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Course: Fundamentals of Nursing

Topic: Health Promotion

The Nurses International Community

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COPYRIGHT

NI Privacy Policy and Terms of Use.

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Module Goals

Learners will be able to:

Define the concept of Optimal Health.
Describe the nurse’s role in health promotion as it relates to diverse racial, ethnic, cultural and economic populations.
Describe the nurse’s role in promoting health across the lifespan.
Explain the individual and community models that guide health promotion interventions.

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Definition of Optimal Health

Constitution, n.d.

‘Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.’

‘The enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without distinction of race, religion, political belief, economic or social condition.’

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Health Promotion Definition

“.. is the process of enabling people to increase control over their health and its determinants, and thereby improve their health.”

WHO’s Bangkok Charter for Health Promotion in a Globalised World, 2005, as cited in VicHealth, n.d.

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Why Health Promotion is Important?

College of Public Health, University of Georgia listed following as importance of health promotion:

Health promotion improves the health status of individuals, families, communities, states, and the nation.
Health promotion enhances the quality of life for all people.
Health promotion reduces premature deaths.
By focusing on prevention, health promotion reduces the costs (both financial and human) that individuals, employers, families, insurance companies, medical facilities, communities, the state and the nation would spend on medical treatment.

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Health Promotion: History

First International Conference on Health Promotion was held in Ottawa, 1986
Since then, WHO Global Health Promotion Conferences have established and developed the global principles and action areas for health promotion
9th global conference (Shanghai 2016), titled ‘Promoting health in the Sustainable Development Goals: Health for all and all for health’

Highlighted the critical links between promoting health and the 2030 Agenda for Sustainable Development
Provides framework through which governments can utilize the transformational potential of health promotion

(WHO, n.d.)

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Health Promotion

Covers a wide range of social and environmental interventions¹

That are designed to benefit and protect individual people’s health and quality of life
That addresses and prevents the root causes of ill health, not just focus on treatment and cure

Health promotion embraces actions that are:

Directed at strengthening individual skills and capabilities²
Directed towards changing social, environmental, political and economic conditions to alleviate their impact on populations and individual health ²

WHO team, 2016
Australian Health Promotion Association, n.d.

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Critical Thinking Question

Why is health promotion important?

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Elements of Health Promotion

According to WHO team (n.d.), there are three elements to Health Promotion:

Good governance for Health
Health literacy
Healthy cities

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Elements of Health Promotion: Good Governance

Requires policy makers of all government departments to:

Make health central line of government policy
Factor health implications to every decision they make
Prioritize policies that prevent people from becoming ill and protect them from injuries

Policies made must be supported by regulations that match private sector incentives with public health goals

Legislation that supports healthy urbanization
e.g walkable cities, reducing air and water pollution, enforcing the wearing of seat belts and helmets, etc.

WHO Team, 2016

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Elements of Health Promotion: Health Literacy

People need to acquire the knowledge, skills and information to make healthy choices

Along with health literacy, people need to have:

Opportunities to make healthy choices
Assurance of an environment in which people can demand further policy actions to further improve their health

WHO Team, 2016

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Elements of Health Promotion: Healthy Cities

Cities have a key role to play in promoting good health

Strong leadership and commitment at the municipal level is essential to:

Healthy urban planning
Building up preventive measures in communities and primary health care facilities

From healthy cities evolve healthy countries and, ultimately, a healthier world

WHO Team, 2016

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Health Promotion Different From Disease Prevention

Disease prevention differs from health promotion because it focuses on specific efforts aimed at reducing the development and severity of chronic diseases and other morbidities.

Rural Health Information Hub, n.d. a

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Activities of Health Promotion and Disease Prevention

Vaccinations

Starting at infancy and throughout the lifespan

Healthy food choices

Intake of balanced nutrition
Avoid smoking/quit smoking
Limit alcohol intake

Staying physically active
Getting good rest and sleep
Getting regular health checkup

Screening like,

Cervical smear (Female)
Prostate exam (Male)

Body mass index
Blood pressure check, Cholesterol level

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Activities of Health Promotion and Disease Prevention

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Health Promotion and Disease Prevention Activities

Without good mental health there is no good health!¹

Activities for mental health promotion and mental illness prevention:

Early childhood interventions: Stable home environment that is emotionally supportive and developmentally stimulating¹.

Child and youth development programmes:

Life skills programmes at school¹.
Capacity to regulate emotions, enhance alternatives to risk-taking behaviours, build resilience for difficult situations and adversities, and promote supportive social environments and social networks, etc.²

WHO, 2018
WHO, 2020

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Mental Health Promotion/ Disease Prevention Activities

Mental health interventions at work: Stress prevention programmes, etc.
Women empowerment: Access to education, income generating skills, free from domestic violence, etc.
Anti-discrimination laws, campaigns.
Social support for elderly population: befriending initiatives, community and day centers for the aged, etc.
Promotion of the rights, opportunities and care of individuals with mental disorders.
Programmes targeted at vulnerable people (minorities, indigenous, migrants, affected by conflicts and disasters, etc.)

