Health Behavior Change at the Individual, Household and Community

Provides students with conceptual tools to analyze health-related behaviours and the social, cultural and environmental context in which they occur. Applies concepts and theories drawn from medical anthropology, psychology and sociology to programmatic examples from Latin America, Africa and Asia concerning care-seeking, treatment of sick children, insecticide-treated mosquito nets, voluntary counselling and testing, sexual risk behaviours, intimate partner violence and other behaviour change challenges in public health.

OpenCoursa

May 17, 2022

English

English [CC]

Description

Course Objectives

Upon successfully completing this course, students will be able to:

describe conceptual tools drawn from medical anthropology pertinent to design of behavior change interventions including standards of efficacy, illness taxonomies, illness etiology, levels of causality, meanings of medication, public and private domains
identify and map the key components of common models of health behavior change at the individual level, and difficulties encountered when trying to apply them in different cultural contexts
describe psychological and anthropological perspectives on risk perceptions, and models of diffusion of innovations and influence of the mass media and apply to specific case studies
be familiar with basic terminology for describing households, kinship systems, communities and social capital and identify their significance for public health interventions
Discuss the basic components of the intervention modalities, including Social Marketing, Peer Education, Counseling, Harm Reduction, Diffusion of Innovation, and Community Mobilization
integrate the major theories covered in class with the various interventions modalities presented
apply appropriate combinations of theoretically based intervention modalities to case studies

Readings

Topic	Readings
Module 1: Culture, health and illness
Class 1, Hour 1 Introduction	Disciplines and fields of study: American Anthropological Association Society for Medical Anthropology Society for Applied Anthropology American Sociological Association American Psychological Association Society for Public Health Education American Communication Association Wikipedia: Psychology Portal List of Psychology Topics Sociology Portal List of Sociology Topics Anthropology Portal List of Anthropology Topics
Class 1, Hour 2 Do we understand each other? Translation problems in behavior change interventions	Terms and Concepts: Phonetic Phoneme Etic, emic Linguistics Portal Further reading Harris M. History and significance of the emic/etic distinction. Ann Rev Anthropol. 1976; 5:329-50.
Class 2, Hour 1 Illness etiologies, levels of causality, standards of efficacy	Terms and concepts: Etiology/Aetiology Personalistics and naturalistic etiologies Equilibrium model Levels of causality: efficient or ultimate cause versus instrumental or immediate cause Divination Assigned reading Foster GM. Disease etiologies in non-western medical systems. American Anthropologist 1976;78(4):773-782 Further reading Pelto PJ, Pelto GH. Studying knowledge, culture and behavior in applied medical anthropology. Medical Anthropology Quarterly 1997;11(2):147-163. Caprara A. Cultural interpretations of contagion. Trop Med Int Health. 1998; 3(12):996-1001.
Class 2, Hour 2 Standards of efficacy	Terms and concepts Rationality Empirical Scientific, empirical and symbolic efficacy Self-limiting illnesses Externalizing and internalizing systems Symptom perceptualization Nosology Nosolocial fusion Assigned reading Young A. An anthropological perspective on medical knowledge. J Med Philos 1980; 5:102-116. Further reading Young A. Internalizing and externalizing medical belief systems: an Ethiopian example. Soc Sci Med. 1976;10(3-4):147-56. Young A. The Dimension of Medical Rationality: A problematic for the psychosocial study of medicine. In: Ahmed PI, Coelho GV, editors. Towards a New Definition of Health. New York NY: Plenum Press; 1979. p. 67-85.
Class 3, Hour 1 Meanings of medications, metonymy	Terms and concepts Esoteric and exoteric Commodities, commodification Commodity fetishism Metaphor Metonymy Assigned reading van der Geest S, White SR. The charm of medicines: Metaphors and metonyms. Medical Anthropology Quarterly 1989;3(4):345-367.
Class 3, Hour 2 Discussion session #1 - Standards of efficacy	Assigned reading (tested in online quiz) Nations MK, Rebhun LA. Mystification of a simple solution: oral rehydration therapy in northeast Brazil. Social Science and Medicine 1988;27(1):25-38. van der Geest S, White SR. The charm of medicines: Metaphors and metonyms. Medical Anthropology Quarterly 1989;3(4):345-367. Young A: An anthropological perspective on medical knowledge. J Med Philos 1980, 5:102-116. Further reading Friedman, Thomas L. Did We Do That? New York Times, October 28, 2007. Stoll-Kleemann et al. The psychology of denial concerning climate mitigation measures: evidence from Swiss focus groups. Global Environmental Change 2001;11:107-117. Young A. Internalizing and externalizing medical belief systems: an Ethiopian example. Soc Sci Med. 1976;10(3-4):147-56. Young A. The Dimension of Medical Rationality: A problematic for the psychosocial study of medicine. In: Ahmed PI, Coelho GV, editors. Towards a New Definition of Health. New York NY: Plenum Press; 1979. p. 67-85. Discussion questions How would you apply the concepts of scientific, empirical and symbolic efficacy to the article by Nations and Rebhun? How do the arguments presented by van der Geest and White for why people take medications fit with Young's model for why people take treatments/medications? What is symptom perceptualization (Young 1980, starting bottom of page 108), and how does it help us understand how people respond to the symptoms of chronic infectious and non-infectious diseases (schistosomiasis, syphilis, AIDS, cancer) and global threats such as climate change? How can concepts of empirical efficacy presented by Young be extended to analyzing the public and policy debate on responding to climate change?
