HLSC 2613
Foundations of Community
Health
Course Notes
Instructor: Ches Jones, PhD
Leading Causes of Death
1900
• Tuberculosis
• Pneumonia
• Diarrhea & Enteritis
• Heart Disease
• Nephritis
• Infancy Diseases
• Apoplexy (Stroke)
• Accidents
• Cancer
• Bronchitis
• Meningitis
• Diphtheria
2000
• Cardiovascular
• Cancer
• Injuries
• HIV/AIDS
• Chronic Lung Disease
• Pneumonia & Influenza
• Diabetes
• Suicide
• Liver Disease
• Homicide
• Kidney Disease
• Blood Infections
Key words, terms, &
definitions
• Health
•
•
•
•
•
dynamic state or condition
multidimenisonal
results from interaction w/ environment
is a resource for living
exists in varying degrees
Health
• A state of complete physical, mental, and
social well-being, not merely the absence of
disease (WHO).
Wellness
• A purposeful, enjoyable, and deliberate
lifestyle choice characterized by personal
responsibility and optimal enhancement of
physical, mental, emotional, social, and
spiritual health.
Health-Disease Scale
Disease
Wellness
Wellness
Severe, disabling,
and lifethreatening
illness effecting
physical, mental
and social health
Health
Complete
• Physical
• Mental
• Social
• Emotional
and
• Spiritual health
Key words, terms, & definitions
(continued)
• Health
• Personal health activities
• those to promote, protect, and preserve health
of self and/or family
Key words, terms, & definitions
(continued)
• Health
• Personal health activities
• Community health
• health status of a defined group
• public & private actions & conditions to
promote, protect, & preserve the health of the
group
Key words, terms, & definitions
(continued)
•Health
•Personal health activities
•Community health
•Public health
• health status of a defined group
• governmental actions & conditions to promote,
protect, & preserve the health of the group
Key words, terms, & definitions
(continued)
• Health
• Personal health activities
• Community health
• Public health
Health education
• Health Education
- “any combination of planned learning
experiences based on sound theories that
provide individuals, groups, and
communities the opportunity to acquire
information and the skills needed to make
quality health decisions” (Joint Committee, 2001)
Dimensions of Health Education
Health
Education
Education
Education
Behavioral
Behavioral
Sciences
Sciences
Public
Public
Health
Health
The Practice of Health Education
• Understand & engage
priority population
• Assess needs & assets
of priority population
• Develop goals &
objectives
• Create an intervention
• Implement the
intervention
• Evaluate the results
Key words, terms, & definitions
(continued)
• Health
• Personal health activities
• Community health
• Public health
• Health education
• Health promotion
Vision/Mission of Health
Education
• The health education profession promotes,
supports, and enables healthy lives and
communities.
Premises of Health Education
1. Grounded in the values and needs of the community
,
health education promotessocial and environmental
justice.
2. The health education profession promoteshealth
literacy and enables and supports healthy lives and
communities.
3. Many of the leading causes of morbidity and mortality
are behaviorally based.
4. Health literacy is an enabling factor in promoting
healthy behavior.
Responsibilities of Health
Educators
Program
Program Planning
Planning
Implementation
Implementation
Program
Program Delivery
Delivery
Program
Program Administration
Administration
Evaluation
Evaluation
• Health promotion
- “any planned combination of educational,
political, environmental, regulatory, or
organizational mechanisms that support
actions and conditions of living conducive
to the health of individuals, groups, and
communities” (Joint Committee, 2001).
Health Education/Health
Promotion
Health
Health Promotion
Promotion
Health Education
Health Education/Promotion
Settings
•
•
•
•
•
•
•
Personal/Family Health
School
Worksite
Community
State, Regional, or National Level
Government
Global/World
Personal/Family Health
•
•
•
•
•
Health Educator
Nutritionist/Dietician
Fitness Instructor
Physician/Nurse
Therapist
School
•
•
•
•
Health Educator/Dual Role
Athletic Trainer
Nutritionist/Dietician
Physician/Nurse
Worksite
•
•
•
•
•
•
Health Educator
Nutritionist/Dietician
Physician/Nurse
Fitness Coordinator
Environmental Health
Occupational Safety
Community
•
•
•
•
•
•
•
Health Educator
Nutritionist/Dietician
Environmental and Occupational
Physician/Nurse
Epidemiologist (Studies Diseases)
Health Program Coordinator
Health Service Administrator
State, Regional, or National
•
•
•
•
•
•
•
Health Educator
Nutritionist/Dietician
Physician/Nurse
Epidemiologist
Health Program Coordinator
Health Service Administrator
Biostatistician
Government
•
•
•
•
•
•
•
Health Educator
Nutritionist/Dietician
Physician/Nurse
Epidemiologist
Health Program Coordinator
Health Service Administrator
Biostatistician
Global/World
•
•
•
•
•
•
•
Health Educator
Nutritionist/Dietician
Physician/Nurse
Epidemiologist
Health Program Coordinator
Health Service Administrator
Biostatistician
Priority Behaviors for Health
Promotion

