Section 3:Population health promotionhealth education process

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Section 3Population health promotion/health
education process

• N205 2009

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Health

• Health is not an end in itselfwe value good
  health because it allows us to do what we want
  with our lives.
• The above definition draws upon the First Nations
  concept of the medicine wheel, which emphasizes
  balance or harmony among the different dimensions
  of health.

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Socioeconomic inequity

• The healthiest societies are those in which there
  is a relatively small gap between the best-off
  and worst-off members. This, in turn, seems to
  reflect the importance of power and control as
  influences on health. People need control over
  their lives in order to reach their health
  potential.

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Health promotion

• The Ottawa Charter the process of enabling
  people to increase control over the determinants
  of health and thereby improve their health.
• Health promotion is carried out by and with
  people, not on or to people with the aim to make
  it possible for people to identify and address
  their own health concerns, with professionals
  helping as needed.
• This was the beginning of the conceptualization
  of empowerment as a component of health promotion.

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CHN Role in Health Promotion

• CHNs promote health in environmental, political,
  and social contexts
• CHNs use the community health nursing process to
• Assess
• Plan
• Intervene
• Evaluate their practice on micro and macro levels

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Community Health Nursing Process

• According to the Canadian Community Health
  Nursing Standards of Practice
• Community health nursing process refers to the
  processes on which CHNs base community health
  nursing decisions
• Comprehensive community assessment
• Planning
• Implementation
• Evaluation

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Evolution of health promotion in Canada

• 1974 Lalonde Report
• 1978 Alma-Ata Declaration
• 1984 WHO working group
• 1986 Ottawa Charter of Health
• 1986 Epp Report
• International conferences on health promotion
• 1994 Federal, Provincial, and Territorial
  Advisory Committee on Population Health
• 1996 Population Health Promotion Model

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Evolution

• Prior to the 1970s, much attention focused on
  health care as a main influence on health.
• The 1970s and 80s saw a growing awareness that
  the way people live--such as their eating and
  exercise habits, use of tobacco and other
  drugs--has a large impact on their health status,
  and that in most cases, health care contributes
  relatively little to their well-being.
• Now it is recognized that many other factors,
  beyond personal behaviours, have a powerful
  effect on health--the social environment,
  including socioeconomic status, social networks,
  and working conditions.
• The understanding of how to promote good health
  has grown from providing universal access to
  health care, to educating about the risks and
  benefits of personal behaviours, to addressing
  the entire range of factors that influence
  health.

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Other concepts in health promotion

• Injury prevention Using strategies to help
  populations and individuals prevent and reduce
  the risk of injury
• Disease prevention The activities taken by the
  health sector to prevent the occurrence of
  disease, to detect and stop disease development,
  and to reduce the negative effects once a disease
  is established (Nutbeam, 1998).
• Risk reduction A disease prevention strategy
  that is used to reduce or alter health concerns
  to prevent moving to a high-risk level

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Other concepts in health promotion

• Health enhancement A health promotion strategy
  that is used to increase health and resiliency to
  promote optimal health and well-being
• Harm reduction Includes strategies to decrease
  the adverse health consequences of actions Ex
• Resiliency The capacity of clients as
  individuals, families, groups, and communities to
  manage effectively when faced with considerable
  adversity or risk
• Risk factors Variables that create stress and
  challenge clients health status
• Protective factors Variables such as individual
  characteristics, family support systems, and
  environmental supports that help clients manage
  the stressors associated with being at risk

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Health Promotion Skills

• Many resources, including Internet resources, are
  available that provide how to information
• Skills that CHNs use in their health promotion
  practice
• Working in focus groups
• Preparing funding proposal applications
• Program planning
• Communication
• Working with others
• Integrating research and practice

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Health Promotion/Population Health

• Health promotion and population health fit
  together very well. A population health
  perspective helps us identify the full range of
  factors that determine health, and a health
  promotion perspective guides action on these
  factors to improve the populations health.
• The Population Health Promotion Model is a
  graphic representation of the above.

