Ecological Model – Strategies and Tactics

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Ecological Model – Strategies and Tactics

Public health analysts and prominent scientific organizations have advocated the adoption of the ecological approach in supporting interventions that are more effective and aimed at the promotion and maintenance of health for populations. Being a crucial aspect of modern health promotion movement and public health, the ecological approach stresses the need to act on a number of health determinants (Weiner et al., 2009). Most literature on the ecological approach have tended to focus on defining it and outlining its central tenets. All the same, the procedures for planning and evaluating programs based on this approach have been developed too. On the professional practice front, samples of ecological programs and various uses to which the approach has been put exist. These include tobacco control, diabetes, nutrition, and physical activity (Richard et al., 2011). Planners and practitioners have received calls from all angles urging them to adopt the ecological approach. This paper examines the application of the ecological approach in controlling tobacco use in Quebec through the lens of the Scheirer model.

Richard et al. (2004) their article Implementing the ecological approach in tobacco control programs: results of a case study use Scheirer’s framework on program implementation as an ecological model. The model integrates a number of theoretical perspectives (political, psychological and organizational development). The framework has been used on many occasions successfully to study program implementation in various fields, including mental and dental health. According to Scheirer, an organization is an open system that is highly influenced by the broader social system in which it operates. Sub-systems exist within the organization system, including individuals and teams. The entire organizational context has to be involved whenever innovation is being implemented in the organization. Organizational context in this regard includes the external environment of the organization (Weiner et al., 2009). Scheirer hypothesizes that the scope of implementation could be higher if the organizational environment characteristics and the nature of the innovation are more similar. The authors proposed three levels for organizational analysis based on the Scheirer model – macro, intermediate, and micro. This paper will focus only on the macro and intermediate levels.

Macro Level

According to Scheirer, this level is all about analyzing the role of institutions and actors from a political perspective. Although the actors and institutions are not directly taking part in the innovation implementation process, they highly influence the organization and the team in charge of the program and whose contribution is key to the success of the program. A macro level analysis holds that the success of the ecological approach in tobacco control programs would depend highly on coherence between the ecological approach and:

political/legislative environment influence

community environment influence

broader organizational influences (mission, priorities, staff support)

Intermediate Level

Analysis at this level pays much attention to the organizational unit key to the process of implementation. For purposes of the program at hand, the tobacco control team is the organizational unit. This analysis looks into the coherence between the tobacco team structures, norms, and processes and the innovation sought to be implemented. Scheirer’s model proposes that success of the ecological approach implementation depends on coherence between it and:

the resources available to the tobacco control team

the team’s familiarity with ecological interventions

training opportunities open to the team

the organization of the team

collaboration of the team with external partners

the support given the team by the control unit supervisor

the established norms of the team

Canadian health services, as per the Constitution, are under provincial jurisdiction. Despite this requirement, a number of provincial governments such as Quebec have devolved decision-making on health matters to regional levels. For instance, Quebec set up 18 regional social and health service boards authorized to, among other things, provide health promotion to the population. This would be done through Public Health Departments, which are legally mandated to organize public awareness campaigns, support and promote health care practices among health professionals, promote the adoption of social policies, and establish mechanisms for inter-sectoral action. These departments are by law required to coordinate with other agencies in the field of health service provision such as local community health centers (Richard et al., 2004).

In 1994, the Ministry of Health and Social Services for Quebec rolled out an action plan to remedy the smoking problem within the province. The plan had a budget of Can$ 20 million. Four strategies were identified for the implementation of the plan – prevention, protection, cessation and surveillance or evaluation. The plan targeted the youth and populations with low income. The plan encouraged collaboration various community partners in developing and implementing interventions. Moreover, the plan rooted for the use of a global ecological approach to controlling tobacco. The approach would include action on several personal and environmental determinants of initiating and maintaining smoking. The action plan was delegated to the Public Health Departments, which had to translate it into solid programs and interventions (Richard et al., 2004). It is out of this that that this paper seeks to analyze the performance of the ecological approach used by the Departments in tobacco control programming.

