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Health Promotion
Copyright Ā©2008 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Community Health Nursing, 5/e
Mary Jo Clark
11
CHAPTER
Community Health Nursing, 5/e
Mary Jo Clark
Copyright Ā©2008 by Pearson Education, Inc.
Evolution of Health Promotion
ā€¢ Religious, political, and cultural sanctions
ā€¢ Miasma control
ā€¢ Contagion control
ā€“ Immunization, disinfection
ā€¢ Preventive medicine
ā€“ Risk factor modification
ā€¢ Primary health care movement
ā€¢ Health Promotion ā€“ 1990s- present
ā€“ Development of capacity for informed health
decisions
Community Health Nursing, 5/e
Mary Jo Clark
Copyright Ā©2008 by Pearson Education, Inc.
Definition of Health Promotion
ā€¢ a process of enabling people to increase
control over, and to improve, their health.
ā€¢ It involves: -
ā€“ Public policy formation
ā€“ Development of environments that support
health
ā€“ Promotion of community action.
Community Health Nursing, 5/e
Mary Jo Clark
Copyright Ā©2008 by Pearson Education, Inc.
Key Elements of Health Promotion
ā€¢ Regulation of health via legislation
ā€¢ Sanitation
ā€¢ Immunization
ā€¢ Focus on risk modification
ā€¢ Recognition of effects of social conditions
on health
ā€¢ Preparation for informed decision making
Community Health Nursing, 5/e
Mary Jo Clark
Copyright Ā©2008 by Pearson Education, Inc.
Health Education
ā€¢ A health promotion strategy
ā€“ It is a mean to accomplish health promotion
ā€¢ Provides clients with information and skills
ā€“ Informed decisions regarding health-related
behaviors
Community Health Nursing, 5/e
Mary Jo Clark
Copyright Ā©2008 by Pearson Education, Inc.
Health Education (continued)
ā€¢ Uses education and motivation to change
behaviors by influencing:
ā€“ Values
ā€“ Beliefs
ā€“ Attitudes
Community Health Nursing, 5/e
Mary Jo Clark
Copyright Ā©2008 by Pearson Education, Inc.
Relationship Between Health
Education and Health Promotion
ā€¢ Health education is one mean to
accomplish health promotion
Community Health Nursing, 5/e
Mary Jo Clark
Copyright Ā©2008 by Pearson Education, Inc.
Models for Health Promotion
ā€¢ Precaution Adoption Process model
ā€¢ The Theory of Reasoned Action/Planned
Behavior
ā€¢ The Health Belief model
ā€¢ Penderā€™s Health Promotion model
Community Health Nursing, 5/e
Mary Jo Clark
Copyright Ā©2008 by Pearson Education, Inc.
Precaution Adoption Process Model
ā€¢ Stages of health-related behavior
decisions
ā€“ Stage 1: Unaware of health-related issue
ā€“ Stage 2: Aware but unengaged
ā€“ Stage 3: Decision to act or not act
ā€“ Stage 4: Decision to not act
Community Health Nursing, 5/e
Mary Jo Clark
Copyright Ā©2008 by Pearson Education, Inc.
Precaution Adoption Process Model
(continued)
ā€“ Stage 5: Decision to act, but no action taken
ā€“ Stage 6: Act to engage
ā€“ Stage 7: Behavior becomes part of lifestyle
routine
(Weinstein and Sandman, 2002)
Community Health Nursing, 5/e
Mary Jo Clark
Copyright Ā©2008 by Pearson Education, Inc.
FIGURE 11-1 Stages of Adoption of Exercise Behavior.
Community Health Nursing, 5/e
Mary Jo Clark
Copyright Ā©2008 by Pearson Education, Inc.
Theory of Reasoned Action/Planned
Behavior
ā€¢ Attitudes reflect attitudes to expected
consequences
ā€¢ Attitudes are a product of subjective
norms influenced by others
ā€“ Intention to act
ā€“ Attitudes of person
ā€“ Perceptions of othersā€™ attitudes
ā€“ Value placed on othersā€™ judgments
(Ajzen and Fishbein)
Community Health Nursing, 5/e
Mary Jo Clark
Copyright Ā©2008 by Pearson Education, Inc.
