Social and Behavioral Sciences Flashcards
Acculturation
A gradual process through which an individual adopts the behavioral norms, attitudes, and beliefs of a culture other than his own.
Adherence
Closely following or sticking to a plan or protocol. In the context of health promotion, we use the term adherence to refer to individuals taking their medications as prescribed (i.e. adherence to antiretroviral therapy) or following program protocols (i.e. sticking to a diet and exercise plan). In the context of health promotion, adherence can also refer to following the implementation protocol when delivering a health promotion program, conducting interviews, etc.
Asset mapping
A component of community capacity assessment and community development that involves conducting an inventory of individual, group and community resources, often physically designating them on a geographical map. A capacity assessment offers an alternative to a needs-based approach to community health and “is a measure of actual and potential individual, group and community resources that can be inherent and/or brought to bear for health maintenance and enhancement.” 25 Once assets are “mapped,” efforts are directed at mobilizing, strengthening and supplementing them while working to achieve a common vision.
Behavioral capability
An individual’s knowledge and skills related to a specific health behavior. In order for an individual to engage in a particular behavior, that individual must first know what the behavior is and how to successfully perform it. Behavioral capability is a key construct of the Social Cognitive Theory.
Behavioral factors
“The patterns of behavior of individuals and groups that protect or put them at risk for a given health or social problem.”
Behavioral intention
“A mental state in which the individual expects to take a specified action at some time in the future.”
Behavioral objective
“A statement of desired outcome that indicates who is to demonstrate how much of what action by when .”
Behavioral risk
A typically modifiable behavior, like smoking or lack of physical activity, which puts an individual at risk for a negative health outcome.
Best practices
“Recommendations for an intervention, based on a critical review of multiple research and evaluation studies that substantiate the efficacy of the intervention in the populations and circumstances in which the studies were done, if not its effectiveness in other populations and situations where it might be implemented.”
Change agent
In the context of Diffusion of Innovations, a change agent is “an individual who influences clients’ innovation-decisions in a direction deemed desirable by a change agency.” The change agent’s functions are often to develop a perceived need for change, facilitate information-exchange, identify a client’s problems, develop a client’s intentions to change, motivate the movement from intentions to action, support long-term adoption of the change, and help the client achieve self-reliance.
Coalition
“A group of organizations or representatives of groups within a community joined to pursue a common objective.”
Co-morbidity
Having more than one illness or condition that compromises quality of life at the same time.
Communication theories
In the context of public health, communication theories are meant to describe how communication processes impact health behavior change and how communication strategies can be used strategically to motivate behavior change. Although there are a number of communication theories and concepts, four that are particularly relevant to public health include the knowledge gap, agenda setting, cultivation studies, and risk communication . The knowledge gap refers to the fact that individuals with more formal education tend to be more knowledgeable about many issues when compared to those with less formal education; therefore, “an increasing flow of information into a social system is more likely to benefit groups of higher socioeconomic status than those of lower SES,” thereby contributing to health disparities and other inequities. Knowledge gaps can be modified by content and channel factors, social conflict and mobilization, community structure, and individual motivational factors. Agenda-setting refers to the ability of the mass media to influence public opinion and priorities, particularly in relation to politics and policymaking. Cultivation studies investigate “the impact the mass media have on our perceptions of reality.”
Community
“A specific group of people, often living in a defined geographical area, who share a common culture, values and norms, are arranged in a social structure according to relationships which the community has developed over a period of time. Members of a community gain their personal and social identity by sharing common beliefs, values and norms which have been developed by the community in the past and may be modified in the future. They exhibit some awareness of their identity as a group, and share common needs and a commitment to meeting them.”
Community-based interventions
“Programs designed to focus on healthful changes in either subgroups or localized populations.”
Community-based participatory research (CBPR)
“A collaborative process that equitably involves all partners in the research process and recognizes the unique strengths that each brings. CBPR begins with a research topic of importance to the community with the aim of combining knowledge and action for social change to improve community health and eliminate health disparities.”
Community capacity
“Combined assets that influence a community’s commitment, resources, and skills used to solve problems and strengthen the quality of life for its citizens.”
