Health Education, Promotion, and Health Behavior

1. Health Education, Promotion, and Health Behavior Abeer Shaheen

2. Outline • Health Education Overview • Definition of health promotion. • Definition of health protection. • Definition of health behaviour. • Health promotion activities. • Nurse role in health promotion. • Selected areas of health promotion • The scope of health promotion. • Core competencies in Health promotion. • Values and principles of good practice for health promotion. • Levels of prevention.

3. Health Education • The past. • The present. • The future.

4. The Past: Give the people the facts, the people will act. • Some people acted on the basis of health information and some did not, so behavioral scientists began to study the dynamics of decision making and the influences of knowledge, attitudes and beliefs on behavior. • Controlled intervention studies were conducted to see who would respond and why, and to determine what alternatives could be offered for those who failed to respond.

5. The present: combine educational and environmental approaches to produce the maximum effect on life-style. • Models mix emphasis on the source and solution of problems: • Combine inductive (grounded) and deductive approaches to health problems (the clinical and public health perspectives).

6. The Future • Meta-analysis, cost-effectiveness evaluations, and role of Government to support both agency directed research (e.g., on AIDS prevention) and investigator-initiated research.

7. Health Promotion • Is a process of enabling people to improve their health by synthesizing personal choice and social responsibility. • Health promotion includes “creating healthy policies and supportive environments, and reorienting health services beyond clinical and curative care; thus, a combination of health education and health advocacy.”

8. Health Promotion • Health promotion is a concept “intended to underscore the broader social structural context of health behavior.” • Health promotion broader than health education. • The actions taken to develop a high level of wellness and is accomplished by influencing individual behavior and the environment in which people live. • Is about raising the health status of individuals and communities.

9. Health Promotion Many people are aware of the relationship between lifestyle and illness and are developing health promoting, habits such as getting adequate exercise, rest and relaxation, maintaining good nutrition and controlling the use of tobacco, alcohol …...

10. Health Protection Health protection or Illness prevention: avoiding development of disease in the future.

11. Health Promotion vs Health Protection Health promotion differs from health protection. • Health promotion: client behavior directed towards developing well-being and actualizing human health potential. • Health protection: client behavior geared towards preventing illness, detecting it early or maintaining function.

12. The difficulty in separating the terms health promotion and health protection lies in the fact that an activity may be carried out for numerous reasons. Example: 40yrs male, may begin a program of walking 30miles/day. If the goal is “to decrease the risk of CVD” then this activity is Health protection. If the goal is “to increase his overall health and feeling of well-being” then this activity is Health Promotion Behavior. Its most helpful to think of health promotion and health protection as being complementary processes because both impact quality of health.

13. Health Behavior. “Act” and “Practices” • Health behavior (the things people do) is the central concern of health education; it is “the crucial dependent variable in research on the impact of health education intervention strategies. • Categories of health behavior include: • Preventive health behavior, • Illness behavior, • Sick-role behavior.

14. Preventive Health Behavior • It is any activity undertaken by an individual who believes himself to be healthy for the purpose of preventing or detecting illness in an asymptomatic state. • Preventive health behavior generally follows from a belief that such behavior will benefit health. An obvious example is quitting smoking to reduce the chances of early morbidity and mortality. • Cultural traditions, attitudes, and beliefs can play an important role in the ways in which people behave.

15. Illness Behavior • The manner in which individuals monitor the structure and functions of their own bodies, interpret symptoms, take remedial action, and make use of health care facilities. • It is any behavior undertaken by an individual who feels ill to relieve that experience or to better define the meaning of the illness experience. • Some individuals who experience physical or mental symptoms turn to the medical care system for help; others may turn to self-help strategies; while others may decide to dismiss the symptoms.

16. Sick-Role Behavior • the sick role and sick-role behavior could be seen as the logical extension of illness behavior to complete integration into the medical care system. • sick-role behavior accepts the symptomatology and diagnosis of the established medical care system, and thus allows the individual to take on behaviors compliant with the expectations of the medical system.