Tobacco

Tobacco

Alcohol/drug

Alcohol/drug use
use

Nutrition

Nutrition

Physical

Physical Activity
Activity

Driving

Driving

Risk

Risk management
management

Human

Human sexuality
sexuality

Family

Family development
development

Stress

Stress management
management

Coping/adaptation

Coping/adaptation

Enhanced

Enhanced self-esteem
self-esteem
Key words, terms, & definitions
(continued)
• Health
• Personal health activities
• Community health
• Public health
• Health education
• Health promotion
• Disease prevention
Disease Prevention
• Disease Prevention
-“the process of reducing risks and
alleviating disease to promote, preserve, and
restore health and minimize suffering and
distress” (Joint Committee, 2001)
Measuring Health
or Health Status
• Typically measured using ill health; injury,
disease and death
• Common means
•
•
•
•
•
Rates (measure of group at certain time)
Life expectancy (birth, 65, and 75)
YPLL (measured at 65 and 75)
DALYs (lost years of healthy life)
Health surveys
Underlying Concepts
of Health Education
• Health field concept (Lalonde, 1974)
•
•
•
•
Human biology (heredity) (26.3%)
Environment (15.8%)
Lifestyle (health behavior) (48.5%)
Health care organization (10.8%)
Health Field Concept
44 Factors
Factors Influencing
Influencing Health
Health
Lifestyle
Lifestyle
Biology/Genetics
Biology/Genetics
Medical
Medical Care
Care
Environment
Environment
Determinants of Health
Determinant
% Deaths
Medical
Services
Heredity
10
% Health Care
Dollar
90
19.8
07
Environment
20.1
01.6
Lifestyle
51.5
01.4
Underlying Concepts
of Health Education (continued)
• Prevention
- the planning for and the measures taken to
forestall the onset of, a disease or other
health problem before the occurrence of
undesirable health events.
Why Health Promotion and
Disease Prevention?
• Historically, the health care field and
services have focused on the treatment of
disease, not the prevention or onset of
illness.
• Why is this so?
• Prevention only accounts for 1% of the
nation’s expenditures for health.
Prevention Counts.
• Why is disease prevention and health
promotion a better way to go?
1)
1) Prevention
Prevention saves
saves lives
lives
2)
2) Prevention
Prevention improves
improves the
the quality
quality of
of life
life
3)
3) Prevention
Prevention is
is cost
cost effective
effective
Why Prevention is not Focus:
-Can’t
-Can’t tell
tell if
if programs
programs have
have saved
saved lives.
lives.
-Do
-Do not
not want
want to
to change
change current
current thinking.
thinking.
-Medical
-Medical personnel
personnel do
do not
not want
want to
to give
give up
up
their
their power/job.
power/job.
-Prevention
,,
-Prevention should
should be
be aa personal
personal matter
matter
not
not aa national
national one.
one.
Three Levels of Prevention
Primary
Primary
Secondary
Secondary
Tertiary
Tertiary
Underlying Concepts
of Health Education (continued)
• Risk factors
- “habit, trait, or condition in a person that is
associated with an increased chance (or
risk) of developing a disease” (Green & Ottoson, 1999
p.181).
• Modifiable (changeable or controllable)
• Nonmodifiable (nonchangeable or
noncontrollable)
Underlying Concepts
of Health Education (continued)
• Health risk reduction
• Risk reduction for noncommunicable
(noninfectious) diseases
• Multicausation Disease Model
• Risk reduction for communicable
(infectious) diseases
• Chain of infection
Underlying Concepts
of Health Education (continued)
• Health risk reduction
• Risk reduction for noncommunicable
(noninfectious) diseases
• Multicausation Disease Model
• Risk reduction for communicable
(infectious) diseases
• Chain of infection
• Communicable Disease Model
Other selected principles of
health education
• Participation
• Ownership
• Ecological
• Population-based approaches (advocacy,
organizational change, community
development, empowerment, & economic
support)
• Cultural sensitivity & competency
Epidemiology
• “the study of the distribution and
determinants of diseases and injuries in
human populations” (Mausner & Kramer, 1985, p. 1)
•Key terms
- endemic, epidemic, and pandemic
History of Community/Public
Health
-Greeks
-Romans
-Early America
-Plagues of Europe, Bubonic Plague,
Epidemics, Pandemics
-Lemuel Shattuck—Modern Health Era
5 Phases in Modern Health Era
-Miasma Phase (1850-1880)
-Bacteriology Phase (1880-1910)
-Health Resources Phase (1910-1960)
-Social Engineering Phase (1960-1975)
-Health Promotion Phase (1975- present)
Life Expectancy
100
90
80
70
60
50
40
30
20
10
76 years-1996
67 years-1946
50 years-1900
41 years-1846
35 years-1780
22 years
18 years-
3000 B.C.
2500
2000
1500
1000
500
A.D.
500
1000
1500
2000
Miasma Phase (1850-1880)
-Disease control was based on the
misconception that disease was caused
by noxious air.
-American Public Health Association
-Establishment of first state health dept.
-Public Health teaching began
Bacteriology Phase (1880-1910)
• -Findings that specific organisms caused
specific diseases.
• -Many vaccines were created to cure
illness
Health Resources Phase (19101960)
-Shifting of importance from
communicable diseases to other health
hazards such as personal health services.
-County health depts were established
Health Resources Phase
(1910-1960) cont.
-Three health resources grew
exponentially:
•Hospitals
•Health personnel
•Biomedical knowledge from research
-Voluntary health agencies grew in
number and importance
Social Engineering Phase
(1960-1975)
-Technical health advances and personal
health resources were not available to
everyone.
-Medicare and Medicaid legislation
-Community outreach programs
-Concern of the containment of medical
care costs and expenditures.
Health Promotion Phase
(1975-present)
The government produced many reports and
legislation trying to bring about interest in
disease prevention and health promotion.
•Healthy People (1979)
•Promoting Health, Preventing Diseases:
Objectives for the Nation (1980).
•Healthy People 2000
Healthy People 2010
