1. Identify a patient or community group that contributes to or is involved in the principal behavior you are attempting to improve with your intervention.
- Physicians who practice in primary care clinics are my primary concern. I am trying to advocate for better mental health screening among older adults and since older adults are more likely to visit primary care clinics than mental health providers, I feel that changing behaviors within this group will really be paramount in the overall care of older adults.
2. Using any of the individual explanatory theories in “Theory at a Glance”, develop an explanatory model for the target behavior (above) that you will be attempting to influence with your intervention. This can be an extension/based on expected findings (or previously published literature) from your answers to Homework #3. Figures are always very useful... keep it simple.
Using the Theory of Planned Behavior
- Targeted Behavior: Not screening for depression and suicidal ideation in Geriatric patients.
Concept: Based on a previous study, physicians are able to identify depression and suicidal ideation in older adults, lack of treatment of and referral for mental health in this population is explained by physician willingness and also the belief that depression and suicidal ideation are a normal part of aging.
Attitudes: In replicating a study that was conducted 10 years ago, I hope to identify the current attitudes of physicians to determine whether they lack awareness and need to be educated, whether they are unwilling due to beliefs, or a combination of both. Educate providers on the fact that depression in older adults is in fact very treatable and suicidal ideation can be successfully prevented.
Subjective Norm: Using social marketing, can advocate for the use of a screening measure or device. This can be a measure that is already in existence such as the PHQ-9 or a tool that can be developed. Hospital systems may have to implement social marketing and create incentives for physicians to use this in regular practice. Developing a new electronic screening tool will require more effort and in this case using the 4 p's will be essential.
Perceived Behavioral Control and Self Efficacy: Set up support to physicians through a easy referral path and incentivize physicians to use the screening measure/tool and make appropriate referrals. Train them on how to use the supports that the system may have in place.
3. Identify how one or more of your specific interventions will target one or more of these key factors contributing to the behavior of interest.
Providing education on how taking time to screen for depression or suicidal ideation will save money. Rewarding physicians for using supports that are in place in the system. Using performance ratings or adding questions relating to whether physicians screened for mental health through patient satisfaction ratings.
4. Create a framework that draws upon a socio-ecological framework to orient your target behavior within a larger context. ie, what are some of broader, external forces that influence the individual behavior of interest...see Figure 2 of “Theory at a Glance.”
- Social and Economic Policies: Social and economic policies are at the heart of influencing many of the behaviors in regards to physicians spending more time to or gaining knowledge about the importance of screening for mental health among older adults. Social influences, attitudes, and behaviors toward the older population and of aging often drive how decisions are made. This is also the case for mental health. The social attitudes toward mental health and who should be in charge of treating mental health are of extreme importance. These social attitudes impact financial decisions. On the other hand economic decisions can also change behavior in a positive direction in regards to mental health in the aging populations. When calculating the cost based on the fact that older adults with mental health conditions such as depression are more likely to be hospitalized and seek out services from physicians, an emerging argument for the use of mental health services in primary care clinics gains strength. Not to mention that older adults commit suicide at alarmingly high rates and the cost of suicides are high.
Systems/Institutions: Have the most power in implementing standards and incentivizing physicians to screen for mental health or adopt better practices for mental health.
Individual and Population Health: Having knowledge about the current condition of mental health in older adults is important on both an individual and population level. On an individual level, having more knowledge de-stigmatizes mental health and in understanding the suicide rates and that depression is very treatable in this group can help decrease the public health severity.