Integrative Theory and Systems Thinking

Integrative Theory and Systems Thinking

Adaptation, Translation, and Global Application Chapter 19 Text DiClemente, R. J., Crosby, R. A., & Kegler, M. C. Issues and Challenges in Applying Theory in Health Promotion Practice and Research

Theory as a Road Map • Theory is instrumental to the: • Design • Implementation • Evaluation Of health promotion interventions / prevention activities It is important to choose the right one(s)!

Priorities for Advancing Theory • Testing in practice-based settings • Importance of evaluation research • Intervention Research • Efficacy vs. effectiveness • Internal vs. external validity • Context, Context, Context! (more later) • Generalizability: The utility of good common measurement systems

Priorities for Advancing Theory • Transferring across cultures • Context, context, context! In what sense? • So then, what is culture? • Identify stable theoretical constructs • Cultural relevance and appropriateness • No impact? What is to blame? • Adaptation/Transference Strategies: • Assessment • Deciding on the right theory • Use of experts

Priorities for Advancing Theory • Expanding Ecological Theories • Emphasis on multi-level understanding of individual, social and cultural environment. What’s missing? • A need to focus on leveraging change. How? • Fortify theoretical underpinnings? • Macro-level change and disparities • Feasibility • Flexibility

Biglan, A. (2004). Prevention Science, 5(1), 15-21 Contextualism and the Development of Effective Prevention Practices

Contextualist Framework • Contrasted from mechanistic models: truth criterion is “predictive verification” • Contextualism: truth criterion is “successful working” with emphasis on outcomes • Functional Contextualism, focusing on: • Identifying variables that allow the prediction of behaviors, and • Influencing (changing) behaviors via manipulation of environmental variables • How does the TTI fit this model?

Research to Practice • Research based on a mechanistic perspective does not make sense to integrate with practice. Why? (p. 17) • Contextualism: Novelty and generalizability • Uniqueness does not negate the possibility of analysis • Does not require that relationships be generalizable to other areas • Generalization infers sameness • Theory-making that focuses on change variables

Mitchie, S. et al. (2008). Applied Psychology, 57(4), 660-680. From Theory to Intervention: Mapping theoretically derived behavioural determinants to behaviour change techniques

A Need for guidance on how to develop theoretically-based techniques to change behavioral determinants.

Development of a Procedure • Step 1: Generating a list of techniques and definitions • Brainstorming • Researching textbooks • Creating a matrix (inter-rater reliability) • Step 2: Mapping techniques to behavioral determinants • Consultation with experts (Delta method)

Further Uses • Helpful in describing interventions that do not have an explicit theoretical basis (as long as they match with the 11 constructed domains) • Can be used to describe interventions published in journal articles • How else might they be useful?

Healthy Public Policy Primary & Secondary Prevention / Treatment Primary & Secondary Prevention / Treatment Levels of Causation for Health Levels of Causation Interventions Environmental Influences Social Position Organization & Community Interventions Social & Cultural Processes Primary & Secondary Prevention Psychological Processes Biological & Genetic Factors from McKinlay & Marceau (2000). Public health matters. Am J Pub Hlth, 90, 25-33, p. 29.

Scope of Health Sciences

Understanding the “Whole” System

TOBACCO USE UNHEALTHY DIET PHYSICAL INACTIVITY ALCOHOL POVERTY, ACCESS STRESS ENVIRONMENT ……… CVD DIABETES CANCER COPD MUSCULOSCELETAL ORAL HEALTH …….. QUANTITY OF QUALLITY LIFE YEARS Common Risk Factors 33

Social Norms and Values • Home and Family • School • Community • Work Site • Healthcare • Food and Beverage Industry • Agriculture • Education • Media • Government • Public Health Systems • Healthcare Industry • Business and Workers • Land Use and Transportation • Leisure and Recreation Sectors of Influence Behavioral Settings • Genetics • Psychosocial • Other Personal Factors Individual Factors Food and Beverage Intake Physical Activity Energy Intake Energy Expenditure Prevention of Overweight and Obesity Among Children, Adolescents, and Adults An Ecological Framework for Organizing Influences on Overweight and Obesity Energy Balance Adapted from: Koplan JP, Liverman CT, Kraak VI, editors. Preventing childhood obesity: health in the balance. Washington, DC: Institute of Medicine, National Academies Press; 2005.

Social Determinants of Health Status and Inequities: Four slides from … Krieger, N. (2008) Ladders, pyramids and champagne: the iconography of health inequities. Journal of Epidemiology and Community Health, 62, 1098-1103.

Krieger, N. (2008) Ladders, pyramids and champagne: the iconography of health inequities. Journal of Epidemiology and Community Health, 62, 1098-1103.

Best A, Stokols D, Green LW, Leischow S, Holmes B & Buchholz K. (2003) An Integrative Framework for Community Partnering to Translate Theory Into Effective Health Promotion Strategy. American Journal of Health Promotion, 18(2), 168-176. The next 3 slides are from:

Best A, Stokols D, Green LW, Leischow S, Holmes B & Buchholz K. (2003) An Integrative Framework for Community Partnering to Translate Theory Into Effective Health Promotion Strategy. American Journal of Health Promotion, 18(2), 168-176.

National Cancer Institute (2007) Greater than the sum: Systems thinking in tobacco control. Tobacco Control Monograph No. 18. Bethesda MD:.USDHHS, NIH, NCI. IH Pub. No. 06-6085, April 2007 [Edited by Best A, Clark PI, Leischow SJ, & Trochim WMK]

Integrative Theory and Systems Thinking