Syllabus

Graduate Programs in Public Health

GPH 726 – Social and Behavioral Health – Spring A 2022

Credits - 3

Description

Using an ecological approach, health behaviors will be considered within the context of influences on individual behaviors. The course will address the use of behavioral and social science theory to inform the development of health promotion and disease prevention programs, and consider the inherent ethical dilemma involved in planned social and behavioral change efforts.

Materials

DiClemente RJ, Salazar LF and Crosby RA. Health behavior theory for public health: Principles, foundations, and applications. 2nd ed. Burlington MA: Jones & Bartlett Learning. 2019.

Learning Objectives and Outcomes

Course Outcomes

  1. Analyze relationships between a healthcare issue and the affected population, its contexts and culture.
  2. Strategize identification of key stakeholders in a specific community.
  3. Plan for how cultural values and practices should influence the design and implementation of a public health intervention.
  4. Research and propose an intervention targeting a specific healthcare issue affecting a specific population.
  5. Select communication strategy as part of larger intervention.
  6. Create a written report and deliver an oral presentation to a community coalition proposing a healthcare intervention

Public Health Competencies

PC 1. Synthesize and incorporate scientific evidence into professional writing

PC 2.  Search databases and critically analyze peer-reviewed literature  

PC 5. Evaluate the use of technological applications in health interventions

FC 13. Propose strategies to identify stakeholders and build coalitions and partnerships for influencing public health outcomes

FC 18. Select communication strategies for different audiences and sectors

FC 19. Communicate audience-appropriate public health content, both in writing and through oral presentation

FC 20. Describe the importance of cultural competence in communicating public health content

Assignments

Discussions 

Each student is expected to post at least three times each week in response to forum questions on that week’s topic (exceptions are noted within individual discussion prompts). Because this is an online course, the online discussion portion is an important way to exchange ideas with your classmates. Students will be graded on their participation and effort of their posts. These posts will take time to complete but they are an essential part of this online course and a great way to get to know your colleagues. Please be familiar with the course material (readings/lectures) before posting each week. 

Many of the discussions in this course will be Group Discussions, in which you will be working with your group on a specific healthcare issue. 

Major Assignments

Assignment 1: Evaluation of Interventions

Use PubMed to search the peer-reviewed literature to identify at least 5 articles that present evaluations of the effectiveness of interventions used to address the modifiable determinants of health that you identified as the target of your intervention. Complete a table listing key facts for each article. Provide a brief evaluation for each intervention, and submit along with a PubMed clipboard document containing abstracts of each article.

Assignment 2: Report to the Coalition

Based on the information you have gathered and discussed during the class, write a 4-6 page report to your community coalition recommending a theory-based intervention to address an identified health issue within the community. 

Quizzes

Students will complete quizzes in Weeks 2, 4, 6 and 8, focusing on the assigned textbook chapters and application of theories presented in the course. The Week 8 quiz focuses on broad concepts covered in the course. Unless otherwise noted within the quiz instructions, quizzes open at 12:00 AM on Wednesday, and close the following Wednesday at 11:59 PM ET.

Grading Policy

Your grade in this course will be determined by the following criteria:

Grade Breakdown

Course RequirementsPoints (Out of 100)
Discussion (1 @ 2 points, 1 @ 6 points, 5 @ 8 points)48 pts
Assignment 1: Evaluation of Interventions10 pts
Assignment 2: Report to the Coalition20 pts
Quizzes (Week 2 - 3pts, Week 4 - 7 pts, Week 6 - 3 pts, Week 8 - 9 points)22 pts
Total100 pts

Grade Scale

Grade Points Grade Point Average (GPA)
A 94 – 100% 4.00
A- 90 – 93% 3.75
B+ 87 – 89% 3.50
B 84 – 86% 3.00
B- 80 – 83% 2.75
C+ 77 – 79% 2.50
C 74 – 76% 2.00
C- 70 – 73% 1.75
D 64 – 69% 1.00
F 00 – 63% 0.00

Schedule

Each week opens on Wednesday at 12:01 AM Eastern Time (ET). Each week closes on Wednesday at 11:59 PM ET, with the exception of Week 8, which ends on Sunday. 

  • Week 1: Jan 5 – Jan 12
  • Week 2: Jan 12 – Jan 19
  • Week 3: Jan 19 – Jan 26
  • Week 4: Jan 26 – Feb 2
  • Week 5: Feb 2 – Feb 9
  • Week 6: Feb 9 – Feb 16
  • Week 7: Feb 16 – Feb 23
  • Week 8: Feb 23 – Feb 27

The assignment/discussion descriptions mentioned below are summaries. Review full assignment prompts in the course. There may be additional readings/videos that are not mentioned in this weekly summary.

