Basic and Fundamental Principles of Health Promotion - PowerPoint PPT Presentation

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Basic and Fundamental Principles of Health Promotion


Title: Health Promotion and Disease Prevention Role of FNP Author: Hector Mart nez Last modified by: Elba N. Ortiz Padilla Created Date: 7/19/2011 6:37:42 PM – PowerPoint PPT presentation

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Title: Basic and Fundamental Principles of Health Promotion

Basic and Fundamental Principles of Health
  • Prof. Elba N. Ortiz MSN FNP-BC
  • Catedrática Auxiliar
  • Programa de FNP, RCM, UPR

  • Recognize the health care trends and facts in the
  • Discuss basic and fundamental concepts and
    principles related to health promotion.
  • Compare theories related to the health promotion
    on individuals, family and community.

Health Promotion and FNP Certification Exam
  • Knowledge of
  • 1. Health promotion
  • concepts
  • Skill in
  • 2. Making appropriate health promotion
    recommendations (considering age, developmental
    level, health status, current guidelines,
    primary, secondary, and tertiary prevention

Health Care Trends
  • Changes in causes of infant mortality
  • Infectious and nutritional problems no
    infectious problem, congenital anomalies,
    perinatal events.
  • Resurgence of previously controlled infection, as
    TB and the emergency of newer infections as HIV
  • Concern on monitoring for biological agents of
  • Emphasis on disease prevention and health

  • Major causes of morbidity and mortality
  • 50 of illness related to lifestyle and unhealthy
  • Healthy People 2020
  • Preventive health services
  • Well baby care, immunizations, birth control
  • Health protection activities
  • Fluoridation, injury prevention, occupational
  • Health promotion behaviors
  • Smoking cessation, exercise, stress reduction,
  • Visit website for Health People 2020
  • http//

Healthy People 2020
  • Vision
  • A society in which all people live long, healthy
  • Mission
  • Healthy People 2020 strives to
  • Identify nationwide health improvement
  • Increase public awareness and understanding of
    the determinants of health, disease, and
    disability and the opportunities for progress.
  • Provide measurable objectives and goals that are
    applicable at the national, State, and local
  • Engage multiple sectors to take actions to
    strengthen policies and improve practices that
    are driven by the best available evidence and
  • Identify critical research, evaluation, and data
    collection needs.

Healthy People 2020
  • Overarching Goals
  • Attain high-quality, longer lives free of
    preventable disease, disability, injury, and
    premature death.
  • Achieve health equity, eliminate disparities, and
    improve the health of all groups.
  • Create social and physical environments that
    promote good health for all.
  • Promote quality of life, healthy development, and
    healthy behaviors across all life stages.

Healthy People 2020
  • Four foundation health measures will serve as an
    indicator of progress towards achieving these
  • General Health Status
  • Health-Related Quality of Life and Well-Being
  • Determinants of Health
  • Disparities

Epidemiologic Principles
  • Natural history of disease
  • Stages susceptibility (prepathological)
    presymptomatic disease (subclinical)
    clinical disease disability (or death)
  • Etiology of disease defines cause of a disease
  • Prevalence rates describes the number of persons
    in a defined group that have a disease at a
    certain point in time
  • Incidence rates rate of development of a
    disease in a group over a period of time.

Human Rights
  • Human rights are universal legal guarantees
    protecting individuals and groups against actions
    that interfere with fundamental freedoms and
    human dignity. Some of the most important
    characteristics of human rights are that they
  • guaranteed by international standards
  • are legally protected
  • focus on the dignity of the human being
  • oblige states and state actors
  • cannot be waived or taken away
  • are interdependent and interrelated and
  • are universal.
  • Source The United Nations system and human
    rights guidelines and information for the
    Resident Coordinator System, March 2000

Social determinants of health
  • The social determinants of health are the
    conditions in which people are born, grow, live,
    work and age, including the health system.

Social determinants of health
  • These circumstances are shaped by the
    distribution of money, power and resources at
    global, national and local levels, which are
    themselves influenced by policy choices.
  • The social determinants of health are mostly
    responsible for health inequities - the unfair
    and avoidable differences in health status seen
    within and between countries.

Social determinants of health
  • Responding to increasing concern about these
    persisting and widening inequities, WHO
    established the Commission on Social Determinants
    of Health (CSDH) in 2005 to provide advice on how
    to reduce them.
  • The Commission's final report was launched in
    August 2008, and contained three overarching
  • 1. Improve daily living conditions
  • 2. Tackle the inequitable distribution of power,
    money, and resources
  • 3. Measure and understand the problem and assess
    the impact of action

Health promotion (WHO, 2011)
  • Health promotion is the process of enabling
    people to increase control over, and to improve,
    their health.
  • It moves beyond a focus on individual behavior
    towards a wide range of social and environmental

Health promotion (WHO, 2011)
  • Health promotion approaches do not focus on
    illness experiences or optimal use of medical
    services. In health promotion the focus usually
    is much broader and emphasizes healthy general
    living conditions and peoples chances to live
    healthy lives. Moreover, health promotion calls
    for improving the resources people need in order
    to be active for their health, their own personal
    health, the health of their families and
    communities, including the power to change things
    for the better.