Designed
Designed to:
to:
1.
1. promote
promote healthy
healthy behaviors;
behaviors;
2.
2. promote
promote healthy
healthy and
and safe
safe
communities;
communities;
3.
3. improve
improve systems
systems for
for personal
personal and
and public
public
health;
health; and,
and,
4.
4. prevent
prevent disease
disease and
and disorders.
disorders.
Healthy People 2010
467
467 objectives
objectives
26
26 focus
focus areas
areas
22 major
major goals
goals
-Increase
-Increase the
the quality
quality
of
of life
life as
as well
well as
as the
the
years
years of
of healthy
healthy life.
life.
-Eliminate
-Eliminate health
health
disparities
disparities
For each priority area, a lead agency has been assigned
to monitor and implement services.
Healthy People 2010
Leading Health Indicators:
•
•
•
•
•
•
•
Physical Activity
Overweight and obesity
Tobacco use
Substance abuse
Responsible sexual behavior
Mental health
Injury and violence
Healthy People 2010
Leading Health Indicators:
• Environmental quality
• Immunization
• Access to health care
Healthy People 2010
Populations for Consideration:
-Infants
-Infants
-Children
-Children
-Adolescents
-Adolescents and
andYoung
Young Adults
Adults
-Adults
-Adults
-Older
-Older Adults
Adults
Settings for Health Education
•
•
•
•
-School
-Community
-Worksite
-Health Care
Community Health
-Voluntary
-Voluntary Health
Health Agencies
Agencies
-Public
-Public Health
Health Agencies
Agencies
-Private
-Private Health
Health Agencies
Agencies
Voluntary Health Agencies
-Education
-Education
-Service
-Service
-Research
-Research
Public/Private Agencies
-Education
-Education
-Public
-Public Relations
Relations
-Program
-Program Planning
Planning
Worksite Health
Four Levels of Programs
Health Assessment
Health Information
Health Instruction
Follow Up and Counseling
School Health Education
• Why?
• Comprehensive School Health
-12 Elements
-7 Standards
-8 Components
Comprehensive School
Health Education (CSHE)
• “health education in a school setting that is
planned and carried out with the purpose of
maintaining, reinforcing, or enhancing the
health, health-related skills, and health
attitudes and practices of children and youth
that are conducive to their health.”
Health Education:
• is eclectic in nature.
• is an applied science.
• has a body of knowledge that comes from
other disciplines. (Galli, 1976)
• is bigger than a discipline.
• is smaller than a profession.
Health Education:
An Emerging Profession
Discipline
• “a branch of knowledge or instruction”
• “an occupation that properly involves a
liberal, scientific, or artistic education”
Profession
• “the sociological construct for an occasion
that has special status”
• “one who pursues as a business some
vocation or occupation”
Why not a profession?
• Not clearly defined by others, though now
recognized by U.S. Dept. of Commerce and
Labor
• Several issues still unresolved
•
•
•
•
Period of preparation
System to regulate behavior of members
Culture peculiar to profession
Single association
Current status of
Health Education
• More visible than ever before
• 1974 - beginning of health promotion era of
public health
• 1979 - publication of Healthy People
• 1990, 2000, 2010 goals and objectives for
the nation
Unit 2
Philosophical/Theoretic
al
Foundations
Philosophy
• What is philosophy?
• A statement summarizing the attitudes,
principles, beliefs, values, and concepts held by
an individual or a group.
• Why does one need a philosophy?
• People’s philosophies help form the basis of
reality for them. A philosophy helps to
determine how one lives, works, plays, and
generally approaches life.
Major
Schools of Philosophy
• Realism - truth exists independent of the mind; nature is the
appropriate guide
• Idealism - reality is composed of ideas; conception of things as
one thinks they should be
• Pragmatism - experience is the ultimate reality; therefore what
works (or is practical) is right
• Eclectic - made up of what seems best of varied sources
A Philosophy of an...
• individual is expressed in the way he/she
sees the world (what is true for him/her)and
is reflected in how one acts.
• organization is often expressed in its
mission statement.
From Where Does One’s
Philosophy of Life Come?
• Environment
• - Learned from family and friends
• - Guidance from significant others (i.e.,
teachers, religious leaders, mentors)
•
•
•
•
Education and study
Experiences
Scientific data
Other
Philosophies Associated
with Health
• Philosophy of Symmetry
• Health has physical, emotional, spiritual, and
social components, and each is just as important
as the other.
• Holistic Philosophy
• “Man [sic] is essentially a unified integrated
organism” (Oberteuffer, 1953, p.105).Thus the health of
the person should be considered as a whole and
not as the individual components.
Philosophies Associated
with Health (cont’d)
• Humanism
• Characterized by a concern for humanity. It
also “promotes the basic premise of the worth
of human life and the ability of individuals to
achieve…self fulfillment” (Bedworth & Bedworth, 1992,
p. 5)
• Wellness
• A positive quality, as opposed to illness which
is a negative quality. Impacted by the
dimensions and and continuum of wellness
Predominant Health Education
Philosophies
• Behavior Change philosophy
• Focuses on modifying unhealthy habits of an
individual
• Cognitive-Based philosophy
• Focuses on the acquisition of content and
factual information
• Decision-Making philosophy
• Emphasizes critical thinking and lifelong
learning
Predominant Health Education
Philosophies (cont’d)
• Freeing/Functioning philosophy
• Focuses on freeing people to make best health
decision for them-- not necessarily for society
• Social Change philosophy
• Emphasizes creating social, economic, &
political change that benefits health of
individuals & groups
• Eclectic philosophy
• Focuses on an adapting approach that is
appropriate for setting
Writing a Philosophy
• Philosophy impacts one’s approach to life,
