Health Status

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Health Status

• Definition WHOs
• Components of Health (beyond the physical)
• Measuring Health
• Traditional Indices
• mortality, morbidity, life expectancy
• Modern innovations
• Years of Healthy Life, Self- assessment,
  Health Risk Appraisal

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Leading causes of death

• Heart disease
• Cancer
• Stroke
• COPD
• Unintentional Injury
• Pneumonia Influenza
• Diabetes
• HIV/AIDS
• Suicide
• Homicide

• Tobacco Use
• Obesity
• sedentary life
• nutrition habits
• Alcohol and drug use
• microbial agents
• risk taking
• toxic agents
• firearms
• sexual behavior
• motor vehicles

VS
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Health Determinants

• Lifestyle Behaviors
• Genetics
• Environment
• Social
• Physical
• Health Care

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Personal Behavior

• Cigarette smoking
• Dietary Practices
• Alcohol and Drug use
• Unintentional injuries
• Intentional injuries
• AIDS

• Stress
• Exercise
• Use of Preventative Services
• Pregnancy prevention
• HBP Control
• Cancer Screenings
• Immunizations
• Obesity counseling ??

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Health Education--Early Years
Volunteer Organizations
Governmental Organizations
School Health
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Health Education--Present
Volunteer Organizations
Governmental Organizations
School Health
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Health Education

• Teaching
• Training
• Counseling
• Consulting
• Communications/Media

• Media and Advocacy
• Policy Development and
• advocacy
• Organizational Change
• Diffusion
• Community Development and social change

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Areas of Health Education

• Target Populations mothers, children,
• elderly, minorities,etc
• Settings school, worksite, health care,
• community
• Content nutrition, exercise, sexuality, chronic
  
• disease, mental health,
  TB/immunization
• Process program planning, teaching,
• community development, media relations

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Foundations of Health Education

• Behavioral Sciences psychology,
• sociology,
• Education curriculum development,
• learning theory
• Public Health epidemiology, statistics,
• environmental health, health services

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The Planning Process

• Needs assessment
• Goals and Objectives
• Planning the Program
• Program Development
• Implementation
• Evaluation

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Planning Models

• PRECEDE-PROCEED
• (predisposing, reinforcing, enabling, causes,
  in educational, diagnosis, evaluation)
• (policy, regulatory, organizational
  constraints in educational environmental
  development)
• PATCH

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PRECEDE-PROCEED

• Social diagnosis
• Epidemiological diagnosis
• Behavioral and environmental diagnosis
• Educational and organizational diagnosis
• Administrative and policy diagnosis
• Implementation
• Evaluation

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PATCH

• Planned
• Approach
• To
• Community
• Health

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Needs Assessment

• Health, Educational, Resource Needs
• Sources of Information
• Prior research studies, existing records
• Target population
• Field professionals and staff
• Observations
• Surveys

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Goals and Objectives
You have to be very careful if you dont know
where you are going, because you might not get
there Yogi
Berra
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MATCHMultilevel Approach to Community Health

• Individual
• Interpersonal
• Organizational
• Social
• Governmental

Five social levels to which intervention can be
directed
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MATCH---phases

• 1. Goal Selection
• 2. Intervention Planning
• 3. Program Development
• 4. Implementation Preparations
• 5. Evaluation

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Intervention Actions

• Teaching
• Training
• Counseling
• Consulting
• Using Media

I never teach my students, I only attempt to
provide the conditions in which they can
learn -Albert Einstein
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Teaching

• Learners must be motivated
• Self-esteem, respect and accomplishment
• Learners have previous learning experience
• Each is individually different
• Establish conditions for Learning
• Select and apply appropriate teaching-learning
  methods
• Conducting the teaching session depends on
  climate, style and preparation

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Learning

• Continuos Motivation necessary
• By doing Immediate response
• Readiness Transfer not automatic
• People vary in perception and response
• Response varies with environment
• People learn only what is relevant
• Learning is a facilitated process

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Internalization
Health Learning
Health Values Health Attitudes Health Facts
Self directed Behavior Recommended
Action Imposed Action
Hierarchy of Learning
Public Health
Superficial
Indoctrination
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Training

• Steps to develop training programs
• Stages of training
• Training Goals
• develop skills
• individual learning
• process vs content
• shared learning experiences
• opportunity for experimentation

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Counseling

• Client- Centered Counseling
• Counseling for Decision Making
• Behavior Counseling

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Evaluation
Levels of Evaluation

• Process Program
• Impact Behavior
• Outcome Health

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Cognitive and Affective Learning

• Learning
• integrating new perceptions
• with prior ones and storing them
• as values, beliefs, attitudes,
• knowledge, skills
• change in behavior as a result
• of experience

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To Promote Learning

• 10 Principles Enhancing the Likelihood of
  Learning
• Use several senses.
• Involve the participants.
• Provide an appropriate learning environment.
• Assess learner readiness.
• Establish the relevance of the information.
• Use repetition.
• Strive for pleasant learning experience.
• Begin with known, move to the unknown.
• Generalize the information.
• Pace delivery of the information.

