Understanding risk and behaviour behaviour: : Understanding risk - - PowerPoint PPT Presentation

Understanding risk and Understanding risk and behaviour behaviour: : a socio a socio-

• ecological model

ecological model

Jane T Bertrand, PhD, MBA Jane T Bertrand, PhD, MBA Center for Communication Programs Center for Communication Programs Johns Hopkins University Johns Hopkins University

Acknowledgment to my colleagues Acknowledgment to my colleagues at CCP/Hopkins at CCP/Hopkins

• D. Larry Kincaid
• D. Larry Kincaid
• Doug Storey

Doug Storey

• Maria Elena Figueroa

Maria Elena Figueroa

• Carol Underwood

Carol Underwood

• Credits for Photos:

Credits for Photos:

• Photoshare

Photoshare, CCP , CCP

Overview of today Overview of today’ ’s presentation s presentation

• Socio

Socio-

• ecological model

ecological model

• Implications for BCC

Implications for BCC

• Implications for M&E

Implications for M&E

RADIO SPOTS BEGIN & END RADIO SERIAL BEGINS NO INTERVENTION

Average monthly clinic visits

Ecology and Social Ecology Ecology and Social Ecology

• Ecology (

Ecology (derived from the biological sciences) derived from the biological sciences): :

• Describes the complex interrelationships among

Describes the complex interrelationships among

• rganisms and the environment in which they are
• rganisms and the environment in which they are

embedded embedded

• Social Ecology

Social Ecology

• The study of the influence of the social context on

The study of the influence of the social context on behavior, including institutional and cultural behavior, including institutional and cultural variables ( variables (Sallis Sallis & Owen, 2002) & Owen, 2002)

Two key features of social ecology Two key features of social ecology (systems approach) (systems approach)

• Embeddedness

Embeddedness

• One system is nested in hierarchy of

One system is nested in hierarchy of

• ther systems at different levels of
• ther systems at different levels of

analysis analysis

• Emergence

Emergence

• System at each level is greater than the

System at each level is greater than the sum of its parts sum of its parts

Key ideas behind S Key ideas behind S-

• E model

E model

• Factors at multiple levels affect human

Factors at multiple levels affect human behavior behavior

• Essential to understand and address

Essential to understand and address barriers and constraints to behavior barriers and constraints to behavior change at multiple levels change at multiple levels

• Unrealistic to expect individuals to

Unrealistic to expect individuals to change behavior if barriers at higher change behavior if barriers at higher levels are insurmountable levels are insurmountable

Implications of social ecological Implications of social ecological approach for behavior change approach for behavior change

• Interventions for planned change should

Interventions for planned change should address all four levels to be effective: address all four levels to be effective:

• Individual

Individual

• Social network

Social network

• Community

Community

• Societal

Societal

• Communication interventions

Communication interventions

• Can overcome barriers at each level

Can overcome barriers at each level

• Facilitate change

Facilitate change

If social change supports individual If social change supports individual change, more self change, more self-

• sustaining

sustaining

Social Change NO YES YES NO Individual Change Maintenance

• f

status quo Self- sustained health improvement Limited health improvement Increased potential for health improvement

Interaction between Individual and Social Change

Implications for Monitoring and Implications for Monitoring and Evaluation (M&E) Evaluation (M&E)

• Much of program evaluation has

Much of program evaluation has focused on the individual only focused on the individual only

• Rarely does a single data source

Rarely does a single data source measure more than one level measure more than one level

• Example: policy level AND individual

Example: policy level AND individual behavior behavior

• Exceptions: DHS measures individual

Exceptions: DHS measures individual and some community variables and some community variables

Main challenges facing evaluators Main challenges facing evaluators

• Developing the right indicators

Developing the right indicators

• To reflect appropriate levels

To reflect appropriate levels

• Indicators must be:

Indicators must be:

• Relevant to the appropriate level

Relevant to the appropriate level

• Reliably measurable

Reliably measurable

• Conceptually sound

Conceptually sound

• Amenable to change

Amenable to change

Using the correct measurement Using the correct measurement and analytic approaches and analytic approaches

• Allow inferences about causal links

Allow inferences about causal links across levels of analysis across levels of analysis

• How to make connections about

How to make connections about change at two levels change at two levels

• Ex: individual and social change

Ex: individual and social change

• How both relate to communication

How both relate to communication intervention(s intervention(s) )

Difficulty of testing the effects of Difficulty of testing the effects of the drivers of the epidemic the drivers of the epidemic

• Researchers can test the effects of

Researchers can test the effects of specific interventions through specific interventions through controlled trials controlled trials

• Example: male circumcision

Example: male circumcision

• Researchers can

Researchers can’ ’t t “ “manipulate manipulate” ” the the drivers in an experimental sense: drivers in an experimental sense:

• Example: status of women, poverty

Example: status of women, poverty

… …and as with any other evaluation and as with any other evaluation

• The eternal challenge:

The eternal challenge:

• Standardized indicators endorsed by

Standardized indicators endorsed by international agencies international agencies versus versus

• Indicators generated through

Indicators generated through participatory processes participatory processes

Questions? Questions?