Health intervention development - Translating theory to practice Flashcards
Theory:
Explains/predicts phenomena through variable relations.
Health Intervention Development:
Health Issue
then
Factors/determinants
then
Theory/frameworks
then
Intervention
Bandura’s Theory Pyramid:
Behavior, Environment, Personal factors.
Models: Show interactions, not explanations.
Models
Show factors & their interactions
Don’t explain why, just how
Specific to a behavior or situation
Health Belief Model (HBM)
Explains why people take (or don’t take) health actions:
Perceived threat = perceived risk/susceptibility + seriousness
Weigh benefits vs. barriers
Self-efficacy = belief they can do it
Cues to action = reminders/triggers, ex: ad, reminder
→ All lead to health behavior (like getting vaccinated)
Modifying Variables (like age, gender, knowledge) affect how people think.
Theory:
Adults remember 10% (hear), 65% (hear/see), 80% (hear/see/do).
Self-directed learning; morning classes = more productivity.
Practice:
Apply theory: use auditory/visual aids, involve learners, be a facilitator.
Schedule classes (e.g., 8:30am) for personal preference.
Theory and practice:
Considerations:
Learning Styles
Logistics
Motivation
External Factors: Dark, cold, tired
Need for Theory in Health Programming:
Behavior isn’t always logical.
Complex environment-behavior interaction.
Effective interventions are crucial (costly, time-consuming).
Influences: Individual, Interpersonal, Organizational, Community, Society.
Where Theory Comes Into Play:
Links intervention to outcomes.
Guiding theory explains health components.
Program theory: Connects delivery to outcomes.
Logic Analysis:
Justifies how strategies will lead to outcomes.
- Identifies change mechanisms.
- Uses literature, expert opinion, practice.
Helps plan or revise interventions.
Logic analysis helps you figure out if your health intervention makes sense by showing how your plan will lead to the results you want, based on both theory and real-life situations.
Intervention Mapping:
Plans health promotion interventions, from problem to solution.
The Process:
Needs assessment
Set objectives
Select methods and strategies
Create materials
Plan implementation
Design evaluation
Determinants:
Factors influencing outcomes.
Link strategies to outcomes.
Informed by theory.
Example:
Aim: Use IM to improve lifestyle and quality of life in overweight children (6-10) and enhance parental self-efficacy and family engagement.
Step: Methods & Results
Needs Assessment:
See the table
Methods: Focus groups, parent interviews, literature review.
Results:
Weight is sensitive.
Parental denial and low nutritional literacy.
Develop Change Objectives:
Identified key behaviors and set objectives.
Step: Methods & Results
Select Strategies:
Used self-determination theory to choose determinants.
- They use Self-Determination Theory, which says people are more motivated when they feel autonomous, competent, and connected to others.
Created a matrix linking objectives to determinants.
Strategies based on theory.
Resulting Program:
Children: Education and PA sessions.
Parents: Nutritional literacy counseling.
Family: Meal prep and health habits courses.
*Emphasized adaptation and positive reinforcement.
Operationalizing Theory through Frameworks:
Frameworks link determinants to outcomes.
Guide selection of determinants and strategies.
Example:
EnRICH: Guides interventions to increase adaptive capacity in vulnerable communities, developed through community input and theory.
What Happens Without Theory?:
Misses key aspects, ignores underlying paradigms.
Reduced efficacy and long-term impact.
Cultural iceberg: Ignores non-observable factors.
Interventions may result in unintended outcomes
Lifestyle Drift: Shift from societal issues to individual behaviours.
Reasons:
Denial/Indifference: Avoid addressing systemic problems.
Individualism: Focus on personal responsibility.
Ease: Individual solutions are quicker.
Political Pressure: Target high-risk groups, not root causes.
Example:
Air Pollution: Marginalized communities suffer more, but solutions focus on individual actions (e.g., masks) instead of addressing pollution sources.
Lifestyle Drift
Social issue identified → enters political debate.
Public demands focus on high-risk populations.
If affected group has power:
→ Issue stays political, seen as a societal problem.
If group has less power:
→ Issue becomes individualized (blamed on personal behavior).
→ Seen as a personal failure or pathology.
→ Reinforced by some health promotion efforts.
Lifestyle drift = shifting focus from social/political causes → individual responsibility.
Nudge Politics
Nudge = subtle change in environment to guide behavior.
Doesn’t remove choices (preserves freedom).
Based on libertarian paternalism (help people make better choices without forcing them).
Criticism:
→ Ignores deeper social/economic factors.
→ Reinforces lifestyle drift (blaming individuals).
Examples of Nudges
Nutrition labels
Putting healthy food at eye level
Budges (Stronger than nudges – more regulatory)
Budges = policy-level changes that limit unhealthy options.
E.g.:
Sugar tax
Restrictions on junk food ads
Salutogenesis
Focus on what creates health, not just what causes disease.
Promotes well-being and resilience, not just risk reduction.
Salutogenesis is the approach to health that focuses on how people can stay healthy and what factors promote well-being, rather than just focusing on preventing or treating illness.
