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Describe the Social Ecological Model.
- 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!
Begin with a one time event such as a rock event/health fair
- Vegetable cartoon characters
- Vegeratble taste testing
- Give recipes for vegetable dishes
- Cooking demos
- Healthy tips
- Win a steamer
What are the advantages for the one time rock event / health approach?
- Not traditional
- Variety of levels
- Accomodate a lot of people
What are the disadvantages for the one time rock even / health approach?
- Not addressing availability / access
- Doesn't address barriers / long-term impact
Next level - Program (offer regular cooking class)
What are the advantages?
- 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
Next level - Program (offer regular cooking class)
What are the disadvantages?
- Reach is smaller
- Not sustainable
What could a community do that would address the remaining issues?
- Overcoming barriers to fruit/vegetable consumption
- That is where policy comes in!
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
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?
Policy & Environment are intertwined concepts
- Crosstalk among levels:
- Laws & policies
- Physical environment
- Organizational / normative environment
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
- Zoning / land use
- Public budget
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)
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
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
- Buy-in, education
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
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
- 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?
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
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)
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
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
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
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:
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)
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.