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Summary HEP4210 Understanding Health Behavior
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CASESCASE 1 - WHERE TO START?
Learning goals:
1. What is health promotion?
2. Where to start with health promotion?
3. What steps are there to develop solutions to a health problem (e.g., figuring out the health
problem…)?
4. What important causes of death and risk factors are there? (literature: our world in data, 2023)
5. How does awareness and understanding of risk factors and threats help us to understand health
Behavior?
LG1. WHAT IS HEALTH PROMOTION?
The ref from the resources of the case said:
“Any planned combination of educational, political, regulatory, and organizational supports for actions and
conditions of living conducive to the health of individuals, groups, or communities.” (Green et al.).
WHO says:
- Health promotion is the process of enabling people to increase control over, and to improve, their
health. It moves beyond a focus on individual behaviour towards a wide range of social and
environmental interventions.
- As a core function of public health, health promotion supports governments, communities and
individuals to cope with and address health challenges. This is accomplished by building healthy public
policies, creating supportive environments, and strengthening community action and personal skills.
Important to educate people in order to prevent diseases and create an environment which makes it easier for
people to change their behavior (but also environmental settings, such as grocery stores).
Health behavior is not only sports/healthy eating, but also mental health, speeding, alcohol consumption etc.
LG2. WHERE TO START WITH HEALTH PROMOTION?
You have to identify the health problem → however this LG overlaps with the next one.
LG3. WHAT STEPS ARE THERE TO DEVELOP SOLUTIONS TO A HEALTH PROBLEM (E.G., FIGURING
OUT THE HEALTH PROBLEM…)?
From the lecture it was these steps:
,Resource: Glanz, Rimer, & Viswanath (2008) Intervention Mapping (1990s) builds on the logic model of the
problem developed in Precede and expands on Proceed to add detail to the process of intervention
development
Each step of Intervention Mapping requires several tasks. The completion of tasks in each step leads to
products that inform the subsequent step, and the completion of all steps creates a blueprint, or map, for
designing, implementing and evaluating an intervention. The process is iterative rather than strictly linear.
- Step 1: conduct a needs assessment, which will result in the development of a logic model of the
problem. Developers use a modified version of Precede, combining predisposing and reinforcing
factors into one category of personal determinants. Enabling factors are included in the environment
box of the logic model.
- Step 2: health professionals use theory and evidence to describe the targets of change for the
intervention: “what needs to change to decrease or eliminate the health problem and the behavioral
and environmental risks?”. Planners will decide which behavioral and environmental factors are most
strongly associated with improved health outcomes and which are most changeable. o A central tool is
to create a matrix of the change objectives that specify who an what should change as a result of the
interventions.
- Step 3 (program plan) and 4 (program production): planners work from the logic model of change
(step 2) to conceptualize and design the intervention. They make decisions about theory-based change
methods, shape their interpretation into a deliverable intervention, and then develop the needed
materials and messages.
- Step 5 (implementation plan): potentially effective health promotion programs will have no impact if
they are not implemented and will not reach as far as desired in the populations for which they are
intended if they are not sustained or disseminated. Without a planned dissemination intervention to
ensure adoption, implementation, maintenance, and sustainability, a program is likely to be less
widely used than possible. For new programs, demonstration projects, and research projects, the
focus of this step is on planning for program use in initial testing of the program’s efficacy or
effectiveness.
- Step 6 (evaluation plan): planners propose process and outcome evaluation methods, based on the
product from previous steps. Once the logic of the program is understood, evaluations determine
whether the intervention was successful in meeting program goals and objectives (effect or outcome
evaluation), and why the intervention was or was not successful (process evaluation). Using the
output from each Intervention Mapping step, planners determine evaluation questions, indicators and
measures, and an appropriate research design to ensure that findings can be appropriately attributed
to the program under consideration.
,Green, L.W., Gielen, A.C., Kreuter, M.W., Peterson, D.V., & Ottoson, J.M. (2022). A model for population health
planning, implementation, and evaluation. In Health program planning, implementation, and evaluation (pp. 3-
38). Johns Hopkins University Press. https://maastrichtuniversity.on.worldcat.org/oclc/1287076369
PRECEDE-PROCEED MODEL
Precede-Proceed Model (Lawrence W. Green, 1970s) can help to guide the process of designing, implementing,
and evaluating health behavior change programs. PRECEDE-PROCEED can be thought of as a road map, and
behaviour change theories as the specific directions to a destination. The road map presents all the possible
avenues, while the theory suggests certain avenues to follow.
- Main purpose of the model is not to predict or explain the relationships among factors thought to be
associated with the outcome, but to provide a structure for applying theories and concepts
systematically in the planning and evaluating of health behaviour change programs.
- The model promotes in-depth understanding of the target population and its needs, as well as both
the proximal determinants of health and quality-of-life problems and the more distant contextual
causes.
- General Hallmarks: (1) its flexibility and scalability, (2) its evidence-based process and evaluability, (3)
its commitment to the principle of participation, and (4) its provision of a process for appropriate
adaptation of evidence-based best practices to specific populations and circumstances.
Precede: predisposing, reinforcing, and enabling constructs in educational/ecological diagnosis and evaluation
- Consists of a series of planned assessments (or diagnoses) that generate information that will be used
to guide subsequent decisions
Proceed: policy, regulatory, and organizational constructs in educational and environmental development
, - Marked by the strategic implementation and evaluation of multiple actions based on what was
learned from the assessments in the initial phases
- Including needs assessment, knowledge about the problem
PRECEDE
Phase 1: social assessment, participatory planning and situation analysis.
- Planners try to understand the community in which they are working, since communities can
contribute to both causes and solutions for health problems.
- Boundaries of communities can be physical, but also demographic (SES, gender, age, etc.), ethic,
problem (experiencing the same health problem), or other identified boundaries (political, behavioral,
religious).
- Often, qualitative methods are used to collect information and opinions; combination of interviews,
focus groups, concept mapping, surveys.
- This is also the time to assure participation of community members (including potential intervention
implementers and participants). They help to ensure that the project addresses issues that are
important to them, that project findings that are locally relevant, and that participating communities
develop capacity in intervention development and research.
Phase 2: epidemiological, behavioral and environmental assessment.
- Epidemiological: the planner begins building a logic model of the health problem from right to left,
usually starting with descriptions of health problems and related quality of life in the community.
When completed the model is read from left to right as a causal model of the health and quality-of-life
problems. The epidemiological analysis includes health problems and their related quality-of-life
impact, behavioral causes of the health problems, and environmental causes of the health problem or
risk behavior.
- Behavioral: this analysis includes what the at-risk group does that increases risk of experiencing the
health problem.
o Most proximal: behaviors/lifestyles that contribute to the occurrence and severity of a health
problem.
o Distal: behavior of others directly affecting the behaviors of individuals at risk.
o Most distal: action of decision makers whose decisions affect the social and physical
environment that influences individuals at risk.
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