Transcript models - Cengage Learning

Chapter 15
Designing Community
Nutrition Interventions
© 2006 Thomson-Wadsworth
Learning Objectives
• Describe five factors to consider
when designing a community
nutrition intervention.
• Describe three levels of
intervention.
• Discuss five theories and models of
consumer health behavior.
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Introduction
• There are two important aspects of
designing interventions:
– You must have information about
your target population and why they
do what they do in terms of behavior.
– You need an arsenal of tools for
influencing behavior.
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Choose an Intervention
Strategy
• The first step in designing an
intervention is to review the
program’s goals and objectives,
which specify the program
outcomes.
• Next you need to design a rough
outline of what the intervention
might look like.
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Choose an Intervention
Strategy
• The intervention strategy is the
approach for achieving the
program’s goals and objectives.
• It addresses the question of how
the program will be implemented
to meet the target population’s
nutritional needs.
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Choose an Intervention
Strategy
• The intervention strategy can be
directed towards:
– Individuals
– Communities
– Systems
• The intervention strategy can also
encompass one or more levels of
intervention:
– Level I
– Level II
– Level III
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Choose an Intervention
Strategy
• Level I: building awareness
– These focus on increasing awareness of a
problem.
– They are helpful for changing attitudes and
beliefs and increasing knowledge of risk
factors but they seldom result in actual
behavior changes.
– Examples include health fairs, screenings,
Internet web sites, and newsletters.
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Choose an Intervention
Strategy
• Level II: changing lifestyles
– These are designed to help individuals make
lifestyle changes.
– They can be successful when they call for
small changes over time and when they use
a combination of education and behavior
modification.
– Level II interventions reach individuals
through one-on-one counseling and small
group meetings.
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Choose an Intervention
Strategy
• Level II (continued)
– They involve a program of assessing current
behaviors, setting goals for behavior
change, developing skills needed to change
behavior, providing support for change, and
evaluating progress.
– Examples include fitness programs in
schools and health promotion programs for
city employees.
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Choose an Intervention
Strategy
• Level III: creating supporting
environments for change
– These work toward creating environments
that support the behavior changes made by
individuals.
– They include worksite health promotion and
cafeteria programs.
– Supportive environments can be created
through policies that support gleaning,
point-of-purchase labeling, and tax
incentives for companies with health
promotion programs.
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Study the Target Population
• When designing an intervention, study
the target population’s eating patterns
and their beliefs, values, and attitudes
about foods and health.
• Conduct library research, review
existing programs that deal with the
target population, network with
colleagues who work with the group,
and post queries about the target
population on Internet listservs.
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Study the Target Population
• The target population’s foodrelated behavior is important.
• Many factors influence food intake
and nutritional status...
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Study the Target Population
• Food Supply and Food Availability
– Food choices are influenced by the
types and amounts of foods available
in the food supply.
– Food availability is affected by the
food distribution system, types of
imported foods, facilities for food
processing and production, and the
regulatory environment.
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Study the Target Population
• Income and Food Prices
– Two economic factors that affect food
consumption.
– Households with higher incomes have
more money to spend on food and
choose whatever foods they want,
regardless of price.
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Study the Target Population
• Sociocultural Factors
– Food choices are strongly influenced by
social groups, and primary social groups
include families, friends, and work groups
with the family exerting the most influence.
– Culture influences food behaviors and even
dictates how foods are stored, processed,
consumed, disposed of, and even which
foods are considered edible.
– Religious beliefs affect food choices, and
some religions specify the foods that may
be eaten and how they should be prepared.
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Study the Target Population
• Food Preferences, Cognitions, and
Attitudes
– Preferences for certain tastes and
foods appear to develop quite early in
humans.
– Food choices are affected by our
cognitions, or what we think.
– Attitudes are believed to influence
behavior indirectly.
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Study the Target Population
• Health Beliefs and Practices
– Beliefs about foods, diet, and health
influence food choices.
– Example: traditional Chinese beliefs
of yin and yang
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Draw from Current Research
on Consumer Behavior
• Many theories have been proposed
to explain the decision-making
process as it relates to health.
• Theories are sometimes presented
in the form of models - simple
images of the decision-making
process.
