PA R K E R E T A L

Application of Health Promotion Theories and Models for Environmental Health

PARKER PAPER

• Main goal: • How can Health Promotion Theories be applied to reduce

exposure to environmental hazards?• Why is this paper unique?• HP Theories are rarely applied to environmental health

issues • Where: Detroit• What: Community Action Against Asthma (CAAA)

STUDY DESIGN

• 1) Exposure Assessment • 2) Intervention• Household level• Neighborhood/policy level

• Participants• 331 households of English/Spanish speaking children, 6-11 yrs• Detroit public schools (SW/E Districts)

• Screening• Questionnaire to find those households with children with persistent

asthma

INTERVENTION DESIGN

2 years

12 Visits by Community Environmental Specialists (CES)

Intensive Year 1Min 9 visits

Less Intensive Year 2Min 3 visits

ECOLOGICAL MODEL: A THEORY OF ACTION

• Introduced in Week 1• Health, behavior, & their

determinants are interrelated

• Response to: environmental barriers can make other HP programs fail to have long-term behavior change

• Target multiple levels (as resources allow) & make changes to the physical, legal, economic, social environment =>• Strong! Long-lasting!

BehaviorIndividual

&Environmental

Factors

Health

ECOLOGICAL MODEL: A THEORY OF ACTION

HOW THE ECOLOGICAL MODEL FRAMEWORK WAS USED

1. Assess Physical & Social Environment

2. Decide targets of change at each level

3. Develop intervention strategies for as many targets as possible

Individual &

EnvironmentalFactors

INTRAPERSONAL LEVEL: HBM

• HEALTH BELIEF MODEL (refresher)

INTRAPERSONAL LEVEL: HBMPERCEIVED THREAT & BENEFITS

• Perceived Threat: • Stress perceived susceptibility to asthma exacerbation

• Allergen type & child-specific allergen info• Reinforce asthma exacerbation if child exposed

• Stress perceived susceptibility to increased morbidity & mortality potential

• Perceived Benefits• “Explained link between exposure to indoor allergens and irritants and asthma

exacerbation” • “Explained how allergens and irritants could be reduced through cleaning behaviors

and by preventing the child from being exposed to tobacco smoke.”

• Do you think that these are interventions that effectively target the perceived benefits construct?

(I’m not sure they do…)

Individual &

EnvironmentalFactors

INTRAPERSONAL LEVEL: HBMBARRIERS AND CUES TO ACTION

Individual &

EnvironmentalFactors

• Perceived Barriers• Identify & strategize

• Competing life demands => agencies that could help

• Equip with resources• Cleaning supplies, mattress covers,

vacuums• Cues to Action

• Shared data from initial data collection• Walkthrough results- visible cockroaches? Visible mold? Dust sample

findings• Recommendations from physician about which triggers to focus on • Discussion Question:

• Book says “events, symptoms, reminders”

• Caregiver confidence of success (in very specific behavior? Not really specified)

• How was it addressed?• Remember, caregiver decidedwhich triggers to target from discussing

with CES• Set small action goals caregivers could meet between visits (6-8

weeks)• Verbal encouragement and support from CES to reinforce

Individual &

EnvironmentalFactors

INTRAPERSONAL LEVEL: HBMSELF-EFFICACY

SOCIAL COGNITIVE THEORY: REFRESHER

Individual &

EnvironmentalFactors

Behavior

Environment

Personal factors

Major determinants:• Environment• Outcome expectations• Self-efficacy• Behavioral capability• Methods for

behavioral change• (…where is goal

formation?)

• Knowledge and Skills• Share knowledge and skills needed to perform behavior like cleaning

• Self-efficacy • intervention same as described for HBM previously• Set small goals & reinforce behavioral change with verbal encouragement &

support

• Methods of Learning (specifically observational)• Model all desired actions (vacuuming, dusting, etc) + reinforcements

• Environment• “Project planners took into consideration the SCT’s definition of

environment”• Understand that caregivers might not be able to alter their environment if they

rent their homes => add in tenant-advocate organization

• Where are outcome expectations and expectancies?

Individual &

EnvironmentalFactors

INTRAPERSONAL LEVEL: SCT

• Social Support• Emotional• Instrumental: tangible aid/services• Informational: advice, suggestions, info• Appraisal: feedback

• How did they address it?

Individual &

EnvironmentalFactors

SOCIAL SUPPORT

CES (Community environmental specialist)

Informational Give info

Emotional Care, empathy

Instrumental Cleaning supplies, bed covers

Appraisal Constructive feedback

• Increase caregiver’s coping resources• Matched to community resources • Ex: Persons with mental health needs to mental health services

• Resources in the community• Increase neighborhood and community support for families with

children with asthma• Reduce environmental triggers on community level

Individual &

EnvironmentalFactors

SOCIAL NETWORKS