Course: Health Behavior Change at the Individual, Household and Community Levels

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Readings


Topic Readings
Module 1: Culture, health and illness

Class 1, Hour 1

Introduction

Disciplines and fields of study:

Wikipedia:

Class 1, Hour 2

Do we understand each other? Translation problems in behavior change interventions

Terms and Concepts:

Further reading

Class 2, Hour 1

Illness etiologies, levels of causality, standards of efficacy

Terms and concepts:

  • Etiology/Aetiology
  • Personalistics and naturalistic etiologies
  • Equilibrium model
  • Levels of causality: efficient or ultimate cause versus instrumental or immediate cause
  • Divination

Assigned reading

Further reading

Class 2, Hour 2

Standards of efficacy

Terms and concepts

  • Rationality
  • Empirical
  • Scientific, empirical and symbolic efficacy
  • Self-limiting illnesses
  • Externalizing and internalizing systems
  • Symptom perceptualization
  • Nosology
  • Nosolocial fusion

Assigned reading

Further reading

Class 3, Hour 1

Meanings of medications, metonymy

Terms and concepts

Assigned reading

Class 3, Hour 2

Discussion session #1 - Standards of efficacy

Assigned reading (tested in online quiz)

Further reading

Discussion questions

  1. How would you apply the concepts of scientific, empirical and symbolic efficacy to the article by Nations and Rebhun?
  2. How do the arguments presented by van der Geest and White for why people take medications fit with Young's model for why people take treatments/medications?
  3. What is symptom perceptualization (Young 1980, starting bottom of page 108), and how does it help us understand how people respond to the symptoms of chronic infectious and non-infectious diseases (schistosomiasis, syphilis, AIDS, cancer) and global threats such as climate change?
  4. How can concepts of empirical efficacy presented by Young be extended to analyzing the public and policy debate on responding to climate change?
Module 2: Health behavior at the individual level

Module 2 General

Resources on models of health behavior change applicable to the entire module

The definitive resource on models of health behavior is:

Class 4, Hour 1

Health belief model

Terms and concepts

Assigned reading

NCI: Theory at a Glance: A Guide for Health Promotion Practice. 2nd Edition. pp. 52. Bethesda MD: National Cancer Institute; 2005:52.

  • Part 1, Foundations of Theory, Pages 3 to 8
  • Part 2 (first section), Theories and Applications, Pages 9 to 14.
  • Pay particular attention to Table 2 on Page 14

Optional reading: read one of these examples of application of the health belief model

Class 4, Hour 2

Theory of reasoned action, theory of planned behavior

Terms and concepts

Assigned reading

Optional reading: read one of these examples of application of TRA/TPB:

Futher reading

Class 5, Hour 1

Social learning theory/social cognitive theory

Terms and concepts

Assigned reading

Optional reading: Read one of the following

Class 5, Hour 2

Discussion Session #2 - Applicability of behavior change models to other cultures
Terms and concepts

Assigned reading

Discussion questions

  1. Identify what other cultural contexts people in the discussion group are familiar with through their family background or work experiences.  Choose a couple of these contexts, and discuss whether each one is closer to the "independent" or "interdependent" self-construals in Table 1 on page 230.
  2. Look at the constructs in the Health Belief Model in Table 2 on Page 14 of Theory At A Glance.  To what degree will each of the constructs in the Health Belief Model (except self-efficacy) vary between cultures with an independent and an interdependent construal of self? 
  3. Look at the constructs in TRA/TPB in Table 2 in Figure 3 on Page 18 of Theory At A Glance.  To what degree will each of the constructs in TRA and TPB vary between cultures with an independent and an interdependent construal of self? 
  4. Consider Voluntary Counseling and Testing - in which a counselor tells the client the result of the HIV test and discusses different options they have for prevention or management of HIV infection - and Community-Based Participatory Research - where we elicit a list of community priorities and work with the community to develop a plan to address them.  How might these approaches differ between cultures where interdependent and independent self-construals are more prominent?

Class 6, Hour 1

Psychological perspectives on risk

Terms and concepts

Assigned reading

Futher reading

Class 6, Hour 2

Anthropological perspectives on risk

Terms and concepts

Assigned reading

Further reading

Module 3: Social networks, diffusion of innovations and social marketing

Class 7, Hour 1

Social networks

Terms and concepts

Assigned reading

Further reading

 

Class 7, Hour 2

Diffusion of innovations

Terms and concepts

Assigned reading

Class 8, Hour 1

Social marketing and mass media interventions

Terms and concepts

Social marketing

Assigned reading

Further reading

Class 8, Hour 2

Discussion session #3 - HIV prevention for serodiscordant couples (One partner HIV +ve, the other HIV -ve) in Africa

Assigned reading (tested in online quiz)

Further reading

Green EC, Mah TL, Ruark A, Hearst N: A framework of sexual partnerships: risks and implications for HIV prevention in Africa. Stud Fam Plann 2009, 40:63-70

