The Promotion of Self-Efficacy for Improved Health and Dengue Prevention

Salutations! Thanks for stumbling upon this post (or seeking it out if you are one of the kind-hearted souls that has), hope you enjoy.

As a Freshman at the College, I have been extremely fortunate to have found a place within the Sharpe Scholars Program and the Student Organization for Medical Outreach and Sustainability (SOMOS). Both of these wonderful experiences have brought me to this point and are the driving forces behind my research for the summer. I would like to take a moment to thank all of my mentors (even those outside of these programs) as they have given me so much guidance and constructive criticism as I maneuvered through the year.

If you were to delve into the immense manuscript that is Dr. Aday’s retelling of the SOMOS story, you would find the long history of a project centered around ‘transformative participatory community-based research’, more than ten years in the making. Dissatisfied with service trips that participated in duffle bag medicine – the temporary alleviation of health concerns through a foreigner’s distribution of pills and medicine – the founding SOMOS-eros decided to engage in a more sustainable alternative. After spending time considering the options and learning through trial and error, the team identified the community of Esfuerzo, at the time a community of many names with one glaring problem: the lack of a sense of community and in turn infrastructure. Through both literature studies and observation, the team identified that this lack of infrastructure sprouted from the marginalization of the community. Using the words of Minkler and Wallerstein (2004), ecological and social systems perspectives came into play when SOMOS  identified marginalization as a key concern. Marginalization is defined as “a process that pushes people, groups, communities, regions, and nations to the edges of spaces (physical and social), resources, and efficacy (ability to affect and to affect activities necessary to survive and thrive; cf. co-author 2013). The community of Esfuerzo was geographically separated from the rest of Paraiso by the cañada (ecological system perspective) and socially separated from the rest of Paraiso as recognized in the sentiments of residents outside of Esfuerzo (social system preferences). The heightened lack of infrastructure within the community also compounded the sense of marginalization. Marginalization becomes a key concern, especially for SOMOS, as it can directly impact health. Were SOMOS to successfully aid in the creation of infrastructure, heightened sense of community, and diminished sense of marginalization, we believe that we can establish a dynamic within Esfuerzo that was conducive to promoting sustainable health efforts and improving the general quality of life.

During the past few years, in order the increase social infrastructure as it related directly to health, SOMOS has worked in conjunction with Esfuerzo to identify clusters of high social network density within the community . Within the most connected (and geographically close) sections of the community, we formed “block groups” that would serve as representational units. To delve deeper, we identified members of each block group whom the community members trusted when it came to discussing health related issues. Through this system of identification, SOMOS helped Esfuerzo form the “Comite de Salud” or Health Committee, who would meet to discuss local health issues and serve the community’s health related needs. By establishing this group to work for the community as a form of representational labor,  Esfuerzo gained an infrastructural component and from preliminary observations and data collection SOMOS has identified a heightened sense of community.

At a meeting of the “Comité de Salud” in-country this past January, the members of the group expressed to SOMOS their desire to implement a Dengue Campaign in the community. Dengue and, more recently, Chiqungunya stir up concern among residents of Caribbean and Latin American countries as more and more of the mosquitoes that breed in the area begin to carry the diseases.  Inspired by the idea and their initiative, SOMOS encouraged the group and offered to provide any resources that the group could not procure. The team returned from the Dominican with the goal of establishing a “Dengue Campaign Toolbox” for the group. As a member of the SOMOS Health Committee Task Group back in Williamsburg, I began discussing this project with Dr. Aday. While discussing pros- and cons-, Dr. Aday brought to my attention some of SOMOS history. In the past, ethnographic interviews had been conducted to gauge the community members’ sense of control over their own lives. The overwhelming lack of perceived control and in turn efficacy within the community was of major concern to the team, and led them to define the community of Esfuerzo as marginalized (Aday 2013). With respect to the proposed Dengue Campaign, I quickly realized that if marginalization involves a lack of perceived efficacy, the efforts to improve community health practices may be hindered by the correlation between changes in behaviors and perceived self-efficacy – if the past interviews were accurate.

