Multiple Influences on a Specific Health Behavior
Among a myriad of public health issues, STDs are an especially notorious problem in public health. Their significance is not only limited to their variety and high incidence but also to their sequelae and their rate of transmission among populations. The research article, “Global Estimates of Prevalence and Incidence of Four Curable Sexually Transmitted Infections in 2012 Based on Systematic Review and Global Reporting” concludes that, “…the global prevalence and incidence of urogenital chlamydia, gonorrhea, trichomoniasis, and syphilis in adult men and women aged 15 to 49 years remain high, with nearly one million new cases of curable STI acquired each day” (Newman-Temmerman et al., 2015). As with a lot of health issues we face, we can use the Socio-Ecological Model to develop a practical solution to reduce the effect of STDs in society.
The Socio-Ecological Model takes into consideration the individual, and their affiliations to people, organizations, and their community at large to be effective. There are five stages to this model – Individual, Interpersonal, Organizational, Community, and Public Policy.
The individual level is concerned with an individual’s knowledge and skills. Knowledge about a disease helps the individual understand more about it. It helps inform them about how susceptible they are to the disease, how serious the disease is, and the overall threat of the disease. Knowledge is not enough to change attitudes most of the time but, it helps a great deal by influencing key attitudes and decisions individuals make.
The interpersonal level has to do with a person’s relationships with other people – family, friends, and so on. At this level, the parents of the individual can have regular talks with their children about sex and go for health screening from time to time. Making condoms available for their kids might also be a good idea since they cannot control their kids’ every move.
The organizational level has the opportunity to reach more people in different sectors of the community. Organizations like schools, and workplaces can take it upon themselves to keep employees and students safe from STDs. Schools can do this by making condoms available at school clinics like University at Buffalo does. In addition to that, an organization can provide counselling and immunization services, coupled with effective insurance plans for workers. Making affiliates of organizations aware of these benefits is also very important.
In this model, a community refers to the culmination of the various organizations in an area. These organizations can pool resources and ideas together in order to improve community health. For example, a hospital agrees to have some of its nurses teach sex education in a nearby school. Organizations in an area could coordinate health events designed to educate and equip affiliates with knowledge and materials to help prevent the spread of STDs in the community. Just like Love Canal had a Homeowners Association, a coalition of organizations in a community have louder voices and more funds.
At the final level – Public Policy – the governing bodies are in charge of the prevention effort. They do this by establishing agencies and laws at every level of government to do research on the spread of STDs and figure out more effective ways of dealing with the problem. The government should set the laws and enforce those laws. This level of the Socio-ecological Model is important because it affects a larger portion of the population than the other levels. For example, a law that ensures that people are immunized before joining an organization or, a law that provides funding to the availability of condoms.
Interaction of The Different Levels of The Model
The Social Ecological Model is a framework put in place in order to understand the multifaceted levels within a society and how individuals and the environment interact within a social system. Different factors and determinants exist at all levels of health, making prevention, control, and intervention most effective when the model is addressed from all levels. Many designs of the model are made so that the different levels overlap, illustrating how one level of the model influences the next. According to the Centers for Disease Control and Prevention, in order to prevent certain risk factors, it is necessary to take action with multiple levels of the model at the same time (CDC, 2018). When approaching a potential problem, it has been proven that in order to best sustain prevention efforts, action should be taken at multiple levels of the model at the same time.
The World Health Organization added this piece from a global campaign addressing violence prevention and the Social Ecological Model:
The ecological framework treats the interaction between factors at the different levels with equal importance to the influence of factors within a single level. For example, longitudinal studies suggest that complications associated with pregnancy and delivery, perhaps because they lead to neurological damage and psychological or personality disorder, seem to predict violence in youth and young adulthood mainly when they occur in combination with other problems within the family, such as poor parenting practices. The ecological framework helps explain the result—violence later in life—as the interaction of an individual risk factor, the consequences of complications during birth, and a relationship risk factor, the experience of poor parenting (The World Health Organization, 2018).
This specific campaign shows how interaction between the different levels of the model is necessary in order to properly deal with complicated situations that often times have different circumstances and components that constitute them. There was a study done titled, “Factors Within Multiple Socio-Ecological Model Levels of Influence Affecting Older SNAP Participants’ Ability to Grocery Shop and Prepare Food,” which goes on to explain factors within multiple levels of the Social Ecological Model and how they were effective in explaining Supplemental Nutrition Assistance Program (SNAP), as well as the participants ability to grocery shop and prepare food as older adults. The study stated how multiple levels of influence were evident in explaining the older adult’s ability to grocery shop and prepare food such as physical and emotional well-being, self-reliance, finance, housing, family and friend interactions, social support, and food access. With all of these different factors being evident in this particular study, the study addresses how important it is to act upon multiple levels of the model in order to effectively influence the older SNAP participants.
