Some models relevant for planning health promotion programs

Ian McDowellMarch, 2012

1. The ‘Big Five’ Personality dimensions• Extraversion: characteristics such as excitability, sociability, talkativeness,

assertiveness, and emotional expressiveness. Extraverted is opposite to introverted ("Would you rather spend an evening with a friend or with a book?")

• Agreeableness: attributes such as trust, altruism, kindness, affection: behaviours that promote social interaction. Agreeable can be contrasted with disagreeable (“Are you interested more in other people's feelings or in your own?”)

• Conscientiousness: this refers to a person's thoughtfulness, their level of impulse control and goal-directed behaviors. Conscientious people are organized and pay attention to detail. Roughly the opposite of playful.

• Neuroticism: a tendency to experience emotional instability, anxiety, moodiness, sadness or irritability. Neurotic vs. stable (“How calm & composed do you remain in stressful circumstances?”)

• Openness, referring to being open to new experiences. Such people are interested in intellectual matters, whether of the imagination or of logic. Related characteristics include insight, having a broad range of interests, being imaginative, intellectual, perhaps witty.

Pathways from Personalityto Health Status

Perceived Susceptibility to Disease

· Demographics (age, sex, ethnicity, etc.) · Sociopsychological variables (personality, social class, peer and reference group pressures, etc.)· Structural variables (knowledge about the disease, prior experience of it, etc.)

Perceived Threat of the Disease

· Raised awareness (e.g., mass media campaign, newspaper article )· Personal advice (e.g., reminder from health professional)· Personal symptoms· Illness of family member or friend

Perceived benefits of taking action, minusPerceived barriers to

action

Likelihood of TakingRecommended Health Action

Modifying Factors

Perceived Severity of Disease

Cues to Action

2. Health Belief Model

Intentions Behavior

Threat appraisal

Vulnerability+

Severity of disease

Coping appraisal

Self efficacy+

Response efficacy

3. Protection Motivation Theory

HealthBehavior

BehavioralIntentions

Subjective norms

Attitudetoward

changing behaviors

Motivation

Beliefs concerning

others’ views

Perceived effectiveness of recommended

action

Perceived importance of health issue

4. Theory of Reasoned Action

Behavioral beliefs(importance of the

health issue &whether the behavior

will be effective)

Normative beliefs:how do others

view the behaviors?

Control beliefs:self-efficacy

Attitudetoward

recommendedbehavior

Subjective norms:felt social

pressures to act

Perceived behavioralcontrol

Intentionto act

(or not)Behavior

5. Theory of Planned Behavior

6. Stages of Change (J. Prochaska, 1985)

• Pre-contemplation no intention of changing

• Contemplation intends to act in a realistic time frame (+/- 6 months for smoking)

• Readiness for action preparing for change in immediate future

• Action is making, or has made changes • Maintenance working to prevent relapse

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Precontemplation

StableLifestyle

Contemplation

PreparationAction

Maintenance

Relapse

7. Transtheoretical Model (Jim Prochaska, 1985)

Precontemplation

StableLifestyle

Contemplation

PreparationAction

Maintenance

Relapse

Precontemplation:The person does not intend to change the behavior,or is unaware of need to change, or is unwilling to do so. The physician can encourage the patient to think aboutthe behavior and how they would feel about changing.Suggest they talk to their spouse, etc.

Contemplation:The person has considered the possibility of changing,but is not ready to actively plan a change. The physician can provide information and encourage them to prepare to actually change.

Preparation:The person is making plans to changein the next month (e.g., has set a quit date). The physician can refer the patient to supportprograms, prescribe nicotine patch, encourage them to set a quit date, etc.

Action:The patient has changed.Encouragement & support are the major physician roles:arrange follow-up visits.

Maintenance:The patient has practiced thenew behaviour for a monthor more and trying to maintainthe change over the longer term.

Relapse:Helping with relapse is an importantrole for the doctor; several attemptsmay be required before a behaviouris finally established. Encourage the patient to look on a relapse as gaining experience.

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“Where is the Road Block?”Two models of behavior change

Prochaska (1985)Stages of Change

Weinstein (1998) Precaution Adoption Process Model

1. Unaware of the issue

2. Unengaged by the issue

3. Deciding about acting

4. Deciding not to act

5. Deciding to act

6. Acting

7. Maintenance

1. Pre-contemplation

2. Contemplation

3. Preparation

4. Action

5. Maintenance, relapse

6. Habitual behavior

How does she feel?

Analyze patient’spersonal risk

Supply information:pros and cons.

Practical guidance:set quit date, etc

Support & aids

Monitoring

MD’s role

Identify the administrative &

financial policies needed

Identify education, skills & ecology

required

Identify desirable outcomes:Behavioural, Environmental, Epidemiological, Social

Predisposing factors

Enabling factors

Reinforcing factors

Lifestyle

Environment

Planning phaseWhat can be achieved? What needs to be changed to achieve it?

What can be learned? What can be adjusted?

Evaluation phaseAdapted from: Green L. http://www.lgreen.net/precede.htm (Accessed May, 2009)

Policies

Resources

Organisation

Service or programme components

Health status Quality of

life

Implementation:What is the programme intended to be?What is delivered in reality?What are the gaps between what was planned and what is occurring?

Process:Why are there gaps between what was planned and what is occurring?What are the relations between the components of the programme?

Impact:What are the programme’s intended and unintended consequences?What are its positive and negative effects?

Outcome:Did the programme achieve its targets?

Start

Finish

Setti

ng u

p th

e pr

ogra

mm

e8. Precede-Proceed model

PRECEDE-PROCEED Framework

Phase 1Social Assessment

Phase 3Behavioral & Environmental Assessment

Phase 2Epidemiologic Assessment

Phase 4Educational & Ecological Assessment

Phase 5Administrative Policy Assessment

Phase 6Implementation

Phase 7Process Evaluation

Phase 8ImpactEvaluation

Phase 9Outcome Evaluation

HEALTHPROMOTION

Health Education

Policy,Regulation,Organization

Predisposingfactors

Reinforcingfactors

Enablingfactors

Behavior &lifestyle

Environment

HealthQuality of life

Social Marketing Cycle

1. Planoverall

strategy

2. Select materials& channels

3. Developinterventionand pretest

4. Implementthe program

5. Assesseffectiveness(process &outcomes)

6. Use resultsto refineprogram

9. Social Marketing

The purposes of population health:A model of the various population

health perspectives

Interested? Other models on SIM web site: Population health models

Pophealthpolicies

Pophealth

interventionsAcademicpopulation

healthDescribing Health Issues

Analyzing Causes & Predicting Risks

Developing Interventions

Developing Delivery Systems

Developing Healthy Policies