HLSC 2613 Foundations of Community Health Course Notes Instructor: Ches Jones, PhD.

HLSC 2613Foundations of Community

Health

HLSC 2613Foundations of Community

Health

Course Notes

Instructor: Ches Jones, PhD

Leading Causes of DeathLeading Causes of Death

1900• Tuberculosis• Pneumonia• Diarrhea & Enteritis• Heart Disease• Nephritis• Infancy Diseases• Apoplexy (Stroke)• Accidents• Cancer• Bronchitis• Meningitis• Diphtheria

2000• Cardiovascular• Cancer• Injuries• HIV/AIDS• Chronic Lung Disease• Pneumonia & Influenza• Diabetes• Suicide• Liver Disease• Homicide• Kidney Disease• Blood Infections

Key words, terms, & definitions

Key words, terms, & definitions

• Health• dynamic state or condition• multidimenisonal• results from interaction w/ environment• is a resource for living• exists in varying degrees

HealthHealth

• A state of complete physical, mental, and social well-being, not merely the absence of disease (WHO).

WellnessWellness

• A purposeful, enjoyable, and deliberate lifestyle choice characterized by personal responsibility and optimal enhancement of physical, mental, emotional, social, and spiritual health.

Health-Disease ScaleHealth-Disease Scale

Severe, disabling, and life-threatening illness effecting physical, mental and social health

Disease Health

Complete

• Physical

• Mental

• Social

• Emotional

and

• Spiritual health

WellnessWellness

Key words, terms, & definitions (continued)


• Health

• Personal health activities • those to promote, protect, and preserve health

of self and/or family



• Health

• Personal health activities

• Community health

• health status of a defined group• public & private actions & conditions to

promote, protect, & preserve the health of the group



•Health

•Personal health activities

•Community health

•Public health

• health status of a defined group• governmental actions & conditions to promote,

protect, & preserve the health of the group



• Health



• Public health

Health educationHealth education

• Health Education- “any combination of planned learning experiences based on sound theories that provide individuals, groups, and communities the opportunity to acquire information and the skills needed to make quality health decisions” (Joint Committee, 2001)

Dimensions of Health EducationDimensions of Health Education

EducationEducation

Public HealthPublic Health

Behavioral SciencesBehavioral Sciences

Health Education

The Practice of Health EducationThe Practice of Health Education

• Understand & engage priority population

• Assess needs & assets of priority population

• Develop goals & objectives

• Create an intervention

• Implement the intervention

• Evaluate the results



• Health



• Public health

• Health education

• Health promotion

Vision/Mission of Health Education

Vision/Mission of Health Education

• The health education profession promotes, supports, and enables healthy lives and communities.

Premises of Health EducationPremises of Health Education

1. Grounded in the values and needs of the community, health education promotes social and environmental justice.

2. The health education profession promotes health literacy and enables and supports healthy lives and communities.

3. Many of the leading causes of morbidity and mortality are behaviorally based.

4. Health literacy is an enabling factor in promoting healthy behavior.

Responsibilities of Health Educators

Responsibilities of Health Educators

Program PlanningProgram Planning

ImplementationImplementation

Program DeliveryProgram Delivery

Program AdministrationProgram Administration

EvaluationEvaluation

• Health promotion• Health promotion

- “any planned combination of educational, political, environmental, regulatory, or organizational mechanisms that support actions and conditions of living conducive to the health of individuals, groups, and communities” (Joint Committee, 2001).

Health Education/Health Promotion

Health Education/Health Promotion

Health Education

Health PromotionHealth Promotion

Health Education/Promotion Settings

Health Education/Promotion Settings

• Personal/Family Health

• School

• Worksite

• Community

• State, Regional, or National Level

• Government

• Global/World

Personal/Family HealthPersonal/Family Health

• Health Educator

• Nutritionist/Dietician

• Fitness Instructor

• Physician/Nurse

• Therapist

SchoolSchool

• Health Educator/Dual Role

• Athletic Trainer


• Physician/Nurse

WorksiteWorksite

• Health Educator


• Physician/Nurse

• Fitness Coordinator

• Environmental Health

• Occupational Safety

CommunityCommunity

• Health Educator


• Environmental and Occupational

• Physician/Nurse

• Epidemiologist (Studies Diseases)

• Health Program Coordinator

• Health Service Administrator

State, Regional, or NationalState, Regional, or National

• Health Educator


• Physician/Nurse

• Epidemiologist



• Biostatistician

GovernmentGovernment

• Health Educator


• Physician/Nurse

• Epidemiologist



• Biostatistician

Global/WorldGlobal/World

• Health Educator


• Physician/Nurse

• Epidemiologist



• Biostatistician

Priority Behaviors for Health Promotion

Priority Behaviors for Health Promotion

Tobacco

Alcohol/drug use

Nutrition

Physical Activity

Driving

Risk management

Tobacco

Alcohol/drug use

Nutrition

Physical Activity

Driving

Risk management

Human sexuality

Family development

Stress management

Coping/adaptation

Enhanced self-esteem

Human sexuality

Family development

Stress management

Coping/adaptation

Enhanced self-esteem



• Health



• Public health

• Health education

• Health promotion

• Disease prevention

Disease PreventionDisease Prevention

• Disease Prevention-“the process of reducing risks and alleviating disease to promote, preserve, and restore health and minimize suffering and distress” (Joint Committee, 2001)

Measuring Health or Health Status

Measuring Health or Health Status

• Typically measured using ill health; injury, disease and death

• Common means• Rates (measure of group at certain time)• Life expectancy (birth, 65, and 75)• YPLL (measured at 65 and 75)• DALYs (lost years of healthy life)• Health surveys

