1.  Introduce new project at PSHMC
 Discuss ethnography and field site projects
 Review and discuss assignment 3

4. – Significant socio-economic barriers
– Lowest level of socio-economic barriers

5. USDA Food Desert Locator
http://www.ers.usda.gov/data-products/food-desert-locator/go-to-the-locator.aspx

6.  How do we work with community
organizations to improve access to healthy
foods and education/information?

13.  An empirical research
method for learning
about cultural
phenomena and
discovering the nature
of peoples

14. Learning the culture of the group
under study before deriving
explanations of their
attitudes/behavior
Physical geography and climate

15.  Historical research
 Active field notes
 Participant observation
 Interviews
 Questionnaires
 Geography/topography

20.  Build a rich history of your site
 Develop relationships & trust
 Identify key informants
 Take rigorous notes & cross-check
with informants
› Quote your informants
 Understand your biases and assumptions
 Keep an open mind

21. Assignment 3
Final assignment

23.  Give voice to an underserved population
 Contextualize your observations
 Identify themes and patterns that can inform
effective intervention strategies
 Determine variables for future research and
develop a testable hypothesis
 Propose more culturally-sensitive plans for
project implementation
 Identify key questions about existing programs
and policies

24.  You are not a consultant, you are a learner
 We are not expecting you to ‘save’ the
organization or its clients
 Think long-term about your involvement
with the organization
 There will be many opportunities for
leadership/action in medical school
Questions or concerns? dgeorge1@hmc.psu.edu
C1747 – Diversity Office

25.  Goals:
› Eliminate preventable disease, disability, injury,
and premature death
› Achieve health equity, eliminate disparities, and
improve the health of all groups
› Create social and physical environments that
promote good health for all.
 Goals (cont.)
› Promote healthy development and healthy
behaviors across every stage of life.
 Objectives
› 37 focus areas

26.  Models serve as frames from which to
build; Provide structure & organization
for the planning process
 Many different models, common
elements, but different labels.
A Generalized Model for Program Planning
26

27.  Biology/
Genetics
 Behaviors
 Social
Environment
 Physical
Environment
 Policies and
Interventions
 Access to
Quality Health
Care/ Services
27

28.  Assessments
 Summary (III)
• Social
• Justify need for an
• Environmental intervention/program
The way • Behavioral • Identify possible solutions
it is… What are the behaviors (interventions) to health
Describe that impact health problem
I problem?  Next Paper: The
Program/Intervention
• Risk and Protective
Analyzing Factors Associated I
targeted with/Influence II
behavior Behaviors
II III
28

29. ?
29

30. 30

31.  Radiation Exposure  Infectious Agents
 Workplace Hazards  Auto/Road Design
 Home Hazards  Speed Limits
 Contaminants  Medical Care Access
 Media  Product Design (e.g., handgun)
 Political Systems  Noise
 Migration  War/Civil Conflict
 Global Warming  Deforestation
 Recreational space  Adequate Surveillance Systems
31

32.  Geography  Discrimination
 Age  Residence
 Race  Literacy
 Education  Isolation
 Crime  Family Composition
 Income  Faith/Spirituality
 Unemployment  Culture
 Roles  Gender
32

33.  Access to care
 Quality of care
 Access to interventions
 Representativeness in
policy development
 Equity and justice
33

34. Hi! I’m the
Literature!
34

35. 35

36.  Behavior = What people do or don’t do
 Factors = influence behavior
An analysis of the determining (predisposing
[facilitate or hinder person’s motivation to change,
e.g., knowledge, attitudes, beliefs, etc.], enabling
[barriers or vehicles created by society or system,
e.g., access to hl, resources, rules, etc.], and
reinforcing [feedbacks & rewards by peers, relatives,
employers, etc.]) factors that influence the chosen
behavior and health problem.

37. 37

38.  Awareness and Knowledge
 Beliefs, Values, and Attitudes
 Perceptions of Susceptibility,
Seriousness, Benefits, & Cost
 Personal Histories
 Behavioral Intentions
 Existing Skills
38

39. 39

40.  Health Care Environment.
› Facilities, clinics, providers, etc.
› Cost, distance, transportation, hours, etc.
 Other Environmental Conditions.
› Availability of fast food, cigarettes, billboard,
alcohol , sports, laws, etc.
 Skills – ability to perform task.
40

41.  Social Support
 Family and Peer Influences
 Advise/Feedback from Providers
 Benefits of the Treatment/Action
 Social and Economical Benefits
 Adverse Consequences
41

42.  Theory - “a set of interrelated concepts,
definitions, and propositions that present a
systematic view of events or situations by
specifying relations among variables in order to
explain and predict the events of the situations”
(Glanz, Lewis, & Rimer, 2002, p. 25)
 Concept - primary elements of theories or
building blocks of theory (Glanz et al., 2002)

43.  “A theory based approach provides direction and
justification for program activities and serves as
the basis for processes that are to be
incorporated into an intervention/program
(Cowdery et al., 1995, p. 248)
 “Theories can provide answers to program
developers’ questions regarding why people
aren’t engaging in a desirable behavior of
interest, how to go about changing their
behaviors, and what factors to look at when
evaluating a program’s focus” (van Ryn &
Heaney, 1992, p. 326).

44.  Perceived Susceptibility – is he/she
vulnerable to health problem?
 Perceived Seriousness – how serious is
the the illness/problem?
 Perceived Benefits – anticipated value of
the recommended action.
 Perceived Barriers – cost involved in
taking a particular action.
 Motivation/Cues to Action & Self-efficacy.

45.  Stages of Changes
› Precontemplation.
› Contemplation.
› Preparation.
› Action.
› Maintenance.
› Termination. *Relapse
 Decisional Balance – pros vs. cons.

46.  Attitudes – toward performing the behavior.
 Subjective Norm – influence of other people
(i.e., parents, friends).
 Intentions – probability of performing.
 Behavior – the actual action.