Week 1: Health Behavior in Context & Evaluating the Evidence

Weekly Outcomes:

  • Identify factors affecting population health relative to a specific healthcare issue
  • Search databases and critically analyze peer-reviewed literature
  • Synthesize and incorporate scientific evidence into professional writing

Readings and Multimedia:

  • Course Introduction lecture
  • Chapter 1: Health Behavior in the Context of the “New” Public Health lecture
  • Chapter 2: How Theory Informs Health Promotion and Public Health Practice lecture
  • Week 1: Finding the Evidence lecture
  • Week 1: Interventions lecture
  • Week 1: Strategies for Writing lecture
  • Using Evidence in Writing lecture
  • Textbook Section 1: Overview, pp. 1-2.
  • Textbook Chapter 1: Health Behavior in the Context of the “New” Public Health
  • Textbook Chapter 2: How Theory Informs Health Promotion and Public Health Practice
  • Mokdad AH, Marks JS, Stroup DF, Gerberding JL. Actual Causes of Death in the United States, 2000. JAMA. 2004; 291:1238-1245.
  • Kovalchick S, Mills JA. How to Read an Academic Article. Powerpoint Presentation.

Assignments:

  • Whole Class Discussion: Introductions
    • Initial post: Introduce yourself to your peers and your instructor. Describe your interest in Social & Behavioral Health. How do you think the theories and models discussed in this course will help you better understand public health?
  • Whole Class Discussion: Evaluating the Mokdad article
    • In 1993, McGinnis and Foege wrote a seminal article attributing the most common causes of death to the underlying behavioral factors associated, identifying these as the actual causes of death.  The 2004 article by Mokdad et al. updates their findings using a similar methodology. Read the Mokdad et al. article using the strategies discussed this week. The focus of your review should be on the writing and presentation of the data. Discuss the following:
      • What did the authors do well in the writing of the article?  
      • What makes this an effective article (if it is effective)? 
      • How would you recommend the authors revise or edit their article to improve readability?
      • Who is the audience for this article?
      • What value does this article have for you as a public health professional?
    • This article has been cited in more than 7,000 publications.  Consider how this article relates to the health issue you selected for your group this term. End your post with a sentence citing this article that you could use to support your argument that it is important to focus on a behavioral risk factor related to your group’s health issue.  (Do not quote directly from the article.) Write this final sentence as you would in a report or article.
  • Group Discussion: Finding and Writing About Evidence 
    • Select a recent article that presents evidence of the link between your health issue and one or more modifiable behavioral determinants of health.

      Initial Post: Describe the search process you used to identify the article, include the database or search engine and search terms used, and explain why you chose this approach over a different strategy. Include why you selected the article that you are presenting. 

      Briefly summarize the main finding(s) of the study (do not describe the study in full), and then answer the following questions:

      • What did the authors do well in the writing of the article?  
      • What makes this an effective or ineffective article?
      • How could this article be revised to improve the article?
      • Who is the audience for this article?
      • What value does this article have for you as a public health professional?

      Response Posts: Select one of the articles presented by your colleagues (try to choose one that does not already have a response). Read their article and explain where you agree and/or differ with their analysis of the article. End your post with a one to two sentence synthesis of the main findings from the two articles. (This final sentence(s) should highlight the main takeaway from these two points of evidence, for example, how the findings from your article and your colleague’s article relate or agree/disagree?). Do not forget to cite properly. For your second post, reflect on the experiences this week of evaluating these articles. Discuss how you and your group can apply this experience to improve your own writing.  (Some groups choose to start a new thread and post all their reflections there, others as responses to existing threads.  Feel free to do whichever you prefer.)

Week 2: Engaging the Community in Health Promotion

Weekly Outcomes:

  • Apply awareness of cultural values and practices to the design or implementation of public health policies or programs
  • Propose strategies to identify stakeholders and build coalitions and partnerships for influencing public health outcomes

Readings and Multimedia:

  • Chapter 3: Planning Models lecture
  • Community-Based Partnerships lecture
  • Textbook: Chapter 3 The PRECEDE-PROCEED Planning Model
  • Duran B, Wallerstein N, Avila MM, Belone L, Minkler M, Foley K. Chapter 2: Developing and Maintaining Partnerships with Communities. in Israel BA, Eng E, Schulz AJ, Parker EA, eds. Methods for Community-Based Participatory Research for Health, 2nd ed. 2013.  pp 43-68. San Francisco: John Wiley & Sons, Inc.
  • Caldwell WB, Reyes AG, Rowe Z, Weinert J, Israel B. Community Partner Perspectives on Benefits, Challenges, Facilitating Factors, and Lessons Learned from Community-Based Participatory Research Partnerships in Detroit. Progress in Community Health Partnerships. 2015;9.2:299-311.
  • Addison CC, Campbell Jenkins BW, Odom D, et al. Building Collaborative Health Promotion Partnerships: The Jackson Heart Study. Int J Environ Res Public Health. 2016(13):25. doi:10.3390/ijerph13010025.

