1.
S
• Aparna Subramaniam
• Unnati Shah
• Vibha Amblihalli
17th November, 2014

2.
INTRODUCTION
S Ecological models incorporate within them
constructs from models on psychological, social and
organizational levels along with community based
factors for a comprehensive framework to explain
health behavior.
S The crux of the ecological models is that it takes the
combination of individual level as well as policy level
interventions to bring about a sustained change in
health behavior.

3.
CORE PRINCIPLES OF
ECOLOGICAL MODELS
S Multiple levels of factors influence health behaviors.
S Influences interact across levels
S Multi-level interventions should be most effective in
changing behavior.
S Ecological models are most powerful when they are
behavior specific.

4.
Health Is Power: an Ecological
Theory-based Health
Intervention for Women of Color
S Rebecca E. Lee, Ph.D., Ashley V. Medina, B.S., Scherezade K. Mama,
M.P.H., Jacqueline Y. Reese-Smith, Ph.D., Daniel P. O’Connor, Ph.D.,
Marcella Brosnan, B.A., Catherine Cubbin, Ph.D., Tracy McMillan, Ph.D.
and Paul A. Estabrooks, Ph.D.
Contemporary Clinical Trials. November 2011 ; Vol 32, No 6; Pg: 916–923

5.
BACKGROUND
S Women of color are most vulnerable to the detrimental effects of
physical inactivity and poor dietary habits.
S Despite publicizing well the benefits of adopting physical activity
and fruit and vegetable consumption, the rates of both remained
low.
S Interventions that have focused on individual aspects have not
shown lasting success and maintenance of the new health
behavior has been difficult to achieve.
S This study describes the rationale, design and methodology of
Health is Power (HIP), a transcultural, community based,
randomized controlled trial.

6.
AIMS OF THE STUDY
S To study the effectiveness of an intervention that targets both
individual and environmental level influences to increase physical
activity and improve dietary habits in African American and Hispanic/
Latina women in Houston and Austin.
S The purpose of this study is to describe the methods used in
developing the Health is Power intervention, founded on the
Ecological Model of Physical Activity (EMPA).
S This study proposed to integrate group dynamics, individual
perceptions and social support to mediate the effect of intervention.
S Thus, HIP intervention is directed to change the group environment,
structure, and processes responsible for increased cohesion.

7.
METHODOLOGY
S Women were screened, recruited and assessed for the study.
S They were randomized into the physical activity or the
vegetable and fruit group.
S Subsequently, they completed six intervention group sessions
over a period of six months.
S Intervention sessions included brief instructions, team based
activities and discussion with the entire group led by a trained
health educator.

8.
Concept Theory Definition Study definition Operationalization
Multiple levels of
factors influence
health behavior
Factors at
intrapersonal,
interpersonal,
organizational,
community and
public policy can
influence health
behaviors.
The EMPA
conceptualizes
micro-, meso-, exo-and
macro-environmental
influences on
physical activity.
Micro-
Neighborhood
streets, physical
activity resources,
goods and services:
Meso- Direct team
participation; Exo-
Contacts and
connections.
Influences interact
across levels
The interaction of
influences mean
that variables work
together.
The EMPA
describes the
linkages and
processes among
environmental
settings and
behavioral choices.
Behavior
maintenance
strategies like
incentives to
complete goals, use
of daily monitoring
logs, promoting
neighborhood and
environmental
awareness

9.
Concept Theory Definition Study Definition Operationalization
Multi-level
intervention should
be most effective in
changing behavior
Educational
interventions
designed to change
beliefs and
behavioral skills are
likely to work better
when policies and
environments
support the targeted
behavior changes.
Increased
perceptions of
group cohesion,
individual
cognitions
related to
physical activity
and social
support were
hypothesized to
mediate the
intervention’s
effect.
Intervention sessions
included personal goal
setting, reducing
barriers, increasing
self- efficacy, social
support, neighborhood
survey.
Ecological models
are most effective
when they are
behavior specific.
Ecological models
appear most useful
to guide research
and intervention
when they are
tailored to specific
health behaviors.
Specific group
dynamics team building
strategies to increase
physical activity
(walked 15 minutes as
a group) or vegetable
and fruit consumption
(sampled two new
vegetables or fruits).

10.
Conceptual and theoretical model incorporating levels from the Ecologic Model of Physical Activity
and Group Cohesion to predict health behavior.

11.
RESULTS
S Interventions guided by the social ecological model
account for multiple levels of influence of initiating and
maintainng health behaviors for improved health
outcomes.
S Findings suggest that emphasis on existing social groups
like families would be more efficient than single focus on
women, men or children alone.

12.
STRENGTHS
S Unlike studies in the past, this intervention attempted
to address both environmental and individual level
characteristics.
S This intervention targeted not just promoting
enhanced initiation but also maintenance of
behavioral change.
S Group dynamics principles were integrated into
EMPA and adapted them to include dietary habits.
S The strategies and techniques that were developed
were couched in time tested behavioral strategies.

13.
LIMITATIONS
S The personal as well as group targets to be achieved
were self reported.

14.
IMPLICATIONS
S Women are the important behavioral gatekeepers.
S Dissemination efforts of data related to environmental
factors can be aimed towards urban planning and
transportation in order to encourage walking.
S The study findings can be distributed among researchers
and health promoters as a simple and effective strategy
to implement changes in health behavior.

15.
REFERENCES
S Rebecca E. Lee, Ph.D., Ashley V. Medina, B.S., Scherezade K.
Mama, M.P.H., Jacqueline Y. Reese-Smith, Ph.D., Daniel P.
O’Connor, Ph.D., Marcella Brosnan, B.A., Catherine Cubbin,
Ph.D., Tracy McMillan, Ph.D. and Paul A. Estabrooks, Ph.D.
Health Is Power: an Ecological Theory-based Health Intervention
for Women of Color. Contemp Clin Trials. 2011 November ; 32(6):
916–923
S Glanz, K., Rimer, B.K., Viswanath, K. (Eds.). (2008). Health
Behavior and Health Education: Theory, Research, and Practice.
San Francisco: Jossey-Bass, 4th edition.