Health promotion

Health Promotion
Copyright ©2008 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Community Health Nursing, 5/e
Mary Jo Clark
11
CHAPTER

Mary Jo Clark
Evolution of Health Promotion
• Religious, political, and cultural sanctions
• Miasma control
• Contagion control
– Immunization, disinfection
• Preventive medicine
– Risk factor modification
• Primary health care movement
• Health Promotion – 1990s- present
– Development of capacity for informed health
decisions

Mary Jo Clark
Definition of Health Promotion
• a process of enabling people to increase
control over, and to improve, their health.
• It involves: -
– Public policy formation
– Development of environments that support
health
– Promotion of community action.

Mary Jo Clark
Key Elements of Health Promotion
• Regulation of health via legislation
• Sanitation
• Immunization
• Focus on risk modification
• Recognition of effects of social conditions
on health
• Preparation for informed decision making

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Health Education
• A health promotion strategy
– It is a mean to accomplish health promotion
• Provides clients with information and skills
– Informed decisions regarding health-related
behaviors

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Health Education (continued)
• Uses education and motivation to change
behaviors by influencing:
– Values
– Beliefs
– Attitudes

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Relationship Between Health
Education and Health Promotion
• Health education is one mean to
accomplish health promotion

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Models for Health Promotion
• Precaution Adoption Process model
• The Theory of Reasoned Action/Planned
Behavior
• The Health Belief model
• Pender’s Health Promotion model

Mary Jo Clark
Precaution Adoption Process Model
• Stages of health-related behavior
decisions
– Stage 1: Unaware of health-related issue
– Stage 2: Aware but unengaged
– Stage 3: Decision to act or not act
– Stage 4: Decision to not act

Mary Jo Clark
Precaution Adoption Process Model
(continued)
– Stage 5: Decision to act, but no action taken
– Stage 6: Act to engage
– Stage 7: Behavior becomes part of lifestyle
routine
(Weinstein and Sandman, 2002)

Mary Jo Clark
FIGURE 11-1 Stages of Adoption of Exercise Behavior.

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Theory of Reasoned Action/Planned
Behavior
• Attitudes reflect attitudes to expected
consequences
• Attitudes are a product of subjective
norms influenced by others
– Intention to act
– Attitudes of person
– Perceptions of others’ attitudes
– Value placed on others’ judgments
(Ajzen and Fishbein)

Mary Jo Clark
Health Belief Model
• Individual perceptions of susceptibility and
seriousness
• Modifying factors/variables
– Demographic
– Sociopsychological
– Structural
• Perceptions of benefits and barriers to
action
• Cues to action
(Becker and Rosenstock)

Mary Jo Clark
Individual Perceptions Modifying Factors Likelihood of Action
•Demographics
•Personality
•Knowledge
Perceived threat
Cues to Action
•Education
•Symptoms
•Media
•Perceived Susceptibility
•Perceived Severity
Perceived Benefits
minus
Perceived Barriers
Likelihood of
Behavior change

Mary Jo Clark
Pender’s Health Promotion Model
• Behavior is influenced by individual
characteristics
• Behavior-specific cognitions and emotions
result in a commitment to action
• Commitment to action results in actual
behavior
• Behavior may be modified by competing
demands and preferences
(Pender)

Mary Jo Clark
Pender’s Health Promotion Model
(Pender)

Mary Jo Clark
Strategies for Health Promotion
• Empowerment
– Environmental conditions affect health
promotion actions
• Social Marketing
– Enhance people’s motivation to act
• Health education
– Activities that seek to inform

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Social Marketing
• Apply commercial marketing technologies
• Designed to influence voluntary behavior
of target audiences
• Improve audiences’ or society’s personal
welfare

Mary Jo Clark
Empowerment
• Process of enabling communities to
acquire knowledge and skills
• Allow communities to make informed
decisions

Mary Jo Clark
Key Requisites of Empowerment
• Motivate community participation
• Peer and organizational norms that
support health promotion practice
• Community agency managers who are
empowerment-oriented
• Agency internal policies for empowerment
of community members

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Community Empowerment
• Active process engaging community
members in their own health education
and health promotion needs
• Empower individuals for their own
personal action
• Empower individuals to form small mutual
assistance groups

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Community Empowerment
• Empower groups to create community
organizations
• Empowering community organizations to
form partnerships
• Empower communities to take social and
political action to improve environmental
conditions that affect health

Mary Jo Clark
Fostering Health Promotion through
Empowerment
• Individuals and communities become
active participants in the health promotion
process when they:
– Act on information and create knowledge and
solutions from their own experiences
– Make informed decisions
– Recognize that structural and behavioral
changes are necessary to promote health and
well-being

Mary Jo Clark
Health Education Process
• Inform the individual on the nature and
cause of health/illness
• Inform the individual of risk associated
with lifestyle-related behavior
• Learning domains (Table 11.3 page 265)
– Cognitive
– Affective
– Psychomotor
– Perceptual

Mary Jo Clark
Purpose of Health Education
• Assist clients in making health-related
decision about:
– Self-care
– Use of health resources
– Societal health issues

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Goals of Health Education
• Client participation in health decision
making
• Increased potential to comply with health
recommendations
• Development of self-care skills
• Improved client and family coping
• Increased participation in continuing care
for specific conditions
• Adoption of healthier lifestyle

Mary Jo Clark
Health Education Process
• Assess health education needs
• Plan and implement health education
programs
• Prioritize learning needs
• Develop goals and objectives

Mary Jo Clark
Design and Implementation
• Needs assessment
– A planned process
– Identify the reported needs of an individual or
group
– Identify and select target audience
– Assess health education needs
– Assess learning environment

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Identify Audience Characteristics
• Biophysical
• Psychological
• Physical environmental
• Sociocultural
• Behavioral
• Health system factors

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Planning and Implementation
• Elements of planning process
– Prioritize learning needs
– Goals and objectives
– Content selection
– Teaching/learning strategies

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Language and Health Literacy
•Health literacy
– Ability to obtain, interpret, and understand
basic health information and services
– Ability to use such information and services to
enhance health

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Basic Principles
• Content based on written objectives
• Reader involvement is critical
• Easy to read and understand
• Materials look easy to read
• Visual features clarify and motivate reader

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Evaluating Internet Information
• Major issues
– Internet accuracy
– Information bias

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Evaluative Elements
• Owner of site and reputability
• Sources of financial support
• Purpose of site
• Sources of information provided

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Evaluative Elements (continued)
• Evidence provided
• Editorial oversight
• Currency of information

Mary Jo Clark
Evaluation of Health Promotion
Programs (Refer to Table 11-6)
• Diagnostic evaluation
– Accuracy of needs assessment
• Formative evaluation
– How the program is carried out
• Summative evaluation
– Program outcome and/or impact

Mary Jo Clark
Additional Elements for Evaluation
• Evaluations based on achieving criteria
related to
– Empowerment
– Participation
– Intersectoral collaboration
– Use of multiple strategies
– Sustainability

Health promotion

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