SOCIALE MARKETING
Inhoud
Introductie .................................................................................................................................... 5
Examen ..................................................................................................................................... 5
H1: Planmatige bevordering van gezond gedrag .............................................................................. 6
Inleiding .................................................................................................................................... 6
Doelen gezondheidsbevordering.................................................................................................. 7
Doelgroep en preventie .............................................................................................................. 8
Preventieparadox .................................................................................................................... 8
Middelen om gezondheidsbevordering te bereiken ...................................................................10
Gedrag en omgeving .................................................................................................................10
Ethiek.......................................................................................................................................11
H2: Analyse van gezondheidsproblemen ........................................................................................16
Verschillende soorten levensverwachtingen ................................................................................16
Compressie van morbiditeit ........................................................................................................18
Optreden van aandoeningen ......................................................................................................18
Prevalentie versus incidentie ......................................................................................................19
Impact van aandoeningen .........................................................................................................20
Ongelijkheden in gezondheid .....................................................................................................21
H3: Analyse van gedrag ................................................................................................................23
Risicofactoren voor aandoeningen ..............................................................................................23
Epidemiologisch onderzoek ........................................................................................................25
Kenmerken causaliteit ............................................................................................................25
Epidemiologisch onderzoek: onderzoeksontwerp ......................................................................26
Epidemiologisch onderzoek: meetmethoden ............................................................................26
Epidemiologisch onderzoek: verstorende variabelen .................................................................27
Epidemiologisch onderzoek: externe validiteit ..........................................................................28
Maten van associatie .................................................................................................................28
Relatieve risico op een gezondheidsprobleem ..........................................................................28
Risicoverschil op een gezondheidsprobleem .............................................................................29
Attributieve risico op een gezondheidsprobleem ......................................................................29
Populatie attributieve risico op een gezondheidsprobleem ........................................................29
Regressiecoëfficiënt & Correlatiecoëfficiënt ..............................................................................30
Voorkomen van ongezond gedrag ..............................................................................................30
Formuleren van interventiedoelen ..............................................................................................30
H4: Determinanten van gedrag .....................................................................................................31
1
, Hoe ontstaat gedrag? ................................................................................................................32
De centrale gedragsdeterminanten .............................................................................................33
Persoonlijke determinanten ....................................................................................................34
Omgevingsdeterminanten ......................................................................................................40
H5: Interventieontwikkeling ..........................................................................................................48
Inleiding ...................................................................................................................................48
Stap 2: Programmadoelen .........................................................................................................49
Stap 3: Programmaontwerp .......................................................................................................52
Stap 4: Programmaproductie .....................................................................................................55
Stap 5: Toepassing van intervention mapping voor het verbeteren van bestaande programma’s ....58
Conclusie IM .............................................................................................................................58
H6: Theorieën en methodieken van verandering ............................................................................59
Inleiding ...................................................................................................................................59
Theoretische methodieken en praktische toepassingen voor beïnvloeding van determinanten:
begripsverheldering ...................................................................................................................59
Gedragsveranderingsmodellen ...................................................................................................60
Stages of Change ..................................................................................................................60
Precaution Adoption Process Model .........................................................................................61
Theorieën over doelgericht gedrag en zelfregulatie ..................................................................64
Theorieën over omgevingsveranderingen ................................................................................65
Algemene methodieken en uitgangspunten bij voorlichting en gezondheidsbevordering ................65
Succesvolle communicatie: aandacht en begrip .......................................................................66
Relevantie en voorlichting op maat .........................................................................................67
Feedback en bekrachtiging .....................................................................................................67
Zelfregulering ........................................................................................................................69
Facilitatie (omgevingsfactoren) ...............................................................................................70
Methodieken voor gedragsdeterminanten ...................................................................................70
Kennis...................................................................................................................................70
Risicoperceptie ......................................................................................................................71
Attitudes en uitkomstverwachtingen .......................................................................................73
Sociale invloed.......................................................................................................................76
Vaardigheden en eigen-effectiviteitsverwachting ......................................................................77
Impulsieve reacties, gewoonte en behoud ...............................................................................78
Methodieken voor omgevingsdeterminanten ...............................................................................80
Algemene methodieken voor omgevingsverandering ................................................................80
Sociale omgeving ...................................................................................................................82
Organisaties ..........................................................................................................................83
Communitybenadering ...........................................................................................................83
H7: Implementatie van interventies ...............................................................................................85
2
, Inleiding ...................................................................................................................................85
Klassieke benadering .................................................................................................................85
Belang van aandacht voor implementatie ...................................................................................88
Raamwerk voor het bevorderen van implementatie .....................................................................88
Voorbereiding op implementatie .............................................................................................88
Opstellen implementatieplan ..................................................................................................91
