Nyambe et al BMC Public Health 2016 16 1166 Page 2 of 15. Background The Theory of Triadic Influence, Prevention refers to the efforts of society to promote The TTI was developed by Flay Snyder and Petraitis. protect and sustain the health of the population This in 1994 as an integrative theory for health related be. paper focuses on vaccination and screening as primary haviors 7 It borrows from and builds of the ideas. and secondary prevention measures respectively The of Bronfenbrenner and Bandura 8 The TTI assumes. aim of vaccination is to actively limit the incidence of that the trail of a behavior is determined by one s decisions. disease by protecting the population from attack before or intentions It is organized in a 3 3 framework with. being affected 1 2 whereas screening tests identify three levels influence causation and three streams of. asymptomatic individuals who may have the disease influence 7. from those who probably do not 2 The levels of causation include ultimate distal and. All parts of the health system have an important role proximal Proximal or immediate variables are those that. in the prevention of health problems 1 Elder Lytle have direct effects on behavior and are under the control. Sallis et al 3 concluded that socio ecological frame of an individual although still influenced by the distal. works are essential in programs or studies that employ and ultimate factors Distal level variables are divided. multi level interventions and measurement strategies into first level influences social personal nexus and. Two key concepts of the ecological perspective help to second level evaluations and expectancies and are. identify intervention points for promoting health 1 composed of variables that individuals are likely to have. behavior both affects and is affected by multiple levels some control over but not as much as proximal influ. of influence 2 individual behavior both shapes and is ences Ultimate variables represent the underlying causes. shaped by the social environment causation 4 of behavior that are broad and relatively stable which. Accordingly a number of multi level models have individuals have little or no control over 7. been developed which incorporate all the different social The types or streams of influence include Intraper. and ecological factors that can affect health behavior in sonal influences which are characteristics that contribute. one single model such as the Social Ecological Model to self efficacy regarding specific behaviors Interper. and the Theory of Triadic Influence Both provide a sonal Social Influences which are the social situation. multilevel framework that can be used to study health context or micro environment that contribute to social. behavior and the social environment normative beliefs about specific behaviors and the. Cultural Environmental Influences which are multiple. socio cultural macro environmental factors that contrib. The Social Ecological Model ute to attitudes toward specific behaviors Within each. The SEM was developed out of the work of a number of stream of influence are two sub streams cognitive. eminent researchers including Bronfenbrenner s Ecological rational and affective emotional 7 The TTI not only. Systems Theory 1979 McLeroy Bibeau Steckler et al considers major influences of behavior as those within. Ecological Model of Health Behaviors 5 and Daniel the three streams but it also considers the interactions. Stokols Social Ecological Model of Health Promotion between stream paths and behavioral experience feed. 1992 2003 4 6 back loops An additional file shows Figure S2 Theory. The below systematic review considers all versions of of Triadic Influence see Additional file 2. the SEM However focus is on the SEM conceived by, McLeroy et al 5 because it is one of the more com Relevance of a systematic review of SEM and TTI. mon utilized versions The SEM targets five levels rings The purpose of this systematic review was to identify the. of influence for health related behaviors and conditions main differences and similarities of SEM and TTI re. which are Intrapersonal individual factors for individual garding screening and vaccination in order to prepare. characteristics such as developmental history knowledge potentially successful prevention programs for practice. attitudes behavior self concept and skills Interpersonal in general and cervical cancer prevention in Zambia in. processes primary groups these are social networks and particular By default this systematic review benefits. support systems Institutional organizational factors for researchers who consider application of these models by. social institutions with organizational characteristics and compiling the work of those authors who have had an. rules and regulations for operation community factors for opportunity to utilize them. relationships among organizations institutions and net The SEM and TTI were selected for review because. works and finally Public policy factors for local state and both models allow for the integration of multiple levels of. national laws and policies 5 The assumption is that influence to establish an overall view of health behavior. people both influence and are influenced by those around change in this case the uptake of vaccines and medical. them 4 An additional file shows Figure S1 Social screening Changing individual s behavior by providing. Ecological Model see Additional file 1 them with the necessary skills and motivation is only. Nyambe et al BMC Public Health 2016 16 1166 Page 3 of 15. possible if environments and contexts are also considered Outcome Set of optimal preventive measures by. Both models target mechanisms of change at several dif SEM and TTI. ferent levels of influence involving both individual level Language Include only studies that are in English. and environmental policy level interventions language. The SEM compared to TTI is a more commonly uti, lized ecological model and has been applied for develop All types of study designs were included in this review. ing for example screening interventions For this reason as long as they fulfilled the inclusion criteria