According to the study results as outlined in the article, the duration between 1994 and 1997 had a social and political climate suitable for adopting the ecological approach in Quebec. Factors that established the climate included the special ministerial initiative and financial resources alongside the action plan, which was focused on multi-target, multi-setting interventions. The same period also involved the implementation of new tobacco control legislation by the teams under study. New partners had to be recruited by the teams. Moreover, the teams had to intensify lobbying actions. The hot debate concerning tobacco necessitated much openness towards controlling tobacco.

Analysis of Site 1

Here, the ecological approach was integral to the organization’s mission. However, tobacco control was not a regional health priority at the time. Most professionals in the tobacco sector felt that the organization did not have sound mechanisms to support tobacco control interventions. However, the tobacco control team at the site had rich resources at their disposal, including finance, partners, and qualified personnel passionate about ecological interventions. This site assembled a variety of interventions portfolios by joining up smaller tobacco control teams already taking part in a range of actions. This resulted in great ecological programming. The coming of the ministerial action plan simply reinforced what was already in existence. The team’s planning process seemed less formal in comparison to that in Site 2 below. A possible explanation for this could be the availability of entrenched ecological programs and higher staff autonomy and experience.

Analysis of Site 2

The ecological approach was important to this organization’s mission as well. As opposed to Site 1, this site supported tobacco control interventions largely. The issue was among its key priorities. Its control team was not as large as the one in Site 1. Despite its professionals’ high qualifications in planning and intervention measures in public health, none had substantial experience in tobacco control. The ministerial action plan became an asset here because of two reasons. Firstly, the site had tobacco control interventions running as at the commencement of the study, but these initiatives were not as broad as the ones in site 1. The ministry guidelines streamlined these initiatives to include several settings and targets. The guidelines also were also resourceful to community partners. This helped set free the human resources at the tobacco control unit. The highly formalized planning processes here aimed mainly at ensuring the programming followed the guidelines in the action plan rather than going after existing programs as seen in Site 1. The relative experience of the team at this site could explain the foregoing aim. In addition, the fact that this site had delegated most functions of tobacco control to community partners meant that the ministerial guidelines were a close reproduction.

The ecological approach is a great step in the realm of health programs such as promotions. The Scheirer model is among many others that guide the implementation of the ecological approach. This paper has looked into the tobacco control interventions in Quebec through the lens of the Scheirer model. In as much as the control program was rolled out on large scale by the Quebec provincial administration, the ecological model on which it was built failed to take root in a number of places. Site 1 has been examined in stark contrast to site 2. The strategies and tactics used in both sites have revealed that the ingredients in the Scheirer model at both macro and micro level must be present before success of the ecological approach can be achieved.

References

Naaldenberg, J., Vaandrager, L., Koelen, M., Wagemakers, A., Saan, H. and Hoog, K. (2009).

Elaborating on systems thinking in health promotion practice. Global Health Promotion, 16(1), 39-47.

Poland, B., Krupa, G. and McCall, D. (2009). Settings for Health Promotion: An Analytic

Framework to Guide Intervention Design and Implementation. Health Promotion Practice, 10(4), 505-516.

Richard, L., Gauvin, L. and Raine, K. (2011). Ecological Models Revisited: Their Uses and

Evolution in Health Promotion Over Two Decades. Annual Review of Public Health, 32. 307-326.

Richard, L., Lehoux, P., Breton, E., Denis, J., Labrie, L., and Leonard, C. (2004). Implementing

the ecological approach in tobacco control programs: results of a case study. Evaluation and Program Planning, 27, 409-421.

Weiner, B. J., Lewis, M. A., and Linnan, M. A. (2009). Using organization theory to understand

the determinants of effective implementation of worksite health promotion programs. Health Education Research, 24(2), 292-305.