PARKER ET AL Application of Health Promotion Theories and Models for Environmental Health

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 2 years 12 Visits by Community Environmental Specialists (CES) 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!

Behavior Individual & Environmental Factors 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)

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 Individual & Environmental Factors 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”

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 INTRAPERSONAL LEVEL: HBM SELF-EFFICACY

SOCIAL COGNITIVE THEORY: REFRESHER Individual & Environmental Factors Behavior Environment Personal factors Major determinants: Environment Outcome expectations Self-efficacy Behavioral capability Methods for behavioral change (…where is goal formation?)

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 INTRAPERSONAL LEVEL: SCT

Social Support Emotional Instrumental: tangible aid/services Informational: advice, suggestions, info Appraisal: feedback How did they address it? Individual & Environmental Factors SOCIAL SUPPORT CES (Community environmental specialist) InformationalGive info EmotionalCare, empathy InstrumentalCleaning supplies, bed covers AppraisalConstructive feedback

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 Individual & Environmental Factors SOCIAL NETWORKS