The premise behind any socio-ecological model is that there are multiple complex layers that influence our health, and all models follow the same premise, as demonstrated by the first image. Depending on the phenomenon it's trying to explain, there may be more levels, or the levels may have different names. But all models seek to demonstrate that external factors of varying degrees play a role in influencing the levels within it.
Looking at the smallest circle, we see that the individual has control over certain aspects of their own health, for example choosing to smoke or not. Other influence outside of yourself also contribute to your decisions to smoke or not. You may decide you no longer want to smoke, but your friends and spouse still smoke. Therefore, that social environment does not create an encouraging environment for you to quit smoking. Even if they're supportive of your attempt to quit, if they still smoking around you, that could make your efforts less successful. As with social environment, if the physical environment is not conducive to quitting, it will be harder to kick the habit. Imagine how hard it would be to quit smoking if it were still allowed in bars and restaurants. Or if cigarette companies were still allowed to advertise. The physical environment around you influences your view on the world, and therefore your choices within it. Lastly, there's policy, which is like a procedural endorsement of what you can and cannot do. When the government decided to change the policy around smoking indoors, that had a trickle down effect on the physical environments, and therefore the social environment and the individual levels. If you're not allowed to smoke inside anymore, you're no longer surrounded by smoke and your attempts to quit become more successful. If more of your friends quit because they're no longer surrounded by it, your social environment becomes more accepting of your attempts to quit, and could lead to better success in quitting smoking. The final outcome of a successfully implemented socio-ecological model results in small changes at many levels to create a large change overall. Moving forward, we can see how real-world examples use these models to affect change.
The Center for Disease Control uses the socio-ecological model as a frame work for preventing violence. Firstly, they examine individual factors like biology, education, income, substance abuse, or history of abuse. Prevention at the individual level include conflict resolution and life-skills training. The second level examines close relationships and the influence it has over the individual for perpetrating, or being a victim of, violence. These include peer groups and familial relationships, which influence the individual's propensity to be violent as that is what they have viewed as acceptable behaviour. Prevention at the relationship level involve mentoring, increasing problem-solving skills, and promotion of health-relationships. At the community level, the CDC assess school, neighborhoods, and work environments to evaluate the characteristics that influence people to become violent. Prevention in the community setting include improving housing situations, decreasing isolation and enacting policies to negate violence. Lastly, they evaluate the inequalities and societal norms that might harbor violence as an acceptable outcome at the societal level. Prevention comes in the form of improving healthcare, boosting economics in the region, and funding increased education (CDC, 2020).
Another example of how models can be implemented to influence health changes includes a study by Nuss et al., which implemented an asthma-friendly model at schools in Louisiana. The changes included; identifying those with asthma and ensuring each had an Asthma-Action plan, allowing students with asthma to self medicate with their own inhaler, that teachers knew how to handle asthma-related issues, and that the environment was free from known asthma triggers like smoke and exhaust. By determining key changes that could be made at the intrapersonal, interpersonal, institutional, community, state and national levels, the study showed statistically significant reduction in asthma-related issues (Nuss et al., 2016).
The socio-ecological model is great for identifying factors at different levels that may help to change health behaviours. Some additional benefits of this model include educating the larger population, demonstrating how it is easier to prevent illness now rather than treating it later, and give individuals the opportunity to take responsibility for their own health. However, the model is not without its limitations. Using a socio-economical model may identify issues at each level, but the actual implementation of a healthier life-style by the individual is more difficult than it sounds. If an individual's attitude towards health changes, but factors outside their control like financial situation or social environment have not, they may still have limited progress towards healthy living. Changing environments can also prove difficult, requiring morale changes from many individuals, who may or may not be invested in the outcome, or are in denial about the problem to begin with. Lastly some disease processes are unavoidable, regardless of changes. If you are genetically predisposed for a degenerative disease like Multiple Sclerosis, a healthy lifestyle may have no affect on the outcome (Kumar, et al., 2011).
The socioecological model is a great tool that can be utilized by not only health agencies, but at a personal level too. If you are interested in changing a behaviour, you must find ways to assist in the development of that behaviour outside of yourself. For example, if your goal is to lose weight you can make changes about your own attitudes and behaviours, but implementing environmental changes will greatly increase your success. Have a gym bag packed and ready by the front door or in you car so you're always ready to workout. Place reminders about your goals in places you will see them to motivate you. Make sure to shop on a full stomach to avoid purchasing unnecessary snack foods, and therefore won't be tempted by poor food choices because there aren't any in the house. Have friends to workout with, to keep each other accountable. On days where you don't feel like exercising, they can encourage you to go. The work environment is an oft forgotten source of motivation. Find coworkers who have similar goals and work towards them together. Eating lunch with them will remind you to pack a healthier lunch in the mornings. You can also go for small walk breaks with them throughout the day. Their presence around you at work will create health-oriented environment to contribute to you own individual practices.
To learn more about socio-ecological models, you can read this online resource, specifically Chapter 4: Application of the Ecological Model.
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