Social and contextual influences on health behaviours in schools

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Social and contextual influences on health
behaviours in schools

• Wendy M. Rodgers
• University of Alberta
• Comprehensive School Health Research Team

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What do we mean by social context?

• Following Emmons Social-Ecological Model
• Idea that there are multiple simultaneous
  influences on behaviour
• Policy level
• local, provincial, federal laws
• Community level
• interventions in community
• integration with community
• Organizational/Environmental level
• Interventions/conditions in schools
• Interpersonal level
• Interventions targeting social norms
• Intrapersonal level
• Motivation, skills of individuals

Emmons, 2000
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Health behaviour change

• Majority of interventions developed on the basis
  of social-cognitive theories individual level
• E.g., self-efficacy theory of planned behavior
• Major premises of these theories
• Behavioural intention is a critical predictor
• Psychological predictors
• Attitudes outcome expectation x value
• Self-efficacy situation specific
  self-confidence
• Perceived behavioural control other control
• self perceptions (esteem, concept, etc)
• Sometimes perceptions of threat, risk, etc
• Subjective norms perceptions of pressure from
  others x motive to comply

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Social-contextual factors

• have been understudied
• Not primary constructs of traditional theories of
  behaviour change
• OR - Traditional constructs dont work very well
• E.g., subjective norm TPB
• So . . . Ignored
• Maybe the wrong ones?
• What if we made social-cognition more social?

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Social-contextual alternatives?

• new variables
• Focus more on actual social-cognition
• Social motives
• Perceptions of the social context
• For example
• Descriptive norms
• what I think similar others are doing
• Behavioural prototypes
• Image of what typical behaviour is like
• Prototype evaluation
• Prototype similarity

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Interaction of behaviour and social context
special relevance to schools

• Basic premise Health behaviours (e.g., smoking)
  are performed in social contexts
• Social image associated with health behaviours
  prototype
• Youth are interested in social image
• Descriptive norms
• Youth are interested in fitting in
• Current research shows
• Direct effects of prototype similarity on
  behaviour
• Interaction of prototype similarity and perceived
  environmental supportiveness influencing BI
• Direct effects of descriptive norms on behaviour

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Summary of new findings

• Over and above traditional TPB variables
• Kids who perceive themselves as similar to a
  behavioural prototype are more likely to engage
  in that behaviour
• Among kids who have a behavioural intention
  those who are higher in prototype similarity AND
  perceive the environment as supportive are most
  likely to engage in the behaviour
• Kids who think their peers are engaging in the
  behaviour are more likely to engage in the
  behaviour

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Where does this take us?

• New targets for intervention
• Perceptions of environment as supportive
• Perceptions of the prototype
• Perceptions of what others are doing
• All these perceptions are susceptible to error
  and
• correctable supposed advantage of social
  cognition
• Offer bridges to higher levels in the
  socio-ecological model
• focus becomes sources of perceptions (or beliefs)
  and targets of perceptions
• Social context

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Who can contribute to our understanding of these
levels and working across them?

• Policy
• Ministry officials
• School board officials
• Community
• Advocacy groups
• Specialist organizations
• Organizational/Environmental
• Principals, parent groups, volunteers, teachers
• Interpersonal
• Principals, parent groups, volunteers, teachers,
  students
• Intrapersonal
• Individuals belief systems, skills systems
  students
• How can we work together?

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An Alberta Example

• Policy Alberta Education legislates 30 minutes
  of physical activity per day in school
• Community
• Edmonton Public School Board needs and
  resources students
• Donation from industrial partner Flaman Fitness
• Alberta Diabetes Foundation support advocacy
• University of Alberta expertise
• Organizational
• Give kids pedometers evaluate their use
• Support directive from school board
• Cooperation of the four partners (EPSP, ADF,
  Flaman, U of A)

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Alberta example

• Results
• Philanthropic goal met donation of pedometers to
  kids and to ADF
• School need for info and ideas met
• University based researchers need for data met
• Potential for future mutually beneficial
  collaborations established
• This is not a researcher driven project it
  came from the community

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A PEI exampleComprehensive School Health
Research Team

• Goal to improve health behaviours of PEI school
  children to improve overall PEI health
• Participants
• University researchers
• PEI school board
• PEI Active Living Alliance
• PEI Public Health

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PEI project

• Policy level
• to be informed by this project
• Policy makers included as partners
• Community level
• Involvement of community resources/groups
• Use of community characteristics to enhance
  population health
• PEI stable consistent population
• Influencing behaviours in school has strong
  probability of influencing whole community
• Organizational/Environmental level
• Support for research project providing
  questions and access
• Relevance of research to schools participation
  of school board
• Sharing of literature search with entire team
• Interpersonal
• Examination of social factors in school contexts
  that are related to the target behaviours
• Intrapersonal
• Examination of student level belief systems as
  they relate to behaviours

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PEI project

• Results
• Development of interventions that
• Influence policy
• Relevant and FEASIBLE in the organization (the
  school)
• Relevant to students
• Entirely based on current theory

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Research Connections Questions

• What are the key questions?
• Who gets to decide?
• What are the levels of the questions?
• What research approaches are appropriate?
• What research approaches are possible?
• What are the opportunities to foster
  collaborative partnerships to satisfy multiple
  needs?
• Start with

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R-E-S-P-E-C-T

• Find out what it means to me . . .
• Find out what it means to your partners
• Negotiated versus assumed hegemony
• (whos needs are more important?)
• Be a symphony not a drum solo

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Future directions for research

• Organizational level choose relevant models
• e.g., RE-AIM (Glasgow et al)
• Reach Effectiveness Adoption Implementation
  Maintenance
• do organizations adopt implement
  policies/programs effectively?
• Organizational capability
• What is sustainable?
• Collaborating with policy and program people to
  examine and optimize feasibility
• Individual level
• Motivation will they do it?
• Individual capability can they do it?
• What is the point of developing behavioural
  recommendations that no one will follow?
• Primary example?
• Exercise prescriptions

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Challenges

• Using theories appropriate for the level of the
  intervention
• Sometimes more than one theory?
• Understand how theoretical variables are
  influenced by other socio-ecological levels
• Where is it best to intervene?
• Ensure articulation across the levels
• Exclusive focus on one level ignores
  challenges/barriers/opportunities from other
  levels