Ecological Theories of Behavior Change

1. The Behavioral Ecological Model Ecological Theories of Behavior Change Jill C. Hoxmeier H 671 October 23, 2012

2. Ecological Models of Behavior Change “Reduction and prevention of morbidity and mortality in populations in a public health goal that can be achieved only by behavior change.” (Hovell, Wahlgren & Adams, 2009) • A Need for New Model of Health Behavior • Current approaches have limited success • In part due to theory, and in part due to focus on individual • Approaches need to be population-focused • Which HRB are you going to change?

3. Ecological Theories of Behavior Change • The Behavioral Ecological Model (BEM) • Links behavioral to biological sciences: Foundation for behavior and learning • Emphasis on ecological principles of selection of behaviors by consequences • At individual level and group/culture level • Mentalism vs. Contextualism • Friend who orders the salad / low-fat dressing… • What do we assume to the cause? • What could be the contextual cause? “Behavioral principles describe the relations between behavior and environment that account for the acquisition and maintenance of learned behavior.” – Glenn, 2004 (Hovell, Wahlgren & Adams, 2009)

4. Behavioral Ecological Model Social/Cultural Community Local Outside the Skin Individual Level Determine Likeliness of Specific Behavior Context Consequences Behavior Learning History Within the Skin Physiology Anatomy Genome (Hovell, Wahlgren & Adams, 2009)

5. Behavioral Ecological Model • Natural Selection • Genetic variants such as reflexes and ability to learn • Operant Selection & Conditioning • Reinforcements / Consequences select for operant behavior • Rush-hour traffic and selecting for commute time • Cultural Selection (Meta-Contingencies) • Practices select for behavior from contingencies of culture • What defines a “culture”? • Unlearned and Learned Reinforcers • Innate vs. Acquired • Conditional reinforcers can become extremely powerful if paired with multiple established reinforcers • Can we use money to reinforce or punish for certain HRB? (Hovell, Wahlgren & Adams, 2009)

6. The Cultural Level • Group Contingencies • Monitor and modify through group “culture” rules: bike vs. climb community • Cultural Practices • Repetition of learned behavior; Interlocking patterns of behavior • Metacontingencies vs. Macrocontingencies? • Aggregate product of group behavior… not interlocked at Macro-level Weight-Loss Support Groups vs. Nation-wide Weight-loss Media Campaign

7. Macrocontingencies: • Does… • Higher gas prices + higher food prices (because of gas prices) = less driving, more walking, and growing your own food? • Social Learning vs. Individual Learning • All learning is individual learning • Learning comprises the events... an individual organism relating to environmental events • The social content in the contingencies that support most of the learning accomplished by humans is a defining feature of cultures (Glenn, 2004)

8. Cultures: Complexity & Selection “Unintended and culturally damaging results of ongoing human behavior are first identified, then bemoaned, and sometimes, finally dealt with… But can they be dealt with fast enough to ensure survival?” (Glenn, 2004) • Examples of culturally damaging results of human behavior? • Warning signs of predictive delayed impact? • Responsible“subcultures”?

9. Meta-Contingencies: Is it too late for the cultural shift? The more widespread a practice, the greater its cumulative effects; the greater the cumulative effects, the more important they are to the well-being of large numbers of people.” (Glenn, 2004) • Question for the class: • What is the meta-contingency context in which the HRB exists?

10. If time permits… evidence to support BEC

11. BEC: Framework for Early WIC Participation (DeBate, R. & Pyle, F, 2004) • Purpose: assess determinants of early WIC participation in NC county. • Measurement:Likert-type questionnaire to assess intrapersonal, interpersonal, organization/system, and community/cultural contingencies • Result: barriers at all levels influence WIC participation • Recommendations: BEC framework to account the personal, cultural, and environmental influences that promote the adoption of positive HRB

12. BEC: Framework for WIC Participation Measurement: 42 item survey using _____ to assess the following. With a partner, develop one survey item for each individual level contingency. • Individual Level Contingencies: • Perceived threat • Perceived benefits • Perceived barriers • Self-efficacy • Cues to action • Does this sound familiar?

13. BEC: Framework for WIC Participation • Individual Level Contingencies: Perceived Threat • I believe a pregnant woman can feel sick if she does not eat right • I believe a baby may be born with health problems if its mother does not eat well during pregnancy • I believe a newborn baby could get sick if it is not properly fed • Individual Level Contingencies: Perceived Benefits • WIC helps me to eat better • My baby benefits from WIC • I believe I am healthier because I eat WIC foods • Individual Level Contingencies: Perceived Barriers • I don’t like to use the food vouchers WIC provides

14. BEC: Framework for WIC Participation • Individual Level Contingencies: Self-Efficacy • Changing the foods I eat was hard to do • Changing the foods my children eat was hard to do • Individual Level Contingencies: Cues to Action • Have you used WIC during previous pregnancies? • I heard about WIC through (friend, family, neighbor, church, health dept., hospital)

15. BEC: Framework for WIC Participation • Local Network: Family, Friends, and Co-Workers • My friends and family have used WIC services • I heard about WIC through (friend, family, neighbor, church, health dept., hospital) • Community Contingencies: Policies/Cultural Competency • The people on the WIC staff are helpful • I believe the people at WIC respect me • It was hard to get on WIC • Social Contingencies: Normative Beliefs, Laws, Policies • It is hard to get on WIC because I have transportation problems

16. BEC: Framework for WIC Participation As a class, what are some strategies we can develop to address the barriers found by the BEC survey? • Local Network: Family, Friends, and Co-Workers • Community Contingencies: Policies/Cultural Competency • Social Contingencies: Normative Beliefs, Laws, Policies

17. BEC Framework Interventions • Local Network: Family, Friends, and Co-Workers • Increase awareness of WIC program • Increase awareness of WIC among social networks • Provide incentives for referral • Community Contingencies: Policies/Cultural Competency • Increase helpfulness of staff • Increase ease of entering program • Increase hours of operation • Decrease length of time in between client contact and first appointment • Social Contingencies: Normative Beliefs, Laws, Policies • Increase awareness of WIC program to all associations, coalitions, formal and information leaders • Increase awareness of WIV benefits • Provide incentives to refer target population to WIC • Develop culturally appropriate social marketing plans which markets WIC benefits of WIC to ethnically divers sub populations • Implement a culturally appropriate social marketing plans which market WIC benefits of WIC to ethnically diverse populations