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Social and Behavioral theories & public health

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why is theory important to health promotion and health behavior practice?
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they help maintain and improve health, reduce disease risks, and manage chronic diseases can also lead to successes in behavior change
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what is theory?
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a set of concepts, constructs, definitions, and propositions that help explain and predict events or situations by illustrating relationships between variables
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How can theory help plan effective programs?
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theories help planners look at the bigger picture and develop unique, tailored solutions to problems like interventions and evaluating their successes answers \”why, what, and how\” of health problems helps identify most suitable target audiences, methods for fostering change, and outcomes for evaluation
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Explanatory theory
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describes why a problem exists HBM, TPB, PAPM
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Change theory
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guides the development of interventions diffusion of innovations
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why are culture and ethnicity critical to consider when applying theory to a health problem?
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1. morbidity and morality rates vary by race and ethnicity 2. differences in prevalence of risk behavior 3. determinants of health behaviors vary
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ecological perspective
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highlights people’s interactions with their physical and social-cultural environments 1. behavior affects and is affected by multiple levels of influences 2. individual behavior shapes and is shaped by the social environment
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ecological perspective: influences
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intrapersonal factors interpersonal factors organizational factors community factors public policy factors
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Intrapersonal factors
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Individual characteristics that influence behavior, such as knowledge, attitudes, beliefs, and personality traits
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Interpersonal factors
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Interpersonal processes and primary groups, including family, friends, and peers that provide social identity, support, and role definition
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Organizational factors
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Rules, regulations, policies, and informal structures, which may constrain or promote recommended behaviors
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Community factors
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Social networks and norms, or standards, which exist as formal or informal among individuals, groups, and organizations
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Public policies
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Local, state, and federal policies and laws that regulate or support healthy actions and practices for disease prevention, early detection, control, and management
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Individual and Interpersonal theory key concepts
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behavior is mediated by cognition knowledge is necessary for most behavior change perceptions, motivations, skills, and social environment influences on behavior
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Health Belief Model
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addresses people’s beliefs about whether or not they susceptible to disease, and their perceptions of the benefits of trying to avoid it, influenced their readiness to act
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Health Belief Model 6 constructs
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Perceived susceptibility: belief that they are susceptible to a condition perceived severity: belief that the condition has serious consequences perceived benefits: belief that taking action would reduce their susceptibility or severity perceived barriers: belief that cost of taking action outweighs the benefits cues to action: exposed to factors that prompt action self-efficacy: confidence to perform an action
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Transtheoretical Model/Stages of Change
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describes individuals’ motivation and readiness to change a behavior behavior change is a process, not an event easy to relapse at any stage
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Transtheoretical Model 5 stages
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Precontemplation: no intention of taking action Contemplation: intends to take action Preparation: intends to take action and develops concrete action plans Action: has changed behavior; social support and reinforcement maintenance: has maintained this changed behavior; avoiding relapses
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Theory of Planned Behavior/Theory of Reasoned Action
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explore the relationship between behavior and beliefs, attitudes, and intentions. behavioral intention is the most important determinant of behavior.
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TPB/TRA key concepts
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Behavioral intention: Perceived likelihood of performing behavior Attitude: Personal evaluation of the behavior Subjective norm: Beliefs about whether key people approve or disapprove of the behavior; motivation to behave in a way that gains their approval Perceived behavioral control:Belief that one has, and can exercise, control over performing the behavior **only in TPB
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What is the difference between TPB and TRA?
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TPB includes an additional construct, perceived behavioral control; this construct has to do with people’s beliefs that they can controla particular behavior
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Precaution Adoption Process Model
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names seven stages in an individual’s journey from awareness to action. It begins with lack of awareness and advances through subsequent stages of becoming aware, deciding whether or not to act, acting, and maintaining the behavior.