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Draw from Current Research
on Consumer Behavior
• Theories include:
– Stages of Change Model
– Health Belief Model
– Theory of Planned Behavior
– Social Cognitive Theory
– Diffusion of Innovation Model
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The Stages of Change Model
• Founded on 3 assumptions:
– Behavior change involves a series of
different steps or stages.
– There are common stages and processes of
change across a variety of health behaviors:
– Tailoring an intervention to the stage of
change in which people are at the moment
is more effective than not considering the
stage people are in.
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© 2006 Thomson-Wadsworth
The Stages of Change Model
• Common stages:
– Precontemplation - the individual is either
unaware of or not interested in making a
change.
– Contemplation - the person is thinking
about making a change, usually within the
next six months.
– Preparation - the person actively decides
to change and plans a change, usually
within one month.
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The Stages of Change Model
• Common stages (continued):
– Action - the individual is trying to make the
desired change and has been working at
making the change for less than six
months.
– Maintenance - the individual sustains the
change for six months or longer and the
changed behavior has become a part of his
or her daily routine.
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The Stages of Change Model
• The model resembles a spiral, with
people moving around the spiral until
they eventually achieve maintenance
and termination.
• People in the contemplation stage are
seeking information...
• ...whereas people in the maintenance
stage are likely to be looking for
information and searching for ways to
strengthen the behavior.
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The Stages of Change Model
• The Application—Individual
– The Smithfield Fitness Club (members
in various stages)
• The Application—Communities
– City of Scottsville (in
precontemplation stage)
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The Health Belief Model
• Developed to explain why people failed
to participate in programs designed to
detect or prevent disease.
• The model has three components:
– The perception of a threat to health.
– The expectation of certain outcomes related
to a behavior.
– Self-efficacy - the belief that one can
make a behavior change.
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The Health Belief Model
• Other variables, such as education,
income, sex, age, and ethnic
background influence health
behaviors in this model, but they
are believed to act indirectly.
• The Application
– American Cancer Society’s public
awareness campaign
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The Theory of Planned
Behavior
• a.k.a. the Theory of Reasoned Action
• A fundamental model for explaining
virtually any health behavior over which
the individual has control.
• Behavior is determined directly by a
person’s intention to perform the
behavior.
– Intentions - the instructions people give to
themselves to behave in certain ways.
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The Theory of Planned
Behavior
• In forming intentions, people consider
the outcome of their behavior and the
opinion of significant others before
committing themselves to a particular
action.
– In other words, intentions are influenced by
attitudes and subjective norms, or
perceived social pressure to perform or not
perform a behavior.
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The Theory of Planned
Behavior
• Attitudes are determined by:
– The individual’s belief that a certain
behavior will have a given outcome.
– An evaluation of the actual outcome of the
behavior.
– A perception of his or her ability to control
the behavior.
• The Application
– Fairlawn Weight Management Center’s “Get
Fit Now” program
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Social Cognitive Theory
• Explains behavior in terms of a
model in which behavior, personal
factors such as cognitions, and the
environment interact constantly,
such that a change in one area has
implications for the others.
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Social Cognitive Theory
• The environment includes:
– The social real (family, friends,
peers, coworkers)
– The physical real (the workplace,
layout of a kitchen, etc.)
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Social Cognitive Theory
• Strength of this model = it focuses
on certain target behaviors rather
than on knowledge and attitudes.
• The Application
– Peer counseling course to reduce pica
among WIC participants
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Eat Healthy: Your Kids Are
Watching
• Michigan Nutrition Support Network
– A public–private partnership to improve the
nutritional health of Michigan’s low-income
families.
• “Eat Healthy, Your Kids Are Watching”
– Focus group–tested message designed to
prompt awareness in parents that they are
role models for their children.
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Eat Healthy: Your Kids Are
Watching
• Goals and Objectives
– Primary goal - improve the nutritional
health of Kent County’s low-income families
through collaborative efforts among
partners.
– Objectives:
• Develop and implement “awareness-building”
activities promoting healthful eating to the target
audience and to the public in general
• Construct a public–private partnership with
businesses and agencies to assist with specific
programs for the campaign.