Health Belief Model
ā€¢ Individual perceptions of susceptibility and
seriousness
ā€¢ Modifying factors/variables
ā€“ Demographic
ā€“ Sociopsychological
ā€“ Structural
ā€¢ Perceptions of benefits and barriers to
action
ā€¢ Cues to action
(Becker and Rosenstock)
Community Health Nursing, 5/e
Mary Jo Clark
Copyright Ā©2008 by Pearson Education, Inc.
Individual Perceptions Modifying Factors Likelihood of Action
ā€¢Demographics
ā€¢Personality
ā€¢Knowledge
Perceived threat
Cues to Action
ā€¢Education
ā€¢Symptoms
ā€¢Media
ā€¢Perceived Susceptibility
ā€¢Perceived Severity
Perceived Benefits
minus
Perceived Barriers
Likelihood of
Behavior change
Community Health Nursing, 5/e
Mary Jo Clark
Copyright Ā©2008 by Pearson Education, Inc.
Penderā€™s Health Promotion Model
ā€¢ Behavior is influenced by individual
characteristics
ā€¢ Behavior-specific cognitions and emotions
result in a commitment to action
ā€¢ Commitment to action results in actual
behavior
ā€¢ Behavior may be modified by competing
demands and preferences
(Pender)
Community Health Nursing, 5/e
Mary Jo Clark
Copyright Ā©2008 by Pearson Education, Inc.
Penderā€™s Health Promotion Model
(Pender)
Community Health Nursing, 5/e
Mary Jo Clark
Copyright Ā©2008 by Pearson Education, Inc.
Strategies for Health Promotion
ā€¢ Empowerment
ā€“ Environmental conditions affect health
promotion actions
ā€¢ Social Marketing
ā€“ Enhance peopleā€™s motivation to act
ā€¢ Health education
ā€“ Activities that seek to inform
Community Health Nursing, 5/e
Mary Jo Clark
Copyright Ā©2008 by Pearson Education, Inc.
Social Marketing
ā€¢ Apply commercial marketing technologies
ā€¢ Designed to influence voluntary behavior
of target audiences
ā€¢ Improve audiencesā€™ or societyā€™s personal
welfare
Community Health Nursing, 5/e
Mary Jo Clark
Copyright Ā©2008 by Pearson Education, Inc.
Empowerment
ā€¢ Process of enabling communities to
acquire knowledge and skills
ā€¢ Allow communities to make informed
decisions
Community Health Nursing, 5/e
Mary Jo Clark
Copyright Ā©2008 by Pearson Education, Inc.
Key Requisites of Empowerment
ā€¢ Motivate community participation
ā€¢ Peer and organizational norms that
support health promotion practice
ā€¢ Community agency managers who are
empowerment-oriented
ā€¢ Agency internal policies for empowerment
of community members
Community Health Nursing, 5/e
Mary Jo Clark
Copyright Ā©2008 by Pearson Education, Inc.
Community Empowerment
ā€¢ Active process engaging community
members in their own health education
and health promotion needs
ā€¢ Empower individuals for their own
personal action
ā€¢ Empower individuals to form small mutual
assistance groups
Community Health Nursing, 5/e
Mary Jo Clark
Copyright Ā©2008 by Pearson Education, Inc.
Community Empowerment
ā€¢ Empower groups to create community
organizations
ā€¢ Empowering community organizations to
form partnerships
ā€¢ Empower communities to take social and
political action to improve environmental
conditions that affect health
Community Health Nursing, 5/e
Mary Jo Clark
Copyright Ā©2008 by Pearson Education, Inc.
Fostering Health Promotion through
Empowerment
ā€¢ Individuals and communities become
active participants in the health promotion
process when they:
ā€“ Act on information and create knowledge and
solutions from their own experiences
ā€“ Make informed decisions
ā€“ Recognize that structural and behavioral
changes are necessary to promote health and
well-being
Community Health Nursing, 5/e
Mary Jo Clark
Copyright Ā©2008 by Pearson Education, Inc.