 So, why the interest in self-efficacy? No good ever comes from dealing with plants at the surface – whether it is weed removal or flower nourishment, the issue must be handled at the roots. Health and the alteration of healthcare practices, it seems, are just as systemic as flower care and weed removal. The literature shows that initiatives aimed at altering a population’s healthcare practices by solely presenting them with information and plastering areas with flyers will yield superficial results. Higher rates of sustainably changed behavior have been correlated to systematic approaches that target the roots, the driving force, of individual and population health care practices – perceived self-efficacy. Albert Bandura (2004) argues that “whatever other factors may serve as guides and motivators [with regards to health practices], they are rooted in the core belief that one has the power to produce desired changes by one’s actions”. With this understanding, alongside of the knowledge and experience I have gained thus far from my involvement in Student Organization for Medical Outreach and Sustainability (SOMOS), I am studying self-efficacy with regards to health practices and dengue as they relate to the members of our group’s partnering community in the Dominican Republic. By doing so, I hope to establish a baseline time-zero measurement of perceived self-efficacy, primarily with respect to dengue, in the community and begin the implementation of efficacy altering healthcare initiatives. Conducting this research would help my readers understand how established perceived self-efficacy scales work in the field, in addition to helping my team (SOMOS) understand where we need to focus our efforts in order to promote effective health care related projects – in particular our Dengue Campaign.

Because the team’s past research with regards to efficacy was cursory and used as a means to define the state of the community (Aday 2013), I plan to conduct a thorough interviewing cycle in-country as a part of my research project. Schwarzer and Jerusalem (1995) developed a “General Self-Efficacy Scale” that has been widely used in the field of efficacy research. By referencing their scale, I would establish a set of questions with which I would conduct in-home interviews of adult community members in order to establish a time-zero reading of community wide perceived self-efficacy, currently as it relates to the threat of Dengue. The scale includes ten questions, that Schwarzer and Jerusalem (1995) recommend integrating into a larger questionnaire of 15-20 questions. From their experience with the scale, Schwarzer and Jerusalem (1995) indicate that administration of the scale takes, on average, four minutes. Were I to realize that during my first trial interview in Spanish that the questions utilized by the scale were not accessible or did not elicit a response, I plan to troubleshoot using current literature. Grieve and Witteveen (2013) in particular have developed a sub-sectioned version of the scale that yielded test-retest reliability and internal consistency. During interviews, I foresee myself working with the in-country members of the “Comité de Salud”, as their facilitation of this project would encourage their roles as community leaders and advocates. Together, we can establish a base-line time zero and begin to understand the most logical approach to implementing a public health related awareness campaign. By  the end of the data analysis process, I plan to contact the “Comité de Salud” and begin to draft an improved methodology and approach to their Dengue Campaign. Ideally, SOMOS will help promote the Dengue Campaign during the annual trip this coming January.

As I begin to count down the days until my departure for the Dominican Republic, I grow more and more excited for this research. This project, alongside the several others that will be conducted this summer, indicate SOMOS’ growing maturity and its entrance into a new “Time Phase” of the project. The initial foundations have been laid over the past decade and now we are able to focus directed efforts on the continued improvement of infrastructure, sense of community, and in turn health promotion to improve the quality of living. I hope you will share in my excitement as you follow my blogs this summer!

Thank you (whoever you may be reading this), for your time and support!

¡Besos!   – Morgan


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  2. Miranda Elliott says:

    As a mathematics/computer science student, I never fit as many social science courses into my schedule as I’d like, and this convinced me that I need to try harder. Just the first paragraph of this post blew my mind – I had never considered that ecological systems, social systems, infrastructure, sense of community, marginalization, and health could all be so interconnected. Thanks for opening the eyes of someone who’s taken too many statistics and not enough sociology courses. Hope your work this summer was as fascinating and fulfilling as it sounds!