Assignments:

  • Whole Class Discussion: Engaging the Community
    • Identify a community that is affected by the public health issue that your group is addressing. You should briefly describe your community (city, county, or other specific geographic location). This will allow you to ground your proposal within the demographic and environmental factors unique to your community that may influence your intervention proposal. Remember that while you will all be working on the same health issue within your small group, you will each be developing your own intervention and working with a community of your choice.

      Initial Post : Title the subject line of your initial post with your health issue and community (e.g., Diabetes prevention in Wyoming County, WV). Briefly describe your community, including information regarding the physical environment (rural/urban, unique characteristics) and demographics (race/ethnicity, SES, etc.), and the impact of your health issue within this community.

      Based on the readings and lectures this week, describe how you would identify stakeholders within your community and begin to build partnerships. How will you include the needs and perspectives of multiple members within the community coalition? Be specific in the strategies you propose to both identify and include a variety of stakeholders in your coalition.

      Response Posts (minimum of two response posts engaging with others in the discussion to address the following points): Read through your colleagues’ posts. Using specific examples, discuss how awareness of cultural values and practices should be incorporated into the design and implementation of your coalitions’ public health interventions. Consider why community involvement and understanding cultural values and practices is important to include in the planning process. How could a lack of community involvement hinder the success of an intervention?

  • Week 2 Quiz

Week 3: Value Expectancy & Fear Appeals

Weekly Outcomes:

  • Identify determinants of health for a specific healthcare issue
  • Map determinants of health for a specific condition and population to the socioecological model

Readings and Multimedia:

  • Chapter 4: Value-Expectancy Theories lecture
  • Chapter 5: Models Based on Perceived Threat and Fear Appeals lecture
  • Textbook Chapter 4: Value-Expectancy Theories
  • Textbook Chapter 5: Models Based on Perceived Threat and Fear Appeals

Assignments:

  • Group Discussion: Modifiable Determinants of Health
    • When designing a theory-based health intervention, it is important to focus first on the modifiable determinants of health, and not go into the planning phase with a predetermined intervention. This week you will be evaluating the evidence to determine the focus of your intervention.

      Initial Post: Identify the determinants of health related to your health issue, using peer-reviewed health literature to support. Most health issues are influenced by multiple determinants. In your discussion, consider both determinants of health risk and health protection behavior as you write a well-organized and concise description of the data linking behavioral or structural factors related to your health issue. Your post should provide a clear summary of the evidence linking your health issue to behavioral or modifiable structural determinants.

      Response Posts: Discuss how the determinants of health identified by your group relate to the socioecological model. Consider also the relative changeability and importance of each of these health-promoting behaviors or conditions.

      In your second post, discuss how the changeability and importance may differ depending on the population and structure of your communities. Apply this consideration to your community and make an argument, based in evidence, for which modifiable determinants of health you will focus your intervention on for your community.

Week 4: Stage Models, Social Cognitive Theory & Health Communication

Weekly Outcomes:

  • Search databases and critically analyze peer-reviewed interventions to address a specific health issue
  • Synthesize and incorporate scientific evidence into professional writing

Readings and Multimedia:

  • Chapter 6: Stage Models for Health Promotion lecture
  • Chapter 7: Social Cognitive Theory Applied to Health Behavior lecture
  • Chapter 8: Health Communication: Theory, Social Marketing & Tailoring lecture
  • Textbook: Chapter 6: Stage Models for Health Promotion
  • Textbook: Chapter 7: Social Cognitive Theory Applied to Health Behavior
  • Textbook: Chapter 8: Health Communication: Theory, Social Marketing & Tailoring
  • Merkx A, Ausems M, de Vries R, Nieuwenhuijze MJ.  Come On! Using intervention mapping to help healthy pregnant women achieve healthy weight gain. Public Health Nutrition, 2017:1-15. DOI: 10.1017/S136898001700027

