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HPM 525 Complete Study Guide 2025 latest
reventative behavior activity undertaken by an individual who perceives themselves to be health for the purpose of detecting illness illness behaviour an activity undertaken by an individual who perceives themselves to be ill to define the condition and to discover a suitable remedy sick-role behavior an activity undertaken by an individual who considers themselves to be ill of the purpose of getting well or managing illness What are the three types of prevention primary, secondary, tertiary mediator intervening variable that explains the relationship between the 2 moderator variable or factor that weakens or enhances the relationship between 2 variables Ecological Model multiple levels of systems influence health What are the level of ecological model interpersonal or individual interpersonal or sociocultural factors organizational or institutional factors community factors public policy factors What are the 5 principles of the ecological model
- there are multiple levels of influence on health behaviors
- environmental contexts are significant health determinators
- influences on behavior interact across levels
- ecological models should be behavior-specific
- multiple level interventions should be most effective in changing behaviors theory a system of constructs and propositions that collectively presents a logical, generalizable, systematic, and coherent explanation of why things happen What do health behavior theories explain explain or predict the events or situations and increases efficiency or odds of success What is the purpose of using social and behavioral theories? allows for better problem solving for different health problems ie) SDOH What are the components of theories? concepts, constructs, variables which are all factors What are the benefits of the ecological model
- examination of problems in physical and social contexts
- development of multilevel or broad interventions
- highlights the complexity of health determinants
- helps to set priorities What are the limitations or challenges of the ecological model
- multiple levels with unique factors at each level that interact with each other
- limited funding to implement interventions
- most powerful when behavior-specific (may not be helpful for all issues/not replicable) What are the two types of influences affecting the SDOH? upstream and downstream What are upstream influences on the SDOH? economic and social opportunities/resources, living and working conditions What are downstream influences on the SDOH? genetics, medical care, educational attainment, health literacy, physical environment What influence of focus has the largest impact on SDOH? Which influence has the biggest impact on the choice of behavior change theories to use?
describes the relationship between individuals and their environment influenced by personal attributes, physical and social environments/settings target of intervention factor trying to change at any level ecological model target population pop or group who will experience a change level of intervention who/what is delivering the intervention ultimate target individual people (in PH) proximate target factor most immediately changed by the intervention What are the initial steps taken when developing a health promotion program? community needs assessment, community engagement, and using planning models when developing program/interventions Needs assessment a community health assessment that identifies gaps between what is and what should be in terms of resources, health outcomes, and resources that either are missing or available in community to address health issues What must all hospitals perform every three years due to the ACA? CHNAs What are Community Health Needs Assessments considered? primary prevention What are the steps to conducting a community needs assessment?
- Identify a community
- Define the Problem
- Get input from community members What is a Community Health Improvement Plan? (CHIP)
Accompanies a needs assessment and is used to generation action areas where intervention activities can occur to tackle issues addressed in needs assessment Precede-Proceed Model 8 phase model that links needs assessment to program planning conceptualizing long term goals of intervention, factors targeted by intervention What are the 8 Phases of the Precede-Proceed Model?
- Social assessment
- Epidemiological assessment
- Education and ecological assessment
- Administrative and policy assessment
- Implementation
- Process eval
- Impact eval
- Outcome eval What is the purpose of social assessment in the precede-proceed model? to determine outcomes that the community finds important regardless of intended scope of intervention What is the purpose of the epidemiological assessment in precede-proceed model? to look for the issues that might cause/influence the phase one outcome, identify modifiable behavioral, environmental and health outcomes What examples of epidemiological assessment factors that may be targeted?
- behavioral/lifestyle factors (KAB)
- environmental (Physical and social)
- genetics
- economics What is the purpose of educational and ecological assessment in the precede-proceed model? identify factors that can help achieve change, and incorporate the information from existing literature to inform interventions What are the types of factors influenced by the educational and ecological assessment?
What are the modifying characteristics of the HBM age, gender, ethnicity, SES, personality and knowledge What are the two additional constructs in HBM cues to action and self efficacy self efficacy a person's confidence or belief in their ability to complete a task or take action What are the strengths of HBM? Weaknesses? strengths perceived barriers, self efficacy, usefulness in preventative and sick role behaviors weaknesses: assumes everyone has equal access to info, perceived severity, does not consider external influences. What are the four factors that influence self efficacy?
