THE UNIVERSITY OF VERMONT SOCIAL AND BEHAVIORAL FOUNDATIONS OF PUBLIC HEALTH PH 395 OL2 CRN: 61108 Syllabus COURSE: PH 395 OL2: Social and Behavioral Foundations of Public Health CREDITS: 3 SEMESTER: Summer Session, 2013 (July 1- August 9, 2013) PREREQUISITES: None FACULTY: Professor William Wargo: wwargo@uvm.edu BRIEF COURSE DESCRIPTION: The social and behavioral sciences in public health address the behavioral, social, and cultural factors related to individual and population health, health behaviors and health disparities over the life course. This course emphasizes the importance of social context and cultural construction, and examines current issues in health from a social and behavioral sciences perspective. Special topics include childhood obesity, mental health and illness, violence, unintentional injury and occupational health. INTRODUCTION: This course is designed to: encourage students to think about the multiple and complex roots of behavior ( what people do ), and introduce students to the relationship between behavior and a selection of major health issues; provide an introductory background to the kinds of social and behavioral theories that guide our understanding of health related behavior, and that form the background for health promotion and prevention efforts; and explore some of the ways in which these theories and approaches are used in applied health promotion efforts. LEARNING OBJECTIVES: At the completion of this course, the student should be able to: 1. Identify basic theories, concepts, and models from a range of social and behavioral disciplines that are used in public health research and practice. 2. Identify the causes of social and behavioral factors that affect health of individuals and populations. 3. Identify individual, organizational and community concerns, assets, resources and deficits for social and behavioral science interventions. 1
4. Identify critical stakeholders for the planning, implementation and evaluation of public health programs, policies and interventions. 5. Describe steps and procedures for the planning, implementation and evaluation of public health programs, policies and interventions. 6. Describe the role of social and community factors in both the onset and solution of public health problems. 7. Describe the merits of social and behavioral science interventions and policies. 8. Apply evidence-based approaches in the development and evaluation of social and behavioral science interventions. 9. Apply ethical principles to public health program planning, implementation and evaluation. 10. Specify multiple targets and levels of intervention for social and behavioral science programs and/or policies. These learning objectives are also intimately related to certain core competencies identified by the Association of Schools of Public Health (ASPH) for the Master of Public Health (MPH) degree in graduate schools and programs of public health. The primary vision for the ASPH initiative is the graduation of professionals who are more fully prepared for the many challenges and opportunities in public health in the forthcoming decade. See: Calhoun et al., 2008. Development of a core competency model for the Master of Public Health Degree. American Journal of Public Health, 98(9), pp. 1598-1607. See, also: http://www.asph.org/document.cfm?page=851. DETAILED COURSE DESCRIPTION: The course is divided into four Sections consisting of fourteen Chapters (Modules). Section I. On Health and Behavior An Introduction (Chapters 1-2) In the first section, we will look at the relationship of behavior to health, review a sample of current and ongoing health problems (domestic and international), and, in a broad sense, discuss the relationship of behavior to those health problems. Section II. On the Roots of Behavior A Multidisciplinary Survey (Chapters 3-7) In the second section, we will examine a context from which to understand theory, and survey theoretical perspectives from psychology, social psychology, sociology, and anthropology that offer explanations of human behavior, keeping in mind that health behavior is one domain of human behavior in general thus linking the field of health promotion/prevention to the broader context of social/behavioral theory. Section III. Putting Theory Into Practice (Chapters 8-13) 2
