Models & Theories of Health Promotion in Models & Theories of Health Promotion in Multicultural PopulationsMulticultural Populations

Dr. Jim FrankishDr. Jim FrankishSenior Scholar, Michael Smith Foundation for Health ResearchSenior Scholar, Michael Smith Foundation for Health Research

Partners in Community Heath

Research-Training Program

Current & Recent ProjectsCurrent & Recent Projects• Research Training Program in Community Partnership Research• BC Homelessness & Health Research Network Project• Evaluation of Homeless Individuals & Families Information System• Service Utilization for Homeless Persons with Mental Illness• Social Construction of Homelessness - Whose Fault? What Solutions?• Measurement of Health Literacy• Health Promotion in Primary Care Project• "Health 101" Course• Report Card on Impacts of 2010 Games on Health & Quality of Life• Measuring Community Capacity & Measures of Community Health• Evaluation of the "Cooking Fun for Families" Program• Health Regions and Non‑Medical Determinants of Health• Adolescents’ Concept of Depression and Help-Seeking• Ethics Guidelines for Community-Based Research • National Health Literacy Survey• Evaluation of National Literacy and Health Program• QUEST - Georgia Basins Future Project• Mid‑Life Health Interventions for Healthy Aging

Current Student ProjectsCurrent Student Projects• Primary health care reform and disadvantaged

populations• Health education in women with Aids in Latin America• Mental health promotion and early psychosis• Multicultural nutritional health literacy• Criteria for health resource allocations to "special

interest" groups• Pediatric HIV education• Adolescent depression• Early child development and health• IV drug use and street kids• Living well with chronic illness• Poverty and nutrition in inner-city schools• Child injury prevention in low-income parents• Social capital and health in resource communities• Poverty and nutrition - cultural variations

Source Publication

• 2007. Frankish J, Lovato C, Poureslami, I. Models, Theories and Principles of Health Promotion in Multicultural Populations in R. Huff & M. Kline, Editors, Promoting Health in Multicultural Populations, Second Edition, Sage.

• "By telling us about the what, how, when, and why, theories can inform programs in health education....The what tells us the elements we should consider as the targets for the intervention....The why tells us about the processes by which changes occur in the target variables. The when tells us about the timing and sequencing of our interventions in order to achieve maximum effects. The how tells us the methods or ways we should focus our interventions; it includes the specific means of inducing changes in the explanatory variables (Glanz, Lewis & Rimer, 1990).

Basic Approach

• Rationale for Using a Theoretical Framework

• Distinguishing Theories, Models and Frameworks

• Values and Theories

Links Between Theory & Applied Models of Health & Illness

theory

Positivism Post-positivism

Biopsychosocial ModelBiomedical Model

Population Health

Disease Ecology

Human Ecology

Ecosystem Health

Introduction to Theory

– Positivism:• The “scientific method”• Quantitative – data driven• Top down• Scientific reductionism• Quest for causes and universal laws

– Post-positivism or Humanism• Holistic, interdependencies complexity of systems and

interactions between systems• Qualitative, constructivist• Quest is for understanding

More comparisons of positivism/ humanism or post-positivist

POSITIVISM:Considers aggregate data, large-scale

projectsPreserves status quoTop down Minimizes importance of dynamic

determinants

• Theories built up by reproducing studies, facts and truth

EXAMPLES: AIDS/HIV in New York spread along

commuter linesSpatial patterning of diseases

POST-POSITIVISM/humanism:• Recognizes importance of individual

experience• Gives rise to individual level studies• Doesn’t strip context• Considers issues of participation,

equity, community, justice

• “Sonnets no matter how eloquent do not stop viruses, do not help us look ahead”

• Emphasizes individuality and subjectivity

• Theories are built up through learning

EXAMPLES:Anthropological and ethnographic studies:

men living with HIV, women living with MS

A Lexicon for Health Promotion• Concepts: the 'idea' of community capacity

• Constructs: the operational definition or characteristics of community capacity

• Theories/Models: Hypothesized relations between important constructs

• Measures/Indicators: Data on important constructs

• Strategies: Means of acting to change important relations between constructs in the model or theory

• Standards: definitions of success for each aspect of community capacity

Theory/Model Originators Level of Change Basic Concept

Health Belief Model Godfrey Hochbaum, Stephen Kegels, Irwin Rosenstock1952

Individual Predicts health-related behaviour in terms of certain patterns of beliefs. The model is used to explain and predict preventative health behaviour, sick role and illness behaviour.

Transtheoretical Model(Stages of Change)

James Prochaska, Carol DiClemente1979

Individual Processes of change that need to occur to produce a change in behaviour.

Social Cognitive Theory Albert Bandura1986

Interpersonal Behaviour as a product of reciprocal interaction of personal factors, behaviour and the environment. Looks at role of cognitions in pathway.

Theory of Planned Behaviour/Reasoned Action

Icek Ajzen, Martin Fishbein, 1967-1970 Interpersonal Relationship between an individual’s attitudes and behaviour. Predicts motivational influences on behaviour.

Diffusion of Innovations, Communication Theory, Organizational Change

Various researchers Community Looks at process of social and organizational change. How behaviours are adopted at community, organizational and social levels.

Ecological Models Ecological Psychology, Kurt Lewin, 1936Social Ecological Approach, Rudolph Moos, 1970s, Stokols, 1992

Environmental Looks at behaviour in relation to the environment (interpersonal, organizational and community levels)

(Source: Adapted from materials from University of South Florida, Community & Family Health, 1999)

Four Prevalent Models for Health Education

• Social Learning Theory (Reference Group‑Based Social Influence Theory)

• Health Belief Model

• Theory of Reasoned Action/Theory of Planned Behavior

• Transtheoretical (Stages of Change) Model

More Ecological Models

• Precede-Proceed

• Social Ecology

• PEN-3 Model

• Community Participation

Additional Models

• Aids Risk Reduction Model• Coping Theory• Cognitive‑Behavioral Theory• Communication Theory• Diffusion of Innovation• Expectancy‑Value Theory• Information-Motivation Model• Learned Helplessness Theory• Precaution Adoption Model• Social Marketing Theory• Social Support Theory

Contact InformationContact Information

• Dr. Jim Frankish, Senior Scholar, Michael Smith FoundationInstitute of Health Promotion ResearchRm 425, Library Processing Centre2206 East Mall Vancouver BC V6T 1Z3604-822-9205, 822-9210, frankish@interchange.ubc.caPersonal Website: jimfrankish.comBC Homelessness & Health Research – Network bchhrn.ihpr.ubc.caBC Homelessness Virtual Library - www.hvl.ihpr.ubc.caPartners in Community Health Research www.pchr.net