Survey
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
Chapter 15 Designing Community Nutrition Interventions © 2006 Thomson-Wadsworth Learning Objectives • Describe five factors to consider when designing a community nutrition intervention. • Describe three levels of intervention. • Discuss five theories and models of consumer health behavior. © 2006 Thomson-Wadsworth Introduction • There are two important aspects of designing interventions: – You must have information about your target population and why they do what they do in terms of behavior. – You need an arsenal of tools for influencing behavior. © 2006 Thomson-Wadsworth Choose an Intervention Strategy • The first step in designing an intervention is to review the program’s goals and objectives, which specify the program outcomes. • Next you need to design a rough outline of what the intervention might look like. © 2006 Thomson-Wadsworth Choose an Intervention Strategy • The intervention strategy is the approach for achieving the program’s goals and objectives. • It addresses the question of how the program will be implemented to meet the target population’s nutritional needs. © 2006 Thomson-Wadsworth Choose an Intervention Strategy • The intervention strategy can be directed towards: – Individuals – Communities – Systems • The intervention strategy can also encompass one or more levels of intervention: – Level I – Level II – Level III © 2006 Thomson-Wadsworth © 2006 Thomson-Wadsworth Choose an Intervention Strategy • Level I: building awareness – These focus on increasing awareness of a problem. – They are helpful for changing attitudes and beliefs and increasing knowledge of risk factors but they seldom result in actual behavior changes. – Examples include health fairs, screenings, Internet web sites, and newsletters. © 2006 Thomson-Wadsworth Choose an Intervention Strategy • Level II: changing lifestyles – These are designed to help individuals make lifestyle changes. – They can be successful when they call for small changes over time and when they use a combination of education and behavior modification. – Level II interventions reach individuals through one-on-one counseling and small group meetings. © 2006 Thomson-Wadsworth Choose an Intervention Strategy • Level II (continued) – They involve a program of assessing current behaviors, setting goals for behavior change, developing skills needed to change behavior, providing support for change, and evaluating progress. – Examples include fitness programs in schools and health promotion programs for city employees. © 2006 Thomson-Wadsworth Choose an Intervention Strategy • Level III: creating supporting environments for change – These work toward creating environments that support the behavior changes made by individuals. – They include worksite health promotion and cafeteria programs. – Supportive environments can be created through policies that support gleaning, point-of-purchase labeling, and tax incentives for companies with health promotion programs. © 2006 Thomson-Wadsworth Study the Target Population • When designing an intervention, study the target population’s eating patterns and their beliefs, values, and attitudes about foods and health. • Conduct library research, review existing programs that deal with the target population, network with colleagues who work with the group, and post queries about the target population on Internet listservs. © 2006 Thomson-Wadsworth Study the Target Population • The target population’s foodrelated behavior is important. • Many factors influence food intake and nutritional status... © 2006 Thomson-Wadsworth Study the Target Population • Food Supply and Food Availability – Food choices are influenced by the types and amounts of foods available in the food supply. – Food availability is affected by the food distribution system, types of imported foods, facilities for food processing and production, and the regulatory environment. © 2006 Thomson-Wadsworth Study the Target Population • Income and Food Prices – Two economic factors that affect food consumption. – Households with higher incomes have more money to spend on food and choose whatever foods they want, regardless of price. © 2006 Thomson-Wadsworth Study the Target Population • Sociocultural Factors – Food choices are strongly influenced by social groups, and primary social groups include families, friends, and work groups with the family exerting the most influence. – Culture influences food behaviors and even dictates how foods are stored, processed, consumed, disposed of, and even which foods are considered edible. – Religious beliefs affect food choices, and some religions specify the foods that may be eaten and how they should be prepared. © 2006 Thomson-Wadsworth Study the Target Population • Food Preferences, Cognitions, and Attitudes – Preferences for certain tastes and foods appear to develop quite early in humans. – Food choices are affected by our cognitions, or what we think. – Attitudes are believed to influence behavior indirectly. © 2006 Thomson-Wadsworth Study the Target Population • Health Beliefs and Practices – Beliefs about foods, diet, and health influence food choices. – Example: traditional Chinese beliefs of yin and yang © 2006 Thomson-Wadsworth Draw from Current Research on Consumer Behavior • Many theories have been proposed