Digital Literacy Lecture Notes PDF

Lecture 6-8 COMBO Digital Literacy POH705 School of Occupational and Public Health Toronto Metropolitan University Week 6  Lesson Objectives To understand the core components of digital literacy To identify factors that contribute to digital literacy leve...

Lecture 6-8 COMBO Digital Literacy POH705 School of Occupational and Public Health Toronto Metropolitan University Week 6  Lesson Objectives To understand the core components of digital literacy To identify factors that contribute to digital literacy levels To discuss patterns and measures of digital literacy across population groups To reflect on why digital literacy matters for health promotion Recall from Week 8 “Health literacy is the ability to access, understand, evaluate and communicate information as a way to promote, maintain, and improve health in a variety of settings across the life course.” - Canadian Public Health Association Expert Panel on Health Literacy What is digital literacy? 5  What is digital literacy? “The ability to use information and communication technologies to find, evaluate, create, and communicate information, requiring both cognitive and technical skills.”1 Digital literacy involves: Confident and critical use of a range of digital technologies for basic problem-solving in all aspects of life2 Underpinned by basic computer and tech skills 1Loewus, L. (2020, December 9). What is Digital Literacy? Education Week. https://www.edweek.org/teaching-learning/what-is-digital-literacy/2016/11 2https://tcg.uis.unesco.org/wp-content/uploads/sites/4/2021/08/Metadata-4.4.2.pdf  Evolution of literacy The definition of digital literacy has evolved over time Constantly changing availability of digital tools and technology Digital literacy first focused only on the ability to use computers to find and access information, but now, it includes Smartphones Smartwatches ChatGPT and other AI platforms Issues of data privacy and security Anything else? Asino, T. I., Jha, K., & Adewumi, O. (2020, August 28). Literacy in the digital age: From traditional to digital to mobile digital literacies. Learning in the Digital Age. https://open.library.okstate.edu/learninginthedigitalage/chapter/literacy_in_the_digital_age/  Have you heard of the SDGs? Source: https://sdgs.un.org/goals  SDG 4: Ensure inclusive and equitable quality education and promote lifelong learning opportunities for all Target 4.4: By 2030, substantially increase the number of youth and adults who have relevant skills, including technical and vocational skills, for employment, decent jobs and entrepreneurship 4.4.2: Percentage of youth/adults who have achieved at least a minimum level of proficiency in digital literacy skills Source: https://tcg.uis.unesco.org/wp-content/uploads/sites/4/2021/08/Metadata-4.4.2.pdf The importance of digital literacy during the pandemic Siobhán McPhee Associate Professor of Teaching, & Micheal Jerowsky PhD Candidate. (2022, October 4). What is 'blended learning' and how can it benefit post-secondary students? The Conversation. https://theconversation.com/what-is-blended-learning-and-how-can-it-benefit-post-secondary-students-187971 The importance of digital literacy during the pandemic Pandemic created a surge in remote learning Flexible and creative approach Increased use of softwares such as Microsoft Teams, Zoom, etc. Digital literacy impacts on learning ○ Educators ○ Students ○ Families Many people have struggled to use this technology based on: Comfort, access, understanding Siobhán McPhee Associate Professor of Teaching, & Micheal Jerowsky PhD Candidate. (2022, October 4). What is 'blended learning' and how can it benefit post-secondary students? The Conversation. https://theconversation.com/what-is-blended-learning-and-how-can-it-benefit-post-secondary-students-187971  The digital literacy landscape in Canada 98% of students from socioeconomically privileged schools, reported having access to a computer at home vs. 88% of students from low socioeconomic schools 70% of 15-year-old students reported receiving instruction on how to recognize subjective or biased information vs. the OECD average of 55% 20% of Grade 4 students (20%) reported never or almost never using a computer or tablet at home for schoolwork in 2016 vs. global average (23%) These data were collected pre-COVID. Government of Canada, S. C. (2020, December 14). Digital literacy skills of Canadian youth compare favourably with the OECD average. The Daily. https://www150.statcan.gc.ca/n1/daily-quotidien/201214/dq201214a-eng.htm Internet service use in Canada Upward shift in the distribution of Canadians across internet user groups (“non-user, basic, intermediate, advanced”) Increase in majority of online activities (video calls, ordering goods, etc.)  What has been your experience with digital literacy? Did you grow up in a digitally literate household? Are your parents comfortable with using tech?  What does it mean to be digitally literate? Example: Travelling and need to check vaccination regulations Able to use digital tools to: Find information Understand findings Assess the quality of that information Culmination of technical and cognitive abilities Asino, T. I., Jha, K., & Adewumi, O. (2020, August 28). Literacy in the digital age: From traditional to digital to mobile digital literacies. Learning in the Digital Age. https://open.library.okstate.edu/learninginthedigitalage/chapter/literacy_in_the_digital_age/ How does digital literacy relate to health education and promotion?  Example of digital literacy x health literacy How did the pandemic magnify the issue of health illiteracy? Information was primarily shared online Interventions (e.g., booking tests) were via virtual appointments = intersection of digital x health literacy Glicksman, E. (2020, August 2). Health illiteracy is nothing new in America. but the pandemic magnifies how troubling it is. The Washington Post.https://www.washingtonpost.com/health/health-illiteracy-is-nothing-new- in-america-but-the-pandemic-magnifies-how-troubling-it-is/2020/07/31/091c8a18-d053-11ea-9038-af089b63ac21_story.html  Example of digital literacy x health literacy “One in five people struggle with health information” - Michael S. Wolf During the pandemic, best practices were rapidly evolving Sanitizing packages, patrons were told to stop microwaving library books → COVID is airborne → masking + ventilation low health literacy = increased COVID-19 deaths Difficulty understanding key terms “immunocompromised” Unequal access to tech Ultimately, issue with accessing and understanding precautions and protocols to stay safe Glicksman, E. (2020, August 2). Health illiteracy is nothing new in America. but the pandemic magnifies how troubling it is. The Washington Post.https://www.washingtonpost.com/health/health-illiteracy-is-nothing-new-in-america-but-the-pandemic-magnifies-how-troubling-it-is/2020/07/31/091c8a18-d053-11ea-9038- af089b63ac21_story.html  Digital literacy vs. Health literacy What is at the intersection here? The ability to access, analyze, and evaluate The ability to look information, develop for, interpret, and new knowledge, and evaluate health interact with others ? information, then use using digital that information to technology and treat or solve a health communication tools condition. correctly and safely. