Topic Eleven

Health Promotion


Goals: 

Overview:

 What is Health Promotion?

The Development of Health Promotion in Canada

            The goals of health promotion in Canada

            Health Promotion Mechanisms

Improving health promotion by applying principles of psychology

            Prominent theories in health psychology applied to health promotion

            The social psychology of health promotion

            The elaboration likelihood model of persuasion

            Fear appeals: An example of health promotion by peripheral route

            The application of other social-psychological principles to health promotion

The Precede-Proceed Model

Assessing the effective of health promotion programmes      

 


Health Promotion

 What is Health Promotion?

WHO defines it as "the process of enabling people to increase control over,
and to improve, their health" (Ottawa Charter for Health Promotion, 1986).

 

As such increased control over and states of health can be altered
 or achieved through many different methods.

 

Health Promotion strategies may involve individual cognitive and behavioural
management techniques as well as social engineering and international politics. 
 E.g., go smoke free, international HIV/AIDS awareness campaigns. See Lubek et al.

 

The Development of Health Promotion in Canada

Early history of health in Canada (1700s) was focused on keeping clean cities
through sewers and later sanitary hospitals. 

 

 More recently this has involved public education about proper sanitation
and other aspects of health and health behaviours.

 

Recent programs have included (1971) ParticipAction for increase physical fitness,
(1973) Hole in the Fence to fight drug use, and (1976) Dialogue on Drinking.


 Others include: Sun Smart, Heart Health, and Healthy Communities.

 

For a summary of Health promotion and the main issues and characteristics
 of programmes see <Figure 8-1>

 

While a national program it still has a focus on the individual and his or her
 responsibility for taking a role in personal health, locus of control on the person.
This also included both self-care and mutual aid. 


 

Labonte (1987) offers a three-level framework for community oriented health promotion.
 

1) Medical level focuses on disease, initial diagnosis as well as treatment.
 

2) Public Health level involves behavioural interventions that will work
towards health promotion, e.g., safe sex, sun screening, exercise, etc.
 

3) Socio-environmental level includes: social  change and public policy.
Here the emphasis is on bringing change through legislation and adjustments
to the living landscape or setting (toxins, living conditions, food availability).    

 

 Prevention is the central concern here and money saving along with better health is also an important consideration.


 

            The goals of health promotion in Canada

Main goal is to promote better health among all Canadians through a bio-psycho-social model of health.


This include individual psychology (self-care), collective sociology (community strengthening)
as well as geography (healthy environments).

 

Health Challenges: Equity is one of the biggest challenges facing healthcare. For many years the goal of an equitable and universal healthcare has been sought.

It has been found, however, that poor and Aboriginal people tends to have more health concerns and higher mortality rates that the more wealthy Canadians.
 <see box 8-1-p. 189>

NEw attention is being paid to first, Nations or Aboriginal Health Issues
i.e. Health Canada and the Department of Indian Affairs regarding a range of areas
 from housing and water to disease control and even experimental studies on diet
and well-being (i.e., Oolichan Grease).

 

Age and occupation are also reviewed by Poole et al. indicating that inequities exist
in proneness to disease for these and other categories or classes of people.


 

            Health Promotion Mechanisms

Three main areas of interest are found in health promotion: self-care, mutual aid, & environmental care. 
 

Self-Care involves diet, exercise, risk behaviours, voluntary screening, & regular checkups.


Mutual Aid
refers to the help and support from friends and family and community in achieving health goals and behavioural change.

 

The Locus of Responsibility must be placed on the citizen for his or her health,
yet, government can still provide information, encouragement and support for that.


The financial benefits to provincial and federal governments can be huge if successful.  

 

E.g., Obesity is an ever growing problem in North America where more and more adults
 and now children are raising he prevalence rates for it nationally (Canadian Health Network). 
This leads to heart and circulatory diseases as well as type II diabetes.

 

Other areas include Pap test for cervical cancer, which has been in the decline since the introduction of a program of regular testing in BC in the 1970s with reduced death rates (Health Canada).

 

Likewise, campaigns to reduce smoking have also shown to rely on a blend of self-care and mutual aid.


The problem of addiction, arises here to complicate matters, where the social support
and informational change may pale in light of the physiological addiction.  
 

 Combined approaches are needed where physiological, social, behavioural and
 cognitive interventions together will be more likely to lead to cessation. 
 

While the individual is focused on self-care and bio-medical issues,
others around them can focus on social support.

 

Social Support can be simple or complicated in nature,
including naturally occurring and agency-provided support.
 

Naturally occurring support involves the casual or coordinated support
 of friends, family and acquaintances.
 

Agency-Provided Support involves the professional support services
of an organization focused on specific care or support providing. 
This may come from support groups or paid providers in one or more of three forms...

 

Practical (tangible) Support - including  everyday activities, duties or therapeutic needs.

Informational Support - including diagnosis, treatment, options and prognosis.

Emotional Support - including "being there" or someone to talk to, helping to raise mood, get distracted, be calmed or feel reassured.