Health Education Process
ā€¢ Inform the individual on the nature and
cause of health/illness
ā€¢ Inform the individual of risk associated
with lifestyle-related behavior
ā€¢ Learning domains (Table 11.3 page 265)
ā€“ Cognitive
ā€“ Affective
ā€“ Psychomotor
ā€“ Perceptual
Community Health Nursing, 5/e
Mary Jo Clark
Copyright Ā©2008 by Pearson Education, Inc.
Purpose of Health Education
ā€¢ Assist clients in making health-related
decision about:
ā€“ Self-care
ā€“ Use of health resources
ā€“ Societal health issues
Community Health Nursing, 5/e
Mary Jo Clark
Copyright Ā©2008 by Pearson Education, Inc.
Goals of Health Education
ā€¢ Client participation in health decision
making
ā€¢ Increased potential to comply with health
recommendations
ā€¢ Development of self-care skills
ā€¢ Improved client and family coping
ā€¢ Increased participation in continuing care
for specific conditions
ā€¢ Adoption of healthier lifestyle
Community Health Nursing, 5/e
Mary Jo Clark
Copyright Ā©2008 by Pearson Education, Inc.
Health Education Process
ā€¢ Assess health education needs
ā€¢ Plan and implement health education
programs
ā€¢ Prioritize learning needs
ā€¢ Develop goals and objectives
Community Health Nursing, 5/e
Mary Jo Clark
Copyright Ā©2008 by Pearson Education, Inc.
Design and Implementation
ā€¢ Needs assessment
ā€“ A planned process
ā€“ Identify the reported needs of an individual or
group
ā€“ Identify and select target audience
ā€“ Assess health education needs
ā€“ Assess learning environment
Community Health Nursing, 5/e
Mary Jo Clark
Copyright Ā©2008 by Pearson Education, Inc.
Identify Audience Characteristics
ā€¢ Biophysical
ā€¢ Psychological
ā€¢ Physical environmental
ā€¢ Sociocultural
ā€¢ Behavioral
ā€¢ Health system factors
Community Health Nursing, 5/e
Mary Jo Clark
Copyright Ā©2008 by Pearson Education, Inc.
Planning and Implementation
ā€¢ Elements of planning process
ā€“ Prioritize learning needs
ā€“ Goals and objectives
ā€“ Content selection
ā€“ Teaching/learning strategies
Community Health Nursing, 5/e
Mary Jo Clark
Copyright Ā©2008 by Pearson Education, Inc.
Language and Health Literacy
ā€¢Health literacy
ā€“ Ability to obtain, interpret, and understand
basic health information and services
ā€“ Ability to use such information and services to
enhance health
Community Health Nursing, 5/e
Mary Jo Clark
Copyright Ā©2008 by Pearson Education, Inc.
Basic Principles
ā€¢ Content based on written objectives
ā€¢ Reader involvement is critical
ā€¢ Easy to read and understand
ā€¢ Materials look easy to read
ā€¢ Visual features clarify and motivate reader
Community Health Nursing, 5/e
Mary Jo Clark
Copyright Ā©2008 by Pearson Education, Inc.
Evaluating Internet Information
ā€¢ Major issues
ā€“ Internet accuracy
ā€“ Information bias
Community Health Nursing, 5/e
Mary Jo Clark
Copyright Ā©2008 by Pearson Education, Inc.
Evaluative Elements
ā€¢ Owner of site and reputability
ā€¢ Sources of financial support
ā€¢ Purpose of site
ā€¢ Sources of information provided
Community Health Nursing, 5/e
Mary Jo Clark
Copyright Ā©2008 by Pearson Education, Inc.
Evaluative Elements (continued)
ā€¢ Evidence provided
ā€¢ Editorial oversight
ā€¢ Currency of information
Community Health Nursing, 5/e
Mary Jo Clark
Copyright Ā©2008 by Pearson Education, Inc.
Evaluation of Health Promotion
Programs (Refer to Table 11-6)
ā€¢ Diagnostic evaluation
ā€“ Accuracy of needs assessment
ā€¢ Formative evaluation
ā€“ How the program is carried out
ā€¢ Summative evaluation
ā€“ Program outcome and/or impact
Community Health Nursing, 5/e
Mary Jo Clark
Copyright Ā©2008 by Pearson Education, Inc.
