Lecture 4: Approaches to Health Promotion (A) Dr J. Sitali MPH 541 Lecture 4: Approaches to Health Promotion (A) Dr J. Sitali

Lecture Outline Recap of relevant key concepts Introduction Disease prevention approach Education approach Empowerment approach Social change approach

Recap of Relevant Key Concepts Concept of health Measuring health Determinants of health Health inequalities Understanding health promotion

Introduction Diversity in concepts of health, determinants of health and ways of measuring health gives rise to the different approaches to health promotion. Approaches are not a guide to action. They reflect different ways of working. The best approach varies. In practice approaches are mixed.

Choice of Approach Will depend on: Resources Time Expertise Sponsors

General Framework Theoretical background Aim Methods Evaluation

Disease Prevention Approach Also called medical approach Theoretical background: Underpinned in western medical model of health Does not seek positive health. sees medical interventions as the key to attaining health. Does not acknowledge social and environmental dimensions of health.

Disease Prevention Approach Aims: Reduce morbidity. Reduce premature mortality. Note: Targets whole populations. Special focus on high-risk groups.

Disease Prevention Approach Methods: Primary prevention: Prevention of onset of disease. Secondary prevention. Preventing the progression of disease. Tertiary prevention. Reduce further disability and suffering in those already ill.

Class Discussion Point Give practical examples of the following disease prevention interventions: Primary prevention. Secondary prevention. Tertiary prevention.

Disease Prevention Approach Evaluation: Short term: Uptake of an intervention. Long term: a reduction of morbidity and mortality.

Disease Prevention Approach This approach is popular because: Uses scientific methods. Prevention is cheaper than treatment. It’s a top – down (expert lead) intervention. A lot of Success in public health has resulted from the use of this approach.

Class Group Exercise Clearly define a health problem that is amenable to the disease prevention approach. Highlight how you would use the disease prevention approach to tackle this problem under the headings: Theoretical background. Aim(s) Method(s) Evaluation

Educational Approach Theoretical background: Acknowledges the influence of lifestyle, social and environmental factors on health. Based on the premise that education will lead to increase in knowledge, which will lead to a change in attitude, which in turn will lead to a change in behavior.

Educational Approach Aim: To empower people so that they gain control of their social determinants of health by enabling them to make informed choices about their health by: Provision of knowledge and information. Development of necessary skills.

Educational Approach Note: The Educational approach: Does not set out to persuade or motivate change in a particular direction. [Education] will always have an outcome. This approach allows clients to make their own choices.

Educational Approach Methods: Increase in knowledge/ information. Information pamphlets Lectures/ counseling Posters TV/ Radio adverts

Educational Approach Methods: Increase in skill. Role playing. Drama. Demonstrations.

Educational Approach Note: The methods employed here are based on psychological theories of learning that state that learning involves three aspects: Cognitive (information and understanding) Affective (attitude and feelings) Behavioral (skills)

Educational Approach Evaluation: Measure increase in knowledge. Questionnaire. Test/ exam. Verbal feedback. Surveys

Educational Approach Evaluation: Assess change in skill. Observe in natural setting. Practical exam/ test. Role play. Feedback.

Class Group Exercise Clearly define a health problem that is amenable to the Educational approach. Highlight how you would use the Educational approach to tackle this problem under the headings: Theoretical background. Aim(s). Method(s). Evaluation.

Empowerment Approach Theoretical background: Acknowledges the influence of social and environmental factors on health. Champions principles of community development. Be clear to distinguish between self- and community- empowerment.

Empowerment Approach Aim: To facilitate people’s identification of their health concerns and help them gain control of their lives by acquiring the necessary skills and confidence needed to act upon their concerns.

Empowerment Approach Note: To be empowered, people need to: Recognize and understand their powerlessness. See the need for change. Feel capable of making change. This is a bottom-up approach.

Empowerment Approach Methods: Formal participation in decision-making. Community action. Facilitating processes which equip. Professional and community interface. Strategic support.

Empowerment Approach Evaluation: Difficult to evaluate – it’s a long term strategy. How to ascertain the reason for change? Often, the results of this approach are vague

Empowerment Approach Two useful ways to evaluate: Outcome Evaluation: Extent to which specific aims have been met. Process Evaluation: degree to which the group has gelled.

Class Group Exercise Clearly define a health problem that is amenable to the Empowerment approach. Highlight how you would use the Empowerment approach to tackle this problem under the headings: Theoretical background. Aim(s). Method(s). Evaluation.

Social Change Approach Also called the radical health promotion approach. Theoretical background: Acknowledges the role of socio-economic environment in determining health. Health is strongly influenced by social factors. Focus is at policy or environmental level.

Social Change Approach Note: It’s a top – down approach. The poor experience the greatest ill health. Low socio – economic groups have the higher proportions of unhealthy tendencies.

Social Change Approach Aim: To bring about changes in the physical, social and economic environment which will have the effect of promoting health. Making the healthy choice the easier choice. Need to change cost, availability and or accessibility of the healthier choice.

Social Change Approach Methods: Top – down methods. Skills required include: Lobbying Policy planning Negotiating implementation

Social Change Approach Evaluation: Difficult to evaluate – it’s a long term strategy. How to ascertain the reason for change? Often, the results of this approach are vague

Social Change Approach Evaluation: Outcomes: legislation, organizational or regulatory changes. Process: Extent of partnership working & profile of health issues on common agendas.

Class Group Exercise Clearly define a health problem that is amenable to the social change approach. Highlight how you would use the social change approach to tackle this problem under the headings: Theoretical background. Aim(s). Method(s). Evaluation.

The end!