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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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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)
slide4

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

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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