Health Promotion and Health

Education
Health Promotion
• helping people develop resources to maintain
health and enhance their knowledge.
• the process of enabling people to increase
control over and to improve their health
(Ottawa Charter)
Health Promotion
• First Use of The Term Health Promotion
Occurred in 1945
• “Health is promoted by providing a decent
standard of living, good labor contains,
education, physical culture, means of rest and
recreation.”
-Henry E. Sigeret
Four (4) Major Tasks of Medicine
1. The Promotion of Health
2. The Prevention of Disease
3. The Restoration of the Sick
4. Rehabilitation
Health Promotion
• 1986 – The who, health and welfare Canada
and the Canadian Public Health Association
organized an international convention on
health promotion.
• The result of the conference was the Ottawa
Charter for Health Promotion.
Ottawa Charter for Health
Promotion
• guiding principle in health promotion

• Health is a positive concept emphasizing

social and personal resources as well as
physical capacities.
• Health promotion is not just the responsibility
of health sector but goes beyond lifestyles to
well-being.
Task of an Individual to Reach a
State of Health:
1. Identify and realize aspiration
2. Satisfy needs
3. To change or cope with the environment.
Prerequisite for Health
• fundamental conditions and resources for
health
• Improvement in health requires a secure
foundation in the basic prerequisites.
Prerequisite for Health
1. Peace
2. Shelter
3. Education
4. Food
5. Income
6. A Stable Eco-System
7. Sustainable Resources
8. Social Justice
9. Equity
Ottawa Charter Action Area
• to operationalize the concept of health
promotion
Ottawa Charter Action Area
1. Build Healthy Public Policy
• Health promotion beyond health care
• Health on agenda of p makers
• Health promotion policy combines diverse but
complementary approaches including:
e. Legislation
f. Fiscal measures
g. Taxation
h. Organizational charge
• Coordinated actions that leads to healthy income and social
policies that foster great equity
• Identify obstacles to the adaptation of healthy public policy
in non-health sectors and ways of removing them.
 Ottawa Charter Action Area
2. Create Supportive Environments
• The extricable links between people and their environment
constitutes the basis for a socio-ecological approach to health.
• The overall guiding principle for all is the need to encourage
reciprocal maintenance- to take care of each other, our
communities and our national environment.
• Conservation of natural resources should be emphasized as a
global responsibility.
• Health promotion generates living and working conditions
that are safe stimulating satisfying and enjoyable.
• Systematic assessment of health impact of rapidly changing
environment is essential must be followed by actions to
ensure positive benefits to public health.
• The protection of the natural and built environment and
conservation of natural resources must be addressed in any
health promotion strategy.
Ottawa Charter Action Area
3. Strengthen Community Action
• Health promotion works through concrete and effective
community action in setting priorities, making decisions,
planning strategies and implementing them to achieve better
health.
• Empowerment of communities is the heart of this process.
• Community development draws an existing human and
material resources in the community to enhance self-help and
social support and to develop flexible system for strengthening
public participation in and direction of healthy ministers.
• Requires full and continuous access to information, learning
opportunities for health as well as finding support.
Ottawa Charter Action Area
4. Develop Personal Skills
• Health promotion supports personal and social
development through providing information,
education for health and enhancing life skills.
• Increase the options available to people to exercise
more control over their own health and over their
own environment and to make choices conducive
to health.
• Enabling people to learn throughout life, to prepare
themselves for all of its stage and to cope with
chronic illness and injuries is essential.
 Ottawa Charter Action Area
5. Reorient Health Services
• The responsibility for health promotion in health
services is shared among individual community groups,
health professionals health services, institutions and
government.
• The role of the health sector must move increasingly in
health promotion direction, beyond its responsibility for
providing clinical and curative services.
• Health services need to embrace and expanded mandate
which is sensitive and respects cultural needs.
• Requires stronger attention to health research as well as
changes in professional education and training.
WHO Principles of Health
Promotion
1. Health Promotion involves the population as a
whole in the context of their everyday life, rather
than focusing on people risk from specific
disease.
2. Health Promotion is directed towards action on
determinants or cause of health. This requires a
close of health. This requires a close cooperation
