Course: Social and Behavioral Foundations of Primary Health Care

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Course Description

Social and Behavioral Foundations of Primary Health Care aims at providing you with the knowledge and skills needed to diagnose (understand) community, individual, and organizational behaviors and change processes in developing countries and in cross-cultural settings as a foundation for planning culturally appropriate primary health care (PHC) in the context of the ecological model of health behavior.

Course Objectives

After completion of this course, you will be able to do the following:

  • Outline the contributions of social and behavioral science theory in the planning and implementation of PHC programs.
  • Apply relevant social and behavioral theories to diagnose and understand individual, social network, organizational, community, and policy-maker behaviors associated with the planning, implementation, evaluation, and maintenance of community-based primary health care programs.
  • Identify the factors that promote and inhibit community involvement in PHC program development and implementation, and outline indigenous management strategies to sustain PHC at the community level.


Recommended reading: Green LW and MW Kreuter. Health Promotion Planning. Mayfield Publishing Company (ISBN: 0767405242, Hardcover 3rd edition, February 1999).

Order from Matthews Johns Hopkins Medical Book Center: 1830 East Monument Street, Baltimore, MD 21205 USA; 410.955.3931; 800.266.5725; 410.955.0576 Fax

Course Philosophy

Graduate education is a self-directed approach to learning. Thus, the instructor is more of a resource than a vessel from which knowledge is poured. This means that the student and the instructor are engaged in a partnership that fosters active learning. Because there is a sizable amount of information to cover in only a term, all parties must share the responsibility for learning. It is largely through the process of self-discovery that new concepts are internalized.

Cleary MJ, Stuhldreher WL, Bavaro JA, Lindsay JE, Taylor LMS, Birch DA (1997). "Using Teaching Portfolios to Enhance Teaching Effectiveness in Health Education." American Journal of Health Studies; 13(1): 33 - 43.

Course Topics

  • Basic PHC concepts and processes
  • Social dimensions of the PHC approach
  • The social and cultural context of health
  • Health behavior, units of identity
  • The change process
  • The ecological model
  • Theories and models of individual behavior
  • Culture, folk illness, and epidemiology: explanatory models
  • The household as a basic health unit
  • Social networks: implications for AIDS
  • Social support systems
  • Social change theories
  • The concept of community
  • Empowerment: the process of community organization
  • The effects of participation
  • Social networks and the diffusion of innovations
  • Organizing through local groups
  • Organizational change and adaptation
  • Community management of PHC programs
  • Levels and strategies of policy change for PHC development
  • Integration: viewing the ecological levels together

Course Format

The course is based around the ecological model that views health behavior in broader social, political, cultural, and economic contexts. Each module explores a different level of the ecological model.

Each week consists of lectures and lab assignments. For each lab assignment, you're encouraged to work together in assigned groups to informally discuss lab topics. Several days before each lab assignment is due, the class will meet online in a LiveTalk session to discuss the lab assignment. Please come prepared to ask questions and initiate discussion.

Lab Assignments

There are seven lab assignments during the course, which constitute 100% of your grade.

Most labs contain both a small group component plus an individual component. In these instances, the groups will first discuss the topics, sharing experiences and ideas; then members will individually write up the assignments to be submitted via email a few days later. Two of the seven labs will be conducted solely as group efforts. You will receive group assignments during the first week of class. All groups will be formed with an effort to put together people in same time zone to make communications easier. You are encouraged to use email, DED Messenger (live chats with audio), the BBS, or any other communication mechanism to conduct group work.


All labs are accessible on the first day of the course so that you can plan ahead and work flexibly to complete the assignments, if you would like to, according to your and your group's optimal pacing. All labs, though, are tied conceptually to the lectures, so it is ideal to review the corresponding lecture material before completing the labs.


Lab topics:

  • Lab 1: Social Sciences in PHC - Ecological Model, Health Behavior Analysis
  • Lab 2: Applying and Comparing HBM, SLT, and TRA
  • Lab 3: Applying PRECEDE Framework and Transtheoretical Model
  • Lab 4: Social Support and Social Networks
  • Lab 5: Community Change Case Studies
  • Lab 6: Organizational Change Case Studies
  • Lab 7: Policy Stakeholder Analysis

Group members' responsibilities:

The goal of small group work in the labs is for you to share your knowledge and skills with your fellow group members, and for all group members to benefit from the mutual sharing. For this to optimally take place, each group member should do the following:

  • Punctually attend group sessions as scheduled (DED Messenger and chats in LiveTalk area as scheduled by groups)
  • Contribute meaningfully to group discussions
  • Complete the group assignments on time
  • Prepare work in a quality manner
  • Demonstrate a cooperative and supportive attitude
  • Contribute overall to the success of the project

Grading Scheme


1. Sciences ini PHC - Ecological Model, Health Behavior Analysis


2. Applying and Comparing HBM, SLT, and TRA


3. Applying PRECEDE Framework and Transtheoretical Model


4. Social Support and Social Networks


5. Community Change Case Studies


6. Organizational Change Case Studies

7. Policy Stakeholder Analysis 30



Final grades:
A+ = 237.5 - 250
A = 212.5 - 237
B = 187.5 - 212
C = 162.5 - 187

Late policy: We recognize that people will experience personal, work-related or other problems that make it difficult to submit assignments on time. If you experience such problems, please notify us BEFORE the deadline for a particular assignment and give us an estimated submission date. Late assignments without such notification will be docked 1 point for each day late.

Time Commitment

The course evaluations submitted by students during the most recent offering of this course (Summer term Academic Year 2003-04) indicated that successfully completing the course involved a range of time commitments, as follows:

  • 19% of all students evaluated spent fewer than 11 hours per week
  • 31% of all students evaluated spent 11 - 15 hours per week
  • 50% of all students evaluated spent 16 - 20 hours per week
  • 0% of all students evaluated spent more than 20 hours per week