social ecological models. fall 2006 how can we begin to understand all of the factors that influence...
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Social Ecological Models
Fall 2006
How can we begin to understand all of the factors that influence
health?
Ecological
Model
Fall 2006
Community
Population/Policy
Institutions
Interpersonal
Individual
Fall 2006
What is an Ecological Perspective?
A framework that enables us to consider the influence of
individual and environmental
factors on health & health-related behaviors
Fall 2006
Why the ecological framework? Health & health problems are complex
Health problems are influenced by multiple variables
These variables interact with each other
Multiple levels are relevant for understanding & changing:– Human behavior– Complex environments
Fall 2006
By focusing on factors beyond the individual, we are… Less likely to ‘blame the victim’
More likely to address the underlying determinants of health & health behavior
Fall 2006
By focusing on factors beyond the individual, we are…
Better able to see where action is needed
Upstream action vs.
Downstream approaches
What do we mean by up/down stream approaches?
Fall 2006
Ecological Framework helps us with…
Problem analysis
Intervention design
Intervention evaluation
Fall 2006
Problem analysis
Public Health Problem Determinants
PopulationCommunity
OrganizationalInterpersonal
Individual
Fall 2006
Community
Population/Policy
Institutions
Interpersonal
Individual
Fall 2006
Youth Smoking Determinants
Population/Policy Lack of law enforcement for selling to minors
CommunityPositive attitudes toward smoking
OrganizationalEasy availability of cigarettes at stores
InterpersonalPopular kids smoke/parents smoke
IndividualLack skills/self-efficacy to ‘just say no’
Fall 2006
Intervention Design
Prevent or ameliorate existing problems
Interventions, at their best are…– Intended to Identify & shape solutions
Specifying goals, objectives, activities
– Theory-based– Designed by multi-disciplinary teams– Targeted at multiple levels– Able to maintain a broad (ecological) scope
Fall 2006
Individual Level Interventions
Target of change Individual Person
Focus on characteristics of the individual – E.g., knowledge, attitudes, skills, beliefs…
Fall 2006
Individual Level Interventions
What types of strategies might we use at this
level?
What type of individual level
intervention would be useful in
youth tobacco prevention?
Fall 2006
Interpersonal Level Interventions
Target of change Social influences– E.g., family, work group, friendship networks…
Focus on nature of social relationships– E.g., social norms, access to diverse & supportive
networks/influences
Fall 2006
Interpersonal Level Interventions
What types of strategies might we use at this
level?
What type of interpersonal level intervention would be useful in youth
tobacco prevention?
Fall 2006
Organizational Level Interventions
Target of change Organization/Institution– E.g., worksites, schools, agencies, churches…
Focus on organizational culture– E.g., norms, rules & regulations, incentives &
benefits, structures
Fall 2006
Organizational Level Interventions
What types of strategies might we use at this
level?
What type of organizational
level intervention would be useful in youth tobacco
prevention?
Fall 2006
Community Level Interventions
Target of change Social environment
Focus on community norms, values, attitudes, & power structures
Fall 2006
Community Level Interventions
What types of strategies might we use at this
level?
What type of community
level intervention
would be useful in youth tobacco
prevention?
Fall 2006
Population Level Interventions Target of change Local, state, & national
laws & policies
Focus on government regulations & other regulatory processes, procedures, or laws to protect health
Fall 2006
Population Level Interventions
What types of strategies might we use at this
level?
What type of population level
intervention would be useful in youth
tobacco prevention?
Fall 2006
What types of health issues or health behaviors lend themselves to using
the social-ecological model?
Are there any issues that don’t?
Fall 2006
Challenges to ecological interventions A lot of work – involving several sectors of society
Difficult to evaluate change at environmental level
Challenge to translate interest in change into social norms and public policy
– Powerful norms are hard to change– Budget cuts – so difficult to undertake wide-range interventions– Difficult to get certain health issues on public policy agenda
Still, it’s being done!E.g., nutrition guidelines, tobacco, fitness, elder transportation
Fall 2006
So…
The ecological framework emphasizes:– Relationships among behaviors, socio-political
structures & health
– Applying this framework allows us to: Determine & describe public health problems Move beyond solely focusing on (& blaming) the
‘individual’ Assess multi-level determinants of health & how to
address them Design, implement, & evaluate interventions