish conceptual models from theory a Conceptual model diagram of proposed causal linkages among set of concepts believed to be related to a public health problem b Different from a theory i Not concerned with global classes of behavior but with specific behaviors in specific contexts 0 You would develop a conceptual model for a specific health behavior or health related outcome 0 Cure Violence Cease Fire 0 Effective broad community approach to preventing and reducing gang violence 0 Approaches violence as an infectious disease 0 Tries to interrupt the next event the next transmission or next violent activity 0 Targets a small population I members of the community with a high chance of being shot or being shooters in the near future 10 0 Uses a threeprong approach I Detection and interruption where to concentrate efforts focus resources and intervene in violence identifies communities most impacted and provides a picture of those individuals at the highest risk for violence I Behavior change intervenes in crises mediates disputes between individuals and intercedes in group disputes to prevent violent events counsel clients I Changing community norm works to change the thinking on violence at the community level and for society at large through the use of public education communitybuilding activities and motivational interviewing with the highest risk 0 Decision alternatives I Wanted to provide situation specific alternatives to shooting I Violence interrupters and changing community norms I Promoted truces and negotiated I Harm reduction was seen as a successful outcome 0 Norm change I Defined range of behavior that is normally acceptable and drew some limits outside of which people are not supposed to stray I Encourage local debates over what people will and won39t accept I Marches rallies prayer vigils 0 Risk and cost enhancement I Incarceration injury and death I Emphasized the social risks of involvement I potential impact of violence on the families and other gang members I Posits that shooting will be reduced through more widespread realization of the direct human costs of violence 14 Understand relevance of context even when using individuallevel health behavior theories such as the health belief model discussed during HBM lecture a Important to still remember context b Example i An adolescent39s decision to have sex is likely to be in uenced by the cues they receive from other young people in their social circle at school in their neighborhood etc 15 Understand history behind the development of the health belief model HBM for example developed by social psychologists trying to understand why individuals did not participate in certain type of screening a People will engage in healthy behavior if they value the outcome related to the behavior being healthy and if they think that the behavior is likely to result in that outcome b Oldest of the individual behavioral theories and most widely used c A TB screening station was set up and was free but not many people came i This is how this theory was developed 11 d Based on motivation of the individuals 16 Be able to define what is meant by valueexpectancy theory discussed in HBM lecture a Refers to the assumption that people will engage in healthy behavior if i They value the outcome being healthy related to the behavior ii They think the behavior is likely to result in that outcome 17 Be able to define key constructs within HBM recognize examples of those constructs and understand how constructs work together to predict someone engaging in certain health behavior a CONSTRUCTS i Perceived susceptibility ii Perceived severity iii Perceived benefits of an action iv Perceived barriers to taking that action v Cues to action were needed as direct motivation vi Selfefficacy a persons belief in his or her ability to take the action b Using the following example i She thinks she is susceptible to the specific health problem the behavior will prevent believes she is potentially at risk ii She thinks that the health problem is severe if she gets it there will be severe consequences iii She thinks that taking preventative action will do some good perceived benefits in taking that good action iv She thinks that there aren39t too many negative consequences if she takes that action the perceived barriers are low v Something happens that gives her a push to act a friend is diagnosed with the disease she sees something on TV about it etc vi She believes she is capable of taking the action she has the skills will etc to do it c In order to make it successful don39t just go by the constructs i Must do research and target your program the theory and the people you are trying to help ii These theories are tools guidelines and frameworks to help you develop an effective program Tweak the theory to reach your target population 19 Be able to define and recognize examples of positive reinforcement negative reinforcement and punishment Dr Hyner s lecture 20 Be able to define and recognize examples of key constructs within TTM a For each stage of the model different things are going on and different behavioral theories are applicable by stage i If someone is in the decision making stage TPB or HBM might be applicable b STAGES 12 i Precontemplation person does not intend to take action don39t know there is a problem with what they are doing want to increase awareness of need for change and concern about current pattern of behavior amp envision possibility of change ii Contemplation