The Ecological Perspective for Health Promotion and Behavior Change Interventions

The ecological perspective is a fulcrum in health promotion advancement. Employing this concept involves designing multi-faceted, multi-level health interventions that operate using mixed methods – a far shift from simply providing health education to individuals.

Essentially, the ecological perspective assesses health and behavior based on two key constructs: (1) the effect of behavior on multiple levels of influence (i.e. intrapersonal, interpersonal, and community level), and, conversely, of these levels on behavior; and (2) the reciprocal causation between people and their social environment. Integrating both of these constructs into one comprehensive innovation is a strategy used in the most effective health promotion and behavior change interventions. Such strategy is done in Healthy Balangueno 2020, an initiative that utilizes both the Social Cognitive Theory (SCT) and the Theory of Participatory Action (TPA). Both the SCT and the TPA are known to support the development of peer education. The SCT functions at the interpersonal level by using the social environment as a behavioral model, while the TPA works at the community level and has an empowerment component.

Social Cognitive Theory

Developed by Albert Bandura, the Social Cognitive Theory revolves around the basic premise that people acquire and maintain certain behavioral patterns depending on the reciprocal interaction between the following factors: (1) individual experiences, (2) the actions of others, and (3) the environment.

The SCT is a furthered version of the Social Learning Theory (SLT), which was proposed by Neal Miller and John Dollard in 1941. In the SLT, it is postulated that an individual’s learnings are obtained not only via his or her lived experiences, but also through observation of the actions of other people and the benefits of said actions. In 1977, Bandura expanded the SLT by introducing the concept of self-efficacy. He then renamed it as the Social Cognitive Theory.

A distinctive feature of the SCT is that it operates at the interpersonal level, meaning it has emphasis on the influence of a social environment, which is comprised of the individual’s family members, co-workers, peers, and health professionals. This theory acknowledges that the social environment has an impact on behavior, and thus has an impact on health.

Since its proposal, the SCT has been used in health communication as it arranges for opportunities for social support through self-efficacy, goals, outcome expectancies, while using observational learning and other reinforcements, all for the goal of attaining a change in behavior. The adoption of new behaviors will cause a ripple of change in both the environment and the person. Bandura recognizes that ‘behavior is not simply the result of the environment and the person, just as the environment is not simply the result of the person and the behavior.’

Constructs from cognitive, behaviorist, and emotional models of behavior change are assimilated to form the SCT. The concepts central to this theory include: reciprocal determinism, behavioral capability, expectations, observational learning or modeling, reinforcements, and self-efficacy.

Reciprocal determinism refers to the mutuality between personal factors, environmental factors, and human behavior; each one is an influence to the other components. A strategy is the implementation of a variety of ways to promote behavior change, such as adjusting the environment or influencing personal attitudes. Healthy Balangueno 2020 employs this concept by using a mixed method approach in educating the youth, such as lecture-discussions, small group discussions, role plays, drills/ games, practice exercises, and practicum sessions so as to maximize learning. This tactic is deemed to create a learning environment that is suitable to teenagers.

Behavioral capability describes the process whereby knowledge of a behavior precedes competence in performing the behavior. To promote mastery in learning, Healthy Balangueno 2020 conducts participatory teaching-learning methods. The objective is to have participants who are equipped with knowledge on various health topics.

Observational learning is a process of learning that occurs when a person examines the actions of credible role models. The Healthy Balangueno 2020 initiative plans to create a group of Youth Leaders who are capable of sharing knowledge and providing emotional, social, and informational support to their peers.

Expectations are the end results a person foresees will occur after taking action. Setting expectations involves demonstrating the positive outcomes of a healthy behavior. In the context of Healthy Balangueno 2020, this is achieved by equipping adolescents with knowledge that will improve the health seeking behavior in Balanga City.

Self-efficacy, or a sense of personal agency, pushes a person to persist in behavior change despite hindrances in the process. This is the concept identified by Bandura as the prime personal factor in behavioral change. As a strategy, behavior change is approached via a part-by-part process so as to guarantee success. An application of this theory is the conduct of participatory teaching-learning methods that will eventually result in a behavior change that entails utilization of health services, adaptation of healthy lifestyle behaviors, avoidance of risky behavior (i.e. smoking, alcohol use, drug abuse, and risky sexual behaviors), and participation in the development of a healthy community.

Reinforcements are positive or negative responses to the behavior of an individual. Positive reinforcements promote the likelihood of reoccurrence, while negative reinforcements prompt a person to remove a negative stimulus. This construct is not utilized in Healthy Balangueno 2020, but may be incorporated in future activities after the establishment of the organization of Youth Leaders. Positive reinforcements may be in the form of incentives such as plus points in the extra-curricular component of the grading system, monetary compensation, or medals/ distinctions.

Theory of Participatory Action

The integration of community participation, research, and action gave rise to the collaborative process of inquiry termed as Participatory Action Research (PAR). This is an unorthodox research method that involves utilizing local insights and abilities in resolving community issues, through a cooperative inquiry between the researcher and the community. In essence, PAR was “research that was with and for people rather than on people.”

Participatory action research is grounded from theoretical constructs from community organization, specifically: (1) empowerment and (2) participation. PAR particularly draws from the works of Brazilian educator Paolo Freire, who viewed education as a means to change power relationships. An emphasis is placed on the involvement and empowerment of the marginalized.

Empowerment is an essential tactic wherein people gain control over their lives while participating with their community, driven by an aim to change their social and political realities. It is a social action process, meaning it capacitates the community in problem solving and achieving tangible progress towards social justice. A potential change strategy that enables empowerment is allowing community members to assume greater power or realize their own potential. In Healthy Balangueno 2020, the youth are conferred the opportunity to hold a larger role by becoming a Youth leader, with tasks such as providing support to peers, knowledge-sharing, and participation in the programs organized by the Health Promotion Board. Orientation-seminars were made to equip the adolescents with knowledge so as to make them appreciate their capability of contributing to the initiative.

Participation entails engaging the community members in the organizing process, primarily through equipping the members with leadership skills, knowledge, and resources. The Healthy Balangueno 2020 initiative utilizes participatory teaching-learning methods such as lecture-discussions, small group discussions, role plays, drills/ games, practice exercises, and practicum sessions so as to maximize learning. As aforesaid, the members are given the chance to be a Youth Leader and take part in health promotion programs in the city.