Community organization
“The set of procedures and processes by which a population and its institutions mobilize and coordinate resources to solve a mutual problem or to pursue mutual goals.”
Consciousness raising
A process of “learning new facts, ideas and tips that support the healthy behavior change.” Efforts to increase awareness about the causes and consequences of a disease or unhealthy behavior during a media campaign would be considered consciousness raising. Consciousness raising is a process of change included in the Transtheoretical model that is most appropriate for individuals in the earliest stages of change (precontemplation and contemplation).
Cues to action
“Strategies to activate one’s readiness” to engage in a particular behavior or activity. A cue to action can be either an internal or external stimulus that motivates a person to act. Cues to action is a key construct in the Health Belief Model.
Cultural competence
“The design, implementation, and evaluation process that accounts for special issues of select population groups (ethnic and racial, linguistic) as well as differing educational levels and physical abilities.”
Decisional balance
The relative weight an individual places on the perceived pros and cons of changing or engaging in a certain behavior. Typically, the pros of change need to outweigh the cons of change before an individual will be ready to take action and maintain a behavior change. Decisional balance is a key construct in the Transtheoretical model.
Determinants of health
“The range of personal, social, economic and environmental factors which determine the health status of individuals or populations.”
Diffusion of innovations (DOIs)
A community-level theory that attempts to describe the rate and process of the adoption of new ideas and behaviors in a specific population or between populations. An innovation is defined as “an idea, practice or object that is perceived as new by an individual or other unit of adoption,” while diffusion is defined as “the process by which an innovation is communicated through certain channels over time among the members of a social system.” The process of diffusion occurs over the course of five stages: innovation development, dissemination, adoption, implementation, and maintenance. The adoption stage requires that an individual: 1) has knowledge of the innovation (has an awareness that the innovation exists, knowledge of how to use the innovation and how it works); 2) goes through a process of persuasion or attitude development, in which the individual discusses the innovation with others and forms a favorable or negative attitude toward it; 3) decides to adopt the innovation; 4) implements, or begins to use the innovation; and 5) goes through a process of confirmation, in which the individual integrates the innovation into his life and recommends it to others. In general, not everyone adopts an innovation at the same time. Diffusion of Innovations categorizes individuals into five groups, based on when they adopt an innovation: innovators are the first to adopt, followed by early adopters , then early majority adopters , followed by late majority adopters and finally laggards . The process of adoption in a population over time, as described by DOI, roughly follows a standard normal distribution: early majority adopters and late majority adopters are within one standard deviation of the mean; early adopters and laggards are within two standard deviations; and innovators are within three standard deviations of the mean. There are certain attributes of an innovation that determine the speed and extent of its diffusion. These attributes include: the relative advantage of the innovation over existing alternatives; its compatibility with the intended audience; its complexity , or ease of use; its trialability , or whether or not someone can try the innovation before deciding whether or not to adopt it; the observability or measurability of its results; its likely impact on social relations ; its reversibility ; its communicability , or how easily and clearly it can be understood; the time required to adopt the innovation; the level of risk or uncertainty associated with its adoption; the level of commitment required to use the innovation effectively; and the modifiability of the innovation over time.
Early adopters
“Those in the population who accept a new idea or practice soon after the innovators (but before the middle majority), and who tend to be opinion leaders for the middle majority.”
Ecological approaches/levels
Ecological approaches recognize the multiple levels of influence on and the varying nature of determinants of health. They view health behavior as both affected by and affecting the physical and social environment (reciprocal determinism). They move beyond a “victim blaming,” individual-level approach to health promotion, emphasizing the use of multiple strategies to impact determinants of health, partnerships between multiple sectors to enhance health promotion efforts, and targeting change at multiple levels of intervention. The levels of an ecological approach in health promotion include intrapersonal factors, interpersonal processes and primary groups, institutional factors, community factors, and public policy.