person is thinking about changing sometime in the future weighing pros and cons can take some time not yet ready to take action decisional balance weighing pros and cons careful evaluation that leads to a decision to change amp decisionmaking iii Preparation person is ready to do something and intends to change intend to act soon and have some kind of plan or idea about what they want to do use programs that provide action steps in this stage want to increase commitment and create change plan that is acceptable accessible and effective iv Action person has taken action recently towards a change want to implement strategies for change revise plan as needed and sustain commitment in face of difficulties v Maintenance person has made a significant change in their behavior in terms of health risk and is now focused on keeping that behavior change going requires serious work want to sustain change over time and across a wide range of difficult situations vi Termination person in this stage has completed the process of behavior change bad habit is no longer a part of person39s behavior anymore not typical to get to this stage most people stay in maintenance stage key construct in this stage is the issue of selfefficacy in maintenance stage people are developing their selfefficacy and when they reach termination they HAVE full selfefficacy 21 Be able to recognize a person s stage of change if given a specific survey item see surveys reviewed in class a Do you exercise regularly according to this definition i Yes I have been for MORE than 6 months ii Yes I have been for LESS than 6 months iii No but I intend to in the next 30 days iv No but I intend to in the next 6 months v No and I do NOT intend to in the next 6 months 22 Be able to define and recognize examples of the 10 cognitive and behavioral processes of change understand the stages at which certain processes of change are more relevant For example consciousnessraising is most relevant for people who are in precontemplation a Consciousness raising increased awareness about causes consequences and cures for problem behavior use feedback confrontations and media campaigns precontemplation b Dramatic relief produces heightened emotions followed by reduced affect or anticipated relief if person takes action roleplaying personal testimonies health risk feedback media campaigns precontemplation 13 c Selfreevaluation assessment of one39s selfimage with and without an unhealthy behavior such as one39s image as couch potato and active person clarification having healthy role models guided imagery contemplation d Environmental reevaluation affective and cognitive assessment of how the absence or presence of one39s behavior affects others such as the impact of one39s smoking on others documentaries testimonials family interventions precontemplation e Selfliberation belief one can change and commitment to change new year39s resolutions and public testimonies preparation f Helping relationships building caring trust support with others as a way to support behavior change counselor calls buddy systems preparation g Counterconditioning learning healthier behaviors that can replace unhealthy ones relaxation nicotine replacement positive selfstatements preparation h Reinforcement or contingency management provide positive consequences for taking steps toward behavior change incentives group recognition actionmaintenance i Stimulus control removing cues for unhealthy behaviors and adds prompts for healthier alternatives avoidance environmental reengineering and self help groups actionmaintenance j Social liberation requires increase in social opportunities or alternatives important for those who are deprived or depressed advocacy empowerment techniques and healthful policies precontemplation Exam 1 Readings 0 Edberg chapters 1 23 parts of 4 HBM FINAL EXAM STUDY GUIDE EXAM 2 MATERIAL 1 Identify the levels TRA TPB and social cognitive theories operate at e g individual interpersonal a TRA and TPB are individual b Social cognitive theories are interpersonal 2 Define and be able to identify examples of key constructs within theory of reasoned action TRA theory of planned behavior TPB and social cognitive theory a TRA constructs i Attitudes and components behavioral beliefs evaluationvalue placed on outcome ii Subjective norms and components normative beliefs and motivation to comply iii Behavioral intention b TPB constructs 14 i All of the TRA constructs and perceived behavioral control and components control beliefs and perceived power c Social cognitive theory i ii iii iv Reciprocal determinism continuous interaction among characteristics of a person behavior of that person and the environment in which the behavior is performed can39t just target the individual for change but have to target environment as well 1 Hard to test the validity of this 2 Not been empirically evaluated Outcome expectations person learns that certain events are likely to occur in response to behavior in certain situations and then expects them to occur when that situation occurs 1 Ex Youth learn to expect from others that smoking can be fun or exciting or that they will look grown up from engaging in that behavior 2 In order to make this positive in an intervention you should model positive outcomes of health behavior 3 Learned four ways a Previous experience b Observing others vicarious learning c Hearing about the situations from other people d Emotional or physical responses to behaviors Selfefficacy