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 Social and Behavioral Aspects of Public Health   posted by  boym   on 3/24/2008  Add Courseware to favorites Add To Favorites  
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Abstract/Syllabus:

410.616

Social and Behavioral Aspects of Public Health


Gambian families visiting the regional clinic. Photo by mknobil from flickr.com. Some rights reserved.

Staff

Instructor:
Larry Wissow

Originally Offered

Fall 2006

Offered By

Department of Health, Behavior, and Society

 

Description

The course is designed to help students develop basic literacy regarding social concepts and processes that influence health status and public health interventions. The course also hopes to help students develop insight into populations with whom they have worked in the past or will work in the future, and to develop one kind of effective writing tool (the narrative) for communicating about psychosocial issues in public health. These overall aims are approached through lectures, discussion, readings, workshopping, individual compositions, and group discussion of student writings.

Course Objectives

  1. To familiarize students with views on key concepts that form a basis for literacy in the social and behavioral aspects of public health: culture, race/ethnicity, gender, poverty/disparities, factors related to behavior change, community, organizational climate, family.
  2. To familiarize students with the concept of a narrative as a therapeutic, policy, and investigative tool.
  3. To help develop empathy for and a collaborative stance toward populations with whom one will work in the field of public health.
  4. To promote interest in further study of the social and behavioral determinants of health.

 

OCW offers a snapshot of the content used in courses offered by JHSPH. OCW materials are not for credit towards any degrees or certificates offered by the Johns Hopkins Bloomberg School of Public Health.

Syllabus

 

Course Description

The course is designed to help students develop basic literacy regarding social concepts and processes that influence health status and public health interventions. The course also hopes to help students develop insight into populations with whom they have worked in the past or will work in the future, and to develop one kind of effective writing tool (the narrative) for communicating about psychosocial issues in public health. These overall aims are approached through lectures, discussion, readings, workshopping, individual compositions, and group discussion of student writings.

Course Objectives

  1. General background: The overall framework for the course is based on the biopsychosocial or ecologic perspective on health. In these models, health is seen as being determined by biologic, behavioral, social, and environmental factors that interact with each other and, to a greater or lesser extent, can be influenced by individuals and groups.
  2. Specific aims:
    1. To familiarize students with views on key concepts that form a basis for literacy in the social and behavioral aspects of public health: culture, race/ethnicity, gender, poverty disparities, factors related to behavior change, community, organizational climate, family.
    2. To familiarize students with the concept of a narrative as a therapeutic, policy, and investigative tool.
    3. To help develop empathy for and a collaborative stance toward populations with whom one will work in the field of public health.
    4. To promote interest in further study of the social and behavioral determinants of health.
  3. Teaching philosophy
    1. Less is more - topics are selected to introduce selected issues rather than provide comprehensive review; less reading, attempt to pick articles that are not too technical, hope in that way that busy students can actually complete the reading assignments.
    2. Study that is personally engaging is more likely to be meaningful. The course attempts to be engaging and not an intellectualized view of the topics.
    3. Emphasis on peer discussion and feedback as befitting graduate school and rich, diverse backgrounds of students. Emphasis on the community of learners versus the teacher as oracle.
  4. Skills/knowledge at end our course
    1. Have the ability to recognize importance of key biopsychosocial/ecologic concepts when they appear (or fail to appear) in studies of public health problems.
    2. Develop a sense of empathy and partnership with individuals and groups who become involved in public health problems; develop ability to tell/listen to stories as a mechanism for developing empathy and partnership.
    3. Develop ability to read and write narrative accounts of public health problems.
    4. Develop ability to work collaboratively to achieve clear communication (often across cultural and language barriers) about public health problems.

Course Requirements

  1. Units are comprised of a lecture/discussions or lectures and presentation and discussion of student narratives
    1. For each unit, there is one main article assigned, with other optional background readings. The lecture material serves as a framework for a large-group discussion; we will try to highlight material from the readings and encourage questions related to the readings.
    2. For four of the units (see schedule), students are asked to write a 2-3 page narrative describing either their personal experience with the topic or something vicariously experienced through contact with other individuals or communities. Details about writing narrative are presented in the introductory lecture.
    3. Narrative writing is done in stages:
      1. Initial composition alone
      2. Workshopping with a partner (time allotted in class)
      3. Revision alone
      4. Optional lab time for further revision
      5. Reading aloud to class followed by discussion
      6. Optional recording in lab time
  2. Lab sessions: these sessions are optional. They represent office hours to discuss course or related material in more depth and in addition:
    1. Opportunities for workshopping materials with the instructors
    2. Training in basic audio editing and recording for narratives
    3. Opportunities to record and edit narratives
  3. Reading narrative: students are asked to select a chapter from one book from the course list and use it as an example of narrative and as a source of information about the key topic or topics for which they have the most interest. Other narrative sources can include the narrative sections included in many medical journals. This will be the basis for one of the midterm assignments.
  4. Midterm assignments
    1. Students will be asked to turn in their second narrative. The submitted material should include the original narrative and the final workshopped version. Criteria for evaluation include:
      1. Is there a focus? This need not come out immediately with a topic sentence; however, by the end, the reader should feel that there has been a specific point or points made?
      2. Does your voice or the voice of the protagonist really come through? What techniques are used to do this?
      3. Is it detail-rich and multi-layered? Are specific events, people, and situations described?
      4. Does the writing convey feelings?
      5. Is the flow of ideas coherent? Are there discontinuities in voice or topic, are these explained?
      6. Are there insights revealed beyond telling the story? This goes back to (a): is the story a stepping-off point to something deeper or more generalizable?
    2. A brief review of the outside narrative material (described above). The review should be 3-4 pages long and include a summary of the following points. When addressing these points, use specific examples. Give full bibliographic information about the narrative so that others can locate it.
      1. Implications for public health interventions or policies that stem from the experiences of the lead character(s) and his/her/their community
      2. Techniques the author(s) use to help readers understand the social reality of the characters
      3. Techniques the authors(s) use to convey the voice of the subjects and to create a personal connection with the reader
  5. Final assignments
    1. A portfolio of the narratives written during the course. Each narrative should be preceded by a 1-2 paragraph definition of the key topic to which it is linked. The definition should include references. The original version of each narrative plus the revised workshopped version should be included. Evaluation of the portfolio will be based on 1) the definition paragraphs, 2) overall completeness of the portfolio, and 3) detailed reading by the instructors of one of the narratives (students should indicate which they would like the instructor to read in detail).
    2. Short answer exam about a short narrative. It involves reading a short narrative and answering some questions about its content, form, and related information from the course.
  6. Evaluation: 15% on the mid-term narrative, 15% on the midterm narrative review/analysis, 20% on the final short answer exam, and 50% on the portfolio.
  7. Readings
    1. The required and recommnded readings for each unit are available on the Readings page.
    2. The books illustrating narrative are readily available for purchase from on-line sources or at area bookstores. They are also available in libraries, and you may own one or more already. Feel free to suggest others: please, however, run it by the instructor prior to deciding to use it. It is permissible to use a book you have already read, if you are willing to revisit it. We will also entertain the possibility of using narrative material in other media - films, audio, collections of photographs.

