Socio-ecological Model Of Health Research Articles

Exploring social workers' use of the socioecological model as an intervention and research framework for treating overweight or obese clients.

The purpose of this study was to identify the empirical contribution made by the social work profession in the prevention and treatment of overweight and obesity. The constructs of the socioecological model of health, which suggest that there are multiple levels of influence on individual behaviors, were used as a conceptual framework to synthesize studies authored by social work researchers investigating overweight and obesity risk factors. A review of obesity-related research written by social workers published over an unrestricted time was conducted. The author found 51 articles in published peer-review journals written by social workers from 1993 to 2013. The reviewed studies included participants living in the United States, China, Israel, and Australia. Findings indicate that the majority of research conducted by social workers address overweight and obesity treatment and consequences at the individual level, and there is little on how social workers plan to address this issue from community-level or policy-related perspectives. This review is the first comprehensive study of social workers' empirical coverage of varying levels of influences affecting obesity. Practice and policy implications are discussed for social work professionals employed in community settings.

The use of a collaborative structured methodology for the development of a multifaceted intervention programme for the management of asthma (the MIA project), tailored to the needs of children and families of South Asian origin: a community-based, participatory study

BackgroundAsthma is one of the most common chronic childhood illnesses in the UK. South Asian children are more likely to suffer from their asthma and be admitted to hospital. While this inequality needs to be addressed, standard behaviour-change interventions are known to be less successful in minority ethnic groups. Evidence suggests a need to enhance services provided to ethnic minority communities by developing culturally sensitive tailored interventions.ObjectivesThe Management and Interventions for Asthma (MIA) project aimed to test an iterative multiphase participatory approach to intervention development underpinned by the socioecological model of health, producing an intervention-planning framework and enhancing an evidence-based understanding of asthma management in South Asian and White British children.DesignInterviews and focus groups facilitated by community facilitators (CFs) were used to explore knowledge and perceptions of asthma among South Asian communities, children, families and healthcare professionals (HCPs). A smaller comparison group of White British families was recruited to identify aspects of asthma management that could be addressed either by generic interventions or by a tailored approach. Collaborative workshops were held to develop an intervention planning framework and to prioritise an aspect of asthma management that would be used as an exemplar for the development of the tailored, multifaceted asthma intervention programme.SettingThe community study was based in a largely urban environment in Leicester, UK.ParticipantsParticipants were recruited directly from the South Asian (Indian, Pakistani and Bangladeshi) and White British communities, and through the NHS. Children were aged between 4 and 12 years, with a range of asthma severity.Intervention developmentThe study had four phases. Phase 1 consisted of an evidence review of barriers and facilitators to asthma management in South Asian children. Phase 2 explored lay understandings of childhood asthma and its management among South Asian community members (n = 63). Phase 3 explored perceptions and experiences of asthma management among South Asian (n = 82) and White British families (n = 31) and HCP perspectives (n = 37). Using a modified intervention mapping approach incorporating psychological theory, phase 4 developed an intervention planning framework addressing the whole asthma pathway leading to the development of an exemplar multifaceted, integrated intervention programme called ‘ACT [Awareness, Context (cultural and organisational) and Training] on Asthma’.ResultsData on the social patterning of perceptions of asthma and a lack of alignment between the organisation of health services, and the priorities and competencies of British South Asian communities and families were produced. Eleven key problem areas along the asthma pathway were identified. A four-arm multifaceted tailored programme, ‘ACT on Asthma’, was developed, focusing on the theme ‘getting a diagnosis’. This theme was chosen following prioritisation by families during the collaborative workshops, demonstrating the participatory, iterative, phased approach used for the intervention design.ConclusionsThe MIA study demonstrated barriers to optimal asthma management in children at the family, provider and healthcare system levels and across the whole asthma pathway. Interventions need to address each of these levels to be effective. Minority ethnic communities can be successfully engaged in collaborative intervention development with a community-focused and culturally sensitive methodology.Future workFurther research is required to (1) assess the feasibility and effectiveness of the proposed ‘ACT on Asthma’ programme, (2) develop methods to increase active participation of children in research and service development, (3) develop and test strategies to enhance public understanding of asthma in South Asian communities and (4) identify effective means of engaging the wider family in optimising asthma management.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

Development of tailored and integrated health-care interventions to reduce inequalities in health outcomes: the Management and Interventions for Asthma (MIA) project