This is due. the SEM is an appropriate model to discuss in this to the fact that there are few studies that utilize the SEM. review In contrast the TTI was selected because com and even less studies the TTI Studies were considered. pared to other multi level models it appears to greatly eligible for the review if they involved human partici. differ in structure and complexity with the SEM Flay et pants and followed the SEM or the TTI i e the full. al 7 indicated that the TTI was used to conduct a conceptual frameworks or modified versions of the. screening study suggesting this model is appropriate for frameworks. studies focusing on screening and vaccination The ques The focus was on all diseases or conditions that can. tion is therefore justified which of these models would be vaccinated and or screened Special interest was given. be most effective in designing an effective screening and to cancer because of future research plans Substance. vaccination program abuse risk behavior studies were included if the study il. Summarizing this review addresses the research ques lustrated the use of the TTI regardless of whether there. tion What are the main differences and similarities of was a primary or secondary prevention intervention. the SEM and TTI regarding screening and vaccination This was due to the fact that very few studies that utilize. programs the TTI address screening and or vaccination The TTI. was initially developed for substance abuse studies. Methods therefore inclusion of studies that focus on substance. Criteria for selecting studies for this review abuse was relevant to illustrate the use of the TTI The. The systematic review protocol was based on guidelines geographic location was not a factor in this review. from the Cochrane Reviewer s Handbook 9 to deter We also took into account the types of outcome mea. mine the extent that screening and vaccination as pro sures that is the factors that predict health behavior. posed by the SEM and TTI are different The inclusion choices such as knowledge access to health care facil. criteria for articles in the systematic review were the ities and personal beliefs The SEM and the TTI frame. following works state that health behavior choices are influenced. by a number of factors When these factors are consid. Geography Include any country Priority given to ered they should therefore be able to predict whether a. Sub Saharan African countries health behavior is practiced in this case screening and. Time Include studies starting from the year 2000 vaccination For the review it was expanded to include. to date the acquisition and cessation of risk behavior and. Participants Includes all people with health substance abuse as mentioned earlier for the sake of the. behavior affected from intrapersonal interpersonal TTI which has relatively few studies that address screen. organizational community and policy level in ing and vaccination. accordance with the SEM For the TTI from Literature searches were performed using Medline. ultimate distal and proximal levels as well as Ovid Proquest PubMed University of Antwerp Discovery. intrapersonal interpersonal social and socio cultural Service and Web of Science Searches were conducted. environment streams during January and February of the year 2015 The. Disease Priority is given to cancers and diseases searches were generated for a time span from 2000 to the. that can be screened or vaccinated against Also present Other criteria specified were English language. include substance abuse risk behavior if they academic journal articles and for databases where it was. illustrate the use of the TTI possible human participants was specified. Exposure Intervention Primary and secondary The SEM produced a vast number of results compared. prevention procedures including vaccination to the TTI It was therefore decided to narrow down the. screening methods and control of risk behavior search for SEM studies to include only screening and. Comparison May not be applicable in this study vaccination while for TTI all studies were searched for. but will include people who do not practice primary due to the low number of results produced Therefore. and secondary prevention measures the search terms for the SEM studies were Social. Study Model Include Social Ecological Model and Ecological Model AND Screening Social Ecological. Theory of Triadic Influence Model AND Vaccination Social Ecological Model AND. Nyambe et al BMC Public Health 2016 16 1166 Page 4 of 15. Vaccine Social Ecological Model AND Immunisation i General Study Details For information on aims. Social Ecological Model AND immunization The Boolean research questions hypothesis study setting units of. search term was the word AND For TTI studies the observation level of analysis target disease and. search term was Theory of Triadic Influence The full category of treatment investigated. search strategies for each database are summarized in ii Evaluation Design Focused on indicating the type. Table 1 below of study design independent variables and the. extent of use of the study model whether it is,completely used or modified in some way. Data collection and analysis iii Data Sources 1 Facilitators This was filled in only. Prior to commencing the review a Data Extraction Form for studies that used facilitators to assist in obtaining. was developed to assist with data extraction The form data from participants If more than one type of. was divided into two sections Only studies that had facilitator was used then this part was repeated to. adequate inclusion criteria were fully evaluated by the cover all facilitators It included information on. Data Extraction Form All studies had to have the first source sample size sampling design and. section completed and it had two parts recruitment method. iv Data Sources 2 Actual Participants This was, i General Information This included date of data information on actual participants of the study such. extraction general publication information such as as the target population sample size basic. the title of the publication the type of publication demographic characteristics sampling strategy