to explain the decision-making process as it relates to health. • Theories are sometimes presented in the form of models - simple images of the decision-making process. © 2006 Thomson-Wadsworth © 2006 Thomson-Wadsworth © 2006 Thomson-Wadsworth Draw from Current Research on Consumer Behavior • Theories include: – Stages of Change Model – Health Belief Model – Theory of Planned Behavior – Social Cognitive Theory – Diffusion of Innovation Model © 2006 Thomson-Wadsworth The Stages of Change Model • Founded on 3 assumptions: – Behavior change involves a series of different steps or stages. – There are common stages and processes of change across a variety of health behaviors: – Tailoring an intervention to the stage of change in which people are at the moment is more effective than not considering the stage people are in. © 2006 Thomson-Wadsworth © 2006 Thomson-Wadsworth The Stages of Change Model • Common stages: – Precontemplation - the individual is either unaware of or not interested in making a change. – Contemplation - the person is thinking about making a change, usually within the next six months. – Preparation - the person actively decides to change and plans a change, usually within one month. © 2006 Thomson-Wadsworth The Stages of Change Model • Common stages (continued): – Action - the individual is trying to make the desired change and has been working at making the change for less than six months. – Maintenance - the individual sustains the change for six months or longer and the changed behavior has become a part of his or her daily routine. © 2006 Thomson-Wadsworth The Stages of Change Model • The model resembles a spiral, with people moving around the spiral until they eventually achieve maintenance and termination. • People in the contemplation stage are seeking information... • ...whereas people in the maintenance stage are likely to be looking for information and searching for ways to strengthen the behavior. © 2006 Thomson-Wadsworth The Stages of Change Model • The Application—Individual – The Smithfield Fitness Club (members in various stages) • The Application—Communities – City of Scottsville (in precontemplation stage) © 2006 Thomson-Wadsworth The Health Belief Model • Developed to explain why people failed to participate in programs designed to detect or prevent disease. • The model has three components: – The perception of a threat to health. – The expectation of certain outcomes related to a behavior. – Self-efficacy - the belief that one can make a behavior change. © 2006 Thomson-Wadsworth The Health Belief Model • Other variables, such as education, income, sex, age, and ethnic background influence health behaviors in this model, but they are believed to act indirectly. • The Application – American Cancer Society’s public awareness campaign © 2006 Thomson-Wadsworth The Theory of Planned Behavior • a.k.a. the Theory of Reasoned Action • A fundamental model for explaining virtually any health behavior over which the individual has control. • Behavior is determined directly by a person’s intention to perform the behavior. – Intentions - the instructions people give to themselves to behave in certain ways. © 2006 Thomson-Wadsworth The Theory of Planned Behavior • In forming intentions, people consider the outcome of their behavior and the opinion of significant others before committing themselves to a particular action. – In other words, intentions are influenced by attitudes and subjective norms, or perceived social pressure to perform or not perform a behavior. © 2006 Thomson-Wadsworth The Theory of Planned Behavior • Attitudes are determined by: – The individual’s belief that a certain behavior will have a given outcome. – An evaluation of the actual outcome of the behavior. – A perception of his or her ability to control the behavior. • The Application – Fairlawn Weight Management Center’s “Get Fit Now” program © 2006 Thomson-Wadsworth Social Cognitive Theory • Explains behavior in terms of a model in which behavior, personal factors such as cognitions, and the environment interact constantly, such that a change in one area has implications for the others. © 2006 Thomson-Wadsworth Social Cognitive Theory • The environment includes: – The social real (family, friends, peers, coworkers) – The physical real (the workplace, layout of a kitchen, etc.) © 2006 Thomson-Wadsworth Social Cognitive Theory • Strength of this model = it focuses on certain target behaviors rather than on knowledge and attitudes. • The Application – Peer counseling course to reduce pica among WIC participants © 2006 Thomson-Wadsworth Eat Healthy: Your Kids Are Watching • Michigan Nutrition Support Network – A public–private partnership to improve the nutritional health of Michigan’s low-income families. • “Eat Healthy, Your Kids Are Watching” – Focus group–tested message designed to prompt awareness in parents that they are role models for their children. © 2006 Thomson-Wadsworth Eat Healthy: Your Kids Are Watching • Goals and Objectives – Primary goal - improve the nutritional health of Kent County’s low-income families through collaborative efforts among partners. – Objectives: • Develop and implement “awareness-building” activities promoting healthful eating to the target audience and to the public in general • Construct a public–private partnership with businesses