BackgroundSouth Asian children are more likely than others to suffer from their asthma and be admitted to hospital. The UK Public Health Outcomes Framework focuses on partnership across locally led systems to plan and deliver health-care services in the context of broader social determinants of health. The Management and Interventions for Asthma (MIA) project aimed to embody localism by using a collaborative, participatory model to develop an intervention designed to improve asthma management in South Asian children. MethodsThe project was multi-phase, iterative, and participatory, underpinned by the socio-ecological model of health, recognising the importance of issues arising from the individual, family, wider community, and organisational and environmental contexts of family health. Building on this model, the project worked collaboratively with linguistically and culturally competent community facilitators (CFs), to engage and develop a partnership between South Asian community members, parents and children living with asthma, health-care professionals (HCPs), and researchers. The study had four phases. Phase 1 consisted of an evidence review of barriers and facilitators to asthma management in South Asian children. Phase 2 explored lay understandings of asthma in South Asian children using focus groups (n=67) with members of South Asian communities (Indian, Pakistani, Bangladeshi) recruited by trained CFs. Phase 3 explored experiences of asthma management via semi-structured interviews with South Asian and White British parents and children (n=82 participants) recruited from the NHS and by CFs and included semi-structured interviews with HCPs (n=37). Focus groups and interviews were done in the preferred language of the participants. Focus group facilitators and interviewers were trained and supervised to reduce bias. Data were analysed with principles of interpretive thematic analysis facilitated by NVivo. Interviews with a comparison sample of White British parents and children (n=31) identified aspects of asthma management that could be addressed by generic interventions and those needing a tailored approach. Data from phases 1–3 were combined with thematic analysis to identify 11 key themes that needed to be addressed to optimise asthma management. In phase 4, an intervention planning framework was developed, with a novel modified intervention mapping approach incorporating psychological theory. Collaborative workshops, including parents, children, academics, and HCPs, were held to integrate data, develop an asthma intervention planning framework, and prioritise one aspect of asthma management to be used as an exemplar for the tailored intervention programme. FindingsThe 11 key themes were: being able to talk to doctors and nurses, being able to use services, community awareness of asthma, getting a diagnosis, having suitable information on asthma, medicines for asthma, school and my child's asthma, services available for asthma, quality of care, understanding asthma, and what to do day to day. Parents chose getting a diagnosis as a priority and a multifaceted programme, ACT (awareness, context, training) on asthma, was developed as an exemplar intervention, consisting of community awareness, education and training, clinical support, and a central advice centre, coordinated by a central team. Recruitment targets were exceeded and participants gave positive feedback. InterpretationKey issues in optimum asthma management in children arise at the patient, provider, and health-care system levels and interventions must address all these levels. Minority ethnic communities can be successfully engaged in collaborative intervention development with a community focused and culturally sensitive methodology. FundingNIHR Health Services and Delivery Research (HS&DR) Programme (09/2001/19). Views and opinions expressed those of the authors and do not necessarily reflect those of the HS&DR Programme, the NIHR, the NHS, or the Department of Health.

Accessing maternal and child health services in Melbourne, Australia: reflections from refugee families and service providers.

BackgroundOften new arrivals from refugee backgrounds have experienced poor health and limited access to healthcare services. The maternal and child health (MCH) service in Victoria, Australia, is a joint local and state government operated, cost-free service available to all mothers of children aged 0–6 years. Although well-child healthcare visits are useful in identifying health issues early, there has been limited investigation in the use of these services for families from refugee backgrounds. This study aims to explore experiences of using MCH services, from the perspective of families from refugee backgrounds and service providers.MethodsWe used a qualitative study design informed by the socioecological model of health and a cultural competence approach. Two geographical areas of Melbourne were selected to invite participants. Seven focus groups were conducted with 87 mothers from Karen, Iraqi, Assyrian Chaldean, Lebanese, South Sudanese and Bhutanese backgrounds, who had lived an average of 4.7 years in Australia (range one month-18 years). Participants had a total of 249 children, of these 150 were born in Australia. Four focus groups and five interviews were conducted with MCH nurses, other healthcare providers and bicultural workers.ResultsFour themes were identified: facilitating access to MCH services; promoting continued engagement with the MCH service; language challenges; and what is working well and could be done better. Several processes were identified that facilitated initial access to the MCH service but there were implications for continued use of the service. The MCH service was not formally notified of new parents arriving with young children. Pre-arranged group appointments by MCH nurses for parents who attended playgroups worked well to increase ongoing service engagement. Barriers for parents in using MCH services included access to transportation, lack of confidence in speaking English and making phone bookings. Service users and providers reported that continuity of nurse and interpreter is preferred for increasing client-provider trust and ongoing engagement.ConclusionsAlthough participants who had children born in Melbourne had good initial access to, and experience of, using MCH services, significant barriers remain. A systems-oriented, culturally competent approach to service provision would improve the service utilisation experience for parents and providers, including formalising links and notifications between settlement services and MCH services.