between sectors beyond health care reflecting the
diversity of conditions which influence health.
WHO Principles of Health
Promotion
3. Health Promotion combines diverse but
complementary approaches, including
communication, education, legislation, fiscal
development and spontaneous local activities
against health hazards.
4. Health Promotion aims particularly at effective
and concrete public participation. This requires
the further development of problem-defining and
decision-making life skills, both individually
and collectively and promotion of effective
participation mechanism.
WHO Principles of Health
Promotion
5. Health Promotion is primarily a societal and
political venture and not a medical services
although health professionals have an
important role in advocating and enabling
health promotion.
• “ Mediating strategy between people and their
environments, synthesizing personal choice
and social responsibility in health”
-WHO
HEALTH EDUCATION
• Any combination of learning experience designed
to facilitate voluntary adaptation of behavior
conducive to health. (Green et.al. 1980)
• The process of assisting individuals acting
separately or collectively to make informed
decisions about matters affecting the personal
health and of others. ( National Task Force on the
Preparation and Practice of Health Educators.)
Scope of Health Education
• Covers continuity of the levels of
prevention.
• All the programs thrusts of the health care
delivery system have corresponding health
education/promotion components.
Labels for Health Education
Programs and Activities:
1. Dissemination of health information
2. Communication
3. Social marketing
4. Motivation programs
5. Behavior modification
6. Health counseling
Health Education Setting
a. Formal
b. Informal/Incedental
Location/ Places for Health
Education:
1. Health centers
2. Clinics
3. Hospitals
4. Health maintenance organization
5. School
6. Communities
7. Worksite
8. Food establishments
9. Entertainment establishments
THEORIES RELATED TO
HEALTH PROMOTION
Theory – a plausible or scientifically acceptable
general principle offered to explain observed
facts.
– A hypothesis assumed for the sake of argument or
investigation.
Model – visual representation of the concept that
work together to become a theory.
– A pattern of something to be made
THEORIES RELATED TO
HEALTH PROMOTION
1. Health Belief Models
a. Rosenstock’s Health Belief Model
b. Becker’s Health Belief Model
2. Health Locus of Control Model
3. PENDER’S Health Promotion Theory/Model
4. BADURA’S Self Efficacy Theory/Model
THEORIES RELATED TO
HEALTH PROMOTION
5. Health Behavior Change Model
(Transtheoritical Model of Behavior Change)
6. Theory of Planned Behavior
7. Theory of Social behavior
8. Protection Motivation Theory
9. O’Donnell Model of Health Behavior
 Health Locus of Control
• Determines client action regarding health, and
that health status is under one’s own health or
others control.
• Plays role in the clients choices about health
behaviors, can be used to predict which people are
at most likely to change their behavior.
• The result of the assessment of the health locus
of control of a client can be used to plan internal
reinforcement training necessary to improve
client’s effort towards better health.
•
Types of Locus of Control:
1. Internal – People who believes that they have
a major influence on their health status.
– Health is largely self- determined in this type of
control
– Clients initiates for own health care, knowledge
and adhere to prescribe health care regimens.
2. External – People who believe that their
health is largely controlled by outside forces.
 Health Belief Model
1. Rosenstock’s Health Belief Model
– Health Belief Model is intended to predict which individual
would/wouldn’t use such preventive measures.
– Assumed that good health is an objective common to all people.
– Emphasize on predicting individual preventive health behavior
– Based on an individual’s ideas about and appraisal or perceived
benefits compared to perceived barriers and costs of taking a
health action.
– Suggest that a person’s susceptibility to a health threat and its
seriousness influence the decision to engage in a preventive
health behavior.
– Helps to identify the strength and weakness of the individual
that could affect the success of a plan of action for disease
prevention.
 Health Belief Model
2. Becker’s Health Belief Model
– Based on motivational theory
– Assumed that positive health motivation should be
considered to attain good health.
– Modifies the Health Belief Model of Rosenstock’s to
include the following
Components:
a. Individual Perception
b. Modifying Factors
c. Variables Likely to Affect Initiating
Action/Likehood of Action
 Pender’s Health Promotion Model
• Is a competence or approach-oriented model
that depicts the multideminsional nature of
persons interacting with their interpersonal and
physical environments as they pursue health.
• Focused on health promoting behaviors rather
than health protection or illness prevention
behaviors.
Variables of Health Promotion Model

