1. Health Promotion & those who are homeless
Denise Proudfoot
FEB 2011

2. 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).

3. 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.

4. 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)

5. 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.

6. 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.

7. 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.

8. 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.

9. 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.

10. 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

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

12. 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.

13. 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.

14. 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

15. 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?

16. 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

17. 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.

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

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

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

21. 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

22. 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

24. 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

25. 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?

26. 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.

27. 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.

28. 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

29. 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

30. 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?

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

32. 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.

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

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

35. 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.

36. 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