beliefs about health, & the delivery of
health education, therefore:
• What is your philosophy of…
• Life?
• Health?
• Health Education?
Philosophy of Life
• Consider
• What is important in your life?
• What do you value most?
• What ideals do you hold?
• How do the answers to the above questions
influence the way you believe and act?
• Complete the stem: “The purpose of life is
to…”
Examples
“The purpose of life is a life of
purpose”
Robert Burns
“If your ship doesn’t come in, swim
out to meet it”
Unknown
“The more I practiced, the luckier I
got”
Arnold Palmer
“No matter what you undertake, you
will never do it until you think you
can”
Famous Philosopher Anon
“You can’t change the wind, but you
can adjust your sails”
Unknown
“Whether you think you can or you
think you can’t, you are right”
Henry Ford
“If there is righteousness in the heart
There will be beauty in the character
If there is beauty in the character
There will be harmony in the home
If there is harmony in the home
There will be order in the nation
If there is order in the nation
There will be peace in the world”
Chinese Proverb
“Do all the good you can
By all the means you can
In all the ways you can
In all the places you can
At all the times you can
To all the people you can
As long as ever you can”
John Wesley
Philosophy of Health
• Consider
• Creating you own definition of health
• The dimensions of wellness
• The continuum of wellness
• Complete the stem: “The purpose of health
is to…”
Philosophy of
Health Education
• Consider
•
•
•
•
•
the predominant health education philosophies
definitions of health education
- benefits of health education
- limitations of health education
- responsibilities of a health educator
• Complete the stems:
• -
The purpose of health education is to...
• Thus far, I believe health education…
• (Hint: see what practicing health educators wrote- p. 85 of textbook)
To be useful...
Philosophy -> principles -> practice
Key Definitions
• Theory
• “a set of interrelated concepts, definitions, and
propositions that presents a systematic view of
events or situations by specifying relations
among variables in order to explain and predict
the events of the situations” (Glanz, Lewis, & Rimer,
1997, p. 21)
• Concepts
• the primary elements of theories (Glanz, Lewis, &
Rimer, 1997)
4 Uses of Theory
•
•
•
•
Describe
Explain
Predict
Prescribe
Key Definitions (cont’d)
• Construct
• a concept that has been developed, created, or
adopted for use with a specific theory (Kerlinger,
1986)
• Variable
• “specify how a construct is to be measured in a
specific situation” (Glanz & Rimer, 1995, p. 11)
Key Definitions (cont’d)
• Model
• “a subclass of a theory” (McKenzie & Smeltzer, 2001, p.
138); draws “on a number of theories to help
people understand a specific problem in a
particular setting or context” (Glanz, Lewis, & Rimer,
1997, p. 24)
Examples
• Concept
• Personal beliefs
• Construct
• Perceived benefit
• Variable
• Model
• Theory
• Rank order incentives
• Health Belief Model
• Social Cognitive Theory
Why use theory?
• Help guide the practice of health educators
• “…provides direction and justification for
program activities…” (Cowdery et al., 1995, p. 248)
More specifically, theory…
(Nutbeam & Harris, 1999, p. 12)
• “helps identify targets for intervention.”
• “helps to clarify how & when change can be
achieved…”
• “indicates how to achieve organization
change, & raise community awareness.”
• “provides a benchmark against which actual
can be compared with ideal program.”
• “defines outcomes and measurements for
use in evaluation.”
Types of Theories/Models
• Theories /models of implementation (for
planning, implementation, & evaluation)
referred to as planning models
• Change process theories (for use in
behavior change) referred to as behavior
change models
Planning Models (Theories/Models of
Implementation)
PRECEDE-PROCEED
• predisposing, reinforcing, and enabling
constructs in educational/ecological
diagnosis and evaluation – policy,
regulatory, and organization constructs in
educational and environmental development
(Green & Kreuter, 1999)
Program Planning Models
(cont’d)
• PRECEDE-PROCEED
• MATCH
•
Multilevel Approach to Community
Health (Simons-Morton, D., Simons-Morton, B., Parcel, &
Bunker, 1988)
Program Planning Models
(cont’d)
• PRECEDE-PROCEED
• MATCH
• CDCynergy
Program Planning Models
(cont’d)
•
•
•
•
PRECEDE-PROCEED
MATCH
CDCynergy
Several others
Program Planning Models
(cont’d)
•
•
•
•
•
PRECEDE-PROCEED
MATCH
CDCynergy
Several others
Generalized Model for Program Planning
(McKenzie & Smeltzer, 2001)
Behavior Change Theories /
Models
• First need to decide on what level to intervene
• Consider the ecological perspective (McLeroy et al., 1988)
•
•
•
•
•
Intrapersonal, or individual, factors
Interpersonal factors
Institutional, or organizational, factors
Community factors
Public policy factors
Behavior Change Theories /
Models
•
•
•
•
Health Belief Model (HBM)
Self-efficacy
Theory of Planned Behavior
Transtheoretical Model (TTM)
• aka-Stages of Change
Social Change Theories
• Diffusion Theory
• Social Cognitive Theory
• Social Marketing Theory
Health Belief Model
• Four major components
•
•
•
•
Perceived severity
Perceived susceptibility
Benefits
Barriers
• Mediating factors
• Social, environmental, media, others
Health Belief Model
Benefits
Barriers
Perceived Severity
Perceived Threat
Outcome
Perceived Susceptibility
Modifying Factors
-Media
-People
-Other factors
Self-Efficacy
Self-Efficacy
• Definition: person’s confidence to perform
a specific task.
Self Efficacy Theory
• Person
Efficacy
Expectation
Can I Do Activity?
Behavior
Outcome
Outcome
Expectations
If I Do Activity, What
Will Happen?
Sources of Self-Efficacy
Performance
attainment
Vicarious
learning
Verbal
persuasion
Physiological
monitoring
Behavior
Decision to
perform
Perceived
Self-Efficacy
Effort
expended
Persistence
Theory of Planned Behavior
• Intentions predict behaviors
• Three factors that affect a person’s intention