17. Health Promotion Activities • Health education programs • Economic and regulatory activities • Environmental health measures • Health public policies • Organizational development • Community based work • Preventive health services (primary, secondary and tertiary)

18. Nurses Role in Health Promotion • Nurses have played key role in prevention in areas such as prenatal care, immunization program, occupational health and safety, cardiac rehabilitation, and public health education. • Nurses in all settings can meet health promotion needs of patient, whether practice in the hospitals, clinics, patient's home or community settings. • Health promotion is primarily accomplished through patient education, an independent function of nursing.

19. Selected Areas of Health Promotion • Nutrition and diet. • Smoking prevention and cessation. • Exercise and fitness • Relaxation and stress management. • Sexual health. Helps the patient gain knowledge about sexual health, validate normalcy, prepare changes in sexuality throughout life cycle, and prevent harm gain through sexual activity. • Environment.

20. The Scope of Health Promotion • Illness and disability services • Personal social services. • Health care services. • Positive health activities • Health education programs. • Preventive health services. • Community based work. • Organizational development. • Health public policies. • Environmental health measures. • Economic and regulatory activities.

21. Why do we need health promotion? • Promotes quality of life • Reduces inequalities in health • Reduces pressure on services “Adds life to years Adds years to life”

22. Upstream Thinking “Health Promotion is concerned with making healthier choices easier choices” (Dennis et al 1982)

23. Core Competencies in Health Promotion • Educating. Additional educational competencies are required so that health educators can work in different settings such as formal lecturing or informal group work. • Marketing and publicizing. This requires competence in, for example, marketing and advertising, using local radio and getting local press coverage of health issues. • Facilitating and networking. It means helping others to promote their own and other people's health, using various means such as sharing skills and information, and building up confidence and trust • Influencing policies and practice. Health promoters needs to understand how power is distributed and exercised between people at any level, from a group of colleagues to those in position of great authority.

24. Core Competencies in Health Promotion • Managing. Manage resources for health promotion, including money, materials, oneself and other people. • Planning. Systemic planning is needed for effective and efficient health promotion. • Evaluating. Evaluate the effectiveness of the health promotion • Communicating. Health promotion is about people, competencies in communication are essential and fundamental. A high level of competencies in needed in one-to-one communication and in working with groups.

25. Values and Principles of Good Practice for Health Promotion • Values identifies should have respect for: • The human condition and its complexity • Our essential humanity • The wealth of human experience • The holistic nature of health and social well-being • Diversity

26. Values and Principles of Good Practice for Health Promotion • Principles of good practice • Balancing people's right and responsibilities to others and to wider society and challenging those which affect the rights of others. • Promoting values of equality and diversity, acknowledging the personal beliefs and preferences of others and promoting anti-discriminatory practice. • Maintaining the confidentiality of information provided that this does not place others at risk. • Recognizing the effect of wider social, political, economic, context on health and social well being and on people's development.

27. Enabling people to develop to their full potential, to as autonomous and self managing as possible and to have a voice and be heard. • Recognizing and promoting health and social well-being as a positive concept. • Balancing the needs of people who use services with the resources available and exercising financial probity. • Developing and maintaining effective relationships with people and maintaining the integrity of these relationships through setting appropriate role boundaries. • Developing oneself and one's own practice to improve the quality of services offered. • Working within statutory and organizational framework.

28. The Nurse's Role in Health Promotion 1-Assessing Health history & physical examination… It provides a means for detecting any existing problems Ex. Immunization History, Nutritional assessment. Physical Fitness Assessment Ex. The nurse assesses several component of the body's physical functioning (muscle endurance, flexibility …)

29. Lifestyle Assessment -Focuses on the personal lifestyle habits of the clients as they affect health. -Categories of lifestyle generally assessed are physical activity, nutritional practices, stress management, and habits such as smoking. Health Risk Assessment Is an assessment and educational tools that indicates a client's risk for disease or injury during the next 10 years by comparing the client's risk with the mortality risk of the corresponding age, gender, and racial group.

30. Social Support System Review Understanding the social context in which a person lives and works is important in health promotion. Social Support systems contribute to health by creating an environment that encourage healthy behaviors, promote self-esteem and wellness. Examples of Social Support systems: family, peer supporting group, religion support system.

