Social Ecology of Asthma: Engaging Stakeholders in Integrating Health Behavior Theories and Practice-Based Evidence Through Systems Mapping
Social Ecology of Asthma: Engaging Stakeholders in Integrating Health Behavior Theories and Practice-Based Evidence Through Systems Mapping
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DOI：
10.1177/1090198113486804
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发表时间：
2014-02-01
影响因子：
4.2
通讯作者：
Lewis, Megan A.
中科院分区：
文献类型：
--
作者：
Gillen, Emily M.;Lich, Kristen Hassmiller;Lewis, Megan A.
本文描述了一个过程，将健康行为和社会科学理论与基于实践的见解相结合，使用参与式系统思维和系统动力学方法的启发。这种整合可以通过提供一种系统的方法将多个领域的利益相关者聚集在一起，从而有助于缩小健康教育和健康行为研究与实践之间的差距。在这个过程中，我们创建了一个图表，使用结构从多个健康行为理论在社会生态框架的各个层面作为变量的因果循环图。这一过程的目标是阐明解释因素之间的相互关系，在社会生态框架的各个层面，使这么多的公共卫生问题棘手。为了说明，我们详细介绍了一个基于理论的，可复制的过程，用于创建一个定性的图表，以丰富对护理人员和提供者行为的理解，围绕遵守儿科哮喘行动计划。我们描述了如何将这种推理作为将证据转化为实践的基础，以应对现实世界的挑战。获得的关键见解包括认识到影响父母/护理人员和医疗提供者是否以及如何有效地共同制定哮喘行动计划的复杂多层次因素，以及可以支持或破坏正在进行的合作的重要反馈动态。虽然本文将这种方法应用于儿童哮喘行动计划的遵守，但该方法和由此产生的图表也适用于需要持续日常行动的其他健康行为。
This article describes a process for integrating health behavior and social science theories with practice-based insights using participatory systems thinking and diagramming methods largely inspired by system dynamics methods. This integration can help close the gap between research and practice in health education and health behavior by offering a systematic approach to bring together stakeholders across multiple domains. In this process we create a diagram using constructs from multiple health behavior theories at all levels of the social ecological framework as variables in causal loop diagrams. The goal of this process is to elucidate the reciprocal relationships between explanatory factors at various levels of the social ecological framework that render so many public health problems intractable. To illustrate, we detail a theory-based, replicable process for creating a qualitative diagram to enrich understanding of caregiver and provider behavior around adherence to pediatric asthma action plans. We describe how such diagramming can serve as the foundation for translating evidence into practice to address real-world challenges. Key insights gained include recognition of the complex, multilevel factors affecting whether, and how effectively, parents/caregivers and medical providers co-create an asthma action plan, and important feedback dynamics at play that can support or derail ongoing collaboration. Although this article applies this method to asthma action plan adherence in children, the method and resulting diagrams are applicable and adaptable to other health behaviors requiring continuous, daily action.