to do a specific behavior:
• Personal attitudes
• Social norm (what others think)
• Perceived behavioral control
Theory of Planned Behavior
Attitudes
Inentions
Intentions
Social
Social Norm
Norm
Perceived
Control
Behavior
Stages of Change Theory
• 6 stages of behavior change
•
•
•
•
•
•
Precontemplation
Contemplation
Preparation
Action
Maintenance
Termination
Stages of Change Theory
• Precontemplation
• Person is not aware that they have a problem
and does not see how unhealthy behavior is
effecting their life or health.
• Process of change:
• Consciousness raising
• Social liberation
• Helping relationships
Stages of Change Theory
• Contemplation
• Person knows that change would be good, but
does not have the confidence to change and
needs more information.
• Process of change:
• Self-reevaluation
• Dramatic relief (emotional arousal)
• Helping relationships
Stages of Change Theory
• Preparation
• Person begins preparing for changing unhealthy
behavior for new healthy behavior.
• Process of change
• Self-liberation (commitment)
• Helping relationships
Stages of Change Theory
• Action
• Person begins the new healthy behavior.
• Process of change
•
•
•
•
Reinforcement management (Reward)
Helping relationships
Stimulus control
Counterconditioning
Stages of Change Theory
• Maintenance
• Person is practicing healthy behavior but may
need feedback and a booster to avoid obstacles
and temptations.
• Process of change
• Helping Relationships
Stages of Change Theory
• Termination
• Person feels that new behavior is a part of their
life and they never look back and think about
the unhealthy behavior.
• Helping Relationships
Diffusion Theory
• Definition: spread of ideas and innovations over
time through communication channels among
members of a social system.
• Used to predict best channels to communicate
health information in hopes of behavior change.
Diffusion Theory
• Adopter categories
•
•
•
•
•
Innovators (1.3%)
Early adopters (16%)
Early majority (33%)
Late majority (33%)
Laggards (16%)
Diffusion Theory
Percent adoption
• Diffusion Curve
at 20% adoption,
Innovation takes off!
Time
Social Cognitive Theory
• Based on premise that an interaction exists
between behavior, individual, and the
environment.
• Reciprocal Determinism
Environment
Behavior
Individual
Social Cognitive Theory
• Behavior change occurs in 4 phases:
•
•
•
•
Pre-Training
Training
Initial Testing
Continual Performance
Social Cognitive Theory
• Pre-Training Phase
• Reciprocal Determinism
• Behavioral Capability
• Is person capable of performing task?
Social Cognitive Theory
• Training Phase
• Expectations
• What will the likely outcome be?
• Expectancies
• Value placed on expected outcomes
• Self-Efficacy
• Emotional coping response
Social Cognitive Theory
• Initial Testing Phase
• Observational learning
• Self-control or self-regulation
Social Cognitive Theory
• Continual Performance Phase
• Reinforcement
• Locus of control
• Internal--self reward
• External--other reward
Social Marketing Theory
What is it?
• Social Marketing Theory• Applies the concept of traditional marketing to
the “sale” or promotion of healthy behaviors.
• Elements
•
•
•
•
•
market plan
carefully designed messages
employment of mass media
consensus building
appropriate packaging
SMT continued
• SMT emphasizes the importance of
specific target audiences and segmentation
of the population when designing programs.
• Gender, race, age, religion, education, etc.
Components
• The eight components include but are not limited
to:
•
•
•
•
•
•
•
•
consumer orientation
exchange theory
audience analysis and segmentation
formative research
channel analysis
marketing mix
process tracking
marketing management
1) Consumer orientation
• This component consists of familiarizing
the health educators and marketers to the
needs of the consumers to better market
towards them.
• To discover the needs and wants of the
consumers, focus groups can be formed to
represent the demographic being served.
2) The Exchange Theory
• Tangible and non-tangible items that are
given up to achieve health behavior goal.
• To achieve a lower triglyceride level and decrease
your total cholesterol you might have to give up
eating at McDonalds five times a week in exchange
for two times a week.
3) Audience Analysis and
Segmentation
• Audience analyses, knowing your target
populations.
• what population you are working with
• who is at risk
• Segmentation, describes breaking down
populations into more specific groups. This
makes groups readily available for analysis,
diagnosis, and treatment with new
implementation of programs.
4) Formative Research
•
•
•
•
•
Documentation of development
Extensive note taking
Existing materials
Materials that need to be made
Continuous Evaluation
5) Channel Analysis
• Channels refer to the lines of communication through
which an individual is reached.
•
•
•
•
•
•
•
Billboards
TV
Internet
Print Media
Novelty Items
Radio
News Outlets
• When trying to promote the Gardasil vaccination,
concentrate on channels of media that young women are
exposed to, such as teen magazine, MTV.
6) Marketing Mix
• Based on the 4P’s:
•
•
•
•
product
price
place
Promotion
• And sometimes PARTNER
6) Marketing Mix cont.
• Product• What we are trying to “sell”?
• May be a tangible product or in our case an
intangible product, the idea of health.
• Can be used to explore the consumer’s
perception of the problem or product and how
to remedy it.
6) Marketing Mix cont.
• Price• Price describes what the consumer has to “pay”
for the product.
•
•
•
•
Monetary
Time
Effort
Remembering to do it
• Behaviors will more likely be adopted if the
benefits outweigh the costs.
6) Marketing Mix cont.
• Place• Where will you promote?
• Where will product be sold?
•
•
•
•
shopping malls
mass media
fliers
brochures
6) Marketing Mix cont.
• Promotion• Integrates the advertisements, public relations,
promotion, media, personal testimonials, and
entertainment sources.
• The rationale for promotion is to create and