data. and source of the publication collection methods and finally main outcome. ii Inclusion Exclusion Criteria These were questions measures that were assessed This part was also. based on the criteria for including studies such as repeated if more than one type of study participant. indicating the study model that is used whether SEM was assessed in the study. or TTI type of participants and setting whether it v Analysis and Evaluation This part focused on. was a primary or secondary prevention study the indicating the analysis plan be it for qualitative or. presence of conclusions and finally the decision to quantitative study plans If bias was noticed in the. include the study or not If the study was not induced study it was indicated here. then the reason for exclusion would be stated vi Results and Evaluation This part illustrated the. positive and negative outcome measures assessed the. If the article fulfilled the inclusion criteria then it will overview of the effectiveness of the SEM TTI and. further be analyzed under the Characteristics of Included whether effect size and power calculation was. Studies section This section was divided into seven parts considered in the study. Table 1 Search terms and data bases searched,Databases searched Limitations Search terms. Medline Date Published 2000 01 01 2015 12 31a Social Ecological Model ANDb Screening. Language English Social Ecological Model ANDb Vaccination. Document type Academic Journals Social Ecological Model ANDb Vaccine. Social Ecological Model ANDb Immunisation, Ovid Date Published 2000 01 01 2015 12 31a Social Ecological Model ANDb Immunization. Language English,Theory of Triadic Influence,Participants Human. Proquest Date Published 2000 01 01 2015 12 31a,Language English. Document type Scholarly Journals,PubMed Date Published 2000 01 01 2015 12 31. Language English,Participants Human, University of Antwerp Discovery Service Date Published 2000 01 01 2015 12 31. Language English,Document type Academic Journals, Web of Science Date Published 2000 01 01 2015 12 31a. Language English,Document type Article, The range selected was between 2000 to present however the database adjusts the dates when articles are available. AND was the Boolean search term, Nyambe et al BMC Public Health 2016 16 1166 Page 5 of 15. vii Other Information Was a section to indicate inclusion and exclusion criteria Articles that could not. whether ethical approval was obtained if funding be easily obtained were evaluated based on abstract and. was available and whether references to other title After strict evaluation of the articles 40 SEM stud. studies were given A final question was to state ies and 46 TTI studies were included A summary of. whether further correspondence was necessary these results are found below as study flow Figs 1 and 2. There were five main reasons for studies not to be in. The form was pilot tested by two researches independ cluded in review These reasons include not applying the. ently JW AN to assess reliability and the final task SEM or the TTI in the research having non human par. of extracting the data was conducted by an independent ticipants addressing an irrelevant disease or condition. researcher AN It was felt that having all this sections for SEM studies specifically not addressing screening or. and parts was important to have a complete overview of vaccination and finally having irrelevant outcomes Most. the articles to be reviewed which were diverse in struc studies that were eliminated had a combination of these. ture and content An additional file has a copy of the reasons Studies that were eliminated for only a single. complete Data Extraction Form see Additional file 3 reason were for either not applying the models in the. In addition to systematically reviewing the articles for research or not having human participants. content matter all articles passing the inclusion criteria There were a total of 251 possible SEM studies ex. were also screened for methodological consistency This cluded Majority were excluded for not being a study that. quality assessment addressed 7 issues vital for determin addresses screening or vaccination n 173 this is. ing the empirical basis of the conclusions advanced in followed by studies were found but did not apply the SEM. each article see e g 10 including the clarity of the re in the research n 153 As for the possible articles in. search question s data collection methods sampling volving the TTI a total of 85 studies were excluded Main. plan sample size analysis method s conclusions and reason being that the study did not apply the TTI in the. limitations Studies were not excluded from the review research n 82 and this is followed by assessing an. based on their quality rating Quality assessment criteria irrelevant disease or condition in the study n 50. can be found in Table 2 Another six studies SEM n 5 TTI n 1 were not. The results of data extraction were input into a MS included in the review because of inaccessibility of the. Excel computer program Basic descriptive statistics was publication and are therefore still awaiting classification. utilized to summarize the general characteristics of the The brief information provided by the titles and or. studies This was facilitated with the use of IBM SPSS abstracts of these articles makes exclusion inconclusive. software The main results review were identified and Efforts have been made to access the full text from the. tabulated authors of these articles However there has not been. any response up to the date of submission of this sys. Results tematic review An additional file lists these studies in. Description of studies Table S1 see Additional file 4. Separate literature searches were conducted for the SEM The Data Extraction Form used closed questions that. studies and TTI studies The literature searches yielded focused on items that would be of interest to the review. 