The third section will introduce theory-based program planning and application, providing real-world examples across a range of settings including community, school, and workplace programs, global health, mass media/communications, and programs targeting special populations. This section will also show how theory links program design, implementation, and evaluation. Section IV. Current Trends (Chapter 14) In the final section, current issues in the applied field of health behavior/health promotion will be reviewed. COURSE ASSIGNMENTS AND GRADING: The course will be taught online and utilize online discussions guided by questions specific to the issues and learning objectives covered. Some of those questions appear below. Course grading will be based on the following: 50% Discussion. See below for details about Discussion Board postings. 50% Short Written Assignments. There will be four short written papers assigned in the course. Each will require you to write 3-4 pages about a specific topic. These assignments are best submitted to me as e-mail attachments. If some problem develops regarding transmission, please let me know right away. You can contact me at wwargo@uvm.edu or through the Email section of the upper left hand menu of the course website. Again, do not hesitate to contact me regarding any difficulty. Discussion Board Postings Questions will be posted in the Course Materials: Modules, which you will address on the class discussion board. Try to incorporate relevant background material from the chapters into your responses. You are required to participate in the online discussion by answering questions posed in the assignments and responding to at least one other student's post for each module (there is no "back of the classroom" in online discussion). Here are the ground rules for discussion postings: Answers to assignment questions should be 200-250 words long Responses to others can be shorter, 1-2 paragraphs All posts must be written in complete, grammatically correct sentences A civil, respectful tone must be maintained in all posts, especially when you disagree Also, remember to back up anything you post! I STRONGLY recommend you compose your posts as Word or Notepad files, save them, and then copy and paste them into your posts (but do 3
not attach the files to your posts!) because things can be easily lost, and you don't want to spend a long time composing a post and then lose it because of a mistaken key stroke! Here are the criteria I will use to grade each original post: Excellent (A/5): posts answers on time, sometimes exceeding required number; comments are based on detailed and insightful understanding of material; properly refers to specific parts of the texts or other materials to support ideas; suggests other perspectives/directions; posts are clear, organized, and well-written Good (B/4): posts answers on time; comments show a good understanding of material, may make reference to specific parts of the texts or other materials to support ideas; does not suggest other perspectives/directions; posts are adequately written Fair (C/3): posts answers on time; comments show only a basic understanding of the material; does not refer to specific parts of the texts or other materials to support ideas; posts are understandable but may lose focus and show some consistent mechanical errors Poor (D/2): misses deadline; comments show only a limited understanding of the material with few/no references to texts for support; posts are difficult to understand, frequently wander off-topic, use an inappropriate tone, and/or show significant writing problems Failing (F/1): misses deadline and doesn't participate As you see, it is important to post your comments in a timely way. The discussion board is a central component of creating an online learning community. It is up to you to foster an online learning community. There are several things you can each do to enhance the learning experiences online: 1. ALWAYS READ THE ASSIGNED READINGS BEFORE POSTING -- If you have not taken an online course before, you will quickly learn that it is much more difficult to come to an online course unprepared than it is to go to a large lecture class unprepared. Don't learn this the hard way! 2. DON'T PROCRASTINATE... POST EARLY -- Don't wait until the last minute to post your responses to the questions. Having an ongoing dialogue requires students to engage early. Note that I will be monitoring your postings over the course of the semester and keeping track of the time, frequency, and quality of your postings. 3. RESPECT AND CHALLENGE EACH OTHER -- Students are encouraged to challenge each other in a respectful way. I strongly encourage each of you to observe your own silence, anger and defensiveness around the issues we will be addressing in this course, and to try hard to challenge yourself and to engage in the discussions in a 4
respectful manner. Keep in mind that listening is also very important, so when you are responding to your classmates, be sure that you are doing just that rather than re-voicing your own views. 4. STAY FOCUSED! -- It is easy to get off track. Keep in mind that it is fine to bring in personal experiences and observations if you wish, but be sure that you connect them specifically to the course material. Postings need to be anchored in the course concepts and readings. 5. FINALLY-- I can't repeat this enough. Please, when you compose a post, be sure to compose it in a Word or Notepad file, or some equivalent, and then copy and paste it into the online posting screen. Sadly, many people have lost lengthy writings because they have not done this - you do not want to be one of them!! Guidelines for All Other Written Assignments (Short Written Assignments) A Level 1. Introduction is comprehensive, gives reader good direction, sets the scene, and is followed throughout paper. 