Module 2: Health behavior at the individual level
Module 2 General Resources on models of health behavior change applicable to the entire module	NCI: Theory at a Glance: A Guide for Health Promotion Practice. 2nd Edition. pp. 52. Bethesda MD: National Cancer Institute; 2005:52. Coreil J: Chapter 4: Behavioral and Social Science Theory. In: Social and Behavioral Foundations of Public Health. 2nd edition. Edited by Coreil J. Thousand Oaks, CA: Sage Publications; 2009: 69-88. Munro S, Lewin S, Swart T, Volmink J. A review of health behaviour theories: how useful are these for developing interventions to promote long-term medication adherence for TB and HIV/AIDS? BMC Public Health. 2007;7:104. Elder JP, Ayala GX, Harris S. Theories and intervention approaches to health-behavior change in primary care. American Journal of Preventive Medicine. 1999;17(4):275-84. The definitive resource on models of health behavior is: Health Behavior and Health Education: Theory, Research, and Practice, 4th Edition, 2008, edited by Karen Glanz, Barbara K. Rimer, and K. Viswanath
Class 4, Hour 1 Health belief model	Terms and concepts Behavior change model Stimulus-response theories vs. cognitive theories Value-expectancy theory or expectancy-value theory The "default model" of behavior change used by health professionals without formal training in behavior change interventions Health belief model Self-efficacy Behavioral cue or stiumuls Assigned reading NCI: Theory at a Glance: A Guide for Health Promotion Practice. 2nd Edition. pp. 52. Bethesda MD: National Cancer Institute; 2005:52. Part 1, Foundations of Theory, Pages 3 to 8 Part 2 (first section), Theories and Applications, Pages 9 to 14. Pay particular attention to Table 2 on Page 14 Optional reading: read one of these examples of application of the health belief model Buglar ME, White KM, Robinson NG: The role of self-efficacy in dental patients' brushing and flossing: testing an extended Health Belief Model. Patient Educ Couns 2010; 78:269-272. Downing-Matibag TM, Geisinger B. Hooking up and sexual risk taking among college students: a Health Belief Model perspective. Qual Health Res 2009, 19:1196-1209. Lindsay JJ, Strathman A. Predictors of recycling behavior: An application of a modified Health Belief Model. J Appl Soc Psych 1997; 27(20): 1799-1823. Phuanukoonnon S, Brough M, Bryan JH. Folk knowledge about dengue mosquitoes and contributions of Health Belief Model in dengue control promotion in Northeast Thailand. Acta Trop 2006;99(1):6-14.
Class 4, Hour 2 Theory of reasoned action, theory of planned behavior	Terms and concepts Theory of reasoned action Theory of planned behavior Self-efficacy vs. perceived behavioral control Assigned reading NCI: Theory at a Glance: A Guide for Health Promotion Practice. 2nd Edition. pp. 52. Bethesda MD: National Cancer Institute; 2005:52. Part 2 (second section), Theories and Applications, Pages 15 to 18. Pay particular attention to Figure 3 on Page 18 Optional reading: read one of these examples of application of TRA/TPB: Bosompra K. Determinants of condom use intentions of university students in Ghana: an application of the theory of reasoned action. Social Science and Medicine. 2001; 52(7): 1057-69. Guo Q, Johnson CA, Unger JB, Lee L, Xie B, Chou CP, et al. Utility of the theory of reasoned action and theory of planned behavior for predicting Chinese adolescent smoking. Addict Behav. 2007; 32(5):1066-81. Lifflander A, Gaydos LM, Hogue CJ: Circumstances of pregnancy: low income women in Georgia describe the difference between planned and unplanned pregnancies. Matern Child Health J 2007, 11:81-89. Molla M, Astrom AN, Brehane Y. Applicability of the theory of planned behavior to intended and self-reported condom use in a rural Ethiopian population. AIDS Care. 2007; 19(3):425-31. Munoz-Silva A, Sanchez-Garcia M, Nunes C, Martins A. Gender differences in condom use prediction with Theory of Reasoned Action and Planned Behaviour: the role of self-efficacy and control. AIDS Care. 2007;19(9):1177-81. Schultz PW, Oskamp S. Effort as a moderator of the attitude-behavior relationship: General environmental concern and recycling. Soc Psych Q. 1996;59(4):375-83. Futher reading Armitage CJ, Conner M. Efficacy of the Theory of Planned Behaviour: a meta-analytic review. British Journal of Social Psychology 2001;40(Pt 4):471-99. Montano DE, Kasprzyk D. The Theory of Reasoned Action, Theory of Planed Behavior, and the Integrated Behavioral Model. In: Glanz K, Rimer BK, Viswanath K, editors. Health Behavior and Health Education: Theory, Research, and Practice 4th ed. San Francisco: Jossey-Bass; 2008. p.67-96.