Implementatieproces .............................................................................................................94
H8: Evaluatie van interventies ter bevordering van gezond gedrag ..................................................96
Inleiding ...................................................................................................................................96
Waarom en wanneer evalueren? ................................................................................................96
Evalueren van proces en effect ..................................................................................................97
De drie centrale vragen bij effectevaluatie ..................................................................................99
Stapsgewijze evaluatie ............................................................................................................ 100
Literatuur- en theorieverkenning .............................................................................................. 101
Het gecontroleerde experiment voor onderzoek naar efficacy .................................................... 101
Het veldonderzoek .................................................................................................................. 102
Implementatieonderzoek ......................................................................................................... 103
Economische evaluatie ............................................................................................................ 103
H9: Settingbenadering ................................................................................................................ 105
Inleiding ................................................................................................................................. 105
Setting en community ............................................................................................................. 106
Uitgangspunten & setting als systeem ...................................................................................... 107
Uitgangspunten ................................................................................................................... 107
Setting als systeem .............................................................................................................. 109
Settingbenaderingen ............................................................................................................... 109
Methodieken kenmerkend voor settingbenadering ..................................................................... 110
Participatie .......................................................................................................................... 110
Sociale netwerkbenadering ................................................................................................... 111
Intersectorale samenwerking ................................................................................................ 112
Aansluiten bij het bestaande en streven naar inbedding ......................................................... 113
Praktijkcollege ............................................................................................................................ 114
Onbedoelde effecten van gezondheidsvoorlichting ........................................................................ 115
Soorten onbedoelde effecten ................................................................................................... 115
5 dimensies van onbedoelde effecten .................................................................................... 115
5 dimensies – 11 types ........................................................................................................ 118
Boomerang effecten ................................................................................................................ 123
Intented construct activation ................................................................................................ 125
Unintended construct activation ............................................................................................ 126
Entertainment education ............................................................................................................. 128
3
, Mediasaturatie ........................................................................................................................ 128
Overtuigingskracht entertainment-education ............................................................................. 131
Involvement in E-E .............................................................................................................. 131
Effect E-E: theorie ............................................................................................................... 132
Case study: orgaandonatie ...................................................................................................... 135
4
Inhoud
Introductie .................................................................................................................................... 5
Examen ..................................................................................................................................... 5
H1: Planmatige bevordering van gezond gedrag .............................................................................. 6
Inleiding .................................................................................................................................... 6
Doelen gezondheidsbevordering.................................................................................................. 7
Doelgroep en preventie .............................................................................................................. 8
Preventieparadox .................................................................................................................... 8
Middelen om gezondheidsbevordering te bereiken ...................................................................10
Gedrag en omgeving .................................................................................................................10
Ethiek.......................................................................................................................................11
H2: Analyse van gezondheidsproblemen ........................................................................................16
Verschillende soorten levensverwachtingen ................................................................................16
Compressie van morbiditeit ........................................................................................................18
Optreden van aandoeningen ......................................................................................................18
Prevalentie versus incidentie ......................................................................................................19
Impact van aandoeningen .........................................................................................................20
Ongelijkheden in gezondheid .....................................................................................................21
H3: Analyse van gedrag ................................................................................................................23
Risicofactoren voor aandoeningen ..............................................................................................23
Epidemiologisch onderzoek ........................................................................................................25
Kenmerken causaliteit ............................................................................................................25
Epidemiologisch onderzoek: onderzoeksontwerp ......................................................................26
Epidemiologisch onderzoek: meetmethoden ............................................................................26
Epidemiologisch onderzoek: verstorende variabelen .................................................................27
Epidemiologisch onderzoek: externe validiteit ..........................................................................28
Maten van associatie .................................................................................................................28
Relatieve risico op een gezondheidsprobleem ..........................................................................28
Risicoverschil op een gezondheidsprobleem .............................................................................29
Attributieve risico op een gezondheidsprobleem ......................................................................29
Populatie attributieve risico op een gezondheidsprobleem ........................................................29
Regressiecoëfficiënt & Correlatiecoëfficiënt ..............................................................................30
Voorkomen van ongezond gedrag ..............................................................................................30
Formuleren van interventiedoelen ..............................................................................................30
H4: Determinanten van gedrag .....................................................................................................31
1
, Hoe ontstaat gedrag? ................................................................................................................32
De centrale gedragsdeterminanten .............................................................................................33
Persoonlijke determinanten ....................................................................................................34
Omgevingsdeterminanten ......................................................................................................40
H5: Interventieontwikkeling ..........................................................................................................48
