Goals

Introduce new project at PSHMC Discuss ethnography and field site

projects Review and discuss assignment 3

Community garden at PSHMC

CHNA Study Area

– Significant socio-economic barriers

– Lowest level of socio-economic barriers

http://www.ers.usda.gov/data-products/food-desert-locator/go-to-the-locator.aspx

USDA Food Desert Locator

How do we work with community organizations to improve access to healthy foods and education/information?

Prevention Produce

Prevention Produce

“Prescription produce”

“Farm Fresh” menu

Ethnography

An empirical research method for learning about cultural phenomena and discovering the nature of peoples

Physical geography and climate

Learning the culture of the group under study before deriving explanations of their attitudes/behavior

Ethnographic data collection

Historical research Active field notes Participant observation Interviews Questionnaires Geography/topography

Medical anthropology

Medical anthropology and health interventions

Application of medical anthropology to field experience

Build a rich history of your site Develop relationships & trust Identify key informants Take rigorous notes & cross-check

with informants› Quote your informants

Understand your biases and assumptions

Keep an open mind

Assignment 3

Final assignment

Value of ethnography at your field site

Give voice to an underserved population Contextualize your observations Identify themes and patterns that can inform

effective intervention strategies Determine variables for future research and

develop a testable hypothesis Propose more culturally-sensitive plans for

project implementation Identify key questions about existing

programs and policies

Final thoughts…

You are not a consultant, you are a learner

We are not expecting you to ‘save’ the organization or its clients

Think long-term about your involvement with the organization

There will be many opportunities for leadership/action in medical school

Questions or concerns? dgeorge1@hmc.psu.eduC1747 – Diversity Office

Healthy People 2020http://www.healthypeople.gov/2020/default.aspx

Goals:› Eliminate preventable disease, disability, injury,

and premature death› Achieve health equity, eliminate disparities, and

improve the health of all groups› Create social and physical environments that

promote good health for all. Goals (cont.)

› Promote healthy development and healthy behaviors across every stage of life.

Objectives› 37 focus areas

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Planning Models Models serve as frames from which to

build; Provide structure & organization for the planning process

Many different models, common elements, but different labels.

A Generalized Model for Program Planning

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Needs Assessment –Part IAssignment #3

Biology/ Genetics Behaviors Social

Environment Physical

Environment Policies and

Interventions Access to

Quality Health Care/ Services

Health Problem: Statement of Problem

Assessments• Social• Environmental• Behavioral

What are the behaviors that impact health problem?

• Risk and Protective Factors Associated with/Influence Behaviors

Summary (III)• Justify need for an

intervention/program• Identify possible solutions

(interventions) to health problem

Next Paper: The Program/Intervention

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The way it is…

DescribeI

Analyzingtargetedbehavior

II IIIIII

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Introduction and Statement of the Problem: A brief summarization of the health problem that you have chosen to address based upon one or two HP 2020 goals.

Example: Obesity

Talk briefly about epidemiological data available to justify the health problem in your specific target population (or geographical region). Please describe the incidence/prevalence among different groups (i.e. race/ethnics, ages, etc.) to emphasize the significance of the problem among the target group.

Obesity – What is the definition? To what degree does obesity impact your target population?

What is the incidence/prevalence rate of Obesity nationwide?What is the incidence/prevalence rate of Obesity locally?What is the incidence/prevalence rate of Obesity among your target population?

?

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Social Assessments: A description of the geographic, age, social, educational, racial, economic, crime, etc., characteristics of your target population. Who?

1. Who is the target population? – Describe demographic characteristics including socio-economic indicators and other relevant information. 2. Where does this population live? – Describe the city, town, school, neighborhood, etc.3. What are the social implication (quality of life) resulting from the health problem? – Describe any juvenile offense, school disciplinary incidences, crime, discrimination, unemployment, welfare, etc.4. What are the existing resources that may be useful for your program? – Describe any community, organizations and/or school resources and assets that can be used to solve the problem.

Environmental? Policy? Access to Care?

