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

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Health promotion

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