Underlying Concepts of Health Education

Underlying Concepts of Health Education

• Health field concept (Lalonde, 1974)

• Human biology (heredity) (26.3%)• Environment (15.8%)• Lifestyle (health behavior) (48.5%)• Health care organization (10.8%)

Health Field ConceptHealth Field Concept

4 Factors Influencing Health4 Factors Influencing Health

Medical CareMedical Care

LifestyleLifestyle

Biology/GeneticsBiology/Genetics

EnvironmentEnvironment

Determinants of HealthDeterminants of Health

01.451.5Lifestyle

01.620.1Environment

0719.8Heredity

9010Medical Services

% Health Care Dollar

% DeathsDeterminant

Underlying Concepts of Health Education (continued)


• Prevention

- the planning for and the measures taken to forestall the onset of, a disease or other health problem before the occurrence of undesirable health events.

Why Health Promotion and Disease Prevention?

Why Health Promotion and Disease Prevention?

• Historically, the health care field and services have focused on the treatment of disease, not the prevention or onset of illness.

• Why is this so?

• Prevention only accounts for 1% of the nation’s expenditures for health.

Prevention Counts.Prevention Counts.

• Why is disease prevention and health promotion a better way to go?

1) Prevention saves lives1) Prevention saves lives

2) Prevention improves the quality of life2) Prevention improves the quality of life

3) Prevention is cost effective3) Prevention is cost effective

Why Prevention is not Focus:Why Prevention is not Focus:

-Can’t tell if programs have saved lives. -Can’t tell if programs have saved lives.

-Do not want to change current thinking.-Do not want to change current thinking.

-Medical personnel do not want to give up their power/job.-Medical personnel do not want to give up their power/job.

-Prevention should be a personal matter,

not a national one.

-Prevention should be a personal matter,

not a national one.

Three Levels of PreventionThree Levels of Prevention

PrimaryPrimary

SecondarySecondary

TertiaryTertiary



• Risk factors - “habit, trait, or condition in a person that is associated with an increased chance (or risk) of developing a disease” (Green & Ottoson, 1999

p.181).

• Modifiable (changeable or controllable)• Nonmodifiable (nonchangeable or

noncontrollable)



• Health risk reduction

• Risk reduction for noncommunicable (noninfectious) diseases• Multicausation Disease Model

• Risk reduction for communicable (infectious) diseases• Chain of infection



• Health risk reduction• Risk reduction for noncommunicable

(noninfectious) diseases• Multicausation Disease Model

• Risk reduction for communicable (infectious) diseases• Chain of infection• Communicable Disease Model

Other selected principles of health education

Other selected principles of health education

• Participation• Ownership• Ecological• Population-based approaches (advocacy,

organizational change, community development, empowerment, & economic support)

• Cultural sensitivity & competency

EpidemiologyEpidemiology

• “the study of the distribution and determinants of diseases and injuries in human populations” (Mausner & Kramer, 1985, p. 1)

•Key terms

- endemic, epidemic, and pandemic

History of Community/Public Health

History of Community/Public Health

-Greeks

-Romans

-Early America

-Plagues of Europe, Bubonic Plague, Epidemics, Pandemics

-Lemuel Shattuck—Modern Health Era

5 Phases in Modern Health Era5 Phases in Modern Health Era

-Miasma Phase (1850-1880)

-Bacteriology Phase (1880-1910)

-Health Resources Phase (1910-1960)

-Social Engineering Phase (1960-1975)

-Health Promotion Phase (1975- present)

Life ExpectancyLife Expectancy

100908070605040302010

3000 B.C. 2500 2000 1500 1000 500 A.D. 500 1000 1500 2000

22 years

18 years-

35 years-1780

41 years-1846

50 years-1900

76 years-1996

67 years-1946

Miasma Phase (1850-1880)Miasma Phase (1850-1880)

-Disease control was based on the misconception that disease was caused

by noxious air.

-American Public Health Association

-Establishment of first state health dept.

-Public Health teaching began

Bacteriology Phase (1880-1910)Bacteriology Phase (1880-1910)

• -Findings that specific organisms caused specific diseases.

• -Many vaccines were created to cure illness

Health Resources Phase (1910-1960)

Health Resources Phase (1910-1960)

-Shifting of importance from communicable diseases to other health hazards such as personal health services.

-County health depts were established

Health Resources Phase (1910-1960) cont.

Health Resources Phase (1910-1960) cont.

-Three health resources grew exponentially:

•Hospitals

•Health personnel

•Biomedical knowledge from research

-Voluntary health agencies grew in number and importance

Social Engineering Phase (1960-1975)

Social Engineering Phase (1960-1975)

-Technical health advances and personal health resources were not available to everyone.

-Medicare and Medicaid legislation

-Community outreach programs

-Concern of the containment of medical care costs and expenditures.

Health Promotion Phase (1975-present)

Health Promotion Phase (1975-present)

The government produced many reports and legislation trying to bring about interest in disease prevention and health promotion.

•Healthy People (1979)

•Promoting Health, Preventing Diseases: Objectives for the Nation (1980).

•Healthy People 2000

Healthy People 2010Healthy People 2010

Designed to:Designed to:

1. promote healthy behaviors;1. promote healthy behaviors;

2. promote healthy and safe communities;2. promote healthy and safe communities;

3. improve systems for personal and public health; and,

4. prevent disease and disorders.

3. improve systems for personal and public health; and,

4. prevent disease and disorders.


467 objectives467 objectives26 focus areas 26 focus areas

2 major goals 2 major goals

-Increase the quality of life as well as the years of healthy life.

-Increase the quality of life as well as the years of healthy life.

