Application of Health Promotion
Theories and Models for
Environmental Health
PARKER ET AL
PARKER PAPER
• Main goal:
• How can Health Promotion Theories be applied to reduce
exposure to environmental hazards?
• Why is this paper unique?
• HP Theories are rarely applied to environmental health
issues
• Where: Detroit
• What: Community Action Against Asthma (CAAA)
STUDY DESIGN
• 1) Exposure Assessment
• 2) Intervention
• Household level
• Neighborhood/policy level
• Participants
• 331 households of English/Spanish speaking children, 6-11 yrs
• Detroit public schools (SW/E Districts)
• Screening
• Questionnaire to find those households with children with persistent
asthma
INTERVENTION DESIGN
12 Visits by Community Environmental Specialists (CES)
2 years
Intensive Year 1
Min 9 visits
Less Intensive Year 2
Min 3 visits
ECOLOGICAL MODEL: A THEORY OF
ACTION
• Introduced in Week 1
• Health, behavior, & their
determinants are
interrelated
• Response to:
environmental barriers can
make other HP programs
fail to have long-term
behavior change
• Target multiple levels (as
resources allow) & make
changes to the physical,
legal, economic, social
environment =>
• Strong! Long-lasting!
Individual
&
Environmental
Factors
Behavior
Health
ECOLOGICAL MODEL: A THEORY OF
ACTION
HOW THE ECOLOGICAL MODEL
FRAMEWORK WAS USED
1. Assess Physical & Social Environment
1. Decide targets of change at each level
1. Develop intervention strategies for as many
targets as possible
Individual
&
Environmental
Factors
INTRAPERSONAL LEVEL:
HBM
• HEALTH BELIEF MODEL (refresher)
Individual
&
Environmental
Factors
INTRAPERSONAL LEVEL: HBM
PERCEIVED THREAT & BENEFITS
• Perceived Threat:
• Stress perceived susceptibility to asthma exacerbation
• Allergen type & child-specific allergen info
• Reinforce asthma exacerbation if child exposed
• Stress perceived susceptibility to increased morbidity & mortality potential
• Perceived Benefits
• “Explained link between exposure to indoor allergens and irritants and asthma
exacerbation”
• “Explained how allergens and irritants could be reduced through cleaning behaviors
and by preventing the child from being exposed to tobacco smoke.”
• Do you think that these are interventions that effectively target the perceived
benefits construct?
(I’m not sure they do…)
Individual
&
Environmental
Factors
INTRAPERSONAL LEVEL: HBM
BARRIERS AND CUES TO ACTION
• Perceived Barriers
• Identify & strategize
• Competing life demands => agencies
that could help
• Equip with resources
• Cleaning supplies, mattress covers,
vacuums
• Cues to Action
• Shared data from initial data collection
• Walkthrough results- visible cockroaches? Visible mold? Dust sample
findings
• Recommendations from physician about which triggers to focus on
• Discussion Question:
• Book says “events, symptoms, reminders”
Individual
&
Environmental
Factors
INTRAPERSONAL LEVEL: HBM
SELF-EFFICACY
• Caregiver confidence of success (in very specific behavior? Not really
specified)
• How was it addressed?
• Remember, caregiver decidedwhich triggers to target from discussing
with CES
• Set small action goals caregivers could meet between visits (6-8
weeks)
• Verbal encouragement and support from CES to reinforce
Individual
&
Environmental
Factors
SOCIAL COGNITIVE THEORY: REFRESHER
Behavior
Major determinants:
• Environment
Environment
Personal
factors
•
•
•
•
Outcome expectations
Self-efficacy
Behavioral capability
Methods for
behavioral change
• (…where is goal
formation?)
Individual
&
Environmental
Factors
INTRAPERSONAL LEVEL:
SCT
• Knowledge and Skills
• Share knowledge and skills needed to perform behavior like cleaning
• Self-efficacy
• intervention same as described for HBM previously
• Set small goals & reinforce behavioral change with verbal encouragement &
support
• Methods of Learning (specifically observational)
• Model all desired actions (vacuuming, dusting, etc) + reinforcements
• Environment
• “Project planners took into consideration the SCT’s definition of
environment”
• Understand that caregivers might not be able to alter their environment if
they rent their homes => add in tenant-advocate organization
• Where are outcome expectations and expectancies?
Individual
&
Environmental
Factors
SOCIAL SUPPORT
• Social Support
•
•
•
•
Emotional
Instrumental: tangible aid/services
Informational: advice, suggestions, info
Appraisal: feedback
• How did they address it?
CES (Community environmental specialist)
Informational
Give info
Emotional
Care, empathy
Instrumental
Cleaning supplies, bed
covers
Appraisal
Constructive feedback
Individual
&
Environmental
Factors
SOCIAL NETWORKS
• Increase caregiver’s coping resources
• Matched to community resources
• Ex: Persons with mental health needs to mental health services
• Resources in the community
• Increase neighborhood and community support for families with
children with asthma
• Reduce environmental triggers on community level