Introduction
There is a wide array of health education and health behavior changes in today’s world. Many health professionals and specialists are providing counseling to the population, about major issues, such as AIDS and other such illnesses. These professionals work in schools, workplaces, and other settings, to foster health improvement with their policies. They look into new researches and ways to impart the best of knowledge regarding health improvement.
Health behavior and health education are interrelated. The goals of health education are to create positive alterations in health behavior. If in any case, the health scenario is not improved despite changes in behavior, then other issues need to be looked into, like the link between the behavior and health status. Informed decision-making is necessary for issues concerned with medical ambiguity, and studies have shown that there is a more positive outcome of health if decision-making is shared (Frosch and Kaplan, 1999).
Ecology is a term that connects to the relation between the environment and organisms. Social ecology is a broader term, related to the cultural, social, and institutional transactions of people and their environment. Human ecology was previously related only to the biological and geographic fields but is now used in a wider context.
Social ecology includes the hub of the suppositions of human health and the progression of useful strategies to enhance personal and combined welfare. Some of these suppositions are given as under:
- The good health of an environment and the comfort of the people are dependent upon the physical as well as social atmosphere. The physical aspect may include geographical features, architecture, and technology, whereas the social elements are inclusive of culture, economics, and politics.
- Some personal characteristics like genetic inheritance, psychological temperament, and behavioral aspects also affect the health conditions of persons.
- Attempting to promote human well-being is to be dependent upon environmental and individual factors, instead of just wholly on the environmental or biological aspects.
- Human environments should be analyzed in relation to the physical and social aspects, and there should be more dimensions to the analyses because they are multi-faceted enough to be explored.
- These environments can be distinguished according to their objective or actual traits, or to their subjective or apparent ones. Environments can also be depicted as an assortment of separate features like lighting, temperature, noise, etc. or, they can be portrayed as collective associations among numerous features like behavior settings, person-environment fit, and social atmosphere (Stokols, 1987). Health promotion programs are evaluated according to these multicolored faces of human environments.
- The people existing in environments can be described at various levels, like as individuals, as groups, or as large organizations. The social-ecological factor analyzes the healthfulness of locations using a wide variety of methods including questionnaires, medical exams, and environmental recordings. The social-ecological viewpoint is that health promotion programs are effective and can be made more so, by the synchronization of people such as family members encouraging health practices, or other such groups, with organizational health gurus who provide health services.
Comparison of Interventions
Paper I
This is a random study of 279 postmenopausal women, who are patients of Type II diabetes, and are at a high risk of acquiring coronary heart disease. This intervention is named the ‘Mediterranean Lifestyle Trial’, and emphasizes dietary patterns, physical activities, social support, and management of anxiety and tension. The Social Cognitive Theory and Social-Ecological Theory have been used to deal with the intervention.
The number of women dying of coronary heart disease is rising. This study has shown that some of the CHD factors in women are the result of behavioral patterns, like consumption of high-fat diets, smoking, and a sedentary lifestyle. Social isolation and extreme levels of stress are of interactions between human behavior and the social surroundings may prove to be more beneficial, than focus on a single health issue (Toobert et al.,1998). This study is, therefore, also a contributor (Case et al., 1992). Changes in behavior patterns, such as reduction in fats in the diet, an increase in physical activity, and management of stress may help reduce the risks of CHD. Studies have shown that an analysis of multiple risk factors for the evaluation is worthwhile in this respect.
A predicament of this study is the proportion of the importance of the study, to the people reached. Studies state that the more intense an intervention, the better the results. Sadly, this was not so in this case, having reached a very low number of members. The study was carried out with the aim of attracting a large number of participants but failed to do so.
This study has made numerous essential contributions to the existing behavior-change intervention research. It speaks of a gender gap between CHD and diabetes research. Procedures developed earlier for lifestyle management have been modified with this research. Simple strategies related to behavior patterns have been adopted by this study.
Paper-II
The WellWorks Study was carried out at a research center, it was conducted to test the effectiveness of health promotion. Workplaces are an important place to promote healthy practices in order to reduce the risks of diseases such as cancer. This study focuses on cancer prevention strategies for blue-collar workers, and analyzes their dietary habits and behavioral patterns, to assess the risks they face at work.
There were twelve intervention worksites, and one of the strengths of this study was that one general procedure was followed by all of them. The emphasis was on changes that that was seen in a legion of workers present for the full intervention span of two years.
However, there were some boundaries to the study as well, that need to be elucidated. The work sites were no doubt randomized to the conditions put forward, but the sites which agreed to take part in the study were not arbitrarily selected. They were selected on the basis of particular qualifying criteria, which included the utilization of known or suspected occupational carcinogens, and on their enthusiasm to take part in the study. Therefore, the outcomes can be widespread to similar worksites only, which are willing to promote the health of employees.
Members of this group of workers were at variance with important points from defendants to the standard survey. The members in the survey constituted a low number of smokers and office workers. These differences in the expected number and the actual number affected the real impact of the intervention on smoking termination.
