Theories Related To Health Promotion

Health Promotion and Health Education

Health Promotion • helping people develop resources to maintain health and enhance their knowledge. • the process of enabling people to increase control over and to improve their health (Ottawa Charter)

Health Promotion • First Use of The Term Health Promotion Occurred in 1945 • “Health is promoted by providing a decent standard of living, good labor contains, education, physical culture, means of rest and recreation.” -Henry E. Sigeret

Four (4) Major Tasks of Medicine 1. 2. 3. 4.

The Promotion of Health The Prevention of Disease The Restoration of the Sick Rehabilitation

Health Promotion • 1986 – The who, health and welfare Canada and the Canadian Public Health Association organized an international convention on health promotion. • The result of the conference was the Ottawa Charter for Health Promotion.

Ottawa Charter for Health Promotion • guiding principle in health promotion • Health is a positive concept emphasizing social and personal resources as well as physical capacities. • Health promotion is not just the responsibility of health sector but goes beyond lifestyles to well-being.

Task of an Individual to Reach a State of Health: 1. Identify and realize aspiration 2. Satisfy needs 3. To change or cope with the environment.

Prerequisite for Health • fundamental conditions and resources for health • Improvement in health requires a secure foundation in the basic prerequisites.

Prerequisite for Health 1. 2. 3. 4. 5. 6. 7. 8. 9.

Peace Shelter Education Food Income A Stable Eco-System Sustainable Resources Social Justice Equity

Ottawa Charter Action Area • to operationalize the concept of health promotion

Ottawa Charter Action Area 1. Build Healthy Public Policy • Health promotion beyond health care • Health on agenda of p makers • Health promotion policy combines diverse but complementary approaches including: e. Legislation f. Fiscal measures g. Taxation h. Organizational charge • Coordinated actions that leads to healthy income and social policies that foster great equity • Identify obstacles to the adaptation of healthy public policy in non-health sectors and ways of removing them.

Ottawa Charter Action Area 2.

Create Supportive Environments • The extricable links between people and their environment constitutes the basis for a socio-ecological approach to health. • The overall guiding principle for all is the need to encourage reciprocal maintenance- to take care of each other, our communities and our national environment. • Conservation of natural resources should be emphasized as a global responsibility. • Health promotion generates living and working conditions that are safe stimulating satisfying and enjoyable. • Systematic assessment of health impact of rapidly changing environment is essential must be followed by actions to ensure positive benefits to public health. • The protection of the natural and built environment and conservation of natural resources must be addressed in any health promotion strategy.

Ottawa Charter Action Area 3.

Strengthen Community Action • Health promotion works through concrete and effective community action in setting priorities, making decisions, planning strategies and implementing them to achieve better health. • Empowerment of communities is the heart of this process. • Community development draws an existing human and material resources in the community to enhance self-help and social support and to develop flexible system for strengthening public participation in and direction of healthy ministers. • Requires full and continuous access to information, learning opportunities for health as well as finding support.

Ottawa Charter Action Area 4. Develop Personal Skills • Health promotion supports personal and social development through providing information, education for health and enhancing life skills. • Increase the options available to people to exercise more control over their own health and over their own environment and to make choices conducive to health. • Enabling people to learn throughout life, to prepare themselves for all of its stage and to cope with chronic illness and injuries is essential.

Ottawa Charter Action Area 5. Reorient Health Services • The responsibility for health promotion in health services is shared among individual community groups, health professionals health services, institutions and government. • The role of the health sector must move increasingly in health promotion direction, beyond its responsibility for providing clinical and curative services. • Health services need to embrace and expanded mandate which is sensitive and respects cultural needs. • Requires stronger attention to health research as well as changes in professional education and training.

WHO Principles of Health Promotion 1. Health Promotion involves the population as a whole in the context of their everyday life, rather than focusing on people risk from specific disease. 2. Health Promotion is directed towards action on determinants or cause of health. This requires a close of health. This requires a close cooperation between sectors beyond health care reflecting the diversity of conditions which influence health.

WHO Principles of Health Promotion 3. Health Promotion combines diverse but complementary approaches, including communication, education, legislation, fiscal development and spontaneous local activities against health hazards. 4. Health Promotion aims particularly at effective and concrete public participation. This requires the further development of problem-defining and decision-making life skills, both individually and collectively and promotion of effective participation mechanism.

WHO Principles of Health Promotion 5. Health Promotion is primarily a societal and political venture and not a medical services although health professionals have an important role in advocating and enabling health promotion.

• “ Mediating strategy between people and their environments, synthesizing personal choice and social responsibility in health” -WHO

HEALTH EDUCATION • Any combination of learning experience designed to facilitate voluntary adaptation of behavior conducive to health. (Green et.al. 1980) • The process of assisting individuals acting separately or collectively to make informed decisions about matters affecting the personal health and of others. ( National Task Force on the Preparation and Practice of Health Educators.)

Scope of Health Education Covers continuity of the levels of prevention. • All the programs thrusts of the health care delivery system have corresponding health education/promotion components. •

Labels for Health Education Programs and Activities: 1. 2. 3. 4. 5. 6.

