Panter-Brick Catherine, Clarke Sian E, Lomas Heather, Pinder Margaret, Lindsay Steve W
Department of Anthropology, Durham University, UK.
Soc Sci Med. 2006 Jun;62(11):2810-25. doi: 10.1016/j.socscimed.2005.10.009. Epub 2005 Dec 13.
Behaviour change is notoriously difficult to initiate and sustain, and the reasons why efforts to promote healthy behaviours fail are coming under increasing scrutiny. To be successful, health interventions should build on existing practices, skills and priorities, recognise the constraints on human behaviour, and either feature community mobilisation or target those most receptive to change. Furthermore, interventions should strive to be culturally compelling, not merely culturally appropriate: they must engage local communities and nestle within social and ecological landscapes. In this paper, we propose a social ecology perspective to make explicit the links between intention to change, actual behaviour change, and subsequent health impact, as relating to both theory-based models and practical strategies for triggering behaviour change. A social ecology model focuses attention on the contexts of behaviour when designing, implementing or critically evaluating interventions. As a case study, we reflect on a community-directed intervention in rural Gambia designed to reduce malaria by promoting a relatively simple and low-cost behaviour: repairing holes in mosquito bednets. In phase 1, contextual information on bednet usage, transactions and repairs (the 'social lives' of nets) was documented. In phase 2 (intervention), songs were composed and posters displayed by community members to encourage repairs, creating a sense of ownership and a compelling medium for the transmission of health messages. In phase 3 (evaluation), qualitative and quantitative data showed that household responses were particularly rapid and extensive, with significant increase in bednet repairs (p<0.001), despite considerable constraints on human agency. We highlight a promising approach-using songs-as a vehicle for change, and present a framework to embed the design, implementation and critical evaluation of interventions within the larger context-or social ecology-of behaviour practices that are the bedrock of health interventions.
众所周知，行为改变很难启动并维持，促进健康行为的努力失败的原因正受到越来越多的审视。为了取得成功，健康干预措施应基于现有的做法、技能和优先事项，认识到人类行为的限制因素，并且要么以社区动员为特色，要么针对那些最易接受改变的人群。此外，干预措施应努力在文化上具有吸引力，而不仅仅是在文化上合适：它们必须吸引当地社区并融入社会和生态环境。在本文中，我们提出一种社会生态学视角，以明确与基于理论的模型以及触发行为改变的实际策略相关的改变意图、实际行为改变和随后的健康影响之间的联系。社会生态学模型在设计、实施或批判性评估干预措施时，将注意力集中在行为的背景上。作为一个案例研究，我们反思了在冈比亚农村地区开展的一项以社区为导向的干预措施，该措施旨在通过推广一种相对简单且低成本的行为来减少疟疾：修补蚊帐上的破洞。在第一阶段，记录了有关蚊帐使用、交易和修补（蚊帐的“社会生活”）的背景信息。在第二阶段（干预阶段），社区成员创作了歌曲并展示了海报以鼓励修补，营造了一种主人翁意识，并成为传播健康信息的有力媒介。在第三阶段（评估阶段），定性和定量数据表明，尽管人类能动性受到相当大的限制，但家庭的反应特别迅速且广泛，蚊帐修补量显著增加（p<0.001）。我们强调了一种有前景的方法——使用歌曲作为改变的载体，并提出了一个框架，将干预措施的设计、实施和批判性评估嵌入到作为健康干预措施基石的行为实践的更大背景或社会生态中。
