Question

Q1- Nada is a working mother. She gave birth to a healthy baby. When her baby was two months old, she stopped breastfeeding the baby. Using the Socio-Ecological Model, explain why Nada might have taken this health decision. Explain in a narrative essay covering at least three points for each of the intrapersonal, interpersonal, institutional, community, and policy levels. (1-2 pages) Q2- You are a preventive medicine physician at a smoking cessation clinic. Explain how you will use the Transtheoretical Model's processes of change to help a patient in the pre- contemplation stage move on to the action stage of smoking cessation. (1-2 pages)

Answer 1

Q1.

*Ecological models are specific to health promotion and are multifaceted targeting environmental, behavioral and social policy changes that help people to adopt healthy behaviors.
- Social-ecological models of health behavior are characterized by multiple levels of influence on behavior and emphasize environmental and policy influences.
- Not all interventions incorporate all levels of the model.

*Multiple Levels of influence:

According to the socio-ecological model, the behavior is influenced at the following levels:
1. Intrapersonal
2. Interpersonal
3. Organizational
4. Community
5. Public Policy

1. Intrapersonal Level of Social-Ecological Model :

It takes into account an individual's:
i. Knowledge
ii. Attitudes
iii. Beliefs
iv. Self-concept
v. Self-esteem

2. Interpersonal Level of Social Ecological Model

Takes into account an individual's:
i. Social networks
ii. Social supports
iii. Families
iv. Workgroups
v. Peers
vi. Neighbors :
These factors are not necessarily mutually exclusive, and they will often overlap.

3. Organizational Level of Social-Ecological Model

i.Norms
ii. Incentives
iii. Organizational culture
iv. Management styles
v. Organizational structure
vi. Communication networks

4. Community Level of Social-Ecological Model:

i. Community resources
ii. Neighborhood organizations
iii. Social and health services
iv. Organizational relationships
v. Folk practices
vi. Governmental structures
vii. Informal and formal leadership

In the present scenario, Nada is a working mother. She gave birth to a healthy baby. When her baby was two months old, she stopped breastfeeding the baby.

1. Intrapersonal: Nada stopped breastfeeding the baby at 2 months old aimed at the reason for continuing her job after her maternity leave

2. Interpersonal: Stoppage of breastfeeding offered Nada with the objective of changing her baby's demand feeding in addition to starting a healthy weaning

3. Organizational: Give more concentration in the workplace and working environment

4. Community: Training community health workers to be effective in providing health information specific to Nada regarding initiation of weaning

5. Public Policy: A program aimed at convincing health care professionals specific to increasing weaning knowledge and its initiation with the aim of improving the health of the baby

Q2.

The transtheoretical model describes phases that people go through and mechanisms that people use when they adopt/modify/eliminate health behaviors.

*6 stages of the transtheoretical model :

1. Pre-contemplation
2. Contemplation
3. Preparation
4. Action
5. Maintenance
6. Termination

Smoking addiction is considered a disease according to the International Classification of Diseases. There is a need for regular treatment due to relapse occurrence. For this reason, the psychosocial dimension of the disease should be treated. Healthcare professionals are required to find the most convenient approach to provide healthy behaviors for individuals.

In the present scenario, You are a preventive medicine physician at a smoking cessation clinic. Here you are using the Transtheoretical Model's processes of change to help a patient in the pre-contemplation stage move on to the action stage of smoking.

Most smokers will cycle through the stages 3 to 4 times before quitting for life.

Here you and the client should keep in mind that each attempt offers the opportunity to learn new skills and new techniques that will help clients in their next attempt.

Remember that relapse is a normal event in the process of making behavioral change.

The Stages of Change

1. Pre-contemplation

Unaware or unwilling to change. Not thinking of quitting in the next 6 months.

Goal: Help the client begin to think seriously about quitting.

• Ask regarding feelings about smoking
• Ask about the pros and possible cons of smoking
• Advise by offering quitting information and assistance at any time

2. Contemplation

Ambivalent, but thinking about quitting within 6 months.

Goal: To help smoker move toward a decision to stop smoking. To help them feel more confident.

• Ask about the pros and cons of both continuing to smoke and quitting (decision balance). Acknowledge ambivalent feelings.
• Assist by reinforcing their reasons for change, and exploring new ones
• Suggest they cut back or stop for a day
• Assist by offering a future visit and information

3. Preparation

Getting ready to stop within the next 30 days. Have set stop smoking date. Have made a 24 hour quit attempt in the last 12 months.

Goal: To help smoker prepare for and anticipate positively a quit date.

• Ask about concerns, preparations and lessons learned from previous attempts.
• Advise by identifying barriers to stopping and elicit solutions.
• Assist by offering Booklet, Action Plan, Nicotine Replacement, Date for quitting (also known as B.A.N.D.).

4. Action

Have quit smoking within past 6 months and are actively applying cessation skills.

Goal: To help the client stay off tobacco products and recover from relapses.

• Ask how the client is doing: relapses, temptations, successes, NRT use.
• Advise re: relapse prevention, weight gain, triggers.
• Assist by focusing on successes, encourage self rewards and increase support, · elicit solutions for problems.

5. Maintenance

Quit for more than 6 months. Integrating smoke-free living into their routine.

Goal: To help the client remain smoke-free for a lifetime.

• Ask how the client is doing: risk situations, relapses.
• Assist by offering suggestions for difficult times, support, encouragement.
• Congratulate!