Theories

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• 63-171
• Theories Models of Health Promotion

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Health Promotion

• Health promotion is the process of enabling
  people to increase control over, and improve,
  their health (WHO, 1986)
• Health promotion is much broader than disease
  prevention

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Health Promotion

• Penders definition
• Health promotion is directed toward increasing
  the level of well-being and self-actualizationit
  focuses on efforts to approach or move
  towardhigh-level health and well-being (p.34)

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Health Protection/Disease Prevention

• Directed toward decreasing the probability of
  experiencing health problemsit focuses on
  efforts to move away from or avoidillness and
  injury(p. 34).

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Levels of Prevention

• Primary Prevention
• Secondary Prevention
• Tertiary Prevention

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Principles of Health Promotion

• Addresses health issues in context
• Supports a holistic approach
• Long-term perspective
• Multisectoral
• Draws on knowledge from a variety of sources

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An increased Awareness

• Do people choose poor health?
• Or do their environments (living and working
  conditions pose obstacles and barriers that
  influence their ability to engage in healthy
  behaviours?)
• (air pollution, water quality, stress, work
  hazards, poverty).

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Fundamental Conditions Resources for Health

• Stable ecosystem
• Sustainable Resources
• Social Justice
• Equity

• Peace
• Shelter
• Education
• Food
• Income

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The Key Health Determinants

• Income social status
• Social support networks
• Education
• Employment and working conditions
• Physical environments

• Biology and genetic endowment
• Personal health practices and coping skills
• Healthy child development
• Health Services

Updated in 1996 to include three other
determinants gender, culture and social
environments.
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Health Promotion Models

• The Health Belief Model
• Penders Health Promotion Model
• Population Health Promotion Model
  (Hamilton and Bhatti)

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Theories of Human Health Behaviour

• Emphasis is on predicting individual preventative
  health behaviour.
• Offered an explanation for why people do not
  participate in disease prevention programs.

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The Health Belief Model

• HBM is based on an individuals ideas about and
  appraisal of perceived benefits compared to
  perceived barriers and costs of taking a health
  action.
• Attempts to predict health-related behaviour in
  terms of certain belief patterns.
• Suggests that a persons susceptibility to a
  health threat and its seriousness influences ones
  decision to engage in a preventable health
  behaviour.

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Components of the HBM

• Individuals perception of susceptibility to an
  illness
• Individuals perception of the seriousness of the
  illness
• The likelihood that an individual will take
  preventive action

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The Health Belief Model

• Helps to identify the strengths as well as the
  weaknesses of the individual that could affect
  the success of the plan of action for disease
  prevention.
• The model assumes that individuals value health.
• Intended as a disease-prevention model.

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Health Belief Model Limitations

• Factors other than health beliefs heavily
  influence health behaviour practices i.e. SES
  status, previous experiences, culture.
• Fear/threat is seen as a source of motivation and
  the avoidance-oriented approach is of limited
  usefulness in motivating overall healthy
  lifestyles in certain groups (children, youths,
  young adults).

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The Pender Model of Health Promotion

• The Pender HPM has been used to provide the
  framework and guidance for many health promotion
  activities.
• These activities include the preparation of
  individual client health promotion plans , health
  promotion programs for workplaces schools as
  well as community health promotion programs.

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Health Promotion Model

• Competence or approach oriented model
• Does not include fear or threat as a source of
  motivation
• It is a model with potential applicability across
  the life span because it does not rely on
  personal threat as a source of health motivation

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Penders Health Promotion Model

• People will work toward what they feel is of
  value to them and are influenced by internal and
  external factors unique to the individual.

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Assumptions

• Seven assumptions that emphasize the active role
  of the client in shaping and maintaining health
  behaviours and in modifying the environmental
  context for health behaviours.

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Theoretical Propositions

• Provide a basis for investigative work in regard
  to health behaviours.

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Pender

• The model has a holistic perspective.
• Variables grouped under 3 major categories
• 1. Individual characteristics and experiences, 2.
  Behaviour-specific cognition and affect, and 3.
  Behaviour outcome.

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Health Promotion Model
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Health Promotion Model

• Individual characteristics unique personal
  characteristics and prior related behaviour
• Assists in identifying variables that may be
  relevant to a specific health behaviour

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Behaviour-Specific Cognitions and Affect

• This set of variables is considered to be of
  major motivational significance
• Critical core for intervention through nursing
  actions

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Behavioural Outcome

• Health-promoting behaviour is the endpoint or
  action outcome.
• Health-promoting behaviour is directed toward
  attaining positive health outcomes for the
  client.

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Ask Yourself?

• Monthly breast self-exam is recommended for all
  women as a means of early detection for breast
  cancer. Is knowledge of how to do a breast
  self-exam all that is necessary for a woman to
  carry out this activity?
• What other resources might be necessary?
• Is the womans perception of her ability to do an
  accurate self-exam important?

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Strategies for Population Health.

• In a population health approach, the entire
  range of known individual and collective factors
  and conditions that determine population health
  status and the interactions among them are taken
  into account in planning action to improve
  health (Health Canada, 1998)

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The Population Health Promotion Model Hamilton
Bhatti, 1996)

• This model is intended to guide our actions to
  improve health by answering 3 major questions.
• 1. On what should we take action?
• 2. How should we take action?
• 3. With whom should we act
• (we need to direct attention to all determinants
  of health the what in the document Strategies
  for Population Health).

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Transtheoretical Model of Change

• Motivation to change is described as a state of
  readiness that fluctuates and can be influenced
  by external encouragement.
• Developed by Prochaska, DiClemente, Norcross
• Consists of five stages

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Stages of Change

• Precontemplation
• Contemplation
• Preparation/Determination
• Action
• Maintenance

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Stages of Change

• Precontemplation client is not thinking
  seriously about a change.
• Contemplation client is thinking about a change
  ambivalent about the need to change a behaviour.
• Preparation client is willing to make a change
  Something has to change

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Stages of Change

• Action client has made specific overt
  modifications to effect the needed change.
• Maintenance client has successfully avoided any
  temptations to return to old behaviour client is
  able to anticipate situations in which relapse
  can occur and prepare coping strategies in
  advance.