- mastery or personal experience _observation of others/social modeling
- physiological and emotional state
- verbal persuasion Theory of Reasoned Action value expectancy theory that recognizes upstream influences What determines behavioral intention in TRA? attitude toward the behavior and subjective norms What determines attitude in TRA? behavioral beliefs and eval of behavioral outcomes What determines subjective norms in TRA? normative beliefs, and motivation to comply Theory of Planned Behavior TRA plus the addition of perceived behavioral control What determines behavioral control in TPB? control belief and perceived power
Control belief perceived presence on absence of resources for impediments to behavioral performances perceived power perceived impact of each resource and impediment to facilitate or inhibit behavior What do attitudes, subjective norms, and perceived behavioral control influence? intention to perform behavior which influences actual behavior subjective norms characteristic of individuals social norms characteristics of the community or society How would TRA be implemented? identify most important behavioral outcomes and referents for each behavior, intervention then designed to change important beliefs or associated values Strengths and weaknesses of TRA Strengths: takes into account social context Weaknesses: usefulness depends on target population, and must understand behavioral controls Why focus on individual level? individual behaviors can lead to health problems and are thought to be more readily modified What is the usefulness of health behavior theories? to identify determinants of health related behavior and suggest mechanisms that influence behavior What are the essential characteristics of stage theories?
- small number of distinct stages
- temporal sequence
- similar barriers to progress in same stage
- different barrier between stages Transtheoretical Model (Prochaska & DiClemente, 1983)
weighing pros and cons What stage are the majority of people in? precontemplation and contemplation What stage should TTM interventions target? Individuals in preparation (15% of people) and best used in social work on individuals or niche groups Precaution Adoption Process Model (PAPM)
- Unaware
- Unengaged
- undecided
- decided not to act
- decided to act
- acting
- maintenance What should you do for interventions in the different stages if the PAPM 1)Provide info about risks
- Provide personalized info 3)Cost benefit info
- cost benefit info 5)provide reminders, how to info and access to social support
- provide reminders and assist in developing long range plan
- on going support services/access What is the difference between PAPM and TTM? PAPM detailed info not provided about stage transitions and focuses on mental states, TTM uses timeframes and has a lot of info about stage transitions Social Cognitive Theory (SCT) explains how observation allows for social learning which influences cognitive behavior What are the key constructs of SCT? self efficacy (efficacy expectations), reciprocal determinism, outcome expectation, behavioral capacity Reciprocal determinism
a persons behavior both influence an may be influenced by personal factors and the social environment outcome expectation a person's behavior both influence and may be influenced by personal factors and the social environment what is the process of SCT? efficacy expectations influence person which determines behaviors that lead to outcomes with outcome expectancies A strong sense of __________ increases the likelihood of behavior change. self efficacy What are methods for increasing self efficacy? mastery experience, social modeling , verbal persuasion, and psychological state. mastery experience maintaining success Common themes in HBM beliefs about behavior, perceived threats Common themes in TRA/TPB attitude towards behavior, subject norms and perceived control Common themes in SCT outcome expectation, self efficacy TTM & PAPM pros/cons of behavior and outcomes, consciousness raising, self eval, stimulus control and helping relationships What are interpersonal relationships important for...
- source of health-related info
- a reference point for perceived norms
- influences health of environment (social and physical)
social relationships that surround individuals social support the functions provided by social networks social influence/norms another function of social networks what are the types of social support emotional support tangible support info support belonging support tangible support provision of aid and services that directly aids a person in need info support info that can help someone help themselves- good for things we can't control belonging support sense of belonging, good for things we can't control benefits of social network/support for health social support leads to connection, esteem, and control for health behaviors stress preventions social support helps enhance coping resources and reduce exposure to negative life events and secondary stressors influenced by health behaviors stress buffering better stress coping and appraisal, social supports, and norms can buffer stressors and can influence health behaviors direct health effects of social support
- social support has a generally health-enhancing effect
- social norms can be either positive or negative for health
- instrumental support may lead to reduced self efficacy
- intention of social support must be positive to be helpful
- people's KAB regardless of science can influence health behavior What are two important factors to consider in social support perceived vs received support on relationship quality Social network theory (3 components)
- people take action based off of their network environment
- a person's position in network influence their behavior 3)networks have structures and these properties influence system performance How does a social network influence health behavior?
- acts as an information source and outlet
- source of social support
- influence in the social norms in terms of prevalence (descriptive norm) and acceptability of the behavior injunctive norm What is the two network process? influence: one tries to conform to the behavior consistent with their network partners selection: individual changes their network to be consistent with their current behavior or goal How does position in network influence health interventions, spread of disease, and behaviors?
- central individuals have more ties to others and thus are a good person to target to spread info in network
- bridging individual connects different networks
- peripheral individuals separate from social norms of network How can interventions leverage social networks?
