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Summary HEP4210 CASES - Understanding Health Behaviour
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HEP4210 – Understanding Health BehaviourCase 1
The role of obesity and lifestyle behaviours in a productive workforce
This study aims to investigate the role of lifestyle factors in relation to the presence and
degree of productivity loss at work and sick leave.
Results
Obesity was associated with the presence of sick leave and prolonged duration
(predictor of future sick leave).
Insufficient physical activity and smoking were also associated with the presence of
sick leave.
The presence of sick leave was also associated the presence of diseases, younger age
and working in a mentally demanding job.
Smoking, obesity and insufficient fruit and vegetable intake were associated with the
degree of productivity loss at work.
The presence of productivity loss at work was also associated with the amount of
alcohol consumption, the presence of diseases and younger age.
The combined population attributable fractions of lifestyle factors for sick leave and the
higher levels of productivity loss at work were above 10%. So, more than 10% of sick leave
and productivity loss is due to lifestyle factors.
Conclusions
Lifestyle-related factors, especially smoking and obesity, were associated with the presence
and duration of sick leave and degree of productivity loss at work. More than 10% of sick
leave and the higher levels of productivity loss at work may be attributed to lifestyle
behaviours and obesity. Hence, primary interventions on lifestyle may have a noticeable
contribution to maintaining a productive workforce. Based on the results in the current study,
the prevention of unhealthy lifestyle behaviours and obesity are important in both physically
and mentally demanding jobs.
Precede-proceed model (planning model)
The main purpose of the PRECEDE-PROCEED Model is not to predict or explain the
relationship among factors thought to be associated with a certain outcome. Rather, its main
purpose is to provide a structure for applying theories and concepts systematically for
planning and evaluating health behaviour change programs.
The authors also distinguish between causal theory that seeks to identify the determinants of
an outcome and action theory that attempts to explain how interventions affect the
determinants and outcomes. Together, causal and action theories make up program theory,
depicted as logic models. PRECEDE-PROCEED is an example of a logic model.
Issues/limitations of the model:
The model is heavily data-driven, and its application may require greater financial and
human resources, technical skill, and time than are available in some situations.
However, it may be possible to shorten some of the model’s intermediate assessment
phases by using literature.
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, The PRECEDE-PROCEED planning process also does not emphasize the specifics of
intervention development and methods in detail.
Phase 1: Social assessment, participatory planning and situation analysis
At this stage, the planners expand their understanding of the community in which they are
working by conducting multiple data collection activities, such as interviews with key opinion
leaders, focus groups with members of the community, observations, and surveys.
The social assessment articulates the community’s needs and desires and considers the
community members’ problem-solving capacity, their strengths and resources, and their
readiness to change.
The planner should engage the community in partnership to build the program and link the
community’s concerns about quality-of-life issues to the program objectives. Developing a
planning committee, holding community forums, and conducting focus groups or surveys are
all examples of helpful activities to engage the audience in planning.
Concept mapping is a participatory method that allows the planner to obtain a conceptual
model of how people understand or feel about a particular topic or issue.
Phase 2: Epidemiological, behavioral and environmental assessments
This phase of the needs assessment identifies the health priorities and their behavioral
and environmental determinants.
Epidemiological assessment This analysis (1) identifies the health problems, issues,
or aspirations on which the program will focus, (2) uncovers the behavioral and
environmental factors most likely to influence the identified priority health issues, and
(3) translates those priorities into measurable objectives for the program being
developed. Planners can conduct secondary data analysis using existing data sources
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, such as various online databases. Although genetic factors are not changeable through
a health promotion program, they may be useful to identify high-risk groups for
intervention.
Behavioral determinants The behavioral determinants of a health problem can be
understood on three levels.
o Most proximal are those behaviors or lifestyles that contribute to the
occurrence and severity of a health problem (for example, a teen smoker’s
tobacco use).
o The second, more distal determinant is the behavior of others who can directly
affect the behavior of the individuals at risk (such as the teen smoker’s parents
keeping cigarettes in the home).
o The third and most distal behavioral determinant is the action of decision
makers whose decisions affect the social or physical environment that
influences the individuals at risk (for example, actions by police to enforce
laws that restrict youth access to cigarettes).
Environmental determinants Environmental factors are those social and physical
factors external to the individual, often beyond his or her personal control, that can be
modified to support the behavior or influence the health outcome e.g. the availability
of unhealthy foods in schools.
Phase 3: Educational and Ecological assessment
After selecting the relevant behavioral and environmental factors for intervention, the
framework directs planners to identify the antecedent and reinforcing factors that should be in
place to initiate and sustain the change process.
Predisposing factors are antecedents to behavior that provide the rationale or
motivation for the behavior, they include individuals’ knowledge, attitudes, beliefs,
personal preferences, existing skills, and self-efficacy beliefs.
Reinforcing factors are those factors following a behavior that provide continuing
reward or incentive for the persistence or repetition of the behavior. Examples include
social support, peer influence, significant others, and vicarious reinforcement.
Enabling factors are antecedents to behavioral or environmental change that allow a
motivation or environmental policy to be realized. They include programs, services,
and resources necessary for behavioral and environmental outcomes e.g. availability
of health food
Phase 4: Administrative and policy assessment and intervention alignment
In Phase 4, the planner selects and aligns the program’s components (that is, interventions)
with the priority determinants of change previously identified. Its purpose is to identify
resources, organizational barriers and facilitators, and policies that are needed for program
implementation and sustainability.
When creating the program plan, it is important to look at two levels of alignment between the
assessment of determinants and the selection of interventions
At the macro level, the organizational and environmental systems that can affect the
desired outcomes should be considered. These are interventions that affect enabling
factors for environmental change, which in turn support the desired health behavior or
health outcome.
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, At the micro level, the focus is on individual, peer, family, and others who can
influence the intended audience’s health behaviors more directly. Interventions at the
micro level are specifically directed at changing the predisposing, reinforcing, and
enabling factors.
Successful programs use multiple strategies to have an effective impact on complex health
issues.
Phases 5-8: Implementation and Evaluation
At this point, the health promotion program is ready for implementation (Phase 5). Data
collection plans should be in place for evaluating the process, impact, and outcome of the
program, which are the final three phases in the PRECEDE-PROCEED planning model
(Phases 6–8).
Process evaluation determines the extent to which the program was implemented
according to protocol.
Impact evaluation assesses change in predisposing, reinforcing, and enabling factors,
as well as in the behavioral and environmental factors. focus determinants/the
things you need to change to get a better quality of life
Outcome evaluation determines the effect of the program on health and quality-of-life
indicators. focus program/quality of life
Health Belief model (HBM)
Since the early 1950s, the Health Belief Model (HBM) has been one of the most widely used
conceptual frameworks in health behavior research, both to explain change and maintenance
of health-related behaviors and as a guiding framework for health behaviour interventions.
Key constructs
Perceived Susceptibility beliefs about the likelihood of getting a disease or condition. For
instance, a woman must believe there is a possibility of getting breast cancer before she will
be interested in obtaining a mammogram.
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