1. Amazon river, Oran, Peru March 2012 KIN 464 - WEEK 3 Thursday Jan 19/16 Summary – Evolution of HP Why are theories of health and physical activity promotion important but problematic?

2. Evolution of Health Promotion in Canada O’Neill et al., 2012 EraPredominant ApproachYears 1Health Education Prior to 1974 2Health Promotion Development1974-1994 3Population Health1994-2007 4Population Health Promotion2007 - Present What was unique about Era 1? Era 2? What were the significant change drivers in development of health promotion in Canada over the first two eras? Another interesting perspective: Raphael, D. (2008). Grasping at straws: a recent history of health promotion in Canada. Critical Public Health, 18(4), 483-495.

3. Epp, J. (1986). Achieving health for all: a framework for health promotion. Ottawa, ON: Health and Welfare Canada. Retrieved from Health Canada website: http://www.hc-sc.gc.ca/hcs- sss/pubs/system-regime/1986-frame-plan- promotion/index-eng.php A new perspective on the health of Canadians. Lalonde Report Era 2: Health Promotion Development

4. Healthy Cities Projects Healthy Cities Projects Towards making every city a healthy city (WHO, 2012) Six Characteristics: 1 2 3 4 5 6

5. Evolution of Health Promotion in Canada O’Neill et al., 2012 EraPredominant ApproachYears 1Health Education Prior to 1974 2Health Promotion Development1974-1994 3Population Health1994-2007 4Population Health Promotion2007 - Present What was unique about Era 3? Era 4? What were the significant change drivers in development of health promotion in Canada over the last two eras? Another interesting perspective: Raphael, D. (2008). Grasping at straws: a recent history of health promotion in Canada. Critical Public Health, 18(4), 483-495.

6. Compare and contrast: Biomedical model of health Biopsychosocial model of health According to the ancient Greek Physiocratic school of thought “health and disease cannot be dissociated from particular physical and social environments nor from human behavior” (Tountas, 2009).

7. Theories, Models, Frameworks Theory – “A theory is 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” (Kerlinger, 1986 as sited in Glanz, Lewis & Rimer, 2002 p. 25). Model – “Models may draw on a number of theories to help understand a particular problem in a certain setting or context” (National Cancer Institute, 2005). Framework – guides the practical implementation of theories and models. Outlines the fundamental structure of how the concepts, principles, and strategies are applied in order to guide planning, action and evaluation.

8. What is health promotion theory? A systematic way of understanding health-related events and situations (NCI, 2005). A tool to think with (Dorothy Smith, formerly in Sociology at UBC). “Theory helps me think through how and why I approach a health problem the way I do.” (Health Educator, NCI, 2005)

9. Benefits of HP Theory Moves beyond intuition Encourages us to look at the bigger picture – a roadmap for studying complex health problems Usually have some evidence behind them Helps to identify what indicators should be monitored Increases possibility of success http://www.cancer.gov/cancertopics/ca ncerlibrary/theory.pdf

10. Application of theory to practice… no ‘right’ or ‘wrong’ ‘guidelines’ for understanding change & developing programs/HP initiatives Theories should never be applied without a thorough understanding of the individuals, groups, organizations and communities you are working with: lived experiences local context asset-focused Ohprs.ca

11. health promotion models and frameworks Complexity combining theories Theories explaining: 1.health behaviour change in individuals 2.change in communities 3.change in organizations 4.healthy public policy development Theories explaining: 1.health behaviour change in individuals 2.change in communities 3.change in organizations 4.healthy public policy development

12. A Social-Ecological Model for Physical Activity – Adapted from Heise, Ellsberg & Gottemoeller (1999)

13. One Example of a Ecological Perspective (NCI, 2005) Ecological LevelDefinition IntrapersonalIndividual characteristics influence behaviour – knowledge, attitudes, beliefs, personality traits InterpersonalInterpersonal influences – family, friends, peers; social identity, support and role definition Community Level Institutional level Community factors Public policy Rules, regulations, internal policies, informal structures that constrain or promote behaviours Social networks and norms, standards of behaviour among individuals, groups, organizations. Local, provincial, federal policies and laws that regulate or support healthy actions and practices

14. Summary of HP Theories (NCI, 2005) Ecological LevelTheory/ModelFocus IndividualHealth Belief ModelPerceived benefits of avoiding a threat Stages of Change ModelAn individuals motivation and readiness to change a problem behavior Theory of Planned BehaviorAttitudes, perceptions of norms, beliefs about difficulty of changing Precaution Adoption Process Model Also a stage theory - how individuals move from being unaware to deciding about whether or not to act.

15. Health Belief Model In the 1950s the famous Health Belief Model, the first of a long series of theoretical models of individual health behavior, was conceived at Johns Hopkins School of Hygiene and Public Health in Baltimore.

16. AKA: The Transtheoretical Model Prochaska & DiClemente Assesses readiness to change Commonly applied to interventions targeting health behaviour change The dominant model of health behaviour change?

17. A Social-Ecological Model for Physical Activity – Adapted from Heise, Ellsberg & Gottemoeller (1999)

18. Interpersonal & Community Level HP Theories Ecological LevelTheory/ModelFocus InterpersonalSocial Cognitive TheoryPersonal and environmental factors exert pressure on one another CommunityCommunity OrganizationCommunity-driven approaches to assessing and solving health problems Diffusion of InnovationsHow new HP practices spread from one community to another Communication TheoryHow different types of communication affect health behavior

19. Diffusion of Innovation Theory innovators (the source of the innovation) early adopters (“first on the block”) early majority late majority laggards

20. Applying theory – increasing Physical Activity Stages of Change ModelDiffusion of Innovation Theory 1. 2. 3.

21. Social Capital Bowling Alone: America's Declining Social Capital. Robert D. Putnam (2000) Better together http://www.bettertogether.org/socialcapital.htm

22. Ecological LevelTheory/Model/Framework SocietalSocial Determinants Population Health Promotion Summary of HP Theories con’t

23. Community Health Promotion Socio-ecologicalSettings

24. Settings Approach Comprehensive school health Torabi & Yang, 2000 www.dashbc.ca Directorate of Agencies for School Health in British Columbia (DASH BC) www.cash-aces.ca Canadian Association for School Health (CASH)

25. Target Population Approach Government Assisted Refugees – Settlement support services – Wrap around support is needed

26. Issue Approach Surrey’s Safe & Active Schools Program: -Built environment improvements: side walks, cross walks, traffic calming, curb extensions - Parent, student and teacher education: reflective clothing, awareness, student pick up/drop off, safe routes -Group support: walking groups, school challenges -Enforcement: parking, speeding

27. Approaches to Targeted Health Promotion Initiatives: - setting - population - issue

28. Healthy Communities Framework Healthy Communities Framework http://www.ohcc-ccso.ca/en/webfm_send/550