What is Social Ecological Model?
Social Ecological Model (SEM)
"Social Ecology is viewed as an overarching framework or set of theoretical principles for understanding the interrelations among diverse personnel and environmental factors in human health and illness"
-Daniel Stokols
Divide into 6 groups
Scenario: You are a team of public health professionals trying to implement an intervention to address obesity in a predominantly non-Hispanic White (NHW) rural community.
What would your intervention look like using SEM?
Public Health Promotions: More than, "Absence of Illness"
- Behavioral Change and Lifestyle Modification
- Environmental Enhancement and Restructuring
- Social Ecological Analysis of Health Promotion
Core Themes of SEM
2 Key Types
Blaire Hamilton
Jon Kim
- Examine Links between Multiple Facets of Well-being and Diverse Conditions of Environment-office chairs
- Behavioral= Active Interventions
- Holding HIV Testing Drive
- Teaching a class on diabetes prevention
- Training Peer Sex Educators
- Environmental= Passive
- Building grocery stores in a food desert
- Playing anti-smoking adds on the radio
- Noise ordinances
- Joint Influence of Interpersonal and Environmental Conditions on Individual and Community Well-Being-smoking
- Develop Health Promotion Programs that Enhance the Fit Between People and Their Surroundings-ramps
- Focus Promotion on Leverage Points in the Community-Stress
- Address Inter dependencies between physical and social environment and encompass multiple settings and lie domains-dorm rooms
- Multidisciplinary Perspectives in the Design of Health Promotion Programs and use Multiple Methods to Gage Effectiveness-mixed measures
Five Levels of SEM
Study: Walking Group Intervention to Promote Health in Urban Neighborhoods
SEM in the Literature
Discussion
- Evaluation study for effectiveness of Walk Your Heart to Health (WYHH) iniative
- Aimed to reduce cardiovascular risk (CVR) among non-Hispanic Black (NHB) and Hispanic residents of Detroit, MI.
- Community-based participatory research
- Residents, health service providers, researchers
- 236 -> 157 articles analyzed through Medline
- researchers identified specific ecological levels
- multiple levels identified for most interventions
- Most interventions have not approached health promotion with multiple levels (intrapersonal, interpersonal, institutional, community, policies)
- WHY?
- limited scope and resources
- better for understanding health behavior, not the best tool for intervention strategies
- single-level interventions better for health issues in situationally specific populations
- STILL...
- Interventions remain focused on individual beliefs, attitudes and actions of social networks
- institutions, communities, policies: limited
Dependent
- physical activity indicators
- WYHH Steps, non-WYHH Steps
- Overall Steps
- CVR indicators
- high blood pressure
- high density lipoproteins
- glucose, waist circumference, BMI
Independent
- adherence to WYHH protocol
- number of sessions attended
- consistency of participation
- demographic controls
- physical activity (with CVR as dependent)
- WYHH, CATCH: PATH
- Community-identified priorities
- SEM-driven, that individual behaviors and risks occur within the context of organizational, community and policy environments
- Addressed multiple levels
- Social support interventions
- Group dynamics theories
- Walking groups led by lay-health advisors
- Peer support and leader promotion of group cohesion
- Hosted by community- or faith-led organizations
- Attention to cultural and demographic details
Results from Literature Review
- Baseline data obtained using pedometers
- Baseline Health Risk Assessment (HRA) to measure CVR
- 30 WYHH groups (intervention and lagged intervention groups as control)
- 11 total sites, groups met 3 times a week for 1.5 hours each time
- 8-week WYHH intervention -> data collection -> 24-week maintenence -> data collection
- Small sample considering amount of journals representing health promotion
- Search strategy may have resulted in inaccurate set of samples
Still,
- Health Education & Behavior is a leading health promotion journal
- Coding strategy was liberal to allow leniency on diversity
- Results are similar to other literature reviews
- 1/3 interventions reported no theoretical underpinning
- SCT > Social Support > Transtheoretical Model
- Fewer than 10% of articles used SEM as basis
- Interventions targeting upper levels of SEM are more difficult to reproduce than intra/interpersonal-levels
- More barriers exist in government
- Health educators may lack training in planning and implementing programs in higher levels
- Diffusion of Innovations / Grounded Theory more popular for higher levels, but focus on creating change or movement, not necessarily an "outcome"
- Intervention approaches should broaden its scope of view in steps
- new community partners
- social networks
- policies determining health
Results from Literature Review
- 132 Interventions
- 21 behaviors, 8 different settings
- > 1/3 nutrition inititives
- > 1/4 physical activity programs
- Settings
- >1/3 Schools and communities
- 2/3 Results of impact or outcome evaluation
- >1/3 process evaluation
- Study supports growing evidence that interventions promoting walking in groups are effective in increasing physical activity
- Culturally homogenous groups and heightened interests in walking groups
- Walking group interventions in collaboration with community members addressing local social and physical environments address levels of SEM and show that such interventions can be effective
Collaboratively designed interventions that engage community and academic partners build on community strengths and assets.
- Retention fell below 70% after 32 weeks
- Systematic? Ruled out race, ethnicity, income, household education as reasons
- Study did not yield comparison to NHWs
- Inclusion of specific measures of dietary intake may have contributed to declines in HDL