“AN INTEGRATIVE FRAMEWORK FOR COMMUNITY PARTNERING TO TRANSLATE THEORY INTO EFFECTIVE HEALTH PROMOTION STRATEGY” Allan Best, Daniel Stokols, Lawrence W. Green, Scott Leischow, Bev Holmes, Kaye Buchholz Clarice Amorim

Health Promotion’s Perfect Reality

Gap between Research and Practice Stokols - health promotion programs lack a clear theoretical foundation or are based on narrow conceptual models that emphasize the individual and neglect the environment Sorensen et al - population health strategies, although feasible, have had modest effects Best et al - there is a disjuncture between the multiple theories/models of health promotion; we need a more unified set of guidelines

“Thinking about health and health promotion has become too complex to expect any one theory to provide a comprehensive framework for research and programming. Instead, what we need are broad framing models that provide relatively comprehensive perspectives on key dimensions to health promotion, combined with more specific and well-tested theories that help us ‘populate’ these frameworks with effective policy and intervention strategies for a particular context.”

Integrative Framework: Models Social Ecology “How do we frame health problems in a multilevel fashion?” PRECEDE-PROCEDE “How do we promote change in a powerful and coherent way?” Life Course Health Development Model “How do we address health through the lifespan?” Community Partnership Model “How do we work together?”

Integrative Framework: Models Social Ecology Multidisciplinary / Interdisciplinary Concerned with overarching conceptual principles that underlie the field of health promotion Incorporate several concepts drawn from systems theory: Interdependence Homeostasis Negative feedback Deviation amplification

Integrative Framework: Models PRECEDE-PROCEDE

Integrative Framework: Models

Community Partnership Model Focus on process Focus on structure Focus on outcome Partnerships: 1)Among researchers in a discipline 2)Between researchers in different disciplines 3)Among community health organizations

Relatively generic and apply to most health promotion situations

More specific focusing theories for each particular research and planning context

Expanded, integrated evaluative models to make sense of this comprehensive framework

The Need for Systems Thinking This perspective suggests that comprehensive, participatory, and collaborative approaches to health promotion are more effective than narrowly targeted, less collaborative ones Systems theory adds value in two respects: It provides a holistic, integrative perspective Research from other disciplines identifies important constructs for a comprehensive community health promotion framework

The Need for Systems Thinking What systems thinking brings into existing health promotion theories: Theoretical and methodological pluralism Feedback loops Stakeholder collaboration Learning organizations

Discussion Is the TTI a systems theory? How can we best move toward the development of an overarching framework that integrates existing theory and produces a strategy for community health? What are some potential tensions around community partnering? How can we address them?

17 The TTI Developmental-Ecological System P SS S E P Eval Behavior SNBSelf Efficacy Att Intentions Will + Skill Exp McNB KnowValue Social Bonds Role Models Self- Control Com- petence SNB Values Environment Knowledge Environment E NVIRONMENT S ituation P erson EE Affective/Control Substreams Cognitive/Competence Substreams DEVELOPMENT & TIME Ultimate Underlying Causes Levels of Causation Distal Predisposing Influences Proximal Immediate Predictors