1. Individual characteristics and experience – an

individuals unique factors or characteristics and
experiences will depend on the target behavior for
health promotion
Includes the following:
C. Personal factor
– Biological
– Psychological
– Socio-cultural
D. Prior related behavior
– Previous experience
– Knowledge
– Skills in health promoting actions
Variables of Health Promotion Model

2. Behavioral –specific cognitions and affect

– Constitute critical core for intervention because
this can be modified through nursing interventions.

Includes the following:

D. Perceived benefits of action
– anticipated benefits or outcome affect the persons
plan to participate in health-promoting behaviors
and may facilitate continued practice (can be
affected by experience/vicarious experience).
Variables of Health Promotion Model
B. Perceived barriers to action
– person’s perceptions about available time, inconvenience
expense and difficulty performing the activity may act as a
barrier (decrease commitment to a plan of action).
C. Perceived self-efficacy
– the conviction that the person can successfully carryout the
behavior necessary to achieve a desired outcome (serious
doubt about capabilities decrease effort and give-up)
D. Activity related affect
– the subjective feelings that occur before, during, and
following an activity influence a person to repeat again or
maintain behavior.
Variables of Health Promotion Model

E. Interpersonal influence – perception of the person

concerning the behavior, beliefs or attitudes of
others.
– Includes expectations of significant others, social
support and learning through observing others.
Sources of interpersonal Influences:
3. Family
4. Peers
5. health professionals
(sources of interpersonal influence can affect the
person’s health –promoting behaviors)
Variables of Health Promotion Model
F. Situational Influence – direct and indirect
influence on health-promoting behaviors
– A person is apt to perform health-related
behaviors if the environment is comfortable
versus feeling of alienation.
Includes the following:
3. Perception of available options
4. Demand characteristic
5. Aesthetic features of the environment
Variables of Health Promotion Model
3. Commitment to a plan of action
– The interest of a person in carrying-out
and reinforce health-promoting behaviors
Involves 2 process:
A. Commitment – good intention
B. Identifying specific strategy – Actual
performance of the behavior
4. Immediate competing demands and preferences
– situations that the person is experiencing in
everyday life that could affect the control of
health-promoting behaviors.
Involves 2 types of control:
A. Low control
B. High control
Variables of Health Promotion Model

5. Behavioral outcome
– Directed towards attaining positive health
outcome for the client
– Should result in improved health and
better quality of life at all stages of
development.
Bandura’s Self-Efficacy Theory
• Self – efficacy theory of Albert Bandura

• Self- efficacy – perception/belief of a person

about his own capabilities to produce effect.

• Self-regulation – exercise of influence over

one’s own motivation, thought process
emotional state and patterns of behavior.
 Bandura’s Self-Efficacy Theory
Sources of self-efficacy
- Self efficacy is developed by four (4) main
source of influence
4 main source of influence
1. Mastery of Experience/performance
accomplishment
2. Vicarious Experience provided by social models
3. Social persuasion (Support/Motivation from
significant others)
4. Reduction of stress reactions and alter negative
emotional proclivities and interpretation of
physical and emotional traits.
 “Strong sense of efficacy
enhances human
accomplishment and
personal well-being in many
ways.”
Efficacy- Activated processes
• There are 4 major psychological
processes through which self-belief of
efficacy affect human functioning.
4 Major Psychological Processes:
1. Cognitive Process – thinking process,
involve acquisition, organization and
use of information
– Most course of actions are initially
organized in thought.
4 Major Psychological Processes:
2. Motivational Process – cognitive generated
-Activation to action

Level of motivation:
5) Choice of course of action
6) Intensity
7) Persistence of effort
4 Major Psychological Processes:
Motivation processes is covered by 3 types of
Self-Influence:
2) Self-satisfying
3) Self- dissatisfying reactions to one’s
performance
4) Perceived self efficacy
5) Readjustment of personal goal based on
one’s progress
4 Major Psychological Processes:
3. Affective Process – process regulating
emotional state and elicitation of emotional
reactions.
- The stronger the sense of self-efficacy the
bolder people are in taking on taxing and
threatening activities.