Health promotion (WHO, 2011)
  • Health literacy includes the skills to obtain and
    use appropriate knowledge about health and its
    determinants. Emphasizing the empowerment
    component in health promotion, health literacy
    approaches should also address peoples knowledge
    and skills necessary to work on and change those
    factors that constitute their health chances In
    health promotion practice, health literacy means
    to understand the conditions that determine
    health and to know how to change them.

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Prevention is more than education and goes beyond
the individual
Spectrum of Prevention
Level of Spectrum Definition of Level
1. Strengthening Individual Knowledge and Skills Enhancing an individual's capability of preventing injury or illness and promoting safety
2. Promoting Community Education Reaching groups of people with information and resources to promote health and safety
3. Educating Providers Informing providers who will transmit skills and knowledge to others
4. Fostering Coalitions and Networks Bringing together groups and individuals for broader goals and greater impact
5. Changing Organizational Practices Adopting regulations and shaping norms to improve health and safety
6. Influencing Policy Legislation Developing strategies to change laws and policies to influence outcomes
Risk Factors
  • A risk factor is any attribute, characteristic or
    exposure of an individual that increases the
    likelihood of developing a disease or injury.
    Some examples of the more important risk factors
    are underweight, unsafe sex, high blood pressure,
    tobacco and alcohol consumption, and unsafe
    water, sanitation and hygiene. (WHO, 2011)

Risk Factors
  • Age, sex, social, cultural, familial,
    occupational, lifestyle history represent
    potential sources of problem.
  • Modifiable / no modifiable
  • Risk reduction programs are established to reduce
    vulnerability of individuals to problems.

Communicable/Infectious Disease
  • Patterns in which organisms attack and invade
    vulnerable individuals
  • Reservoirs of infection
  • Cases and carriers
  • Mechanisms of Transmission of infection
  • Direct (touching, kissing, intercourse
  • Indirect air vector, water, food
  • Control Measures
  • isolation, insect spraying (reservoirs)
  • Water purification (interrupt transmission)
  • Immunization (reduce susceptibility)

Primary Care
  • Primary care is the term for the health services
    by providers who act as the principal point of
    consultation for patients within a health care
  • Depending on the nature of the health condition,
    patients may then be referred for secondary or
    tertiary care.

Primary Care
  • The World Health Organization attributes the
    provision of essential primary care as an
    integral component of an inclusive primary health
    care strategy.
  • Primary care involves the widest scope of health
    care, including all ages of patients, patients of
    all socioeconomic and geographic origins,
    patients seeking to maintain optimal health, and
    patients with all manner of acute and chronic
    physical, mental and social health issues,
    including multiple chronic diseases.

Primary Care
  • Consequently, a primary care practitioner must
    possess a wide breadth of knowledge in many
  • Continuity is a key characteristic of primary
    care, as patients usually prefer to consult the
    same practitioner for routine check-ups and
    preventive care, health education, and every time
    they require an initial consultation about a new
    health problem.
  • Collaboration among providers is a desirable
    characteristic of primary care.

Primary Care
  • Health care should be effective and safe.
    Professionals as well as the general public often
    over-rate the performance of their health
  • The emergence of evidence-based medicine in the
    1980s has helped to bring the power and
    discipline of scientific evidence to healthcare
    decision-making, while still taking into
    consideration patient values and preferences.

Primary Care
  • Primary care brings promotion and prevention,
    cure and care together in a safe, effective and
    socially productive way at the interface between
    the population and the health system.
  • In short, what needs to be done to achieve this
    is to put people first to give balanced
    consideration to health and wellbeing as well as
    to the values and capacities of the population
    and the health workers.
  • Features of health care effectiveness and
    safety, are essential in ensuring improved health
    and social outcomes.

Primary health care
  • Primary health care, often abbreviated as PHC,
    has been defined as "essential health care based
    on practical, scientifically sound and socially
    acceptable methods and technology made
    universally accessible to individuals and
    families in the community through their full
    participation and at a cost that the community
    and the country can afford to maintain at every
    stage of their development in the spirit of
    self-reliance and self-determination".

Primary health care
  • In other words, PHC is an approach to health
    beyond the traditional health care system that
    focuses on health equity-producing social
  • This ideal model of health care was adopted in
    the declaration of the International Conference
    on Primary Health Care held in Alma Ata in 1978
    (known as the "Alma Ata Declaration"), and became
    a core concept of the World Health Organization's
    goal of Health for all.

