Basic and Fundamental Principles of Health Promotion

1
Basic and Fundamental Principles of Health
Promotion

• Prof. Elba N. Ortiz MSN FNP-BC
• Catedrática Auxiliar
• Programa de FNP, RCM, UPR

2
Objectives

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

3
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
  strategies)

4
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
  terrorism
• Emphasis on disease prevention and health
  promotion

5
Facts

• Major causes of morbidity and mortality
• 50 of illness related to lifestyle and unhealthy
  decisions.
• Healthy People 2020
• Preventive health services
• Well baby care, immunizations, birth control
• Health protection activities
• Fluoridation, injury prevention, occupational
  safety
• Health promotion behaviors
• Smoking cessation, exercise, stress reduction,
  diet
• Visit website for Health People 2020
• http//www.hhs.gov.healthypeople2020

6
Healthy People 2020

• Vision
• A society in which all people live long, healthy
  lives.
• Mission
• Healthy People 2020 strives to
• Identify nationwide health improvement
  priorities.
• 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
  levels.
• Engage multiple sectors to take actions to
  strengthen policies and improve practices that
  are driven by the best available evidence and
  knowledge.
• Identify critical research, evaluation, and data
  collection needs.

7
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.

8
Healthy People 2020

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

9
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.

10
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

11
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.

12
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.

13
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
  recommendations
• 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

14
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
  interventions.

15
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.

16
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.

17
(No Transcript)
18
Prevention is more than education and goes beyond
the individual
19
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
20
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)

21
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.

22
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)

23
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
  system.
• Depending on the nature of the health condition,
  patients may then be referred for secondary or
  tertiary care.

24
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.

25
Primary Care

• Consequently, a primary care practitioner must
  possess a wide breadth of knowledge in many
  areas.
• 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.

26
Primary Care

• Health care should be effective and safe.
  Professionals as well as the general public often
  over-rate the performance of their health
  services.
• 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.

27
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.

28
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".

29
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
  policy.
• 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.

30
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.

31
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)

32
Models of Health Promotion
33
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
  responsibility.
• 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.

34
Health Belief Model Constructs

• The original model included these four
  constructs
• Perceived susceptibility (an individual's
  assessment of their risk of getting the
  condition)
• 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
  behavior).
• A variant of the model include the perceived
  costs of adhering to prescribed intervention as
  one of the core beliefs.

35
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
  experiences)
• Health motivation (whether an individual is
  driven to stick to a given health goal)
• Perceived control (a measure of level of
  self-efficacy)
• Perceived threat (whether the danger imposed by
  not undertaking a certain health action
  recommended is great)

36
The Health Belief Model.
37
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.

38
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
  development.

39
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.

40
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
  protection.
• 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.

41
Health Promotion Model

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

42
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
  significance.
• These variables can be modified through nursing
  actions.

43
Health Promotion Model

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

44
Health Promotion Model