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10 Principles Enhancing the Likelihood of
LearningFirst Principle

• People retain
• 10 of what is read
• 20 of what is heard
• 30 of what they see
• 50 of what they hear and see
• 70 of what they say
• 90 of what they do an say

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10 Principles Enhancing the Likelihood of
LearningSecond Principle

• Instead of having passive participants, use
  methods that enable them to be active.
• Using discussion rather than lecture.

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10 Principles Enhancing the Likelihood of
LearningThird Principle

• Ensure comfortable accommodations.
• Maintain extraneous interference and distractions
  to a minimum.

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10 Principles Enhancing the Likelihood of
LearningFourth Principle

• People only learn if they are physically and
  emotionally ready.

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10 Principles Enhancing the Likelihood of
LearningFifth Principle

• People learn what they perceive important for
  them
• Knowing whats important to them can aid in
  making the information meet their needs.

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10 Principles Enhancing the Likelihood of
LearningSixth Principle

• Learning is enhanced if information is repeated
  in a variety of ways.

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10 Principles Enhancing the Likelihood of
LearningSeventh Principle

• Encouragement through positive feedback and
  recognizable progress contribute to a positive
  experience.

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10 Principles Enhancing the Likelihood of
LearningEighth Principle

• When presenting information gradually progress
  from simple to complex in an organized manner.

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10 Principles Enhancing the Likelihood of
LearningNinth Principle

• Learning is more likely to occur if the
  information is applied to many instead of one
  setting or situation.

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10 Principles Enhancing the Likelihood of
LearningTenth Principle

• To meet the needs of the participants, adjust the
  rate at which information is covered.

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Health Behavior Theories
Theories are used for the basis for program
development
A theory is a set of interrelated
ideas, Definitions, and suggestions That allows
for a systematic study of an Event or situation
through the identification of Relationships among
variables, In order to explain and predict the
Circumstance.

Glanz, Lewis, Rimer
1997
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Cognitive Consistency Theory
Health Education Knowledge (and
Skills) Attitude
Behavior
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Persuasive Communication
Attention Need
Cognitive--facts , statistics authoritative
statement Affective--feelings,
personal story, example
Satisfaction
Benefit
Behavior
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Eco-model of Health Behavior
Public Policy
Institutional Factors Community Factors
Institutional Factors
Interpersonal Relationships Intrapersonal Factors
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Health Belief Model
Individual Perceptions
Modifying Factors
Likelihood of Action
Demographic variables Sociopsychological Structura
l Variables
Perceived Benefits Barriers
Perceived susceptibility severity
Perceived Threat
Likelihood of taking Health Action
Cues to Action
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Health Belief Model

• Individuals Perceptions
• Susceptibility
• Severity
• Perceived Treat of Disease
• Perceived Benefits minus Barriers
• of the Behavior Change

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Theory of Reasoned Action
Based on individual motivational factors as
determinants of the likelihood of performing a
specific behavior.
Misconception because of the name that it is a
model of RATIONAL BEHAVIOR this is not true.
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Theory of Reasoned Action
Most important determinant of behavior is a
persons behavioral intentions
Attitude toward the behavior individuals
beliefs about outcomes or attributes of
performing the behavior Subjective norm
normative beliefs-important referent individuals
weighed by motivation to comply with
those referents
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Theory of Planned Behavior
Attitude toward behavior
Behavior
Subjective Norm
Behavioral Intention
Perceived Behavioral Control
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Theory of Planned Behavior

• Behavioral Intention Likelihood
• Attitude/Behavior Belief
• Normative Belief
• Motivation to Comply
• Perceived Behavioral Control
• Perceived Power

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Attribution Theory

• Individuals make determinations about whether
  something is within their control or beyond their
  control
• Internal locus ability, aptitude, personality
• External locus environment, circumstances
• luck

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Stages of Change
Stage of Change Attitude toward Change

• Precontemplation
• Contemplation
• Preparation
• Action
• Maintenance

• Never
• Someday
• Soon
• Now
• Forever

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Stages of Change
Process of Change

• Consciousness Raising
• Dramatic Relief
• Self-reevaluation
• Environmental
• reevaluation
• Self-liberation