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PAPM 7 stages
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1. Unaware of issue 2. unengaged by issue 3. deciding about acting 4. decided not to act 5. decided to act 6. acting 7. maintenance
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Interpersonal level theory concepts
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assume individuals exist within, and are influenced by, a social environment. The opinions, thoughts, behavior, advice, and support of the people surrounding an individual influence his or her feelings and behavior, and the individual has a reciprocal effect on those people.
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Social Cognitive Theory
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describes a dynamic, ongoing process in which personal factors, environmental factors, and human behavior exert influence upon each other
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SCT 3 main factors that can affect the likelihood that a person will change a behavior
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self-efficacy** goals outcome expectancies
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SCT 6 concepts
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1. reciprocal determinism: interaction of the person, behavior, and the environment in which the behavior is performed 2. behavioral capability: Knowledge and skill to perform a given behavior 3. expectations: Anticipated outcomes of a behavior 4. self-efficacy: Confidence in one’s ability to take action and overcome barriers 5. observational learning: Behavioral acquisition that occurs by watching the actions and outcomes of others’ behavior 6. reinforcements: Responses to a person’s behavior that increase or decrease the likelihood of reoccurrence
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Community level models
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explore how social systems function and change and how to mobilize community members and organizations. They offer strategies that work in a variety of settings, such as health care institutions, schools, worksites, community groups, and government agencies.
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Diffusion of Innovations Theory
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addresses how ideas, products, and social practices that are perceived as \”new\” spread throughout a society or from one society to another.
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DOI 4 concepts
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1. innovation: An idea, object, or practice that is thought to be new by an individual, organization, or community 2. communication channels: The means of transmitting the new idea from one person to another 3. Social system: A group of individuals who together adopt the innovation 4. Time: How long it takes to adopt the innovation
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Communication theory
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explores \”who says what, in which channels, to whom, and with what effects.\” It investigates how messages are created, transmitted, received, and assimilated.
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Planning Models
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help practitioners develop programs step by step, integrating multiple theories to explain and address health problems
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Social Marketing
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uses marketing techniques to influence the voluntary behavior of target audience members for health benefit
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the 4 P’s of social marketing
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Product (the right kind of behavioral change) includes not only the behavior that is being promoted, but also the benefits that go along with it. • Price (an exchange of benefits and costs) refers to barriers or costs involved in adopting the behavior (e.g., money, time, effort). • Place (making new behaviors easy to do) is about making the \”product\” accessible and convenient. It means delivering benefits in the right place at the right time. • Promotion (delivering the message to the audience) is how the practitioner notifies the target market of the product, as well as its benefits, reasonable cost, and convenience.
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PRECEDE-PROCEED model
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It does not predict or explain factors linked to the outcomes of interest, but offers a framework for identifying intervention strategies to address these factors. an \”educational diagnosis\” (PRECEDE) and an \”ecological diagnosis\” (PROCEED
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PRECEDE
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acronym stands for Predisposing, Reinforcing, Enabling Constructs in Educational/ Environmental Diagnosis and Evaluation an educational diagnosis is needed to design a health promotion intervention, just as a medical diagnosis is needed to design a treatment plan.
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PROCEED
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stands for Policy, Regulatory, and Organizational Constructs in Educational and Environmental Development. to take into account the impact of environmental factors on health
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PRECEDE steps
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(1) social assessment: data collection like surveys (2) epidemiological assessment: secondary data analysis or original data collection (3) behavioral and environmental assessment:internal and external factor identification (4) educational and ecological assessment: identifies antecedent and reinforcing factors that must be in place to initiate and sustain change (5) administrative and policy assessment: information gathered in previous steps; the availability of needed resources; and organizational policies and regulations that could affect program implementation
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PROCEED steps
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(6) implementation: prepare plans for evaluating the process (7) process evaluation: gauges the extent to which a program is being carried out according to plan (8) impact evaluation: looks at changes in factors (i.e., predisposing, enabling, and reinforcing factors) that influence the likelihood that behavioral and environmental change will occur. (9) outcome evaluation: looks at whether the intervention has affected health and quality-of-life indicators.