Pekka puska combining medical and social behavioural theories to devolop strategies for prevention...
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Prof Pekka Puska
Ex Director General
National Institute for Health and Welfare (THL)
Finland
Combining medical and social
behavioural theories to develop
strategies for prevention and health
promotion
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medical
epidemiological
framework
Social
behavioural
framework
GENERAL GOAL
- Improved Public Health
MAIN OBJECTIVES
- Specific NCDs, health outcomes
INTERMEDIATE OBJECTIVES
- risk factors, behaviours
PRACTICAL INTERVENTION
PROGRAMME
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“Nothing is so practical
as a good theory”
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Major behavioral and social
theoretical perspectives
(used e.g. in North Karelia Project, Finland)
1. Social marketing Marketing
2. Behavior - modification (Social) Psychology
3. Communication - behavior change Communication
4. Innovation - diffusion Sociology
5. Community organization Social policy
Theory Discipline area
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I. SOCIAL MARKETING
Background: Large experience and practice of
commercial marketing (of various products)
Question: Should we not market health in the same
way?
Yes: We should apply as much as possible the good
principles of marketing:
• associating the message with emotional issues
• sequencing the target audience
• pre-testing etc
Problem: Marketing health issues is a more
profound task than marketing choice of certain
products
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II. BEHAVIOUR MODIFICATION
6. COMMUNITYORGANIZATION
5. ENVIRONMENTAL SUPPORT
4. SOCIAL SUPPORT
3. PRACTICAL SKILLS
2. PERSUASION
1. KNOWLEDGE
(Puska and McAlister)
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1. Increased health knowledge
• simple message
• practical advise
• check understanding
• several channels
• personal contacts
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2. Persuasion
• credible message source
• attention to emotional aspects
• anticipate counter arguments
• achievable goals
• positive goals, minimize fear
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3. Training for practical skills
• demonstration of desired
behaviours
• guided practice
• feed-back
• positive reinforcement
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- family
- work-site groups
- establishment of therapeutic
groups:
weight reduction etc
4. Social support
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5. Environmental modification
• food-industry
• food marketing
• restaurants, canteens etc
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6. Community organization
- general support in the community
for the desired goals
- formal decision making: political
leaders, health authorities, school
authorities etc
- other formal leaders: business,
mass media etc
- informal opinion leaders
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III. COMMUNICATION - BEHAVIOUR
CHANGE
• Mass communication can reach large
masses
• Historical development:
- early enthusiasm
- empirical nihilism
- balanced view
• Generally mass communication
reinforces existing attitudes and behaviours
1.
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III. COMMUNICATION - BEHAVIOUR
CHANGE
• Well designed mass communication,
combined with relevant field work can have
meaningful impact
• Mass communication should be combined
with practical work in the community,
promoting interpersonal interaction
• Small relative effects can mean big
absolute numbers - and favourable cost
effective ratio (e.g. stop smoking TV
programmes in Finland)
2.
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IV. INNOVATION - DIFFUSION
• New risk reducing lifestyles are
innovations that diffuse in the
community following certain rules
• Project represents change agent -
people can be classified as innovators,
early adopters, early and late majority
and laggards
• Critical mass, reaching early majority
is crucial
1.
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IV. INNOVATION - DIFFUSION
Two-step flow of innovation:
a) Mass media are effective in
disseminating information
b) Opinion leaders and interpersonal
contacts influence opinions, attitudes and
behaviour
• Opinion leaders (“gatekeepers”) can be
identified and used in the programme (e.g.
lay leader programme in North Karelia)
2.
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VI. COMMUNITY ORGANIZATION
• Every community is a complex network of
organizations
• Every individual in the community is
connected with a great number of
organizations that influence his/her
behaviours
• The health project can work with many
organizations to promote the desired
changes in the community
1.
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VI. COMMUNITY ORGANIZATION
Critical for Success:
• Collaboration calls for shared interest
• Personal contacts and trust
2.
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COMMENTS
• Many programmes emphasize
dissemination of information and
persuation - while the greatest problems
for change are issues that relate to
social and physical environment
• The big task and strength of community
based programmes is to influence the
community as a whole so that the
desired behaviours are as easy as
possible!
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COMMUNITY-BASED
(PILOT/
DEMONSTRATION)
PROGRAMMES
NATIONAL
PROGRAMMES
AND POLICIES
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PUBLIC
POLICY
HEALTH PROGRAMME
POPULATION
PRIVATE
SECTOR
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National policies and private sector involvment:
Social change process
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FOR SUCCESSFUL
PROGRAMME
1)Do the right thing
2)Do enough of it
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FOR SUCCESSFUL
PROGRAMME
Combine 1) leadership
with 2) partnership
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13/03/2014 Pekka Puska, Ex Director General
Thank you