Copyright © 2008 Delmar. All rights reserved. Chapter 13 Principles of Health Promotion

Copyright © 2008 Delmar. All rights reserved.

Chapter 13

Principles of Health Promotion


2

Healthy People 2010

• Health of the total population and the consequences of the determinants of health:– Biology– Behavior– Social environment– Physical environment– Policies– Intervention


3

Healthy People 2010

• Policies

• Intervention


4

Holistic Concept of Health

• Nursing and public health view of health as a holistic concept– Encompasses

• Physical• Psychological• Social • Spiritual dimension


5

Smith Model of Health

• Four models:1. Clinical health

2. Role performance health

3. Adaptive health

4. Eudaemonic health


6

Pender

• Actualization of inherent and acquired human potential through – Goal directed behavior– Competent self care– Satisfying relationships while maintaining

structural integrity with environments


7

Health Promotion History

• WHO Ottawa Charter

• Multidisciplinary practice

• Florence Nightingale (1859) wellness-illness continuum– Promoted health through education – Nursing care included personal living and

healthful environments


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• Nursing’s meta-paradigm– Person

• Environment

– Health• Nursing


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• 1973– ANA Standards of Nursing Practice

• 1979 – Healthy People: Surgeon General’s Report on

Health Promotion and Disease


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Theoretical Foundations

• Behavioral Model– Behavior is a function of the rational decision

making process– Lewin

• Positive valence• Negative valence

• Value expectancy theory


11

Health Belief Model

• Based on value expectancy theory

• Rosenstock (1966) added variables to the model– Variables that explain or predict behavior:

• Susceptibility• Severity • Barriers• Cues to action


12

Pender’s Health Promotion Model

• Pender modified the Health Belief Model

• Integrates concepts from HBM and social cognitive theory

• Revised in 2002


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• Concepts grouped in three major categories:1. Individual characteristics and experiences

• Prior-related behavior• Personal factors


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• Concepts grouped in three major categories2. Behavior-specific cognitions and affect

• Perceived benefits• Perceived barriers to the action


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• Concepts grouped in three major categories

3. Perceived self-efficacy• Activity related affect• Interpersonal influences• Situational influences

– Behavioral outcome


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Theory of Planned Behavior

• Extension of the theory of reasoned action

• Intention

• Attitude

• Subjective norm

• Perceived behavioral control

• Outcome expectancy


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Transtheoretical Model of Behavioral Change

• Individuals progress through stages during behavioral change process – Precontemplation stage– Contemplation stage– Preparation stage– Action stage– Maintenance stage


18

Transtheoretical Model of Behavioral Change

• Three constructs that influence behavior change:

1. Process of change

2. Self-efficacy

3. Decisional change


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Ecological Models

• Social Cognitive Theory– Triadic reciprocal determinism– Outcome expectancies


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Ecological Models

• Bandura self-efficacy expectations– Developed from four sources of information:

1. Enactive attainment

2. Vicarious experiences

3. Verbal persuasion

4. Physiological or emotional arousal


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Ecological Models• Ecological model of health behavior

– Five system levels1. Intrapersonal

2. Interpersonal

3. Organizational

4. Community

5. Public policy


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Other Ecological Frameworks

• Integrative Model for Community Health Promotion and the Structural Model of Health Behavior (SMHB)– Three foci of care:

• Illness/disease prevention• Health promotion• Illness care


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Other Ecological Frameworks

• SMHB includes four factors that influence health at the population level– Availability/accessibility of consumer products– Physical structures– Social structures and policies– Media and cultural messages


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Focus on Population

• Emphasis is on lowering the average risk of all individuals in the community

• Three approaches:1. Framework for health communication

programs

2. PRECEDE-PROCEED model

3. Social Marketing


25

Social Marketing

• Uses marketing strategies to create an advantage for changing behavior– Three concepts:

• Audience segmentation• Marketing 4 Ps • Marketing mix

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Copyright © 2008 Delmar. All rights reserved. Chapter 13 Principles of Health Promotion