The Social Ecological Model has proven, in many differing situations, that in order to get the best results out of people at risk, it is best to approach the situation while addressing all levels of the framework. Many situations can be complicated on different levels, making a multi-faceted approach the best way to conquer a problem at all different angles.
Methods of Behavioral Change
Health behaviors are determined by an individual’s relationships and the environment in which they live. These relationships and environments fall within one of the five levels of the Social Ecological Model. The various levels of the Social Ecological Model can be utilized, as part of intervention strategies, to manipulate health behaviors. Behavior change communication, social change communication, social mobilization, and advocacy are the strategies often used as behavior modification techniques.
At the individual level, only behavior change communication is used. Behavior change communication and social change communication are both used at the interpersonal level. At the community level, social change communication is utilized. Social mobilization is used at the organizational level, and at the policy/enabling environment level, advocacy is utilized. Various health behavior modification techniques are used due to the varying nature of the participant groups. The different intervention strategies have specific features, which are designed to target the specific participant groups.
Behavior Change Communication
Behavior change communication is an approach used alone at the individual level, and along with social change communication at the interpersonal level. This type of intervention works through interpersonal communication. This system can work via direct communication with another individual, but it can also work through mass campaigns, such as social media, which target many individuals at once. Participant groups involved in behavior change communication include individuals, families, and small groups. In order to form appropriate interventions, research of the population must be completed. Interventions are tailored to the exact population they wish to target. The population’s initial knowledge, attitudes, beliefs and behaviors must be understood in order to effectively intervene and promote behavior change to improve the health of the population. Behavior change communication works by raising awareness about the problem, increasing knowledge about the health benefits of the targeted health behavior change, promoting attitude changes in favor of the healthier behavior, reducing stigma surrounding the healthy behavior, creating demand for the health intervention, promoting services for the prevention and control of the health problem, and improving skills of self-efficacy for the individuals involved. Behavior change communication is an important approach, which is used at the individual and interpersonal levels of the Social Ecological Model.
Social Change Communication
Social change communication is used, in combination with behavior change communication, at the interpersonal level and, alone, at the community level. This type of approach encourages participation, and it uses such participation in order to target large scale behavior changes. Behaviors targeted by this approach include social norms and culture-specific practices. This type of intervention also utilizes social norms and cultural practices in order to strategically develop health interventions that the targeted population will be most receptive to. Interventions can include mass-media campaigns, social-media campaigns, or information communication technology strategies, which can act as catalysts for health behavior change. Once the population is aware of the health problems, the community can begin developing health interventions. The system of social change communication is built on the idea that an individual community has the ability to change unhealthy social norms, cultural practices, environmental favors, and policies on their own. The collective efficacy these populations gain from such social change communication can enable them to make additional health behavior changes in the future.
Social Mobilization is used at the organizational level. Individuals and entire communities use this approach in order to raise awareness of a health problem. Then, this approach is adopted to engage and motivate national and community leaders, public and private partners, and community organizations to make health changes. The catalyst of these health changes is the community. By using the social mobilization approach, they are empowered to make their own health changes. This also allows the community to help with the development of appropriate health interventions, implementation of such changes, and monitoring of the changes. In order to effectively develop behavior change interventions, interventions at other levels of the Social Ecological Model should also be used.
Advocacy is used at the policy/enabling environment level. This approach consists of well-thought out and organized efforts. These efforts are designed to convince individuals in leadership roles, such as policymakers, program planners, and community leaders, to make health changes at the policy level. According to UNICEF, “The purpose for advocacy is (1) to promote the development of new policies, change existing governmental or organizational laws, policies or rules, and/or ensure the adequate implementation of existing policies (2) to redefine public perceptions, social norms and procedures, (3) to support protocols that benefit specific populations affected by existing legislation, norms and procedures, and/or (4) to influence funding decisions for specific initiatives”.
Within the advocacy level, there are three different types of advocacy, which are called policy advocacy, community advocacy, and media advocacy. Policy advocacy encourages legislative, social, and infrastructural element changes via policy changes. Community advocacy encourages individuals within a community to demand policy changes within the environment in which they live. Media advocacy encourages the media to push policy makers towards changes, which make the environment healthier. All of these changes are achieved by motivating decision leaders to make policy level changes.
Interventions, at all levels of the Social Ecological Model, play an important role in health behavior change. Behavior change communication, social change communication, social mobilization, and advocacy all contribute to the change of health behaviors at one or more level of the Social Ecological Model; however, the most effective approach to changing health behavior is to target the Social Ecological Model at multiple levels simultaneously. Multilevel interventions are the most effective at promoting long-term behavior change, and if possible, multilevel interventions should be utilized when promoting health behavior change.