Health Assessment of Wayne County, New York, in 1999-2004

Introduction to the 1999-2004 Wayne County, New York, Health Assessment Article

The assigned article aims to identify the community health needs of Wayne County, New York. Broadly, it provides an overview of the community’s health needs and services to improve their health outcomes. In line with this goal, the report provides essential information regarding the people and outlines the available health related data regarding the same (New York State Department of Health, 1999). The report is divided into seven key sections. In the first part, the author provides a demographic profile and health status of the Wayne County population and in the second section of the report, the author talks about the local health unit capacity of the community by referring to the its capacity to provide quality health care services to the residents. The third section of the report highlights the challenges facing health care service providers and the community as a whole.

In this section, the New York State Department of Health (1999) talks about the community’s needs by evaluating collaborative efforts in the health care sector, assessing available health care services, and discussing significant health outreach efforts. Still in the third section, the authors also discuss the profile of unmet needs for services in Wayne County. The fourth and fifth sections of the report discuss the local health care priorities of the community and the opportunities for action respectively. The sixth section of the report contains information about statewide performance measures, which are further discussed in the last section of the paper, which is a community report card (New York State Department of Health, 1999). Comprehensively, the Wayne County Community health assessment report examines the indicators for the health status of community members with the aim of identifying the key problems and assets in the community. The information provided in the report should act as a useful tool for health experts to address community health needs and formulate the right strategies of managing them to improve the overall health status of the county.

Data that Supports the Need for Intervention

The New York State Department of Health (1999) outlines the need for an intervention in Wayne County because the residents of the region suffer from several behavioral risk factors that compromise the general health of the population. These behavioral risk factors are significant to the overall health of the county because such risk factors have been identified as some of the main reasons for the prevalence of several health conditions such as sexually transmitted diseases and HIV (New York State Department of Health, 2006). Other diseases attributed to the same risk factors include WIC access, prenatal problems, under immunization of adults and injuries (New York State Department of Health, 1999). The aforementioned behavioral health risks have not only contributed to the prevalence of the above health conditions, but also contributed to the fact that populations in urban areas of the county suffer a greater risk of developing these diseases and injuries compared to populations that live in the rural areas (New York State Department of Health, 1999).

Access to health care is a problem for some population cohorts, such as drug addicts and the unemployed. For example, although migrant health services are available to underserved populations in Wayne County, only a cross section of this population (those who migrated with the past two years) is eligible for such services (New York State Department of Health, 1999). Thus, a significant section of this demographic does not have access to the requisite health care services. Migrant populations are not the only ones that suffer from this problem; ethnic minorities that live in the county also experience similar barriers to health services and suffer a high risk of developing HIV/AIDS, tuberculosis, diabetes and other health conditions.

Two Possible Theories that would Guide the Intervention

The health belief model and the theory of planned behavior are two models that could be used to change the behavioral risk profile of minorities and underserved populations in Wayne County. The theory of planned behavior focuses on the role of intention in changing health behaviors, while the theory of planned behavior mostly focuses on the role of people’s beliefs in changing their actions (Oyekale & Oyekale, 2010). These two theories are central to the formulation of public health interventions in Wayne County because we recognize that there are two sets of affected people in the county – those who have the power to change their circumstances, or behaviors, and those who do not have the power to do so. The theory of planned behavior would be central to formulating health interventions for people who do not have the power to change their actions. In other words, this theory would be instrumental in changing the behaviors of people who do not have absolute control over their lifestyle. Based on this premise, the theory of planned behavior postulates that the willingness of someone to change their behavior is directly proportional to the level of control they have on their behaviors (Weinstein, Sandman, & Blalock, 2008). It also points out that the strength or intention of an individual to change his behavior would be a great predictor of the kind of outcome health practitioners should expect regarding behavior change. Based on these factors, this theory would be instrumental in determining the extent to which people’s self-efficacy would influence their behaviors.