57 potentially relevant articles in Medline 172 titles in Table 3 below summarizes the top three most common. Ovid 21 titles in Proquest 56 titles in PubMed 75 titles items from the result fields in the articles based on fre. in University of Antwerp Discovery Service and 58 titles quency The frequency of the results below the top three. in Web of Science for SEM studies A total of 439 items is relatively low The Data Extraction Form. articles and without duplicates 290 potentially relevant allowed for an option of other for items that did not. articles were found fall under the predetermined items of interest This table. As for the TTI studies literature searches yielded 18 ti excludes the result other even if it had been in high. tles in Medline 54 titles in Ovid 23 titles in Proquest 22 frequency because it is composed of a combination of. titles in PubMed 65 titles in University of Antwerp Dis random items An additional file shows the complete. covery Service and 46 titles in Web of Science In a brief compilation of results in Tables S2 and S3 see. systematic review on the TTI it was discovered that a Additional file 4. study was conducted on colorectal cancer screening As seen from the table most studies for both SEM and. using this theory Therefore Google Scholar was used TTI were undertaken in the USA However it should be. specifically to find this study because of its relevance noted that some studies took place in multiple countries. for this research A total of 229 articles and without SEM n 4 TTI n 3 When it came to study partici. duplicates 131 potentially relevant articles were found pants some studies assessed more than one type of. Based on the number of potentially relevant articles it participant For this review sampling strategy data col. was decided to find and evaluate all articles with the lection method and outcome measures for each unique. Nyambe et al BMC Public Health 2016 16 1166 Page 6 of 15. Table 2 Data extraction form for quality assessment. Indicator Categorization Criteria, 1 Clarity of CRQ s hypothesis 0 Missing At best only sub questions specified. 1 Unclear CRQs supplied inappropriately e g only in abstract. or incomprehensively e g as identification of a research gap. 2 Clarity of data collection methods 0 Missing None specified. 1 Unclear Incompletely specified e g type of interview observation application. 3 Clarity of sampling plan 0 Missing None specified. 1 Unclear Missing for at least one reported data collection method. 4 Clarity of sampling size 0 Missing None specified. 1 Unclear Imprecise e g more than or missing for at least one reported. data collection method, 5 Clarity of analysis method 0 Missing None specified. 1 Present At least some description of data handling after collection e g. mention of transcription CAQDA grounded theory content analysis. regression analysis etc, 6 Clarity of conclusions 0 Missing None specified or none with a relationship to research questions. 1 Present At least one conclusion has a however weak link with one of the. research questions,7 Clarity of limitations 0 Missing None specified. 1 Unclear Possible instrument effects and or fallacies are mentioned but. without further discussion, 2 Clear research limitations are appropriately identified. participant group were considered However some this The outcomes were divided into positive and negative. information especially from the additional study partici predictors Positive predictors were factors that would. pants in both SEM and TTI studies was not as empha cause someone to go for screening vaccination or to. sized as the primary participant data resulting into some practice non risk behavior Negative predictors were the. cases of missing or not reported data In articles using opposite of these These factors were variable depending. the SEM nine studies had more than one type of partici on the focus or nature of the study. pant group The reported sample sizes ranged from 1 Finally not all accepted studies using the SEM and the. 70 121 In TTI studies a total of ten studies had more TTI reported on the overall effectiveness of these models. than one type of participant group Reported sample size For studies that used the SEM 17 studies 42 5 reported. ranged from 10 36 000 on effectiveness of the model and they all considered the. Considering disease or condition under study the Data model to be efficient From the studies that gave an over. Extraction Form focused on different types of cancers view of the effectiveness of the TTI ten studies reported. cancer in general substance abuse and then grouped all the TTI to be effective 21 7 while seven reported it to. other diseases and conditions under the option other be effective if modified 15 2. This was because cancer in particular cervical cancer is a. disease of interest for future study and for the TTI sub Quality Assessment. stance abuse is the most common condition researched The studies were not checked for risk of bias in meas. In that regard for the SEM cancer in general was studied urement because there was insufficient detail provided. in 4 studies 7 7 and this included studies that assessed in all of the papers Therefore quality assessment was. both breast and cervical cancer 22 studies 42 3 conducted in accordance to the data extraction form for. focused on other diseases or conditions such as diabetes quality assessment which allows for maximum amount. HIV AIDS and Obesity As for TTI studies 21 studies of twelve points see Table 2 for the scoring system. 33 3 focused on other diseases or conditions such as Table 4 below summarizes the overall quality of the. obesity risk behavior and HIV AIDS SEM and TTI studies In general the mean overall result. Nyambe et al BMC Public Health 2016 16 1166 Page 7 of 15. 439 records identified,through database searching,18 records excluded based on abstract for. not using the SEM n 2,not having human participants n 1. irrelevant disease condition under,290 records screened. after duplicates removed,no mention of screening and or. vaccination in the intervention n 16,having irrelevant outcomes not of. interest to this review n 7,5 inaccessible missing. records excluded,3 based on abstract,2 based on title. 