Proximal distal levels
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Proximal-Distal Levels. Levels of Causation. Earlier interpretation: Proximal – Biological Distal – Social Later 19 th Century – Levels: Levels ranging from Individual to Institutional Difference between how and why biologically Space – Time Causal pathways. Public Health and Levels.

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Proximal-Distal Levels

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Proximal distal levels

Proximal-Distal Levels


Levels of causation

Levels of Causation

  • Earlier interpretation:

    • Proximal – Biological

    • Distal – Social

  • Later 19th Century – Levels:

    • Levels ranging from Individual to Institutional

    • Difference between how and why biologically

    • Space – Time Causal pathways


Public health and levels

Public Health and Levels

  • Multifactorial approach to disease causation – agent, host, & environment

  • Move beyond the web of causation – Z Axis

  • Proximal-Distal Terminology

    • Gene-environment interaction

    • Social determinants of health

  • Space, Time, Distance, Levels and Causal Potency (association)


Proximal distal levels

THE THEORY OF TRIADIC INFLUENCE

Levels of

Causation

Ultimate

CULTURAL

SOCIAL

BIOLOGY/

Causes

ENVIRONMENT

SITUATION

PERSONALITY

1

2

3

4

5

6

a

f

Social/

Personal

Nexus

c

d

e

b

Sense of

Information/

Interpersonal

Others’

Social

Interactions w/

Self/Control

Opportunities

Bonding

Beh & Atts

Competence

Social Instit’s

Distal

Influences

7

8

9

10

11

12

g

r

p

i

q

h

k

n

m

l

j

o

Expectancies

& Evaluations

Self

Skills:

Motivation

Perceived

Values/

Knowledge/

Determination

Social+General

to Comply

Norms

Evaluations

Expectancies

13

14

15

16

17

18

s

x

ATTITUDES

SOCIAL

SELF-EFFICACY

u

w

v

t

Affect and

Cognitions

TOWARD THE

NORMATIVE

BEHAVIORAL

BEHAVIOR

BELIEFS

CONTROL

Proximal

19

20

21

Predictors

Decisions

A

G

B

H

C

I

D

E

F

22

K

Experiences

23

Related Behaviors

J

Intrapersonal Stream

Social/Normative Stream

Cultural/Attitudinal Stream

Biological/Nature

Nurture/Cultural

DECISIONS/INTENTIONS

Trial Behavior

EXPERIENCES: Expectancies -- Social Reinforcements -- Psychological/Physiological

4


From theory to practice

From Theory to Practice


Why use theories

Why use theories?

  • Help target causal determinants of behavior

  • Theoretically informed evaluations

  • Improved future theories

  • But how…?

    • Wide range of theories

    • Range of techniques to modify behavior

    • Basis of selecting specific theory to change specific behavior


Causal modeling approach

Causal Modeling Approach

  • Identify behavioral determinants

  • Develop methods to clarify list of behavior change techniques

  • Identify links between the behavior change technique and behavior determinants


Results

Results

  • 53 Techniques (examples):

    • Setting goals

    • Providing rewards/incentives

    • Improve coping skills

    • Increasing skills (problem-solving, decision-making)

    • Feedback etc.

  • 71% Agreement in mapping technique on theoretical constructs.


List of determinants

List of Determinants

  • Social/Professional role and identity

  • Knowledge

  • Skills

  • Beliefs about capabilities

  • Beliefs about consequences

  • Motivation and goals

  • Memory, Attention, Decision Process

  • Environmental Context and Resources

  • Social Influences

  • Emotion

  • Action Planning


Conclusions

Conclusions

  • This exercise makes theories more accessible to researchers.

  • Need to move forward and keep adding to the list

  • Improve replicability of interventions in different populations because the basic construct is the same

  • Conservation of resources due to clarity about determinant-technique relationship


Question

Question…

  • Do we agree with this approach?

  • The mapping and relationship are opinions of researchers.


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