MD4ASSGNBOATENGJ.DOC
Johnson Boateng
Appril 2nd,2020.
Applying the Social-Ecological Model
The social-ecological model (SEM) assists in understanding the dynamic interrelation between different individual and environmental factors. The model argues that health behavior can be explained by these two factors. In regards to the individual, these are internal factors such as beliefs and attitudes while the external environment includes features such as social supports (Hayden, 2019). The environment has both internal and external factors. SEM also contends that the external environment can comprise both social, as well as physical influences (Hayden, 2019). In this regard, when SEM is used in health promotion, it alters both social and physical environment, which ultimately influences change in the individual. SEM examines five main factors when addressing health promotion. These are intrapersonal, interpersonal. Institutional, community, and societal.
Intrapersonal and interpersonal Levels
Intrapersonal levels that influence health promotion include knowledge, beliefs, personal traits, perceptions, and also self-efficacy. Among female sex workers, various intrapersonal level factors influence their ability to use family planning methods such as condoms. For example, female sex workers who have education and knowledge of the risks of not using family planning methods such as condoms often protect themselves (Hayden, 2019). Also, a woman’s self-efficacy to exert control over her own life influences her ability to use condoms. For instance, a woman who has goals such as engaging in commercial sex for financial stability but not risking one’s health. This is a woman who plans her encounters and knows what she can agree to and what she is against in regards to sexual encounters. When a woman has such power, control, and understanding of her priorities, she is likely to use safe family planning methods like condoms to protect herself.
Interpersonal level indicates that a person’s relationship with others affect one’s social identity. Interpersonal level denotes the external factors such as family, friends, peers, and networks (Centers, 2015). An individual relationship with these social networks influences one’s behavior. For example, a female sex worker who has friends or co-workers who believe that use of family planning like condoms deters clients is likely to use them. The individual reasons that if friends and peers are not using condoms and they are okay, there is no need to use them. The relationship that one has with the peers or family determines how one approaches a certain issue. If use of family planning is not considered vital within the family setting, them a female sex worker would likely not consider it.
Institutional, Community, and Societal Levels
Institutional level indicates that rules and regulations set by organizations or groups can influence behavior. When it comes to sex workers, some women work under institutions (Golden et al., 2015). The instructions dictate whether the female sex workers can use family planning methods such as condoms. If the institution rules demand otherwise, the female sex worker would be compelled to engage in unprotected sex (Hayden, 2019). Other times, the institution or organization can give incentives to female sex workers who would like to engage in sexual contact with clients without condoms. If the woman desperately needs the money, the reward becomes a motivating factor.
Community level factors include the social norms or standards of behavior that exist either formally or informally. These norms dictate accepted behavior within that community. Some enhance health while others do not (Hayden, 2019). For instance, an organization that works with female sex workers to teach them health promoting behaviors would encourage use of family planning like condoms. On the other hand, men may expect that women working as sex workers have no self-worth and would not expect to use condoms with them. This would force these women in unprotected sexual encounters.
Societal level involves the various policies such as social, economic, and cultural that impact behavior. For example, cultural differences influence how female sex workers use family planning (Golden et al., 2015). For example, among racial minorities, the increase levels of poverty push many female sex workers to be reckless or feel compelled to engage in unprotected sex. The presence of poverty and fewer supports for such women encourages risker sexual behaviors.
Challenges to Achieving Health Equality
Issues such as structural bias and racism contribute to poor health outcomes for female sex workers. Structural bias and racism refer a system where institutions, social forces, public policies, ideologies, and various processes that interact to create inequalities (Gee & Ford, 2011). These inequalities persist in major socioecological levels leading to racial and ethnic inequalities. Structural bias and racism can result in poor health outcomes for female sex workers in regards to use of family planning. For example, people of color who may be engaging in commercial sex can experience disregard for their demand to use condoms with a client when dealing with a white customer. In many cases, black female workers may lack support from groups that promote health outcomes for minorities through education and guidance. Such women would have little understanding of the risks they may be facing because their problems have largely been ignored. On the other hand, outright racism puts these women of color at risk of abuse and exploitation when it comes to family planning (Gee & Ford, 2011). For example, the customer may indicate that a black female worker his beneath him and refuse to use a condom increasing the risk of sexually transmitted illnesses for the sex worker.
Structural bias and racism lead to social inequalities, which also support poor health outcomes for female sex workers. Social inequality occurs when there is unequal opportunities and rewards for various social positions within groups in the society (Gee & Ford, 2011). Social inequality creates challenges for achieving health equality among female sex workers because some have less access to essential resources. For example, some female sex workers can access condoms while others may not.
Summary of Application of SEM
The SEM shows that personal and environmental factors play a role in developing health outcomes. The individual belief and self-efficacy to exert control over one’s health impacts the decisions to use family planning. One’s relationship with the social networks such as family and peers also encourage one to use or not to use family planning. The institution rules and policies that a sex worker abides by also encourages or discourages use of family planning methods such as condoms. Accepted community or societal norms or standards such as disregard of sex workers as immoral people can limit their ability to access better health outcomes. However, if they are supported, they can increase use of family planning. Societal social, economic, and cultural policies also shape how sex workers are treated and in turn, the support they get can promote their use of family planning.
References
Centers for Disease Control and Prevention. (2015). Social ecological model. Retrieved from https://www.cdc.gov/cancer/crccp/sem.htm
Gee, G. C., & Ford, C. L. (2011). Structural racism and health inequities: Old issues, new directions. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4306458/
Golden, S. D., McLeroy, K. R., Green, L. W., Earp, J. A., & Lieberman, L. D. (2015). Upending the social ecological model to guide health promotion efforts toward policy and environmental change. Health Education & Behavior, 42(1_suppl).
Hayden, J. (2019). Introduction to health behavior theory (3rd ed.). Burlington, MA: Jones & Bartlett Learning.