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PARKER PAPER
• Main goal: • How can Health Promotion Theories be applied to reduce
exposure to environmental hazards?• Why is this paper unique?• HP Theories are rarely applied to environmental health
issues • Where: Detroit• What: Community Action Against Asthma (CAAA)
STUDY DESIGN
• 1) Exposure Assessment • 2) Intervention• Household level• Neighborhood/policy level
• Participants• 331 households of English/Spanish speaking children, 6-11 yrs• Detroit public schools (SW/E Districts)
• Screening• Questionnaire to find those households with children with persistent
asthma
INTERVENTION DESIGN
2 years
12 Visits by Community Environmental Specialists (CES)
Intensive Year 1Min 9 visits
Less Intensive Year 2Min 3 visits
ECOLOGICAL MODEL: A THEORY OF ACTION
• Introduced in Week 1• Health, behavior, & their
determinants are interrelated
• Response to: environmental barriers can make other HP programs fail to have long-term behavior change
• Target multiple levels (as resources allow) & make changes to the physical, legal, economic, social environment =>• Strong! Long-lasting!
HOW THE ECOLOGICAL MODEL FRAMEWORK WAS USED
1. Assess Physical & Social Environment
2. Decide targets of change at each level
3. Develop intervention strategies for as many targets as possible
INTRAPERSONAL LEVEL: HBMPERCEIVED THREAT & BENEFITS
• Perceived Threat: • Stress perceived susceptibility to asthma exacerbation
• Allergen type & child-specific allergen info• Reinforce asthma exacerbation if child exposed
• Stress perceived susceptibility to increased morbidity & mortality potential
• Perceived Benefits• “Explained link between exposure to indoor allergens and irritants and asthma
exacerbation” • “Explained how allergens and irritants could be reduced through cleaning behaviors
and by preventing the child from being exposed to tobacco smoke.”
• Do you think that these are interventions that effectively target the perceived benefits construct?
(I’m not sure they do…)
Individual &
EnvironmentalFactors
INTRAPERSONAL LEVEL: HBMBARRIERS AND CUES TO ACTION
Individual &
EnvironmentalFactors
• Perceived Barriers• Identify & strategize
• Competing life demands => agencies that could help
• Equip with resources• Cleaning supplies, mattress covers,
vacuums• Cues to Action
• Shared data from initial data collection• Walkthrough results- visible cockroaches? Visible mold? Dust sample
findings• Recommendations from physician about which triggers to focus on • Discussion Question:
• Book says “events, symptoms, reminders”
• Caregiver confidence of success (in very specific behavior? Not really specified)
• How was it addressed?• Remember, caregiver decidedwhich triggers to target from discussing
with CES• Set small action goals caregivers could meet between visits (6-8
weeks)• Verbal encouragement and support from CES to reinforce
Individual &
EnvironmentalFactors
INTRAPERSONAL LEVEL: HBMSELF-EFFICACY
SOCIAL COGNITIVE THEORY: REFRESHER
Individual &
EnvironmentalFactors
Behavior
Environment
Personal factors
Major determinants:• Environment• Outcome expectations• Self-efficacy• Behavioral capability• Methods for
behavioral change• (…where is goal
formation?)
• Knowledge and Skills• Share knowledge and skills needed to perform behavior like cleaning
• Self-efficacy • intervention same as described for HBM previously• Set small goals & reinforce behavioral change with verbal encouragement &
support
• Methods of Learning (specifically observational)• Model all desired actions (vacuuming, dusting, etc) + reinforcements
• Environment• “Project planners took into consideration the SCT’s definition of
environment”• Understand that caregivers might not be able to alter their environment if they
rent their homes => add in tenant-advocate organization
• Where are outcome expectations and expectancies?
Individual &
EnvironmentalFactors
INTRAPERSONAL LEVEL: SCT
• Social Support• Emotional• Instrumental: tangible aid/services• Informational: advice, suggestions, info• Appraisal: feedback
• How did they address it?
Individual &
EnvironmentalFactors
SOCIAL SUPPORT
CES (Community environmental specialist)
Informational Give info
Emotional Care, empathy
Instrumental Cleaning supplies, bed covers
Appraisal Constructive feedback
• Increase caregiver’s coping resources• Matched to community resources • Ex: Persons with mental health needs to mental health services
• Resources in the community• Increase neighborhood and community support for families with
children with asthma• Reduce environmental triggers on community level
Individual &
EnvironmentalFactors
SOCIAL NETWORKS