-Eliminate health disparities-Eliminate health disparities

For each priority area, a lead agency has been assigned to monitor and implement services.

Healthy People 2010 Healthy People 2010

• Physical Activity

• Overweight and obesity

• Tobacco use

• Substance abuse

• Responsible sexual behavior

• Mental health

• Injury and violence

Leading Health Indicators:


• Environmental quality

• Immunization

• Access to health care

Leading Health Indicators:


Populations for Consideration:

-Infants -Infants

-Children-Children

-Adolescents and Young Adults-Adolescents and Young Adults

-Adults -Adults

-Older Adults

-Older Adults

Settings for Health EducationSettings for Health Education

• -School

• -Community

• -Worksite

• -Health Care

Community HealthCommunity Health

-Voluntary Health Agencies-Voluntary Health Agencies

-Public Health Agencies-Public Health Agencies

-Private Health Agencies-Private Health Agencies

Voluntary Health AgenciesVoluntary Health Agencies

-Education-Education

-Service-Service

-Research-Research

Public/Private AgenciesPublic/Private Agencies

-Education-Education

-Public Relations-Public Relations

-Program Planning-Program Planning

Worksite HealthWorksite Health

Four Levels of ProgramsHealth Assessment

Health Information

Health Instruction

Follow Up and Counseling

School Health EducationSchool Health Education

• Why?

• Comprehensive School Health

-12 Elements

-7 Standards

-8 Components

Comprehensive School Health Education (CSHE)Comprehensive School Health Education (CSHE)

• “health education in a school setting that is planned and carried out with the purpose of maintaining, reinforcing, or enhancing the health, health-related skills, and health attitudes and practices of children and youth that are conducive to their health.”

Health Education:Health Education:

• is eclectic in nature.

• is an applied science.• has a body of knowledge that comes from

other disciplines. (Galli, 1976)

• is bigger than a discipline.

• is smaller than a profession.

Health Education:An Emerging Profession

Health Education:An Emerging Profession

Discipline• “a branch of knowledge or instruction”

• “an occupation that properly involves a liberal, scientific, or artistic education”

Profession• “the sociological construct for an occasion that

has special status”

• “one who pursues as a business some vocation or occupation”

Why not a profession?Why not a profession?

• Not clearly defined by others, though now recognized by U.S. Dept. of Commerce and Labor

• Several issues still unresolved• Period of preparation• System to regulate behavior of members• Culture peculiar to profession• Single association

Current status of Health EducationCurrent status of Health Education

• More visible than ever before

• 1974 - beginning of health promotion era of public health

• 1979 - publication of Healthy People

• 1990, 2000, 2010 goals and objectives for the nation

Philosophical/Philosophical/TheoreticalTheoretical

FoundationsFoundations

Unit 2Unit 2

• What is philosophy?• A statement summarizing the attitudes,

principles, beliefs, values, and concepts held by an individual or a group.

• Why does one need a philosophy?• People’s philosophies help form the basis

of reality for them. A philosophy helps to determine how one lives, works, plays, and generally approaches life.

PhilosophyPhilosophy

Major Schools of Philosophy

Major Schools of Philosophy

• Realism - truth exists independent of the mind; nature is the appropriate guide

• Idealism - reality is composed of ideas; conception of things as one thinks they should be

• Pragmatism - experience is the ultimate reality; therefore what works (or is practical) is right

• Eclectic - made up of what seems best of varied sources

A Philosophy of an...A Philosophy of an...

• individual is expressed in the way he/she sees the world (what is true for him/her)and is reflected in how one acts.

• organization is often expressed in its mission statement.

From Where Does One’s Philosophy of Life Come?From Where Does One’s

Philosophy of Life Come?

• Environment• - Learned from family and friends• - Guidance from significant others (i.e.,

teachers, religious leaders, mentors)

• Education and study

• Experiences

• Scientific data

• Other

• Philosophy of Symmetry• Health has physical, emotional, spiritual, and

social components, and each is just as important as the other.

• Holistic Philosophy• “Man [sic] is essentially a unified

integrated organism” (Oberteuffer, 1953, p.105).Thus the health of the person should be considered as a whole and not as the individual components.

Philosophies Associated with Health

Philosophies Associated with Health

• Humanism• Characterized by a concern for humanity. It

also “promotes the basic premise of the worth of human life and the ability of individuals to achieve…self fulfillment” (Bedworth & Bedworth, 1992, p. 5)

• Wellness• A positive quality, as opposed to illness which

is a negative quality. Impacted by the dimensions and and continuum of wellness

Philosophies Associated with Health (cont’d)

Philosophies Associated with Health (cont’d)

Predominant Health Education Philosophies

Predominant Health Education Philosophies

• Behavior Change philosophy• Focuses on modifying unhealthy habits of an

individual

• Cognitive-Based philosophy• Focuses on the acquisition of content and

factual information

• Decision-Making philosophy • Emphasizes critical thinking and lifelong

learning

Predominant Health Education Philosophies (cont’d)

Predominant Health Education Philosophies (cont’d)

• Freeing/Functioning philosophy• Focuses on freeing people to make best health

decision for them-- not necessarily for society

• Social Change philosophy• Emphasizes creating social, economic, & political

change that benefits health of individuals & groups

• Eclectic philosophy • Focuses on an adapting approach that is

appropriate for setting

Writing a PhilosophyWriting a Philosophy

• Philosophy impacts one’s approach to life, beliefs about health, & the delivery of health education, therefore:

• What is your philosophy of…• Life?• Health?• Health Education?

Philosophy of LifePhilosophy of Life

• Consider

• What is important in your life?

• What do you value most?

• What ideals do you hold?

