Social Ecological Models

1. Social Ecological Models

2. How can we begin to understand all of the factors that influence health?  Ecological Model

3. Individual Interpersonal Institutions Community Population/Policy

4. What is an Ecological Perspective? A framework that enables us to consider the influence of individual and environmental factors on health & health-related behaviors

5. Why the ecological framework? • Health & health problems are complex • Health problems are influenced by multiple variables • These variables interact with each other • Multiple levels are relevant for understanding & changing: • Human behavior • Complex environments

6. By focusing on factors beyond the individual, we are… • Less likely to ‘blame the victim’ • More likely to address the underlying determinants of health & health behavior

7. By focusing on factors beyond the individual, we are… • Better able to see where action is needed Upstream action vs. Downstream approaches What do we mean by up/down stream approaches?

8. Ecological Framework helps us with… • Problem analysis • Intervention design • Intervention evaluation

9. Problem analysis Public Health Problem Determinants  Population Community Organizational Interpersonal Individual

10. Individual Interpersonal Institutions Community Population/Policy

11. Youth Smoking Determinants  Population/Policy Lack of law enforcement for selling to minors Community Positive attitudes toward smoking Organizational Easy availability of cigarettes at stores Interpersonal Popular kids smoke/parents smoke Individual Lack skills/self-efficacy to ‘just say no’

12. Intervention Design • Prevent or ameliorate existing problems • Interventions, at their best are… • Intended to Identify & shape solutions • Specifying goals, objectives, activities • Theory-based • Designed by multi-disciplinary teams • Targeted at multiple levels • Able to maintain a broad (ecological) scope

13. Individual Level Interventions • Target of change  Individual Person • Focus on characteristics of the individual • E.g., knowledge, attitudes, skills, beliefs…

14. Individual Level Interventions What types of strategies might we use at this level? What type of individual level intervention would be useful in youth tobacco prevention?

15. Interpersonal Level Interventions • Target of change  Social influences • E.g., family, work group, friendship networks… • Focus on nature of social relationships • E.g., social norms, access to diverse & supportive networks/influences

16. Interpersonal Level Interventions What type of interpersonal level intervention would be useful in youth tobacco prevention? What types of strategies might we use at this level?

17. Organizational Level Interventions • Target of change  Organization/Institution • E.g., worksites, schools, agencies, churches… • Focus on organizational culture • E.g., norms, rules & regulations, incentives & benefits, structures

18. Organizational Level Interventions What type of organizational level intervention would be useful in youth tobacco prevention? What types of strategies might we use at this level?

19. Community Level Interventions • Target of change  Social environment • Focus on community norms, values, attitudes, & power structures

20. Community Level Interventions What type of community level intervention would be useful in youth tobacco prevention? What types of strategies might we use at this level?

21. Population Level Interventions • Target of change  Local, state, & national laws & policies • Focus on government regulations & other regulatory processes, procedures, or laws to protect health

22. Population Level Interventions What type of population level intervention would be useful in youth tobacco prevention? What types of strategies might we use at this level?

23. What types of health issues or health behaviors lend themselves to using the social-ecological model? Are there any issues that don’t?

24. Challenges to ecological interventions • A lot of work – involving several sectors of society • Difficult to evaluate change at environmental level • Challenge to translate interest in change into social norms and public policy • Powerful norms are hard to change • Budget cuts – so difficult to undertake wide-range interventions • Difficult to get certain health issues on public policy agenda • Still, it’s being done! E.g., nutrition guidelines, tobacco, fitness, elder transportation

25. So… • The ecological framework emphasizes: • Relationships among behaviors, socio-political structures & health • Applying this framework allows us to: • Determine & describe public health problems • Move beyond solely focusing on (& blaming) the ‘individual’ • Assess multi-level determinants of health & how to address them • Design, implement, & evaluate interventions