Policy & Environment Change

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  1. Describe the Social Ecological Model.
    • Intrapersonal
    • Interpersonal
    • Organizational
    • Community
    • Policy
  2. Why policy?
    • Start with the goal...CDC priorities
    • More fruits and vegetables
    • Reduce sugar sweetened beverages
    • More physical activity
    • Decrease screen time
    • Increase breast feeding
    • So...let's get people to eat more fruits and vegetables!
  3. Begin with a one time event such as a rock event/health fair
    • Vegetable cartoon characters
    • Band
    • Festive
    • Vegeratble taste testing
    • Give recipes for vegetable dishes
    • Cooking demos
    • Healthy tips
    • Win a steamer
  4. What are the advantages for the one time rock event / health approach?
    • Not traditional
    • Variety of levels
    • Fun
    • Accomodate a lot of people
  5. What are the disadvantages for the one time rock even / health approach?
    • Not addressing availability / access
    • Cost
    • Reach
    • Sustainability
    • Doesn't address barriers / long-term impact
  6. Next level - Program (offer regular cooking class)

    What are the advantages?
    • Fun
    • Free
    • Family friendly
    • Demonstrates how to use variety of seasonal vegetables
    • Hands-on involvement
    • Practice skills
    • Change norms
    • Ongoing - can have behavior impact
    • Easy to plan and replicate
  7. Next level - Program (offer regular cooking class)

    What are the disadvantages?
    • Accessability
    • Difficulty
    • Reach is smaller
    • Short-lived
    • Not sustainable
  8. What could a community do that would address the remaining issues?
    • Reach
    • Sustainability
    • Overcoming barriers to fruit/vegetable consumption
    • That is where policy comes in!
  9. List examples of policy.
    • Increase fruit and vegetables served in schools
    • Zone public space (or incentivize use of private space) for community gardens or farmer's markets
    • Tax or other incentives for full service grocery stores in parts of community with limited access
    • Transportation support for delivery of local fruits/vegetables to schools, daycare, underserved parts of community, etc.
    • Reduced cost or free bus/train/cab rides to/from farmer's markets or grocery stores
    • Commitment to funding for elements of program
    • Can enhance, supplement, kick off, and maintain motivationwith additional programs and events that support the overall cause
  10. List the issues to consider.
    • Acceptable - are the policies acceptable to gatekeepers and community members?
    • Effective - do the policies bring about the types of behavior change we are hoping for?
    • How do we get these to happen?
    • What does it take to make these happen?
  11. Policy & Environment are intertwined concepts
    • Crosstalk among levels:
    • Laws & policies
    • Implementation
    • Physical environment
    • Behavior
    • Organizational / normative environment
    • Enforcement
  12. Describe the "Big P" and "little p" policies.
    • Little p: institutional policies
    • Worksite policies/investments
    • NGO policies
    • Individual school policies
    • Norms and standards that drive other action
    • Big P: Public polcy
    • Legislation
    • Regulations
    • Zoning / land use
    • Taxes
    • Public budget
  13. Provide examples of Big P and little p.
    • A business decides to require calorie information on all cafeteria items (little p) vs. health care reform requires restaurant labeling across the country (Big P)
    • A school decides to require recess time for every child every day (little p), vs. school district or state makes a similar requirement (Big P)
  14. Why bother with little p?
    • Easier to get started
    • Allows you to "try out" policies that can later spread
    • What were some exampes from the "Healthier communities" on-line training?
    • Local, smoke-free
    • Hospital, reduced sugar-sweetend beverages
  15. Consider the "systems" level.
    • How the policy gets implemented and enforced
    • Consider: a hospital decides to become a tobacco-free campus (i.e., indoors and outdoors)
    • What systems need to be in place to make this policy a reality?
    • Advisory board
    • Signage
    • Enforcement
    • Buy-in, education
  16. List some examples of environment changes.
    • Built / physical - examples:  
    • Neighborhood walkability
    • Access to markets with healthy food
    • Lacation room
    • Organizational / normative:  
    • Non-smoking environment
    • Breastfeeding welcome here policies
  17. Breastfeeding-friendly environment

    Describe how the "crosstalk" works.
    • Starts with policy:  
    • Little p - an organization establishes a policy that it will create a breastfeeding friendly environment for its employees
    • Systems:  
    • Education of staff about the new policy
    • Buy-in by those who plan and assign space to set up lactation room with proper facilities
    • Work with managers to facilitate worker breaks for pumping
    • Changes in the environment: lactation room, signage
    • Why is the enforcement an important part of the picture?
  18. Why is policy health interested in moving to Policy & Environment changes?
    • Recall the "four core principles of ecological models of health behavior change": Multi-level interventions should be most effective in changing behaviors
    • Other advantages from RE-AIM: Reach, Sustainability / Maintenance
  19. How does environment influence behavior? What mechanism?
    • A smoke-free restaurant policy (assuming you are a smoker)
    • Improved nutritional choices in vending machines where you work 
    • Labeling preferable vending machine choices with green (vs. yellow or red) stickers
    • Piping interesting music into the stairwells
    • Putting signs by the elevators that remind you it is healthier to use the stairs
    • Slowing down the elevator speed (nudge, change reinforcement value)
  20. List some priciples of how policy changes work.
    • Restrictions: can't smoke, buy large drinks (most are restrictive)
    • Facilitation: expanded choices, default decisions
    • Informational cues, reminders: Heuristics
    • Modify alternative reinforcements: make the healthier alternative more rewarding
    • Most policy is Facilitation, Cues, Alternative reinforcements
  21. Describe relationships to other theoretical perspectives.
    • Thinking about the social norms research we read, to what extent would you expect people to be aware of how they are influenced by the built or organizational environment?: Not much
    • Reciprocal determinism: environment changes us and is changed by us
  22. Describe Kremer's dual process model (from readings).
    • Consider parallels to Elaboration Likelihood Model
    • Individual differences in how people "read" environmental cues
    • Some of the individual differences may be related to additional interventions happening at the intra- or inter- personal levels
    • Some are processed actively others are subtle or unaware
  23. Kremer's Dual Process Model
    • Environmental Research Framework: incorporates TPB aspects
    • Cognitive mediators: (attitude, subjective norms, perceived control, intention)
    • Moderators: (person / demographic, personality, awareness, involvement --- behavior / habit strength, clustering)
    • Environment: (level / micro, macro --- type / physical, political, economic, sociocultural)
    • Energy balance related behavior:  
  24. Describe an example of the process model / policy.
    • Environmental modfication: Building a waling trail around a senior center
    • Potential behavioral outcome: Increased walking among seniors who use the center
    • Potential cognitive mediators: Change in perceived social norm / see others walking, perceived behavioral control / I can do this, intention / since it is there, I should use it)
    • Non-cognitive effects: Imitation of others, joining others who are walking / Subtle cues or reinforcements (attractive trail, curiosity about exploring it)
  25. Describe the challenge.
    • How can we build a theory of change that will help us tell in advance how effective a policy or environmental change will be, and under what circumstances?:  
    • What are the characteristics of the policy or environment changes that make them effective?
    • What are the pre-conditions that need to exist for such a change to be effective?
    • Theory is still in early stages of development:  
    • Much interest in this type of approach, but little theory to guide us about how to do it best.
Card Set:
Policy & Environment Change
2012-12-08 00:35:54
Policy Environment Change

Policy & Environment Change
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