models

Chapter 15

Designing Community

Nutrition Interventions

© 2006 Thomson-Wadsworth

Learning Objectives

• Describe five factors to consider when designing a community nutrition intervention.

• Describe three levels of intervention.

• Discuss five theories and models of consumer health behavior.


Introduction

• There are two important aspects of designing interventions:

– You must have information about your target population and why they do what they do in terms of behavior.

– You need an arsenal of tools for influencing behavior.


Choose an Intervention

Strategy

• The first step in designing an intervention is to review the program’s goals and objectives, which specify the program outcomes.

• Next you need to design a rough outline of what the intervention might look like.



Strategy

• The intervention strategy is the approach for achieving the program’s goals and objectives.

• It addresses the question of how the program will be implemented to meet the target population’s nutritional needs.



Strategy

• The intervention strategy can be directed towards:

– Individuals

– Communities

– Systems

• The intervention strategy can also encompass one or more levels of intervention:

– Level I

– Level II

– Level III




Strategy

• Level I: building awareness

– These focus on increasing awareness of a problem.

– They are helpful for changing attitudes and beliefs and increasing knowledge of risk factors but they seldom result in actual behavior changes.

– Examples include health fairs, screenings,

Internet web sites, and newsletters.



Strategy

• Level II: changing lifestyles

– These are designed to help individuals make lifestyle changes.

– They can be successful when they call for small changes over time and when they use a combination of education and behavior modification.

– Level II interventions reach individuals through one-on-one counseling and small group meetings.



Strategy

• Level II (continued)

– They involve a program of assessing current behaviors, setting goals for behavior change, developing skills needed to change behavior, providing support for change, and evaluating progress.

– Examples include fitness programs in schools and health promotion programs for city employees.



Strategy

• Level III: creating supporting environments for change

– These work toward creating environments that support the behavior changes made by individuals.

– They include worksite health promotion and cafeteria programs.

– Supportive environments can be created through policies that support gleaning, point-of-purchase labeling, and tax incentives for companies with health promotion programs.


Study the Target Population

• When designing an intervention, study the target population’s eating patterns and their beliefs, values, and attitudes about foods and health.

• Conduct library research, review existing programs that deal with the target population, network with colleagues who work with the group, and post queries about the target population on Internet listservs.



• The target population’s foodrelated behavior is important.

• Many factors influence food intake and nutritional status...



• Food Supply and Food Availability

– Food choices are influenced by the types and amounts of foods available in the food supply.

– Food availability is affected by the food distribution system, types of imported foods, facilities for food processing and production, and the regulatory environment.



• Income and Food Prices

– Two economic factors that affect food consumption.

– Households with higher incomes have more money to spend on food and choose whatever foods they want, regardless of price.



• Sociocultural Factors

– Food choices are strongly influenced by social groups, and primary social groups include families, friends, and work groups with the family exerting the most influence.

– Culture influences food behaviors and even dictates how foods are stored, processed, consumed, disposed of, and even which foods are considered edible.

– Religious beliefs affect food choices, and some religions specify the foods that may be eaten and how they should be prepared.



• Food Preferences, Cognitions, and

Attitudes

– Preferences for certain tastes and foods appear to develop quite early in humans.

– Food choices are affected by our cognitions, or what we think.

– Attitudes are believed to influence behavior indirectly.



• Health Beliefs and Practices

– Beliefs about foods, diet, and health influence food choices.

– Example: traditional Chinese beliefs of yin and yang


Draw from Current Research on Consumer Behavior

• Many theories have been proposed to explain the decision-making process as it relates to health.

• Theories are sometimes presented in the form of models - simple images of the decision-making process.




Draw from Current Research on Consumer Behavior

• Theories include:

– Stages of Change Model

– Health Belief Model

– Theory of Planned Behavior

– Social Cognitive Theory

– Diffusion of Innovation Model


The Stages of Change Model

• Founded on 3 assumptions:

– Behavior change involves a series of different steps or stages.

– There are common stages and processes of change across a variety of health behaviors:

– Tailoring an intervention to the stage of change in which people are at the moment is more effective than not considering the stage people are in.




• Common stages:

– Precontemplation - the individual is either unaware of or not interested in making a change.

– Contemplation - the person is thinking about making a change, usually within the next six months.

– Preparation - the person actively decides to change and plans a change, usually within one month.



• Common stages (continued):

– Action - the individual is trying to make the desired change and has been working at making the change for less than six months.

– Maintenance - the individual sustains the change for six months or longer and the changed behavior has become a part of his or her daily routine.



• The model resembles a spiral, with people moving around the spiral until they eventually achieve maintenance and termination.

• People in the contemplation stage are seeking information...

• ...whereas people in the maintenance stage are likely to be looking for information and searching for ways to strengthen the behavior.



• The Application—Individual

– The Smithfield Fitness Club (members in various stages)

• The Application—Communities

– City of Scottsville (in precontemplation stage)


The Health Belief Model

• Developed to explain why people failed to participate in programs designed to detect or prevent disease.

• The model has three components:

– The perception of a threat to health.

– The expectation of certain outcomes related to a behavior.

– Self-efficacy - the belief that one can make a behavior change.


The Health Belief Model

• Other variables, such as education, income, sex, age, and ethnic background influence health behaviors in this model, but they are believed to act indirectly.

• The Application

– American Cancer Society’s public awareness campaign


The Theory of Planned

Behavior

• a.k.a. the Theory of Reasoned Action

• A fundamental model for explaining virtually any health behavior over which the individual has control.

