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

Copyright © 2008 Delmar. All rights reserved. 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

Copyright © 2008 Delmar. All rights reserved. 3 Healthy People 2010 Policies Intervention

Copyright © 2008 Delmar. All rights reserved. 4 Holistic Concept of Health Nursing and public health view of health as a holistic concept –Encompasses Physical Psychological Social Spiritual dimension

Copyright © 2008 Delmar. All rights reserved. 5 Smith Model of Health Four models: 1.Clinical health 2.Role performance health 3.Adaptive health 4.Eudaemonic health

Copyright © 2008 Delmar. All rights reserved. 6 Pender Actualization of inherent and acquired human potential through –Goal directed behavior –Competent self care –Satisfying relationships while maintaining structural integrity with environments

Copyright © 2008 Delmar. All rights reserved. 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

Copyright © 2008 Delmar. All rights reserved. 8 Health Promotion History Nursing’s meta-paradigm –Person Environment –Health Nursing

Copyright © 2008 Delmar. All rights reserved. 9 Health Promotion History 1973 –ANA Standards of Nursing Practice 1979 –Healthy People: Surgeon General’s Report on Health Promotion and Disease

Copyright © 2008 Delmar. All rights reserved. 10 Theoretical Foundations Behavioral Model –Behavior is a function of the rational decision making process –Lewin Positive valence Negative valence Value expectancy theory

Copyright © 2008 Delmar. All rights reserved. 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

Copyright © 2008 Delmar. All rights reserved. 12 Pender’s Health Promotion Model Pender modified the Health Belief Model Integrates concepts from HBM and social cognitive theory Revised in 2002

Copyright © 2008 Delmar. All rights reserved. 13 Pender’s Health Promotion Model Concepts grouped in three major categories: 1. Individual characteristics and experiences Prior-related behavior Personal factors

Copyright © 2008 Delmar. All rights reserved. 14 Pender’s Health Promotion Model Concepts grouped in three major categories 2. Behavior-specific cognitions and affect Perceived benefits Perceived barriers to the action

Copyright © 2008 Delmar. All rights reserved. 15 Pender’s Health Promotion Model Concepts grouped in three major categories 3. Perceived self-efficacy Activity related affect Interpersonal influences Situational influences –Behavioral outcome

Copyright © 2008 Delmar. All rights reserved. 16 Theory of Planned Behavior Extension of the theory of reasoned action Intention Attitude Subjective norm Perceived behavioral control Outcome expectancy

Copyright © 2008 Delmar. All rights reserved. 17 Transtheoretical Model of Behavioral Change Individuals progress through stages during behavioral change process –Precontemplation stage –Contemplation stage –Preparation stage –Action stage –Maintenance stage

Copyright © 2008 Delmar. All rights reserved. 18 Transtheoretical Model of Behavioral Change Three constructs that influence behavior change: 1.Process of change 2.Self-efficacy 3.Decisional change

Copyright © 2008 Delmar. All rights reserved. 19 Ecological Models Social Cognitive Theory –Triadic reciprocal determinism –Outcome expectancies

Copyright © 2008 Delmar. All rights reserved. 20 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

Copyright © 2008 Delmar. All rights reserved. 21 Ecological Models Ecological model of health behavior –Five system levels 1.Intrapersonal 2.Interpersonal 3.Organizational 4.Community 5.Public policy

Copyright © 2008 Delmar. All rights reserved. 22 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

Copyright © 2008 Delmar. All rights reserved. 23 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

Copyright © 2008 Delmar. All rights reserved. 24 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

Copyright © 2008 Delmar. All rights reserved. 25 Social Marketing Uses marketing strategies to create an advantage for changing behavior –Three concepts: Audience segmentation Marketing 4 Ps Marketing mix