and collective efficacy confidence a person feels to perform a specific activity or to overcome barriers to engage in behavior beliefs about ability of a group to perform certain actions that will bring desired outcomes 1 Approach behavior in small steps to ensure success 2 Be very specific about behavior changes that are sought 3 Four areas of in uence a Mastery experience engaging in an activity and interpreting the results experience of performance mastery is strongest in uence on selfefficacy belief b Vicarious experience of social modeling important to those who have doubts about their ability or have limited experience trying to do so good situation to use modeling so people can see that others like them can do the task c Physiological states both physical and emotional your moods can in uence your confidence level in a certain task d Social persuasion or verbal persuasion occurs when we hear others make comments regarding our behaviors you can do it Observational learning vicarious learning more efficient than operant individual observes others engaging in the behavior and can see rewards and penalties involved Selfregulationselfcontrol personal regulation of goal directed behavior or performance 15 1 Six ways to achieve it a Selfmonitoring systematic observation of one39s behavior Goal setting incremental changes Feedback getting info about quality of one39s performance Selfreward providing rewards to yourself Selfinstruction talking yourself through complex behavior f Enlisting social support vi Incentive motivation through the provision of rewards or punishments for desiredundesired behaviors 1 Ex Laws have punitive or unintended effects and taxes that can deter the onset of tobacco use vii Facilitation provision of resources and recognizes the environmental barriers to behavior change 1 Provision of free condoms as part of an HIV risk reduction program viii Moral engagement people disengage from selfregulatory moral standards by thinking about harmful behaviors and the people who would be harmed in ways that make these behaviors acceptable 1 Can in uence people in terms of using aggression or committing corporate transgressions Differentiate between TRA and TPB what is different about these two theories a TPB added in perceived behavioral control i Addresses the degree to which someone believes they have control over whether they can take the action and the strength of that belief Describe or recognize how the constructs within TRA and TPB are linked together to predict health behaviors might help to refer to diagrams in Powerpoints Know what is the strongest or most proximal predictor of behavior within the TRA and TPB a Behavioral intention Definition and examples of referents what s the relevant theoretical construct a Based off of subjective norm which is a construct of TPB and TRA b Referents are the significant people in one39s life that in uence someone to decide whether or not they should or shouldn39t perform a behavior i Normative beliefs beliefs regarding whether important referents approve or disapprove of performing the behavior ii Motivation to comply person39s motivation to comply with particular referents Define Healthy People 2020 What is it What is it used for a Definition set of goals and objectives with 10year targets designed to guide national health promotion and disease prevention efforts to improve the health of all people in the US b 5 main missions i Identify nationwide health improvement priorities ii Increase public awareness and understanding of determinants of health disease and disability and the opportunities for progress 9906 16 C iii Provide measureable objectives and goals that are applicable at the national state and local levels iv Engage multiple sectors to take actions to strengthen policies and improve practices that are driven by the best available evidence and knowledge v Identify critical research evaluation and data collection needs Organized into 42 topic areas with corresponding objectives i Ex increase routine vaccination coverage levels for adolescents by giving 3 doses of HPV vaccine for females by age 13 to 15 years of age 8 Define environment and situation and be able to describe how the constructs incentive motivation and facilitation are environmental factors that can in uence behaviors a b c Environment objective factors external to person that can affect behavior Situation person39s perception of environment Incentive motivation involves punishment or rewards to reinforce or inhibit desired or undesired behaviors laws with high taxes on alcohol and tobacco Facilitation involves providing of resources that enable behavior or make them easier to perform I recognizes the environmental barriers to behavior change providing free condoms as part of HIV risk program 9 Understand be able to recognize different types of intervention strategies based on SCT constructs e g strategies to increase selfefficacy 10 If given a specific survey item see surveys reviewed in class and in your readings be able to recognize what construct a scale has been designed to measure e g to determine Attitudes towards vaccinating daughters who were 915 years old mothers were asked whether HPV 9 639 vaccinating is necessary 1s a good idea and is beneficial Exam 2 Readings Relevant sections of Edberg include parts of chapters 4 and 5 e g on TRA TPB and social cognitive theory Askelson N M Campo S Lowe J B Dennis L K Smith S amp Andsager J 2010 Factors Related to Physicians39 