(An item from the ISHN Member information service)  This blog advocates use of ecological analysis and action (comprising an ecological approach) so that the complex, inter-related factors in the real world can be considered when identifying and implementing interventions to influence both individual behaviours as well as conditions that influence those behaviours. An article in Issue #3, 2015 of Health Promotion International got our attention when it called for more attention to " time, a dimension beyond the socio-ecological model, is a critical factor of families' busy lives". We have no quarrel with the argument presented in the article. "Physical activity and healthy eating have long been promoted as key strategies in tackling the ‘wicked problem’ of obesity. Both practices are assumed to go hand-in-hand, but whether one dominates the other has largely remained unexamined. ". The study conducted 47 family interviews as part of a mixed methods study examining environmental influences on youth obesity. "Time pressure to meet the demands associated with scheduled physical activity for youth was the dominant theme across interviews from all neighborhoods. Physical activity and healthy eating were valued differently, with greater value placed on physical activity than healthy eating. The pressure to engage youth in organized physical activity appeared to outweigh the importance of healthy eating, which led to neglecting family meals at home and consuming fast food and take out options. Our findings further reinforce the need to move beyond the socio-ecological model to integrate critical dimensions such as ‘time’, to allow for a more nuanced understanding of contemporary healthy living." Our quarrel rests with the interpretation of the ecological model. Surely that is the purpose of examining the ecology of the situation, including all relevant factors such as time, transportation, economics and much more. Note: The ISHN definition of an ecological approach can be found here.  Read more>>

(An item from the ISHN Member information service)  The use of ecological analysis of the over-lapping and inter-acting influences of individual, family, neighbourhood, school and larger community on behaviour and health status is now well-accepted in health promotion research. The ISHN has a version of this thinking that we developed with several researchers. However, it is very difficult to sort out the relative impact of these various layers. Indeed, the more "proximal" and "distal" influences are likely to vary for different individuals, at different times in their lives and events. An article in Issue #11, 2015 of Public Health Nutrition describes the relative contributions of these layers of the Social Ecological Model (SEM) when examining childhood obesity. A randomized telephone survey conducted in 2009–2010 collected information on parental perceptions of their neighbourhoods, and household, parent and child demographic characteristics. Parents provided measured height and weight data for their children. Geocoded data were used to calculate proximity of a child’s residence to food and physical activity outlets. Multiple logistic regression models were estimated to determine the joint contribution of elements within each layer of the SEM as well as the relative contribution of each layer. Layers of the SEM representing parental perceptions of their neighbourhoods, parent demographics and neighbourhood characteristics made the strongest contributions to predicting whether a child was overweight or obese. Layers of the SEM representing food and physical activity environments made smaller, but still significant, contributions to predicting children’s weight status. Read more>>

(An item from the ISHN Member information service)  A special issue (#5-6, 2015) of The Journal of Early Adolescence uses different measures to understand the early adolescents’ experience in schools. The introduction noted that "We are particularly interested in measures with direct application—providing actionable data to teachers, principals, parents, school counselors, or the students themselves, in ways that promote social-emotional and academic learning. In this introduction, we highlight the ways in which articles in this special issue offer rigorous, relevant, and feasible approaches to this measurement work". The next two articles examined the non-classroom settings within the school, hallways, cafeterias and school yards and measured items such as the density of student gatherings, verbal noise and staff perceptions, all of which were found to be significant. In the schoolyard, the researcher suggested a much greater focus on non-social students who were excluded from activities. My only question, a serious one, was whether the study included the bathrooms in the schools. Note: In the ISHN complex, ecological and systems-based model depicting the school environment, we do depict these various sub-settings within the school. Read more>>

(From the ISHN Member information service)  In our extensive monitoring of the research, we find that the now-popular "ecological approach" is more often actually applied in the "analysis" stage, identifying the complex, multiple and multi-level influences on behaviour and practice, rather than being actually used in the "action" stage, where the approach is used to organize and deliver a planned variety of interventions to affect the multiple influences. We are pleased to read the article in the August 2014 issue of International Journal of Behavioral Nutrition & Physical Activity, which reports on a superb application of the ecological approach in 15 elementary schools in Mexico. The authors report that "Thirty-two distinct intervention strategies were implemented in one setting (i.e., school) to engage four different target-groups (students, parents, school representatives, government) across two domains (Nutrition and Physical Activity). Overall, 47.5% of the strategies targeted the school infrastructure and/or personnel; 37.5% of strategies targeted a key political actor, the Public Education Secretariat while fewer strategies targeted parents (12.5%) and children (3%). More strategies were implemented in the Nutrition domain (69%) than Physical Activity (31%). The most frequently used SCT construct within both intervention domains was Reciprocal Determinism (e.g., where changes to the environment influence changes in behavior and these behavioral changes influence further changes to the environment); no significant differences were observed in the use of SCT constructs across domains. Findings provide insight into a promising combination of strategies and theoretical constructs that can be used to implement a school-based obesity prevention program. Strategies emphasized school-level infrastructure/personnel change and strong political engagement." The complete text of the article is available. A full report on the project is also available here.  