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Environmental Influences Radiation Exposure Workplace Hazards Home Hazards Contaminants Media Political Systems Migration Global Warming Recreational space

Infectious Agents Auto/Road Design Speed Limits Medical Care Access Product Design (e.g., handgun) Noise War/Civil Conflict Deforestation Adequate Surveillance Systems

Social InfluencesIncome + Occupation + Education = SES Geography Age Race Education Crime Income Unemployment Roles

Discrimination Residence Literacy Isolation Family Composition Faith/Spirituality Culture Gender

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Policy/Access Influences

Access to care Quality of care Access to interventions Representativeness in

policy development Equity and justice

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Behavioral Assessment: A description and analysis of behavioral factors that put your population at risk for the health problem. Rank the causal strength (i.e. relative risk) and changeability of each factors based on your target group.

What are the behaviors associated with the health problem, Obesity, present in your target population

Are we talking about high fat food intake?Are we talking about inactivity?Are we talking about low levels of fruit and vegetable intake?

To what degree are these behaviors present among your group? – You need to get national/state/local data and infer the incidence/prevalence rate (percentage) to your population.

Which behavioral factors are most important in addressing your health problem? – You should be able to justify the importance of each behavior and the likelihood for change.

High fat food intake? 3Inactivity? 1Low levels of fruit and vegetable intake? 2

Hi! I’m the Literature!

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Assessment of Risk and Protective Factors (Educational and Organizational Assessment): An analysis of the determining (predisposing, enabling and reinforcing) factors that influence the chosen behavior(s) and obesity. Rank each factor based on its importance and your ability to change it.

Inactivity

What are the Factors that impact this behavior? Rank each factor…

What are the risk and protective factors associated with the Inactivity and Obesity identified in the previous sections? – Describe the positive and the negative factors.

Which predisposing, reinforcing, and enabling factors are most important in addressing your behaviors? – Describe each of these categories of factors separate and justify the importance and likelihood for change of each factor

1. PREDISPOSING FACTORS

2. REINFORCING FACTORS

3. ENABLING FACTORS

Behaviors and Factors

Behavior = What people do or don’t do Factors = influence behavior

An analysis of the determining (predisposing [facilitate or hinder person’s motivation to change, e.g., knowledge, attitudes, beliefs, etc.], enabling [barriers or vehicles created by society or system, e.g., access to hl, resources, rules,

etc.], and reinforcing [feedbacks & rewards by peers, relatives, employers, etc.]) factors that influence the chosen behavior and health problem.

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Predisposing Factors

Awareness and Knowledge Beliefs, Values, and Attitudes Perceptions of Susceptibility,

Seriousness, Benefits, & Cost Personal Histories Behavioral Intentions Existing Skills

Health Belief Model/Theory

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Enabling Factors Health Care Environment.

› Facilities, clinics, providers, etc.› Cost, distance, transportation, hours, etc.

Other Environmental Conditions.› Availability of fast food, cigarettes, billboard,

alcohol , sports, laws, etc. Skills – ability to perform task.

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Reinforcing Factors

Social Support Family and Peer Influences Advise/Feedback from Providers Benefits of the Treatment/Action Social and Economical Benefits Adverse Consequences

Theories & Models: Used to Understand Behavior

Theory - “a set of interrelated concepts, definitions, and propositions that present a systematic view of events or situations by specifying relations among variables in order to explain and predict the events of the situations” (Glanz, Lewis, & Rimer, 2002, p. 25)

Concept - primary elements of theories or building blocks of theory (Glanz et al., 2002)

Why use theories & models? “A theory based approach provides direction and

justification for program activities and serves as the basis for processes that are to be incorporated into an intervention/program (Cowdery et al., 1995, p. 248)

“Theories can provide answers to program developers’ questions regarding why people aren’t engaging in a desirable behavior of interest, how to go about changing their behaviors, and what factors to look at when evaluating a program’s focus” (van Ryn & Heaney, 1992, p. 326).

Health Belief Model/Theory

Perceived Susceptibility – is he/she vulnerable to health problem?

Perceived Seriousness – how serious is the the illness/problem?

Perceived Benefits – anticipated value of the recommended action.

Perceived Barriers – cost involved in taking a particular action.

Motivation/Cues to Action & Self-efficacy.

Transtheoretical Model/Theory

Stages of Changes› Precontemplation.› Contemplation.› Preparation.› Action.› Maintenance.› Termination. *Relapse

Decisional Balance – pros vs. cons.

Theory of Reasoned Action Attitudes – toward performing the behavior. Subjective Norm – influence of other people

(i.e., parents, friends). Intentions – probability of performing. Behavior – the actual action.