2. Summary/conclusion is thoughtful and relevant. 3. Fundamental issues addressed in depth with original arguments and critical judgements, demonstrating insight and creativity. 4. Current and classic primary literature sources are utilized. 5. Writing style shows evidence of individuality, unity and fluency. 6. Overall presentation of the paper is professional with no errors in syntax, spelling, etc. (i.e. Proper English language usage), and follows APA format. B Level 1. Introduction gives reader direction and is addressed throughout the paper. 2. Summary/conclusion is clear and concise. 3. Fundamental issues addressed with evidence of some original arguments and critical judgments. 4. Current literature sources utilized (primary and secondary) 5. Writing style is fluent with evidence of individuality and clarity. 6. Overall presentation of paper is neat and well organized with few minor errors in syntax, spelling, etc. (i.e. Proper English language usage), and follows APA format. C Level 1. Introduction gives reader direction. 2. Summary/conclusion is clear and concise. 3. Fundamental issues described but limited originality of arguments and few critical judgments. 4. Limited literature sources are utilized (current and/or classic). 5. Writing style is fluent and some evidence of individuality and clarity. 6. Overall presentation of paper is neat and minor errors in syntax, spelling, etc. (i.e. proper English language usage), and follows APA format. 5
READING: The main text for the course is Essentials of Health Behavior: Social & Behavioral Theory in Public Health (2007) by Mark Edberg. This book is published by Jones & Bartlett Learning, and its ISBN number is 978-0763737962. I will occasionally share other readings with you, including current news items related to the topics we will be covering. I will also supplement the reading with websites as part of the online course. COURSE CALENDAR AND READING: Section I. On Health and Behavior An Introduction Chapter 1. The Links Between Health and Behavior 1. Understand that there are multiple influences on health behavior 2. Define what is meant by the ecological model 3. Explain the types of factors influencing health that are covered in an ecological model 1. What is the goal of the field of study concerned with health behavior? 2. What is the relationship between health behavior and behavior in general? 3. In what ways would a shift from an agrarian economy to an industrialized economy impact health conditions? 4. What is the main assumption of the ecological model? 5. What types of broad factors exist in the ecological model? Chapter 2. Health Issues and Behavior 1. Describe behaviors related to obesity and its consequences (e.g., diabetes, cardiovascular health problems), and factors influencing those behaviors 2. Describe behaviors related to youth violence and its consequences (e.g., injury), and factors influencing those behaviors 3. Describe behaviors related to HIV/AIDS transmission, and factors influencing those behaviors 1. What are some key links between the environment and behavior in terms of the problem of obesity? 2. Would it be fair to say that obesity is a problem resulting just from individual choice in terms of behavior? 3. What kinds of factors may influence youth to engage in violence? 4. What are consistent patterns of behavioral risk for HIV/AIDS around the globe? How could these patterns be influenced by the larger social or economic context? 6
5. Where should we focus our efforts to address behaviors related to obesity? Youth violence? HIV/AIDS? Section II. On the Roots of Behavior A Multidisciplinary Survey Chapter 3. Social/Behavioral Theory and its Roots 1. Understand what is meant by the term theory in relation to explanations of behavior 2. Understand some of the assumptions underlying theory as it is used in a scientific context, and the history behind those assumptions 3. Describe key influences on behavioral theory from sociology, social psychology, sociology, cultural anthropology, and the study of ecology/biological systems 1. What is a theory? Why is a theory like a story? 2. The term theory as we know it takes its meaning from a Western tradition of philosophy and science that has four main tenets. What are they? 3. What are the schools of thought in psychology that contributed to modern behavioral theory? 4. What are some contributions from the social sciences sociology and anthropology on modern behavioral theory? 5. Why, as public health practitioners, is it important for us to understand the concepts of social psychology? Anthropology? 6. How has the study of natural systems contributed an important concept to modern behavioral theory in public health? 7. Why is it important to develop health promotion programs within the context of an ecological model? Chapter 4. Individual Health Behavior Theories 1. Describe key behavioral theories focusing on the individual the Health Belief Model, Theory of Reasoned Action, Theory of Planned Behavior, Trans-Theoretical Model (TTM), and the Precaution Adoption Process Model (PAPM) 2. Understand how these individual-oriented theories might be applied 1. Why are the theories in this chapter called individual theories? What do they assume about behavior? 2. According to the Health Belief Model, what is the decision making process a person goes through before taking a health-related action? 3. The Theory of Planned Behavior evolved 7