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8861384/  Digital health literacy Ability to read and write about health using digital/tech devices Communicate health information in online social environments Evaluate the relevance, trustworthiness and risks of sharing and receiving health information online Dunn P, Hazzard E. Technology approaches to digital health literacy. Int J Cardiol. 2019;;293:294-296. doi: 10.1016/j.ijcard.2019.06.039.  Digital health literacy_ Described as a “super determinant of health” More than simply the sum of its parts Refer to reading for this week In the digital age, we likely cannot have high levels of health literacy without being digitally literate Dunn P, Hazzard E. Technology approaches to digital health literacy. Int J Cardiol. 2019;;293:294-296. doi: 10.1016/j.ijcard.2019.06.039.  Why does digital health literacy matter? Ability to prevent illness and manage health/disease Communication with healthcare providers Remote communication Enable shared decision-making ○ Healthcare team collaboration ○ Remote care Aids in navigating the navigating the healthcare system Dunn P, Hazzard E. Technology approaches to digital health literacy. Int J Cardiol. 2019;;293:294-296. doi: 10.1016/j.ijcard.2019.06.039. Digital literacy for health promotion and education “Utilizing digital technologies and health innovation to advance the world's progress toward health and wellbeing” - WHO 1) Reach specific target groups 2) Reduce implementation costs 3) Improve population health Stark AL, Geukes C, Dockweiler C. Digital Health Promotion and Prevention in Settings: Scoping Review. J Med Internet Res. Jan 28;24(1):e21063. 1) Reach Specific Target Groups Article: Effectiveness of Digital Health Literacy Interventions in Older Adults: Single-Arm Meta-Analysis. Found that the use of digital health literacy programs targeted to older adults have positive effects on their health and health management Example: HelpAge Canada- Lets Connect Digital Literacy Programs that are tailored specifically to older adults Dong, Q., Liu, T., Liu, R., Yang, H., & Liu, C. (2023). Effectiveness of Digital Health Literacy Interventions in Older Adults: Single-Arm Meta-Analysis. Journal of Medical Internet Research, 25(1)https://doi.org/10.2196/48166 Help Age Canada: https://helpagecanada.ca/our-programs/canadian-programs/lets-connect/ 2) Reduce Implementation Costs DLEP – Digital literacy exchange program https://ised-isde.canada.ca/site/audits-evaluations/en/node/223 3) Improve Population Health via Health Promotion Efforts Article: Remote Evidence-Based Health Promotion Programs During COVID: A National Evaluation of Reach and Implementation for Older Adult Health Equity. Found that remote evidence-based health promotion programs were a promising way to deliver quality health promotion, with relatively low costs and improved access to participants. Steinman, L., Chavez Santos, E., Chadwick, K., Mayotte, C., Johnson, S. (Snowy), Kohn, M., Kelley, J., Denison, P., Montes, C., Spencer-Brown, L., & Lorig, K. (2024). Remote Evidence-Based Health Promotion Programs During COVID: A National Evaluation of Reach and Implementation for Older Adult Health Equity. Health Promotion Practice, 25(3), 475–491. https://doi.org/10.1177/15248399231175843 Digital literacy across population groups Who has the highest digital literacy? Lowest digital literacy?  Digital literacy among youth Percentage of 15-year-old students who reported having been taught digital literacy and well- being, by skill in 2018 Government of Canada, S. C. (2020, December 14). Digital literacy skills of Canadian youth compare favourably with the OECD average. The Daily. https://www150.statcan.gc.ca/n1/daily-quotidien/201214/dq201214a-eng.htm  Digital literacy among youth More Canadian students received instruction on evaluating the reliability of information obtained from the internet and the ramifications of disclosing personal information on sites like Facebook or Instagram 81% of Canadian students versus the global average of 76% Fewer Canadian students (38%) claimed to have received instruction on how to recognize phishing or spam emails 38% of Canadians vs. 41% OECD average Government of Canada, S. C. (2020, December 14). Digital literacy skills of Canadian youth compare favourably with the OECD average. The Daily.  Digital literacy among adults - eHEALS Survey data from Canadians aged 16 and above (n = 6002) in 2020 Used 8-item measure called eHEALS Knowledge Comfort Perceived skills at finding, evaluating and applying electronic health information to health problems https://www.infoway-inforoute.ca/en/component/edocman/resources/reports/benefits-evaluation/3882-digital-health-literacy-of-canadian-adults-evidence-from- the-2020-canadian-digital-health-survey  Digital literacy among adults - eHEALS Finding health information https://www.infoway-inforoute.ca/en/component/edocman/resources/reports/benefits-evaluation/3882-digital-health-literacy-of-canadian-adults-evidence-from- the-2020-canadian-digital-health-survey  Digital literacy among adults - eHEALS Using and assessing health information https://www.infoway-inforoute.ca/en/component/edocman/resources/reports/benefits-evaluation/3882-digital-health-literacy-of-canadian-adults-evidence-from- the-2020-canadian-digital-health-survey  Digital literacy among adults - eHEALS Age: Highest digital literacy among ages 16-24 Why? https://www.infoway-inforoute.ca/en/component/edocman/resources/reports/benefits-evaluation/3882-digital-health-literacy-of-canadian-adults-evidence-from- the-2020-canadian-digital-health-survey  Digital literacy among adults - eHEALS Gender: No difference found