S

• Aparna Subramaniam

• Unnati Shah

• Vibha Amblihalli

17th November, 2014

INTRODUCTION

S Ecological models incorporate within them

constructs from models on psychological, social and

organizational levels along with community based

factors for a comprehensive framework to explain

health behavior.

S The crux of the ecological models is that it takes the

combination of individual level as well as policy level

interventions to bring about a sustained change in

health behavior.

CORE PRINCIPLES OF

ECOLOGICAL MODELS

S Multiple levels of factors influence health behaviors.

S Influences interact across levels

S Multi-level interventions should be most effective in

changing behavior.

S Ecological models are most powerful when they are

behavior specific.

Health Is Power: an Ecological

Theory-based Health

Intervention for Women of Color

S Rebecca E. Lee, Ph.D., Ashley V. Medina, B.S., Scherezade K. Mama,

M.P.H., Jacqueline Y. Reese-Smith, Ph.D., Daniel P. O’Connor, Ph.D.,

Marcella Brosnan, B.A., Catherine Cubbin, Ph.D., Tracy McMillan, Ph.D.

and Paul A. Estabrooks, Ph.D.

Contemporary Clinical Trials. November 2011 ; Vol 32, No 6; Pg: 916–923

BACKGROUND

S Women of color are most vulnerable to the detrimental effects of physical inactivity and poor dietary habits.

S Despite publicizing well the benefits of adopting physical activity and fruit and vegetable consumption, the rates of both remained low.

S Interventions that have focused on individual aspects have not shown lasting success and maintenance of the new health behavior has been difficult to achieve.

S This study describes the rationale, design and methodology of Health is Power (HIP), a transcultural, community based, randomized controlled trial.

AIMS OF THE STUDY

S To study the effectiveness of an intervention that targets both individual and environmental level influences to increase physical activity and improve dietary habits in African American and Hispanic/ Latina women in Houston and Austin.

S The purpose of this study is to describe the methods used in developing the Health is Power intervention, founded on the Ecological Model of Physical Activity (EMPA).

S This study proposed to integrate group dynamics, individual perceptions and social support to mediate the effect of intervention.

S Thus, HIP intervention is directed to change the group environment, structure, and processes responsible for increased cohesion.

METHODOLOGY

S Women were screened, recruited and assessed for the study.

S They were randomized into the physical activity or the vegetable and fruit group.

S Subsequently, they completed six intervention group sessions over a period of six months.

S Intervention sessions included brief instructions, team based activities and discussion with the entire group led by a trained health educator.

Concept Theory Definition Study definition Operationalization

Multiple levels of

factors influence

health behavior

Factors at

intrapersonal,

interpersonal,

organizational,

community and

public policy can

influence health

behaviors.

The EMPA

conceptualizes

micro-, meso-, exo-

and macro-

environmental

influences on

physical activity.

Micro-

Neighborhood

streets, physical

activity resources,

goods and services:

Meso- Direct team

participation; Exo-

Contacts and

connections.

Influences interact

across levels

The interaction of

influences mean

that variables work

together.

The EMPA

describes the

linkages and

processes among

environmental

settings and

behavioral choices.

Behavior

maintenance

strategies like

incentives to

complete goals, use

of daily monitoring

logs, promoting

neighborhood and

environmental

awareness

Concept Theory Definition Study Definition Operationalization

Multi-level

intervention should

be most effective in

changing behavior

Educational

interventions

designed to change

beliefs and

behavioral skills are

likely to work better

when policies and

environments

support the targeted

behavior changes.

Increased

perceptions of

group cohesion,

individual

cognitions

related to

physical activity

and social

support were

hypothesized to

mediate the

intervention’s

effect.

Intervention sessions

included personal goal

setting, reducing

barriers, increasing

self- efficacy, social

support, neighborhood

survey.

Ecological models

are most effective

when they are

behavior specific.

Ecological models

appear most useful

to guide research

and intervention

when they are

tailored to specific

health behaviors.

Specific group

dynamics team building

strategies to increase

physical activity

(walked 15 minutes as

a group) or vegetable

and fruit consumption

(sampled two new

vegetables or fruits).

Conceptual and theoretical model incorporating levels from the Ecologic Model of Physical Activity

and Group Cohesion to predict health behavior.

RESULTS

S Interventions guided by the social ecological model

account for multiple levels of influence of initiating and

maintainng health behaviors for improved health

outcomes.

S Findings suggest that emphasis on existing social groups

like families would be more efficient than single focus on

women, men or children alone.

STRENGTHS

S Unlike studies in the past, this intervention attempted

to address both environmental and individual level

characteristics.

S This intervention targeted not just promoting

enhanced initiation but also maintenance of

behavioral change.

S Group dynamics principles were integrated into

EMPA and adapted them to include dietary habits.

S The strategies and techniques that were developed

were couched in time tested behavioral strategies.

LIMITATIONS

S The personal as well as group targets to be achieved

were self reported.

IMPLICATIONS

S Women are the important behavioral gatekeepers.

S Dissemination efforts of data related to environmental

factors can be aimed towards urban planning and

transportation in order to encourage walking.

S The study findings can be distributed among researchers

and health promoters as a simple and effective strategy

to implement changes in health behavior.

REFERENCES

S Rebecca E. Lee, Ph.D., Ashley V. Medina, B.S., Scherezade K. Mama, M.P.H., Jacqueline Y. Reese-Smith, Ph.D., Daniel P. O’Connor, Ph.D., Marcella Brosnan, B.A., Catherine Cubbin, Ph.D., Tracy McMillan, Ph.D. and Paul A. Estabrooks, Ph.D. Health Is Power: an Ecological Theory-based Health Intervention for Women of Color. Contemp Clin Trials. 2011 November ; 32(6): 916–923

S Glanz, K., Rimer, B.K., Viswanath, K. (Eds.). (2008). Health Behavior and Health Education: Theory, Research, and Practice. San Francisco: Jossey-Bass, 4th edition.