3. Understand selected critiques of these theories. because it didn t account for what kind of factor that could influence behavior? 4. What is it about the Trans-Theoretical Model that is trans-theoretical? 5. What are the key stages in TTM and PAPM? How are they similar or different? Chapter 5. Social, Cultural, and Environmental Theories (Part I) 1. Understand how social, cultural, and environmental theories of behavior are different from, and overlap with, individual-oriented theories 2. Describe a selection of key behavioral theories focusing on social influences and group action Social Cognitive Theory, Social Network Theory, Diffusion of Innovations, and Social Marketing 3. Understand how these social/cultural/environmental theories might be applied 4. Understand selected critiques of these theories 1. What is the interaction between social and cognitive in Social Cognitive Theory? 2. What does Bandura mean by reciprocal determinism? 3. What is a basic difference between the explanation for behavior in Social Network Theory and the explanations in theories such as the Health Belief Model? 4. What do social marketing and diffusion of innovations approaches have in common with marketing in a business context? What is different? 5. What are some of the key factors that determine speed of adoption in diffusion of innovations theory? Chapter 6. Social, Cultural, and Environmental Theories (Part II) 1. Describe a selection of key behavioral theories focusing on the influence and nature of broader social contexts -- communications theory, community and organizational mobilization, political economy, and culture theory 2. Understand how these social/cultural/environmental theories might be applied 3. Understand selected critiques of these theories. 1. What does encoding and decoding information refer to in communications theory? Why is this important for communicating about health behavior? 2. In terms of an ecological model, what kinds of things does a community mobilization effort address? 3. What is meant by organizational culture? How does it relate, for example, to work-related health behavior? 8 4. Using HIV/AIDS as an example, what issues
would a political economic approach address in terms of potential action? 5. What is cultural about an ethnomedical system? Chapter 7. Doing Something About It: The Ecological Perspective & the Move from Theory to Practice 1. Understand the role of the planning process as a way to link theory to a particular health situation, community, and population 2. Discuss the three basic components of any program panning process 3. Describe the PRECEDE-PROCEED and Risk/Protective Factors models as examples of planning approaches 1. What does picking your battles mean in the context of a health promotion program? 2. What are the three basic parts of most planning models? 3. In general, what role should assessment play in the kind of health promotion program you decide to develop and implement? 4. Why is it important to evaluate health promotion programs? 5. How are the two planning models discussed in this chapter different? Similar? Section III. Putting Theory Into Practice Chapter 8. Communities and Populations As Focus For Health Promotion Programs 1. Understand the difference between community 1. Why is it that communities are the primary (health promotion) interventions and settings for public health/health promotion interventions in a community interventions? 2. Understand the interaction between community 2. What is the difference between a community characteristics and interventions intervention and an intervention in a 3. Define population-based health promotion community? 4. Understand tailoring and sustainability with 3. What kinds of community politics might you respect to health promotion interventions encounter? What theoretical approaches could be used to address some of these political situations? 4. What does it mean to tailor an intervention to a community or population? 5. How can you keep an intervention going? What does sustainability refer to? Chapter 9. Application of Theory: Schools and Worksites 9