Empowerment
“A social action process that promotes participation of people, organizations and communities in gaining control over their lives in their community and larger society. With this perspective, empowerment is not characterized as achieving power to dominate others, but rather power to act with others to affect change.” 6 “In health promotion, empowerment is a process through which people gain greater control over decisions and actions affecting their health.”5
Environment/environmental factors
Factors that influence an individual’s behavior but are physically external to the individual. The environment/environmental factors are explicitly important in social ecological approaches to health education and health promotion, as well as in Social Cognitive Theory.
Ethics in health promotion and health promotion research
Ethical principles in health education and health promotion practice and research are similar to those outlined in the Belmont Report and earlier ethical codes and include principles of respect for persons, beneficence, and justice. In health promotion practice and research, these ethical principles call for informed consent and voluntary participation, a commitment to preserve participant privacy, equitable inclusion in programs and research, a protection of vulnerable populations, and careful efforts to maximize benefits and minimize risks for participants. A unified code of ethics for the health education profession was adopted in 1999, outlining each health educator’s responsibilities to the public, to the profession, to employers, in delivering health education, in conducting research and evaluation, and in professional preparation. The code of ethics is available at www.cnheo.org.
Evaluation
“The comparison of an object of interest against a standard of acceptability.” In health education and health promotion, evaluation is typically thought about in three distinct phases: formative, process and summative.
Evidence-based practice
“Program decisions or intervention selections made on the strength of data from the community concerning needs and data from previously tested interventions or programs concerning their effectiveness, sometimes using theory in the absence of data on the specific alignment of interventions and population needs.”
Feedback
Information provided to individuals based on their individual characteristics or based on comparisons with others. Major types of feedback, in the context of health communication and communication technology, include personal feedback, normative feedback, and ipsative (or iterative) feedback. Personal feedback “refers to the information that respondents obtain about the answers they have provided.” Normative feedback “refers to the information respondents obtain when comparing their responses with the responses of another group.” Ipsative feedback “refers to a comparison between a person’s most recent status and that found at previous assessments.”
Focus group
A focus group study is a carefully planned series of discussions designed to obtain perceptions on a defined area of interest in a permissive, nonthreatening environment.
Formative evaluation
“Any combination of measurements obtained and judgments made before or during the implementation of materials, methods, activities or programs to discover, predict, control, ensure, or improve the quality of performance or delivery.” This can include the combination of needs assessment, pilot testing, process evaluation, etc.
Formative research
“Assesses the nature of the problem, the needs of the target audience, and the implementation process to inform and improve program design. Formative research is conducted both prior to and during program development to adapt the program to audience needs. Common methods include literature reviews, reviews of existing programs, and surveys, interviews, and focus group discussions with members of the target audience.”
Gatekeeper
An individual who formally or informally controls aspects of a community and/or access to a priority population. Gatekeepers are typically very knowledgeable of a community and how it functions. In community health, gaining the cooperation of the community gatekeeper(s) can improve the feasibility, quality and acceptability of community interventions and programs.
Hardiness
A positive coping influence characterized by “high levels of perceived control, commitment to succeed, and a propensity to see stressful life events as challenging.” Challenging, in the context of hardiness, reflects an individual’s ability to view stressful situations and experiences as an opportunity for growth and development and not as a threat. Hardy individuals are less likely to experience illness as a result of stressful events.
Harm reduction
An intermediate approach to behavior change that emphasizes adopting a lower risk alternative to a high risk behavior when an individual is either unwilling or unable to stop the high risk behavior. Needle exchange programs that facilitate the use of sterile injection equipment in order to reduce the transmission of HIV among injection drug-users are an example of harm reduction.
Health belief model (HBM)
An individual-level, value-expectancy health behavior theory developed in the 1950s by social psychologists in the U.S. Public Health Service in efforts to explain why people did not seek preventive health and screening services. The theory was first used in relation to a free Tuberculosis screening program, but has since been applied to numerous health behaviors. The HMB maintains that an individual will engage in behavior to prevent, screen for or control disease or negative health outcomes if they 1) perceive themselves to be at risk for that disease; 2) believe that the disease has potentially serious consequences; 3) believe that a recommended (and available) behavior is effective in reducing their risk for or the consequences of the disease; and 4) believe that the perceived barriers or costs of engaging in that behavior are fewer than the perceived benefits. Internal or external cues to action can motivate a person to take action. Self-efficacy was added as a construct to the HBM in the late 1980s.
