Prof Pekka Puska

Ex Director General

National Institute for Health and Welfare (THL)

Finland

Combining medical and social

behavioural theories to develop

strategies for prevention and health

promotion

medical

epidemiological

framework

Social

behavioural

framework

GENERAL GOAL

- Improved Public Health

MAIN OBJECTIVES

- Specific NCDs, health outcomes

INTERMEDIATE OBJECTIVES

- risk factors, behaviours

PRACTICAL INTERVENTION

PROGRAMME

13/03/2014 Pekka Puska, Ex Director General

“Nothing is so practical

as a good theory”

13/03/2014 Pekka Puska, Ex Director General

Major behavioral and social

theoretical perspectives

(used e.g. in North Karelia Project, Finland)

1. Social marketing Marketing

2. Behavior - modification (Social) Psychology

3. Communication - behavior change Communication

4. Innovation - diffusion Sociology

5. Community organization Social policy

Theory Discipline area

13/03/2014 Pekka Puska, Ex Director General

I. SOCIAL MARKETING

Background: Large experience and practice of

commercial marketing (of various products)

Question: Should we not market health in the same

way?

Yes: We should apply as much as possible the good

principles of marketing:

• associating the message with emotional issues

• sequencing the target audience

• pre-testing etc

Problem: Marketing health issues is a more

profound task than marketing choice of certain

products

13/03/2014 Pekka Puska, Ex Director General

II. BEHAVIOUR MODIFICATION

6. COMMUNITYORGANIZATION

5. ENVIRONMENTAL SUPPORT

4. SOCIAL SUPPORT

3. PRACTICAL SKILLS

2. PERSUASION

1. KNOWLEDGE

(Puska and McAlister)

13/03/2014 Pekka Puska, Ex Director General

1. Increased health knowledge

• simple message

• practical advise

• check understanding

• several channels

• personal contacts

13/03/2014 Pekka Puska, Ex Director General

2. Persuasion

• credible message source

• attention to emotional aspects

• anticipate counter arguments

• achievable goals

• positive goals, minimize fear

13/03/2014 Pekka Puska, Ex Director General

3. Training for practical skills

• demonstration of desired

behaviours

• guided practice

• feed-back

• positive reinforcement

13/03/2014 Pekka Puska, Ex Director General

- family

- work-site groups

- establishment of therapeutic

groups:

weight reduction etc

4. Social support

13/03/2014 Pekka Puska, Director General

5. Environmental modification

• food-industry

• food marketing

• restaurants, canteens etc

13/03/2014 Pekka Puska, Ex Director General

6. Community organization

- general support in the community

for the desired goals

- formal decision making: political

leaders, health authorities, school

authorities etc

- other formal leaders: business,

mass media etc

- informal opinion leaders

13/03/2014 Pekka Puska, Ex Director General

III. COMMUNICATION - BEHAVIOUR

CHANGE

• Mass communication can reach large

masses

• Historical development:

- early enthusiasm

- empirical nihilism

- balanced view

• Generally mass communication

reinforces existing attitudes and behaviours

1.

13/03/2014 Pekka Puska, Ex Director General

III. COMMUNICATION - BEHAVIOUR

CHANGE

• Well designed mass communication,

combined with relevant field work can have

meaningful impact

• Mass communication should be combined

with practical work in the community,

promoting interpersonal interaction

• Small relative effects can mean big

absolute numbers - and favourable cost

effective ratio (e.g. stop smoking TV

programmes in Finland)

2.

13/03/2014 Pekka Puska, Ex Director General

IV. INNOVATION - DIFFUSION

• New risk reducing lifestyles are

innovations that diffuse in the

community following certain rules

• Project represents change agent -

people can be classified as innovators,

early adopters, early and late majority

and laggards

• Critical mass, reaching early majority

is crucial

1.

13/03/2014 Pekka Puska, Ex Director General

IV. INNOVATION - DIFFUSION

Two-step flow of innovation:

a) Mass media are effective in

disseminating information

b) Opinion leaders and interpersonal

contacts influence opinions, attitudes and

behaviour

• Opinion leaders (“gatekeepers”) can be

identified and used in the programme (e.g.

lay leader programme in North Karelia)

2.

13/03/2014 Pekka Puska, Ex Director General

VI. COMMUNITY ORGANIZATION

• Every community is a complex network of

organizations

• Every individual in the community is

connected with a great number of

organizations that influence his/her

behaviours

• The health project can work with many

organizations to promote the desired

changes in the community

1.

13/03/2014 Pekka Puska, Ex Director General

VI. COMMUNITY ORGANIZATION

Critical for Success:

• Collaboration calls for shared interest

• Personal contacts and trust

2.

13/03/2014 Pekka Puska, Ex Director General

13/03/2014 Pekka Puska, Director General

COMMENTS

• Many programmes emphasize

dissemination of information and

persuation - while the greatest problems

for change are issues that relate to

social and physical environment

• The big task and strength of community

based programmes is to influence the

community as a whole so that the

desired behaviours are as easy as

possible!

13/03/2014 Pekka Puska, Ex Director General

COMMUNITY-BASED

(PILOT/

DEMONSTRATION)

PROGRAMMES

NATIONAL

PROGRAMMES

AND POLICIES

13/03/2014 Pekka Puska, Ex Director General

PUBLIC

POLICY

HEALTH PROGRAMME

POPULATION

PRIVATE

SECTOR

13/03/2014 Pekka Puska, Ex Director General

National policies and private sector involvment:

Social change process

FOR SUCCESSFUL

PROGRAMME

1)Do the right thing

2)Do enough of it

13/03/2014 Pekka Puska, Ex Director General

FOR SUCCESSFUL

PROGRAMME

Combine 1) leadership

with 2) partnership

13/03/2014 Pekka Puska, Ex Director General

13/03/2014 Pekka Puska, Ex Director General

Thank you