Why? https://www.infoway-inforoute.ca/en/component/edocman/resources/reports/benefits-evaluation/3882-digital-health-literacy-of-canadian-adults-evidence-from- the-2020-canadian-digital-health-survey  Digital literacy among adults - eHEALS Education level: Highest among those with bachelor’s degree and above Why? https://www.infoway-inforoute.ca/en/component/edocman/resources/reports/benefits-evaluation/3882-digital-health-literacy-of-canadian-adults-evidence-from- the-2020-canadian-digital-health-survey Consider other factors… Earlier data from 2018 supports this We can see these statistics reflected in the number of Internet users Age Gender Education level Schellenberg, G., Schimmele, C., & Wavrock, D. (2021, November 9). A robust internet typology is essential for monitoring how individuals are responding to the digital transformation and for assessing the divide between digital 'haves' and 'have nots.' individuals' capacities to use the internet and digital technologies are an important aspect of this digital divide. using data from the 2018 canadian internet use survey (CIUS), this study presents an internet-use typology that is based on the range and complexity of online activities and digital skills that Canadians report they perform. Five internet-user groups are identified. Internet-use Typology of Canadians: Online Activities and Digital Skills. Retrieved November 4, 2022, from https://www150.statcan.gc.ca/n1/pub/11f0019m/11f0019m2021008-eng.htm Consider other factors… Age Gender Education level Race/ethnicity Household income Employment status Schellenberg, G., Schimmele, C., & Wavrock, D. (2021, November 9). A robust internet typology is essential for monitoring how individuals are responding to the digital transformation and for assessing the divide between digital 'haves' and 'have nots.' individuals' capacities to use the internet and digital technologies are an important aspect of this digital divide. using data from the 2018 canadian internet use survey (CIUS), this study presents an internet-use typology that is based on the range and complexity of online activities and digital skills that Canadians report they perform. Five internet-user groups are identified. Internet-use Typology of Canadians: Online Activities and Digital Skills. Retrieved November 4, 2022, from https://www150.statcan.gc.ca/n1/pub/11f0019m/11f0019m2021008-eng.htm  Digital literacy among adults - eHEALS Race/ethnicity: This study did not find a difference Intersections with recency of immigration, language, SES Household income https://www.infoway-inforoute.ca/en/component/edocman/resources/reports/benefits-evaluation/3882-digital-health-literacy-of-canadian-adults-evidence-from-the-2020-canadian-digital-health-survey  Digital literacy among adults - eHEALS Employment status: Employed and other have highest scores Why? https://www.infoway-inforoute.ca/en/component/edocman/resources/reports/benefits-evaluation/3882-digital-health-literacy-of-canadian-adults-evidence-from-the-2020-canadian-digital-health-survey  Consider other factors… Age Gender Education level Race/ethnicity Household income Employment status Insurance coverage Chronic illness Other: Urban/rural, access to WiFi Digital literacy among adults Canadians scored higher than the global average in using technology to solve problems Sizable intra-country variation Education level impacted people's ability to solve digital problems  Digital literacy among adults 75.6% of adults have computer access, with 68.1% reporting Internet access at home This is a lower proportion compared to the 98% of youth in Canada Access varies across provinces Western provinces have higher proportions of Internet access compared to the Atlantic provinces Access varies within provinces Differences based on population subgroups (SES, newcomers, etc.) Literacy and Digital Technologies: Linkages and Outcomes by B. Veenhof, Y. Clermont and G. Sciadas. Government of Canada. Catalogue no. 56F0004MIE — No. 012 ISSN: 1492-7918 ISBN: 0-662-42253-8  Digital literacy among older adults Approximately 63% of seniors in Canada are either Non-users or Basic Users of the Internet and digital technology Vs. 77% of those aged 15 to 34 are either proficient or advanced users Low proportion of seniors categorized as ‘Advanced user’ Schellenberg, G., Schimmele, C., & Wavrock, D. (2021, November 9). A robust internet typology is essential for monitoring how individuals are responding to the digital transformation and for assessing the divide between digital 'haves' and 'have nots.' individuals' capacities to use the internet and digital technologies are an important aspect of this digital divide. using data from the 2018 canadian internet use survey (CIUS), this study presents an internet-use typology that is based on the range and complexity of online activities and digital skills that Canadians report they perform. Five internet-user groups are identified. Internet-use Typology of Canadians: Online Activities and Digital Skills. Retrieved November 4, 2022, from https://www150.statcan.gc.ca/n1/pub/11f0019m/11f0019m2021008-eng.htm  Why is tech use lower among older adults? Introduced to tech later in life Potentially have limited access (in comparison to other groups) Cognitive capacity could be a factor Interest in digital devices in general Schellenberg, G., Schimmele, C., & Wavrock, D. (2021, November 9). A robust internet typology is essential for monitoring how individuals are responding to the digital transformation and for assessing the divide between digital 'haves' and 'have nots.' individuals' capacities to use the internet and digital technologies are an important aspect of this digital divide. using data from the 2018 canadian internet use survey (CIUS), this study presents an internet-use typology that is based on the range and complexity of online activities and digital skills that Canadians report they perform. Five internet-user groups are identified. Internet-use Typology of Canadians: Online Activities and Digital Skills. Retrieved November 4, 2022, from https://www150.statcan.gc.ca/n1/pub/11f0019m/11f0019m2021008-eng.htm Digital literacy among older adults TMU initiative (not mandatory) exploring how to overcome the digital divide: https://youtu.be/oWJHzI-poGM  Digital Quotient “The understanding and use of present and developing digital technologies, capabilities, practices, and strategies.” Measure which objectively analyzes and scores digital readiness Quantifies your digital skills and proficiency in