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Population Health Promotion Model (PHPM)

• Hamilton Bhatti (1996) Health promotion
  Development Division, Health Canada
• WHO With whom can we act? The levels within
  society where action can be taken.
• WHAT On what can we take action? (The
  determinants of health areas where action could
  improve health.)
• WHY Why take action to improve health? (Using
  the best available information to make decisions
  that are consistent with community needs, values
  and resources.)
• HOW How can we take action to improve health?
  Strategies for health promotion.

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PHPM Key Elements

• Focus on the health of populations
• Address the determinants of health and their
  interactions
• Base decisions on evidence
• Increase upstream investments
• Apply multiple strategies
• Collaborate across sectors and levels
• Employ mechanisms for public involvement
• Demonstrate accountability for health outcomes

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Population Health Promotion (PHP)

• population health has helped us understand the
  diverse influences that explain why some groups
  of people are healthier than other groups from
  income gaps to social support to living and
  working conditions.
• PHP is about creating the conditions that support
  the best possible health for everyone

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Population Health Promotion

• Population health promotion is about removing the
  barriers that make it harder for some people to
  be healthy. This requires not only paying special
  attention to the health concerns of those who are
  socioeconomically disadvantaged, but also
  striving to minimize the gap between rich and
  poor.

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Population Health Promotion

• Helping people gain control over their own lives,
  or empowerment, is a guiding principle. We need
  to create environments in which individuals and
  communities can take the power they need to
  transform their lives.
• Closely connected to empowerment, another
  principle of population health promotion is
  public participation. A major challenge is that
  certain groups of people are more likely to
  participate than others ensuring that everyones
  voice is heard requires special effort on the
  part of those facilitating the participation
  process. Simply providing opportunities to
  participate is not enough--people need to be
  supported with the tools, skills, and resources
  they require for meaningful participation.

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Population Health Promotion

• Because the determinants of health are so broad,
  population health promotion requires the
  involvement of a much wider range of agencies,
  organizations, departments and individuals than
  just those working directly in the health field.
• Another key principle of population health
  promotion is intersectoral collaboration, which
  refers to the formation of partnerships between
  different parts of society to improve health. It
  includes co-operative efforts among the public
  sector (that controlled by government), civil
  society (ordinary citizens), and the private
  sector (not directly controlled by government),
  as well as different parts of a sector.

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Equity

• Equity means fairness. Equity in health means
  that people's needs guide the distribution of
  opportunities for wellbeing.. Equity in health is
  not the same as equality in health status.
  Inequalities in health status between individuals
  and populations are inevitable consequences of
  genetic differences, of different social and
  economic conditions, or a result of personal
  lifestyle choice. Inequities occur as a
  consequence of differences in opportunity which
  result, for example in unequal access to health
  services, to such things as nutritious foods and
  adequate housing. In such cases, inequalities in
  health status arise as a consequence of
  inequities in opportunities in life.
• The aim of policy for equity and health is not
  to eliminate all health differences so that
  everyone has the same level and quality of
  health, but rather to reduce or eliminate those
  that result from factors which are considered to
  be both avoidable and unfair. Equity is therefore
  concerned with creating equal opportunities for
  health and bringing health differentials down to
  the lowest level.

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Assumptions and values PHP

• The most basic assumption underlying population
  health promotion is that the health of the
  population is a fundamental investment that
  creates healthier societies, both in economic and
  other terms.
• Some common values on which health promotion is
  based include respect for the worth and dignity
  of each individual,
• Pursuing social justice to reduce health
  inequities
• Caring for the environment, so that the health
  and prosperity of the present generation are not
  purchased at the expense of future generations.