Class 5, Hour 1 Social learning theory/social cognitive theory	Terms and concepts Self-efficacy Social learning theory Social cognitive theory Assigned reading NCI: Theory at a Glance: A Guide for Health Promotion Practice. 2nd Edition. pp. 52. Bethesda MD: National Cancer Institute; 2005:52. Part 2 (third section), Theories and Applications, Pages 19 to 21 Pay particular attention to Table 5 on Page 20 Optional reading: Read one of the following Anderson-Bill ES, Winett RA, Wojcik JR, Williams DM. Aging and the social cognitive determinants of physical activity behavior and behavior change: evidence from the guide to health trial. J Aging Res. 2011;2011:505928. Bandura A. Social cognitive theory: an agentic perspective. Annual Review of Psychology 2001;52:1-26. Gaines A, Turner LW. Improving Fruit and Vegetable Intake Among Children: A Review of Interventions Utilizing the Social Cognitive Theory. Californian Journal of Health Promotion 2009; 7(1): 52-66. Watt MH, Maman S, Earp JA, Eng E, Setel PW, Golin CE, Jacobson M. "It's all the time in my mind": facilitators of adherence to antiretroviral therapy in a Tanzanian setting. Soc Sci Med. 2009;68(10):1793-800.
Class 5, Hour 2 Discussion Session #2 - Applicability of behavior change models to other cultures	Terms and concepts Construal Individualism Assigned reading Markus HR, Kitayama S. Culture and the self: implications for cognition, emotion and motivation. Psychological Review 1991;98(2):224-253. Required: Page 224 until start of Consequences for Cognition on Page 231, focus on Figure 1 on page 226 and Table 1 on page 230. Optional: Pages 231-253. NCI: Theory at a Glance: A Guide for Health Promotion Practice. 2nd Edition edition. pp. 52. Bethesda MD: National Cancer Institute; 2005:52. Pages 9-21 Discussion questions Identify what other cultural contexts people in the discussion group are familiar with through their family background or work experiences. Choose a couple of these contexts, and discuss whether each one is closer to the "independent" or "interdependent" self-construals in Table 1 on page 230. Look at the constructs in the Health Belief Model in Table 2 on Page 14 of Theory At A Glance. To what degree will each of the constructs in the Health Belief Model (except self-efficacy) vary between cultures with an independent and an interdependent construal of self? Look at the constructs in TRA/TPB in Table 2 in Figure 3 on Page 18 of Theory At A Glance. To what degree will each of the constructs in TRA and TPB vary between cultures with an independent and an interdependent construal of self? Consider Voluntary Counseling and Testing - in which a counselor tells the client the result of the HIV test and discusses different options they have for prevention or management of HIV infection - and Community-Based Participatory Research - where we elicit a list of community priorities and work with the community to develop a plan to address them. How might these approaches differ between cultures where interdependent and independent self-construals are more prominent?
Class 6, Hour 1 Psychological perspectives on risk	Terms and concepts Behavioral disinhibition Learned helplessness Locus of control Post-exposure prophylaxis Risk Risk compensation Risk homeostasis Risk perception Time horizon Uniqueness to personal threat (UPT) hypothesis Assigned reading Eaton LA, Kalichman S: Risk compensation in HIV prevention: implications for vaccines, microbicides, and other biomedical HIV prevention technologies. Curr HIV/AIDS Rep 2007, 4:165-172. Kalichman S, Eaton L, Pinkerton S: Circumcision for HIV prevention: failure to fully account for behavioral risk compensation. PLoS Med 2007, 4:e138. Futher reading Kristof ND. When Our Brains Short-Circuit. New York Times. 02 July 2009. Lau RR. Beliefs about control and health behavior. In: Gochman DS, editor. Health Behavior: Emerging Research Perspectives. New York: Plenum Press; 1988. p. 43-63. Rimal RN, Morrison D. A uniqueness to personal threat (UPT) hypothesis: how similarity affects perceptions of susceptibility and severity in risk assessment. Health Commun. 2006;20(3):209-19. Slovic P, Fischhoff B, Lichtenstein S. Facts versus fears: Understanding Perceived Risk. In: Kahneman D, Slovic P, Tversky A, editors. Judgment under Uncertainty: Heuristics and Biases. Cambridge: Cambridge University Press; 1982. p. 463-89. Slimak MW, Dietz T. Personal values, beliefs, and ecological risk perception. Risk Anal. 2006;26(6):1689-705.