Additional Elements for Evaluation
ā€¢ Evaluations based on achieving criteria
related to
ā€“ Empowerment
ā€“ Participation
ā€“ Intersectoral collaboration
ā€“ Use of multiple strategies
ā€“ Sustainability

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Health promotion

  • 1. Health Promotion Copyright Ā©2008 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Community Health Nursing, 5/e Mary Jo Clark 11 CHAPTER
  • 2. Community Health Nursing, 5/e Mary Jo Clark Copyright Ā©2008 by Pearson Education, Inc. Evolution of Health Promotion ā€¢ Religious, political, and cultural sanctions ā€¢ Miasma control ā€¢ Contagion control ā€“ Immunization, disinfection ā€¢ Preventive medicine ā€“ Risk factor modification ā€¢ Primary health care movement ā€¢ Health Promotion ā€“ 1990s- present ā€“ Development of capacity for informed health decisions
  • 3. Community Health Nursing, 5/e Mary Jo Clark Copyright Ā©2008 by Pearson Education, Inc. Definition of Health Promotion ā€¢ a process of enabling people to increase control over, and to improve, their health. ā€¢ It involves: - ā€“ Public policy formation ā€“ Development of environments that support health ā€“ Promotion of community action.
  • 4. Community Health Nursing, 5/e Mary Jo Clark Copyright Ā©2008 by Pearson Education, Inc. Key Elements of Health Promotion ā€¢ Regulation of health via legislation ā€¢ Sanitation ā€¢ Immunization ā€¢ Focus on risk modification ā€¢ Recognition of effects of social conditions on health ā€¢ Preparation for informed decision making
  • 5. Community Health Nursing, 5/e Mary Jo Clark Copyright Ā©2008 by Pearson Education, Inc. Health Education ā€¢ A health promotion strategy ā€“ It is a mean to accomplish health promotion ā€¢ Provides clients with information and skills ā€“ Informed decisions regarding health-related behaviors
  • 6. Community Health Nursing, 5/e Mary Jo Clark Copyright Ā©2008 by Pearson Education, Inc. Health Education (continued) ā€¢ Uses education and motivation to change behaviors by influencing: ā€“ Values ā€“ Beliefs ā€“ Attitudes
  • 7. Community Health Nursing, 5/e Mary Jo Clark Copyright Ā©2008 by Pearson Education, Inc. Relationship Between Health Education and Health Promotion ā€¢ Health education is one mean to accomplish health promotion
  • 8. Community Health Nursing, 5/e Mary Jo Clark Copyright Ā©2008 by Pearson Education, Inc. Models for Health Promotion ā€¢ Precaution Adoption Process model ā€¢ The Theory of Reasoned Action/Planned Behavior ā€¢ The Health Belief model ā€¢ Penderā€™s Health Promotion model
  • 9. Community Health Nursing, 5/e Mary Jo Clark Copyright Ā©2008 by Pearson Education, Inc. Precaution Adoption Process Model ā€¢ Stages of health-related behavior decisions ā€“ Stage 1: Unaware of health-related issue ā€“ Stage 2: Aware but unengaged ā€“ Stage 3: Decision to act or not act ā€“ Stage 4: Decision to not act
  • 10. Community Health Nursing, 5/e Mary Jo Clark Copyright Ā©2008 by Pearson Education, Inc. Precaution Adoption Process Model (continued) ā€“ Stage 5: Decision to act, but no action taken ā€“ Stage 6: Act to engage ā€“ Stage 7: Behavior becomes part of lifestyle routine (Weinstein and Sandman, 2002)
  • 11. Community Health Nursing, 5/e Mary Jo Clark Copyright Ā©2008 by Pearson Education, Inc. FIGURE 11-1 Stages of Adoption of Exercise Behavior.