- consider target health goals and determine which relationships individuals have to impact health of network
- train network members skills that support provision
- involve partners in behavior change programs
- train persons with illnesses to mobilize social networks
- develop new linkages in network
- identify natural helpers in community to expand reach of intervention What are new linkages that can be created in social networks?
behaviors, environment, psychosocial conditions Karasek's Demand-Control Model stress is greatest in jobs characterized by high psychological demands and low decision control which increases psychosocial symptoms effort reward imbalance theoretical model imbalance between the costs and the gains defines a state of emotional distress, ie effort should equal rewards, but imbalance causes distress What are the types of health policy? (With examples) economic incentives or disincentives (taxing cigs), deregulation, regulation of information(restrictions on marketing of tobacco products), indirect regulation (Tort law), and direct regulation (FDA drug approval process) economic incentives or disincentives policy: strengths and challenges Strength: provide economic relief for healthy behavior Challenge: inhibit personal freedom, regressive, blame victim especially when the behavior may be somethign that is out of their control Regulation of Info (strengths and challenges) strength: attempt to influence human behavior with info with the public health goal of providing an information environmental that promots health edu, restrtics negative health behaviors, and requires action for health challenge: gov't regulation vs freedom of expression, limitation of commercial speech direct regulation (strengths and challenges) gov't authority to regualte private interests to protect, preserve and promote the health and safety of the people strengths: set health safety standards, monitor compliance, and punish non compliance, clear pubilc benefit challenges: public good vs personal freedom, can have negative effects on individual market and unfair enforcement restrictions indirect regulation (strengths and challenges)
Strength: to make up for past and prevent future hazards to health while assigning risk and responsibilty to organization/individuals who pose risk, compensate for loss, deter hazardous conduct, promote inovation in risk management challenges: may not be direct enough to accomplish goal What is tort law? A body of rights, obligations, and remedies that is applied by courts in civil proceedings to provide relief for persons who have suffered harm from the wrongful acts of others. civil law as opposed to criminal law that seeks to remedy in terms of monetary changes Program evaluation Systematic investigation of a program in terms of its merit worth cost-effectiveness significance, and quality Evaluation plan A plan that contains research methods, responsibilities, timeline, and budget for evaluation processes What must evaluation questions be seeking to answer? Whether or not the goal or outcome of the program is achieved When should program evaluation be planned? Prior to program implementation What are essential inputs for program evaluation? Time, resources, personnel, and money. What are the types of program evaluation? Formative evaluation process evaluation, outcome, evaluation, and impact evaluation Formative evaluation Evaluation that is typically conducted prior to the full implementation of the program for example, a small pilot study to assess whether or not the program is feasible, appropriate or acceptable Process evaluation
Systematic visual way to represent and share your understanding of the project, indicating an understanding of the relationship between resources, planned activities, and the expect outcomes as a result of the program. Outcomes included should be both short term 1 to 3 years and long-term 4 to 6 years with the impact statement encompassing 7 to 10 years. What are the components of a logic model? Resources/inputs activities, outputs outcomes, impact, assumptions and context What are the two component categories of a logic model? Planned work (resources, and program activities) and intended results (outputs, outcomes, and impact) Logic model outcomes and impacts should be what type of goal SMART goal In a logic model, what is the part of the category that demonstrates if a program is successful? Outcomes What is a key feature of all steps of program evaluation planning? Asking questions about what methods are best Why is evaluation so important? Because it allows us to gain new knowledge it provides evidence of program effectiveness improves existing programs builds capacity, strengthens relationships, and helps secure funding for future programs Why is process evaluation so important? Because it allows for understanding of the success or lack there of when replicating programs What historically has influenced the design of public health policies Epidemiologic transitions What are the operationalized composite measures used to define socioeconomic status? Economic status, social status, and work status What are very influenced by socioeconomic status? Healthcare, environmental exposures and health behaviors What role does education level play in social economic status?
It influences life expectancy, social network, family income, children's health levels of social stress exposure, allostatic load, and general health outcomes What is allostatic load? A construct the arise to quantify stress induced biological risk protective social factors for SES? Social support, self-esteem, self efficacy What is the fundamental cause of persistent health and equity? Socioeconomic status, which influences access to flexible resources at the individual and contextual levels What four features of socioeconomic status impact health
- SES influences multiple disease outcomes
- it affects disease outcomes via multiple risk factors
- the influence of SES on health involves access to resources
- association between SES and health is reproduced overtime What health conditions does SES impact most? Resource dependent health conditions What are interventions for socioeconomic status? Reduce resource inequalities/inequities contextualize risk factors, prioritize interventions that do not entail use of resources, tackle racism What is health literacy? The degree to which individuals can obtain process understand and communicate about health related information needed to make informed health decisions. It is a combination of individual skills and demands/complexity of health info and systems. What are the types of literacy? Functional literacy, critical literacy, interactive literacy, and health numeracy Functional literacy Basic skills used for everyday life Critical literacy