227 full text studies excluded for,not using the SEM n 151. not having human participants n 30,irrelevant disease condition under. study n 56,267 full text studies,no mention of screening and or. assessed for eligibility vaccination in the intervention n 157. having irrelevant outcomes not of,interest to this review n 113. other i e publication type main text,summary animal vaccine n 6. 40 relevant,studies identified, Fig 1 Prisma study flow diagram of search results for SEM Note Some studies were excluded for more than one reason For studies excluded. based on abstract 9 studies were excluded for 1 reason 6 studies excluded for 2 reasons 2 studies excluded for 3 reasons and 1 study excluded. for 4 reasons For studies excluded based on full text 71 studies were excluded for 1 reason 73 studies excluded for 2 reasons 48 studies excluded for. 3 reasons 22 studies excluded for 4 reasons and 13 studies excluded for 5 reasons. for studies using the SEM is 7 4 and for TTI studies 9 3 should also be noted that some studies modified the. It is apparent that studies utilizing the TTI were of model by addressing only specific independent variables. slightly better quality compared to studies using the or integrating other models that were of interest to the. SEM This may be due to the fact that more of the researchers Furthermore the studies either involved a. articles using the SEM were secondary simple overview single or several types of study participants Whereas. articles and therefore did not elaborate much on meth the researchers would either observe a single group and. odology and study design compared to articles using the investigate their views in regards to the different con. TTI For both SEM and TTI the majority of missing structs of the model or they would observe the inter. data is in the reporting of the sampling plan analysis action between groups of participants. method and limitations On the other hand all studies re In regards to study aims most SEM studies looked at. ported conclusions to their research These conclusions evaluating interventions followed by accessing the ac. are trusted to give a comparison of the SEM and TTI but ceptance or non acceptance of a preventive measure for. it should be noted that the empirical basis on which au instance In terms of outcomes positive experiences lead. thors based their conclusions remains unclear in most to positive outcomes while negative experiences lead to. studies An additional file shows Tables S4 and S5 which negative outcomes as expected. have a complete view of quality assessment of studies In practice the SEM is advocated to be an effective. using the SEM and TTI respectively see Additional file 4 model in determining vaccination and screening behavior. Perhaps this is due to the flexibility of the SEM in regards. Discussion to individual variables within the levels For instance a. Characteristics of SEM study by Maar Wakewich Wood et al 11 applied the. The SEM has been applied in a number of prevention SEM to increase screening participation and concluded. method studies focusing on breast colorectal and that cervical screening promotion needs to be imple. cervical cancers The majority of the studies utilized the mented at multiple culturally compatible levels In regards. SEM developed by McLeroy et al 2008 However it to vaccination a study by Kumar Quinn Kim et al 12. Nyambe et al BMC Public Health 2016 16 1166 Page 8 of 15. 228 records 1 record identified,identified through through other source. database searching i e Google scholar,9 records excluded based on abstract for. not using the TTI n 9,not having human participants n 0. irrelevant disease condition under,131 records screened. after duplicates removed,no mention of screening and or. vaccination in the intervention n 0,having irrelevant outcomes not of. interest to this review n 5,1 inaccessible missing. record excluded based,on abstract,75 full text studies excluded for. not using the TTI n 73,not having human participants n 6. 120 full text studies,irrelevant disease condition under. assessed for eligibility study n 43,having irrelevant outcomes not of. interest to this review n 37,other i e not in English n 1. 46 relevant,studies identified, Fig 2 Prisma study flow diagram of search results for TTI Note Some studies were excluded for more than one reason For studies excluded. based on abstract 1 study was excluded for 1 reason 4 studies excluded for 2 reasons and 4 studies excluded for 3 reasons For studies. excluded based on full text 30 studies were excluded for 1 reason 11 studies excluded for 2 reasons 28 studies excluded for 3 reasons and 6. studies excluded for 4 reasons, validated all levels of the SEM as determinants of vaccine For instance a study may primarily focus on adolescents. uptake Furthermore according to another study the SEM and then might also question parents to identify if ado. was said to provide a useful schematic to assess how lescents with parents who practice a certain behavior. systems facilitate or create barriers to vaccinate how indi will emulate them In terms of outcomes as with the. vidual level factors and community discourse beliefs and SEM positive experiences lead to positive outcomes and. practices shape a person s perceptions and decisions to vice versa which is expected. vaccinate 13 In practice the TTI is advocated to effectively pre. dict substance abuse and risk behavior However the. Characteristics of TTI TTI might prove to be too complex for screening or. Studies that used the TTI mainly focused on substance vaccination decision studies As evident in the study. abuse and risk behavior This is not a surprise as the genesis by Kremers Mesters Pladdet et al 14 that applied. of the TTI occurred after a careful review of the substance the TTI to determine colorectal cancer screening par. use literature 7 It should be noted that all studies used ticipation and non participation decisions The model. the TTI as developed by Flay et al however some authors proved to be useful in explaining screening participa. modified the model to only assess variables of interest tion behavior but it was recommended to redefine the. In regards to study aims the TTI generally aims to operationalization of some variables to improve reliability. determine the cause of behavior