• How do the answers to the above questions influence

the way you believe and act?

• Complete the stem: “The purpose of life is to…”

ExamplesExamples

“The purpose of life is a life of purpose”

Robert Burns

“If your ship doesn’t come in, swim out to meet it”

Unknown

“The more I practiced, the luckier I got”

Arnold Palmer

“No matter what you undertake, you will never do it until you think you

can”

Famous Philosopher Anon

“You can’t change the wind, but you can adjust your sails”

Unknown

“Whether you think you can or you think you can’t, you are right”

Henry Ford

“If there is righteousness in the heartThere will be beauty in the character

If there is beauty in the characterThere will be harmony in the home

If there is harmony in the homeThere will be order in the nation

If there is order in the nationThere will be peace in the world”

Chinese Proverb

“Do all the good you canBy all the means you canIn all the ways you canIn all the places you canAt all the times you can

To all the people you canAs long as ever you can”

John Wesley

Philosophy of HealthPhilosophy of Health

• Consider

• Creating you own definition of health

• The dimensions of wellness

• The continuum of wellness

• Complete the stem: “The purpose of health is to…”

Philosophy of Health Education

Philosophy of Health Education

• Consider • - the predominant health education philosophies• - definitions of health education• - benefits of health education• - limitations of health education• - responsibilities of a health educator

• Complete the stems:• - The purpose of health education is to...

• - Thus far, I believe health education… • (Hint: see what practicing health educators wrote- p. 85 of textbook)

To be useful...To be useful...

Philosophy -> principles -> practice

Key DefinitionsKey Definitions

• Theory• “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” (Glanz, Lewis, & Rimer, 1997, p. 21)

• Concepts• the primary elements of theories (Glanz, Lewis, &

Rimer, 1997)

4 Uses of Theory4 Uses of Theory

• Describe

• Explain

• Predict

• Prescribe

Key Definitions (cont’d)Key Definitions (cont’d)

• Construct• a concept that has been developed, created, or

adopted for use with a specific theory (Kerlinger, 1986)

• Variable• “specify how a construct is to be measured in a

specific situation” (Glanz & Rimer, 1995, p. 11)

Key Definitions (cont’d)Key Definitions (cont’d)

• Model• “a subclass of a theory” (McKenzie & Smeltzer, 2001, p.

138); draws “on a number of theories to help people understand a specific problem in a particular setting or context” (Glanz, Lewis, & Rimer,

1997, p. 24)

ExamplesExamples

• Concept

• Construct

• Variable

• Model

• Theory

• Personal beliefs

• Perceived benefit

• Rank order incentives

• Health Belief Model

• Social Cognitive Theory

Why use theory?Why use theory?

• Help guide the practice of health educators• “…provides direction and justification for

program activities…” (Cowdery et al., 1995, p. 248)

More specifically, theory… (Nutbeam & Harris, 1999, p. 12)

More specifically, theory… (Nutbeam & Harris, 1999, p. 12)

• “helps identify targets for intervention.”

• “helps to clarify how & when change can be achieved…”

• “indicates how to achieve organization change, & raise community awareness.”

• “provides a benchmark against which actual can be compared with ideal program.”

• “defines outcomes and measurements for use in evaluation.”

Types of Theories/ModelsTypes of Theories/Models

• Theories /models of implementation (for planning, implementation, & evaluation) referred to as planning models

• Change process theories (for use in behavior change) referred to as behavior change models

Planning Models (Theories/Models of

Implementation) Planning Models (Theories/Models of

Implementation)

PRECEDE-PROCEED • predisposing, reinforcing, and enabling

constructs in educational/ecological diagnosis and evaluation – policy, regulatory, and organization constructs in educational and environmental development (Green & Kreuter, 1999)

Program Planning Models (cont’d)


• PRECEDE-PROCEED

• MATCH • Multilevel Approach to Community

Health (Simons-Morton, D., Simons-Morton, B., Parcel, & Bunker, 1988)



• PRECEDE-PROCEED

• MATCH

• CDCynergy



• PRECEDE-PROCEED

• MATCH

• CDCynergy

• Several others



• PRECEDE-PROCEED

• MATCH

• CDCynergy

• Several others• Generalized Model for Program

Planning (McKenzie & Smeltzer, 2001)

Behavior Change Theories / Models


• First need to decide on what level to intervene• Consider the ecological perspective (McLeroy et al., 1988)

• Intrapersonal, or individual, factors

• Interpersonal factors

• Institutional, or organizational, factors

• Community factors

• Public policy factors



• Health Belief Model (HBM)

• Self-efficacy

• Theory of Planned Behavior

• Transtheoretical Model (TTM)• aka-Stages of Change

Social Change TheoriesSocial Change Theories

• Diffusion Theory

• Social Cognitive Theory

• Social Marketing Theory

Health Belief ModelHealth Belief Model

• Four major components• Perceived severity• Perceived susceptibility• Benefits• Barriers

• Mediating factors• Social, environmental, media, others

Health Belief ModelHealth Belief Model

Perceived Severity

Perceived SusceptibilityOutcome

Benefits

Barriers

Self-Efficacy

Perceived Threat

Modifying Factors -Media -People -Other factors

Self-EfficacySelf-Efficacy

• Definition: person’s confidence to perform a specific task.

Self Efficacy TheorySelf Efficacy Theory

• Person Behavior Outcome

Efficacy Expectation

Outcome Expectations

Can I Do Activity? If I Do Activity, What Will Happen?