Comparatively, the health belief model would also be instrumental in changing the behaviors of those who have the power to do so. The theory would help to develop interventions that would solely focus on the attitudes and beliefs of the population and explain how health practitioners could use the same to determine behavior change (Oyekale & Oyekale, 2010). The health belief model would mostly be used in formulating interventions that focus on changing people’s behaviors regarding “lifestyle diseases,” such as HIV and AIDS. For example, it is a useful tool for predicting people’s willingness to practise safe sex as an HIV prevention strategy (Hiltabiddle, 2006). Here, the theory would postulate that people’s willingness to engage in protected sex would best occur if they believe doing so would help them avoid HIV, or if they have a positive expectation that by doing so they would live healthier and more fulfilling lives. Based on such premises and assumptions, the health belief model and the theory of planned behavior are useful in creating behavior change among underserved populations of Wayne County.

Key Objectives of the Intervention and their Link to the Two Theories

The proposed intervention strives to reduce the rate of HIV/AIDS among the targeted population by investigating the relationship between HIV transmission (dependent variable) and behavior change. The two theories mentioned above would be instrumental in achieving the objectives of the intervention because they would help health researchers to understand behavior change among the targeted population. For example, the health belief model would help public health workers to understand the attitudes and beliefs of the targeted population. Such information would help them to understand factors that could potentially lead to the increase of HIV transmission rates. Here, health workers would understand the quantitative factors underlying HIV transmission rates among the targeted population (Glanz, Rimer, & Viswanath, 2008b).

Comparatively, the theory of planned behavior would help the health workers to understand the intentions of the targeted population in changing their behavioral health risk patterns. Comprehensively, the two theories would help to achieve the objectives of the intervention by influencing the intentions, attitudes and beliefs of the target population. These factors are at the center of understanding people’s behavioral patterns and are integral to comprehending their sexual health behaviors. Therefore, by understanding these three main factors affecting behavior change, public health workers could effectively influence people’s behavioral patterns by formulating interventions that tap into these innate and humanistic factors influencing behavior change.

How the Two Theories Drive the Intervention

The above section of this paper explains how the health belief model and the theory of planned behavior could drive the intervention. However, it fails to describe the different elements of the health belief model that would lead to the achievement of the intervention’s objectives. The health belief model has six main elements that strive to predict people’s behaviors – perceived susceptibility, perceived severity, perceived benefits, perceived barriers, self-efficacy, and cues to action (Tavares, Plotnikoff, & Loucaides, 2009). Cues to action and self-efficacy are two main concepts of the theory that would not possibly apply to the intervention. This is because they focus on providing training and guidance to affected persons. The outlined intervention is mainly aimed at promoting behavior change and not necessarily teaching people how to do something (Glanz, Rimer, &Viswanath, 2008a). The cues to action concept would also not apply to the intervention because it focuses on providing reminders to targeted populations to do something.

Based on the nature of the health issue, such cues to action would be irrelevant to our intervention because although health workers would strive to educate the targeted population about their behaviors, they would not be necessarily reminding them to change their behaviors, especially when they do not do what is expected. Based on these factors, the two concepts of the health belief model do not apply to the intervention. However, the other four concepts of the health belief model were applied to the intervention. The relevant concepts are perceived susceptibility, perceived severity, perceived benefits and perceived barriers. The concept of perceived susceptibility works well in the intervention because it defines the populations at risk and helps public health workers to personalize people’s risk, based on their personalities and behaviors (Hiltabiddle, 2006). Therefore, this concept is useful to our intervention because it helps to formulate interventions that address the risk profiles of the targeted individuals. The concept of perceived severity is also useful to the intervention because it specifies the consequences of risky sexual behaviors and specifies the consequences that victims may suffer. Lastly, the concepts of perceived barriers and perceived benefits apply to the intervention as well because they define the actions that the targeted individuals should take and similarly clarify the positive effects to expect by doing so.

The concepts also identify and reduce the barriers to adopting responsible sexual behaviors by providing reassurance through incentives and assistance. The concepts of the theory of planned behavior are also useful to the targeted intervention because they strive to understand the intentions of the targeted population by examining their attitudes subjective norms and perceived behavioral controls. In other words, intentions predict behavior. Thus, all the concepts of the theory apply to the targeted intervention because normative beliefs, subjective norms, control beliefs, perceived behavioral control, and behavioral intention all contribute towards understanding people’s perceptions of risky sexual behaviors (Hiltabiddle, 2006).