Class 6, Hour 2 Anthropological perspectives on risk	Terms and concepts Risk discourse Mary Douglas Cultural theory of risk Risk perception Assigned reading Lupton D: Risk as moral danger: the social and political functions of risk discourse in public health. Int J Health Serv 1993, 23:425-435. Riess TH, Achiengï¿½ MM, Otieno S, Ndinya-Achola JO, Bailey RC: "When I Was Circumcised I Was Taught Certain Things": Risk Compensation and Protective Sexual Behavior among Circumcised Men in Kisumu, Kenya. PLoS ONE 2010, 5:e12366. Further reading Bajos N, Marquet J. Research on HIV sexual risk: social relations-based approach in a cross-cultural perspective. Soc Sci Med. 2000;50(11):1533-46. Bajos N. Social factors and the process of risk construction in HIV sexual transmission. AIDS Care. 1997;9(2):227-37.
Module 3: Social networks, diffusion of innovations and social marketing
Class 7, Hour 1 Social networks	Terms and concepts Social network Centrality Weak ties Assigned reading Hawe P, Webster C, Shiell A. A glossary of terms for navigating the field of social network analysis. Journal of Epidemiology and Community Health 2004;58(12):971-5. Further reading Bond KC, Valente TW, Kendall C. Social network influences on reproductive health behaviors in urban northern Thailand. Social Science and Medicine 1999;49(12):1599-614.
Class 7, Hour 2 Diffusion of innovations	Terms and concepts Diffusion of innovations Adopter categories Everett Rogers Development communication Assigned reading Berwick DM. Disseminating innovations in health care. JAMA 2003;289(15):1969-75. NCI: Theory at a Glance: A Guide for Health Promotion Practice. 2nd Edition edition. pp. 52. Bethesda MD: National Cancer Institute; 2005:52. Diffusion of innovations, pages 27-29
Class 8, Hour 1 Social marketing and mass media interventions	Terms and concepts Social marketing Assigned reading NCI: Theory at a Glance: A Guide for Health Promotion Practice. 2nd Edition edition. pp. 52. Bethesda MD: National Cancer Institute; 2005:52. Social marketing, pages 36-39 Maibach EW, Roser-Renouf C, Leiserowitz A: Communication and marketing as climate change-intervention assets a public health perspective. Am J Prev Med 2008, 35:488-500. Further reading Lefebvre RC, Flora JA. Social marketing and public health intervention. Health Education Quarterly 1988;15(3):299-315. Storey JD, Saffitz GB, Rimon JG. Social Marketing. In: Glanz K, Rimer BK, Viswanath K, editors. Health Behavior and Health Education: Theory, Research, and Practice 4th ed. San Francisco: Jossey-Bass; 2008. p.435-464. Brown J, Einsiedel E. Public Health Campaigns: Mass Media Strategies. In: Ray EB, Donohew L, editors. Communication and Health: Systems and Applications. Mahwah NJ: Lawrence Erlbaum; 1989. p. 153-170.
Class 8, Hour 2 Discussion session #3 - HIV prevention for serodiscordant couples (One partner HIV +ve, the other HIV -ve) in Africa	Assigned reading (tested in online quiz) Bunnell RE, Nassozi J, Marum E, Mubangizi J, Malamba S, Dillon B, Kalule J, Bahizi J, Musoke N, Mermin JH. Living with discordance: knowledge, challenges, and prevention strategies of HIV-discordant couples in Uganda. AIDS Care. 2005;17(8):999-1012. Editors. HIV treatment as prevention--it works. Lancet. 2011;377:1719. Epstein H, Morris M. Letter in response to editorial on HIV Treatment for Prevention Trial HPTN 052. Lancet 2011; 378: 225. Seale A, Lazarus JV, Grubb I, Fakoya A, Atun R. Letter in response to editorial on HIV Treatment for Prevention Trial HPTN 052. Lancet 2011; 378: 226. Karim SS, Karim QA. Antiretroviral prophylaxis: a defining moment in HIV control. Lancet 2011 Published online July 15, 2011 DOI:10.1016/S0140-6736(11)61136-7 Further reading Green EC, Mah TL, Ruark A, Hearst N: A framework of sexual partnerships: risks and implications for HIV prevention in Africa. Stud Fam Plann 2009, 40:63-70 Discussion questions Bunnell et al., (2005) states that few clients or counselors could state accurate information about why HIV discordance among couples exists. What are the common reasons people use to explain discordance? What implications do these have on sexual behavior? What implications do these have for behavioral interventions attempting to prevent transmission? The Bunnell study never fully defines what it means to be a "couple." What do you think defines a couple? Based on your definition, how would you define your target population for a couples-based intervention? Could there be individual and/or group components as well? The opening paragraph of The Lancet editorial entitled "HIV treatment as prevention - it works" makes a bold statement. Do you think we can treat our way out of the HIV epidemic? Why or why not? HPTN 052, as discussed in The Lancet editorial, demonstrated that using treatment as prevention among sero-discordant couples was effective at reducing transmission of HIV to the uninfected partner. Based on these results, if you were the Minister of Health in Uganda, would you try to scale-up treatment as prevention for sero-discordant couples? Why or why not? Seale ï¿½s response to The Lancet editorial says that we should "not hastily abandon non-biomedical elements of HIV prevention" even though there is less rigorous evidence available on the effectiveness of non-biomedical interventions. Do you agree with Seale's statement? Why or why not? If you do agree, what non-biomedical elements would you consider including in a couples-based intervention? The Karim comment discusses recent results from several pre-exposure prophylaxis (PrEP) trials. What are some of the benefits of implementing PrEP for sero-discordant couples? What are some of the drawbacks? The Karim comment discusses that it may be necessary to implement both treatment-as-prevention and PrEP in hyper-endemic settings, like Uganda. Do you agree or disagree? Are there any possible behavioral or structural interventions that could be combined with these biomedical interventions?