Effort expended

Performance attainment

Vicarious learning

Verbal persuasion

Physiological monitoring

Decision to perform

Perceived Self-Efficacy

Persistence

Sources of Self-Efficacy Behavior

Theory of Planned BehaviorTheory of Planned Behavior

• Intentions predict behaviors

• Three factors that affect a person’s intention to do a specific behavior:• Personal attitudes• Social norm (what others think)• Perceived behavioral control

Theory of Planned BehaviorTheory of Planned Behavior

Attitudes

Social Norm

Inentions Behavior

Attitudes

Social Norm

Intentions Behavior

Perceived Control

Stages of Change TheoryStages of Change Theory

• 6 stages of behavior change• Precontemplation• Contemplation• Preparation• Action• Maintenance• Termination


• Precontemplation• Person is not aware that they have a problem

and does not see how unhealthy behavior is effecting their life or health.

• Process of change: • Consciousness raising

• Social liberation

• Helping relationships


• Contemplation• Person knows that change would be good, but

does not have the confidence to change and needs more information.

• Process of change:• Self-reevaluation

• Dramatic relief (emotional arousal)



• Preparation• Person begins preparing for changing unhealthy

behavior for new healthy behavior. • Process of change

• Self-liberation (commitment)



• Action• Person begins the new healthy behavior.• Process of change

• Reinforcement management (Reward)


• Stimulus control

• Counterconditioning


• Maintenance• Person is practicing healthy behavior but may

need feedback and a booster to avoid obstacles and temptations.

• Process of change• Helping Relationships


• Termination• Person feels that new behavior is a part of their

life and they never look back and think about the unhealthy behavior.

• Helping Relationships

Diffusion TheoryDiffusion Theory

• Definition: spread of ideas and innovations over time through communication channels among members of a social system.

• Used to predict best channels to communicate health information in hopes of behavior change.


• Adopter categories• Innovators (1.3%)• Early adopters (16%)• Early majority (33%)• Late majority (33%)• Laggards (16%)


• Diffusion CurveP

erce

nt a

dopt

ion

Time

at 20% adoption,Innovation takes off!

Social Cognitive TheorySocial Cognitive Theory

• Based on premise that an interaction exists between behavior, individual, and the environment.

• Reciprocal Determinism

Behavior Individual

Environment


• Behavior change occurs in 4 phases:• Pre-Training• Training • Initial Testing• Continual Performance


• Pre-Training Phase• Reciprocal Determinism• Behavioral Capability

• Is person capable of performing task?


• Training Phase• Expectations

• What will the likely outcome be?

• Expectancies• Value placed on expected outcomes

• Self-Efficacy• Emotional coping response


• Initial Testing Phase• Observational learning• Self-control or self-regulation


• Continual Performance Phase• Reinforcement• Locus of control

• Internal--self reward

• External--other reward

Social Marketing TheorySocial Marketing Theory

What is it?What is it?

• Social Marketing Theory-• Applies the concept of traditional marketing to

the “sale” or promotion of healthy behaviors. • Elements

• market plan• carefully designed messages • employment of mass media • consensus building• appropriate packaging

SMT continuedSMT continued

• SMT emphasizes the importance of specific target audiences and segmentation of the population when designing programs.• Gender, race, age, religion, education, etc.

ComponentsComponents

• The eight components include but are not limited to: • consumer orientation• exchange theory • audience analysis and segmentation• formative research • channel analysis• marketing mix• process tracking• marketing management

1) Consumer orientation 1) Consumer orientation

• This component consists of familiarizing the health educators and marketers to the needs of the consumers to better market towards them. • To discover the needs and wants of the

consumers, focus groups can be formed to represent the demographic being served.

2) The Exchange Theory2) The Exchange Theory

• Tangible and non-tangible items that are given up to achieve health behavior goal.

• To achieve a lower triglyceride level and decrease your total cholesterol you might have to give up eating at McDonalds five times a week in exchange for two times a week.

3) Audience Analysis and Segmentation

3) Audience Analysis and Segmentation

• Audience analyses, knowing your target populations.• what population you are working with• who is at risk

• Segmentation, describes breaking down populations into more specific groups. This makes groups readily available for analysis, diagnosis, and treatment with new implementation of programs.

4) Formative Research 4) Formative Research

• Documentation of development

• Extensive note taking

• Existing materials

• Materials that need to be made

• Continuous Evaluation

5) Channel Analysis 5) Channel Analysis

• Channels refer to the lines of communication through which an individual is reached.• Billboards• TV• Internet• Print Media• Novelty Items• Radio• News Outlets

• When trying to promote the Gardasil vaccination, concentrate on channels of media that young women are exposed to, such as teen magazine, MTV.

6) Marketing Mix6) Marketing Mix

• Based on the 4P’s: • product• price• place• Promotion

• And sometimes PARTNER

6) Marketing Mix cont.6) Marketing Mix cont.

• Product-• What we are trying to “sell”?• May be a tangible product or in our case an

intangible product, the idea of health.• Can be used to explore the consumer’s

perception of the problem or product and how to remedy it.


• Price-• Price describes what the consumer has to “pay”

for the product. • Monetary

• Time

• Effort

• Remembering to do it

• Behaviors will more likely be adopted if the benefits outweigh the costs.


• Place-• Where will you promote?• Where will product be sold?

• shopping malls

• mass media

• fliers

• brochures


• Promotion-• Integrates the advertisements, public relations,

promotion, media, personal testimonials, and entertainment sources.

• The rationale for promotion is to create and sustain the product.

• a PSA may be used to increase awareness of breast cancer and give tips on self examination.

7) Process Tracking 7) Process Tracking

• Evaluations• surveys • Letters to the editors• Press release

• process (what you are doing right now)

• impact (directly after the fact), and

• outcome (after the program, ie. 6 months) evaluations.