sustain the product.
• a PSA may be used to increase awareness of breast
cancer and give tips on self examination.
7) Process Tracking
• Evaluations
• surveys
• Letters to the editors
• Press release
• process (what you are doing right now)
• impact (directly after the fact), and
• outcome (after the program, ie. 6 months)
evaluations.
Partner
• Teaming up with other organizations to
better market to the desired consumer
• Collaboration of time, resources, people,
money, etc.
8) Marketing Management
• Involves the specific aspects of the program
you are trying to manage
•
•
•
•
Budget
Administration issues
Team building
Leadership
Unit 3
• Ethics and the Health Education Profession
Three Areas of Philosophy
• Ethics - The study of morality
• Epistemology - The study of knowledge
• Metaphysics - The study of the nature of
reality
Ethics
• The study of good and bad, right and
wrong, of duty and obligation, and of
reasoning and choices.
• The important thing to remember is that
moral-immoral and ethical-unethical
essentially mean right-wrong, good-bad.
Reasons to Act Ethically
•
•
•
•
Brings meaning & purpose to life
It provides a standard by which to live
Establishes your credibility & reputation
It leads to a healthier & more emotionally
satisfying life
• It is expected of professionals
• Others appreciate it & will tend to treat you
likewise
Why Be Ethical?
“A good name is more desirable than
great riches; to be esteemed is better
than silver or gold.”
King Solomon
Ethical Theories
• Formalism (deontological or nonconsequentialism) - looking at the act; the
end does not justify the means.
• Consequentialism - looking at the
consequences; the end does justify the
means.
Ethical Theories
• Natural Law-person has a right to choose
their own behavior unless the behavior
harms society.
• Utilitarianism-Overall benefit to society
• Paternalism-Can act if person is unable to
decide, significant harm without action, or
will agree to action at a later date.
Ethical Theories
• Distributive Justice-distributing goods and
services equally. Not discriminating by
gender, age, ethnicity, or education
• Social Justice-determining the root causes
underlying health problems. Not providing
charity but helping society in order to help
people to live a healthier lifestyle.
5 Basic Principles for Common
Moral Ground
• Value of Life - The first and most basic
principle
• Goodness or Rightness - Subdivided into
two related principles
• Nonmaleficence - The first duty is to do no
harm
• Beneficence or Benevolence - To do good;
actions that provide for the greater good of the
community
5 Basic Principles for Common
Moral Ground (cont’d)
• Justice or Fairness - everyone has an equal
chance at obtaining the benefits
• Honesty or Truthfulness - the heart of any
moral relationship and meaningful
communication
• Autonomy - Individuals must have the
freedom to choose their own way of being
ethical using the framework of the first four
principles.
Ethical Decision Making
• Define problem & seek answers to relevant
questions.
• Consider the goals & ideals for which you
are striving.
• Consider the consequences of each
alternative.
• Consider consequences in terms of various
ethical principles.
Ethical Decision Making
(cont’d)
• Consider the impact of a proposed action on
you as a moral person.
• Consider the impact of a proposed action on
society and environment.
• Apply the “categorical imperative”; how
would you want others to act?
• Select your best alternative and act.
Context is Important
•
•
•
•
•
•
•
Place
Time
Identity
Social relationships
The ideal - “most noble” alternative
The concrete
Seriousness
Ethical Obligations as
Health Educators
• Obligation to:
•
•
•
•
•
provide service
clients
third parties
employers
the profession
Ethical Dilemmas
• Must be an issue (a controversy); two sides
• Must involve a question of right and wrong
Ensuring Ethical Behavior
• Limit Entry into the Profession
•
•
•
•
Selective admission to programs
Retention standards in academic programs
Completion of internships
Graduation requirements (from an accredited
[SABPAC] program?)
• Credentialing (CHES)
• Continual updating
Ensuring Ethical Behavior
(cont’d)
• Practicing Professionals
• Code of ethics - Unified Code in 1999
Code of Ethics - Preamble
(p. 311 of text)
The health education profession is dedicated to
excellence in the practice of promoting individual,
family, organizational and community health.
Guided by common ideals, health educators are
responsible for upholding the integrity and ethics
of the profession as they face the daily challenges
of making decisions. By acknowledging the value
of diversity in society and embracing a crosscultural approach, health educators support the
worth, dignity, potential and uniqueness of all
people.
Ensuring Ethical Behavior
(cont’d)
• Practicing Professionals
• Code of ethics - Unified Code in 1999
• Self Monitoring
• Peer review committee (panel)
• Legal System
Code of Ethics for Health Educators
• Informed Consent
•
•
•
•
•
•
•
•
•
•
Benefits
Risks
Voluntary
Confidentiality
Advocate for Health
Privacy for Customers
Quality of Programs and Services
Equality
Commitment to Profession
Research
The Health Educator:
Roles, Responsibilities,
Certifications, Advanced Study
Credentialing - meeting specified
standards of credentialing body
• Accreditation - evaluation of program or
institution
• Licensure - governmental agency grant
permission to practice based on standards
(i.e., teachers)
• Certification - recognition based standard of
performance (i.e., CHES)
History of Role Delineation and
Certification
• 1974, Helen P. Cleary, SOPHE President
History of Role Delineation and
Certification
• 1978, Bethesda Conference on Commonalities
and Differences• In settings?
• In preparation?
• National Task Force on the Preparation and
Practice of Health Educators created with reps.
from CNHEO members
• 1979 role delineation began (role created,