• Behavior is determined directly by a person’s intention to perform the behavior.

– Intentions - the instructions people give to themselves to behave in certain ways.



Behavior

• In forming intentions, people consider the outcome of their behavior and the opinion of significant others before committing themselves to a particular action.

– In other words, intentions are influenced by attitudes and subjective norms, or perceived social pressure to perform or not perform a behavior.



Behavior

• Attitudes are determined by:

– The individual’s belief that a certain behavior will have a given outcome.

– An evaluation of the actual outcome of the behavior.

– A perception of his or her ability to control the behavior.

• The Application

– Fairlawn Weight Management Center’s “Get

Fit Now” program


Social Cognitive Theory

• Explains behavior in terms of a model in which behavior, personal factors such as cognitions, and the environment interact constantly, such that a change in one area has implications for the others.



• The environment includes:

– The social real (family, friends, peers, coworkers)

– The physical real (the workplace, layout of a kitchen, etc.)



• Strength of this model = it focuses on certain target behaviors rather than on knowledge and attitudes.

• The Application

– Peer counseling course to reduce pica among WIC participants


Eat Healthy: Your Kids Are

Watching

• Michigan Nutrition Support Network

– A public–private partnership to improve the nutritional health of Michigan’s low-income families.

• “Eat Healthy, Your Kids Are Watching”

– Focus group–tested message designed to prompt awareness in parents that they are role models for their children.



Watching

• Goals and Objectives

– Primary goal - improve the nutritional health of Kent County’s low-income families through collaborative efforts among partners.

– Objectives:

• Develop and implement “awareness-building” activities promoting healthful eating to the target audience and to the public in general

• Construct a public–private partnership with businesses and agencies to assist with specific programs for the campaign.



Watching

• Methodology

– Potential partners were located

– Awareness-building activities:

• 30-second cable spots

• Campaign newsletters in English and Spanish

• Signs on and in transit buses

• Logo and slogan program with grocery stores and school districts

• Toll-free telephone number with messages in

English and Spanish



Watching

• Methodology (continued)

– Partnership programming:

• Information on grocery store tours

• Cooking demonstrations

• WIC module for nutrition education

– Partner kit included an events schedule, lesson plans, activity sheets, and recipes



Watching

• Results

– Reached an estimated 49,000 residents, including close to 7,000 low-income households

– Random sample of 800 adults in households with children surveyed

– Campaign awareness was 52%



Watching

• Results (continued)

– 67% in low-income households

– 2/3 indicated that they understood and agreed with the message when they heard it

– 20% indicated that they would adopt the message



Watching

• Lessons Learned

– An enthusiastic collaboration among businesses, community agencies, and community leaders was the key to the success of this venture.

– Partnerships forged between public and private organizations can grow strong as a result of working together on such campaigns.


The Diffusion of Innovation

Model

• Developed to explain how a product or idea becomes accepted by a majority of consumers.



Model

• It consists of four stages:

– Knowledge - the individual is aware of the innovation and has acquired some information about it.

– Persuasion - the person forms an attitude either in favor of or against the innovation.



Model

• Four stages (continued):

– Decision - the individual performs activities that lead to either adopting or rejecting the innovation.

– Confirmation - the individual looks for reinforcement for his or her decision and may change if exposed to counter-reinforcing messages.



Model

• Consumers are classified according to how readily they adopt new ideas or products:

– Innovators - adopt the innovation quite readily and perceive themselves as popular and financially privileged.

– Early adopters - the next to adopt; include opinion leaders, are integrated into the community and are well respected by their families and peers.



Model

• Consumer classifications (continued):

– Early majority - tend to be cautious.

– Late majority - skeptical; usually adopt an innovation only through peer pressure.

– Laggards - the last to adopt; tend to come from small families, to be single and older, and to be traditional.

• The Application

– Seeking early adopters for the “Heart-

Healthy Living” program


Put It All Together: Case

Study 1

• Defining levels of intervention for target groups

• Formative evaluation and literature review

• Influence of theories of consumer behavior on health promotion activities



Use Entrepreneurship to

Steer in a New Direction

• One of the major challenges for community nutritionists is to think of new ways of delivering health messages and services to vulnerable populations.

• We need a better understanding of the community factors that influence change and the reasons why consumers resist change.


Use Entrepreneurship to

Steer in a New Direction

• When you plan community interventions:

– Think of new ways to reach your target audience.

– Plan strategies for finding out why your clients are resisting a behavior change.

– Apply your creativity to influencing people to achieve behavior change.


Being an Effective Speaker

• Things to Do Before Your

Presentation

– First, tell your audience what you are going to tell them...

– then tell them what you have to tell them...

– and finally, tell them what you told them!



• Before Your Presentation (continued)

– Prepare your visual aids so that they present your ideas effectively.

• Clear purpose

• Readily understood

• Simple format

• Free of nonessential information

• Graphical format

• Visible

• Legible

• Integrated with verbal text



• Before Your Presentation (cont.)

– Rehearse your presentation several times.

– Use mental imaging to boost your self-confidence.

• Mental imaging - a technique to develop and strengthen a positive mental picture of the performance.



• Things to Do During Your

Presentation

– Smile

– Use eye contact

– Use gestures

– Control the pace

– Use pauses

– Vary the volume and pitch



• Remember that the purpose of your presentation is to share information with your audience.

• You will want to develop your own style.


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