PartnerPartner

• Teaming up with other organizations to better market to the desired consumer

• Collaboration of time, resources, people, money, etc.

8) Marketing Management 8) Marketing Management

• Involves the specific aspects of the program you are trying to manage • Budget • Administration issues• Team building• Leadership

Unit 3Unit 3

• Ethics and the Health Education Profession

Three Areas of PhilosophyThree Areas of Philosophy

• Ethics - The study of morality

• Epistemology - The study of knowledge

• Metaphysics - The study of the nature of reality

EthicsEthics

• The study of good and bad, right and wrong, of duty and obligation, and of reasoning and choices.

• The important thing to remember is that moral-immoral and ethical-unethical essentially mean right-wrong, good-bad.

Reasons to Act EthicallyReasons to Act Ethically

• Brings meaning & purpose to life

• It provides a standard by which to live

• Establishes your credibility & reputation

• It leads to a healthier & more emotionally satisfying life

• It is expected of professionals

• Others appreciate it & will tend to treat you likewise

Why Be Ethical?Why Be Ethical?

“A good name is more desirable than great riches; to be esteemed is better than silver or gold.”

King Solomon

Ethical TheoriesEthical Theories

• Formalism (deontological or non-consequentialism) - looking at the act; the end does not justify the means.

• Consequentialism - looking at the consequences; the end does justify the means.


• Natural Law-person has a right to choose their own behavior unless the behavior harms society.

• Utilitarianism-Overall benefit to society

• Paternalism-Can act if person is unable to decide, significant harm without action, or will agree to action at a later date.


• Distributive Justice-distributing goods and services equally. Not discriminating by gender, age, ethnicity, or education

• Social Justice-determining the root causes underlying health problems. Not providing charity but helping society in order to help people to live a healthier lifestyle.

5 Basic Principles for Common Moral Ground

5 Basic Principles for Common Moral Ground

• Value of Life - The first and most basic principle

• Goodness or Rightness - Subdivided into two related principles• Nonmaleficence - The first duty is to do no

harm• Beneficence or Benevolence - To do good;

actions that provide for the greater good of the community

5 Basic Principles for Common Moral Ground (cont’d)

5 Basic Principles for Common Moral Ground (cont’d)

• Justice or Fairness - everyone has an equal chance at obtaining the benefits

• Honesty or Truthfulness - the heart of any moral relationship and meaningful communication

• Autonomy - Individuals must have the freedom to choose their own way of being ethical using the framework of the first four principles.

Ethical Decision MakingEthical Decision Making

• Define problem & seek answers to relevant questions.

• Consider the goals & ideals for which you are striving.

• Consider the consequences of each alternative.

• Consider consequences in terms of various ethical principles.

Ethical Decision Making (cont’d)

Ethical Decision Making (cont’d)

• Consider the impact of a proposed action on you as a moral person.

• Consider the impact of a proposed action on society and environment.

• Apply the “categorical imperative”; how would you want others to act?

• Select your best alternative and act.

Context is ImportantContext is Important

• Place

• Time

• Identity

• Social relationships

• The ideal - “most noble” alternative

• The concrete

• Seriousness

Ethical Obligations as Health Educators

Ethical Obligations as Health Educators

• Obligation to: • provide service

• clients

• third parties

• employers

• the profession

Ethical DilemmasEthical Dilemmas

• Must be an issue (a controversy); two sides

• Must involve a question of right and wrong

Ensuring Ethical BehaviorEnsuring Ethical Behavior

• Limit Entry into the Profession• Selective admission to programs• Retention standards in academic programs• Completion of internships• Graduation requirements (from an accredited

[SABPAC] program?)• Credentialing (CHES)• Continual updating

Ensuring Ethical Behavior (cont’d)


• Practicing Professionals• Code of ethics - Unified Code in 1999

Code of Ethics - Preamble (p. 311 of text)

Code of Ethics - Preamble (p. 311 of text)

The health education profession is dedicated to excellence in the practice of promoting individual,

family, organizational and community health. Guided by common ideals, health educators are

responsible for upholding the integrity and ethics of the profession as they face the daily challenges of making decisions. By acknowledging the value

of diversity in society and embracing a cross-cultural approach, health educators support the worth, dignity, potential and uniqueness of all

people.



• Practicing Professionals• Code of ethics - Unified Code in 1999

• Self Monitoring

• Peer review committee (panel)

• Legal System

Code of Ethics for Health EducatorsCode of Ethics for Health Educators

• Informed Consent• Benefits• Risks• Voluntary• Confidentiality

• Advocate for Health• Privacy for Customers• Quality of Programs and Services• Equality• Commitment to Profession• Research

The Health Educator:The Health Educator:

Roles, Responsibilities, Certifications, Advanced Study

Credentialing - meeting specified standards of credentialing body

Credentialing - meeting specified standards of credentialing body

• Accreditation - evaluation of program or institution

• Licensure - governmental agency grant permission to practice based on standards (i.e., teachers)

• Certification - recognition based standard of performance (i.e., CHES)

History of Role Delineation and Certification


• 1974, Helen P. Cleary, SOPHE President



• 1978, Bethesda Conference on Commonalities and Differences-• In settings?• In preparation?

