Health Promotion

and Practice in

National ParksJuleon W. Rabbani, MPH

Doctor of Public Health CandidateDepartment of Preventive Medicine and BiometricsF. Edward Hébert School of Medicine

Uniformed Services University of the Health Sciences

Health Promotion and Practice

When thinking about improving the health of visitors in

national parks, there are several factors to consider

before program creation

Successful health promotion programs generally include

these elements (Glanz & Rimer 1995):

A clear understanding of the targeted health behavior

The environmental context in which these behaviors occur

Health behavior theory

Strategic planning models

Targeting a Behavior

It is important to pinpoint which specific behavior you are

trying to change or influence

Example behaviors:

Physical activity in the park Even more specific: running on a trail

Visiting a park

Behavior TheoriesThere are several health behavior theories to consider when thinking about creating a health program. Some examples:

Social Cognitive Theory

Health Belief Model

Stages of Change Model

A good baseline resource for learning more about health behavior theories:

Glanz K, Rimer BK. 1995. Theory at a Glance: A Guide to Health Promotion Practice. Bethesda MD: National Cancer Institute. 2nd edition 2005. NIH Publ. 05-3896.

Social Cognitive Theory

Behavior

Individual EnvironmentAdapted from Bandura (1986)

According to one component of Social Cognitive Theory (SCT), behavior change is bidirectionally influenced by the interaction between the individual and the environment

Social Cognitive Theory

BehaviorPhysical Activity (PA) in a Park

IndividualPersonal beliefs,

attitudes, knowledge, perceptions about PA in

the park

EnvironmentSocial environment [crowds, safety], physical environment [built park features, scenery,

lighting]Adapted from Bandura (1986)

Example:

Applying Behavior TheoryHealth promotion programs can use a theory like SCT as a framework for choosing appropriate health programs Individual Level

Programs that promote behavior change through an individual

Examples: Creating a physical education program that increases a visitor’s knowledge of

exercise techniques

Disseminating materials that influences a visitor’s perception of park features or activity area

Environmental Level Programs that promote behavior change through the social or

physical environment

Examples: Physical Environment: Creating a new trail or fixing up an existing one to promote

use and physical activity

Social Environment: Increasing park police patrols to reduce perceived or actual safety concerns in a park

Creating a Conceptual Model Conceptual models drive the design of well-planned

health programs

They are usually based on a health behavior theory and

background literature (i.e. what has already been done)

Example and explanation of a conceptual model on the

next 2 slides

Program Elements Measures of Engagement Health Assessment

Physical Activity

Levels

Mood

Wellness

Enjoyment

Stress

Crime/Safety

Injury

Survey, Direct

Measurement

and/or Direct

Observation of

Park Visitors

Promoting Health in

National Parks: A

Multilevel Approach

Educational Strategies

• Physical Education• Health Classes• Promotional Materials• Self-Monitoring

Adaptations to the Social Environment

• Addressing Crime/ Safety

• Optimizing Park Policies Adaptations to the Physical

Environment

• Increasing/Improving Features (facilities and amenities)

• Improving Conditions • Improving Aesthetics• Improving Access

Direct Observation

and/or Policy

Change of

Park Environments

Ind

ivid

ua

l

Lev

el

En

vir

on

me

nta

l Le

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Example Conceptual Model Program Elements

Using SCT, we know that we should look at both individual and environmental strategies to influence behavior

Measures of Engagement There are several ways to measure health programs to ensure they

are working as intended

Health Assessment Assessing whether a program made an actual impact on overall

health can be tricky Why? There are several factors, outside of a park program, that can

influence someone’s health

However, there are immediate ways to measure components of health

Heart rate, level of enjoyment, stress level

Strategic Planning Model Planning models help us create and evaluate programs

based on health behavior

They complement conceptual and behavioral models because they frame an entire program

One example: PRECEDE-PROCEED Model(Developed by Green and Kreuter (2005))

PRECEDE (Predisposing, Reinforcing, Enabling Constructs in Educational/ Environmental Diagnosis and Evaluation) Planning/Assessment

PROCEED (Policy, Regulatory, and Organizational Constructs in Educational and Environmental Development) Implementation

Evaluation

Source: Green LW & Kreuter MW, 2005

Summary

Elements of a successful health promotion program:

A clear understanding of the targeted health behavior

The environmental context in which these behaviors occur

Health behavior theory

Strategic planning models

References Green, L. & Kreuter, M. (2005). Health Promotion Planning: An

Educational And Ecological Approach (4 Th Ed.). Mountain View, Ca : Mayfield Publishers.

Bandura, A. 1986. Social Foundations Of Thought And Action: A Social Cognitive Theory. , Englewood Cliffs, NJ, Prentice-hall, Inc.

Bedimo-Rung, A. L., Mowen, A. J. & Cohen, D. A. 2005. The Significance Of Parks To Physical Activity And Public Health: A Conceptual Model. American Journal Of Preventive Medicine, 28.

Glanz K & Rimer BK. 1995. Theory at a Glance: A Guide to Health Promotion Practice. Bethesda MD: National Cancer Institute. 2nd edition 2005. NIH Publ. 05-3896.