Social/Health Ecological Model
Review of Theory
The Social Ecological Model (SEM) stems from multiple ecological models of health behavior in which there are multiple levels of influence on the outcome: intrapersonal, interpersonal, organizational, community, and public policy (Bronfenbrenner, 1979, McLeroy, Bibeau, Steckler, & Glanz, 1988; Sallis, Owen, & Fisher, 2015). Initially, Bronfenbrenner (1979) theorized three levels of environmental systems that affected behavior: microsystems, mesosystems, and exosystems. McLeroy et al. (1988) applied this to health behaviors with intrapersonal factors, interpersonal processes, institutional factors, community factors, and public policy influencing people’s health. Currently, social ecological models are well accepted by major organizations and professionals as suitable grounding for public health programs. Behavior change is maximized when the levels support healthful choices and when individuals are motivated to make these choices; thus, the combination of individual-level and environmental-level interventions will ideally achieve the largest gains in positive health behaviors.
In adults, research has shown a gap in understanding community environmental attributes (Sallis et al., 2015). While some studies have revealed that access to physical activity facilities and their aesthetic qualities are related to leisure time physical activity levels (Humpel, Owen, & Leslie, 2002), and that adults who live in “walkable neighborhoods” engage in more walking/су cling for transportation (Saelens, Sallis, & Frank, 2003), environmental influences on physical activity have not been shown to be as important as personal and social influences and their interactions (Dollman, 2018). What is known is that providing individuals with motivation and the knowledge/skills to change their behavior doesn’t work without environments and policies that support healthy behaviors.
For youth, interventions focused on diet, physical activity, and smoking have shown that behavior can be modified, but typically only on a small scale (Cushing, Brannon, Suorsa, & Wilson, 2014), apparently due to failure to focus on individual behavior modification and the lack of comprehensive approaches. Biddle, Braithwaite, and Pearson (2014) found an overall small but positive effect in their meta-analysis indicating that an increase in physical activity is possible for adolescent girls when activity-based interventions target girls within the educational setting. Educational, or school-based, interventions were supported, along with multi-component interventions that focus on simultaneously changing the environment (i.e., improving access to physical activity opportunities and collaborating with parents and teachers).
Evidence in Youth
The Memphis GEMS pilot study, an intervention targeting African American girls (aged 8 to 10) and their parents, intended to promote healthy eating and improved physical activity (Beech et al., 2003). Group activity and informational sessions for the girls and their parents led to a 12 percent increase in moderate-to-vigorous physical activity. In a similar group of girls (middle schoolers), the Trial of Activity for Adolescent Girls linked school and community in an ecological approach to prevent physical activity decline (Lytle et al., 2009). They found a statistically significant positive effect on physical activity outside of school for the girls involved. In accord with the theory, self-efficacy, social support from friends and others, and transportation to community activities served as mediators for physical activity.
Another intervention, which consisted of group education in community centers, included active play for children and an educational component for parents to serve as role models in the home. Results showed the children engaging in fewer minutes of sedentary time than the controls and more minutes of physical activity (O’Dwyer, Fairclough, Knowles, & Stratton, 2012).
A more recent intervention for adolescents incorporated the SEM by using physical education lessons designed to maximize physical activity, personal activity plans, recess and lunchtime activity opportunities, connection to the community with newsletters to parents, and awareness of community physical activity programs (Sutherland et al., 2015). After 12 months, students in the intervention schools demonstrated significantly more physical activity, and there was a reduction in the decline in physical activity among adolescents from disadvantaged schools.
Of late, decreasing sedentary time has been a focus of many health-related research studies. In Australia, a school-based study with groups focusing on (1) reducing sedentary behavior, (2) increasing physical activity, (3) reducing sedentary time and increasing physical activity, and (4) control, found the group focusing on both decreasing sedentary time and increasing physical activity spent 13 minutes per day less in sedentary time than those in the control group (Carson et al., 2013). The combination of efforts appeared to be most effective. All intervention groups had more positive perceptions of access to standing options in the classroom environment.