Module 4: Households and couples
Class 9, Hour 1 Public and private domains, household structure	Terms and concepts Household Household production of health Public Domain Private Domain or Domestic Domain Assigned reading Berman P, Kendall C, Bhattacharyya K. The household production of health: integrating social science perspectives on micro-level health determinants. Social Science and Medicine 1994;38(2):205-15. Winch PJ, Lloyd LS, Hoemeke L, Leontsini E. Vector control at the household level: an analysis of its impact on women. Acta Tropica 1994;56(4):327-39. Further reading Guyer J. Household and community in African studies. African Studies Review 1981;24(2/3):87-137. Kranzer K, McGrath N, Saul J, Crampin AC, Jahn A, Malema S, et al. Individual, household and community factors associated with HIV test refusal in rural Malawi. Trop Med Int Health. 2008;13(11):1341-50. Murray L, Moreno L, Rosario S, Ellen J, Sweat M, Kerrigan D. The role of relationship intimacy in consistent condom use among female sex workers and their regular paying partners in the Dominican Republic. AIDS Behavior 2007;11(3):463-70. Winch PJ, Alam MA, Akther A, Afroz D, Ali NA, Ellis AA, et al. Local understandings of vulnerability and protection during the neonatal period in Sylhet District, Bangladesh: a qualitative study. Lancet 2005;366(9484):478-85.
Class 9, Hour 2 Kinship systems	Terms and concpepts Descent group, lineage, clan Kinship terminology Patriarchy, matriarchy Patrilineality Matrilineality Patrilocal residence Matrilocal residence Neolocal residence Intergenerational intervention approaches Articles University of Manitoba Kinship and Social Organization tutorial. Do at least Topic #1 "Kin Fundamentals" Katabarwa NM, Richards FO, Jr., Ndyomugyenyi R. In rural Ugandan communities the traditional kinship/clan system is vital to the success and sustainment of the African Programme for Onchocerciasis Control. Ann Trop Med Parasitol 2000;94(5):485-95. Katabarwa MN, Habomugisha P, Agunyo S, McKelvey AC, Ogweng N, Kwebiiha S, Byenume F, Male B, McFarland D. Traditional kinship system enhanced classic community-directed treatment with ivermectin (CDTI) for onchocerciasis control in Uganda. Trans R Soc Trop Med Hyg. 2010; 104(4): 265-72.
Class 10, Hour 1 Counseling	Terms and concepts Counseling Assigned reading Searight R. Realistic approaches to counseling in the office setting. Am Fam Physician. 2009; 79(4):277-84. Further reading Denison JA, O'Reilly KR, Schmid GP, Kennedy CE, Sweat MD. HIV voluntary counseling and testing and behavioral risk reduction in developing countries: a meta-analysis, 1990--2005. AIDS Behav. 2008;12(3):363-73. Gilroy K, Winch PJ, Diawara A, Swedberg E, Thiero F, Kane M, et al. Impact of IMCI training and language used by provider on quality of counseling provided to parents of sick children in Bougouni District, Mali. Patient Education and Counseling 2004;54(1):35-44.