In this case what Nevertheless the only other study that focused on screen. would cause someone to practice a preventive meas ing for a HIV AIDS intervention 15 did not specify the ef. ure Most studies were cross sectional in nature fectiveness of the TTI None of the studies found by this. However it was expressed that a longitudinal study systematic review focused on vaccination. may be more effective because a follow up determin Other studies that specified that the TTI is better. ing whether the population of interest will practice modified found it was too complex for guidance in. the risk behavior is beneficial the field 16 complexity in analysis of the relation. Studies either involved a single or several types of ship between cultural and social context 17 cul. study participants in relation to constructs of the model tural stream factors were of less significance and the. Nyambe et al BMC Public Health 2016 16 1166 Page 9 of 15. Table 3 Summary of most common results, Field Topic Item s Articles using SEM Articles using TTI. Frequency Percent Frequency Percent,Location USA 25 62 5 17 37 0. Canada 2 5 0 1 2 2,India 2 5 0 0 0,Netherlands 0 0 7 15 2. Australia 1 2 5 3 6 5,Study participants Women 14 26 9 1 1 6. Books journal articles 10 19 2 4 6 3,Men 7 13 5 0 0. Students 0 0 22 34 9,Parents guardians 1 1 9 9 14 3. Adolescents 0 0 8 12 7, Aim Objective To form or evaluate interventions 12 30 0 14 30 4. Determine the acceptance or non acceptance 11 27 5 1 2 2. of screening vaccination or treatment,Determine the cause of behavior 7 17 5 19 41 3. Explore views 3 7 5 2 4 3,Disease Condition Breast cancer 6 15 0 0. Colorectal cancer 4 10 1 2 2,Cervical cancer 3 7 5 0 0. Substance abuse 0 0 23 50 0,Skin cancer 0 0 1 2 2,Intervention Screening 29 72 5 2 4 3. Vaccination 9 22 5 0 0,Substance Abuse Risk Behavior 5 12 5 20 43 5. Study design primary Cross sectional 5 12 5 16 34 8. Case study 4 10 0 1 2 2,Cohort 2 5 0 4 8 7,Longitudinal 0 0 0 9 19 6. Randomized controlled trial 0 0 0 5 10 9, Study design secondary Simple overviews 12 30 0 4 8 7. Systematic reviews 3 7 5 2 4 3,Guideline 1 2 5 3 6 5. Sampling strategy Judgmental 14 26 9 17 27 0,Convenience 11 21 2 20 31 7. Simple random 4 7 7 9 14 3,Stratified 4 7 7 3 4 8,Snowball 1 1 9 8 12 7. Not reported 11 21 2 19 30 2, Data collection method Secondary data 15 28 8 12 19 0. Interviews 14 26 9 9 14 3,Questionnaires 13 25 0 41 65 1. Not reported 1 1 9 1 1 6, Outcome variables Screening was practiced 19 36 5 2 3 2. Nyambe et al BMC Public Health 2016 16 1166 Page 10 of 15. Table 3 Summary of most common results Continued,Screening is not practiced 3 5 8 0 0. Vaccination is practiced 8 15 4 0 0,Vaccination not practiced 5 9 6 0 0. Risk behavior is practiced 1 1 9 40 63 5,Risk behavior is not practiced 2 3 8 19 30 6. Not reported 8 15 4 6 9 5, Positive predictors Positive influences and surroundings 18 45 0 21 45 7. Having knowledge or awareness 18 45 0 5 10 9, Recommendations from healthcare providers 13 32 5 1 2 2. Access to healthcare providers or facilities 13 32 5 3 6 5. Personal beliefs 6 15 0 13 28 3,enforcing policies rules 9 22 5 6 13 0. Not reported 10 25 0 13 28 3, Negative predictors Negative personal beliefs 15 37 5 17 37 0. Negative influences and surroundings 13 32 5 28 60 9. Lack of access to healthcare providers or facilities 11 27 5 2 4 3. Culture of the group of people 4 10 0 7 15 2,Not reported 15 37 5 11 23 9. For these items the percentage is calculated over 52 for the SEM and over 63 for the TTI due to multiple study participants The percentage in general is. calculated over the total number of accepted studies which are 40 for the SEM and 46 for the TTI. levels of influence were not hierarchical 18 and necessarily the norm and healthcare providers may be. further studies stated the lack of data to properly positioned at a different level of interaction. operationalize the model thus reducing its effective The main difference consists of the division of the TTI. ness 19 20 into levels of causation ultimate distal and proximal. which are not considered within the levels of the SEM. Similarities and Differences of SEM and TTI The TTI separates levels of causation from ecological. The SEM and TTI are valuable theoretical frameworks domains by making them independent dimensions. that are relevant for several types of health behaviors within each ecological domain This finding is consistent. Generally these frameworks share similar theoretical con to the description by Flay et al 7 who also stated that. cepts In terms of composition the streams of influence of the TTI overcomes problems of terminology and under. the TTI correspond with the levels of the SEM Whereas standing by incorporating levels of causation The im. the TTI intrapersonal stream would be equated to the portance of dividing behavior into levels of influence is. SEM intrapersonal level the TTI social situation stream probably dependent on the interest of the researcher. to the SEM interpersonal level and finally the TTI cultural Based on an initial study on TTI by its developers. environmental stream to a combination of the SEM Petraitis et al 21 the authors felt that some readers. organizational community and policy levels might disagree with the location of some variables. Basically these theoretical frameworks differ in struc within the levels of causation To resolve the issue the. ture of the model and how the variables interact with authors specified that the location of specific variables. each other The TTI being a matrix while the SEM hav only affected the order in which findings were discussed. ing a ring or level by level structure In spite of most of and had no effect on conclusions drawn i e the relation. the articles for both SEM and TTI being from the USA ship between peer drug use and illicit substance use is. the basic function of these models has been expressed the same whether peer drug use is considered an imme. However depending on the society the model is being diate or a distal influence. used in some of the concepts and interactions may need In summary the literature in this review provided in. to be modified to fit with the local situation For formation that compares and contrasts the SEM and. instance while it is common to have family doctors in TTI However the quality of the studies used in this. the USA which places healthcare providers in a more review is compromised due to the lack of some infor. interpersonal level in third world countries this is not mation in the articles assessed The data that is not. Nyambe et al BMC Public Health 2016 16 1166 Page 11 of 15. Table 4 Summary results of the data extraction form for quality assessment. Indicator Categorization Articles using SEM Articles using TTI. Frequency Percenta Frequency Percenta, 1 Clarity of CRQ s hypothesis 0 Missing 10 25 0 6 13 0. 