and agencies to assist with specific programs for the campaign. © 2006 Thomson-Wadsworth Eat Healthy: Your Kids Are Watching • Methodology – Potential partners were located – Awareness-building activities: • • • • 30-second cable spots Campaign newsletters in English and Spanish Signs on and in transit buses Logo and slogan program with grocery stores and school districts • Toll-free telephone number with messages in English and Spanish © 2006 Thomson-Wadsworth Eat Healthy: Your Kids Are Watching • Methodology (continued) – Partnership programming: • Information on grocery store tours • Cooking demonstrations • WIC module for nutrition education – Partner kit included an events schedule, lesson plans, activity sheets, and recipes © 2006 Thomson-Wadsworth Eat Healthy: Your Kids Are Watching • Results – Reached an estimated 49,000 residents, including close to 7,000 low-income households – Random sample of 800 adults in households with children surveyed – Campaign awareness was 52% © 2006 Thomson-Wadsworth Eat Healthy: Your Kids Are Watching • Results (continued) – 67% in low-income households – 2/3 indicated that they understood and agreed with the message when they heard it – 20% indicated that they would adopt the message © 2006 Thomson-Wadsworth Eat Healthy: Your Kids Are Watching • Lessons Learned – An enthusiastic collaboration among businesses, community agencies, and community leaders was the key to the success of this venture. – Partnerships forged between public and private organizations can grow strong as a result of working together on such campaigns. © 2006 Thomson-Wadsworth The Diffusion of Innovation Model • Developed to explain how a product or idea becomes accepted by a majority of consumers. © 2006 Thomson-Wadsworth The Diffusion of Innovation Model • It consists of four stages: – Knowledge - the individual is aware of the innovation and has acquired some information about it. – Persuasion - the person forms an attitude either in favor of or against the innovation. © 2006 Thomson-Wadsworth The Diffusion of Innovation Model • Four stages (continued): – Decision - the individual performs activities that lead to either adopting or rejecting the innovation. – Confirmation - the individual looks for reinforcement for his or her decision and may change if exposed to counter-reinforcing messages. © 2006 Thomson-Wadsworth The Diffusion of Innovation Model • Consumers are classified according to how readily they adopt new ideas or products: – Innovators - adopt the innovation quite readily and perceive themselves as popular and financially privileged. – Early adopters - the next to adopt; include opinion leaders, are integrated into the community and are well respected by their families and peers. © 2006 Thomson-Wadsworth The Diffusion of Innovation Model • Consumer classifications (continued): – Early majority - tend to be cautious. – Late majority - skeptical; usually adopt an innovation only through peer pressure. – Laggards - the last to adopt; tend to come from small families, to be single and older, and to be traditional. • The Application – Seeking early adopters for the “HeartHealthy Living” program © 2006 Thomson-Wadsworth Put It All Together: Case Study 1 • Defining levels of intervention for target groups • Formative evaluation and literature review • Influence of theories of consumer behavior on health promotion activities © 2006 Thomson-Wadsworth © 2006 Thomson-Wadsworth Use Entrepreneurship to Steer in a New Direction • One of the major challenges for community nutritionists is to think of new ways of delivering health messages and services to vulnerable populations. • We need a better understanding of the community factors that influence change and the reasons why consumers resist change. © 2006 Thomson-Wadsworth Use Entrepreneurship to Steer in a New Direction • When you plan community interventions: – Think of new ways to reach your target audience. – Plan strategies for finding out why your clients are resisting a behavior change. – Apply your creativity to influencing people to achieve behavior change. © 2006 Thomson-Wadsworth Being an Effective Speaker • Things to Do Before Your Presentation – First, tell your audience what you are going to tell them... – then tell them what you have to tell them... – and finally, tell them what you told them! © 2006 Thomson-Wadsworth Being an Effective Speaker • Before Your Presentation (continued) – Prepare your visual aids so that they present your ideas effectively. • • • • • • • • Clear purpose Readily understood Simple format Free of nonessential information Graphical format Visible Legible Integrated with verbal text © 2006 Thomson-Wadsworth Being an Effective Speaker • Before Your Presentation (cont.) – Rehearse your presentation several times. – Use mental imaging to boost your self-confidence. • Mental imaging - a technique to develop and strengthen a positive mental picture of the performance. © 2006 Thomson-Wadsworth Being an Effective Speaker • Things to Do During Your Presentation – Smile – Use eye contact – Use gestures – Control the pace – Use pauses – Vary the volume and pitch © 2006 Thomson-Wadsworth Being an Effective Speaker • Remember that the purpose of your presentation is to share information with your audience. • You will want to develop your own style. © 2006 Thomson-Wadsworth