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Health Promotion Strategies Strengthening
Community Action

• Community development Assisting the community in
  identifying issues and concerns in the community.
• Capacity building Recognizing and utilizing
  strengths (rather than deficits) such as
  available services, resources, and programs in
  order to resolve their health issues.
• Empowerment Assisting communities to state
  their health requirements and be involved in, and
  take charge of, the strategies required to
  achieve improved health.

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Building Healthy Public Policy

• Healthy public policy Ex

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Creating Supportive Environments

• Awareness of the determinants of health

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Developing Personal Health Skills

• Health education is a strategy for the
  development of personal health skills.

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Health Communication and Social Marketing

• Strategies used to deliver health promotion
  messages to various targeted populations.

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Advocacy

• Action taken to influence decision makers in
  communities and governments to support a policy
  or cause that is health promoting

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Health Education

• What is health education?
• Any combination of learning experiences that
  involves assimilating new information that
  promotes a change in behaviour.

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Health Education

• Is health education an entry level competency for
  RNs?
• What about CHN practice?

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Teaching learning

• In order to teach you need to understand
  learning.
• People approach a learning task in different
  ways, different preferences.
• Learning can be divided into three components or
  domains.
• Blooms taxonomy of learning (1964), cognitive,
  psychomotor, affective
• In health education the CHN needs to understand
  what domain's) of learning is/are involved

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Cognitive Domain

• Knowledge
• Comprehension
• Application
• Analysis
• Synthesis
• Evaluation

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Psychomotor Domain

• Learning involving skills
• The client(s) must be capable to do the skill
  Must have the sensory image of how it works,
  demonstrate ability to practice

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Affective Domain

• feelings
• Different levels listen, participate, value,
  finally they internalize or adopt

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Teaching learning principles

• Clients readiness to learn
• Clients perceptions
• environment
• Client participation
• Subject relevance
• Client satisfaction
• Client application

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Teaching Process/Nursing process

• Assessment, prioritizing
• diagnosis
• Establishing goals and objectives Planning
• Implementing/teaching
• Evaluation

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Health promotion assignment Clinical N205

• Lesson Plan

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The educational process

• Selecting channels and materials.
• What channels are best?
• Are their existing resources?
• What formats?

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Formats

• Brainstorming sessions
• Demonstration
• Group discussion
• Lecture
• One to one discussion
• Role playing
• Task force committee

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Materials and media

• Audiotapes
• Bulletin boards
• Displays/posters
• Flip charts
• Games
• Overhead slides
• Interactive videotapes
• Guest speakers
• Field trips Programmed material
• Teaching cards
• Radio/Newspapers
• Television
• Videotapes
• On-line resources

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Checklist for assessing Material

• Format layout Is the material organized
  clearly? Are heders used to cue the reader?
  Does the information appear easy to read or
  cluttered?
• Type Is the type or font a readable size?
• Verbal Content Is the information current,
  relevant and accurate? Are difficult terms
  explained? What is the reading level?
• Visual content Are the graphics accurate,
  current, relevant?
• Is there a connection between the picture and
  the printed words.
• Are the intended meanings of the pictures
  understood?
• Do the pictures on the outside reflect the
  material on the inside?
• Is the material appealing?
• Are there any special features that are helpful?

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What is Evaluation?

• Process evaluation Examines the procedures and
  tasks involved in the program.
• Outcome evaluation Short and long term results.

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Adult Learners/ Adult learning principles

• Need to know Adults must know why they need to
  know
• Self concept Adults want to be capable of
  self-direction.
• Experience Adults have life experiences that can
  be drawn upon.
• Readiness to learn Timing learning with
  developmental tasks
• Orientation to learning priority
• Motivation self-esteem, life goals

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Literacy

• Definition More than being able to read and
  write." The ability to understand and employ
  printed information in daily activities at home,
  work and in the community. Human Resources
  development Canada (1999).