those skills Aka→ Limited, I. (n.d.). Digital Quotient: Lodestar for future Ready talent. Infosys. https://www.infosys.com/insights/human-potential/digital-quotient.html  Digital Quotient Areas of overlap with digital literacy. More focused on building skills Limited, I. (n.d.). Digital Quotient: Lodestar for future Ready talent. Infosys. https://www.infosys.com/insights/human-potential/digital-quotient.html What is your digital quotient? Can access quizzes online if you’re interested in assessing your DQ Examples of questions: What softwares do you use? How many devices do you have? Youth are clearly the leaders in DQ  Measures of digital literacy https://tcg.uis.unesco.org/wp-content/uploads/sites/4/2021/08/Metadata-4.4.2.pdf Examples of digital literacy measures Many different measures tailored for different population groups, ages, or aspects of digital literacy TEL Assessment - To assess technological literacy knowledge and skills that identifies the applications of technology principles - Skills-based test International Computer and Information Literacy Study (ICILS) Assessment - To investigate the ways in which young people are developing computer and information literacy (CIL) - Assesses computer use and competency with gathering and communicating information - Skills-based test and questionnaire Programs to improve digital literacy among children and youth Incorporating technology throughout the curriculum: Curriculum-based learning approach Introduce technology and digital literacy concepts Social Media Online collaboration Coding Data Analysis Programs to improve digital literacy among children and youth BrainPOP Learning resources for educators and families to help guide youth Lesson ideas, game- based learning tips, assessment tools, help for ESL learners Digital etiquette Distance learning Cyberbullying Copyright Online safety Plagiarism Digital literacy programs for adults ABC Digital Literacy Programs - Teaches new Internet users how to use the Internet - Free workbooks and downloadable resources - Adults improve understanding of what the internet is, how to access it, and how to stay safe online ABC Internet Matters Searching safely online (2022) ABC Internet Matters workbook (2020) ABC Internet Matters: Getting around with Google Maps ABC Internet Matters: Staying safe online with secure websites ABC Internet Matters online facilitator training. Money Matters for People with Diverse Abilities: Money Safety workbook (English only) Youth Teaching Adults lesson plans Canadian Bankers Association: Cyber Security Toolkit Digital literacy programs for seniors Dig-IT (National Program) - Offers devices, data, technical assistance, and online learning classes - Improve technology use and stay secure online Digital health literacy program Canada Health Infoway: https://www.infoway-inforoute.ca/en/patients-families-caregivers/digital-health-learning-program Case Example Lower digital literacy in rural/remote areas with limited digital connectivity Precede-Proceed model Digital literacy gaps in Indigenous communities → Indigitize Enable participation in digital health initiatives Youth-focused, school-based Case Example Digital Fluency Ethics and Empathy Searching and authenticating Digital identity information Cyberbullying Apps and computing Data management and Consumer Awareness storage Phishing Terms of service Digital Security and Privacy Cookies, passwords, and data sharing Viruses and identity theft Case Example  Case Example Findings: Identified 15 digital literacy programs in Canada ○ focusing on key areas: data safety, cyberbullying, digital media. Uncovered 12 digital literacy assessment tools ○ recognized many lacked the flexibility to adapt across different socio-demographic/geographic contexts. Created a comprehensive and adaptable youth-focused program and a 15-item assessment tool to evaluate and improve digital literacy within diverse communities Buchan, M.C., Bhawra, J. & Katapally, T.R. Navigating the digital world: development of an evidence-based digital literacy program and assessment tool for youth. Smart Learn. Environ. 11, 8 (2024). https://doi.org/10.1186/s40561-024-00293-xn So, why do we care about digital literacy in health promotion and education? Individual Health Behaviour POH705 School of Occupational and Public Health Toronto Metropolitan University Week 8 64 Why do we care about behaviour change in health promotion? 65 Lesson Objectives Recognize variables that impact behaviour change Develop an in-depth understanding of three behaviour change theories Identify tools that can be used to facilitate change 66  Learning and Behaviour Learning is generally defined as a change in behaviour as a result of experience S-R Theory: Learning results from events that activate a response (i.e., behaviour) S O R Stimuli Organism Response If a behaviour is followed by a reward → behaviour likely to be repeated 67  However, in learning there are also cognitive variables Learning is a cognitive process – not just stimuli pushing our response or behaviour Cognitive theorists emphasize the role of subjective beliefs or expectations held by individuals Mental processes including thinking, reasoning, hypothesizing, or expecting 68  Major Cognitive Variables 1. Knowledge – An intellectual awareness of _facts_____, truth or principles gained by sight, experience or report 2. Skills – The ability to do something well, arising from talent, training or practice 3. Beliefs – Acceptance of or confidence in an alleged fact or body of facts as true or right without positive knowledge or proof (perception is reality) 69  Major Cognitive Variables 1. Knowledge – You have knowledge about the number of cases of yellow fever in the area you are Example: visiting (fact) You are planning a trip 2. Skills to India – how would – You are able to do research on these cognitive factors the risks of yellow fever (ability to search for credible play into whether or not information) you get a yellow fever 3. Beliefs vaccine? – You believe that getting yellow fever on your vacation is possible, and that getting vaccine can prevent it 70  Major Cognitive Variables 4. Attitudes Attitudes can be difficult to – Manner, disposition, feeling change or position toward a person Potential to influence by or thing providing more knowledge and increasing skills 5. Values Personal, religious or political – Ideas, ideals, customs that values may influence whether arouse an emotional response you get a vaccine for yellow for or against