Have you ever tried to lose weight, quit smoking, or change some other health behavior and were unsuccessful? Contrary to what people may say, it may not be all your fault. We are influenced by many things, both positive and negative, that can affect our ability to change our behaviors, especially health behaviors.
In health education, this is called the Social Ecological Model. Because we live in a social environment, we are affected by different layers of (social) relationships. These different factors or layers of relationships are Intrapersonal, Interpersonal, Insitutional/Organizational, Community, and Public Policy.
Intrapersonal is the self. This includes your genetics, gender, age, socioeconomic status, beliefs, knowledge, etc. These personal attributes affect your health and your ability to change your health. These intrapersonal factors are your core. You have the most control over this aspect of your life, but not entirely. For instance, you have no control over your age. An older person may be more likely to get a disease, like alzheimers, than a younger person. Men and women have different problems and suffer from different diseases.
Interpersonal is made up of your friends, family, and peers. These relationships have a huge amount of influence over your behaviors. They can help or hinder your ability to change. For instance, children rely on their parents and other adults to feed them. They don’t have a lot of control over what they eat. Another example is if you are a smoker and want to stop but your friends and/or family continue to smoke around you, it may be harder for you to change. If you are trying to stop drinking alcohol but your entirely social life exists in a bar, then you may have to re-examine this aspect of your social life. It is important to develop a plan or strategy to deal with these scenarios if you are going to be successful in your behavior change.
The Institutional, or Organizational, level is made up of those organized groups to which we belong. They include our work, school, churches, clubs, etc. These groups have written or unwritten “rules” that as a member we abide by. There is also a set of social norms that are apart of these institutions. Take work for example. If you are trying to lose weight or eat healthier and your work cafeteria only offers greasy, fried and unhealthy foods, you are more likely to eat those foods. You could bring your lunch but if you forget your options are not good. It also takes a lot of willpower to avoid those foods while watching everyone else eat them. However, if your work offered only healthy food, it would be easier for you to eat healthy because you have easy access to it. If your work has a no smoking policy, it will be easier for you to quit and they are making it harder for you to continue.
Your Community is your outward environment; your town infrastructure, social networks, and broad social norms/beliefs. It is hard to go outside and exercise if you live in a neighborhood riddled with violence and gangs. On the other hand, if you live somewhere that has access to parks, sidewalks, bike paths, gyms, pools, etc, you are more likely to engage in those activities. Look at your community. Do you have fast food restaurants or healthy ones? Can you go for a walk at work or at home? Does your town support healthy activities like road races, bike events, and sports? I live in a town with a lot of health nuts and athletes. You cannot drive through town without passing someone walking, running, or riding a bike. If you want to find someone to exercise with, you can. The social norm is for healthy habits. I would not dare send my child to school with a hostess twinkie. In another school, a child may be embarassed to bring granola. Each community is different and does affect your behavior.
Public Policy are those local, state and federal laws that affect our health and health behaviors. When I was young we did not use seat belts. We could ride in the back of my dad’s pick up truck, hanging off the edge. Not today! As much as some do not like being told that HAVE to use a seatbelt, the seatbelt laws have been successful in saving lives, reducing the number of fatalities in motor vehicle accidents. These laws did make a positive impact. Today, we don’t think twice about using seatbelts. Even I feel naked without it. This is a behavior change affected by public policy.
So what does this mean? It means that when you want to make a change, you really are being influenced by many factors and you must take them all into consideration. In order to be successful, you need to look at the different people, places, and things affecting your ability to change and have a plan of action. Otherwise, you can lose your ground just because you weren’t prepared.
Health Educators and Health Coaches are trained to help people identify and evaluate these factors and develop strategies and anticipatory plans to deal with these social ecological influences.