Social Ecological Models

How can we begin to understand all of the factors that influence health?  Ecological Model Fall 2006

Individual Interpersonal Institutions Community Population/Policy Fall 2006 Population/Policy

What is an Ecological Perspective? A framework that enables us to consider the influence of individual and environmental factors on health & health-related behaviors Fall 2006

Why the ecological framework? Health & health problems are complex Health problems are influenced by multiple variables These variables interact with each other Multiple levels are relevant for understanding & changing: Human behavior Complex environments Fall 2006

By focusing on factors beyond the individual, we are… Less likely to ‘blame the victim’ More likely to address the underlying determinants of health & health behavior Fall 2006

By focusing on factors beyond the individual, we are… Better able to see where action is needed Upstream action vs. Downstream approaches What do we mean by up/down stream approaches? Fall 2006

Ecological Framework helps us with… Problem analysis Intervention design Intervention evaluation Fall 2006

Public Health Problem Determinants Problem analysis Public Health Problem Determinants  Population Community Organizational Interpersonal Individual Fall 2006

Individual Interpersonal Institutions Community Population/Policy Fall 2006 Population/Policy

Youth Smoking Determinants  Population/Policy Lack of law enforcement for selling to minors Community Positive attitudes toward smoking Organizational Easy availability of cigarettes at stores Interpersonal Popular kids smoke/parents smoke Individual Lack skills/self-efficacy to ‘just say no’ Fall 2006

Intervention Design Prevent or ameliorate existing problems Interventions, at their best are… Intended to Identify & shape solutions Specifying goals, objectives, activities Theory-based Designed by multi-disciplinary teams Targeted at multiple levels Able to maintain a broad (ecological) scope Fall 2006

Individual Level Interventions Target of change  Individual Person Focus on characteristics of the individual E.g., knowledge, attitudes, skills, beliefs… Fall 2006

Individual Level Interventions What types of strategies might we use at this level? What type of individual level intervention would be useful in youth tobacco prevention? Fall 2006

Interpersonal Level Interventions Target of change  Social influences E.g., family, work group, friendship networks… Focus on nature of social relationships E.g., social norms, access to diverse & supportive networks/influences Fall 2006

Interpersonal Level Interventions What types of strategies might we use at this level? What type of interpersonal level intervention would be useful in youth tobacco prevention? Fall 2006

Organizational Level Interventions Target of change  Organization/Institution E.g., worksites, schools, agencies, churches… Focus on organizational culture E.g., norms, rules & regulations, incentives & benefits, structures Fall 2006

Organizational Level Interventions What types of strategies might we use at this level? What type of organizational level intervention would be useful in youth tobacco prevention? Fall 2006

Community Level Interventions Target of change  Social environment Focus on community norms, values, attitudes, & power structures Fall 2006

Community Level Interventions What types of strategies might we use at this level? What type of community level intervention would be useful in youth tobacco prevention? Fall 2006

Population Level Interventions Target of change  Local, state, & national laws & policies Focus on government regulations & other regulatory processes, procedures, or laws to protect health Fall 2006

Population Level Interventions What types of strategies might we use at this level? What type of population level intervention would be useful in youth tobacco prevention? Fall 2006

Are there any issues that don’t? What types of health issues or health behaviors lend themselves to using the social-ecological model? Are there any issues that don’t? Fall 2006

Challenges to ecological interventions A lot of work – involving several sectors of society Difficult to evaluate change at environmental level Challenge to translate interest in change into social norms and public policy Powerful norms are hard to change Budget cuts – so difficult to undertake wide-range interventions Difficult to get certain health issues on public policy agenda Still, it’s being done! E.g., nutrition guidelines, tobacco, fitness, elder transportation Fall 2006

So… The ecological framework emphasizes: Relationships among behaviors, socio-political structures & health Applying this framework allows us to: Determine & describe public health problems Move beyond solely focusing on (& blaming) the ‘individual’ Assess multi-level determinants of health & how to address them Design, implement, & evaluate interventions Fall 2006