The PEN-3 Model


In my final installment of models for health education I will talk about the PEN-3 model.  This model is not as well-known as some of the other models.  However, it has a very important use.  This model helps to identify specific cultural factors that are important to know to implement a health education program with diverse populations.  Dr. Collins Airhihenbuwa developed the PEN-3 model in 1990 (Airhihenbuwa, 1990).  The key thing to know about this model is that’s it’s meant for non-Western cultures.  It’s easier to implement a program in cultures closer to our own.  If the culture is vastly different, you first need to understand their motivations.

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The PRECEDE-PROCEED model is probably one of the most talked about in public health.  One of the reasons being that it’s a comprehensive model for developing public health education programs.  There are a lot of arrows showing the relationship between items within a phase and between phases.

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Protection Motivation Theory

What are you afraid of?  Probably a lot of things.  If there is something you are afraid of, you will avoid it.  That’s what fear appeals do, they make you fear something to avoid it.  Fear appeals can be used in good ways (think CDC’s anti-smoking campaign).  Some in not so good ways (think of Dr. Wakefield’s Lancet study forever incorrectly linking the MMR vaccine to autism).  The Protection Motivation Theory first developed in 1975 was designed to explain fear appeals.

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Social Ecological Models

Social Ecological Models are not one model per se, they are models that are multi-level.   They idea is that a person is influenced by their environment from their family to the community, to the society as a whole.  McLeroy, Bibeau, Stecklter & Glanz (1988) developed the model for use in health education programs.  The model starts with the individual and the knowledge they have within.  The next is interpersonal which includes family and friends and now in this day and age friends in person and on the Internet.  Organizational which are the organizations that the individual works with and the community which is the network of organizations.  Finally, public policy which are the laws that everyone abides by.

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Models for Health Education – Stages of Change

The Transtheoretical Model or Stages of Change was developed by James O. Prochaska and Carlo Di Clemente in 1977.  It outlines the different stages a person goes through to make a health behavior change, hence the reason it is also called “Stages of Change”.  It starts by the person not being ready to make a change to the final stage of dropping the old behavior in favor of a new one.  Here is what the model looks like:

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Cool science – GM mosquitos how to tackle to the communication issue

A new study was published in PLoS Currents Outbreaks that surveyed a sample of people in Florida to get their thoughts on the use of genetically modified (GM) mosquitos.  In a nutshell, many of those surveyed were skeptical of their use.   The reason they cited were concerns about the possible negative effect on humans and the ecosystem.  What was interesting about this finding is the less worried someone was about mosquito-borne disease, the less likely they were to accept the use of GM mosquitos.  The main outcome of the study was to further risk communication and education about the use of GM mosquitos.  What does this mean, exactly?

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Models for Health Education – Theory of Reasoned Action

The Theory of Reasoned Action was developed in 1967 that looks at the expectations of the person who performs the behavior (Fishbein & Azjen, 1975).  The job of the person using this model is basing their outcomes on what the person or group expects will happen, not what they think should happen.  This points back to perceptions.  Even if I believe the outcome to a behavioral intervention will be positive, the person may have beliefs which has them thinking otherwise.  In public health we can assume anything about any group we are working with.

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Why didn’t you study….?

One of the most common questions I am asked in terms of my research is “Why didn’t you study [insert group]?”  It can be hard to understand why I would pick a certain group to study and not others.  First, when you are doing any scientific research project, you have to narrow your focus.  In this case I narrowed my field to one type of immigrant.  To include other types of immigrants would have taken too long to pursue.  It’s better to focus your study and get better results for one group than it is to do too many groups at once.  Not saying you can’t, but I wanted to graduate in some reasonable time frame and I did not have grant funding to pay for my time.

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Models for Health Education – The Health Belief Model

The next article in a series of health education model critiques is the Health Belief Model.  This model attempts to explain what beliefs and perceptions will prompt someone to promote or not perform a health behavior.  The model was developed in the 1950’s by Godfrey Hochbaum, Irwin Rosenstock, Stephen Kegeles, and Howard Leventhal (Janz & Becker, 1984).  Understanding the perceptions of the health behavior is key to understanding why someone will or will not do it.

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