7. Selection Process – the choices the person

make that cultivate different competencies,
interest and social network that determines
life courses.
“Self- Efficacy is concerned with people’s
beliefs in their capabilities to exercise
control over their own functioning and
over events that affect their lives.”
Health Behavior Change Model
(Transtheoritical Model of Behavior Change)
– A cyclic phenomenon in which people
progress through several stages.
– This model can be used in the assessment
of the person’s readiness to perform
health-promoting behaviors through
identifying the stages of behavior change.
Health Behavior Change Model
(Transtheoritical Model of Behavior Change)
3 Elements of Health Behavior Change Model
2) Thought
3) Action
4) Time
Stages of Health Behavior Change:
1. Precontemplative stage – the person in this
stage typically denies having a problem,
views others having a problem and
therefore wants others to change their
behavior
– Do not think about changing behavior, nor
interested in information about the behavior.
– May have previous experience of failures
– Takes months to years in precontemplation
Stages of Health Behavior Change:
2. Contemplative stage- the person acknowledge having a
problem, seriously consider changing behavior actively
gathering information and verbalizes plan to change
the behavior in the near future.
– The person may not be ready to commit to action
– Transition to the next stage of behavior change begins
when the person is observed of doing the following:
i. Focusing on the solution rather than the problem
v. Think more about the future than the past

– Takes months to years in contemplation

Stages of Health Behavior Change:
3. Preparation stage – occurs when the
person undertakes cognitive and
behavioral activities that prepare the
person for change
– Making of final plans to accomplish the change
– Starting to take small behavioral changes
Stages of Health Behavior Change:
4. Action stage – occurs when the person
actively implements behavioral and
cognitive strategies to interrupt previous
behavioral patterns and adopt new ones.
– Requires the greatest commitment of time and
energy.
Stages of Health Behavior Change:
5. Maintenance stage – integration of newly
adopted behavior patterns into lifestyle.
– Last until person no longer experience
temptation to return to previous unhealthy
behavior.
– Without strong commitment to maintenance a
relapse to precontemplative or contemplative
stage may occur.
Stages of Health Behavior Change:
6. Termination/ Continual maintenance stage the
ultimate goal where the individual has
complete confidence that the problem is no
longer a temptation or threat.
Theory of Planned Behavior
• control of behavior is not always voluntary
and that a type of behavior control
continuum exist with lack of control at one
end and extending to total control at the
other end.
Components:
3) Resources
4) Support
5) Skills needed for certain behavior
Theory of Social Behavior
• introduce the concept of habit in that it
distinguishes behavior under the individual’s
control from behavior that has become
automatic or habit.
• The likehood of health behavior action is
further influenced by the connection between
physical arousal (physiologic effects, the habit
has on the body) and Facilitating conditions
(supporting effects, favors the change).
Protection Motivation Theory
• is a Fear-driven model, proposed that a perceived
threat to health activates thought processes
regarding the severity of the threatened event, the
probability of its occurrence, and coping
mechanisms.
• Motivation to protect results from the perception
of the threat and the ability or self-efficacy for
coping
• Oriented more towards disease prevention than
health promotion.
Protection Motivation Theory
Components:
2) Vulnerability
3) Severity
4) Response efficacy
5) Self-Efficacy
 O’Donnell Health Behavior Model
• shows how intentions toward a particular
behavioral beliefs, health values, belief in
those that prescribe or support referent
( desired behavior) and motivation to
comply with the referents
• A composite of theory of planned behavior,
theory of social behavior , health belief and
health promotion model