them fever 71  Cognitive Variables Knowledge is ___necessary_________ to produce behaviour change, but not __sufficient_________. What does this mean? Cognitive variables impact peoples’ perceptions and willingness (i.e., motivation) to improve health Individual knowledge of health plays a role (e.g., health literacy) There is an important role for health educators here! – To increase health literacy, knowledge, and shift beliefs 72  What are health risks? “The chance or likelihood that something will harm or otherwise affect your health.” - Does not mean that you definitely will be affected by this risk factor or illness - Reflects a possibility that you could be affected 73 https://newsinhealth.nih.gov/2016/10/understanding-health-risks  Video summary This video discusses how families are navigating COVID-19 risks during the Easter weekend, featuring perspectives from two families in Ontario and insights from Dr. Peter Juni. Highlights: 00:043 Family plans and COVID-19 precautions Rina from Toronto shares her family’s plans Emphasizes vaccination and communication Mentions decision fatigue and risk assessment 01:484 Switch to remote learning Mandy from London, Ontario discusses her decision Feels abandoned by the provincial government Highlights challenges of remote learning 03:325 Expert advice on COVID-19 precautions Dr. Peter Juni provides guidance Recommends selective contact and careful use of rapid tests Discusses issues with test sensitivity and new variants Source: https://youtu.be/vyku4EuVUXU?si=fv1Or_5I7OFCf6KM 74  How people view health risks varies What factors do you think influence this? – Social situation and status – Role models – Immediate vs long term risk – Expectations of peer group – Others.. 75  Health risks are affected by: - Personal characteristics, i.e., age, sex, family history of disease, lifestyle - Health behaviours, i.e., diet, physical activity, wearing a seatbelt, flossing - Social determinants of health, i.e., access to healthcare services, resources to manage health Perception of risk is further influenced by: - Frequency of messaging related to a disease/threat in the media - Individual values or beliefs - Group dynamics 76 https://newsinhealth.nih.gov/2016/10/understanding-health-risks  Push and Pull Discussion Should Ontario move from universal to private healthcare? What factors come into your argument? – FOR – AGAINST Which cognitive variables are relevant? – Attitudes, beliefs, values, knowledge What are the associated health risks? Source: https://www.cbc.ca/news/canada/british- Source: https://www.cbc.ca/news/health/canada- columbia/angus-reid-health-care-privatization-1.6762099 healthcare-privatization-debate-second-opinion- 1.6554073 78  Recall: Theory is used to… Indicate why people are behaving in unhealthy ways Identify information we need before developing an intervention Provide a conceptual framework Determine how best an intervention should be developed Identify measurements needed to evaluate the impact Allow for comparisons across studies 79  Different levels of theories https://cancercontrol.cancer.gov/sites/default/files/2020-06/theory.pdf Theory selection depends on the level at which we plan to implement a program or intervention  The Health Belief Model Most widely used framework Used to explain why individuals take part in health behaviour ___change______ as well as ____maintenance_________ of health behaviours Initially was used to understand screening and immunization program participation People will take action to improve health based on 5 key constructs 82  The Health Belief Model 1. Perceived Susceptibility: Perceive themselves to be susceptible to a problem or condition E.g., an individual must believe there is a ____possibility of getting__ colon cancer before being interested in screening 2. Perceived Severity: Feelings about the ___seriousness________ of contracting an illness or leaving it untreated Medical/Clinical and social consequences 3. Perceived Threat: = Combination of Susceptibility & Severity 83  The Health Belief Model 4. Perceived Benefits: Even if there is a perceived threat, behaviour change will be influenced to individual belief regarding ___benefits_____ of the ___actions________ to reduce threat E.g,. Financial savings from quitting smoking, family benefit 5. Perceived Barriers: Negative aspects of a health action could act as impediments to undertaking recommended behaviours Typically an unconscious ____cost benefit analysis________________ occurs where individuals weigh potential costs (i.e., side effects, inconvenience, etc.) with benefits 84  The Health Belief Model Modifying factors Cues to action: __external factors______________ that could trigger action Individual variables: age, sex, sociodemographic status, etc. Mass media campaigns, advice from others, reminders from a healthcare professional, illness of a family member/friend, online information Self Efficacy ___Confidence___________ in one’s own ability to perform a certain task Not originally included in the model, new addition 85 Health Belief Model: Smoking Cessation Example https://youtu.be/fXI1BKpe4fA?si=YP_eQn4C9_fMOCU5 86  Diagram of the Health Belief Model Perceived Susceptibility Perceived Threat Perceived Seriousness Self-efficacy Perceived Benefits Outcome Expectations Perceived Barriers Research supports that for behaviour change to succeed, individuals must: 1) Feel threatened by their current behavioural patterns 2) Believe behaviour change will result in a valued outcome at an acceptable cost 3) Must feel competent to overcome perceived barriers to take action 87 With other modifying factors taken into account. Chart available in your readings (Glanz, 2008) Theory of Reasoned Action (TRA) and of Planned Behaviour (TPB) Most important determinant of behaviour here is ____intention__________ People's intention to perform a behaviour depends on: – __Attitude__________ towards the behaviour – Belief of what others think they should do – TPB adds the element of perceived control over the behaviour, i.e., ease/difficulty of performing the behaviour 89 Attitude towards the behaviour Subjective norms Intention Behaviour Perceived behavioural control Theory of reasoned Action (TRA) takes all the green boxes into account. Theory of planned behaviour (TPB) considers yellow box 90 Theory of Reasoned Action (TRA) and of Planned Behaviour (TPB) 91 https://youtu.be/iiWKnqKdbHk?si=JxQta7Wu2knhRlot  Transtheoretical Model (TTM) Uses __stages of change___ to understand