Comparison of the Chosen Theories with Other Theories

The health action model is an alternative theoretical platform that researchers have used to predict health behaviors, but was unfit for our targeted intervention because of its key characteristics, which do not apply to the health issue under study. For example, a key tenet of this theory is the understanding that healthy behavior is a self regulating process whereby people choose a goal, or are involved in a goal-setting phase. The theory also postulates that people are often involved in a goal pursuit phase, which is often denoted by the term “volition” (Tavares et al., 2009). Although the pre-action and action phases of the theory (the second phases of the model) are relevant to our intervention, the first part of the model negates its relevance to the intervention. In other words, from the standpoint of the target population, they do not have a goal-setting objective when it comes to HIV transmission. Instead, they are only made aware of their behaviors and how they contribute to people’s vulnerability to HIV and AIDS.

The stages of change model also failed to meet our threshold of a useful theory for our intervention because it involves a five-step process that is lengthy and inappropriate for a target population that would not be in constant touch with health practitioners (the five stages are pre-contemplation, contemplation, preparation for action, action, and maintenance). This theory is useful in therapies, counseling sessions, or when people are in constant contact with health care professionals. This is not the case in our intervention because the health care service providers would be detached from the target population in the long run. Furthermore, the intervention is going to target many people at once, while the stages of change model are mostly suited to changing the behaviors of one person, or a few people (Tavares et al., 2009). Nonetheless, all the theories highlighted here are similar in the sense that they strive to promote positive behavior change among the people.

Strengths and Weaknesses of the Theories Chosen

Health Belief Model

• Strengths: The main strength of the health belief model is that it helps us to understand that people’s behaviors are not only informed by rational thought, but also by their emotions and habits. The theory also teaches us that social conditioning and personal behavior are significant influences of human behavior. Thus, the theory is advantageous to the formulation of our health intervention because it provides effective social teaching methods around healthy habits (Glanz, Rimer, &Viswanath, 2015).
• Disadvantages: The theory’s focus on health risk behaviors is a significant limitation in our application of the same because we are unable to understand other factors that would affect people’s behaviors. These factors could be social, personal and environmental factors that affect people’s behavioral patterns. For example, it is easy to use a person’s belief system to understand whether they would smoke, but it is difficult to predict whether the same person would develop lung cancer because of the same habit. This is the main limitation of the health belief model.

Theory of Planned Behavior

• Strengths: This theory is advantageous to our research premise because it helps us to understand people’s non-volitional behavior. This strength is valid when striving to change the behaviors of people who do not have absolute control over their actions. In this regard, the theory is useful because it can easily draw the link between people’s intentions and actual behaviors. Lastly, this theory could be useful in predicting people’s social behaviors because it considers social norms as a significant influence of people’s actions (Tavares et al., 2009).
• Weaknesses: The main undoing of the theory of planned behavior is its focus on cognitive reasoning as its main premise. The theory also fails to explain where people’s beliefs and attitudes that inform their social behaviors come from. Although some of these criticisms have been challenged by proponents of the theory based on the premise that they come from the poor application of the theory, the reliance on internal validity to justify its assumptions is a significant drawback of the theory (Kim, 2010).

How to Apply the Two Theories using Theory-Based Examples

Many researchers have used other theories, besides the theory of planned behavior and the health belief model, to promote healthy behaviors that led to a reduction in HIV transmission rates. For example, many of them have used the theory of reasoned action to predict people’s likelihood of using condoms as a preventive mechanism for HIV (Hiltabiddle, 2006). Oyekale and Oyekale’s (2010) study that used the theory of planned behavior to understand the sexual behaviors of Nigerian youth highlights this example because it demonstrated that condom use was linked to people’s intentions. They also found out that intentions were products of people’s attitudes and subjective norms (Oyekale & Oyekale’s, 2010). Based on this application of the theory, we could also model the theory in our intervention to understand the likelihood of the target population using condoms as a preventive measure for HIV transmission. Using the same approach, we could easily establish how the perceived behavioral control of the targeted population could predict the likelihood that the it would adopt positive health behaviors for improved health outcomes.