2011… a year of celebrations

In the year 2011, the International Union for Health Promotion and Education (IUHPE) is celebrating 60 years of dedication to health promotion. There are, in history, epoch making events. The birth of the IUHPE occurred just after the end of the war and just after the establishment of the World Health Organisation (WHO), two events which had a great influence on the atmosphere of reconstruction of a new life for Europe and for the world, in an effort to explore and promote values articulated in terms of philosophy and action. The governing idea in planning and launching the IUHPE was the establishment between all health workers of closer links and the promotion of mutual understanding which would contribute to constant progress (1). In the year 2011, we are also celebrating the 25th anniversary of the Ottawa Charter for Health Promotion. It is a unique and exceptional time to reaffirm our engagement for a more equitable world and to contemplate with optimism changes for the future. We are therefore celebrating two events in our professional environment, a framework to guide our efforts at all levels whether political, academic and operational levels or local, regional, national and international, with respect of and in complementarity to our respective roles and missions. We are celebrating the cutting edge of public health. We are celebrating the role of health promotion as a public health response to challenges posed by our societies. We are celebrating principles and values that unite us into health promotion, that guide us and that enable us to identify in a world increasingly entangled with concepts, more or less consensual theories and practices. These values and principles form the habits of mind that in turn provide a common basis for the practice of health promotion. These include: a socio-ecological model of health that takes into account the cultural, economic, and social determinants of health; a commitment to equity, and social justice; a respect for cultural diversity and sensitivity; a dedication to sustainable development; and a participatory approach to engaging

Characteristics of physically active and inactive men from low socioeconomic communities and housing estates: a qualitative study using the socioecological model

This qualitative study compares experiences of men from low socioeconomic status (SES) communities who achieved sufficient physical activity (PA) with those who did not. The socioecological model of health guided interviews with men (n=25) and community health workers (n=4) to explore individual, interpersonal, organizational, community, environmental and policy influences on PA participation. Men generally reported that they had poor health, financial barriers, were unfamiliar with community PA facilities and programs, had limited social support, and lived in unsafe neighbourhoods. There were clear differences between active and inactive men. Inactive men described their inability to cope with poor health, and consequent perceptions of disconnection. They did not identify positive PA outcomes and seemed consumed by stressful life situations. Active men identified barriers to existing programs such as the exclusive culture of PA facilities. It is important that personal circumstances are understood, and financial and cultural barriers addressed to promote PA among men from low SES communities.

Using a Socioecological Approach to Examine Participation in Sport and Physical Activity Among Rural Adolescent Girls

Adolescence is a critical time for developing lifelong healthy behaviors, including active lifestyles. Participation in sport and physical activity, however, declines during adolescence, and few studies have comprehensively identified why, particularly among rural girls. This article identifies a range of independent and interacting factors that influence sport and physical activity participation of rural adolescent girls. The socioecological model of health was used to guide four focus group discussions with Grade 7 girls (n = 34). The results showed that adolescent girls were positively influenced when sports or physical activities were fun, when they involved being with friends, and when they were supported by families and teachers through role modeling and positive feedback. A range of intrapersonal and organizational factors affected perceived self-competence, particularly the coeducational nature of school physical education classes and peer teasing, which supported social comparisons of skill level. In promoting sport and physical activity to rural adolescent girls, focus must be directed on developmentally appropriate activities that are fun, offering opportunities for single-sex classes, and generating cultural changes that encourage noncompetitive and self-referencing activities.

Meeting the information needs of the ‘Health for all’ challenge—lessons from Scotland

To create a public health data resource for Scotland that is based on a socio-ecological model of the determinants of health and would, therefore, meets the needs of the emerging public health agenda. Action research, in which the approach moved logically through stages of action (conception, feasibility study, pilot projects, leading to a national set of integrated health and well-being profiles). Each stage built on the results of the previous research. The conceptual stage identified the need for an approach to public health data that kept pace with the increasingly accepted socio-ecological models of the determinants of health. A feasibility study concluded that sufficient data were available to populate the health fields that represented the important determinants of health. At this time strengths and weakness in data were defined. This led to the articulation of a 'vision' for integrated public heath data in Scotland that was the subject of a wide consultation. Pilot studies provided local stakeholders with imaginatively presented data (on population demographics, health and function, behaviour, social environment, economy, physical environment, morbidity and mortality) for their local communities. The response to these was so positive that a demand was created for a comprehensive set of 'community profiles'. These, in addition to parliamentary constituency profiles, have now been created and widely disseminated. It has been possible, despite many difficulties, to develop approaches to public health information that are informed by the socio-ecological model of health and create outputs that represent a significant advance on previous approaches to public health data. This is a work in progress and many issues remain unresolved. Interaction with others engaged in parallel tasks will facilitate the next steps.