Epa cambios comportamentales población

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Presentación en la que Gina Perigo hace una brillante exposición de como los Enfermeros de Práctica Avanzada y más concretamente los Nurse Practitioners pueden jugar un papel fundamental a la hora de potenciar y generar un cambio en los comportamientos en la población de salud que contribuyen al mantenimiento del estado de salud de la población y de la comunidad

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Epa cambios comportamentales población

  1. 1. Do Advanced Nurse Practitioners have a wider role to play inhave a wider role to play in behaviour change at community d l i l l?and population level? Gina Perigo Health Outcomes Support ManagerHealth Outcomes Support Manager Public Health,Liverpool PCT
  2. 2. Aim of this Session • To discuss the levers for behaviour change and how theyg y can impact on the individual, social, environment and economic factors that impact on behaviour. • To understand the behaviour change model and the i limportance to set clear outcomes measures to assess behaviour change • To consider how the Advanced Nurse Practitioner can play a wider role in influencing and shaping services to improvea wider role in influencing and shaping services to improve public health
  3. 3. Health-related Behaviour Change • Changing people’s health-related behaviour can have major impact on some of the largest causes of mortality and morbidity. • Behaviour plays an important role in people’s health. For example; smoking, poor diet, lack ofhealth. For example; smoking, poor diet, lack of exercise and sexual risk taking can cause a large number of diseases.large number of diseases.
  4. 4. Raising Rates and Rising Cost of: • Obesity• Obesity • Alcohol abuse • Smoking related deaths • Infectious diseases• Infectious diseases • Drug abuseg • Poor mental health H lth I liti• Health Inequalities
  5. 5. Dahlgren and Whitehead (1991)
  6. 6. NHS White Paper sets out its vision: f• to strengthen the role of local government in improving healthp g • ring fenced public health budgets i th t th NHS h h l• recognises that the NHS has a huge role to play in Public Health • emphasis public health is everyone businessbusiness
  7. 7. A New Approach to Public Health “ P bli h lth i t d b f“ Public health is a movement, owned by everyone, for everyone's benefit. A movement which unites those who have been trying to prevent ill health with thosey g p responsible for treating it…. …. to work hand and hand with colleagues across local government and the NHS, to challenge and lead others; to d li b f h i Tdeliver better outcomes for the nation; …. To support communities and empower individuals …..” Department of Health, A New Approach to Public Health, UK Faculty of Public Health Conference, 7th July 2010.
  8. 8. How can you as an Advanced Nurse Practitioner develop your role in publicPractitioner develop your role in public health and influence and shape services to improve health outcomes at a community and population level?and population level?
  9. 9. NICE GuidanceNICE Guidance • Interventions to change behaviour have enormous potential to alter current patterns of diseasealter current patterns of disease • Often the theories and principles in relation to behaviourOften the theories and principles in relation to behaviour change are not taken into account when planning, delivering and evaluating health improvement initiatives • NICE produced eight generic principles that can be used as th b i f l i d li i d l ti blithe basis for planning, delivering and evaluating public health activities aimed at changing health-related behaviour at individual community and population levelsindividual, community and population levels NICE public health guidance 6 2007 www nice org uk/PH006NICE public health guidance 6. 2007 www.nice.org.uk/PH006
  10. 10. Behaviour Change ModelBehaviour Change Model • Provides a framework to ensure we are more effective and systematic in identifying approaches and strategies in relationsystematic in identifying approaches and strategies in relation to health-related population behaviour change • It is based on North Karelia model • It is underpinned by a mix of theory types • Takes account of the individual, social, economic and environmental factors which impact on behaviour change • Makes the link between the intervention, its outcomes and the impact on behaviouroutcomes and the impact on behaviour.
  11. 11. BEHAVIOURAL CHANGE PROCESS INFORMATION PERSUASION MEDIA MESSAGES TRAINING FOR SKILLS MESSAGES TRAINING FOR SKILLS COMMUNITY SOCIAL SUPPORT SERVICES & ORGANISATIONS ENVIRONMENTAL MODIFICATION & COMMUNITY SUPPORT
  12. 12. Choosing Appropriate Outcomes for Health-Related Behaviour ChangeHealth Related Behaviour Change Levers for change Information Persuasion Training for Skills Social Support Community Organisations Environmental Change Outcome Measures Raised Awareness Changed Attitudes Enhanced practical skills Enhanced motivation and success Increased support, Removed barriers, Increased Awareness Increased Knowledge Attitudes Increased Motivation Empowered and increased self-efficacy via professionals peer, family support advocacy and more favourable social norms opportunities Increased demand Change policy Impact on Behaviour Less likely toLess likely to happen or be sustained by simply providing Need to be persuaded to act on information Easier to translate intention into action More likely to change and sustain if reinforced by social environment providing information information action © Liverpool PCT HOU Based on North Karelia Model, McAlister et al, 1982, American Journal for Public Health