how people modify their behaviour Helps to identify the factors that contribute to successful behaviour change – Smoking cessation program – Also applied to anxiety disorders, substance abuse, bullying, HIV/AIDS prevention 92  Stages of Change Model Behaviour change is a process not an event Five stages of change Process is __circular__, not ___linear______ Speed of movement varies Can be impacted by individual confidence 93 94  Stages of Change Model 1. Pre contemplation Those not considering change and those who consciously intend not to change 2. Contemplation A person considers making a change to their behaviour 3. Preparation Person makes a commitment to change 95  Stages of Change Model 4. Action Behaviour change is ___initiated______ 5. Maintenance __Sustaining_________ change 6. Termination (optional 6th step) Will not return to unhealthy behaviour 96  Transtheoretical Model (TTM) 97 https://youtu.be/IwxyyE--AjU?si=1TIeBNHNAuS1yCGA Source: www.emro.who.int/dsaf/EMRPUB_2012_EN_1362.pdf  Stages of Change Model Useful for selecting appropriate interventions for population groups (i.e., patients) By identifying a patient's position in the change process, physicians can tailor an intervention, often with skills they already possess Thus, the focus of the visit is not to convince the patient to change behavior, but to help the patient move along the stages of change 99  Discussion Use the Stages of Change Theory to develop a plan for promoting a fitness program among factory workers: Suggested Action Pre-contemplation Promote awareness, increase knowledge Contemplation Motivate people to begin a program, promote benefits Determination Also the preparation stage, assist with developing goals Action Provide feedback and supports Maintenance Help people cope, have reminders 100  Interpersonal-Level Theories Social Learning Theory Social Cognitive Theory Recall, interpersonal processes include family, friends, and peers that contribute to our social identity 101  Social Learning Theory Based on the idea that people not only self-regulate their environments and actions, they are also acted upon by their environments. – I.e., They create and are influenced by their surroundings “The opinions, thoughts, behaviour, advice, and support of the people surrounding an individual influence his or her feelings and behaviour, and the individual has a _____reciprocal effect_______ on those people” – Also termed “reciprocal determinism” 102  Social Learning Theory Behaviour Personal Environmental factors factors 103  Social Cognitive Theory Incorporates basic parts of social learning theory but adds… – Observational learning – Vicarious reinforcement Refers to watching and learning from the actions of others E.g., watching parents driving fast and not wearing a seat belt (role models this behaviour to children) Positive or negative ____reinforcement_________ will determine if that behaviour is ____repeated_________ Three main factors for behaviour change: – self-efficacy – goals – outcome expectancies 104  Social Cognitive Theory Three main factors for behaviour change: 1. Self-efficacy – With self-efficacy, can change behaviour even when faced with obstacles 2. Goals – Setting specific health-related goals, e.g., exercising for 10 minutes/day, drinking 1L of water, etc. 3. ___Outcome expectancies_________________________ – Belief that when a certain behaviour is performed, it will lead to an anticipated outcome – E.g., If I do yoga for 10 mins/day, I will become more flexible 105 www.emro.who.int/dsaf/EMRPUB_2012_EN_1362.pdf Example: Improving Sun Safety in Children *Symbolic modeling is another term for observational learning. www.emro.who.int/dsaf/EMRPUB_2012_EN_1362.pdf  Which theory applies? No single theory dominates Addressing a health problem will likely require more than one theory Think about: – Does the theory include all relevant variables or issues? – Does it exclude redundant variables? – Does its use make logical sense in the particular situation? – Has it been used by others for similar purposes? – Are there any published studies that use the theory for similar purposes? – Is it consistent with the values integral to the work? 108  Some Considerations There are no ‘right’ or ‘wrong’ theories Theories should be viewed as guidelines for understanding change and developing appropriate programs Many of the theories are based on very narrow assumptions about individual behaviour change Theories should never be applied without a thorough understanding of your population 109  Factors to improve success for all behaviour changes Personalize the health information – Make it about them! Communicate the risks/benefits that are important to that person/group Stress short term consequences – Short-term risk initiates more change than long-term Make information relevant to individuals – Make it matter to them! This includes not using too much jargon and giving practical information 110  Who is your audience/ target population? Life phases impact our acceptance of change initiatives – E.g., parenting tips would be of greater interest to an adult population, vs. avoiding falls for elderly Understanding aspects of life phases can assist in targeting health education techniques where it is most needed 111 Life Stages Infant Toddler Preschooler School child Adolescence and youth Young adult Middle-aged person Later Adulthood 112 How do health messages change over life stages? 1. Who is the target audience here? 2. What is the message, and what behaviour are we trying to change? 3. Would this be effective? - Personalized - Highlights short term consequences - Targets young people in their 20s - Message – get tested for STDs - Relevant 1. Who is the target audience here? 2. What is the message, and what behaviour are we trying to change? 