Class 10, Hour 2 Peer group education, peer counseling	Terms and concepts Peer group Peer group education, peer counseling Assigned reading Turner G, Shepherd J. A method in search of a theory: peer education and health promotion. Health Educ Res. 1999;14(2):235-47. Further reading Cornish F, Campbell C. The social conditions for successful peer education: a comparison of two HIV prevention programs run by sex workers in India and South Africa. Am J Community Psychol. 2009;44(1-2):123-35. Medley A, Kennedy C, O'Reilly K, Sweat M. Effectiveness of peer education interventions for HIV prevention in developing countries: a systematic review and meta-analysis. AIDS Educ Prev. 2009;21(3):181-206. Milburn K. A critical review of peer education with young people with special reference to sexual health. Health Education Research 1995;10(4):407-20. Norr KF, Norr JL, McElmurry BJ, Tlou S, Moeti MR. Impact of peer group education on HIV prevention among women in Botswana. Health Care for Women International 2004;25(3):210-26. Plummer ML, Wight D, Obasi AI, Wamoyi J, Mshana G, Todd J, et al. A process evaluation of a school-based adolescent sexual health intervention in rural Tanzania: the MEMA kwa Vijana programme. Health Education Research 2007;22(4):500-12. Plummer ML, Wight D, Wamoyi J, Nyalali K, Ingall T, Mshana G, et al. Are schools a good setting for adolescent sexual health promotion in rural Africa? A qualitative assessment from Tanzania. Health Education Research 2007;22(4):483-99. Ross DA, Changalucha J, Obasi AI, Todd J, Plummer ML, Cleophas-Mazige B, et al. Biological and behavioural impact of an adolescent sexual health intervention in Tanzania: a community-randomized trial. AIDS 2007;21(14):1943-55.
Class 11, Hour 1 Intimate partner violence, Transtheoretical model (Stages of Change)	Terms and concepts Gender roles Violence against women Stage models Stages of changes Pre-contemplation, contemplation, preparation, action, maintenance Assigned reading Jewkes R. Intimate partner violence: causes and prevention. Lancet 2002;359(9315):1423-9. Prochaska JO, DiClemente CC, Norcross JC. In search of how people change. Applications to addictive behaviors. American Psychologist 1992;47(9):1102-14. Further reading Campbell J, Jones AS, Dienemann J, Kub J, Schollenberger J, O'Campo P, Gielen AC, Wynne C: Intimate partner violence and physical health consequences. Arch Intern Med 2002, 162:1157-1163. Gielen AC, O'Campo PJ, Campbell JC, Schollenberger J, Woods AB, Jones AS, Dienemann JA, Kub J, Wynne EC: Women's opinions about domestic violence screening and mandatory reporting. Am J Prev Med 2000, 19:279-285. Jones AS, Dienemann J, Schollenberger J, Kub J, O'Campo P, Gielen AC, Campbell JC: Long-term costs of intimate partner violence in a sample of female HMO enrollees. Womens Health Issues 2006, 16:252-261.
Class 11, Hour 2 Discussion session #4 - Intimate partner violence (IPV)	Burke JG, Denison JA, Gielen AC, McDonnell KA, O'Campo P. Ending intimate partner violence: an application of the transtheoretical model. American Journal of Health Behavior 2004;28(2):122-33. Jewkes R. Intimate partner violence: causes and prevention. Lancet 2002;359(9315):1423-9. Lary H, Maman S, Katebalila M, McCauley A, Mbwambo J. Exploring the association between HIV and violence: young people's experiences with infidelity, violence and forced sex in Dar es Salaam, Tanzania. International Family Planning Perspectives 2004;30(4):200-6. Murray L, Moreno L, Rosario S, Ellen J, Sweat M, Kerrigan D. The role of relationship intimacy in consistent condom use among female sex workers and their regular paying partners in the Dominican Republic. AIDS Behavior 2007;11(3):463-70 Discussion questions Identify one or two settings from the experience of the members of the group where IPV is common, and discuss what group members have observed. Looking at Figure 3 in Jewkes 2002, which of the various factors in the diagram do you think made the greatest contribution to IPV? Why? Referring to the article by Murray et al., how do you think IPV is related to relationship intimacy in this population? Will IPV be common both in couples with high relationship intimacy and low relationship intimacy? Why? Again referring to the article by Murray et al., do you expect IPV to take a different form, or have different underlying causes, in couples with high and low relationship intimacy? How would you relate Figure 3 of the article by Jewkes 2002 with the concepts of public and private domain? For the article by Lary et al., which of the intervention options listed on page 1428 of the article by Jewkes appear most appropriate? Why? For the article by Burke et al., which of the intervention options listed on page 1428 of the article by Jewkes appear most appropriate? Why?
Module 5: Community, ecological models and multi-level interventions
Class 12, Hour 1 Concepts of community	Terms and concepts Community Communitas Victor Turner Gemeinschaft and Gesellschaft Ferdinand van Tï¿½nnies Organic and mechanical solidarity ï¿½mile Durkheim Assigned reading Jencson L. Disastrous rites: Liminality and communitas in a flood crisis. Anthropology and Humanism. 2001;26(1):46-58. Paul BD, Demarest WJ. Citizen participation overplanned: the case of a health project in the Guatemalan community of San Pedro la Laguna. Social Science and Medicine 1984;19(3):185-92. Further reading Adams A. An Open Letter to a Young Researcher. African Affairs. 1979;78(313):451-79. Sallnow M. Communitas Reconsidered: The Sociology of Andean Pilgrimage. Man(NS) 1981;16(2):163-182.
