Culturally compelling strategies for behaviour change: A social ecology model and case study in malaria prevention
Culturally compelling strategies for behaviour change: A social ecology model and case study in malaria prevention
复制标题
DOI：
10.1016/j.socscimed.2005.10.009
复制
发表时间：
2006-06-01
影响因子：
5.4
通讯作者：
Lindsay, Steve W.
中科院分区：
文献类型：
--
作者：
Panter-Brick, Catherine;Clarke, Sian E.;Lindsay, Steve W.
众所周知，行为改变很难启动和维持，促进健康行为的努力失败的原因正受到越来越多的审查。为了取得成功，卫生干预措施应建立在现有做法、技能和优先事项的基础上，认识到人类行为的制约因素，并以社区动员为特色，或以最容易接受变革的人为目标。此外，干预措施应力求在文化上具有说服力，而不仅仅是在文化上适当：干预措施必须让当地社区参与，并与社会和生态景观相结合。在本文中，我们提出了一个社会生态学的角度来明确的意图改变，实际的行为变化，随后的健康影响之间的联系，有关的理论为基础的模型和实际策略，触发行为的变化。社会生态学模型在设计、实施或批判性评估干预措施时，将注意力集中在行为的背景上。作为一个案例研究，我们反映了冈比亚农村社区为导向的干预措施，旨在通过促进一个相对简单和低成本的行为来减少疟疾：修补蚊帐上的洞。在第一阶段，记录了关于蚊帐使用、交易和修理（蚊帐的“社会生活”）的背景资料。在第二阶段（干预），社区成员创作歌曲并张贴海报，鼓励维修，创造主人翁意识，并成为传播健康信息的有力媒介。在第三阶段（评价），定性和定量数据表明，尽管人类行为受到相当大的限制，但家庭的反应特别迅速和广泛，蚊帐修理率显著增加（p < 0.001）。我们强调了一个有前途的方法-使用歌曲-作为一种变革的工具，并提出了一个框架，嵌入设计，实施和干预措施的重要评价在更大的背景下-或社会生态学的行为实践，是健康干预措施的基石。(c)2005爱思唯尔有限公司保留所有权利。
Behaviour change is notoriously difficult to initiate and sustain, and the reasons why efforts to promote healthy behaviours fail are coming under increasing scrutiny. To be successful, health interventions should build on existing practices, skills and priorities, recognise the constraints on human behaviour, and either feature community mobilisation or target those most receptive to change. Furthermore, interventions should strive to be culturally compelling, not merely culturally appropriate: they must engage local communities and nestle within social and ecological landscapes. In this paper, we propose a social ecology perspective to make explicit the links between intention to change, actual behaviour change, and subsequent health impact, as relating to both theory-based models and practical strategies for triggering behaviour change. A social ecology model focuses attention on the contexts of behaviour when designing, implementing or critically evaluating interventions. As a case study, we reflect on a community-directed intervention in rural Gambia designed to reduce malaria by promoting a relatively simple and low-cost behaviour: repairing holes in mosquito bednets. In phase 1, contextual information on bednet usage, transactions and repairs (the 'social lives' of nets) was documented. In phase 2 (intervention), songs were composed and posters displayed by community members to encourage repairs, creating a sense of ownership and a compelling medium for the transmission of health messages. In phase 3 (evaluation), qualitative and quantitative data showed that household responses were particularly rapid and extensive, with significant increase in bednet repairs (p < 0.001), despite considerable constraints on human agency. We highlight a promising approach-using songs-as a vehicle for change, and present a framework to embed the design, implementation and critical evaluation of interventions within the larger context-or social ecology-of behaviour practices that are the bedrock of health interventions. (c) 2005 Elsevier Ltd. All rights reserved.