3. Would this be effective? - Targets mothers, but also patrons of that particular establishment - Intends to improve health of both child and mother by minimizing any stress they may experience when breastfeeding in public Benefits of a Health Education approach: Empowers people to take control over their own health Works directly with people and tailors the message 115 Limitations of a Health Education approach Doesn’t take into consideration the social and _environmental context Are most likely to be acted on by those better off in society Assumes a direct link between behaviour, attitudes and knowledge ‘Victim blaming’ 116 Community and Organizational Change POH705 School of Occupational and Public Health Toronto Metropolitan University Week 8 117 Lesson Objectives Learn about community and organizational change theories Identify community development and mobilization approaches  Theory is… “A systematic arrangement of fundamental principles that provide a basis for explaining certain happenings of life.” Cottrell et al. 2009 119  What is theory for? Indicates why people are behaving in unhealthy ways Identifies information we need before developing an intervention Provides a conceptual framework Determines how best an intervention should be developed Identifies measurements needed to evaluate the impact Allows for comparisons across studies 120 Theory to Practice – Why is Theory Important? Health education programs need to be carefully planned to be efficient and effective – i.e., successful in producing the intended result Underlying theory guides program planning: Shapes the WHY? WHAT? HOW? Directs our research, shape our goals, explain outcomes Important form of evidence More likely to succeed if based on theory Provides an essential framework 121  Different levels of theories https://cancercontrol.cancer.gov/sites/default/files/2020-06/theory.pdf Theory selection depends on the level at which we plan to implement a program or intervention Types of Groups Community Typically thought of in geographic terms Can be non-locality defined as well – Ethnicity – Religion – Sexual orientation – Occupation Types of Groups Community Defined 1. A functional spatial unit meeting basic needs 2. A unit of patterned social interaction 3. A symbolic unit of collected identity 4. A social unit that comes together to act politically for change Types of Groups Organizations Social unit of people structured or managed to meet a need or pursue collective goals Management structures and members with different roles, responsibilities, authority Governed by policies, procedures, norms and culture  Community Development “Building active and sustainable communities based on social justice and mutual respect” (Standing Conference for Community Development, 2001)  Community Development ‘Working with community members to assist them in the process of identifying and addressing their shared health concerns’ What is a community? Group of people with shared interests or characteristics Shared sense of affiliation or belonging  Community Development – Core Principles ◼Empowerment and critical consciousness ◼Community capacity and social capital (coordination) ◼Issue Selection, Participation and Relevance Community Development Activities Profiling Capacity-Building Organizing Networking Negotiating  Community Development and Mobilization Approaches Community mobilization theory: social planning, locality development, social action Community based and community development strategies Community capacity building and empowerment  Discussion What is a healthy community? What are some characteristics of healthy communities?  Video summary The video discusses the concept of healthy communities and the role of the Ontario Healthy Communities Coalition (OHCC) in promoting this idea. It emphasizes the importance of the physical, social, economic, and cultural environments in determining the health and well-being of a community. The video also highlights the role of OHCC in providing expertise and support to communities across Ontario. Highlights: 00:073 Introduction to Healthy Communities Health and well-being depend on the overall environment Emphasis on physical, social, economic, and cultural factors Importance of community connection and engagement 01:124 Role of OHCC Over 600 members across Ontario Provides expertise from local, provincial, and international perspectives Supports communities in addressing health-related issues 02:165 Community Development and Policy Importance of creative and smarter communities Culture and creativity as pillars of sustainability Ontario Healthy Communities Health-friendly environments and community agency 03:106 Impact of Poverty on Health Coalition: Poverty leads to increased health and social issues https://www.youtube.com/wat Investing in healthy communities saves costs long-term Bringing nature into urban environments ch?v=mmUicipC4JY 03:457 OHCC’s Achievements and Future Goals 20 years of promoting healthy communities in Ontario Learning from other communities and sharing successes Encouraging youth involvement and global impact Community Development Challenges Lack of sustained and long-term funding (e.g., on next slide) Community development workers have a dual accountability Approaches not always accepted by government agencies Requires redefining of professional role Difficult to evaluate Video Link: https://www.cbc.ca/player/play/video/9.6426373  Educators as Change Agents – Two Roles Internally Work within an organization to implement policies and programs to improve health Must understand the dynamics of the organization and community to affect change  Educators as Change Agents – Two Roles Externally May work with other agencies to influence their decisions and actions Work with communities to impart information that may have a positive effect on the health of their population Diffusion of Innovations Theory Process by which an innovation is communicated via certain channels over time among members of a social system (diffusion) Planned, systematic efforts designed to make a program or innovation more widely available to a target audience (dissemination)  https://www.youtube.com/watch?v=VltrKovoO9s  Diffusion of Innovations Theory Five Categories of Adopters (Individuals): ◼ Innovators: First to adopt new products or behaviors, they are risk-takers and adventurous ◼ Early adopters: Help bridge gap between innovators and the majority, not first to sign up tho ◼ Early majority: Need external motivation to get involved, cautious & wait for proven benefits. ◼ Late majority: Will not adopt innovation until most ppl do so, sketpics. ◼ Laggards: have limited communication networks & last to become involved. Adopt innovations only when they become mainstream www.emro.who.int/dsaf/EMRPUB_2012_EN_1362.pdf www.emro.who.int/dsaf/EMRPUB_2012_EN_1362.pdf  Diffusion of Innovations Theory Characteristics of innovation affecting diffusion: ◼Relative advantage ◼Compatibility ◼Complexity ◼Trialability ◼Observability In short, an innovation spreads more quickly if it’s clearly better than the old way (relative advantage), fits with people’s lifestyles (compatibility), is simple to use (complexity), can be tried out first (trialability), and shows obvious benefits (observability).  