Willingness to Vaccinate Girls Against HPV The Importance of Subjective Norms and Perceived Behavioral Control Women amp Health 502 144158 a 0909 Type of study observational Setting rural Midwest Iowa Overall health problem HPV Focus behavior vaccinate Constructs i To assess attitudes didn39t in uence intentions I asked if it was a good idea beneficial and protected women from cervical cancer ii To assess subjective norms important I asking about physician willingness to adhere to the Advisory Committee on Immunization Practices most people who are important to me think I should vaccinate according to the recommendations it is expected of me that I will vaccinate against HPV 17 according to the recommendations the people in my profession whose opinions I value would want me to vaccinate patients according to the recommendations iii To assess perceived behavioral control important I asked physicians if vaccinating patients was impossible whether it was up to them to vaccinate if the cost prevented physicians from vaccinating and if parents prevent physicians from vaccinating iv High rates of intention were found f Target population physicians practicing medicine in the states family practice physicians general practice physicians and pediatricians 0 Askelson N M Campo S Lowe J B Smith S Dennis L K amp Andsager J 2010 Using the theory of planned behavior to predict mothers intentions to vaccinate their daughters against HPV The Journal of School Nursing 263 194202 a Type of study observational Setting rural Midwest state Overall health problem HPV Focus behavior vaccinate Constructs given on a Likert 7point scale format 7 being most favorable i To assess intention I asked how likely they were to have their 915 year old daughter vaccinated and at what age they would vaccinate ii To assess subjective norms important I asked to rate how much they agreed with each statement most people who are important to me think I should vaccinate my daughter it is expected of me that I will vaccinate my daughter the people in my life whose opinions I value would want me to vaccinate my daughter iii To assess attitude important I asked whether vaccinating is necessary good idea and is beneficial iv To assess perceived behavioral control didn39t in uence intentions for me vaccinating my daughter against HPV is possible if I wanted to get my daughter vaccinated in the next 6 months it would be easy how much control do you have over your daughter to get vaccinated it is mostly up to me whether or not my daughter gets vaccinated the cost is a barrier to my daughter getting vaccinated f Target population mother39s who had daughters between 915 wanted to figure out their intentions to vaccinate their daughters 9906 FINAL EXAM STUDY GUIDE EXAM 3 MATERIAL 1 Define social integration social network social support social capital 0 Social integration refers to the existence of social ties 0 Social networks linkages between people which may or may not provide support a personcentered web of social relationships 18 Social support functional content of relationships that can be categorized into four broad types of supportive behaviors or acts Social capital expected collective or economic benefits derived from the preferential treatment and cooperation between individuals and groups 2 Understand differences between social networks and social support 0 O 0 Social network can incorporate important concepts other than just social support Social networks allow researchers to examine how changes in one relationship affect other relationships Social networks allow examination of how structural and interactional characteristics of network in uence provision of social support 3 Define 4 dyadic characteristics e g reciprocity of social networks and recognize examplesillustrations of those characteristics 0 O O O Reciprocity extent to which resources and support given and received in a relationship Intensity or strength extent to which social relationships offer emotional closeness Complexity extent to which relationship serve many functions Formality extent to which relationship is embedded in formal institutional or organizational structure 4 Define and recognize examples of 3 overall characteristics e g density of social networks 0 O 0 Density extent to which members know and interact with each other Homogeneity extent to which members are similar in terms of demographic characteristics Geographic dispersion extent to which members live close to focal person in network 5 Define and recognize examples of 4 types of social support eg emotional O O O O Emotional involves the provision of empathy love trust and caring Instrumental involves the provision of tangible aid and services that directly assist a person in need Informational involves the provision of advice suggestions and information that a person can use to address problems Appraisal involves the provision of information that is useful for self evaluation purposes constructive feedback and affirmation 6 Recognize 3 defining characteristics of social support 0 O 0 Always intended to be helpful Consciously provided by sender Provided in context of caring trust and respect for individual39s free choice 7 Define and recognize examples of 4 types of social network interventions 19 0 Enhancing existing social networks I Methods Training network members in skills for providing support Training focal individual in mobilizing and maintaining social networks Systems approach ex marital counseling