1. Understand key issues with respect to implementing health promotion programs in a school setting 2. Understand the kinds of social/behavioral theories that could be applicable to school-based health promotion programs, and describe examples of theory-based programs in school settings 3. Understand key issues with respect to implementing health promotion programs in the workplace 4. Understand the kinds of social/behavioral theories that could be applicable to workplace health promotion programs, and describe examples of theory-based programs in the workplace setting 1. What are some characteristics of school and workplace settings that are similar? How might this affect relevant theory? 2. What is a comprehensive school health approach? 3. What are some of the political issues one might face in trying to implement a school-based health promotion program? 4. What connections are there between schools and their communities that might affect the type of program (and theory) selected? What about connections between workplaces and communities? 5. How have workplace health programs changed over the years, and what does this mean in terms of the kinds of programs and theoretical approaches that would be applicable? Chapter 10. Application of Theory: Communication Campaigns 1. Understand key issues with respect to the use of communications and media for health promotion 2. Understand the kinds of social/behavioral theories that could be applicable to communications campaigns 3. Describe examples of theory-based communications campaigns 1. How has the modern mass media become so important as influences on human behavior and health behavior? 2. What is a communications campaign? 3. How are target audiences and communications channels related? 4. How does formative research help one select and use theory for a communications campaign? 5. In the example of an obesity-related communications campaign in this chapter, how does Diffusion of Innovations theory help explain how exercise (as a behavior) was diffused among adults and youth? 10
Chapter 11. Application of Theory: Global Health 1. Understand key issues with respect to health promotion in a global setting 2. Understand the kinds of social/behavioral theories that could be applicable to global health promotion programs 3. Describe examples of theory-based global health promotion programs 1. Why is global health harder and harder to distinguish from domestic health? 2. What are some of the key components in the overall ecology of global health? Are these different than the ecological context for domestic health? If so, how? 3. What are some examples of the ways in which social inequality impacts health, and how would you address these examples using theoretical approaches discussed in our book? 4. What do you have to do to adapt behavior change approaches developed in a U.S. context for application in a global context? 5. What are some examples of global health approaches that combine multiple theories and/or constructs? Chapter 12. Application of Theory: High-Risk and Special Populations 1. Understand key issues with respect to health promotion among populations at particularly high-risk for key health issues (e.g. HIV/AIDS, substance abuse, violence, tuberculosis, etc.) 2. Understand the kinds of social/behavioral theories, and unique considerations, that could be applicable to health promotion in high risk populations 3. Describe examples of theory-based health promotion programs addressing these populations 1. Why should we be concerned with context when trying to understand and address high-risk behavior? 2. What is meant by risk factors for high-risk behavior? What is meant by the integration of such factors? 3. What is a harm reduction approach? 4. What is a generative approach? 5. How do the approaches discussed in this chapter use the kinds of health behavior theories reviewed in our book? Chapter 13. Evaluation: What is It? Why is It needed? How Does it Relate to Theory? 1. Understand the need for evaluation of health promotion programs and how theory and evaluation are linked 2. Describe the basic types kinds of evaluation: 1. What are three basic reasons to evaluate a program? 2. How does evaluation help you understand whether a theory is applicable or useful? 11
process, impact and outcome 3. Understand how to use a logic model to develop an evaluation 4. Understand basic issues involved in doing a successful evaluation 3. What in the current public health program environment makes evaluation an imperative, on top of the other important reasons for doing it? 4. What are the three basic types of evaluation, and what is the purpose of each? 5. What is a logic model, and how does a logic model help you connect theory to impact or outcome? Section IV. Current Trends Chapter 14. Culture, Diversity, and Health Disparities: Are Current Theories Relevant? 1. Understand the current focus on health disparities and its relationship to diverse populations 2. Understand the range of factors (within an ecological model) that contribute to health disparities 3. Understand how social/behavioral theories can be employed to address this major public health issue 1. What is meant by racial/ethnic disparities in health? Why is this an important issue? 2. What are some of the key factors contributing to these disparities? 3. How can we use individual theories/approaches to address health disparities? 4. How can we use social, group, community, and organizational theories/approaches to address disparities? 12