Schedule

 


SESSION # TOPIC ACTIVITIES
 
Unit 1: Ecology, Narrative, and Meaning
1

This talk introduces several important concepts, including the idea that individuals inhabit and are inhabited by a multilevel environment of influences with which they interact. However, individuals are not passive entities floating in this environment - they have abilities both to shape it and to selectively perceive it. Finally, the individual, features of the environment, and the transaction with the environment evolve over time, so that we become interested not only in static states but in the way in which an individual and his or her environment are changing.

This talk also introduces narratives, the concept of meaning, and the role meaning is thought to have in shaping health, behavior, and development.

Lecture

Composition of trial narratives

2

Critical response/An introduction to workshopping

Lecture

Readings from student s' trial narratives with opportunity for response.

 
Unit 2: Gender
3

What is the difference between sex and gender?

What are the mechanisms that relate gender to wellness and illness?

Lecture
 
Unit 3: Cultural Perspective
4

Why think about health in a cultural perspective?

This talk introduces a description of culture, uses some examples contrasting American Indian and 'White' US health-related attitudes, and talks about Arthur Kleinman's concept of 'explanatory models' as a way of exploring the implications of culture for a particular health-related issue.

Lecture
 
Unit 4: Race and Ethnicity
5 The goal of this session is to introduce the concept of race as a social construct ('how you see yourself, how others see you') that is both meaningless and meaningful, and to discuss some of the public health implications of the concept.

Lecture

Workshopping Narrative 1

6

Race and ethnicity continued.

Lecture

Sharing Narrative 1

 
Unit 5: Poverty, Social Support, and Social Capital
7

The goal of this session is to discuss ways in which poverty is measured, and to explore mechanisms by which poverty is thought to contribute to poor health. Concepts of social support and social capital are introduced as factors that may ameliorate the impact of poverty.

Lecture
 
Unit 6: Role of Families
8 Nearly everyone lives with or is connected to family members. Families have particular ethics - family members are special to each other in ways that have important consequences, yet these relationships are frequently ignored in health programs.

Lecture

Workshopping Narrative 2

9

Role of Families continued

Lecture

Sharing Narrative 2

 
Unit 7: Rational Decision Making
10 Is there such a thing as "rational" decision-making. Lecture
 
Unit 8: Spirituality
11

Spirituality and religion are not only important aspects of identity for many populations, but can have direct and indirect implications for physical and psychological health outcomes. Evidence for this connection will be discusses, as well as the debated role of spirituality in public health and/or medical care.

Lecture

Workshopping Narrative 3

12

Yoga intervention demonstration: Demonstration of a yoga intervention tailored to patients with rheumatoid arthritis. Special consideration is given in this intervention to the role of spirituality in the management of chronic disease, as well as the importance of sensitivity to physical limitations of diversely-abled participants.

Lecture

Sharing Narrative 3.

 
Unit 9: Change Within Systems
13

Making change within systems: the case of changing medical provider behavior. This session will start by discussing observed variation in practice patterns, followed by issues encountered in trying to influence those patterns through educational means. We will end by talking about factors within medical practices that influence the process of change.

Lecture
14

Marketing change at a mass and individual level. This talk plucks from the huge health behavior change literature three 'trendy' concepts that have much appeal and are potentially more accessible than some other approaches. We will talk first about behavior change theories in general, and then address the theory of 'stages of change,' followed by a discussion of motivational interviewing and social marketing.

Workshopping Narrative 4.

15

Continuing talk on behavior change

Lecture

Sharing Narrative 4

16 Summing up: comparing quantitative with anecdotal, narrative ways of knowing and persuasion; thinking about how the narrative process has or has not made the experience of this class different from other classes; brief reports from class members about books; presentation of audio versions of narratives from those who have chosen to make them. Exam




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