About Heart Disease and Stroke

The social-ecological approach, which highlights particular individuals and the setting that affects their health, is crucial for advancing public health. The effectiveness of these measures in promoting public health habits, however, is not fully understood. The authors have been able to recognize these techniques by applying them to 150 distinct articles published in Health Education and Behavior during the previous 20 years by using a coding system. From the research done in this journal, it was identified that most of the research done based on the article, were focused on certain topic such as nutrition and most based on school settings.

Introduction

It is evident that most fields that focus on promoting public health face various criticisms. It is thought that these fields often ignore the forces that affect health directly while focusing on lifestyle changes. From the articles selected, the authors argue that Specific individual and environmental changes used by different program are useful when identifying intervention levels. It can be argued that social, physical, and cultural view of the environment has an effect on health.

The aim of this study is to identify ecological levels that have received attention than others to promote public health. This study also focuses on the determination of the extent to which, most research programs use multiple levels of ecological changes at the same time. These results may be useful to researcher using these interventions. It will also help to identify influences of these interventions in public health therefore, advocating for their inclusion in the future public health work.

Methodology

The information obtained for the analysis was designed to well represent articles in Health Education and Behavior journal that will describe interventions that could be resolved by use of social ecological models. Medline database was used to identify those articles that had “intervention” as the key word. This was done in any search field, including the Health Education and Behavior journal itself. The Medline database was able to identify 236 articles.

Identification of the relevant articles that actually talked about interventions was done by reading the abstract and labeling those that were relevant. A second opinion from a second reader to concur with the removal of those articles that recommended for removal. From this process, 79 articles were eliminated with 157 articles remaining for review using social ecological evaluation tool.

A coding system, which was designed to identify intervention activities, objective to change, program setting and information based on the interventions described in the articles. By use of two readers, the coding system was then tested and revised to clarify the code. It was then applied to all 157 articles that had been sampled. Certain categories in the assessment tool were listed to determine the number and the type of social ecological levels indicated intervention articles. These level specific grouping were guided by the McLeroy et al five-level model. The analysis of the analysis of social ecological model was conducted in two approaches.

These approaches were both activities and target for change. Under activities, grouping was based on individuals who received training, education, and skill enhancement. For example, members of education, training and skill enhancement institutions in beyond intervention targets, modification of institutional environment, and policies were analyzed as institutional-level activities. Type of health behavior determinant that was identified and measured in the article was used to identify intervention targets.

Those interventions that target knowledge, perceptions, intentions, or self-efficacy of the target population were analyzed as intrapersonal levels. For analysis to done the code were then run into Access database where they were converted by conventional statistical software. A series of Pearson chi-square test together with descriptive statistics was conducted.

Results

From the 157 articles that were selected 132 of them describe unique interventions and addressed 21 different behaviors in 8 different environmental settings. School and communities were found to the most common setting with one third of them addressing nutrition. Other article described the results of impact of these interventions while others focused on the process evaluation information. Most articles were more likely to discus interventions activities and targets for change for the lower level of the social economic model. This article has well outlined it results by use of graphs and tables. These supporting data has clearly described interventions activities and target of change at different levels of social ecological model.

Discussion

From the article analyzed in this study it has been identified that calls for the use of a multilevel interventions has not been widely accepted. It may be unrealistic to expect any single intervention to focus on a multilevel model given the limited scope and resources which are available for these interventions. However this social ecological intervention may be useful as a tool to improve our understanding of the health behavior.

The number of articles used for this study represents a small percentage of the work done in health promotion studies. There could be limitation by the Medline database system of the number of article that describes health education and behavior in the relevant time period. The article used in this journal may reflect editorial preferences for interventional type rather than accurately sampling work in the field since these articles are a subset of all health promotion work.

Presence of large multilevel project and use of an inclusive coding strategy suggests that the estimated upper and multilevel projects are likely to be inflated in comparison to actual fieldwork. It can be conclude from the analysis that health educators need to put more emphasis to extend efforts to better address the structural level of the of social ecological influence. There is need to increase focus on the contextual and social determination of health and offer new tools to help health practitioners. From this study, it is critical that improvements are made in both research and practice, multilevel intervention dissemination, through peer-reviewed journals, professional society, and public health network.



References

http://journals.sagepub.com/doi/abs/10.1177/1090198111418634