Nevertheless, despite the barriers, this study still represents the first randomized controlled worksite intervention analysis to review the efficacy of an integrated health promotion health protection intervention.
People have come to realize that the concept of health promotion should be widespread, and not confined to individual behavior. A worksite program that is intended for health promotion and health protection like this one carried out, helps to voice out the complications of workers and politics of their health as a matter of interest for both employees and managers. The information given in this study was from a controlled trial that may prove helpful in carrying out changes in behavioral risk factors in blue-collar workers.
Paper III
This study was carried out to evaluate the people of WIC participation in North Carolina, in a textile-manufacturing county. It was based upon the Behavioural Ecological Model. An analysis was carried out for the adoption of optimistic health behavior among different racial groups. The center of the study was the incorporation of public health and behavioral science.
This study found that intrapersonal, interpersonal, societal, and general eventualities vary with racial groups. The results show that entry into the WIC should be made in the first trimester of pregnancy. It has also been concluded that programs should be structured for all levels of influence because of the sample population and environment.
Non-probability sampling caused imperfect representation. The WIC members of this study may not be of the broad WIC population because a convenience sample was employed. Thus the findings may not be given a general picture. But the study still provides an opportunity to inquire into further research on a more controlled and larger scale.
Title and Authors
Paper One
Deborah J. Toobert, Lisa A. Strycker, Russell E. Glasgow1, Manuel Barrera2 and John D. Bagdade (2002) Enhancing support for health behavior change among women at risk for heart disease: the Mediterranean Lifestyle Trial. HEALTH EDUCATION RESEARCH Theory & Practice Vol.17 no.5 2002 Pages 574–585
Paper Two
Glorian Sorensen., Anne Stoddard., Mary Kay Hunt., James R. Hebert., Judith K. Ockene., Jill Spitz Avrunin., Jay Himmelstein., and S. Katharine Hammond (1998) The Effects of a Health Promotion-Health Protection Intervention on Behavior Change: The WellWorks Study. American Journal of Public Health. November 1998, Vol. 88, No. 11
Paper Three
DeBate, Rita D.; Pyle, Gerald F. (2004) The Behavioral Ecological model: a framework for early WIC participation. American Journal of Health Studies
Provide a brief synopsis of approaches used in each intervention
Paper One
Deborah et al (2002) in the study “Enhancing support for health behavior change among women at risk for heart disease: the Mediterranean Lifestyle Trial” used a Mediterranean lifestyle trial for women with a high risk of coronary heart disease. Mediterranean lifestyle trial is a detailed lifestyle management intervention that included changes in diet, promoting physical activity, social support and managing stress. This trial included at least 4 different lifestyle changes that were to be implemented in the routine of diabetic postmenopausal women who were at high risk of CHD. Researchers used social cognitive theory, social-ecological theory, and goal systems theory as the basis of Mediterranean intervention. This intervention aims towards studying the outcomes of theoretical mechanisms in actual lifestyle change. In improving lifestyle, the four basic risk factors i.e., inadequate diet, stress, lack of physical activity and decreased social support were to be studied, changed, and implemented in their life to bring positive changes.
Changes to these factors were to improve diet, increase physical activity, manage stress and quality of life with social support. The hypothesized variables were self-efficacy, coping, environmental and social support. Each participant was led under any one of the two groups. One was a peer-led group and the other personalized multilevel community resources maintenance condition. Multiple levels of community resources were to be used in the second condition to promote a healthy lifestyle. In the study, the RE-AIM evaluation framework is used to evaluate Reach, Effectiveness, Adoption, Implementation, and Maintenance. The study aims towards maintaining a long-term healthy lifestyle using different community resources focusing on different environmental factors and lifestyle behavior. High-risk factors identified in this study are a diet high in fat and bad cholesterol, smoking, lack of physical activity, stress, and social isolation. Social support factors are also important in maintaining a healthy lifestyle.
The paper under discussion is a study that was carried out to see the lifestyle management of a number of postmenopausal women who were also affected by diabetes. Furthermore, they were at great risk of adopting coronary heart disease. The study took place to see the lifestyles they were spending, and what could be done to change their patterns of behavior, in order to reduce further risks of illnesses. The Social-Ecological Theory had been adopted for helping to solve the problems of these women. This meant, there was a need for change in behavior patterns.
Paper Two
This study was conducted to see the effects of an integrated program on alterations in two targeted behaviors that were related to threats of cancer. These two aspects were the dietary habits of the people and cigarette smoking. Secondly, an analysis was carried out to find out whether the risks increased with occupational exposure, or whether it varied with the job categories. The numerous levels of influence were targeted with the Social-Ecological model, in this Wellworks study.
Paper Three
The aim of this study was to evaluate the health conditions of the WIC participants and to encourage women to become members of the WIC in early pregnancy, through the utilization of the Behavioural Ecological Model in a region of North Carolina. A behavioral ecological framework was developed for the WIC participation. Results show the influential aspects of an early admittance into this organization.