Inleiding ...................................................................................................................................48
Stap 2: Programmadoelen .........................................................................................................49
Stap 3: Programmaontwerp .......................................................................................................52
Stap 4: Programmaproductie .....................................................................................................55
Stap 5: Toepassing van intervention mapping voor het verbeteren van bestaande programma’s ....58
Conclusie IM .............................................................................................................................58
H6: Theorieën en methodieken van verandering ............................................................................59
Inleiding ...................................................................................................................................59
Theoretische methodieken en praktische toepassingen voor beïnvloeding van determinanten:
begripsverheldering ...................................................................................................................59
Gedragsveranderingsmodellen ...................................................................................................60
Stages of Change ..................................................................................................................60
Precaution Adoption Process Model .........................................................................................61
Theorieën over doelgericht gedrag en zelfregulatie ..................................................................64
Theorieën over omgevingsveranderingen ................................................................................65
Algemene methodieken en uitgangspunten bij voorlichting en gezondheidsbevordering ................65
Succesvolle communicatie: aandacht en begrip .......................................................................66
Relevantie en voorlichting op maat .........................................................................................67
Feedback en bekrachtiging .....................................................................................................67
Zelfregulering ........................................................................................................................69
Facilitatie (omgevingsfactoren) ...............................................................................................70
Methodieken voor gedragsdeterminanten ...................................................................................70
Kennis...................................................................................................................................70
Risicoperceptie ......................................................................................................................71
Attitudes en uitkomstverwachtingen .......................................................................................73
Sociale invloed.......................................................................................................................76
Vaardigheden en eigen-effectiviteitsverwachting ......................................................................77
Impulsieve reacties, gewoonte en behoud ...............................................................................78
Methodieken voor omgevingsdeterminanten ...............................................................................80
Algemene methodieken voor omgevingsverandering ................................................................80
Sociale omgeving ...................................................................................................................82
Organisaties ..........................................................................................................................83
Communitybenadering ...........................................................................................................83
H7: Implementatie van interventies ...............................................................................................85
2
, Inleiding ...................................................................................................................................85
Klassieke benadering .................................................................................................................85
Belang van aandacht voor implementatie ...................................................................................88
Raamwerk voor het bevorderen van implementatie .....................................................................88
Voorbereiding op implementatie .............................................................................................88
Opstellen implementatieplan ..................................................................................................91
Implementatieproces .............................................................................................................94
H8: Evaluatie van interventies ter bevordering van gezond gedrag ..................................................96
Inleiding ...................................................................................................................................96
Waarom en wanneer evalueren? ................................................................................................96
Evalueren van proces en effect ..................................................................................................97
De drie centrale vragen bij effectevaluatie ..................................................................................99
Stapsgewijze evaluatie ............................................................................................................ 100
Literatuur- en theorieverkenning .............................................................................................. 101
Het gecontroleerde experiment voor onderzoek naar efficacy .................................................... 101
Het veldonderzoek .................................................................................................................. 102
Implementatieonderzoek ......................................................................................................... 103
Economische evaluatie ............................................................................................................ 103
H9: Settingbenadering ................................................................................................................ 105
Inleiding ................................................................................................................................. 105
Setting en community ............................................................................................................. 106
Uitgangspunten & setting als systeem ...................................................................................... 107
Uitgangspunten ................................................................................................................... 107
Setting als systeem .............................................................................................................. 109
Settingbenaderingen ............................................................................................................... 109
Methodieken kenmerkend voor settingbenadering ..................................................................... 110
Participatie .......................................................................................................................... 110
Sociale netwerkbenadering ................................................................................................... 111
Intersectorale samenwerking ................................................................................................ 112
Aansluiten bij het bestaande en streven naar inbedding ......................................................... 113
Praktijkcollege ............................................................................................................................ 114
Onbedoelde effecten van gezondheidsvoorlichting ........................................................................ 115
Soorten onbedoelde effecten ................................................................................................... 115
5 dimensies van onbedoelde effecten .................................................................................... 115
5 dimensies – 11 types ........................................................................................................ 118
Boomerang effecten ................................................................................................................ 123
Intented construct activation ................................................................................................ 125
Unintended construct activation ............................................................................................ 126
Entertainment education ............................................................................................................. 128
3
, Mediasaturatie ........................................................................................................................ 128
Overtuigingskracht entertainment-education ............................................................................. 131
Involvement in E-E .............................................................................................................. 131
Effect E-E: theorie ............................................................................................................... 132
Case study: orgaandonatie ...................................................................................................... 135
4