• National Task Force on the Preparation and Practice of Health Educators created with reps. from CNHEO members

• 1979 role delineation began (role created, verified, curriculum framework created)

History of Role Delineation and Certification (cont’d)


• 1986, 2nd Bethesda Conference determine type of credentialing

• 1988, National Commission for Health Education Credentialing, Inc. created & charter certification began

• 1990, 1st CHES examination• 1997, Graduate Standards approved• 1998, Competency Update Project (CUP)



• 1988, Charter certification began

• 1990, 1st CHES examination

• 1997, Graduate Standards approved

• 1998, Competency Update Project (CUP)

CHESCHES

Program AccreditationProgram Accreditation

• National Commission for the Accreditation of Teacher Education (NCATE)

• Council on Education for Public Health (CEPH)

• SOPHE/AAHE Baccalaureate Program Approval Committee (SABPAC)

Health Educators:Health Educators:

• are professionally trained.

• serve a variety of roles.• are trained to use appropriate educational

strategies & other methods conducive to health. (Joint Committee, 2001)

What Do Health Educators Do?What Do Health Educators Do?

• Responsibilities - specify scope of practice

• Competencies - reflect ability to understand, know, etc.

• Sub-competencies - reflect ability to list, describe, etc.

• Objectives - reflect ability to perform

Responsibility IResponsibility I

• Assessing individual and community needs for health education

• Priority population• Types of data

• Primary

• Secondary

Responsibility IIResponsibility II

• Planning effective health education strategies, interventions, and programs

• Planning committee• Develop goals & objectives• Create intervention

Responsibility IIIResponsibility III

• Implementing health education strategies, interventions, and programs• Pilot test• Phase-in• Total implementation

Responsibility IVResponsibility IV

• Conducting Evaluation and research related to health education• Plan evaluation and research• Design methods to collect data• Process, impact, & outcome• Formative & summative• Interpret findings

Responsibility VResponsibility V

• Administering health education strategies, interventions, and programs• Exercise leadership• No overlap of services• Facilitate cooperation• Manage human resources

Responsibility VIResponsibility VI

• Serving as a health education resource person • Answering questions• Selecting and developing educational resources• Establishing consultative relationships

Responsibility VIIResponsibility VII

• Communicating and advocating for health and health education• Communication skills• Feeling comfortable working with others• Serving as a filter

Multi-taskingMulti-tasking

• Skill of coordinating and completing multiple projects at the same time

Advanced Study in Health Education

Advanced Study in Health Education

• Master’s degree (M.A., M.Ed., M.P.H., M.S., M.S.P.H.

• Doctoral degree (D.Ed., Dr.P.H., Ed.D., H.S.D., P.h.D.)

Selecting a Graduate SchoolSelecting a Graduate School

• Characteristics of institution and program

• Admission requirements

• Financing graduate education

The Settings for Health Education

The Settings for Health Education

Major SettingsMajor Settings

• Schools

• Worksites

• Health care organizations

• Community/public health agencies

• Colleges/Universities

• International agencies

• Non-traditional settings

SchoolsSchools

• School Health Educators• Teacher preparation curriculum• Licensed by the state

• Coordinated school health program - “an organized set of polices, procedures, and activities designed to protect, promote, and improve the health and well-being of students and staff…” (Joint Committee, 2001)

Schools (cont’d)Schools (cont’d)

• Type of work• Teach (typically 7-12, sometimes K-6)• Develop I.E.Ps for children with special needs• Coordinate school health program• Develop curricula• Committee work (i.e., Drug Task Force)

Why School Health?Why School Health?

• Health and learning reciprocally related

• All must pass through - 52+ million students, 5 million employees

• Health People 2010 - 1/3 of the objectives can be accomplished by schools

Community/Public Health Education

Community/Public Health Education

• Community health education - “a theory-driven process that promotes health and prevents disease within populations” (Joint

Committee, 2001)

• Types of agencies• Governmental (LHD, State Health Dept.,

Federal agencies)• Voluntary (i.e., ACS, AHA, ALA)• Quasi-governmental (i.e., ARC)

Community/Public Health Education (cont’d)

Community/Public Health Education (cont’d)

• Type of work• Planning, implementing, & evaluating health

education/promotion programs• Fund raising events/campaigns• Coalition building• Grant proposal writing• Advocacy• Volunteer recruitment• Arranging for service

WorksitesWorksites

• Health promotion specialist

• Locations• Business and Industries• Health promotion companies (i.e., Summex,

Harris Health Trends)• Hospitals• Managed care organizations (MCOs) /

insurance companies

Worksites (cont’d)Worksites (cont’d)

• Rationale• Protecting human resources• Reducing health care costs• “Most companies now only accept programs

that help meet business objectives” (J. Harris, Harris Health Trends, Feb. 2001)

Worksites (cont’d)Worksites (cont’d)

• Type of work• Planning, implementing, and evaluating health

education/promotion programs• Health (risk reduction) counseling

• In person

• Over the telephone

• Coordinating/managing fitness facilities• Managing high risk cases

Health CareHealth Care

• Health promotion specialist / health educator / patient educator

• Locations• Hospitals (various departments: health

promotion, patient education, public relations, community outreach)

• Clinics• Practitioners’ offices

Health Care (cont’d)Health Care (cont’d)

• Type of work• Planning, implementing, and evaluating health

education/promotion programs• Intrapersonal level (one-on-one)• Interpersonal level (small group, e.g., smoking

cessation, support groups)• Community presentations

Colleges/UniversitiesColleges/Universities

• Campus wellness / student health centers• Clinic education programs• Prevention / awareness programs

• Instructional positions

Colleges/Universities (cont’d)Colleges/Universities (cont’d)

• Instructional positions• Part-Time or Adjunct Positions• Full-Time, Tenure Track Positions• Duties

• Teaching • Research (grants, publishing, presenting)• Service (institution, community, profession)

InternationalInternational

• Developing countries

• Special dedication

• Cultural differences

• Example - Peace Corps

Non-Traditional Employment Settings

Non-Traditional Employment Settings

• Sales• Insurance sales• Pharmaceutical sales• Fitness equipment• Other

• Justice/Mental Health• Publishing• Media• Tourism/Recreation

Landing That First JobLanding That First Job

• Experience• Part-time & summer employment• Volunteering• Well-planned practica & internships• Service learning

• Excellent academic record• Portfolio• Certifications• Get to know Faculty• Get involved in your program• Placement centers• Professional associations and organizations

Health InformationHealth Information

• Increasing demand for the information

• Explosion of information

Types of Information Sources

Types of Information Sources

• Primary Sources – ...written by the person who actually conducted the research or observed the events, e.g., refereed journal articles, legislative records, minutes of meetings

• Secondary Sources – ...written by someone who was not an eyewitness or did not conduct the actual research project, e.g., journal review articles, editorials, non-eyewitness accounts.