Poll What concept is this showing? 1) Culturally-sensitive AIDS education videos are more acceptable in Hispanic communities than the same materials produced for white or African- American audiences? Options: ❑Relative advantage ❑Trialability ❑Compatibility ❑Observability ❑Complexity  Poll What concept is this showing? 2) A mobile mammography unit that offers the same service as a hospital or doctor’s office, but saves travel time and money compared to a stationary facility Options ❑Relative advantage ❑Trialability ❑Compatibility ❑Observability ❑Complexity  Poll What concept is this showing? 3) A digital blood pressure monitor may be appealing for home monitoring use because it is easier to use and to understand than a traditional stethoscope model Options ❑Relative advantage ❑Trialability ❑Compatibility ❑Observability ❑Complexity  Poll What concept is this showing? 4) By providing feedback in the form of case examples and statistics, clinic users can get a concrete sense of the value of a cancer screening program Options: ❑Relative advantage ❑Trialability ❑Compatibility ❑Observability ❑Complexity Practical example UCLA mammography program based on model Community profiling = early adopters had heightened awareness and knowledge on value of mammography Mobilized social influence of early adopters to reach early majority Individualized strategies to reach late majority Media materials incorporated Health Belief Model  "Content creators are making big money and running businesses as influencers." From a marketing perspective, online "influencers" are an example of DOI theory Marketing agencies and companies often find influencers through social media, and will provide or gift a product for them to review in exchange for mass publicity They utilize the characteristics of the theory to influence public opinion, sell product, and reach mainstream audiences Diffusion of Innovations Theory: Definition and Examples. (2023). Investopedia. https://www.investopedia.com/terms/d/diffusion-of-innovations-theory.asp  Limitation of the Diffusion of Innovations Theory Was not developed for public health purposes or for the adoption of health behaviours/innovations Does not have a community-based participatory approach Does not account for individual resources and social supports/networks However, it has been successful in public health programs aiming to change behaviour Understanding Organizations Understanding Organizations Structure Look at the Organization Chart What is the – Locus of authority – Decision making process – Division of labour Understanding Organizations Norms Acceptable standards of behaviour within a group that are shared by the group members Understanding Organizations Climate – ‘Shared Perceptions’ No real definition exists Can be described as the personality of the organization Can be influenced by external forces such as political or social environment  Organizational Climate Ehrhart, M. G., Schneider, B., & Macey, W. H. (2014). Organizational Climate and Culture: An Introduction to Theory, Research, and Practice (1st ed.). Routledge. https://doi.org/10.4324/9781315857664 Understanding Organizations Culture – ‘Shared Assumptions’ Forms the context for the adoption and implementation of organizational innovations Can be universal throughout the organization or varied within segments Can be set by decision makers or influential people Can be changed but usually not overnight  Organizational Culture Ehrhart, M. G., Schneider, B., & Macey, W. H. (2014). Organizational Climate and Culture: An Introduction to Theory, Research, and Practice (1st ed.). Routledge. https://doi.org/10.4324/9781315857664 Understanding Organizations Capacity Production or ability to deliver services or products Maintenance of organizational operations Ability to adapt  Climate or Culture? Leadership style of upper management Climate Leadership style of supervisors and my manager Climate Organizational Rules and Policies Culture Rules and policies are transmitted to new members  Climate or Culture? Organizational mission Climate How the employees feel they are part of the organization Culture How we do things, how we celebrate  Resistance to change Uncertainty Structural inertia Group Inertia Threat to expertise Threat to established power relationships Threat to established resource allocation Overcoming resistance to change Education and communication Participation Support Negotiation Manipulation and cooptation Coercion Source: https://www.linkedin.com/pulse/change-leadership-organizational-culture-attributes- strategies-7vhzc Examples from the literature  Changing Organizations – Four Stages 1. Awareness (Define Problem) Problem assessment Analysis of driving and restraining forces Identify ways for change Increase awareness of the need for change Change agent: Senior administrators  Changing Organizations – Four Stages 2. Adoption (Initiate Action) Plan for and adopt a policy, program or other innovation Identify resources Modify as needed Change agent: day-to-day gatekeepers  Changing Organizations – Four Stages 3. Implementation Innovation implemented Provide training, technical and problem- solving assistance, material support Analysis of driving and restraining forces Change agent: individuals with direct role in implementation  Changing Organizations – Four Stages 4. Institutionalization Inclusion of change in strategic plans and organizational goals and objectives Change agent: Senior administrators Systems for: Monitoring and quality control Resources and training This theory of organizational change is particularly helpful for illustrating: the ways in which organizations function at different levels; how the achievement of organizational change may be achieved through a staged process; and how each stage requires the involvement of different levels within an organization  Time to Practice… You are a quality assurance specialist for a large “ready-to-eat” food processing facility. In routine monitoring, the rate of Listeria contamination of the food products has increased over the past few days to beyond acceptable levels. Deep cleaning of the equipment and environment has reduced contamination, but you also notice that many employees have not been following proper hand-washing protocols even after participating in training sessions. Your Task What are some potential driving and restraining forces for changing the employees‘behaviour? Next Week – Midterm 2