\f\fChapter 6 Health Promotion in Diverse Societies Overview of Chapter Topics Planning models for diverse societies: Two approaches - The health belief model - The PRECEDE-PROCEED model Implementing your health program - Guidelines for developing culturally sensitive communications - Delivering culturally sensitive communications: Three delivery modalities Overview of Chapter Topics Program evaluation in a multicultural setting Case Study: Migrant Asian women and breast screening in Australia Community Planning Public health: health promotion and disease and injury prevention through research, community intervention, and education Health promotion needs to take culture into consideration and be tailored to the unique needs, ideals, and goals of the community Planning Models Interventions require systematic planning and understanding the culture of the target audience. There are numerous planning models that assist with understanding the causes of behaviors, predicting behaviors, and evaluating programs. Models are a starting place on which to build There are many models, two are covered in this chapter - Health Belief Model - PRECEDE-PROCEED Model Planning Models for Diverse Societies: The Health Belief Model Focuses on individual attitudes/beliefs to explain/predict health behaviors Attempts to gauge individual cost/benefit assessments of adopting a given health behavior Key Variables of the Health Belief Model Perceived threat: consists of two parts: - Perceived susceptibility: One's subjective perception of the risk of contracting a health condition - Perceived severity: Feelings concerning the seriousness of contracting an illness or of leaving it untreated (including evaluations of both medical and clinical consequences and possible social consequences) Key Variables of the Health Belief Model Perceived benefits: The believed effectiveness of strategies designed to reduce the threat of illness Perceived barriers: Potential negative consequences of taking a given health action Cues to action: Bodily or environmental triggers to action Self-efficacy: Belief in one's own ability to successfully perform a given health behavior Planning Models for Diverse Societies: The PRECEDE-PROCEED Model Planning approach that examines the factors that contribute to behavior change Acronym for Predisposing, Reinforcing, and Enabling Constructs in Educational/Ecological Diagnosis and Evaluation (PRECEDE); Policy, Regulatory, and Organizational Constructs in Educational and Environmental Development Planning Models for Diverse Societies: The PRECEDE-PROCEED Model The factors that contribute to behavior change are: - Predisposing factors: individual's knowledge, attitudes, behavior, beliefs, and values that affect willingness to change - Enabling factors: factors in the environment or community that facilitate change - Reinforcing factors: the positive or negative effects of adopting the behavior that influence continuing the behavior Planning Models for Diverse Societies: The PRECEDE-PROCEED Model PRECEDE (i.e., pre-intervention) planning steps: four phases 1. Social assessment 2. Epidemiological assessment 3. Educational and ecological diagnosis 4. Administrative and policy assessment and intervention alignment Planning Models for Diverse Societies: The PRECEDE-PROCEED Model PROCEED planning steps (to be performed during and after the intervention): four phases 5. 6. 7. 8. Implementation Process evaluation Impact evaluation Outcome evaluation Planning Models for Diverse Societies: The PRECEDE-PROCEED Model Source: Reprinted with permission from The Community Toolbox (2007). Implementing Your Health Program Importance of effective health communication - - - - - - - - Raises awareness of health risks and solutions Provides positive motivation and skills Helps individuals find sources of care and support Increases demand for appropriate health services, while decreasing demand for inappropriate services Helps people make complex health-related choices Influences public agenda, promoting positive change Improves delivery of services Encourages beneficial social norms Health Communication in the Contemporary Context: Trends, Challenges, and Responses Past/current trends - Continued use of traditional dissemination media Mass one-way communication (billboards, radio, TV) Printed educational material Social marketing techniques - Use of digital media (CDs, World Wide Web) - Emphasis on community centered prevention to promote/reinforce positive health behaviors Regular physical activity Maintenance of healthy weight Responsible sexual behaviors Reduction of substance abuse and violence Health Communication in the Contemporary Context: Trends, Challenges, and Responses Emerging Challenges - Increase in number of communication channels vying for public's attention - Increase in number of health issues called to public's attention - Increasing ability for individuals to personalize and control their information flow Mass one-way communication (billboards, radio, TV) Printed educational materials Social marketing techniques Health Communication in the Contemporary Context: Trends, Challenges, and Responses Responses