• Helping relationships
• Counterconditioning
• Contingency
  
• management
• Stimulus Control
• Social Liberation

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Stages of Change

• Decisional Balance
• PROS The benefit of Changing
• CONS The cost of Changing
• Self-efficacy
• Confidence that one can engage
• in the healthy life style
• Temptation to engage in the
• unhealthy

VS
VS
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Changing Behaviors
Habit is habit and not to be flung out the
window by any man, but coaxed down the stairs a
step at a time. Puddenhead Wilson
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Behaviorism

• ABC Approach
• (antecedents, behavior, consequences)
• Reinforcement-positive or negative
• Aversive punishment
• Respondent Conditioning
• Operant Conditioning
• Reinforcement Hierarchy

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Behavior Modification

• Increase the frequency of a behavior by rewarding
  it
• Decrease the frequency of a behavior by punishing
  it
• Successful with highly motivated individuals

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Behavior Change Techniques

• Positive reinforcement
• Negative reinforcement
• Prompting fading
• Shaping
• Chaining

• Differential reinforcement
• Satiation Restraint
• Overcorrection
• Time out
• Response cost

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Motivation

• Internal Drive that causes action
• Belief System regarding behavior
• Decision/Commitment
• Plan of Action
• Persistence in performing the behavior
• Attitude regarding the Behavior/Results

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Self Management Health Behavior
Client-Centered Programs

• Self-monitoring
• Stimulus Control
• Self-reinforcement/punishment
• Alternative response training
• Biofeedback

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Social Cognitive Theory

• In the social cognitive view people are
  neither driven by inner forces nor automatically
  shaped and controlled by external stimuli.
  Rather, human functioning is explained in terms
  of a triadic reciprocality in which behavior,
  cognitive and other personal factors, and
  environmental events all operate as interacting
  determinants of each other.
  
• Albert Bandura

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Social Cognitive Theory
Behavior of the Individual
Individual
Environment
RECIPROCAL DETERMINISM
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Social Cognitive Theory
ENVIRONMENT/SITUATION
Home- Family,
Friends Work- Staff,
Clients, Employer School-
Classmates, Teachers Leisure Activities-
Peers, Customers Community-
Neighbors, Leaders Society-
Models, Lawmakers
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Social Cognitive Theory
OBSERVATIONAL LEARNING

• A person can learn from others

Modeled Events
Attention Retention Skills
Motivation
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Social Cognitive Theory

• EXPECTATIONS

Previous experiences Observing Others Hearing
about similar situations Emotional or Physical
response behavior

• EXPECTANCIES

• Values a person places on
• a particular outcome

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Social Cognitive Theory

• BEHAVIORAL CAPACITY

• Based on training, intellect, learning
• Knowledge of the Behavior
• Skills - How to perform it

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Social Cognitive Theory

• SELF- EFFICACY

Confidence about performing a particular
behavior

• SELF CONTROL

Behavior under the control of the individual
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Organization culture

• Pattern of basic assumptions
• developed by a group of people
• as it learns to cope with its problems
• that is considered to work and is
• taught to new members as if
• it is the correct way to think, feel, and believe
  in relationship to these problems

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Organization Culture
Concern for Performance
High Low
Integrating Caring
High Low
Concern for Employees
Exacting Apathetic
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Planned Organizational Change

• Initial Assessment
• Preinitiation
• Initiation
• Implementation
• Institutionalization

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Planned Organizational Change

• Initial Assessment
• Problem Assessment Goals
• Force Field Driving vs Restraining
• Choice Of Tactics

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Planned Organizational Change

• Preinitiation
• Choice of Change Agent with Credibility
• Increase awareness within the organization of the
  need for change

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Planned Organizational Change

• Initiation
• Selection of Top Down or Bottom Up Strategies
• Specification of any policies or Procedures in
  Change

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Planned Organizational Change

• Implementation
• Communication Channels
• Administrative Procedures
• Driving or Restraining Forces for Implementation

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Planned Organizational Change

• Institutionalization
• Inclusion of Change in Strategic Plan
• Written Job Description
• Hiring Permanent Staff
• Stable funding

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Community and Social Change

• Levels of Change
• Individuals- knowledge, attitudes
• Groups-normative beliefs, values
• Organizations-schools, business
• Social- communities, regions,
• state, nation

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Stages of Adoption

• Awareness
• Interest
• Trial
• Decision
• Adoption

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Approaches toSocial Change
Empirical-Rational Education Persuasive
Communication Normative
Re-Education Community
Organization Advocacy
Social Marketing
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Six Theoretical Approaches to Social Change
Persuasive communication
Community organization
Marketing
Advocacy
Empirical-Rational Education
Normative Re-education
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Empirical Rational Education

• Information derived from research is
• Synthesized and disseminated to the population
• by means of schools and other agencies
• It is the process by which students are trained
  and professionals become prepared.