Article

An Ecology Perspective on Health Promotion Programs

Department of Public Health Education, University of North Carolina, Greensboro 27412.
Health education quarterly 02/1988; 15(4):351-77. DOI: 10.1177/109019818801500401
Source: PubMed

ABSTRACT During the past 20 years there has been a dramatic increase in societal interest in preventing disability and death in the United States by changing individual behaviors linked to the risk of contracting chronic diseases. This renewed interest in health promotion and disease prevention has not been without its critics. Some critics have accused proponents of life-style interventions of promoting a victim-blaming ideology by neglecting the importance of social influences on health and disease. This article proposes an ecological model for health promotion which focuses attention on both individual and social environmental factors as targets for health promotion interventions. It addresses the importance of interventions directed at changing interpersonal, organizational, community, and public policy, factors which support and maintain unhealthy behaviors. The model assumes that appropriate changes in the social environment will produce changes in individuals, and that the support of individuals in the population is essential for implementing environmental changes.

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    • "The SEM was chosen because a person's behavior is influenced by social, cultural , economic, and environmental factors. Interventions informed by SEM target multiple levels and are expected to be more effective than those intervening at only one level (McLeroy et al., 1988; Sallis et al., 2002; Stokols, 1996). This study is intervening at 4 levels of the SEM (see the Figure). "
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    • "Interpersonal factors are defined as interpersonal processes and groups (e.g., family, friends, peers) providing identity and support. Organizational factors include rules, regulations, policies, or structures from churches, stores, or community organizations that could constrain or promote individual behaviors (McLeroy et al., 1988). To the best of our knowledge, this approach has not yet been applied to the study of PAC although variables included in past caregiving research could be organized and studied according to intrapersonal, interpersonal , and organizational factors. "
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    • "Local tailoring is necessary to ensure that local demographic, cultural and environmental circumstances are appropriately addressed, which may result in more effective interventions through better adoption and sustainability (World Health Organization, 2012). CBIs generally use multiple types of strategies across multiple levels of the socioecological model (McLeroy et al., 1988) via partnership mechanisms (Kumanyika et al., 2002; World Health Organization 2002; Simmons et al., 2009) and focus on community engagement, capacity building, policy and environment changes across a whole community. Robust evaluations confirm CBIs effectiveness (Taylor et al., 2008; Johnson et al., 2012; Swinburn and Wood, 2013; Pettman et al., 2014) and cost-effectiveness (McAuley et al., 2010; Moodie et al., 2013). "
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