Dissemination of health information Communication Social marketing Motivation programs Behavior modification Health counseling

Health Education Setting a. Formal b. Informal/Incedental

Location/ Places for Health Education: 1. 2. 3. 4. 5. 6. 7. 8. 9.

Health centers Clinics Hospitals Health maintenance organization School Communities Worksite Food establishments Entertainment establishments

THEORIES RELATED TO HEALTH PROMOTION

Theory – a plausible or scientifically acceptable general principle offered to explain observed facts. – A hypothesis assumed for the sake of argument or investigation.

Model – visual representation of the concept that work together to become a theory. – A pattern of something to be made

THEORIES RELATED TO HEALTH PROMOTION 1. Health Belief Models a. Rosenstock’s Health Belief Model b. Becker’s Health Belief Model

2. Health Locus of Control Model 3. PENDER’S Health Promotion Theory/Model 4. BADURA’S Self Efficacy Theory/Model

THEORIES RELATED TO HEALTH PROMOTION 5. Health Behavior Change Model (Transtheoritical Model of Behavior Change) 6. Theory of Planned Behavior 7. Theory of Social behavior 8. Protection Motivation Theory 9. O’Donnell Model of Health Behavior

Health Locus of Control Determines client action regarding health, and that health status is under one’s own health or others control. • Plays role in the clients choices about health behaviors, can be used to predict which people are at most likely to change their behavior. • The result of the assessment of the health locus of control of a client can be used to plan internal reinforcement training necessary to improve client’s effort towards better health. • •

Types of Locus of Control: 1. Internal – People who believes that they have a major influence on their health status. – Health is largely self- determined in this type of control – Clients initiates for own health care, knowledge and adhere to prescribe health care regimens.

2. External – People who believe that their health is largely controlled by outside forces.

Health Belief Model 1. Rosenstock’s Health Belief Model – Health Belief Model is intended to predict which individual would/wouldn’t use such preventive measures. – Assumed that good health is an objective common to all people. – Emphasize on predicting individual preventive health behavior – Based on an individual’s ideas about and appraisal or perceived benefits compared to perceived barriers and costs of taking a health action. – Suggest that a person’s susceptibility to a health threat and its seriousness influence the decision to engage in a preventive health behavior. – Helps to identify the strength and weakness of the individual that could affect the success of a plan of action for disease prevention.

Health Belief Model 2. Becker’s Health Belief Model – Based on motivational theory – Assumed that positive health motivation should be considered to attain good health. – Modifies the Health Belief Model of Rosenstock’s to include the following

Components: a. Individual Perception b. Modifying Factors c. Variables Likely to Affect Initiating Action/Likehood of Action

Pender’s Health Promotion Model • Is a competence or approach-oriented model that depicts the multideminsional nature of persons interacting with their interpersonal and physical environments as they pursue health. • Focused on health promoting behaviors rather than health protection or illness prevention behaviors.

Variables of Health Promotion Model 1. Individual characteristics and experience – an individuals unique factors or characteristics and experiences will depend on the target behavior for health promotion Includes the following: C. Personal factor – Biological – Psychological – Socio-cultural

D. Prior related behavior – Previous experience – Knowledge – Skills in health promoting actions

Variables of Health Promotion Model 2. Behavioral –specific cognitions and affect – Constitute critical core for intervention because this can be modified through nursing interventions. Includes the following: D. Perceived benefits of action – anticipated benefits or outcome affect the persons plan to participate in health-promoting behaviors and may facilitate continued practice (can be affected by experience/vicarious experience).

Variables of Health Promotion Model B. Perceived barriers to action – person’s perceptions about available time, inconvenience expense and difficulty performing the activity may act as a barrier (decrease commitment to a plan of action). C. Perceived self-efficacy – the conviction that the person can successfully carryout the behavior necessary to achieve a desired outcome (serious doubt about capabilities decrease effort and give-up) D. Activity related affect – the subjective feelings that occur before, during, and following an activity influence a person to repeat again or maintain behavior.

Variables of Health Promotion Model E. Interpersonal influence – perception of the person concerning the behavior, beliefs or attitudes of others. – Includes expectations of significant others, social support and learning through observing others.

Sources of interpersonal Influences: 3. Family 4. Peers 5. health professionals (sources of interpersonal influence can affect the person’s health –promoting behaviors)

Variables of Health Promotion Model F. Situational Influence – direct and indirect influence on health-promoting behaviors – A person is apt to perform health-related behaviors if the environment is comfortable versus feeling of alienation. Includes the following: 3. Perception of available options 4. Demand characteristic 5. Aesthetic features of the environment

Variables of Health Promotion Model 3. Commitment to a plan of action – The interest of a person in carrying-out and reinforce health-promoting behaviors Involves 2 process: A. Commitment – good intention B. Identifying specific strategy – Actual performance of the behavior

4. Immediate competing demands and preferences – situations that the person is experiencing in everyday life that could affect the control of health-promoting behaviors. Involves 2 types of control: A. Low control B. High control

Variables of Health Promotion Model 5. Behavioral outcome – Directed towards attaining positive health outcome for the client – Should result in improved health and better quality of life at all stages of development.