WHO, 2018

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Critical Thinking Question

How can nurses play a role in promoting health of the people?

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Nurse’s Role in Health Promotion and Disease Prevention

Position statement of American Nurses Association (n.d.) states that:

‘Nursing must expand its efforts to design and implement interventions which support promotion of health and prevention of disease/illness and disability. Preventing illness and staying well involve complex, multidimensional activities focused not only on the individual, but also on families, groups and populations. Approaches to prevention should be comprehensive, encompass primary, secondary and tertiary levels of prevention and involve consumers in their formulation…’

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Nurse’s Role in Health Promotion and Disease Prevention

Integrative review on nurse’s role in health promotion practice (Kemppainen et al, 2012) identified following nurse’s role:

Health educator
Empowerment of individual/families/communities
Managers of Health Promotion Projects

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Nurse’s Role in Health Promotion and Disease Prevention

‘Health Educator’ is a role that is ingrained in nursing profession.
Nurses provide health education both in community and hospital setting.
Nurses provides health education on:

Healthy food choices, proper nutrition, hydration
Importance of keeping physically active
Importance of vaccinations and health screenings
How to take care of newborn, vaccinations needed, milestones to look for healthy development
Healthy habits relating to prevention of communicable diseases
Safe practices to prevent sexually transmitted diseases

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Nurse’s Role in Health Promotion and Disease Prevention

Empowerment of individuals in improving their health is another important role of the nurses
Nurses empower individuals to promote their health and prevent disease through:

Providing health information and education
Referring to resources available in the community to help promote health
Helping individuals identify their strengths, and overcome weaknesses
Advocating for the rights of the individual to optimal health

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Nurse’s Role in Health Promotion and Disease Prevention

As managers of Health Promotion Projects nurses:

Plan, implement and evaluate health promotion interventions and projects.

Supervise and lead research and development actions in nursing.

Coordinate educational and developmental interventions in health-care units and communities.

(Kemppainen et al, 2012)

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Health Promotion and Disease Prevention

Health promotion needs and activities are individual to:

Age
Health status
Cultural/social norms
Occupation
Economic situation
Literacy

Examples:

Health promotion interventions for those who smoke is different to those who do not smoke

Health education on nutrition may have to be tailored keeping in consideration the cultural practice around certain foods

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Models/Theories that Guide Health Promotion

Change in the person’s attitude and behaviour is paramount for health promotion to occur

Some of the widely used theories or models that nurses can use to guide their health promotion interventions are:

Ecological Model
Health Belief Model
Stages of Change Model
Social Cognitive Theory
Theory of Reasoned Action/Planned Behavior

National Cancer Institute, 2005

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Ecological Model

‘Theory at a Glance: A Guide for Health Promotion and Practice’ states:

“Ecological perspectives emphasizes the interaction between, and interdependence of, factors within and across all levels of a health problem. It highlights people’s interactions with their physical and sociocultural environments…...”

Recognize multiple levels of influence on health behaviors, including:

Intrapersonal/individual factors: influence behavior such as knowledge, attitudes, beliefs, and personality

National Cancer Institute, 2005

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Ecological Model

Interpersonal factors: such as interactions with other people, which provide social support or create barriers to interpersonal growth that promotes healthy behavior
Institutional and organizational factors: rules, regulations, policies, and informal structures that constrain or promote healthy behaviors
Community factors: formal or informal social norms that exist among individuals, groups, or organizations, can limit or enhance healthy behaviors
Public policy factors: including local, state, and federal policies and laws that regulate or support health actions and practices for disease prevention including early detection, control, and management

National Cancer Institute, 2005

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Health Belief Model

‘Theory at a Glance: A Guide for Health Promotion and Practice’ states:

‘Health Belief Model (HBM) addresses the individual’s perceptions of the threat posed by a health problem (susceptibility, severity), the benefits of avoiding the threat, and factors influencing the decision to act (barriers, cues to action, and self-efficacy).’

National Cancer Institute, 2005

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Health Belief Model

This model argues that people are ready to act if they:

Believe they are susceptible to the condition (perceived susceptibility)
Believe the condition has serious consequences (perceived severity)
Believe taking action would reduce their susceptibility to the condition or its severity (perceived benefits)
Believe costs of taking action (perceived barriers) are outweighed by the benefits
Are exposed to factors that prompt action (e.g., a television ad or a reminder from one’s physician to get a mammogram) (cue to action)
Are confident in their ability to successfully perform an action (self-efficacy)

National Cancer Institute, 2005

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Stages of Change Model (SCM)

The Stages of Change (Transtheoretical) Model describes individuals motivation and readiness to change a behavior.

