pekka puska combining medical and social behavioural theories to devolop strategies for prevention...
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Prof Pekka Puska
Ex Director General
National Institute for Health and Welfare (THL)
Finland
Combining medical and social
behavioural theories to develop
strategies for prevention and health
promotion
medical
epidemiological
framework
Social
behavioural
framework
GENERAL GOAL
- Improved Public Health
MAIN OBJECTIVES
- Specific NCDs, health outcomes
INTERMEDIATE OBJECTIVES
- risk factors, behaviours
PRACTICAL INTERVENTION
PROGRAMME
13/03/2014 Pekka Puska, Ex Director General
“Nothing is so practical
as a good theory”
13/03/2014 Pekka Puska, Ex Director General
Major behavioral and social
theoretical perspectives
(used e.g. in North Karelia Project, Finland)
1. Social marketing Marketing
2. Behavior - modification (Social) Psychology
3. Communication - behavior change Communication
4. Innovation - diffusion Sociology
5. Community organization Social policy
Theory Discipline area
13/03/2014 Pekka Puska, Ex Director General
I. SOCIAL MARKETING
Background: Large experience and practice of
commercial marketing (of various products)
Question: Should we not market health in the same
way?
Yes: We should apply as much as possible the good
principles of marketing:
• associating the message with emotional issues
• sequencing the target audience
• pre-testing etc
Problem: Marketing health issues is a more
profound task than marketing choice of certain
products
13/03/2014 Pekka Puska, Ex Director General
II. BEHAVIOUR MODIFICATION
6. COMMUNITYORGANIZATION
5. ENVIRONMENTAL SUPPORT
4. SOCIAL SUPPORT
3. PRACTICAL SKILLS
2. PERSUASION
1. KNOWLEDGE
(Puska and McAlister)
13/03/2014 Pekka Puska, Ex Director General
1. Increased health knowledge
• simple message
• practical advise
• check understanding
• several channels
• personal contacts
13/03/2014 Pekka Puska, Ex Director General
2. Persuasion
• credible message source
• attention to emotional aspects
• anticipate counter arguments
• achievable goals
• positive goals, minimize fear
13/03/2014 Pekka Puska, Ex Director General
3. Training for practical skills
• demonstration of desired
behaviours
• guided practice
• feed-back
• positive reinforcement
13/03/2014 Pekka Puska, Ex Director General
- family
- work-site groups
- establishment of therapeutic
groups:
weight reduction etc
4. Social support
13/03/2014 Pekka Puska, Director General
5. Environmental modification
• food-industry
• food marketing
• restaurants, canteens etc
13/03/2014 Pekka Puska, Ex Director General
6. Community organization
- general support in the community
for the desired goals
- formal decision making: political
leaders, health authorities, school
authorities etc
- other formal leaders: business,
mass media etc
- informal opinion leaders
13/03/2014 Pekka Puska, Ex Director General
III. COMMUNICATION - BEHAVIOUR
CHANGE
• Mass communication can reach large
masses
• Historical development:
- early enthusiasm
- empirical nihilism
- balanced view
• Generally mass communication
reinforces existing attitudes and behaviours
1.
13/03/2014 Pekka Puska, Ex Director General
III. COMMUNICATION - BEHAVIOUR
CHANGE
• Well designed mass communication,
combined with relevant field work can have
meaningful impact
• Mass communication should be combined
with practical work in the community,
promoting interpersonal interaction
• Small relative effects can mean big
absolute numbers - and favourable cost
effective ratio (e.g. stop smoking TV
programmes in Finland)
2.
13/03/2014 Pekka Puska, Ex Director General
IV. INNOVATION - DIFFUSION
• New risk reducing lifestyles are
innovations that diffuse in the
community following certain rules
• Project represents change agent -
people can be classified as innovators,
early adopters, early and late majority
and laggards
• Critical mass, reaching early majority
is crucial
1.
13/03/2014 Pekka Puska, Ex Director General
IV. INNOVATION - DIFFUSION
Two-step flow of innovation:
a) Mass media are effective in
disseminating information
b) Opinion leaders and interpersonal
contacts influence opinions, attitudes and
behaviour
• Opinion leaders (“gatekeepers”) can be
identified and used in the programme (e.g.
lay leader programme in North Karelia)
2.
13/03/2014 Pekka Puska, Ex Director General
VI. COMMUNITY ORGANIZATION
• Every community is a complex network of
organizations
• Every individual in the community is
connected with a great number of
organizations that influence his/her
behaviours
• The health project can work with many
organizations to promote the desired
changes in the community
1.
13/03/2014 Pekka Puska, Ex Director General
VI. COMMUNITY ORGANIZATION
Critical for Success:
• Collaboration calls for shared interest
• Personal contacts and trust
2.
13/03/2014 Pekka Puska, Ex Director General
13/03/2014 Pekka Puska, Director General
COMMENTS
• Many programmes emphasize
dissemination of information and
persuation - while the greatest problems
for change are issues that relate to
social and physical environment
• The big task and strength of community
based programmes is to influence the
community as a whole so that the
desired behaviours are as easy as
possible!
13/03/2014 Pekka Puska, Ex Director General
COMMUNITY-BASED
(PILOT/
DEMONSTRATION)
PROGRAMMES
NATIONAL
PROGRAMMES
AND POLICIES
13/03/2014 Pekka Puska, Ex Director General
PUBLIC
POLICY
HEALTH PROGRAMME
POPULATION
PRIVATE
SECTOR
13/03/2014 Pekka Puska, Ex Director General
National policies and private sector involvment:
Social change process
FOR SUCCESSFUL
PROGRAMME
1)Do the right thing
2)Do enough of it
13/03/2014 Pekka Puska, Ex Director General
FOR SUCCESSFUL
PROGRAMME
Combine 1) leadership
with 2) partnership
13/03/2014 Pekka Puska, Ex Director General
13/03/2014 Pekka Puska, Ex Director General
Thank you