Class 12, Hour 2 Interventions at the community level	Terms and concepts Community development Community mobilization Community action cycle Empowerment Community Led Total Sanitation (CLTS) Community-based participatory research Assigned reading Laverack G. Improving health outcomes through community empowerment: a review of the literature. Journal of Health, Population and Nutrition 2006;24(1):113-20. Further reading Apinundecha C, Laohasiriwong W, Cameron MP, Lim S. A community participation intervention to reduce HIV/AIDS stigma, Nakhon Ratchasima province, northeast Thailand. AIDS Care. 2007;19(9):1157-65. Ashburn K, Kerrigan D, Sweat M. Micro-credit, Women's Groups, Control of Own Money: HIV-Related Negotiation Among Partnered Dominican Women. AIDS Behavior 2007. Schwartz NB. Anthropological views of community and community development. Human Organization 1981;40(4):313-322. Winch PJ, Kendall C, Gubler DJ. Effectiveness of community participation vector-borne disease control. Health Policy and Planning 1992;7(4):342-351.
Class 13, Hour 1 Social capital	Terms and concepts Social capital Constructions of social capital: Communitarian, Institutional and Critical (Wakefield Table 1, p 2821) Approaches to Community Development: Social Planning, Locality Development, Social Action (Wakefield Table 2, p 2823) Robert Putnam Pierre Bourdieu Assigned reading Hawe P, Shiell A. Social capital and health promotion: a review. Soc Sci Med. 2000;51(6):871-85. Navarro V. A critique of social capital. Int J Health Serv 2002;32:424ï¿½32. Wakefield SE, Poland B. Family, friend or foe? Critical reflections on the relevance and role of social capital in health promotion and community development. Social Science and Medicine 2005;60(12):2819-32. Futher reading Kawachi I. Commentary: social capital and health: making the connections one step at a time. Int J Epidemiol. 2006;35(4):989-93. Kawachi I. Social capital and community effects on population and individual health. Ann N Y Acad Sci. 1999;896:120-30. Moore S, Shiell A, Hawe P, Haines VA. The privileging of communitarian ideas: citation practices and the translation of social capital into public health research. Am J Public Health. 2005;95(8):1330-7. Nobles J, Frankenberg E. Mothers' community participation and child health. J Health Soc Behav. 2009;50(1):16-30. Pronyk PM, Harpham T, Morison LA, Hargreaves JR, Kim JC, Phetla G, Watts CH, Porter JD. Is social capital associated with HIV risk in rural South Africa? Soc Sci Med. 2008;66(9):1999-2010.
Class 13, Hour 2 Discussion session #5 - Community-level interventions, social capital	Assigned reading Jana S, Basu I, Rotheram-Borus MJ, Newman PA. The Sonagachi Project: a sustainable community intervention program. AIDS Education and Prevention 2004;16(5):405-14. Kerrigan D, Telles P, Torres H, Overs C, Castle C. Community development and HIV/STI-related vulnerability among female sex workers in Rio de Janeiro, Brazil. Health Educ Res. 2008;23(1):137-45. Navarro V. A critique of social capital. Int J Health Serv 2002;32:424ï¿½32. Paul BD, Demarest WJ. Citizen participation overplanned: the case of a health project in the Guatemalan community of San Pedro la Laguna. Social Science and Medicine 1984;19(3):185-92. Robert Putnam Discussion questions Identify settings from the experience of the members of the group where you feel social capital is high or low. What factors do you think contribute to the high or low social capital? Do you think the high or low social capital has any effects on health? Summarize 1) Putnam's construction of social capital, and 2) Navarro's critique of Putnam's construction and the strengths and limitations of Putnam's and Navarro's ideas. Does San Pedro la Laguna have high or low social capital? What behavior change models, if any, do you feel describe the components of the interventions described in the articles by Jana et al. and Kerrigan et al.? The Kerrigan article suggests that "psychological and material factors were associated with participation in community-building activities." Do theories of social capital address psychological or material factors? If you were going to implement a follow-up intervention to the one implemented by Kerrigan et al., what elements would you include? What are the strengths and weaknesses of the interventions described in the articles? Are there any potential negative consequences of interventions that aim to increase social capital? How sustainable are the interventions described in the articles?
Class 14, Hour 1 Ecological/multi-level models	Terms and concepts Ecological model, Multi-Level Model Levels of causation: Individual, Environmental, Structural, Superstructural Assigned reading NCI: Theory at a Glance: A Guide for Health Promotion Practice. 2nd Edition. pp. 52. Bethesda MD: National Cancer Institute; 2005:52. The Ecological Perspective, Pages 10-12 Sweat MD, Denison JA. Reducing HIV incidence in developing countries with structural and environmental interventions. AIDS 1995;9 Suppl A:S251-7. Further reading Burke NJ, Joseph G, Pasick RJ, Barker JC: Theorizing social context: rethinking behavioral theory. Health Educ Behav 2009; 36:55S-70S. Hanenberg RS, Rojanapithayakorn W, Kunasol P, Sokal DC. Impact of Thailand's HIV-control programme as indicated by the decline of sexually transmitted diseases. Lancet 1994; 344(8917): 243-5. McLeroy KR, Bibeau D, Steckler A, Glanz K. An ecological perspective on health promotion programs. Health Education Quarterly 1988; 15: 351-377. Stokols D. Translating social ecological theory into guidelines for community health promotion. American Journal of Health Promotion 1996;10(4):282-98. Thï¿½gersen-Ntoumani C. An ecological model of predictors of stages of change for physical activity in Greek older adults. Scand J Med Sci Sports. 2009;19(2):286-96 Winch PJ. Social and cultural responses to emerging vector-borne diseases. Journal of Vector Ecology 1998;23(1):47-53.
