Health Promotion & those who are homeless Denise Proudfoot FEB 2011

Health promotion …is a process directed towards enabling people to take action. Thus, health promotion is not something that is done on or to people; it is done by, with and for people either as individuals or as groups. It is more than the management and treatment of diseases. It encompasses political health ( standing up for oneself).

What is Health Promotion ? There are various definitions of this concept as it is a contested area. The process of enabling people to increase control over their health and its determinants, and thereby improve their health (WHO,2005) It focuses on activities to improve health and prevent disease.

Health Promotion has also been considered a ‘magpie profession’(Seedhouse,1997) as it borrows techniques,models and theories from a variety of disciplines including medicine,sociology,politics and epidemiology’ Health Promotion can be used as an umbrella term to cover all interventions that promote health,including health education” (Naidoo & Wills,1994) “Health Promotion as actions and interventions to support and enhance people’s health” (Katz et al ,2000)

The WHO proposed 5 key principles for Health Promotion Health Promotion involves the population as a whole. Health Promotion is directive towards the causes or determinants of health so to enhance the environment to be conducive to the health of those who live there. Health Promotion combines a diverse combination of approaches to address the health needs of those it is trying to help.

It supports the principles of self help(empowerment) to encourage people to manage their own health. It embraces the notion that all health professionals have a responsibility to nuture, enable and promote health.

MODEL OF HEALTH PROMOTION : TANNAHILL’S MODEL OF HEALTH PROMOTION (DOWNIE et al – 1990) 5 6. Positive health protection, e.g. workplace smoking policy. 7. Health education aimed at positive health protection, e.g. lobbying for a ban on tobacco advertising. 1. Preventive services, e.g. immunization, cervical screening, hypertension case finding, developmental surveillance, use of nicotine chewing gum to aid smoking cessation. 2. Preventive health education, e.g. smoking cessation advice and information. Health education 7 2 4 6 1 Health protection Prevention 3 3. Preventive health protection, e.g. fluoridation of water. 4. Health education for preventive health protection, e.g. lobbying for seat belt legislation. 5. Positive health education, e.g lifeskills with young people.

Health Education, prevention and Health protection are seen as an all inclusive process Health Promotion. This model is useful to describe what goes on in practice,the scope of health promotion activities and the potential in other areas for practice.( Naidoo & Wills ,1999). However it does not give and insight as to why a practitioner would choose one approach over an other.

Interpreting the model Preventive services -Breast Screening,Vaccinations. Preventive Health Education-smoking cessation advice. Preventive Health Protection-Fluoridation of water Health education for Preventive health protection-lobbying for seat belt legislation Positive Health Education-lifeskills work with young mothers. Positive Health Protection- workplace stress management policy Health education aimed at positive health protection-lobbying for a ban on tobacco advertising.

Healthy social and physical environment MODEL OF HEALTH PROMOTION : THE CONTRIBUTION OF EDUCATION TO HEALTH PROMOTION (TONES et al – 1990) Public pressure Healthy public policy Lobbying Advocacy Mediation Healthy social and physical environment Empowered participating community Healthy promoting organisation HEALTH Healthy services Critical consciousness raising Agenda setting Healthy choices Professional education Education for health

Components of Health Promotion There are 3 main components of Health Promotion. (a) Prevention, (b)Health Education and (c)Healthy Public Policy

Prevention of ill health can be described under three levels Primary prevention attempts to eliminate the possibility of getting a disease e.g no smoking areas/vaccinations Secondary prevention aim to detect and treat a disease at an early stage e.g alcohol awareness/breast screening. Tertiary prevention aims to minimise the effects of an established disease e.g Hip replacement surgery.

Needs Assessment in Health Promotion To be effective in health promotion a practitioner must have a clear understanding of the health needs of the community with which they are working with or intend to work with. Needs must be prioritised because of resources available.

Bradshaw’s Taxonomy of Need Bradshaw (1972) wrote about social need and classified needs into four categories. Normative need Felt need Expressed need Comparative need

Assessing Health Needs What sort of need is it? Who decided that there is a need? What grounds are there for deciding that there is a need? What are the aims of and the appropriate response to the need?