verified, curriculum framework created)
History of Role Delineation and
Certification (cont’d)
• 1986, 2nd Bethesda Conference determine
type of credentialing
• 1988, National Commission for Health
Education Credentialing, Inc. created &
charter certification began
• 1990, 1st CHES examination
• 1997, Graduate Standards approved
• 1998, Competency Update Project (CUP)
History of Role Delineation and
Certification (cont’d)
•
•
•
•
1988, Charter certification began
1990, 1st CHES examination
1997, Graduate Standards approved
1998, Competency Update Project (CUP)
CHES
Program Accreditation
• National Commission for the Accreditation
of Teacher Education (NCATE)
• Council on Education for Public Health
(CEPH)
• SOPHE/AAHE Baccalaureate Program
Approval Committee (SABPAC)
Health Educators:
• are professionally trained.
• serve a variety of roles.
• are trained to use appropriate educational
strategies & other methods conducive to
health. (Joint Committee, 2001)
What Do Health Educators Do?
• Responsibilities - specify scope of practice
• Competencies - reflect ability to understand,
know, etc.
• Sub-competencies - reflect ability to list,
describe, etc.
• Objectives - reflect ability to perform
Responsibility I
• Assessing individual and community needs
for health education
• Priority population
• Types of data
• Primary
• Secondary
Responsibility II
• Planning effective health education
strategies, interventions, and programs
• Planning committee
• Develop goals & objectives
• Create intervention
Responsibility III
• Implementing health education strategies,
interventions, and programs
• Pilot test
• Phase-in
• Total implementation
Responsibility IV
• Conducting Evaluation and research related
to health education
•
•
•
•
•
Plan evaluation and research
Design methods to collect data
Process, impact, & outcome
Formative & summative
Interpret findings
Responsibility V
• Administering health education strategies,
interventions, and programs
•
•
•
•
Exercise leadership
No overlap of services
Facilitate cooperation
Manage human resources
Responsibility VI
• Serving as a health education resource
person
• Answering questions
• Selecting and developing educational resources
• Establishing consultative relationships
Responsibility VII
• Communicating and advocating for health
and health education
• Communication skills
• Feeling comfortable working with others
• Serving as a filter
Multi-tasking
• Skill of coordinating and completing
multiple projects at the same time
Advanced Study
in Health Education
• Master’s degree (M.A., M.Ed., M.P.H.,
M.S., M.S.P.H.
• Doctoral degree (D.Ed., Dr.P.H., Ed.D.,
H.S.D., P.h.D.)
Selecting a Graduate School
• Characteristics of institution and program
• Admission requirements
• Financing graduate education
The Settings for Health
Education
Major Settings
•
•
•
•
•
•
•
Schools
Worksites
Health care organizations
Community/public health agencies
Colleges/Universities
International agencies
Non-traditional settings
Schools
• School Health Educators
• Teacher preparation curriculum
• Licensed by the state
• Coordinated school health program - “an
organized set of polices, procedures, and
activities designed to protect, promote, and
improve the health and well-being of
students and staff…” (Joint Committee, 2001)
Schools (cont’d)
• Type of work
•
•
•
•
•
Teach (typically 7-12, sometimes K-6)
Develop I.E.Ps for children with special needs
Coordinate school health program
Develop curricula
Committee work (i.e., Drug Task Force)
Why School Health?
• Health and learning reciprocally related
• All must pass through - 52+ million
students, 5 million employees
• Health People 2010 - 1/3 of the objectives
can be accomplished by schools
Community/Public Health
Education
• Community health education - “a theorydriven process that promotes health and
prevents disease within populations” (Joint
Committee, 2001)
• Types of agencies
• Governmental (LHD, State Health Dept.,
Federal agencies)
• Voluntary (i.e., ACS, AHA, ALA)
• Quasi-governmental (i.e., ARC)
Community/Public Health
Education (cont’d)
• Type of work
• Planning, implementing, & evaluating health
education/promotion programs
• Fund raising events/campaigns
• Coalition building
• Grant proposal writing
• Advocacy
• Volunteer recruitment
• Arranging for service
Worksites
• Health promotion specialist
• Locations
• Business and Industries
• Health promotion companies (i.e., Summex,
Harris Health Trends)
• Hospitals
• Managed care organizations (MCOs) /
insurance companies
Worksites (cont’d)
• Rationale
• Protecting human resources
• Reducing health care costs
• “Most companies now only accept programs
that help meet business objectives” (J. Harris, Harris
Health Trends, Feb. 2001)
Worksites (cont’d)
• Type of work
• Planning, implementing, and evaluating health
education/promotion programs
• Health (risk reduction) counseling
• In person
• Over the telephone
• Coordinating/managing fitness facilities
• Managing high risk cases
Health Care
• Health promotion specialist / health
educator / patient educator
• Locations
• Hospitals (various departments: health
promotion, patient education, public relations,
community outreach)
• Clinics
• Practitioners’ offices
Health Care (cont’d)
• Type of work
• Planning, implementing, and evaluating health
education/promotion programs
• Intrapersonal level (one-on-one)
• Interpersonal level (small group, e.g., smoking
cessation, support groups)
• Community presentations
Colleges/Universities
• Campus wellness / student health centers
• Clinic education programs
• Prevention / awareness programs
• Instructional positions
Colleges/Universities (cont’d)
• Instructional positions
• Part-Time or Adjunct Positions
• Full-Time, Tenure Track Positions
• Duties
• Teaching
• Research (grants, publishing, presenting)
• Service (institution, community, profession)
International
•
•
•
•
Developing countries
Special dedication
Cultural differences
Example - Peace Corps
Non-Traditional
Employment Settings