Bandura’s Self-Efficacy Theory • Self – efficacy theory of Albert Bandura • Self- efficacy – perception/belief of a person about his own capabilities to produce effect. • Self-regulation – exercise of influence over one’s own motivation, thought process emotional state and patterns of behavior.

Bandura’s Self-Efficacy Theory Sources of self-efficacy - Self efficacy is developed by four (4) main source of influence 4 main source of influence 1. Mastery of Experience/performance accomplishment 2. Vicarious Experience provided by social models 3. Social persuasion (Support/Motivation from significant others) 4. Reduction of stress reactions and alter negative emotional proclivities and interpretation of physical and emotional traits.

“Strong sense of efficacy enhances human accomplishment and personal well-being in many ways.”

Efficacy- Activated processes • There are 4 major psychological processes through which self-belief of efficacy affect human functioning.

4 Major Psychological Processes: 1. Cognitive Process – thinking process, involve acquisition, organization and use of information – Most course of actions are initially organized in thought.

4 Major Psychological Processes: 2. Motivational Process – cognitive generated -Activation to action Level of motivation: 5) Choice of course of action 6) Intensity 7) Persistence of effort

4 Major Psychological Processes: Motivation processes is covered by 3 types of Self-Influence: 2) Self-satisfying 3) Self- dissatisfying reactions to one’s performance 4) Perceived self efficacy 5) Readjustment of personal goal based on one’s progress

4 Major Psychological Processes: 3. Affective Process – process regulating emotional state and elicitation of emotional reactions. - The stronger the sense of self-efficacy the bolder people are in taking on taxing and threatening activities. 7. Selection Process – the choices the person make that cultivate different competencies, interest and social network that determines life courses.

“Self- Efficacy is concerned with people’s beliefs in their capabilities to exercise control over their own functioning and over events that affect their lives.”

Health Behavior Change Model (Transtheoritical Model of Behavior Change) – A cyclic phenomenon in which people progress through several stages. – This model can be used in the assessment of the person’s readiness to perform health-promoting behaviors through identifying the stages of behavior change.

Health Behavior Change Model (Transtheoritical Model of Behavior Change) 3 Elements of Health Behavior Change Model 2) Thought 3) Action 4) Time

Stages of Health Behavior Change: 1. Precontemplative stage – the person in this stage typically denies having a problem, views others having a problem and therefore wants others to change their behavior – Do not think about changing behavior, nor interested in information about the behavior. – May have previous experience of failures – Takes months to years in precontemplation

Stages of Health Behavior Change: 2. Contemplative stage- the person acknowledge having a problem, seriously consider changing behavior actively gathering information and verbalizes plan to change the behavior in the near future. – The person may not be ready to commit to action – Transition to the next stage of behavior change begins when the person is observed of doing the following: i. Focusing on the solution rather than the problem v. Think more about the future than the past –

Takes months to years in contemplation

Stages of Health Behavior Change: 3. Preparation stage – occurs when the person undertakes cognitive and behavioral activities that prepare the person for change – Making of final plans to accomplish the change – Starting to take small behavioral changes

Stages of Health Behavior Change: 4. Action stage – occurs when the person actively implements behavioral and cognitive strategies to interrupt previous behavioral patterns and adopt new ones. – Requires the greatest commitment of time and energy.

Stages of Health Behavior Change: 5. Maintenance stage – integration of newly adopted behavior patterns into lifestyle. – Last until person no longer experience temptation to return to previous unhealthy behavior. – Without strong commitment to maintenance a relapse to precontemplative or contemplative stage may occur.

Stages of Health Behavior Change: 6. Termination/ Continual maintenance stage the ultimate goal where the individual has complete confidence that the problem is no longer a temptation or threat.

Theory of Planned Behavior • control of behavior is not always voluntary and that a type of behavior control continuum exist with lack of control at one end and extending to total control at the other end. Components: 3) Resources 4) Support 5) Skills needed for certain behavior

Theory of Social Behavior • introduce the concept of habit in that it distinguishes behavior under the individual’s control from behavior that has become automatic or habit. • The likehood of health behavior action is further influenced by the connection between physical arousal (physiologic effects, the habit has on the body) and Facilitating conditions (supporting effects, favors the change).

Protection Motivation Theory • is a Fear-driven model, proposed that a perceived threat to health activates thought processes regarding the severity of the threatened event, the probability of its occurrence, and coping mechanisms. • Motivation to protect results from the perception of the threat and the ability or self-efficacy for coping • Oriented more towards disease prevention than health promotion.

Protection Motivation Theory Components: 2) Vulnerability 3) Severity 4) Response efficacy 5) Self-Efficacy

O’Donnell Health Behavior Model • shows how intentions toward a particular behavioral beliefs, health values, belief in those that prescribe or support referent ( desired behavior) and motivation to comply with the referents • A composite of theory of planned behavior, theory of social behavior , health belief and health promotion model