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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    • "This analysis identified multiple levels of influence (i.e., individual , family, peer dialogue group, organization, and community) on father and grandmother peer educator motivation, which are similar to the levels in the socioecological model (McLeroy et al., 1988). Peer educators are embedded within social networks comprised of family members, community members, and other peer educators, which may influence their motivation (Daniels et al., 2005; Dynes et al., 2014; Greenspan et al., 2013). "
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    ABSTRACT: Peer-led dialogue groups (i.e., support or self-help groups) are a widely used community-based strategy to improve maternal and child health and nutrition. However, the experiences and motivation of peer educators who facilitate these groups are not well documented. We implemented eight father and ten grandmother peer dialogue groups in western Kenya to promote and support recommended maternal dietary and infant and young child feeding practices and sought to understand factors that influenced peer educator motivation. After four months of implementation, we conducted 17 in-depth interviews with peer educators as part of a process evaluation to understand their experiences as group facilitators as well as their motivation. We analyzed the interview transcripts thematically and then organized them by level: individual, family, peer dialogue group, organization, and community. Father and grandmother peer educators reported being motivated by multiple factors at the individual, family, dialogue group, and community levels, including increased knowledge, improved communication with their wives or daughters-in-law, increased respect and appreciation from their families, group members' positive changes in behavior, and increased recognition within their communities. This analysis also identified several organization-level factors that contributed to peer educator motivation, including clearly articulated responsibilities for peer educators; strong and consistent supportive supervision; opportunities for social support among peer educators; and working within the existing health system structure. Peer educator motivation affects performance and retention, which makes understanding and responding to their motivation essential for the successful implementation, sustainability, and scalability of community-based, peer-led nutrition interventions. Copyright © 2015 Elsevier Ltd. All rights reserved.
    Social Science & Medicine 10/2015; 143. DOI:10.1016/j.socscimed.2015.08.036 · 2.89 Impact Factor
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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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    ABSTRACT: The effectiveness of community health workers (CHWs) as health educators and health promoters among Latino populations is widely recognized. The Affordable Care Act created important opportunities to increase the role of CHWs in preventive health. This article describes the implementation of CHW-led, culturally specific, faith-based program to increase physical activity among churchgoing Latinas. This study augments previous research by describing the recruitment, selection, training, and evaluation of CHWs for a physical activity intervention targeting multiple levels of the Social Ecological Model.This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 License, where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially.
    The Journal of ambulatory care management 08/2015; 38(4). DOI:10.1097/JAC.0000000000000108
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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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    ABSTRACT: Taking a socioecological perspective, this study assessed the relationship of intrapersonal, interpersonal, and organizational factors to positive aspects of caregiving (PAC) for 642 dementia caregivers by racial/ethnic group from the baseline data of the multisite Resources for Enhancing Alzheimer's Caregiver Health II (REACH II) intervention. Nine intrapersonal indicators, 4 interpersonal indicators, and 12 organizational indicators were used. Blocked-multiple regression analyses by three racial/ethnic groups were computed to examine significant factors related to PAC among caregivers after controlling for memory and behavioral problems. Data showed a significant difference in PAC and significantly different indicators of PAC by racial/ethnic group. Hispanic caregivers reported the highest level of PAC while White participants showed the lowest scores on the measure of PAC. Education, marital status, and using formal transportation services were significant predictors for PAC among Hispanic caregivers; age, education, caregiving duration, and received social support were significant for PAC among African American caregivers; and sex, education, being a spousal caregiver, satisfaction with social support, using help from homemaker and visiting nurse services, and participating in support groups were significant among White caregivers. Findings indicate that PAC varies significantly across the three studied racial/ethnic groups of family caregivers and that intrapersonal, interpersonal, and organizational factors relate uniquely to PAC. Additional investigations of PAC could serve an important role in the development of family caregiving supports and services.
    Aging and Mental Health 07/2015; DOI:10.1080/13607863.2015.1068739 · 1.75 Impact Factor
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