What were the key outcomes/findings?
Paper One
The study addresses several behavioral change models to improve health among women diabetics. Women with type II diabetes are at high risk of CHD, hence, with improved self-care and using modified procedures defined by this research, these women can benefit a lot in improving their health. By using social cognitive theory and social-ecological they enhanced their research intervention and in order to maintain better conditions. This research endorses the positive outcomes of work from Ornish et al (1990) and Glasgow and Toobert (2000). Ornish et al (1990) addressed lifestyle management for patients with heart disease, while Glasgow and Toobert (2000) addressed self-care for diabetics by various physiological and psychological processes. The research adopts RE-AIM framework to reach goals (Reach, adoption, and implementation).
Paper Two
The health promotion health protection intervention that was adopted by the study shows that health behavior changes were more needed in blue-collar workers, as they were more exposed to occupational hazards, and the traditional health promotion strategies employed until now have not proven worthwhile. There were no noteworthy differences by the ages of the people, their consumption of fiber, or claim of exposure to hazardous substances among the people in the group and those who were excluded. The relation of the self-reported exposures to job hazards and the smoking and nutritional effects of the others were also included. The result was that the exposure-related only to fiber intake; unexposed employees had a higher degree of fiber intake in all the job sections.
Paper Three
It has been indicated that cultural, intrapersonal, and interpersonal hindrances cause the delay in entry into the WIC. The Behavioural Ecological Model of this study presents suggestions for a rise in the number of part takers into the WIC, at an early stage.
The trimester of the admittance of the women is greatly influenced by cultural mores. Findings show that the Latino entrants seemed they were less prone to illnesses and had greater professed benefits. Latino WIC participants had lesser perceptions of gaining benefits from the program. They expressed a lack of helpfulness of WIC staff according to this study and also said there were not enough services for the Spanish-speaking participants, in that they were attended for lesser hours.
The findings of this study also point out that behavioral ecological hindrances affect the stage of pregnancy at which the entrance is made, into the WIC program, and those who had made the entry before the birth of their baby had done so due to the health care system, otherwise, the women had entered by hearing about it through family and friends.
Conclusion
From the interventions that were carried out in the research papers selected, it can be concluded that the health promotion and health protection policies adopted by the studies were worthwhile, and held value. It has been made clear to the participants of the studies, that they are exposed to fatal threats if they do not follow certain behavioral patterns in their lives, and as for those who are already ill, like in the first study conducted of the menopausal women, they will suffer twice the amount of hazards if not careful with their lifestyles. Their bodies are already affected, and if they remain careless, they will be closer to death.
References
Case, R. B., Moss, A. J., Case, N., McDermott, M. and Eberly, S. (1992) Living alone after myocardial infarction: impact on prognosis. Journal of the American Medical Association, 267, 585–519.
DeBate, Rita D.; Pyle, Gerald F. (2004) The Behavioral Ecological model: a framework for early WIC participation. American Journal of Health Studies. Web.
Deborah J. Toobert, Lisa A. Strycker, Russell E. Glasgow1, Manuel Barrera2 and John D. Bagdade (2002) Enhancing support for health behavior change among women at risk for heart disease: the Mediterranean Lifestyle Trial. HEALTH EDUCATION RESEARCH Theory & Practice Vol.17 no.5 2002 Pages 574–585. Web.
Frosch, D. L., and Kaplan, R. M. “Shared Decision Making in Clinical Medicine: Past Research and Future Directions.” American Journal of Preventive Medicine, 1999, 17, 285–294.
Glorian Sorensen., Anne Stoddard., Mary Kay Hunt.,James R. Hebert., Judith K. Ockene., Jill Spitz Avrunin., Jay Himmelstein., and S. Katharine Hammond (1998) The Effects of a Health Promotion-Health Protection Intervention on Behavior Change: The WellWorks Study. American Journal of Public Health. Vol. 88, No. 11. Web.
Ornish, D. (1990) Dr. Dean Ornish’s Program for Reversing Heart Disease. Ballantine Books, New York.
Stokols, D. “Establishing and Maintaining Healthy Environments: Toward a Social Ecology of Health Promotion.” American Psychologist, 1992, 47, 6–22.
Toobert, D. J, Glasgow, R. E., Nettekoven, L., Brown, J. E. and LaMont, B. (1998a) Behavioral and psychosocial effects of intensive lifestyle management for women with coronary heart disease. Patient Education and Counseling, 35, 177–188.
Toobert, D. J., Glasgow, R. E. and Radcliffe, J. L. (2000) Physiologic and related behavioral outcomes from the Women’s Lifestyle Heart Trial. Annals of BehavioralMedicine, 22, 1–9
Toobert, D. J., Strycker, L. A. and Glasgow, R. E. (1998b) Lifestyle change in women with coronary heart disease: What do we know? Journal of Women’s Health, 7, 685–699.