to Emerging Challenges - Multidimensional interventions targeting diverse audiences - Public/private partnerships and collaborations - Adoption of an audience-centered communications perspective Identification of target audiences' preferred formats, channels, and contexts of communication Tailoring of messages to the culture preferences, language, and media habits of the target audience - Use of the Internet and other interactive communications media Health Communication in the Contemporary Context: Trends, Challenges, and Responses Problems in the implementation of new health communications media and techniques - Ensuring quality control in content of health information available via the Internet - Protection of privacy and the confidentiality of personal health information - Development of rigorous methods for evaluating the effectiveness of health communication in these media - Limited Internet access in underserved communities - Illiteracy and limited literacy Health Communication in the Contemporary Context: Trends, Challenges, and Responses Implementing your Health Program Guidelines for developing culturally sensitive communications on page 175 Two examples of successful culturally sensitive delivery modalities - Promotores - Fotonovels Implementing your Health Program Guidelines for developing culturally sensitive communications - Acknowledge culture as predominant in shaping behaviors, values, and institutions - Understand and reflect diversity within a given culture - Reflect and respect audience values - Refer to target group using their preferred term(s) - Employ testing to determine the effectiveness of culturally specific images, terms, and other executional details that you are planning to use Implementing your health program Delivering culturally sensitive communications: Three examples of successful delivery modalities - Promotores/promotoras de salud Community members whose standing makes them effective promoters of positive health practices - Fotonovelas Comic book-like publications that use photos or drawings to convey information - Targeted messages in a variety of media Images/messages on posters, billboards and buses Pamphlets, flyers, and messages inserted in paycheck envelopes Evaluating Health Communication in a Multicultural Context Apply six-step CDC guideline for program evaluation Apply recognized principles of multicultural program evaluation Key principles of multicultural evaluation Evaluating Health Communication in a Multicultural Context Six-step CDC guideline for program evaluation Step 1: Engage stakeholders Step 2: Describe program Step 3: Focus the evaluation design Step 4: Gather credible evidence Step 5: Justify conclusions Step 6: Ensure use and share the lessons learned Evaluating Health Communication in a Multicultural Context Evaluating Health Communication in a Multicultural Context Key principles of multicultural evaluation - Address potential cultural/linguistic barriers to development of reliable data collection strategies - Assess existing evaluation methods for cultural appropriateness - Ensure that analysis and dissemination of findings to target audience are culturally competent Evaluating Health Communication in a Multicultural Context - Demystify cultural issues - Distinguish the effects of race/ethnicity, immigrant status, age, gender, sexual orientation, and socioeconomic status - Facilitate community's capacity for selfassessment of needs, resources, and solutions Evaluating Health Communication in a Multicultural Context Key principles of multicultural evaluation (Continued) - Inclusiveness in design and implementation - Acknowledgement/infusion of multiple world views - Use of cultural/systems analysis - Application of culturally appropriate measurements of success - Relevance of results to diverse communities Evaluating Health Communication in a Multicultural Context Essential skills in multicultural evaluation - Experience in diverse communities - Openness to learning about cultural complexity - Flexibility in design and practice - Ability to establish rapport and trust with diverse communities - Ability to recognize one's own cultural biases - Ability to translate and mediate to diverse groups - Understanding of historical/institutional oppression Evaluating Health Communication in a Multicultural Context The spectrum of cultural competence - Cultural incompetence: Cultural diversity completely unacknowledged - Cultural blindness: Some cultural awareness developed, but not to the point of being a primary factor - Cultural sensitivity: Cultural considerations begin to be incorporated into evaluation models - Cultural proficiency: Design and implementation of evaluation methods fundamentally honor and account for diverse cultural factors Summary Programs planners need to consider their target audience. Demographic factors, literacy levels, and other relevant factors need to be considered when selecting the delivery method and communication techniques. Pilot-tests and evaluations are needed to help ensure that your message is not offensive, is received as you intended it to be, and to determine the impact on your target audience. \f\f