• Sales
•
•
•
•
•
•
•
•
Insurance sales
Pharmaceutical sales
Fitness equipment
Other
Justice/Mental Health
Publishing
Media
Tourism/Recreation
Landing That First Job
• Experience
• Part-time & summer employment
• Volunteering
• Well-planned practica & internships
• Service learning
• Excellent academic record
• Portfolio
• Certifications
• Get to know Faculty
• Get involved in your program
• Placement centers
• Professional associations and organizations
Health Information
• Increasing demand for the information
• Explosion of information
Types of Information
Sources
•
•
Primary Sources – ...written by the person
who actually conducted the research or
observed the events, e.g., refereed journal
articles, legislative records, minutes of
meetings
Secondary Sources – ...written by someone
who was not an eyewitness or did not
conduct the actual research project, e.g.,
journal review articles, editorials, noneyewitness accounts.
Types of Information
Sources (cont’d)
• Popular press publications
•
•
•
•
Items published for lay persons
Typically secondary source, but could be primary
Often include opinions, editorials and summaries,
e.g., Newsweek, Reader’s Digest and tabloids.
• Refereed journals
• publishes original manuscripts that have been read
& recommended by a panel of experts (referees),
AKA peer reviewed
• e.g., American Journal of Health Education, &
American Journal of Public Health
Identifying the Components of
Research Article
• Abstract - brief description of article
• Introduction - provides background & purpose
of the study
• Methodology - explains how the study was
conducted
• Results - gives the findings of study
• Discussion – interprets the findings &
provides comment on the implications of the
results
Critically Reading a
Research Article
• Were the aims of the study defined in a
clear manner?
• Were the research questions/hypotheses
clearly stated?
• Was the description of the subjects clear?
Did the article state how the subjects were
recruited?
• Were the design and location of the study
described clearly?
Critically Reading a
Research Article (cont’d)
• Were the data collection instruments
described?
• Did the results directly address the research
questions/hypotheses?
• Were the conclusions logical in terms of
the research design and data analyses
performed?
• Were the study implications meaningful to
the population you serve?
Evaluating the Accuracy of
Non-research Based Sources
• Author’s qualifications? Academic
degree in the field being written about?
• Style of presentation? Scientific?
• References included?
• Purpose of the publication?
• Reputation of the publication?
• New information?
Writing an Abstract or
Summary
Abstract – Short descriptions of research &
main findings (150-250 words)
Summary – Longer review; includes
methodology, findings, limitations, &
detailed presentation of conclusions &
discussion (2-3 pages)
Locating Health-Related Information Journals
Locating Health-Related
Information (cont’d)
• Indexes - provides link to articles from many
refereed journals, books, and research reports,
i.e., Index Medicus & Education Index
• Volumes of just abstracts of research studies
that have appeared in other journals, i.e.,
Psychological Abstracts
• Computerized Databases of indexes or
abstracts, i.e., Medline, ERIC, & PsychLit
The Internet and the World Wide
Web
• World Wide Web - an interactive information delivery
service
• Hypertext - text used on the WWW
• Internet - global network of interconnected computer
networks
• Browser - software package used to access information on
the web, i.e., Netscape
• Uniform Resource Locators (URLs) - Web addresses
usually in http = Hypertext Transfer Protocol)
• Search Engine - device that allows open searching of a
topic area, i.e., Yahoo
Evaluating Information
on the Internet
• Content
• Authority
• Publisher-Source
• References
• Documentation
• Facts
Evaluating Information
on the Internet
• http://www.library.kent.edu/internet/criteria.html
• http://www.nnlm.gov/gmr/publish/eval.html
• http://www.cancer.about.com/library/weekly/aa013002a
• http://www.ohsu.edu/croet/resources/healthinfo.html
• http://www.hitiweb.mitretek.org/docs/policy.html
Trying to Predict the Future
• Is dangerous business
• Only one thing for sure… change will occur
Demographic Changes
• The U.S. population will become more
diverse
A More Diverse Future
Demographic Changes
• The U.S. population will become more
diverse
• The U.S. population will get older as baby
boomers age
Societal Trends
• Technology will impact us more than ever
• Family structure will continue to change
• Traditional family
• Postmodern family
• Frustration with politics & politicians will continue
• Medical care costs will continue to increase
The Future of Professional
Preparation
•
•
•
•
•
Preparation for analytical thinking
Preparation for collaboration
Preparation for delivering multilevel interventions
Preparation to incorporate more technology into practice
Preparation to better use schools as a point of delivery
The Future of Credentialing Health
Educators
•
•
•
•
More than just entry level certification
Sub-special certifications
Graduation from an accredited program
Required to practice, e.g. Arkansas
Implications for Practice
Settings
• School
• better coordinated school health programs with
emphasis on school health services
• Worksite
• keep employees healthy in order to keep
production high & reduce the cost of health
insurance
Implications for Practice
Settings (cont’d)
• Community/Public Health • work more collaboratively; form more
coalitions; advocate for policies
• Health care
• health (patient) education will be necessary to
reduce health care costs
Future is bright for health education
because...
• of presence of managed care.
• of growing influence of health insurance
companies.
• of increasing costs of health care (& thus
health insurance).
• of the continuance of the health promotion era.
• aging of baby boomers.