Socio-ecological Model (SEM)

- is a theory-based framework for understanding the multifaceted and interactive effects of

personal and environmental factors that determine behaviors, and for identifying behavioral and
organizational leverage points and intermediaries for health promotion within organizations

- provides a framework for understanding how individuals and their social environments mutually
affect each other across the lifespan; accounts for the complexity of individuals developing within
embedded systems

- Bronfenbrenner specified micro-, meso-, exo-, and macro- subsystems, which constitute the
settings and life space within which an individual develops (1979). The division of environmental
system are as follows:

o Microsystem: face-to-face influences in the specific settings; interaction within

immediate family members, social networks or work groups
o Mesosystem: interrelations among which individual is involved; school, peer groups or
church
o Exosystem: forces within the larger social system in which the individual is embedded;
unemployment rates affecting job stability
o Macrosystem: cultural beliefs and values that may affect the aforementioned systems

o In this model, each of the subsystems influences the individual and the other subsystems.
The reciprocal causation between the individual and environment is apparent.

o Moreover, Bronfenbrenner viewed the individual as moving through time and being
influenced by his or her developmental and life course experiences (ontogenic
development)

- McLeroy further defined the social ecological model for health promotion to depict interrelated
systems at the intrapersonal, interpersonal, organizational, community, and policy levels,
illustrated as concentric circles.

- Hierarchical levels of influence (McLeroy et al., 1988):

o Individual: Characteristics of an individual that influence behaviour change, including
knowledge, attitudes, behavior, self-efficacy, developmental history, gender, age, religious
identity, racial/ethnic identity, sexual orientation, economic status, financial resources,
values, goals, expectations, literacy, stigma, and others. How individuals behave and
increase their likelihood of becoming sick: psychological or personality disorders, alcohol
and/or substance abuse and a family history of diseases

o Interpersonal: Formal (and informal) social networks and social support systems that can
influence individual behaviors, including family, friends, peers, co-workers, religious
networks, customs or traditions. For example, having violent friends may influence
whether a young person engages in or becomes a victim of violence.
 o Community: Relationships among organizations, institutions, and informational networks
within defined boundaries, including the built environment (e.g., parks), village
associations, community leaders, businesses, and transportation.

o Organizational: Organizations or social institutions with rules and regulations for

operations that affect how, or how well, for example, MNCH services are provided to an
individual or group

o Policy or Enabling environment: Local, state, national and global laws and policies,
including policies regarding the allocation of resources for maternal, newborn, and child
health and access to healthcare services, restrictive policies (e.g., high fees or taxes for
health services), or lack of policies that require childhood immunizations.

Policy/Enabling
Environment (national,
state, local laws)

Organizational
(organizations and social
institutions
Community
(relationships between
organizations)

Interpersonal
(families, friends,
social networks)

Individual
(knowledge,
attitudes,
behaviors)

Figure 1. The SEM Model

Source: United Nations Children's Fund (UNICEF), What are the Social Ecological Model (SEM) and
Communication for Development (C4D). https://www.unicef.org/cbsc/files/Module_1_SEM-C4D.docx

- Implications:
o On health:
 This model provides a framework for understanding the factors that produce and
maintain health and health-related issues, allowing identification of promising
 points of intervention and understanding how social problems are produced and
sustained within and across the various subsystems.

 Project HEART (Health Education Awareness Research Team) used an ecological

model to design a health promotion and disease prevention program to address
cardiovascular disease risk factors. The project uses a community health worker
(CHW) promotora model to provide services (Balcazar et al., 2012)

 CDC's Colorectal Cancer Control Program (CRCCP) was designed to address

multiple factors of influence on colorectal cancer prevention, using ecological
model components

Figure 2. Adapted SEM for the health promotion of CRCCP’s multi-level approach to colorectal cancer
prevention

Source: Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Social
Ecological Model. https://www.cdc.gov/cancer/crccp/sem.htm
References:

McLeroy, K. R., Bibeau, D., Steckler, A., Glanz, K. (1988). An ecological perspective on health promotion
programs. Health Educ. Q. 15: 351–77 Among the first ecological models in health promotion; proposes
five levels of determinants: intrapersonal, interpersonal, institutional, community, and public policies.

Balcázar H, Wise S, Rosenthal EL, Ochoa C, Rodriguez J, Hastings D, et al. An ecological model using
promotores de salud to prevent cardiovascular disease on the US-Mexico border: the HEART Project. Prev
Chronic Dis 2012; 9:110100. DOI: http://dx.doi.org/10.5888/pcd9.110100External Web Site Icon.

Bronfenbrenner, U. (1979). The ecology of human development. Cambridge, MA: Harvard Univ. Press.

United Nations Children's Fund (UNICEF), What are the Social Ecological Model (SEM) and Communication
for Development (C4D). https://www.unicef.org/cbsc/files/Module_1_SEM-C4D.docx