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Plain Language

• Definition A way of presenting information so
  that it makes sense and is easy to read by the
  audience that it is intended for.
• What average grade level should information that
  is to be used by the general public be prepared
  at?
• Many tools available to determine the reading
  level of a document i.e.. WORD

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Reading Level FOG Index

• The FOG index is a way of determining the years
  of schooling needed to understand the printed
  material. i.e. A FOG level of 8 refers to an
  eight grade reading level.

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Examples

• Before
• Precautions Individuals with high blood
  pressure, heart disease, thyroid or chronic lung
  disease, glaucoma, elderly, pregnant, lactating
  or sensitive to any of the ingredients, consult a
  physician.

• After
• Warning Talk to your doctor before you take this
  medication if you have high blood pressure,
  thyroid, lung disease such as asthma, glaucoma.
  If you are older, pregnant or nursing your baby,
  talk to your doctor before you take the
  medication.

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Literacy in Canada

• 43 of adults across Canada have problems using
  the written word (International Adult Literacy
  Survey, 2000).
• 53 of people in Atlantic Canada have problems
  with the written word (International Adult
  Literacy Survey, 2000)
• Fewer than 10 of Canadians with low literacy
  skills have ever enrolled in an upgrading program
  and those who do, the drop out rate is high.

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Health Literacy

• The ability to act upon health information and
  ultimately take control of your life.

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Facts

• Canadians with the lowest literacy skills have
  higher rates of unemployment.
• Canadians with low literacy skills are more
  likely to have lower incomes.
• A significant number of older adults have low
  literacy skills, 40 of Canadians over 65 have
  not completed primary school compared to 4 of
  Canadians between 26-35.(Caution).
• Canadians with low literacy skills are more
  likely to have poorer health. (International
  Adult Literacy Survey, 2000).

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Examples of Literacy Challenges

• Following instructions for a diabetic diet.
• Giving the correct amount of medication to your
  child who has a fever.
• Preparing infant formula safely and in the proper
  strength. Ex
• Completing a medical form
• Understanding an informed consent

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Those at Risk Not always easy to know if someone
has low literacy skills

• Frequently returns for health related services
• Routinely misses scheduled appointments
• Arrives without completed forms.
• Avoids filling out forms
• Relies on others to read material for them
• Claims to have vision or other problems to avoid
  reading
• Never jots down instructions
• Reads something quicker than expected with no
  comprehension

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Examples of documents readability levels

• Document
• Human Rights in BC
• Parliamentary report on World Trade
• Canadian charter on rights and freedom
• Application form for disability benefits, Canada
  Pension Plan

• Rec Actual
• 5/6 12
• 7/8 15
• 7/8 14
• 9 12

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Familiar reading material

• Reading level
• Grade 5/6
• Grade 10
• Grade 13

• Documents
• Charlotteis Web E.B. White
• Animal Farm George Orwell
• National Post

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Health Literacy in Rural N.S

• Research project, partnership with StFX,
  community advisory panel community agencies.
  Doris Gillis Dept of Nutrition Allan Quigley
  Dept of Adult Education.
• Summary report June 2004. Taking off the
  Blindfold Seeing how literacy Affects Health
• http//www.nald.ca/healthliteracystfx
• Looked at how literacy affects health,
  Antigonish, Guysborough and Richmond counties.
  Interviewed 46 adults struggling to get an
  education, 7 meetings with health literacy
  workers and 20 community leaders.

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Results

• Increase awareness and support of literacy as a
  determinant of health.
• Find ways to reduce barriers to enrolling and
  attending literacy programs
• Make health information more accessible to
  everyone, write it in plain language
• Take health information to the people
• Develop health and literacy promotion strategies
  that address needs in rural area

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Group Project

• There has been concerns raised in the community
  where you work as a community health nurse (CHN)
  for more information on (the communicable
  disease). You have decided to respond by holding
  an information session.
• Identify key steps to start the planning.
• Identify one overall goal for the presentation.
• What format might you choose to present and why?
• What key information (be specific to the
  communicable disease) will you be presenting?
• Identify how you plan to evaluate.