According to SCM, person moves through five stages during an attempt to change a behaviour:

Precontemplation
Contemplation
Preparation
Action
Maintenance

National Cancer Institute, 2005

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Stages of Change Model

Stages of SCM occur in the following order:

Pre-contemplation: There is no intention of taking action
Contemplation: There are intentions to take action and a plan to do so in the near future
Preparation: There is intention to take action and some steps have been taken
Action: Behavior has been changed for a short period of time
Maintenance: Behavior has been changed and continues to be maintained for the long-term
Termination: There is no desire to return to prior negative behaviors

Rural Health Information Hub, n.d.b

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Social Cognitive Theory (SCT)

SCT describes the influence of individual experiences, the actions of others, and environmental factors on individual health behaviors.

SCT provides opportunities for social support through instilling expectations, self-efficacy, and using observational learning and other reinforcements to achieve behavior change.

Rural Health Information Hub, n.d.

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Social Cognitive Theory (SCT)

Key components of the SCT related to individual behavior change include:

Self-efficacy: belief that an individual has control over and is able to execute a behavior.
Behavioral capability: Understanding and having the skill to perform a behavior.
Expectations: Determining the outcomes of behavior change.
Expectancies: Assigning a value to the outcomes of behavior change.
Self-control: Regulating and monitoring individual behavior.
Observational learning: Behavioral acquisition that occurs by watching the actions and outcomes of others’ behavior.
Reinforcements: Promoting incentives and rewards that encourage behavior change.

Rural Health Information Hub, n.d.

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Theory of Reasoned Action/Theory of Planned Behavior

Very closely associated theories which suggest that behavioural intention is the most important determinant of behaviour.

Further describes that behavioural intention is influenced by:

A person’s attitude toward performing a behavior and,
And, by beliefs about whether individuals who are important to the person approve or disapprove of the behavior (subjective norm)

National Institute of Health, 2005

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What would the nurse do?

Reflection:

How can the nurse incorporate a client’s health belief into their care?

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Cultural Considerations

Health belief influences behaviour related to health.

Beliefs about cause of illness, how illness can be cured or treated, and who should be involved in the health care process vary across cultures.

Cultural values and beliefs regarding health and illness should be considered for health promotion activities to be effective.

Canadian Paediatric Society, 2018

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Reference:

American Nurses Association. (n.d.). Promotion and disease prevention. Retrieved on 6 September 2021 from https://www.nursingworld.org/practice-policy/nursing-excellence/official-position-statements/id/promotion-and-disease-prevention/

Australian Health Promotion Association (n.d.). What is health promotion?. Retrieved on September 6, 2021 from https://www.healthpromotion.org.au/our-profession/what-is-health-promotion

Canadian Paediatric Society, Caring for Kids New to Canada. (2018, March). How culture influences health. Retrieved on September 3, 2021 from https://www.kidsnewtocanada.ca/culture/influence

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Reference:

Constitution. World Health Organization. Retrieved on September 6, 2021 from https://www.who.int/about/governance/constitution

Kemppainen, V., Tossavainen, K., & Turunen, H. (2013). Nurses’ role in health promotion practice: An integrative review. Health Promotion International, 28(4):490–501. https://academic.oup.com/heapro/article/28/4/490/556908

National Cancer Institute. (2005). Theory at a glance: A guide for health promotion activities (2nd ed.). U.S. Department of Health, National Institute of Health. http://www.sbccimplementationkits.org/demandrmnch/wp-content/uploads/2014/02/Theory-at-a-Glance-A-Guide-For-Health-Promotion-Practice.pdf

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Reference:

Rural Health Information Hub (n.d.a). Definition health promotion and disease prevention.Retrieved September 6, 2021 from https://www.ruralhealthinfo.org/toolkits/health-promotion/1/definition

Rural Health Information Hub (n.d.b). Health promotion and disease prevention theories and models. Retrieved on September 6, 2021 from https://www.ruralhealthinfo.org/toolkits/health-promotion/2/theories-and-models

University of Georgia, College of Public Health. (n.d.). What is health promotion?. Retrieved from: https://publichealth.uga.edu/departments/health-promotion-behavior/what-is-health-promotion/

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Reference:

VicHealth. (n.d.). What is Health Promotion?. Retrieved from: https://www.vichealth.vic.gov.au/media-and-resources/vce-resources/defining-health-promotion

WHO. (2018, March 30 ). Mental health: Strengthening our response. Retrieved on 6 September 2021 from https://www.who.int/news-room/fact-sheets/detail/mental-health-strengthening-our-response

WHO. (2020, September 28 ). Adolescent mental health. Retrieved on 6 September 2021 from https://www.who.int/news-room/fact-sheets/detail/adolescent-mental-health

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Reference:

WHO Team (2016, August 20 ). Health promotion: Q&A. World Health Organization. Retrieved on 6 September 2021 from https://www.who.int/news-room/q-a-detail/health-promotion

WHO (n.d.). Health Promotion. Retrieved on September 6, 2021 from https://www.who.int/health-topics/health-promotion#tab=tab_1

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