Assignments:

  • Assignment 1: Evaluation of Interventions
    • Last week your group discussed the modifiable determinants of health-related to your health issue, and you concluded which modifiable determinant(s) will be the priority for your intervention. Use PubMed to search the peer-reviewed literature to identify at least 5 articles that present evaluations of the effectiveness of an intervention used to address the modifiable determinant(s) of health you identified as the target of your intervention. In a separate document, provide a 300-500 word review of these interventions. Include in your discussion an evaluation of whether the interventions were effective and, based on your review of the literature, which theory or theories are most relevant to addressing your health issue. Create a PubMed clipboard document with abstracts for your 5 references and submit as a separate document for your instructor to review. See the instructions in the course on how to download these.
  • Week 4 Quiz

Week 5: Beyond an Individual Focus on Health Behaviors

Weekly Outcomes:

  • Research and select among communication strategies for healthcare interventions
  • Evaluate the use of technological applications in health interventions
  • Describe the importance of cultural competence in communicating public health content
  • Discuss the role of ethics in designing health messages and interventions

Readings and Multimedia:

  • Chapter 9: Ecological and Structural Approaches to Improving Public Health lecture
  • Chapter 10: Social Network Theory lecture
  • Chapter 11: Diffusion of Innovations Theory lecture
  • Textbook: Chapter 9: Ecological and Structural Approaches to Improving Public Health
  • Textbook, Chapter 10: Social Network Theory
  • Textbook, Chapter 11: Diffusion of Innovations Theory
  • Principles of the Ethical Practice of Public Health

Assignments:

  • Whole Class Discussion: Use of Technological Applications in Health Promotion
    • This week you will continue to review potential interventions. As we read last week and this week, social media and technological applications offer potential strategies for engaging people and delivering health interventions. They may be used either alone or with other strategies, or they may not be appropriate for a particular situation. As with all health promotion, ethics must be considered in intervention development and implementation when developing health apps.

      Initial Post: Identify and share an example of a technological application used in an intervention that relates to your groups’ health issue and the modifiable determinant(s) of health that you have identified. If there is a visual representation of the intervention, please include it or a link to it in your initial post. Include at least one peer-reviewed reference related to the intervention’s implementation and evaluation.

      Describe how this technological application was used to promote health. Your post should briefly describe the intervention and include your analysis of whether this example is a successful strategy, explaining clearly why or why not. Use the theories we have studied to support your analysis. Your analysis of effectiveness may differ from the published reference; just make sure to support your analysis either way. End with a recommendation of whether you would or would not use a technological application to address your health issue with your community and briefly explain why. (Remember that this may not be the best approach for your particular intervention.)

      Response Posts: Read through your colleagues’ posts: Select at least one of your colleague’s examples. Did the intervention identified by your colleague present a culturally competent message? If so, how? If not, how could the message have been improved? Discuss the importance of cultural competence in communicating public health content, whether through apps or other methods.

      Select at least one different example shared in your group, and discuss the role that ethics should play in our work as we design health messages and interventions. Was ethics clearly considered in the design of the interventions that your colleague and you selected? Use specific examples from the studies to support your position. How can you ensure that ethics is considered in the intervention you will propose to your coalition?

Week 6: Intervention Mapping

Weekly Outcomes:

  • Create performance and change objectives for a specific modifiable determinant of health
  • Select intervention methods to target this determinant of health

Readings and Multimedia:

  • Chapter 12: Translating Research to Practice: Putting “What Works” to Work lecture
  • Chapter 13: Learning to Combine Theories: An Introduction to Intervention Mapping lecture 
  • Textbook Chapter 12: Translating Research to Practice: Putting “What Works” to Work
  • Textbook Chapter 13: Learning to Combine Theories: An Introduction to Intervention Mapping
  • Kok G, Gottliebb NH, Peters GJY, et. al. A taxonomy of behaviour change methods: an Intervention Mapping approach. Health Psychology Rev. 2016(10): 297–312. DOI: 10.1080/17437199.2015.1077155.
  • Tables and Figure for A Taxonomy of Behavior Change Methods; an Intervention Mapping Approach

Assignments:

  • Group Discussion: Performance and Change Objectives
    • Throughout the course, you have been working with your group to explore the literature related to your health issue. You have identified relevant determinants of health and selected the focus most important to your community. You have reviewed intervention studies, including the use of technological applications in health promotion, and made a recommendation for which theory is most relevant to your intervention development. This week you will be using this information to develop specific performance and change objectives.