family therapy I Challenges Identifying those willing to provide support and who can sustain support overtime Identifying the changes in attitudes and behaviors that will result in increased perceived support on the part of the support recipient Intervening in ways that are consistent with established norms and styles of that social network 0 Developing new social network linkages I Methods Creating linkages to mentors Develop buddy systems Facilitate selfhelp groups I Challenges New forms of support networks ex little is known about the key components of Internet support groups and for whom and under what circumstances they can have healthpromoting effects 0 Enhancing networks through indigenous helpers I Methods Identify natural helpers or Community Health Workers CHWs Analysis of natural helpers39 existing social networks Train individuals in health topics and community problemsolving strategies I Challenges If you don39t have the community39s support in identifying these natural helpers it will be difficult to carry out the intervention 0 Enhancing networks at the community level through participatory problem solving I Methods Identify overlap of networks within the community Examine social network characteristics of members of the selected needtarget area Facilitate ongoing community problem identification and problem solving I Challenges If the community is very heterogeneous and unengaged there may be challenges around initiating engagement 2O 8 Understand community mobilization and recognize the key issues in creating community level 0 Community mobilization involve collective action by groups and community members to increase awareness about the problem advocate for policy change and engage in other activities to address the ecology of a health problem 0 Key issues I Defining the community I Assessing and working with the community39s capacity for mobilizing I Understanding the community agenda and selecting the right issue 9 Understand organizational amp system change and recognize the key issues in creating organizationallevel 0 Organizational and system change philosophy and an approach to organizational change that view organizations as systems of human beings improves the capability of organizations and systems to respond to health issues through a change process that focuses on several steps 0 Key issues I Assessing and improving group dynamics within the organization system the way people work together I Encouraging shared goals and missions I Identifying organizational impediments to change and unfreezing the organization or system to make changes I Involving the organization or system in identifying and implementing new policies and practices 10 Define different ecological model levels e g individual social environment physical environment policy environment and be able to recognize examples of strategies which bring change at each level 0 Microsystem refers to the immediate environment in which a person is operating dynamic system in which the person is affected and in turn affects the environment ex family classroom peer group neighborhood 0 Mesosystem refers to the interaction of two microsystem environments ex family affecting an adolescent39s peer group 0 Exosystem refers to aspects of the environment in which an individual is not directly involved which is external to his or her experience but nonetheless affects him or her ex parents39 workplace economic state of the community parents39 marriage 0 Macrosystem refers to the larger cultural context including issues of cultural values and expectations in which the other systems function ex values laws resources customs of a particular culture 0 Chronosystem the factor of time added to the other system levels 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 21 11 Understand rationale for using an ecological model 0 O O 0 Changing human behavior is difficult Human behavior is in uenced by multiple factors Ecological model helps to identify opportunities to promote health by impacting the various factors and levels involved Behavior change is more likely to be successful and sustained When multiple levels of in uence are addressed at the same time 12 Define and recognize examples of ecological models 13 Apply ecological models to promotion of physical activity 0 0000000 Comprehensive school health education Physical education School health services School nutrition services School counseling psychological and social services Healthy school environment Schoolsite health promotion for staff Family and community involvement in school health 14 Define innovation diffusion innovation development dissemination adoption 0 O 0 Innovation an idea practice or object that is perceived as new by an individual or other unit of adoption Diffusion the overall spread of an innovation the process by Which an innovation is communicated through certain channels over time among the members of a social system an outcome of dissemination Innovation development all the decisions and activities that occur from the early stage of an idea to its development and production Dissemination active knowledge transfer from the resource system to the user system planned systematic efforts designed to make a program or innovation more Widely available Adoption the update of the behavior or technology by the intended audience 15 Define and recognize examples of the 12 factors that describe innovation product attributes characteristics e g relative advantage 0 O O O O O 0 