Socio-Ecological Model (Nursing)

00:00 Let's talk about the Socio-Ecological Model.

00:04 Now as nurses, we understand that the environment impacts us.

00:08 It impacts us as individuals and as members of the community.

00:12 A healthy environment that includes support of people and strong policies can lead to positive health outcomes.

00:19 However, an environment that does not include support systems that protect our health can lead to health disparities for communities and poor health outcomes for individuals.

00:28 It's important that we look beyond the individual to better understand what impacts our choices, what impacts their health outcomes.

00:35 And today, I'm going to introduce a model that brings structure to doing just that.

00:39 Today, we're going to talk about the Socio-Ecological Model.

00:44 The Socio-Ecological Model conceptualizes health broadly.

00:48 It focuses on a variety of factors that can impact health.

00:52 In this model, we know that health is affected by not just the individual, but also by their interaction with the community; with the physical, social and political environments that surround them.

01:04 This model recognizes the complexity of health problems.

01:08 By using the Socio-Ecological Model, the public health nurse is able to integrate approaches that change physical and social environments rather than focusing only on the individual's behaviors.

01:20 So, there are several versions of the Socio-Ecological Model that are published.

01:24 For the purposes of this presentation, we're going to use the version you see in front of you.

01:28 This is a 4-level version that was developed by the CDC.

01:32 So let's take a look at each of this 4 levels.

01:35 First, we have the individual level.

01:38 This includes specific individual factors that influence health.

01:42 These include individual biology; personal characteristics such as age, education level, income, and health history.

01:51 Next, we have the relationship level.

01:54 This includes a person's closest social circle.

01:57 These are friends, family members, partners, spouses.

02:00 All of these individuals influence a person's behavior and contribute to their experiences.

02:07 Next, we have the 3rd level. This is the community level.

02:10 This level represents settings in which people have social exchanges where they spend their time.

02:15 This could be places of employment, schools, religious institutions, neighborhoods, parks, anywhere you spend your time.

02:24 Here we seek to identify the characteristics of the specific settings that can influence health.

02:30 And then finally we have the 4th level, the societal level.

02:34 This looks at broad societal factors that protect or harm health.

02:38 Examples here include cultural or social norms as well as policies that can either protect our health or do the opposite and create inequalities between groups.

02:49 Now, a couple other considerations to keep in mind when using this model.

02:53 First, we must understand that health status is influenced by more than just the individual; relationships, communities, and society as a whole impact individual health behaviors and individual health outcomes.

03:07 Next, it's also important to recognize that the same environment has different effects on individual's health depending on a variety of factors such as financial resources or those individual characteristics I just mentioned.

03:21 And finally, it's important to recognize that individuals and groups operate in a variety of different environments or parts of neighborhoods, parts of work places, parts of larger communities.

03:31 And all of these can spill over and influence each other.

03:35 So, before we want a case study, I want to remind everyone that there are several versions of this model that are published.

03:41 I'm going to show you just a couple of examples of what those versions look like.

03:45 So here, we have a 6-level version with fancy names for each layer like exosystem and chronosystem.

03:52 Now, here's another 5-level version that uses similar words to what I just explained.

03:58 Now, I'm not showing you this to confuse you.

04:00 I just want you to be aware that you may see different images, you may see different words and that's okay.

04:06 The underlying principle remains the same.

04:09 Remember, with this model, we are understanding that the individual is not the only thing that impacts their health outcomes.

04:15 It's the community in all of those outside factors that they're surrounded by that contribute to their health outcomes.

04:22 So if you see a different version of the Socio-Ecologic Model, don't panic.

04:26 Simply examine the layers and use them no matter what their titles are to consider what influences health at each level.

04:35 Okay, let's run through a quick case study.

04:38 Let's examine a health behavior and consider what might influence that health behavior at each level of the model.

04:44 The example we'll use is breastfeeding.

04:47 Meet Carla. Carla is a new mother to a beautiful baby.

04:50 She has expressed the desire to breastfeed her baby for the first year of life.

04:54 So let's consider all of the factors at each level that might positively or negatively influence her ability to reach her breastfeeding goal.

05:03 First, let's start with the individual.

05:06 What factors at the individual level could influence her ability to reach her goal? This could be knowledge, health literacy.

05:14 Remember, these are characteristics that are specific to the individual.

05:18 If we move out one layer, we're working at the relationship level.

05:22 This is her closest support system, her closest circle of friends.

05:26 This could be friends, family, partner.

05:28 Here, we have to consider whether or not they support her in her goal.

05:32 What are their experiences with breastfeeding in the past? Next, we move out one layer further and this is the community level.

05:39 This includes all of the times in the community that Carla spends her time.

05:44 Does she spend her time at places that are breastfeeding friendly? And then finally, we have the most outer layer, the societal layer.

05:52 This is where we look at social norms, we look at policies, perhaps we examine maternity leave.

05:57 If she returns to work, are there policies in place to support her in reaching her breastfeeding goals? Besides helping clarify factors that influence health and health behaviors, the model can also be used to build interventions.

06:11 So let's consider the example that we just walked through.

06:14 I encourage you to think about an intervention at each level of the model.

06:18 What could you do at the individual level? The relationship level? The community level? The societal level that could help Carla reach her goal? Maybe at the individual level, it's providing her with health education.

06:32 What about that relationship level? How could you build that social support? Maybe it's encouraging going to a breastfeeding support group or a new parents group.

06:41 So, I'll leave the last 2 levels of the model up to you.

06:45 Take some time, write it down.

06:46 What would you do at the community level and the societal level? Remember that you have impacts no matter which level you're working at.

06:55 But imagine how big your impact could be if you implemented an intervention at every level of this model.

07:01 That really shows the power of addressing a health behavior at all levels of the Socio-Ecological Model.