1 Unclear 19 47 5 18 39 1,2 Clear 11 27 5 22 47 8, 2 Clarity of data collection methods 0 Missing 10 25 0 5 10 9. 1 Unclear 3 7 5 1 2 2,2 Clear 27 67 5 40 87 0, 3 Clarity of sampling plan 0 Missing 17 42 5 17 37 0. 1 Unclear 4 10 0 2 4 3,2 Clear 19 47 5 27 58 7, 4 Clarity of sampling size 0 Missing 13 32 5 7 15 2. 1 Unclear 3 7 5 8 17 4,2 Clear 24 60 0 31 67 4, 5 Clarity of analysis method 0 Missing 17 42 5 8 17 4. 1 Present 23 57 5 38 82 6,6 Clarity of conclusions 0 Missing 0 0 0 0. 1 Present 40 100 0 46 100 0,7 Clarity of limitations 0 Missing 16 40 0 8 17 4. 1 Unclear 6 15 0 2 4 3,2 Clear 18 45 0 36 78 3, The percentage is calculated over the total number of accepted studies which are 40 for the SEM and 46 for the TTI. reported may be attributed to some of the studies fol Conclusions. lowing a secondary study design which does not elabor This review presented information on two multi level. ate much on methodology In addition some studies prevention models the SEM and TTI regarding screen. involved the secondary analysis of primary data from ing and vaccination The findings obtained in this review. another study or database and therefore did not effect pointed to some general conclusions about the extent. ively elaborate on how the primary data was obtained that screening and vaccination as determined by the. Finally a more precise assessment of the extent that SEM and TTI are different In general the theoretical. screening and vaccination differ was not a factor that constructs concepts and composition of the models are. could clearly be assessed by the available articles due to similar and the main difference is in structure and vari. the lack of relevant studies covering those topics of able interaction Additionally the TTI is more specific to. interest its application compared to the SEM which tends to be. more flexible, Limitations This review has identified key considerations for po. A number of potential limitations may have affected the tentially successful prevention programs Since the SEM. validity of our results Mostly in terms of possible publi and TTI are similar in composition the following points. cation and selection biases as a result of having more can be considered when selecting a model. strict inclusion criteria for one group of studies com. pared to the other Despite the efforts to identify all 1 Information If you think it is essential to divide the. relevant studies it is possible that some may have been information you obtain into levels of causation then the. missed Furthermore because studies considered for in TTI is best The SEM does not consider levels of. clusion were English language only further data might causation Consider depth of the information you want. have been excluded 2 Target group The SEM differentiates the levels of. In spite of these limitations the main strength of society compared to the TTI that combines the. this study is that it assessed two multi level models higher levels of society into one group Consider. that researchers rarely have a chance to apply in re who you want information from. search This paper has outlined how these models 3 Availability of information In general studies that. have been implemented lacked adequate information failed to conceptualize. Nyambe et al BMC Public Health 2016 16 1166 Page 12 of 15. the TTI Consider how much information is have made substantial contributions to interpreting the data revising the. available to you and ease of obtaining the data manuscript and have given approval of the final version to be submitted. 4 Resources If you have adequate resources and time to. Competing interests, conduct a longitudinal study then the TTI would be a The authors declare that they have no competing interests. good option for research Longitudinal studies have. been proven to be more effective for research applying Consent for publication. the TTI compared to cross sectional studies Consider Not Applicable. the resources and time you have for the research,Ethics approval and consent to participate. Ethical approval and consent to participate was not required for this study. Finally when it comes to effectiveness the SEM appears. to be effective for screening and vaccination studies Author details. Perhaps this is due to the fact that it has been applied Faculty of Medicine and Health Sciences University of Antwerp Antwerp. Belgium 2Department of Epidemiology and Social Medicine University of. more in prevention method studies compared to the TTI Antwerp Antwerp Belgium 3Biometris Wageningen University Wageningen. Notwithstanding that many authors claim that the model The Netherlands 4StatUA Core Facility for Statistical Analysis University of. they applied either SEM of TTI was effective the empir Antwerp Antwerp Belgium. ical basis of such conclusions is inadequately explained in Received 19 October 2015 Accepted 1 November 2016. the articles we studied In many studies information. about data collection sampling and data analysis were at. best incomplete and often even lacking These findings References. 1 National Public Health Partnership NPHP The language of prevention. highlight the emerging nature of this research area and Melbourne NPHP 2006 http www health vic gov au archive archive2014. the need for more research to be conducted nphp publications language of prevention pdf Accessed 4 Sept 2015. 