Friday, October 24, 2008

Deal With It?

Dudes, it was about 20 years ago when I began grad school.  I can hardly believe it because I'm totally not old enough for that.  But I actually just did the math and turns out its true.  I enrolled in 1989.  As if I weren't already bummed enough about what made me think of that.... which was:

This election cycle has been, in my opinion, less ugly between the candidates themselves but far, far more divisive among the citizenry than I can recall.  I think that could be because everyone is SO disgusted with the governance of the last 8 years and there is so much space in which to navigate direction and nature of change that we long for.  Very few people wish for more of the GWBush administration but the range of possibilities for what might follow in terms of "change" is huge---because we're all fairly unhappy with everything.  Of the many ways I think our government is in danger, what causes me the most fear is the polarization of conservatives and liberals.  I really do wonder whether we've ever seen this kind of divide other than the pre-Civil War years.

But back in the day when I began graduate work, we had cause to talk a great deal about Health Belief Models which are deployed to describe, understand, measure and perhaps predict an individual or community's ability and/or likely success in implementing strategies for health improvement.  It occurred to me, even back then, that in a global sense, these same principles must be true for any kind of program or activity put in place to make a change in human behavior as it relates to health or economics or education, etc---it was very, very profound stuff.  Briefly, the Health Belief Model as first described by Rosenstock* and later built upon by a handful of others, takes consideration of the following:

  • Perceived susceptibility (an individual's assessment of their risk of getting the condition)
  • Perceived severity (an individual's assessment of the seriousness of the condition, and its potential consequences)
  • Perceived barriers (an individual's assessment of the influences that facilitate or discourage adoption of the promoted behavior)
  • Perceived benefits (an individual's assessment of the positive consequences of adopting the behavior).
  • A variant of the model include the perceived costs of adhering to prescribed intervention as one of the core beliefs.
  • Demographic variables (such as age, gender, ethnicity, occupation)
  • Socio-psychological variables (such as social economic status, personality, coping strategies)
  • Perceived efficacy (an individual's self-assessment of ability to successfully adopt the desired behavior)
  • Cues to action (external influences promoting the desired behavior, may include information provided or sought, reminders by powerful others, persuasive communications, and personal experiences)
  • Health motivation (whether an individual is driven to stick to a given health goal)
  • Perceived control (
  • Perceived threat (whether the danger imposed by not undertaking a certain health action recommended is great)

I don't suppose I can write a single post that everyone would read on this topic.  What I'd like to point out first is the number of factors to be taken into account about the person(s) to be served by a program or intervention.  Twelve.  That's a lot.  Next take a look at just a couple of them and see if you share my sense of awe at the gravity of those factors to an individual and at the potential range of possibilities among each one.

In the simplest terms, it seems fair to say that the concerns of the individual factor very largely in the success of any effort to deploy services or interventions. Imagine, if you can, how much variation there could be in response to governmental programs with the current US population of greater than 300 million?  Indeed---even a modest sized community, the needs and requirements can vary dramatically.

I am knee deep in this idea tonight because I am overwhelmed by the number of people I hear say things like, "if I could succeed given where I began, anyone can", and, "all you have to do to keep Thingy J safe is to follow X, Y and Z". That is simply not so.  No matter how hard your road has been, it is not valid to assume that the same outcome can be achieved by any other person with the same resources.  Why?  Look at the list again---there are plenty of reasons.

I do not believe it is fair to say that because I have my eyes wide open, a caring heart, an educated mind and a comitment to the principles of right and wrong that I am capable of imagining all of the circumstances a woman might find herself in that would cause her to require the termination of a pregnancy.  I am not able, not equipped, not empowered, (neither sufficiently audacious or interested) to validate any person's circumstances against their perception of the Universe, their needs and the greater good.  I can say what *I* would do and even then I may find myself thinking very differently when actually confronted with a particular reality.  I can not make any assessment of the impact of generations of discrimination on an individual's belief that assistance is available to them or that if taken advantage of that it would actually provide the expected outcome. Neither can anyone else.

When it comes to theology, none of us expects everyone to believe what we believe.  We allow for differences, we make effort to be respectful.  But when it comes to political ideology, all the gloves come off, deeply held beliefs as profound as the sanctity of life itself and when it does or does not begin are scoffed at by those who believe differently.

We must make room for one another in our communities, hearts and policies.  If I could wish only one thing for the world, it would be for all of us to understand that the human experience is as valid for one person as another regardless of their ethnicity or beliefs.  The same is also true for the American experience---the beliefs and customs of generations of working poor are as true and valid as those of anyone else.  Let us not presume to know exactly how and why everyone makes the decisions they do, what their needs are or the quality of their humanity.
*this summary courtesy of Wikipedia


Lyman said...

Hey, I started Grad School ten years ago, Fall of '98. Coincidence?

Fantastic post. The Model you explained is great, it does seem like a methodology that can be applied to many things. When you say it was created for "health improvement" does that mean disease prevention? accident prevention? mental health improvement? all of the above?

KHM said...

You've always wanted to be just like me is all I can figure ;-)

That model, I believe, was initially developed to address health issues that require big-time behavioral change, like smoking cessation. In the end it is certainly something that could describe any of those things you ask about with very different weights associated with each factor. In fact, it can also be used to assess likelihood of failing in any effort.

I'm glad you dug it; I certainly do. It has helped me understand a lot of things about the dynamics of change at the individual as well as the group level.