  13. 13. Choosing Appropriate Outcomes for Health-Related Behaviour Change Levers for change Health Related Behaviour Change Information Persuasion Training for Skills Social Support Community Organisations Environmental Change Outcome Measures Raised Awareness Changed Attitudes Enhanced practical skills Enhanced motivation and success Increased support, Removed barriers, Increased Awareness Increased Knowledge Attitudes Increased Motivation Empowered and increased self-efficacy via professionals peer, family support advocacy and more favourable social norms opportunities Increased demand Change policy Examples Standardized Messages on Breastfeeding Peer Social inclusion Equality Bill 2010Standardized messages Via Social Marketing Campaign, Health Professionals Leaflets, Posters, W b it Messages on benefits for mum and baby, provided by Peers, GPs, Midwives, Health Visitors Breastfeeding Peer Support Service Peer training Breastfeeding Information provided to family & friends will help them support breastfeeding mums Social inclusion team Stakeholder engagement N i hb h d Equality Bill 2010 Local Workplace Charter Breastfeeding Friendly Welcome Scheme Website, Press coverage Children Centre teams Management & Unicef Audit training for professionals mums Peer to Peer support Relevant written materials© Liverpool PCT HOU Neighbourhood teams Local Business Unicef Baby Friendly Initiative Directory of Breastfeeding Welcome Places
  14. 14. Example (personal communication) • ANP working in A&E. • Regularly deals with glass injuries from fights in pubs• Regularly deals with glass injuries from fights in pubs & clubs. Mainl facial & hand inj ries ith significant• Mainly facial & hand injuries with significant consequences. • Gives regular advice on drinking, safety etc (Brief intervention)
  15. 15. • ANP Initiated meeting with: – Police – Licensing Authority – Local Authority – PCT – Representatives from Licensed Premises • Concept – To introduce plastic unbreakable t i t t t d b d l b hcontainers to targeted pubs and clubs where younger people drink(1) to reduce A&E attendances and hospital admissionshospital admissions 1 L k t l A littl i ht l b di i th h lth i li ti f l bbi1. Luke et al: A little nightclub medicine: the healthcare implications of clubbing. Emergency Medical Journal 2002;19:542-545
  16. 16. Series of meetings with held to discuss: D t• Data – (where offences happen, age groups, popular pubs & clubs, time of drinking etc) • How to implement a policy & what would thatHow to implement a policy & what would that look like? • Policy developed, signed off by all partners &y p , g y p implemented.
  17. 17. Expected Outcomes:Expected Outcomes: • Reduction in glass injuries • Reduction in A&E attendancesReduction in A&E attendances • Reduction in alcohol-related hospital admissions However, would this policy influence & change behaviour? Could the ANP taken even further steps to change behaviour? For example: • Alcohol Screening and brief intervention offered to all patients in the A&E department, extend this to all patients in the hospital (System & Scale)hospital (System & Scale) • Put pressure on the key stakeholders to the tackle root cause - binge drinking by implementing an alcohol harm reductiong g y g programme
  18. 18. It is important when planning health improvement interventions to: 1. Critically evaluate the evidence to the specific health related behaviour you want to changerelated behaviour you want to change 2. Design valid and reliable interventions and programmes th t t k t f th l f hthat take account of the levers for change 3 Apply social and behaviour change models and3. Apply social and behaviour change models and concepts to each of the levers of change were appropriate 4. Set clear outcome measures to assess the change in behaviour
  19. 19. SummarySummary • Encouraging healthier lifestyle is the job of all staffEncouraging healthier lifestyle is the job of all staff working in the health service, not just those working specifically on public health projects. • All interactions between patients and health professional presents an opportunity to deliver messages about h l hi lif l d b h ihealthier lifestyles and behaviours. • Advanced Nurse Practitioners can play a valuable role• Advanced Nurse Practitioners can play a valuable role influencing and shaping services and local policy to improve health outcomes at not only an individual level but at a community and population levelbut at a community and population level.
  20. 20. Any questions?y Gina Perigo Health Outcomes Support Manager P bli H lth D t tPublic Health Department Liverpool Primary Care Trust gina perigo@liverpoolpct nhs ukgina.perigo@liverpoolpct.nhs.uk Tel: 0151 296 7839

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