Health disparities
Differences in the incidence, prevalence, mortality, burden of diseases or other adverse health conditions that exist among specific groups within the general population. “A chain of events signified by a difference in: (1) environment, (2) access to, utilization of, and quality of care, (3) health status, or (4) a particular health outcome that deserves scrutiny.”
Health literacy
“The degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions.”
Health Insurance Portability and Accountability Act (HIPAA)
A statute passed in 1996 in efforts to improve the efficiency of healthcare delivery by mandating and standardizing the electronic exchange of health information and to provide Federal protections to preserve the privacy of protected, individually identifiable health information. Under HIPAA’s Privacy Rule, which has been effective since April, 2003, an individual has the right to see and correct his health records, to know how information from those health records is being used and shared, and to deny permission for those health records to be used for certain purposes. In many cases, an individual must provide written permission for certain individuals or groups to be able to received information from his personal health records, unless that information is needed to provide continuity of care or is required to be reported for public health surveillance purposes.
Health status
“A description and/or measurement of the health of an individual or population at a particular point in time against identifiable standards, usually by reference to health indicators.”
Impact evaluation
“The assessment of program effects on intermediate objectives including changes in predisposing, enabling, and reinforcing factors, behavioral and environmental changes, and possibly health and social outcomes.”
Information-motivation-behavior (IMB)
A general model that holds that information, motivation, and behavioral skills are the primary determinants of health-related behaviors. Individuals who are well informed, highly motivated, and who have the necessary behavioral skills are more likely to engage in a specific health-related behavior. The specific types of information, motivational strategies and behavioral skills necessary to lead to behavior change are expected to vary between subpopulations and between behaviors. Behaviorally relevant information is considered “a necessary but not a sufficient condition” for risk reduction behavior. In general even a well-informed and behaviorally skilled individual must be highly motivated in order to engage in a specific health-promoting behavior and to maintain it over time.
Institutionalization
Involves “permanently” incorporating program activities into the routines and structure of an organization or community in order to maximize the long-term benefits of your program and to ensure its sustainability following staffing changes, the termination of formal activities and/or grant funding, etc.
Intervention mapping
A program planning framework intended to facilitate the development of theory- and evidence-based health promotion programs. Following a thorough review of the literature and an appropriate needs assessment, the process of intervention mapping includes five steps: “1) creating matrices of proximal program objectives from performance objectives and determinants of behavior and environmental conditions; 2) selecting theory-based intervention methods and practical strategies; 3) designing and organizing programs; 4) specifying adoption and implementation plans; and 5) generating an evaluation plan.” In step one, a list of performance objectives are generated that define the desired behavioral and environmental outcomes of the program; personal (internal) and external determinants of the behavioral and environmental outcomes are specified; if determinants vary by sub-population, the target population is differentiated; and, finally, performance objectives and determinants are linked in a matrix format, often by level (i.e. individual vs. organizational) and by sub-population, if applicable. Each cell in the resulting matrices will contain either a learning objective (linking a performance objective with a personal determinant) or a change objective (linking a performance objective with an external determinant) that defines what individuals need to learn or what changes need to take place in the environment as a result of the program. In step 2, a list of theoretical intervention methods (i.e. community planning) and a list of possible strategies for delivering those methods (i.e. community forums or meetings) are developed, based on the identified proximal objectives. In step 3, the selected strategies are operationalized into deliverable program components and delivery mechanisms (i.e. channel selection), and program materials are developed and pre-tested. During step 4, a “linkage system” between program users and developers is created so that the program can be modified to meet the needs of the users; adoption and implementation performance objectives are developed; determinants of adoption and implementation are specified; and an implementation plan is developed. Finally, step 5 involves developing an evaluation model, including a plan for process evaluation.
Intervention message
A program-specific message delivered to an individual or group that is designed to increase awareness of a health problem, motivate behavior change, address perceived barriers to engaging in a health behavior, or something else related to the goals and objectives of the program. Theory-based and tailored intervention messages are typically the most effective.