Class 14, Hour 2 Interventions based on multi-level models	Terms and concepts 100% condom use interventions Assigned readings Kerrigan D, Moreno L, Rosario S, Gomez B, Jerez H, Barrington C, et al. Environmental-structural interventions to reduce HIV/STI risk among female sex workers in the Dominican Republic. Am J Public Health 2006;96(1):120-5. Further reading Kerrigan D, Ellen JM, Moreno L, Rosario S, Katz J, Celentano DD, et al. Environmental-structural factors significantly associated with consistent condom use among female sex workers in the Dominican Republic. Aids 2003;17(3):415-23. Sweat M, Kerrigan D, Moreno L, Rosario S, Gomez B, Jerez H, et al. Cost-effectiveness of environmental-structural communication interventions for HIV prevention in the female sex industry in the Dominican Republic. Journal of Health Communication 2006;11 Suppl 2:123-42.
Class 15, Hour 1 Behavior of Health Workers	Terms and concepts Health worker migration Health worker performance Quality assurance Assinged reading Rowe AK, de Savigny D, Lanata CF, Victora CG. How can we achieve and maintain high-quality performance of health workers in low-resource settings? Lancet 2005;366:1026-35. Further reading Bhattacharyya K, Winch P, LeBan K, Tien M. Community health workers incentives and disincentives: How they affect motivation, retention and sustainability. BASICS II Project, Arlington VA, October 2001 Winch PJ, Bhattacharyya K, Debay M, Sarriot EG, Bertoli SA, Morrow RH. Improving the Performance of Facility and Community-based Health Workers. Child Survival Technical Support Project, Calverton MD, December 2003
Class 15, Hour 2 Behavior of Health Workers	Assigned reading (tested in online quiz) Glenton C, Scheel IB, Pradhan S, Lewin S, Hodgins S, Shrestha V: The female community health volunteer programme in Nepal: decision makers' perceptions of volunteerism, payment and other incentives. Soc Sci Med 2010a; 70:1920-1927. Maes KC, Kohrt BA, Closser S: Culture, status and context in community health worker pay: pitfalls and opportunities for policy research. A commentary on Glenton et al. (2010). Soc Sci Med 2010; 71: 1375-1378. Glenton C, Scheel IB, Pradhan S, Lewin S, Hodgins S: Should we care what policymakers think? A response to Maes, Kohrt and Closser. Soc Sci Med 2010b; 71: 1379-1380. Discussion questions What health care worker behaviors were intended to be addressed by the Glenton et al. study? How well do you think the study addressed those behaviors? Who was the intended audience of the original Glenton et al. article? What do you expect this audience would have gleaned from the article? After reading the original article, the critique by Maes et al., and the reply by Glenton et al., which (if any) of the critiques by Maes et al. do you consider valid? Describe the critique(s) and why the reply by Glenton et al. does or does not address the critique(s) in a manner that assuages your doubts. How would you compare the assumptions that went into each set of authors' articles? How do these assumptions manifest themselves in the conclusions each set of authors make about the study design, execution, and conclusions? After reading these articles and considering their respective arguments, what changes (if any) would you have made to the original design of this study or in its analysis? In what ways would the study and/or results have been improved by these changes?

Course Curriculum

Module 1: Culture, health and illness
- Introduction FREE 02:00:00
- Illness etiologies, levels of causality 02:30:00
- Meanings of medications, metonymy 00:55:00
Module 2: Health behavior at the individual level
- Individual-level models of health behavior 02:30:00
- Social Cognitive Theory 01:40:00
- Concepts of Risk 02:00:00
Module 3: Social networks, diffusion of innovations and social marketing
- Social networks; diffusion of innovations 02:00:00
- Social Marketing 01:30:00
Module 4: Households and couples
- Households, public and private domains, kinship 04:00:00
- Counseling and peer education 01:40:00
- Intimate partner violence, transtheoretical model 00:55:00
Module 5: Community, ecological models and multi-level interventions
- Community and community interventions 03:00:00
- Social Capital 00:55:00
- Ecological models and multilevel interventions 03:00:00
- Behavior of health workers 00:55:00
- Career paths related to community and behavioral interventions 00:00:00
Assignments
- Health Behavior Change at the Individual, Household and Community Assignments 03:00:00

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