31. Health Belief Review Client's health beliefs need to be clarified, particularly those belief that determine how they perceive control of their own health care status. Ex. Several cultures have a strong belief in fate: “what will be will be.” if people hold this belief they don’t feel that they can do anything to change the course of their disease. Life Stress Review

32. The Nurse's Role in Health Promotion 2- Diagnosis • Wellness diagnosis: describes human responses to levels of wellness “in an individual, family or community” that have a readiness for enhancement. • It identifies the client strength, recognize self-care abilities, and enhance health promotion goals to help the client reach a higher level of functioning.

33. The Nurse's Role in Health Promotion 3-Planning: • Health promotion Plans needs to be developed according to needs, desire and priorities of the client. • Nurse acts as a resource person rather than an advisor or counselor.

34. Steps of Planning: Identify health goals and related behavior-change options. Ex. A. To reduce the risk of CVD B. To maintain a desired wt. Identify behavioral or health outcome. Ex. To reduce the risk of CVD, the client may need to change behaviors such as stop smoking, lose wt., and increase activity level.

35. Develop a behavior-change plan. Repeat benefits of change. Address environmental and interpersonal facilitators and barriers to change. Ex.environmental and interpersonal factors that support positive change should be used to reinforce the clients efforts to change lifestyle.

36. Determine a time frame for implementation. Commit to behavior change goal. In the past, commitment to changing behaviors have usually been verbal. Increasingly, a formal, written behavioral contract is being used to motivate the client to follow through with selected actions.

37. The Nurse's Role in Health Promotion 4-Implementing: • Implementing is the "doing" part of behavior change. • Self-responsibilities are emphasized for implementing the plan. • Depending on the clients needs, the nursing interventions may include supporting, counseling, facilitating, teaching, consulting, enhancing the behavior change and modeling.

38. The Nurse's Role in Health Promotion 5- Evaluation: • Evaluation takes place on an ongoing basis, both during the achievement of short term goals & after the completion of the long term goals. • Goals are written during the planning phase and a date determined for attaining the specific results or behaviors that are desired to promote health or prevent illness. • During evaluation, the client may decide to continue with the plan, reorder priorities, change strategies, or change the health promotion contract.

39. Levels Of Prevention 1- Primary Prevention: focus on (a) health promotion (b) protecting against specific health problems. The goal of this level: is to decrease the risk of individual or community disease. Example: Immunization against Hep.B

40. Primary prevention Promote general optimal health and prevent illness. Actions occur prior to illness or disease. Increase resistance to illness. Decrease or eliminate the causes of health problems. Foster a healthy environment

41. Primary prevention Providing information and education about health issues, Making appropriate referrals before illness occurs based on assessment of stressors and life changes. Working with families to support family members and group functioning. Working with community and legislative groups on issues related to health.

42. Primary prevention The “first” level of contact between the individual and the health system. Essential health care (PHC) is provided. Provided by the primary health centers.

43. Examples of the primary prevention: • Health education about: • Accident and poisoning prevention, • Standards of nutrition and growth & development for each stage of life • Exercise requirements • Stress management • Protection against occupational hazards

44. Examples of the primary prevention: • Immunizations • Risk assessments for specific disease • Family planning services and marriage counseling • Environmental sanitation and provision of adequate housing, recreation, and work conditions

45. Levels Of Prevention 2- Secondary Prevention: focus on • early identification of health problem • promote intervention to alleviate health problem. • The goal of this level: is to identify individuals in an early stage of a disease. • Example: Screening Survey, HTN Survey.

46. Secondary prevention Early identification and treatment of existing health problems Actions take place after problem has occurred Screening, early diagnosis, and treatment Develop programs to diagnose and treat at community level

47. Secondary prevention Emphasizes early detection of disease, prompt intervention, and health maintenance for individuals experiencing health problems. It includes prevention of complications and disabilities. Intake screening and early case finding.

48. Secondary prevention Secondary care: emergency care, diagnosis and treatment, acute care, community hospital. More complex problems are dealt with. Comprises curative services Provided by the district hospitals

49. Examples of the secondary prevention: Screening surveys and procedures of any type. Encouraging regular medical and dental checkups Teaching self-examination for breast and testicular cancer Assessing the growth and development of children

50. Levels of Prevention 3- Tertiary Prevention: focus on restoration and rehabilitation. • The goal of this level: is to return the individual to an optimal level of functioning • Example Teaching DM pt. to Identify& prevent diabetes complications.