Primary health care
  • The ultimate goal of primary health care is
    better health for all. WHO has identified five
    key elements to achieving that goal
  • reducing exclusion and social disparities in
    health (universal coverage reforms)
  • organizing health services around people's needs
    and expectations (service delivery reforms)
  • integrating health into all sectors (public
    policy reforms)
  • pursuing collaborative models of policy dialogue
    (leadership reforms) and
  • increasing stakeholder participation.

Primary health care
  • Declaration of Alma-Ata International Conference
    on Primary Health Care, Alma-Ata, USSR, 6-12
    September 1978
  • The World Health Report 2008 - primary Health
    Care (Now More Than Ever)

Models of Health Promotion
Health Belief Model
  • The Health Belief Model is a health behavior
    change and psychological model developed by Irwin
    M. Rosenstock in 1966 for studying and promoting
    the uptake of health services.
  • The model was furthered by Becker and colleagues
    in the 1970s and 1980s. Subsequent amendments to
    the model were made as late as 1988, to
    accommodate evolving evidence generated within
    the health community about the role that
    knowledge and perceptions play in personal
  • Originally, the model was designed to predict
    behavioral response to the treatment received by
    acutely or chronically ill patients, but in more
    recent years the model has been used to predict
    more general health behaviors.

Health Belief Model Constructs
  • The original model included these four
  • Perceived susceptibility (an individual's
    assessment of their risk of getting the
  • Perceived severity (an individual's assessment of
    the seriousness of the condition, and its
    potential consequences)
  • Perceived barriers (an individual's assessment of
    the influences that facilitate or discourage
    adoption of the promoted behavior)
  • Perceived benefits (an individual's assessment of
    the positive consequences of adopting the
  • A variant of the model include the perceived
    costs of adhering to prescribed intervention as
    one of the core beliefs.

Health Belief Model Constructs
  • Constructs of mediating factors were later added
    to connect the various types of perceptions with
    the predicted health behavior
  • Demographic variables (such as age, gender,
    ethnicity, occupation)
  • Socio-psychological variables (such as social
    economic status, personality, coping strategies)
  • Perceived efficacy (an individual's
    self-assessment of ability to successfully adopt
    the desired behavior)
  • Cues to action (external influences promoting the
    desired behavior, may include information
    provided or sought, reminders by powerful others,
    persuasive communications, and personal
  • Health motivation (whether an individual is
    driven to stick to a given health goal)
  • Perceived control (a measure of level of
  • Perceived threat (whether the danger imposed by
    not undertaking a certain health action
    recommended is great)

The Health Belief Model.
Social Cognitive Theory
  • Social cognitive theory, used in psychology,
    education, and communication.
  • The theorists most commonly associated with
    social cognitive theory are Albert Bandura and
    Walter Mischel.

Social Cognitive Theory
  • Social cognitive theory is a learning theory
    based on the ideas that people learn by watching
    what others do and that human thought processes
    are central to understanding personality.
  • While social cognitists agree that there is a
    fair amount of influence on development generated
    by learned behavior displayed in the environment
    in which one grows up, they believe that the
    individual person (and therefore cognition) is
    just as important in determining moral

Social Cognitive Theory
  • People learn by observing others, with the
    environment, behavior, and cognition all as the
    chief factors in influencing development. These
    three factors are not static or independent
    rather, they are all reciprocal.
  • For example, each behavior witnessed can change a
    person's way of thinking (cognition). Similarly,
    the environment one is raised in may influence
    later behaviors, just as a father's mindset (also
    cognition) will determine the environment in
    which his children are raised.

Health Promotion Model
  • The health promotion model (HPM) proposed by Nola
    J Pender (1982 revised, 1996) was designed to be
    a complementary counterpart to models of health
  • It defines health as a positive dynamic state not
    merely the absence of disease. Health promotion
    is directed at increasing a clients level of
    well being.
  • The health promotion model describes the multi
    dimensional nature of persons as they interact
    within their environment to pursue health.

Health Promotion Model
  • The model focuses on following three areas
  •  Individual characteristics and experiences
  •  Behavior-specific cognitions and affect
  •  Behavioral outcomes

Health Promotion Model
  • The health promotion model notes that each person
    has unique personal characteristics and
    experiences that affect subsequent actions.
  • The set of variables for behavioral specific
    knowledge and affect have important motivational
  • These variables can be modified through nursing

Health Promotion Model
  • Health promoting behavior is the desired
    behavioral outcome and is the end point in the
  • Health promoting behaviors should result in
    improved health, enhanced functional ability and
    better quality of life at all stages of
  • The final behavioral demand is also influenced by
    the immediate competing demand and preferences,
    which can derail an intended health promoting

Health Promotion Model
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