      Initial Post: Based on the modifiable determinant you have selected as your focus, identify two performance objectives, identify theoretical constructs that would be relevant to the specific objective, and create relevant change objectives. The articles you evaluated for Assignment 1 will help you in this process. The readings this week will be important to review, as developing performance and change objectives is a step in the Intervention Mapping process.

      Refer to the examples for the structure, but do not limit yourself to the constructs identified there. Your table should reflect the theory that you have chosen as the focus for your intervention, and should include the performance objective, the personal determinants (these will be the theoretical constructs of the theory you have identified), and the change objective related to both (what needs to change related to the personal determinant for the individual to achieve the performance objective). See Examples of Performance and Change Objectives and Table 2 in the Merkx article for examples of how the information should be organized. Both your performance objectives and change objectives should be measurable. Present these in a table, and explain the table in detail using peer-reviewed references to support.

      Response Posts (minimum of two response posts engaging with others in the discussion to address the following points): Read your colleagues’ discussions of their change objectives and relevant theories and theoretical constructs. Discuss how the Kok et. al. article and taxonomies, as well as your reviews of intervention literature, can be used to identify the methods you will recommend for your intervention. Use specific examples from the discussion to suggest how your colleagues might apply the taxonomies to the current development of their interventions.

      Based on your discussion and the materials you have reviewed, propose which methods you think will be most relevant to your theory-based intervention.

  • Week 6 Quiz

Week 7: Measurement and Evaluation

Weekly Outcomes:

  • Select communication strategies for different audiences and sectors
  • Communicate audience-appropriate public health content in a written format 
  • Develop a report reviewing the evidence and recommending a theory-based intervention
  • Explain how to evaluate the effect of a theory-based intervention

Readings and Multimedia:

  • Chapter 14: Measurement and Design Related to Theoretically-Based Health Promotion Research and Practice lecture
  • Chapter 15: Evaluating Theory-Based Public Health Programs: Linking Principles to Practice lecture
  • Textbook: Chapter 14 Measurement & Design Related to Theoretically Based Health Promotion, Research, and Practice
  • Textbook: Chapter 15 Evaluating Theory-Based Public Health Program: Linking Principles to Practice

Assignments:

  • Assignment 2: Report to the Coalition
    • Prepare a final report to your community coalition based on the information you have gathered and discussed during the class. Keep in mind that your discussions have been a place to discuss the evidence and develop your ideas, but now you must combine them to create a clear report geared for your community coalition. Do not just paste your previous work, as it was written with a different audience in mind. Incorporate the feedback you have received from your instructor and your group to refine your report and make your final recommendation.

Week 8: Presenting Evidence-Based Intervention Proposals

Weekly Outcomes:

  • Select communication strategies for different audiences and sectors
  • Communicate audience-appropriate public health content through oral presentation
  • Clearly describe a health behavior theory
  • Provide professional and constructive critique to peers

Readings and Multimedia:

  • Week 8 Overview lecture
  • Better Presentations, University of New England
  • Designing and Writing an Effective Presentation, Johns Hopkins School of Public Health
  • How to Convert Your Paper into a Presentation, Duke University Writing Studio
  • Recording a Presentation
  • Uploading Presentation to YouTube
  • Sharing Your Video
  • How to Edit Closed Captioning in YouTube

Assignments:

  • Week 8 Whole Class Discussion
    • Initial post (Due Friday): Your initial post this week is a 2 minute video in which you briefly explain the theory you chose as the basis for your intervention.  Your audience for this explanation is your community coalition. Since members may not be familiar with behavioral health theories or public health vocabulary, make sure to explain the health behavior theory you have selected in clear and easy to understand language.  For your presentation, include a video of yourself presenting the theory. You may also include a screen recording (slides or other visual) to support your explanation. For guidance on how to do this, please refer to the Screencast-O-Matic tutorial in week 8 learning materials.  Identify the theory you are explaining in the subject line of your initial post to the discussion topic.

      Response Posts (Due Sunday): Select a colleague who presented on a different theory than you did.  Provide a critique of their presentation, particularly how well a non-public health audience would understand the theory as explained.  Acknowledge what was effective in their presentation and offer suggestions for how they might improve their explanation. After you view your colleagues’ presentations, post to the Reflection thread. Rewatch your own explanation of the theory you chose and offer a critique of your presentation. End with a paragraph reflecting on the process of presenting your recommendations in a written report to the coalition and explaining the theory orally. What did you learn during this process, and how will you apply this to your future public health work?

  • Week 8 Quiz: Final Assessment

Student Resources

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Online resources: AMA Style Guide

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