Hiltabiddle (2006) has also demonstrated the efficacy of the health belief model in investigating the use of condoms among adolescents (in America) as a way of preventing sexually transmitted diseases. The model helped the researcher to identify unique risk factors that predisposed the adolescents to sexually transmitted diseases. It also helped him understand the unique barriers and facilitators that contributed to the use of condoms among the chosen demographic (Hiltabiddle, 2006). The researcher found out that these barriers and facilitators led to the infrequent use of condoms among adolescents (Hiltabiddle, 2006). His findings also demonstrated that the health belief model is a useful tool for making realistic risk assessments for the sexual behaviors of the adolescents. It also demonstrated that the model is an integral instrument for helping public health officials to inculcate condom use as part of the sex lives of the targeted people. Based on this assessment, we could equally use the health belief model to understand the barriers and facilitators of risky sexual habits among our chosen demographic. It would also be useful in helping us to increase their awareness regarding how their sexual behaviors predispose them to HIV infection.

How Conceptual Framework fits in the Intervention

The health belief model emerges as the main conceptual framework for our proposed intervention. In our analysis, we used the model to promote positive sexual health behaviors to reduce HIV transmission rates. In this regard, other researchers who have used the model for more than a century have supported its efficacy. For example, Hiltabiddle (2006) says many researchers have used it to promote condom and seat belt use. Researchers have also used it to improve medical compliance and promote health screening, just to name a few health-related behaviors. This health related model fits in our intervention because it demonstrates that a person would adopt positive sexual behaviors if he/she believes that by doing so, the negative health condition could be avoided. Stated differently, the model presupposes that the person believes that condom use would effectively prevent HIV transmission. The model has also been based on the understanding that the targeted population believes that they could effectively adopt the recommended health action.

Broadly, the health belief model emerges as an appropriate conceptual model for our study because it encourages people to adopt positive health behaviors. For example, being infected with HIV is a negative health outcome and the use of condoms would encourage the target population to practice safe sex. Here, it is important to point out that a key tenet of the health belief model is the avoidance of negative health outcome as a key motivator for adopting responsible sexual behaviors.

Summary

This paper shows that the process of formulating effective interventions for behavior change requires the proper understating of population dynamics and the effective execution of appropriate theoretical foundations. Demographic data, such as the types of underserved populations and their size, could help to properly understand the targeted populations. However, knowing the target population is only the first step of understanding what needs to be done to create behavior change. The next step involves identifying the right theoretical foundation to promote the desired behavior change.

We chose to use the theory of planned behavior and the health belief model because they appeal to the nature of our intervention. For example, they help to predict the behavior of people who do not have complete control of their actions. By focusing on the theory of planned behavior alone, we see that the theory is advantageous to our research premise because it helps us to understand people’s non-volitional behavior. This strength is valid when striving to change the behaviors of people who do not have absolute control over their actions. In this regard, the theory is useful because it can easily draw the link between people’s intentions and actual behaviors. The health belief model is also appropriate to our intervention because it provides effective social teaching methods around healthy habits. Comprehensively, these two theories are suited to our public health issue.

References

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Glanz, K., Rimer, B. K., &Viswanath, K. (Eds.). (2008b). The precaution adoption process model. In Health behavior and health education: Theory, research, and practice (4th ed.). San Francisco, CA: Jossey-Bass.

Glanz, K., Rimer, B. K., &Viswanath, K. (Eds.). (2015). Health behavior: Theory, research, and practice (5th ed.). San Francisco, CA: Jossey-Bass.

Hiltabiddle, S. J. (2006). Adolescent condom use, the health belief model, and the prevention of sexually transmitted disease. J Obstet Gynecol Neonatal Nursing, 25(1), 61-6.

Kim, S. (2010). AIDS and the question of culture: focus on social cognitive theory. Social Work In Public Health, 25(1), 1–5.

New York State Department of Health. (1999). Wayne County 1999–2004 community health assessment. Web.

New York State Department of Health. (2006). Examples of community health assessments and report cards. Web.

Oyekale, A., &Oyekale, T. (2010). Application of health belief model for promoting behaviour change among Nigerian single youth. African Journal of Reproductive Health, 14(2), 63–75.

Tavares, L., Plotnikoff, R., & Loucaides, C. (2009). Social-cognitive theories for predicting physical activity behaviours of employed women with and without young children. Psychology, Health & Medicine, 14(2), 129–142.

Weinstein, N. D., Sandman, P. M. & Blalock, S. J. (2008). The Precaution Adoption Process Model. Web.