Barriers to health promotion Isolation Lack of targeted initiatives Materials require high levels of literacy Low self esteem/expectations ( Power et al,1999) Diversity of group

Health Literacy Health literacy is the term used to describe people’s ability to understand and communicate health information and make informed decisions. The aim of the MSD/NALA Health Literacy Initiative is to increase peoples understanding of health literacy and develop tools which help both the general public and the healthcare community to address and overcome this issue.

Low literacy occurs in: People who left school early People who experienced learning difficulties People for whom English is not their mother tongue.

Adults with low literacy struggle with: Essential health information Medication instructions Consent forms Signage AND do not feel part of decision making

One in four Irish adults has a difficulty with everyday reading( NLA)

Issues for people with poor literacy: Poor awareness of literacy issues Too much emphasis on the written word Terminology too technical (Campaign for Plain English) Not enough visual aids

Plain English Campaign Before High-quality learning environments are a necessary precondition for facilitation and enhancement of the ongoing learning process. After Children need good schools if they are to learn properly

Alternative methods of conveying messages: Verbal – Individual meetings, lectures and seminars Visual – Posters, illustrated pages and cartoons. Leaflets with pictures. Models Dramatic art – Theatre, dance, role play Audio – Radio, cassette, tape and CD Audiovisual – Television, film, video and DVD Interactive – Computer programmes

When considering health related behaviour the following are important: The individuals view about: the cause and prevention of ill health The extent in which they feel control of their health and life. Whether they believe change is necessary Whether change is perceived to be beneficial in the long term out weighting any difficulties and problems which may be involved. How does this relate to those who are homeless?

The Health Belief Model (Rosenstock,1966) This is probably the best known model of behaviour change. It concentrates on the role beliefs have in decision making. It has been used to predict protective health behaviour such as uptake of vaccinations/screening and compliance with medical advice. This model suggest that two factors influence health behaviour change (a) it’s feasibility and (b) its benefits weighted against its costs.

Within this model for behaviour change to happen an individual must; have an incentive to change feel threatened by their current behaviour feel a change would be beneficial to them in some way and have few adverse consequences. Feel competent to carry out the change.

The Stages of Change Model( Prochaska & DiClemente ,1984,1986) This model views change as been cyclical. It identifies five stages of change Pre-contemplation Contemplation Preparing to change Making the change Maintenance

The Pre-requisites of Change The change must be self-initiated. The behaviour must be come salient The salience of the behaviour must appear over a period of time. The behaviour is not part of the individuals coping strategies The individuals life should not be problematic or uncertain. Social support is available

The Stages of Change Model differs from the other models in that it focuses on how people change rather than why people do not change. Prochaska et al (1992) do acknowledge that while few people will go through change in an orderly way they will go through each phase. This model also allows for relapse as been part ot the process of change rather than seeing it as failure on the individuals part. Can you relate this model to working on behaviour change with your clients?

Are homeless people healthy? Why bother? What can be achieved?

Health and those who are homeless The precarious health of many people experiencing homelessness, particularly those rough sleeping, is well documented. People experiencing homelessness are poorer access to healthcare services.

Health topics that are applicable to Homeless people Diet Personal Hygiene ( Oral health) Exercise Drug & alcohol Smoking Sexual health Mental health/wellbeing.

In group of 3 select one health issue and brainstorm ways to address it with your client group.(10 mins) Feedback

Applying health promotion to the homeless. Consider the client group/setting you work with and address the following What scope do you have to improve their health? What changes could make a difference to their health ? What models of health promotion are applicable to your setting/clients? Is health behaviour change possible with your clients if so give examples of how this may applied in your setting.

REFERENCES: www.nala.ie www.plainenglish.co.uk Naidoo J & Wills J ( 2009) Foundations for Health Promotion (Public Health and Health Promotion (3rd edition) Healthy Hostels (2001) CRISIS ( on moodle). Power et al(1999) Health, Health promotion and homelessness BMJ 318,pg590-92