Relative advantage is innovation better than What it Will replace Compatibility does innovation fit With the intended audience Complexibility is the innovation easy to use Trialability can the innovation be tried before making the decision to adopt Observability are the results of the innovation observable and easily measureable Effect on social relations does the innovation have a disruptive effect on the social environment Reversibility can the innovation be reversed or discontinued easily 22 OO O O Communicability can the innovation be understood clearly and easily Time can the innovation be adopted With a minimal investment of time Risk and uncertainty level can the innovation be adopted With minimal risk and uncertainty Commitment can the innovation be used effectively With only modest commitment Modifiability can the innovation be modified and updated over time 16 Define and recognize 5 categories of adopters e g from innovators to laggards O Innovators I Venturesome I Seekers of information from outside I Able to understand complex issues I Able to cope With uncertainty I Can accept setbacks I Substantial financial resources I Cosmopolitan welltraveled wellinformed I May be seen as different not usually sought out for their opinions Early adopters I Respected I Well integrated into local social system I Opinion leadersrole models I Make judicious innovation decisions I Decrease uncertainty about new ideas by adopting it and evaluating it I Use interpersonal networks Early majority adopters I Deliberate I Interact frequently With peers I Not opinion leaders but important link in system I Willing but not leading I Large proportion of people Late majority adopters I Skeptical I Cautious I Uncomfortable With uncertainty I Require convincing costeffectiveness I Peer pressure is necessary to convince them I Large proportion Laggards I Traditional I Most local in outlook may be nearly isolated I Interact With others like themselves I Refer to past for guidance 23 I May rationalize delaying I Suspicious of innovations and change I Precarious economic position 17 Know defining features of social marketing e g exchange theory etc 0 Exchange theory views consumers acting primarily out of self interest as they seek ways to optimize value by doing what gives them the greatest benefit for the least cost Audience segmentation refers to the segmentation of a target population into meaningful subgroups so that messages and campaigns can be appropriately channeled Targeting the process of developing campaigns closely tailored to the needs attitudes beliefs and behaviors of specific market segments Competition the behavioral options that compete with public health recommendations and services ex bottle feeding vs breast feeding The marketing mix aka the Four P39s product price place promotion Consumer orientation marketing39s conceptual framework demands a steadfast commitment to understanding consumers the people whose behavior we hope to change Continuous monitoring plans for evaluating and monitoring a social marketing intervention begin at the outset of the planning process 18 Social marketing and the HeartTruth Campaign 0 Goals I Raise awareness that heart disease is the number one killer I Increase awareness of the risk factors I Urge women to talk to their doctor Target audience I Women ages 4060 I At least one risk factor I Are not currently taking action Secondary audience I Women ages 1839 I Health care professionals Red dress I National symbol for women and heart disease awareness I quotheart disease doesn39t care what you wear it39s the number 1 killer of womenquot The heart truth 19 Define and recognize examples of the marketing mix the 4 P s e g product etc 0 Product the behavior or technology you are offering its benefits 24 Price for the target population the costs involved in adopting a behavior or using a technology Place how you distribute or make the behavior or technology easily available to the target population issues of access and availability Promotion how you promote or make the target population aware of the previous three elements 20 Recognize critiques of social networks diffusion of innovation social marketing and ecological models 0 O 0 Social networks limited theory and approach and useful for small group interventions labor intensive and can be difficult Diffusion of innovation same as social marketing Social marketing assessing the impact of a social marketing campaign may be difficult because if a behavior change is the goal tracking exposure to the campaigns for those exposed and assessing the degree to which behaviors or attitudes have changed is not always easy Ecological models complex Exam 3 Readings and other materials 0 Chapters 567 of Edberg textbook 0 Grier S Bryant S 2005 quotSocial marketing in public healthquot Annual Review of Public Health Vol 26 pp31939 a VERB program encourages people ages 913 to be physically active everyday b Road Crew reduce alcohol related car crashses in 2134 year old men in Wisconsin driving service c Texas WIC program conducted to increase enrollment and improve customer and employee satisfaction with the special supplemental nutrition program for women infants and children d Food trust increases demand for healthy snacks promote student participation in school meal programs and target food industry to increase availability of healthier choices in local stores 0 The HeartTruth Campaign pdf 25
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