A detailed description of the impact of intervention during its two year implementation is provided here. (Note: the results after two years are modest, with small changes in eating habits and some types of physical activity reported. In our view, this reflects the reality that complex, multi-intervention programs need several years in order to be embedded in the school culture as well as to interact with the local neighbourhood and parents/families. Larger, community, media and societal influences are also important. The study did not report any changes to obesity levels. This is consistent with other studies, not only of school programs, that obesity is a problem that is far more challenging than what can be affected by a single setting within the community.  For schools, we should adjust our expectations of the impact of even well-delivered multiple interventions such that students are truly supported by healthy factors while in school and that they graduate with the knowledge, skills, selected attitudes, beliefs and intentions that can be reasonably expected. If an entire society is obsengenic, then we should recognize the limits of the school's influence.  

The authors capture our above assessment of current efforts to implement ecological approaches as follows: " The premise underlying ecological programming is that a multilevel program is likely to be more effective than an individually focused program because it affords the opportunity to encounter the same behavioral prompts (e.g., to be more physically active) from a variety of sources (parents, teachers, coaches) in a variety of settings (home, school, community) [13]-[16]. Therefore, an intervention program that contains diverse strategies to engage several different stakeholders across a range of settings might address the health behavior in a more comprehensive way and thus yield better results than a simpler program (i.e., fewer targets, less settings). Despite its intuitive appeal and an increase in the use of ecological principles for programming to prevent childhood obesity in developed countries [17], optimal (i.e., effective, easy to implement at low cost) combinations of intervention activities to promote healthy lifestyles have yet to be identified. In addition to determining optimal combinations of intervention activities, health promotion practitioners striving to integrate ecological principles into their programs must also strive to develop programs that are theoretically informed. Challenges to theoretical integration include practitioner difficulties in operationalizing and assessing theoretical constructs [18]. The purpose of this study was to assess the integration of ecological principles and theoretical constructs in a school-based obesity prevention program that was successful in creating a supportive environment for healthy behaviors." 

The conclusion to the paper notes that "The aim of this paper was to assess the integration of ecological principles and theoretical constructs involved in a successful school-based obesity prevention program in Mexico City. We sought to unpack the intervention program along intervention domains in order to develop a map of the successful intervention program. If we compare our ecological map with recommendations in the literature [15],[17],[20], we can ascertain that this intervention program was a genuine ecological effort within a single setting since it delivered a diversity of intervention strategies involving multiple targets (POL, ORG, INT, IND), across both intervention domains. The ecological mapping showed that several different targets (PE teachers, school teachers, food vendors, parents, children and the school environment) were engaged, and that these efforts are consistent with those recommended to promote behavior change and to prevent obesity in children [7],[9],[23],[37]-[39]. Overall, our findings are consistent with existing evidence that policy intervention strategies can impact different ecological levels of influence [42]. This may be especially the case for hierarchical institutions such as school systems, where decisions are made at more than one level."


The reflections offered by the researchers are also interesting. "To our knowledge, this is the first research to document the integration of ecological principles and theoretical constructs in a school-based obesity prevention program in Mexico. The deconstruction of a successful intervention program that has documented environmental and student behavior improvements provides novel information for the implementation of multifactorial interventions in school-based health promotion programs. Although there may be a variety of successful combinations of ecological strategies and theoretical constructs, our findings provide one version that can be used as a starting point to develop even more effective combinations. Within the school setting, this ecological combination of strategies emphasizes school and political targets. Moreover, the strategies in both the Nutrition and Physical Activity domains are most commonly underpinned by the theoretical construct of Reciprocal Determinism. In a context where the school environment is considered “obesogenic” and there is compelling evidence that this environment can shape children's eating and PA patterns, the current findings provide valuable insight about the types of strategies that can be leveraged to optimal effects. It is expected that these findings will be especially meaningful to inform obesity prevention programs in Mexico and in low-middle income countries where childhood obesity is an emerging problem."  Read more>>  

(An item from the ISHN Member information service) "Going beyond training and hoping" is a colourful way to describe the paradigm shift now underway in research, practice and policy-making in school health promotion and social development. The words in the titles of the articles the October 2013 Issue of implementation Science are indicative of the new concepts that must be among the new, fundamentally different way that we approach our work and careers in the future. Although these concepts are applied to non-school settings and practices, their resonance should be self-evident. They include: transfer and implementation, scale-up, spread, and sustainability, making change last, leadership in complex networks, multifaceted, multilevel continuous quality improvement programs, dynamic sustainability frameworks and Social network diagnostics. Read more>>