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Eat Healthy: Your Kids Are
Watching
• Methodology
– Potential partners were located
– Awareness-building activities:
•
•
•
•
30-second cable spots
Campaign newsletters in English and Spanish
Signs on and in transit buses
Logo and slogan program with grocery stores and
school districts
• Toll-free telephone number with messages in
English and Spanish
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Eat Healthy: Your Kids Are
Watching
• Methodology (continued)
– Partnership programming:
• Information on grocery store tours
• Cooking demonstrations
• WIC module for nutrition education
– Partner kit included an events
schedule, lesson plans, activity
sheets, and recipes
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Eat Healthy: Your Kids Are
Watching
• Results
– Reached an estimated 49,000
residents, including close to 7,000
low-income households
– Random sample of 800 adults in
households with children surveyed
– Campaign awareness was 52%
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Eat Healthy: Your Kids Are
Watching
• Results (continued)
– 67% in low-income households
– 2/3 indicated that they understood
and agreed with the message when
they heard it
– 20% indicated that they would adopt
the message
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Eat Healthy: Your Kids Are
Watching
• Lessons Learned
– An enthusiastic collaboration among
businesses, community agencies, and
community leaders was the key to
the success of this venture.
– Partnerships forged between public
and private organizations can grow
strong as a result of working together
on such campaigns.
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The Diffusion of Innovation
Model
• Developed to explain how a
product or idea becomes accepted
by a majority of consumers.
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The Diffusion of Innovation
Model
• It consists of four stages:
– Knowledge - the individual is aware
of the innovation and has acquired
some information about it.
– Persuasion - the person forms an
attitude either in favor of or against
the innovation.
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The Diffusion of Innovation
Model
• Four stages (continued):
– Decision - the individual performs
activities that lead to either adopting
or rejecting the innovation.
– Confirmation - the individual looks
for reinforcement for his or her
decision and may change if exposed
to counter-reinforcing messages.
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The Diffusion of Innovation
Model
• Consumers are classified according to
how readily they adopt new ideas or
products:
– Innovators - adopt the innovation quite
readily and perceive themselves as popular
and financially privileged.
– Early adopters - the next to adopt; include
opinion leaders, are integrated into the
community and are well respected by their
families and peers.
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The Diffusion of Innovation
Model
• Consumer classifications (continued):
– Early majority - tend to be cautious.
– Late majority - skeptical; usually adopt an
innovation only through peer pressure.
– Laggards - the last to adopt; tend to come
from small families, to be single and older,
and to be traditional.
• The Application
– Seeking early adopters for the “HeartHealthy Living” program
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Put It All Together: Case
Study 1
• Defining levels of intervention for
target groups
• Formative evaluation and literature
review
• Influence of theories of consumer
behavior on health promotion
activities
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Use Entrepreneurship to
Steer in a New Direction
• One of the major challenges for
community nutritionists is to think of
new ways of delivering health messages
and services to vulnerable populations.
• We need a better understanding of the
community factors that influence
change and the reasons why consumers
resist change.
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Use Entrepreneurship to
Steer in a New Direction
• When you plan community
interventions:
– Think of new ways to reach your
target audience.
– Plan strategies for finding out why
your clients are resisting a behavior
change.
– Apply your creativity to influencing
people to achieve behavior change.
© 2006 Thomson-Wadsworth
Being an Effective Speaker
• Things to Do Before Your
Presentation
– First, tell your audience what you are
going to tell them...
– then tell them what you have to tell
them...
– and finally, tell them what you told
them!
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Being an Effective Speaker
• Before Your Presentation (continued)
– Prepare your visual aids so that they
present your ideas effectively.
•
•
•
•
•
•
•
•
Clear purpose
Readily understood
Simple format
Free of nonessential information
Graphical format
Visible
Legible
Integrated with verbal text
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Being an Effective Speaker
• Before Your Presentation (cont.)
– Rehearse your presentation several
times.
– Use mental imaging to boost your
self-confidence.
• Mental imaging - a technique to
develop and strengthen a positive mental
picture of the performance.
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Being an Effective Speaker
• Things to Do During Your
Presentation
– Smile
– Use eye contact
– Use gestures
– Control the pace
– Use pauses
– Vary the volume and pitch
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Being an Effective Speaker
• Remember that the purpose of
your presentation is to share
information with your audience.
• You will want to develop your own
style.
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