  • 12. Community Health Nursing, 5/e Mary Jo Clark Copyright Ā©2008 by Pearson Education, Inc. Theory of Reasoned Action/Planned Behavior ā€¢ Attitudes reflect attitudes to expected consequences ā€¢ Attitudes are a product of subjective norms influenced by others ā€“ Intention to act ā€“ Attitudes of person ā€“ Perceptions of othersā€™ attitudes ā€“ Value placed on othersā€™ judgments (Ajzen and Fishbein)
  • 13. Community Health Nursing, 5/e Mary Jo Clark Copyright Ā©2008 by Pearson Education, Inc. Health Belief Model ā€¢ Individual perceptions of susceptibility and seriousness ā€¢ Modifying factors/variables ā€“ Demographic ā€“ Sociopsychological ā€“ Structural ā€¢ Perceptions of benefits and barriers to action ā€¢ Cues to action (Becker and Rosenstock)
  • 14. Community Health Nursing, 5/e Mary Jo Clark Copyright Ā©2008 by Pearson Education, Inc. Individual Perceptions Modifying Factors Likelihood of Action ā€¢Demographics ā€¢Personality ā€¢Knowledge Perceived threat Cues to Action ā€¢Education ā€¢Symptoms ā€¢Media ā€¢Perceived Susceptibility ā€¢Perceived Severity Perceived Benefits minus Perceived Barriers Likelihood of Behavior change
  • 15. Community Health Nursing, 5/e Mary Jo Clark Copyright Ā©2008 by Pearson Education, Inc. Penderā€™s Health Promotion Model ā€¢ Behavior is influenced by individual characteristics ā€¢ Behavior-specific cognitions and emotions result in a commitment to action ā€¢ Commitment to action results in actual behavior ā€¢ Behavior may be modified by competing demands and preferences (Pender)
  • 16. Community Health Nursing, 5/e Mary Jo Clark Copyright Ā©2008 by Pearson Education, Inc. Penderā€™s Health Promotion Model (Pender)
  • 17. Community Health Nursing, 5/e Mary Jo Clark Copyright Ā©2008 by Pearson Education, Inc. Strategies for Health Promotion ā€¢ Empowerment ā€“ Environmental conditions affect health promotion actions ā€¢ Social Marketing ā€“ Enhance peopleā€™s motivation to act ā€¢ Health education ā€“ Activities that seek to inform
  • 18. Community Health Nursing, 5/e Mary Jo Clark Copyright Ā©2008 by Pearson Education, Inc. Social Marketing ā€¢ Apply commercial marketing technologies ā€¢ Designed to influence voluntary behavior of target audiences ā€¢ Improve audiencesā€™ or societyā€™s personal welfare
  • 19. Community Health Nursing, 5/e Mary Jo Clark Copyright Ā©2008 by Pearson Education, Inc. Empowerment ā€¢ Process of enabling communities to acquire knowledge and skills ā€¢ Allow communities to make informed decisions
  • 20. Community Health Nursing, 5/e Mary Jo Clark Copyright Ā©2008 by Pearson Education, Inc. Key Requisites of Empowerment ā€¢ Motivate community participation ā€¢ Peer and organizational norms that support health promotion practice ā€¢ Community agency managers who are empowerment-oriented ā€¢ Agency internal policies for empowerment of community members
  • 21. Community Health Nursing, 5/e Mary Jo Clark Copyright Ā©2008 by Pearson Education, Inc. Community Empowerment ā€¢ Active process engaging community members in their own health education and health promotion needs ā€¢ Empower individuals for their own personal action ā€¢ Empower individuals to form small mutual assistance groups
  • 22. Community Health Nursing, 5/e Mary Jo Clark Copyright Ā©2008 by Pearson Education, Inc. Community Empowerment ā€¢ Empower groups to create community organizations ā€¢ Empowering community organizations to form partnerships ā€¢ Empower communities to take social and political action to improve environmental conditions that affect health
  • 23. Community Health Nursing, 5/e Mary Jo Clark Copyright Ā©2008 by Pearson Education, Inc. Fostering Health Promotion through Empowerment ā€¢ Individuals and communities become active participants in the health promotion process when they: ā€“ Act on information and create knowledge and solutions from their own experiences ā€“ Make informed decisions ā€“ Recognize that structural and behavioral changes are necessary to promote health and well-being
