Let's talk about the
Now as nurses, we understand
that the environment impacts us.
It impacts us as individuals and
as members of the community.
A healthy environment that includes support of people and
strong policies can lead to positive health outcomes.
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.
It's important that we look beyond
the individual to better understand
what impacts our choices, what
impacts their health outcomes.
And today, I'm going to introduce a model
that brings structure to doing just that.
Today, we're going to talk about
the Socio-Ecological Model.
The Socio-Ecological Model
conceptualizes health broadly.
It focuses on a variety of
factors that can impact health.
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.
This model recognizes the
complexity of health problems.
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.
So, there are several versions of the
Socio-Ecological Model that are published.
For the purposes of this presentation, we're going
to use the version you see in front of you.
This is a 4-level version that
was developed by the CDC.
So let's take a look at
each of this 4 levels.
First, we have the
This includes specific individual
factors that influence health.
These include individual biology; personal characteristics
such as age, education level, income, and health history.
Next, we have the
This includes a person's
closest social circle.
These are friends, family
members, partners, spouses.
All of these individuals influence a person's
behavior and contribute to their experiences.
Next, we have the 3rd level.
This is the community level.
This level represents settings in which people
have social exchanges where they spend their time.
This could be places of
religious institutions, neighborhoods,
parks, anywhere you spend your time.
Here we seek to identify the characteristics of
the specific settings that can influence health.
And then finally we have the
4th level, the societal level.
This looks at broad societal factors
that protect or harm health.
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.
Now, a couple other considerations to
keep in mind when using this model.
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.
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.
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.
And all of these can spill
over and influence each other.
So, before we want a case study, I want to remind everyone that
there are several versions of this model that are published.
I'm going to show you just a couple of
examples of what those versions look like.
So here, we have a 6-level version with fancy names
for each layer like exosystem and chronosystem.
Now, here's another 5-level version that
uses similar words to what I just explained.
Now, I'm not showing you
this to confuse you.
I just want you to be aware that you may see different
images, you may see different words and that's okay.
The underlying principle
remains the same.
Remember, with this model,
we are understanding
that the individual is not the only thing
that impacts their health outcomes.
It's the community in all of those outside factors that they're
surrounded by that contribute to their health outcomes.
So if you see a different version of
the Socio-Ecologic Model, don't panic.
Simply examine the layers and use them no matter what their
titles are to consider what influences health at each level.
Okay, let's run through
a quick case study.
Let's examine a health behavior and consider what might
influence that health behavior at each level of the model.
The example we'll use
Meet Carla. Carla is a new
mother to a beautiful baby.
She has expressed the desire to breastfeed
her baby for the first year of life.
So let's consider all of the factors
at each level that might positively
or negatively influence her ability
to reach her breastfeeding goal.
First, let's start
with the individual.
What factors at the individual level could
influence her ability to reach her goal?
This could be knowledge,
Remember, these are characteristics
that are specific to the individual.
If we move out one layer, we're
working at the relationship level.
This is her closest support system,
her closest circle of friends.
This could be friends,
Here, we have to consider whether or
not they support her in her goal.
What are their experiences with
breastfeeding in the past?
Next, we move out one layer further
and this is the community level.
This includes all of the times in the
community that Carla spends her time.
Does she spend her time at places
that are breastfeeding friendly?
And then finally, we have the most
outer layer, the societal layer.
This is where we look at social norms, we look
at policies, perhaps we examine maternity leave.
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.
So let's consider the example
that we just walked through.
I encourage you to think about an
intervention at each level of the model.
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.
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.
So, I'll leave the last 2
levels of the model up to you.
Take some time, write it down.
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.
But imagine how big your impact could be if you
implemented an intervention at every level of this model.
That really shows the power of addressing a health
behavior at all levels of the Socio-Ecological Model.