Discussion questions
  1. Bunnell et al., (2005) states that few clients or counselors could state accurate information about why HIV discordance among couples exists.  What are the common reasons people use to explain discordance?  What implications do these have on sexual behavior?  What implications do these have for behavioral interventions attempting to prevent transmission?
  2. The Bunnell study never fully defines what it means to be a "couple."  What do you think defines a couple?  Based on your definition, how would you define your target population for a couples-based intervention?  Could there be individual and/or group components as well?
  3. The opening paragraph of The Lancet editorial entitled "HIV treatment as prevention - it works" makes a bold statement.  Do you think we can treat our way out of the HIV epidemic? Why or why not? 
  4. HPTN 052, as discussed in The Lancet editorial, demonstrated that using treatment as prevention among sero-discordant couples was effective at reducing transmission of HIV to the uninfected partner.  Based on these results, if you were the Minister of Health in Uganda, would you try to scale-up treatment as prevention for sero-discordant couples?  Why or why not?
  5. Seale �s response to The Lancet editorial says that we should "not hastily abandon non-biomedical elements of HIV prevention" even though there is less rigorous evidence available on the effectiveness of non-biomedical interventions. Do you agree with Seale's statement?  Why or why not?  If you do agree, what non-biomedical elements would you consider including in a couples-based intervention?
  6. The Karim comment discusses recent results from several pre-exposure prophylaxis (PrEP) trials.  What are some of the benefits of implementing PrEP for sero-discordant couples? What are some of the drawbacks? 
  7. The Karim comment discusses that it may be necessary to implement both treatment-as-prevention and PrEP in hyper-endemic settings, like Uganda.  Do you agree or disagree?  Are there any possible behavioral or structural interventions that could be combined with these biomedical interventions?
Module 4: Households and couples

Class 9, Hour 1

Public and private domains, household structure

Terms and concepts

  • Household
  • Household production of health
  • Public Domain
  • Private Domain or Domestic Domain

Assigned reading

Further reading

Class 9, Hour 2

Kinship systems

Terms and concpepts

Articles

Class 10, Hour 1

Counseling

Terms and concepts

Assigned reading

Further reading

Class 10, Hour 2

Peer group education, peer counseling

Terms and concepts

  • Peer group
  • Peer group education, peer counseling

Assigned reading

Further reading

Class 11, Hour 1

Intimate partner violence, Transtheoretical model (Stages of Change)

Terms and concepts

Assigned reading

Further reading

Class 11, Hour 2

Discussion session #4  - Intimate partner violence (IPV)

Discussion questions
  1. Identify one or two settings from the experience of the members of the group where IPV is common, and discuss what group members have observed.  Looking at Figure 3 in Jewkes 2002, which of the various factors in the diagram do you think made the greatest contribution to IPV?  Why?
  2. Referring to the article by Murray et al., how do you think IPV is related to relationship intimacy in this population?  Will IPV be common both in couples with high relationship intimacy and low relationship intimacy?  Why? 
  3. Again referring to the article by Murray et al., do you expect IPV to take a different form, or have different underlying causes, in couples with high and low relationship intimacy?  How would you relate Figure 3 of the article by Jewkes 2002 with the concepts of public and private domain?
  4. For the article by Lary et al., which of the intervention options listed on page 1428 of the article by Jewkes appear most appropriate?  Why?
  5. For the article by Burke et al., which of the intervention options listed on page 1428 of the article by Jewkes appear most appropriate?  Why?
Module 5: Community, ecological models and multi-level interventions

Class 12, Hour 1

Concepts of community

Terms and concepts

Assigned reading

Further reading

 

 

Class 12, Hour 2

Interventions at the community level

Terms and concepts

Assigned reading

Further reading

Class 13, Hour 1

Social capital

Terms and concepts

  • Social capital
  • Constructions of social capital: Communitarian, Institutional and Critical (Wakefield Table 1, p 2821)
  • Approaches to Community Development: Social Planning, Locality Development, Social Action (Wakefield Table 2, p 2823)
  • Robert Putnam
  • Pierre Bourdieu

Assigned reading

Futher reading

Class 13, Hour 2

Discussion session #5 - Community-level interventions, social capital

Assigned reading

Discussion questions

  1. Identify settings from the experience of the members of the group where you feel social capital is high or low.  What factors do you think contribute to the high or low social capital?  Do you think the high or low social capital has any effects on health?
  2. Summarize 1) Putnam's construction of social capital, and 2) Navarro's critique of Putnam's construction and the strengths and limitations of Putnam's and Navarro's ideas.
  3. Does San Pedro la Laguna have high or low social capital?
  4. What behavior change models, if any, do you feel describe the components of the interventions described in the articles by Jana et al. and Kerrigan et al.?
  5. The Kerrigan article suggests that "psychological and material factors were associated with participation in community-building activities." Do theories of social capital address psychological or material factors? If you were going to implement a follow-up intervention to the one implemented by Kerrigan et al., what elements would you include?
  6. What are the strengths and weaknesses of the interventions described in the articles?  Are there any potential negative consequences of interventions that aim to increase social capital?
  7. How sustainable are the interventions described in the articles?

Class 14, Hour 1

Ecological/multi-level models

Terms and concepts

  • Ecological model, Multi-Level Model
  • Levels of causation: Individual, Environmental, Structural, Superstructural

Assigned reading

Further reading

Class 14, Hour 2

Interventions based on multi-level models

Terms and concepts

  • 100% condom use interventions

Assigned readings

Further reading

Class 15, Hour 1

Behavior of Health Workers

Terms and concepts

Assinged reading

Further reading

Class 15, Hour 2

Behavior of Health Workers

Assigned reading (tested in online quiz)

Discussion questions

  1. What health care worker behaviors were intended to be addressed by the Glenton et al. study? How well do you think the study addressed those behaviors?
  2. Who was the intended audience of the original Glenton et al. article? What do you expect this audience would have gleaned from the article?
  3. After reading the original article, the critique by Maes et al., and the reply by Glenton et al., which (if any) of the critiques by Maes et al. do you consider valid? Describe the critique(s) and why the reply by Glenton et al. does or does not address the critique(s) in a manner that assuages your doubts.
  4. How would you compare the assumptions that went into each set of authors' articles? How do these assumptions manifest themselves in the conclusions each set of authors make about the study design, execution, and conclusions?
  5. After reading these articles and considering their respective arguments, what changes (if any) would you have made to the original design of this study or in its analysis? In what ways would the study and/or results have been improved by these changes?

Class 16

Career paths related to community and behavioral interventions

No reading