  • 24. Community Health Nursing, 5/e Mary Jo Clark Copyright Ā©2008 by Pearson Education, Inc. Health Education Process ā€¢ Inform the individual on the nature and cause of health/illness ā€¢ Inform the individual of risk associated with lifestyle-related behavior ā€¢ Learning domains (Table 11.3 page 265) ā€“ Cognitive ā€“ Affective ā€“ Psychomotor ā€“ Perceptual
  • 25. Community Health Nursing, 5/e Mary Jo Clark Copyright Ā©2008 by Pearson Education, Inc. Purpose of Health Education ā€¢ Assist clients in making health-related decision about: ā€“ Self-care ā€“ Use of health resources ā€“ Societal health issues
  • 26. Community Health Nursing, 5/e Mary Jo Clark Copyright Ā©2008 by Pearson Education, Inc. Goals of Health Education ā€¢ Client participation in health decision making ā€¢ Increased potential to comply with health recommendations ā€¢ Development of self-care skills ā€¢ Improved client and family coping ā€¢ Increased participation in continuing care for specific conditions ā€¢ Adoption of healthier lifestyle
  • 27. Community Health Nursing, 5/e Mary Jo Clark Copyright Ā©2008 by Pearson Education, Inc. Health Education Process ā€¢ Assess health education needs ā€¢ Plan and implement health education programs ā€¢ Prioritize learning needs ā€¢ Develop goals and objectives
  • 28. Community Health Nursing, 5/e Mary Jo Clark Copyright Ā©2008 by Pearson Education, Inc. Design and Implementation ā€¢ Needs assessment ā€“ A planned process ā€“ Identify the reported needs of an individual or group ā€“ Identify and select target audience ā€“ Assess health education needs ā€“ Assess learning environment
  • 29. Community Health Nursing, 5/e Mary Jo Clark Copyright Ā©2008 by Pearson Education, Inc. Identify Audience Characteristics ā€¢ Biophysical ā€¢ Psychological ā€¢ Physical environmental ā€¢ Sociocultural ā€¢ Behavioral ā€¢ Health system factors
  • 30. Community Health Nursing, 5/e Mary Jo Clark Copyright Ā©2008 by Pearson Education, Inc. Planning and Implementation ā€¢ Elements of planning process ā€“ Prioritize learning needs ā€“ Goals and objectives ā€“ Content selection ā€“ Teaching/learning strategies
  • 31. Community Health Nursing, 5/e Mary Jo Clark Copyright Ā©2008 by Pearson Education, Inc. Language and Health Literacy ā€¢Health literacy ā€“ Ability to obtain, interpret, and understand basic health information and services ā€“ Ability to use such information and services to enhance health
  • 32. Community Health Nursing, 5/e Mary Jo Clark Copyright Ā©2008 by Pearson Education, Inc. Basic Principles ā€¢ Content based on written objectives ā€¢ Reader involvement is critical ā€¢ Easy to read and understand ā€¢ Materials look easy to read ā€¢ Visual features clarify and motivate reader
  • 33. Community Health Nursing, 5/e Mary Jo Clark Copyright Ā©2008 by Pearson Education, Inc. Evaluating Internet Information ā€¢ Major issues ā€“ Internet accuracy ā€“ Information bias
  • 34. Community Health Nursing, 5/e Mary Jo Clark Copyright Ā©2008 by Pearson Education, Inc. Evaluative Elements ā€¢ Owner of site and reputability ā€¢ Sources of financial support ā€¢ Purpose of site ā€¢ Sources of information provided
  • 35. Community Health Nursing, 5/e Mary Jo Clark Copyright Ā©2008 by Pearson Education, Inc. Evaluative Elements (continued) ā€¢ Evidence provided ā€¢ Editorial oversight ā€¢ Currency of information
  • 36. Community Health Nursing, 5/e Mary Jo Clark Copyright Ā©2008 by Pearson Education, Inc. Evaluation of Health Promotion Programs (Refer to Table 11-6) ā€¢ Diagnostic evaluation ā€“ Accuracy of needs assessment ā€¢ Formative evaluation ā€“ How the program is carried out ā€¢ Summative evaluation ā€“ Program outcome and/or impact
  • 37. Community Health Nursing, 5/e Mary Jo Clark Copyright Ā©2008 by Pearson Education, Inc. Additional Elements for Evaluation ā€¢ Evaluations based on achieving criteria related to ā€“ Empowerment ā€“ Participation ā€“ Intersectoral collaboration ā€“ Use of multiple strategies ā€“ Sustainability