Ian McDowell March 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 o ID: 371085
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Slide1
Some models relevant for planning health promotion programs
Ian McDowell
March, 2012Slide2
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. Slide3
Pathways from Personality
to Health StatusSlide4
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 ModelSlide5
Intentions
Behavior
Threat appraisal
Vulnerability
+
Severity of
disease
Coping appraisal
Self efficacy
+
Response efficacy
3. Protection Motivation TheorySlide6
Health
Behavior
Behavioral
Intentions
Subjective norms
Attitude
toward changing behaviors
Motivation
Beliefs concerning others’ views
Perceived effectiveness of recommended action
Perceived importance of health issue
4. Theory of Reasoned ActionSlide7
Behavioral beliefs
(importance of the
health issue &
whether the behavior
will be effective)
Normative beliefs:
how do others
view the behaviors?
Control beliefs:
self-efficacyAttitudetowardrecommendedbehaviorSubjective norms:felt social pressures to act
Perceived behavioralcontrol
Intentionto act(or not)
Behavior
5. Theory of Planned BehaviorSlide8
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 relapse8Slide9
Precontemplation
Stable
Lifestyle
Contemplation
Preparation
Action
Maintenance
Relapse
7.
Transtheoretical
Model (Jim
Prochaska
, 1985)Slide10
Precontemplation
Stable
Lifestyle
Contemplation
Preparation
Action
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 about
the 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 change
in the next month (e.g., has set a quit date).
The physician can refer the patient to support
programs, 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 the
new behaviour for a month
or more and trying to maintain
the change over the longer term.
Relapse:
Helping with relapse is an important
role for the doctor; several attempts
may be required before a behaviour
is finally established. Encourage the
patient to look on a relapse as gaining
experience.Slide11
11
“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. Acting7. Maintenance
1. Pre-contemplation
2. Contemplation3. 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, etcSupport & aids
Monitoring
MD’s roleSlide12
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 phase
What can be achieved? What needs to be changed to achieve it?
What can be learned? What can be adjusted?
Evaluation phase
Adapted 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
Setting up the programme
8. Precede-Proceed modelSlide13
PRECEDE-PROCEED Framework
Phase 1
Social
Assessment
Phase 3
Behavioral &
Environmental
Assessment
Phase 2
Epidemiologic Assessment
Phase 4Educational & Ecological Assessment
Phase 5
Administrative Policy AssessmentPhase 6Implementation Phase 7Process Evaluation
Phase 8ImpactEvaluation
Phase 9Outcome Evaluation
HEALTH
PROMOTION
Health Education
Policy,Regulation,Organization
Predisposing
factors
Reinforcing
factors
Enablingfactors
Behavior &
lifestyle
Environment
Health
Quality
of lifeSlide14
Social Marketing Cycle
1. Plan
overall
strategy
2. Select materials
& channels
3. Develop
intervention
and pretest
4. Implementthe program
5. Assesseffectiveness(process &outcomes)
6. Use resultsto refineprogram
9. Social MarketingSlide15
The purposes of population health:
A model of the various population health perspectives
Interested? Other models on SIM web site:
Population health models
Pop
health
policies
Pop
health
interventions
Academic
population
healthDescribing Health Issues
Analyzing Causes & Predicting RisksDeveloping Interventions
Developing Delivery Systems
Developing Healthy Policies