Types of Information Sources (cont’d)

Types of Information Sources (cont’d)

• Popular press publications• Items published for lay persons• Typically secondary source, but could be primary• Often include opinions, editorials and summaries, • e.g., Newsweek, Reader’s Digest and tabloids.

• Refereed journals• publishes original manuscripts that have been read

& recommended by a panel of experts (referees), AKA peer reviewed

• e.g., American Journal of Health Education, & American Journal of Public Health

Identifying the Components of a Research Article

Identifying the Components of a Research Article

• Abstract - brief description of article• Introduction - provides background & purpose

of the study• Methodology - explains how the study was

conducted• Results - gives the findings of study• Discussion – interprets the findings &

provides comment on the implications of the results

Critically Reading a Research Article

Critically Reading a Research Article

• Were the aims of the study defined in a clear manner?

• Were the research questions/hypotheses clearly stated?

• Was the description of the subjects clear? Did the article state how the subjects were recruited?

• Were the design and location of the study described clearly?

Critically Reading a Research Article (cont’d)

Critically Reading a Research Article (cont’d)

• Were the data collection instruments described?

• Did the results directly address the research questions/hypotheses?

• Were the conclusions logical in terms of the research design and data analyses performed?

• Were the study implications meaningful to the population you serve?

Evaluating the Accuracy of Non-research Based SourcesEvaluating the Accuracy of

Non-research Based Sources

• Author’s qualifications? Academic degree in the field being written about?

• Style of presentation? Scientific?• References included?• Purpose of the publication?• Reputation of the publication?• New information?

Writing an Abstract or Summary

Writing an Abstract or Summary

Abstract – Short descriptions of research & main findings (150-250 words)

Summary – Longer review; includes methodology, findings, limitations, & detailed presentation of conclusions & discussion (2-3 pages)

Locating Health-Related Information - Journals

Locating Health-Related Information - Journals

Locating Health-Related Information (cont’d)

Locating Health-Related Information (cont’d)

• Indexes - provides link to articles from many refereed journals, books, and research reports, i.e., Index Medicus & Education Index

• Volumes of just abstracts of research studies that have appeared in other journals, i.e., Psychological Abstracts

• Computerized Databases of indexes or abstracts, i.e., Medline, ERIC, & PsychLit

The Internet and the World Wide Web

The Internet and the World Wide Web

• World Wide Web - an interactive information delivery service

• Hypertext - text used on the WWW

• Internet - global network of interconnected computer networks

• Browser - software package used to access information on the web, i.e., Netscape

• Uniform Resource Locators (URLs) - Web addresses usually in http = Hypertext Transfer Protocol)

• Search Engine - device that allows open searching of a topic area, i.e., Yahoo

Evaluating Information on the Internet


•Content

•Authority

•Publisher-Source

•References

•Documentation

•Facts



• http://www.library.kent.edu/internet/criteria.html

• http://www.nnlm.gov/gmr/publish/eval.html

• http://www.cancer.about.com/library/weekly/aa013002a

• http://www.ohsu.edu/croet/resources/healthinfo.html

• http://www.hitiweb.mitretek.org/docs/policy.html

Trying to Predict the FutureTrying to Predict the Future

• Is dangerous business

• Only one thing for sure… change will occur

Demographic ChangesDemographic Changes

• The U.S. population will become more diverse

A More Diverse FutureA More Diverse Future

Demographic ChangesDemographic Changes

• The U.S. population will become more diverse

• The U.S. population will get older as baby boomers age

Societal TrendsSocietal Trends

• Technology will impact us more than ever• Family structure will continue to change

• Traditional family• Postmodern family

• Frustration with politics & politicians will continue• Medical care costs will continue to increase

The Future of Professional Preparation

The Future of Professional Preparation

• Preparation for analytical thinking• Preparation for collaboration• Preparation for delivering multilevel interventions• Preparation to incorporate more technology into practice• Preparation to better use schools as a point of delivery

The Future of Credentialing Health Educators

The Future of Credentialing Health Educators

• More than just entry level certification

• Sub-special certifications

• Graduation from an accredited program

• Required to practice, e.g. Arkansas

Implications for Practice Settings

Implications for Practice Settings

• School • better coordinated school health programs with

emphasis on school health services

• Worksite • keep employees healthy in order to keep

production high & reduce the cost of health insurance

Implications for Practice Settings (cont’d)

Implications for Practice Settings (cont’d)

• Community/Public Health -• work more collaboratively; form more

coalitions; advocate for policies

• Health care • health (patient) education will be necessary to

reduce health care costs

Future is bright for health education because...Future is bright for health education because...

• of presence of managed care.• of growing influence of health insurance

companies.• of increasing costs of health care (& thus

health insurance).• of the continuance of the health promotion era.• aging of baby boomers.

HLSC 2613 Foundations of Community Health Course Notes Instructor: Ches Jones, PhD.

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