Social & Behavioral Aspects Of Global Health

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why use conceptual frameworks?

Back 1

1. to better understand causal mechanisms behind public health problems

2. to better target toward interventions

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2 types of intervention targets

Back 2

1. biological (proximate) determinants

2. sociobehavioral (distal) determinants
-individual level
- family level
-community level

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levels of distal determinants and examples of each

Back 3

Individual: culture, education

Household: wealth, resources

Community: political system, infrastructure

Front 4

types of proximate determinants

(Mosley/Chen article)

Back 4

Maternal factors
Environmental contamination
Nutritional deficiency
Injury
Personal illness control

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general conceptual framework

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Social influences --> behavior --> biological/proximate determinants --> health outcome

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structure

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something arranged in a definite pattern of organization; constraints on one's ability to make choices; "endowment"

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agency

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the extent to which one can make real choices; what you do with your "endowment"

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the difference between structure and agency?

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structure is what you're given to work with, and agency is how you use it

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determinants in the health belief model

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perceived susceptibility/severity/benefits/barriers/self-efficacy

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stages in the "stages of change" model

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1. precontemplation
2. contemplation
3. initiation of change
4. maintenance

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theory of reasoned action

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theory of planned behavior; acknowledges individual decision-making

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components to theory of reasoned action

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1. attitude (agency)
-what you believe will result from a course of action
-evaluation of the outcome (good/bad)

2. norm (structure)
-perception of what the norm is
-how important it is to comply with the norm

also includes self-efficacy: measure of perceived behavioral control

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mediating/intervening variable

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thing through which the independent variable affects the outcome

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moderating/interacting variable

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the degree to which the outcome will happen (i.e. environment, accomplices)

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reliability

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the extent to which your results can be replicated

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internal validity

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the extent to which study results are due to the independent variables, rather than design flaws

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sociology OF medicine

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a critical perspective of health care (i.e., what's wrong with it)

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sociology IN medicine

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applied theory;

involves collaboration between social scientists and biomedical researchers, with the ultimate goal of wanting to act upon findings, rather than just sitting there mulling it over

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the new modern view of medical sociology

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-health care as a major social institution; conservative
-determinants/consequences of health status
-health = well-being

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differences between biomedical and social scientific approaches to research

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SS...

-is iterative
-emphasizes formative research
-mixes qualitative and quantitative approaches

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statistical modeling and data analysis involves...

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-multilevel analysis
-multivariate analysis
-causal analysis

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measurement in SS health research...

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-censored data
-latent variables
-operationalization of abstract variables

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methods used by social scientists in health research

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1. statistical modeling
2. measurement
3. sampling
4. qualitative analysis

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"upstream" ways to address health inequalities

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target social/economic arrangements

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"downstream' ways to address health inequalities

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target health delivery systems and health behavior

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pareto criterion

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a policy that harms no one while making at least a few people better off is a good thing

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things that health policy could target

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-the poor
-specific diseases or groups
-the gradient itself
-directing policy at BOTH health and wealth

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diffusion

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the planned or spontaneous spread of new ideas; a communicative process

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innovation

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an idea, practice, or object that is perceived as "new"

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diffusion of innovation

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an innovation that is communicated through certain channels over time among individuals in a social system

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innovators

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-venturesome
-able to cope with uncertainty
-far ahead of the average individual

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early adopters

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-more integrated in social system
-looked upon for advice, information
-are examples of discrete, successful uses of new ideas

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early majority

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followers who deliberate before they adopt; seldom lead

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late majority

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-skeptical, cautious; do not take up anything new until most of the population has
-peer pressure is necessary

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late adopter

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-usually isolated from social system
-only decide to adopt what has been done in the past

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opinion leaders

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influence others' opinions either informally or via interpersonal communication
-determine rates of adoption of an innovation