(An item from the ISHN Member information service) The existence of a micro-political system in each school has been discussed often in educational research. An article in Issue #3, 2013 of the NASSP Bulletin discusses how this can affect new principals. The researchers report that "This year-long qualitative study detailed the lived experiences of two suburban novice middle school principals as they found themselves leading within a macropolitical environment containing slashed public school budgets, contracted student programs, teacher cutbacks, and policy mandates to improve student achievement. The study captured the ideologies and values of subsystems between teachers and administrators, negotiations of boundaries and turf between administrators and teachers, and how principals asserted bureaucratic leadership approaches for political ends. Read more>>

(An item from the ISHN Member information service) Several articles in a Supplementary Issue of Public Health Reports provide a comprehensive reframing of sexual health promotion, moving away from disease-focused, preventive strategies towards a holistic and health promoting approach. One article in the issue presents an excellent ecological analysis and then presents the principles that could underlie ecology-based actions. These principles include contextualizing the issues, using systemic thinking, focusing on relationships, acknowledging sexuality and emphasizing wellness. Another article reports on how the state or Oregon is shifting from a teen pregnancy strategy to a sexual health promotion approach. Two articles present indicators for monitoring progress in the US and Canada. Two articles discuss the impact of socio-economic status on teen pregnancy and early initiation of sexual activity. Read more>>

(An item from the ISHN Member information service) An article in Issue #6, 2013 of Preventive Medicine reports on the success of a three year capacity-building approach to school physical activity promotion. According to the authors " The objective was to determine changes in capacity over a 3 year intervention (2005–2008) in schools and whether greater increases in capacity were associated with greater decreases in overweight/obesity. “It's your Move!” (IYM) was an obesity prevention project, in 12 Australian secondary schools (5 intervention; 7 comparison), that aimed to increase community capacity to promote healthy eating and physical activity. Capacity was assessed pre/post intervention using the ‘Community Readiness to Change (RTC)’ tool. Comparisons from baseline to follow-up were tested using Wilcoxon Signed-Ranks and results plotted against changes (Newcombe's paired differences) in prevalence of overweight/obesity (WHO standards). RTC increased in intervention schools (p = 0.04) over time but not for comparison schools (p = 0.50). The intervention group improved on 5 of 6 dimensions and the three intervention schools that increased three levels on the RTC scale each had significant reductions in overweight/obesity prevalence. Read more>>

(An item from ISHN Member information service) The use of ecological analysis and action as a concept is emerging in many school-based programs and approaches. It is more than fitting to see how it is in use in the flield of environmental education. An article in Issue #2, 2013 of the Journal of Environmental education suggests that an ecological framework be used to design instructional programs. Read More>

(An item from ISHN Member information service) An article in the December 2012 Issue of Social Science & Medicine suggests that realist perspectives should be integrated within random controlled trials in order to better understand the complexity of interventions and how their components and their characteristics interact with the local context. The authors suggest that `Randomized trials of complex public health interventions generally aim to identify what works, accrediting specific intervention ‘products’ as effective. This approach often fails to give sufficient consideration to how intervention components interact with each other and with local context. ‘Realists’ argue that trials misunderstand the scientific method, offer only a ‘successionist’ approach to causation, which brackets out the complexity of social causation, and fail to ask which interventions work, for whom and under what circumstances. We counter-argue that trials are useful in evaluating social interventions because randomized control groups actually take proper account of rather than bracket out the complexity of social causation. Nonetheless, realists are right to stress understanding of ‘what works, for whom and under what circumstances’ and to argue for the importance of theorizing and empirically examining underlying mechanisms.`The authors also propose that ‘realist’ trials should aim to: examine the effects of intervention components separately and in combination, explore mechanisms of change, analysing how pathway variables mediate intervention effects; use multiple trials across contexts; draw on qualitative & quantitative data; and be oriented towards building theories setting out how interventions interact with context. This last suggestion resonates with recent suggestions that, in delivering truly ‘complex’ interventions, fidelity is important not so much in terms of precise activities but, rather, key intervention ‘processes’ and ‘functions’. Read more

(An item from ISHN Member information service) An article in Issue #5, 2012 of Prevention Science uses ecological analysis to identify the bullying prevention interventions that are more effective in the school context. The researchers report that" Data for this study are drawn from the School-Wide Information System (SWIS) with the final analytic sample consisting of 1,221 students in grades K – 12 who received an office disciplinary referral for bullying during the first semester. Using Kaplan-Meier Failure Functions and Multi-level discrete time hazard models, determinants of the probability of a student receiving a second referral over time were examined. Of the seven interventions tested, only Parent-Teacher Conference (AOR = 0.65, p < .01) and Loss of Privileges (AOR = 0.71, p < .10) were significant in reducing the rate of the reoccurrence of bullying and aggressive behaviors. By using a social-ecological framework, schools can develop strategies that deter the reoccurrence of bullying by identifying key factors that enhance a sense of connection between the students’ mesosystems as well as utilizing disciplinary strategies that take into consideration student’s microsystem roles. Read more.