2 Wilson JMG Jungner G Principles and Practice of Screening for Disease. Public Health Papers No 34 Geneva World Health Organization 1968. Additional files http apps who int iris bitstream 10665 37650 17 WHO PHP 34 pdf. Accessed 4 Sept 2015, Additional file 1 Figure S1 Social Ecological Model Description of 3 Elder JP Lytle L Sallis JF Young DR Steckler A Simons Morton D et al A. data An illustration of the Social Ecological Model 22 DOCX 123 kb description of the social ecological framework used in the trial of activity for. adolescent girls TAAG Health Educ Res 2007 22 2 155 65. Additional file 2 Figure S2 Theory of Triadic Influence Description of 4 National Cancer Institute NCI Theory at a Glance A guide for health. data An illustration of the Theory of Triadic Influence 7 DOCX 358 kb promotion and practice 2nd ed 2005 NIH Publication No 05 3896. Additional file 3 Data Extraction Form Description of data The Data 5 McLeroy KR Bibeau D Steckler A Glanz K Ecological Perspective on Health. Extraction Form used for this systematic review DOCX 71 2 kb Promotion Programs Health Educ Q 1998 15 4 351 77. Additional file 4 Table S1 Studies awaiting classification which not 6 Glanz K Rimer BK Viswanath K editors Health Behavior and Health. included in this review because on inaccessibility Table S2 Characteristics Education Theory Research and Practice 4th ed San Francisco CA. of included SEM studies Table S3 Characteristics of included TTI studies Jossey Bass 2008. Table S4 Quality assessment of studies using the SEM Table S5 Quality 7 Flay BR Snyder F Petraitis J Chapter 16 The Theory of Triadic Influence In. assessment of studies using the TTI Description of the data Tables with DiClemente RJ Kegler MC Crosby RA editors Emerging Theories in Health. study results 23 104 DOCX 132 kb Promotion Practice and Research 2nd ed New York Jossey Bass 2009 p. 8 Crosby RA DiClemente RJ Salaza LF Health Behavior Theory for Public. Abbreviations Health Principles foundations and applications Chapter 11 Ecological. CAQDA Computer Assisted Aided Qualitative Data Analysis Software Approaches in the New Public Health Jones and Bartlett Learning LLC. CRQ Central Research Question DEF Data Extraction Form NA Not 2011 p 231 51. applicable NR Not reported PSA Prostate Specific Antigen SEM Social 9 Higgins JPT Green S editors Cochrane Handbook for Systematic Reviews of. Ecological Model SES Social Economic Status TTI Theory of Triadic Interventions Version 5 1 0 The Cochrane Collaboration 2011 www. Influence USA United States of America handbook cochrane org Accessed 15 Jun 2015. 10 Kampen JK Tam s P Should I take this seriously A simple checklist for calling. Acknowledgements bullshit on policy supporting research Qual Quant 2014 48 3 1213 23. The authors would like to thank Janelle van Wel University of Antwerp for 11 Maar M Wakewich P Wood B Severini A Little J Burchell AN et al. her assistance in conducting the pilot test of the Data Extraction Form Strategies for increasing cervical cancer screening amongst first nations. communities in Northwest Ontario Canada Health Care Women Int 2014. 1 18 http doi org 10 1080 07399332 2014 959168, 12 Kumar S Quinn SC Kim KH Musa D Hilyard KM Freimuth VS The Social. This research received no specific grant from any funding agency in the. Ecological Model as a Framework for Determinants of 2009 H1N1 Influenza. public commercial or not for profit sectors, Vaccine Uptake in the United States Health Educ Behav 2012 39 2 229 43. http doi org 10 1177 1090198111415105, Availability of data and material 13 Boerner F Keelan J Winton L Jardine C Driedger SM Understanding the. All data generated or analyzed during this study are included in this interplay of factors informing vaccination behavior in three Canadian. published article and its supplementary information files provinces Hum Vaccin Immunother 2013 9 7 1477 84 http doi org 10. 4161 hv 24427, Authors contributions 14 Kremers SP Mesters I Pladdet IE van den Borne B Stockbr gger RW. JK conceived the review All authors AN GVH and JK designed and are Participation in a sigmoidoscopic colorectal cancer screening program a. responsible for the reported research AN reviewed titles abstracts undertook pilot study Cancer Epidemiol Biomarkers Prev 2000 9 10 1127 30. data extraction conducted analysis and prepared the initial manuscript GVH 15 Leonard NR Banfield A Riedel M Ritchie AS Mildvan D Arredondo G et al. and JK coordinated and provided general advice on the review All authors Description of an efficacious behavioral peer driven intervention to reduce. 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related products. This study investigates the feasibility of small-scale palm oil processing in Nigeria, using Elele, Rivers State as case study. Information was elicited through interviews and physical observations. Manual processing and screw hand press methods were adopted for palm oil extraction from fresh fruit bunch. Data were analyzed using
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Methods and Tools for Effective Knowledge Life-Cycle-Management This book provides an understanding of what knowledge is and of why it is one of the most stra-tegic issues in future manufacturing competitive-ness, which will be based primarily on high-level technologies and innovative products. The collective experience that contributed to the
Only connect the pre-amplifier to a mains outlet having the same voltage as marked at the back of the unit. Always ensure that when disconnecting and reconnecting your audio equipment the mains supply is switched off. Position the mains lead and signal interconnects where they are not likely to be walked on or trapped by items placed on them.
European Innovation Partnership on Smart Cities and Communities - Strategic Implementation Plan Page 3 of 22 Executive Summary Cities are becoming more and more of a focal point for our economies and societies at large,
1.01. Purpose and Scope. The State of Florida, Department of Environmental Protection (hereinafter referred to as the "Department") is soliciting written replies from qualified vendors to provide Uniforms and Clothing Apparel to establish a fixed price Agency Term Contract of which the term is anticipated to begin