The Need for Social Ecology Theory in Nursing Community Based Research

1
The Need for Social Ecology Theory in Nursing
Community Based Research

• Charlene Pope, PhD
• For Medical University of South Carolina (MUSC)
  College of Nursing Center for Community
  Partnerships
• Summer, 2007

2
Shifts in Paradigm

• Thomas Kuhn (1962)
• The Structure of Scientific Revolutions

Picture of latest edition of Kuhns book from
http//www.amazon.com
Picture of Kuhn taken from Philosophy Archive
at http//www.marxists.org/reference/subject/philo
sophy/works/us/kuhn.htm
3
Traditional Individual Focus in Nursing

• Why do we need a theory of social ecology?
• A focus on the
• individual may
• miss more
• significant
• influences.

4
Most nurse and health service researchers are
more familiar with biological concepts of
ecosystems, than with social ecology.
Borrowed from http//www.ecosystem-health-networ
k.de/ehn_logo3.gif
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Ecosystem Characteristics

• Organisms situated in their environment
• Complexity
• Variability
• Interactive
• Continuous flow cycling of energy
• Multiple influences
• Subject to change
• Interrelated elements

Photo from Dr. Yvonne Michel, Costa Rica
6
Lesson for Social Ecology from Ecological Theory

• Seemingly unconnected parts cannot be isolated
  from the system in which they are situated.
• The interrelatedness of collections of organisms,
  their parts, physical surroundings, and time
  means that changes do not happen in isolation.

7
History of Social Ecology

• Binder, Arnold. (1972). A new context for
  psychology Social ecology. American
  Psychologist, 27, 903-908
• Bronfenbrenner, Urie. (1977). Toward an
  experimental ecology of human development.
  American Psychologist, 32, 513-530.
• Stokols, D. (1988). Transformational processes in
  people-environment relations. In McGrath, J.E.
  (Ed.), The social psychology of time New
  perspectives. Newbury Park, CA Sage
  Publications, 233-252.

8
Father of Social Ecology Theory

• Developmental Psychology
• Co-founder of Head Start
• Social behavioral research
• Cornell Life Course Institute (now named for him)
• Died in 2005

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Other Theorist Daniel Stokol (UCI)

• Four Assumptions of Social Ecology
• dynamic interplay among diverse environmental,
  social, and personal factors
• multiple components (physical, social,
  person-environmental fit, behavioral settings,
  objective, perceived, scale, immediacy)
• requires multiple levels of
  analysis diverse methods
• interdependencies between proximal
  distal factors and dynamic
  interrelationships between
  people environments

Picture of book available at http//www.amazon.co
m
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Six Principles of Social Ecology

• Identify a phenomenon as a social problem
• View the problem from multiple levels and methods
  of analysis
• Utilize and apply diverse theoretical
  perspectives (interdisciplinary)
• Recognize human-environment interactions as
  dynamic and active processes
• Consider the social, historical, cultural and
  institutional contexts of people-environment
  relations
• Understand people's lives in an everyday sense
  (their perspectives)

Attributed to Dave Taylor of the University of
California at Irvine School of Social Ecology
http//www.seweb.uci.edu/cse/cse.html
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What is the Social Human?
Cultural Capital
IDENTITIES Or LOCATIONS
INSTITUTIONS
Figure developed by Charlene Pope, MUSC
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Conceptualizing Problems

• Determinant causes
• Antecedent causes
• Contributing causes
• Types of factors agent (latent, active,
  resistant), human, physical, sociocultural,
  institutional

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What models seek to ground community health?

• PRECEDE-PROCEED model of health promotion in
  communities
• SPCH model
• Wagners model of chronic care
• We can critique these models and draw from them
  --

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PRECEDE-PROCEED MODEL OF HEALTH PROMOTION IN
COMMUNITIES
Structural Model Of Social Ecology Where
is The Social Human?
http//www.ihpr.ubc.ca/ProcedePrecede.html Green,
L.W. and Kreuter, M.W. Health Promotion Planning
An Educational and Ecological Approach, 3rd
edition (Mountain View, CA Mayfield Publishing
1999 to order call 800-433-1279 or fax
650-960-0328).
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What dimensions are missing in the
PRECEDE-PROCEED model ?

• Agency
• (The individual as an actor)
• Ideology
• (Ways of believing, includes cultural
  assumptions)
• Social interaction
• (as a site of structuration)
• Activity
• (Acts, intentional unintentional)

16
SPHC Model Seattle
Ref. Krieger, J. et al. (2002). Using
Community-Based Participatory Research to Address
Social Determinants of Health Lessons learned
from Seattle Partners for Health Communities
(SPHC). Health Education Behavior, 29
(3)361-382.
17
Whats missing from Wagners Chronic Care Model?
Figure from the Institute for Healthcare
Improvement (IHI) http//www.ihi.org/IHI/Topics/C
hronicConditions/AllConditions/Changes/
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A Need for Synthesis
Chronic Care Model

• Needs community person involvement
• Requires behavioral settings activities beyond
  health institutions
• Identify proximal and distal factors,
  antecedents social determinants
• Propose interrelatedness of physical, behavioral,
  sociocultural, environmental life

• Health Institution-weighted lens
• The individual interacts with the health team
  but less with their environment
• Factors that influence behavior are more assumed
• Dynamic relationships receive less attention

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• Anthony Giddens
• Social life is neither a series of individual
  acts nor the result of external social forces.

• Social Framework

External Forces
History
Picture of Giddens from http//www.theory.org.uk/
giddens.htm
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Example Refugee Camp, Nong Samet, Thailand
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Levels of Social Ecological Analysis
Intervention

• Bronfenbrenner (1979)
• Microsystem (biology immediate physical
  environment)
• Mesosystem (lifestyle support network)
• Exosystem
• (access to services resources)
• Macrosystem (social environment,
  societal norms values)

• Emmons (2000)
• Intrapersonal level (motivational change
  individual skills)
• Interpersonal level (services social
  networks)
• Organization/environmental (Health system,
  schools, etc)
• Community level (social advocacy)
• Policy level (local federal
  regulations laws)

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Research Design Considerations

• Adjust the focus to accommodate proposed
  influences on behavior
• Tailor changes to involve participants
  individually collectively
• Deliver messages in multiple ways
• Target institutions, too

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Example of a Social Ecological Framework Derived
from Bronfenbrenner to study Elder Abuse by
Adult ChildrenSchiamberg Gans, 2000) Figure
taken from Schiamberg, L, and Gans. D. (2000).
Elder abuse by adult children An applied
ecological framework for understanding contextual
risk factors and the intergenerational character
of quality of life. International Journal of
Aging and Human Development, 50, 329-359.)
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Individual Framework of DSM Behavior Change
Figure on pg. 965. Ref Jack, L. Jr., Liburd,
L., Spencer T., and Airhihenbuwa, C. (2004).
Understanding the environmental issues in
diabetes self-management education research A
reexamination of 8 studies in community-based
settings. Annals of Internal Medicine, 140,
964-971.
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Example of Ecological Framework for Behavioral
Change
Figure on pg. 967. Ref Jack, L. Jr., Liburd,
L., Spencer T., and Airhihenbuwa, C. (2004).
Understanding the environmental issues in
diabetes self-management education research A
reexamination of 8 studies in community-based
settings. Annals of Internal Medicine, 140,
964-971.