Applying the Social-Ecological Model to Nutrition Issues That Promote Health and Prevent Disease

The social-ecological model1 provides a framework for designing nutrition interventions to promote health and prevent disease. The model identifies 5 targets of interventions: individual factors, interpersonal factors, organizational factors, community factors, and system or policy factors. Nutrition interventions targeted at individual factors are often designed to change knowledge, attitudes, or eating behaviors of individuals, whether they be children or adults. Historically, nutrition education interventions focused on helping individuals understand why it was important to change what they were eating and how to buy, prepare, and consume a healthful diet. The emphasis was on the individual.

However, individuals do not live in a vacuum; rather, they are embedded within complex and multilevel environments. They are part of families, work at worksites, learn in schools, pray in places of workshop, live in neighborhoods, play in communities, and engage within a host of systems and policies that influence each of these sectors. Each of these environments influences the individual's nutritional health. Moreover, the ecological perspective described by Bronfenbrenner2 suggests that there is a mutual reciprocity whereby the environments also are influenced by the individuals within them. This ecological perspective emphasizes that for effective population-based nutrition-related health outcomes, it is important to think not only about what individuals know, believe, think, and do but also about what happens in all of their environments: in their interpersonal relationships, within the organizational structures within which they interact, in the communities where they live, and the systems or policies within which they engage. Interactions within and across each of these levels influence not only individual health but also that of the community at large.

In this issue of Family and Community Health, Novilla and colleagues argue in their review article that significant health improvements can be achieved within this multilevel context and at these various levels of influence by starting with the family as the center of this network. Interventions targeted at interpersonal factors within families or other small groups often rely on formal and informal social networks for improved nutrition-related health outcomes. Ahye and colleagues describe some of these networks in their study of 3 generations of African American women and the roles they play as grandmothers, mothers, and daughters, and the food management strategies that they employ. They emphasize that these roles and systems are dynamic and provide a basis for culturally appropriate, interpersonal-level nutrition interventions.

Evans and colleagues also explore the family and home nutrition environment as the target for nutrition interventions. Although fourth- and fifth-grade students were the direct target of the nutrition and media literacy intervention, their parents were the target of the media campaign developed by the students. This is an example of reciprocity or how individuals as targets of change can, in turn, influence the environments within which they engage. Although there are no articles in this issue that specifically address interventions at the organizational or community levels of the social-ecological model, the second article by Evans and colleagues concludes that environmental and policy changes at home, schools, and when eating out with friends may motivate adolescents to eat a healthier diet.

The policy or systems level of the social-ecological model is addressed by Hughes and his study of the Australian public health nutrition work force. Unlike the other articles in this issue, the target of his research is the work force that promotes the nutritional health of whole or specific populations. His premise is that this work force is an important contributor to how well a society can address its public health priorities. This case study analysis concludes that the work force capacity is limited by determinants across many levels, including, for example, preparation of individuals for public health nutrition work, the degree to which they collaborate with other public health practitioners, disorganization of the work force, and resource allocations that do not equitably support public health nutrition stated policies.

The social-ecological model provides a framework to design nutrition interventions targeted at the individual, interpersonal, organizational, community, and policy levels. It is significant that although most of the articles in this issue focus on one of these sectors, they do recognize and acknowledge that the respective sector of influence is part of a broader and far more complex system. Novilla and colleagues suggest that nutrition interventions begin with the family, acknowledge the various levels of influence, and employ partnerships with the larger public health system. Hughes suggests that at least in Australia the public health nutrition work force also requires interventions so that it has the capacity to address the nutrition-related priorities of populations. The value of the social-ecological model is describing the various levels of influence that impact individual and population health and providing a foundation for designing interventions within each level. The challenge remains to design, test, and evaluate nutrition interventions that use an integrated and ecological approach across all levels of the social-ecological model.

Betsy Haughton, EdD, RD

Professor and Director, Public Health Nutrition, Department of Nutrition, The University of Tennessee, Knoxville. E-mail: mailto:[email protected]

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