 

In summary, Poole et al. identify two goals for health promotion in Canada:

1) Fostering public participation

2) strengthening community health services

Each programme will have a target group and a set of manageable goals.


 

Improving health promotion by applying principles of psychology

Central to Health Psychology is the application of psychological theory or principals to issues of health. Here behavioural, attitudinal and social theory is important.

       Prominent theories in health psychology applied to health promotion

Health Belief Model (review)  Theory of Reasoned Action (review) Theory of Planned Behaviour (review) all involve three key elements:
 1) importance of beliefs about vulnerability;
2) efficacy of a given course of action;
3) high value or regard for health. 

 

Health promotion programmes will provide information about likelihood of threat
 as well as a suitable course of action, and assume that health is valued.

 

TRA & TPB suggest a cost-benefit analysis by the individual.
 

They can be tipped Eg. ParticipACTION focusing on the positive message of fun,
excitement and benefits of exercise.  As indicated in the interview on the archival
participACTION the positive message of activity and exercise were brought out in
 BODYBREAK after it was first brought forward as a programme.

 This, and other techniques from social psychology surround the topic of persuasion.


 

            The social psychology of health promotion


Persuasion involves the successful attempt to alter someone's attitude,
and hopefully also their behaviour. 
 

Attitudes are thoughts or cognitions that have an evaluative (judging) component. 
 Several theories in psychology suggest that attitudes have a causal effect on behaviours.

 

Health promotion involves the manipulation of attitudes through, behavioural,
 informational, and social means.

 

            The elaboration likelihood model of persuasion

ELM of persuasion suggests there are two routes to attitudinal change: Central and peripheral.
 

Central route entails a rational, logical plea for attitudinal change. Statistics and argument are said to sway beliefs and attitudes with logical, rational (scientific) medical facts.
 

Peripheral route involves emotional appeal through fear (or excitement) to get the message across.  Charisma and charm can play a role too, as in politics.

 

Individual differences exist in preference or susceptibility to either approach; e.g., monitors & blunters, reactive vs. rational; thinking vs. feeling. Learning Styles. &Types

 

            Fear appeals: An example of health promotion by peripheral route

Fear appeals provide people with fearful information about their health with
the expectation that they will be motivated to change by the fear. 

They are designed to provide a heightened threat perception,
 increase in perception of vulnerability.

 

Drive-reduction theory suggests that animals will work to reduce the drive
 (thirst, hunger, sex, fear) through appropriate behaviours to reduce tension.

 

Problems with Fear Appeals are largely that high arousal, of fear, will lead to fear reduction
 and not the health behaviour. Such conditions may also lead to a decline in perceptions
 of efficacy in light of the disorganisation of a fear state.

 

e.g.,

Response efficacy is one's belief that a given behaviour will reduce the threat.

 

Self-efficacy refers to one's confidence in oneself to be able to carryout the needed actions.  Fear, anxiety and arousal can reduce self-confidence and efficacy.

 

 

Parallel Response Model  suggests that those who have experienced a fear message will response with fear control or damage control. 

While the fear control removes the acute stressors, only damage control can reduce vulnerability (risk) and benefit health.

 

Emotion-focused coping tends to be more of a fear reduction approach,
 while problem-focused coping tends to be more in line with danger control

 

Extended parallel process model considers the amount of fear as well as the presence of a compensatory behaviour to reduce the threat.

 


 

            The application of other social-psychological principles to health promotion

Persuasion studies suggest that repetition is very important for instilling change or manipulating attitudes and behaviours.

 

The source of the message is also important where credibility is linked to persuasion.

Popularity, appeal, likability, ....

 

Central Route approaches will tend to use authorities from their field, e.g., doctors, police, ...

 

Peripheral Routes will tend to use popular or appealing sources.

 

Multi-Route programmes will combine these and other source, message, & medium influences in conjunction with social and behavioural approaches.

 

Knowledge of the audience is also crucial to successful health promotion campaigns.  Not only does the individual learning or response style vary, but so does the normative or cultural style.

 

The place of health beliefs, attitudes and behaviours in a larger context of cultural values, practices and worldviews suggests that health is part of a larger bio-psycho-social network.

 

Changes that affect or challenge one's everyday experiences will be resisted or ignored.

 

 

Favourable or unfavourable audiences will respond to different types of message.

If initially positive only positive message is needed, however, if initially negative then a two sided presentation is needed to deflect counter arguments raised in response to the message.

 

Knowledgeability of audience will also play a role in terms of level of jargon used and mode of presentation (written, oral, visual, ...).

 

Language choice and comprehension of message.  First, second or third language?


 

The Precede-Proceed Model

A theoretical framework designed to help health promotion professionals to plan, structure and implement a programme of health promotion.
 

It also enables the evaluation of existing or developing programmes. Table 8-2 provides an overview of the precede-proceed model. 

 

 

Assessing the effectiveness of health promotion programmes

 

Fawcett et al. (2001) identify 12 challenges in evaluating health promotion programmes.

 

Poole et al, four part evaluation process

1) health and social outcomes - quality of life, ability to function independently, reduced morbidity, morbidity

2) intermediate health outcomes - lifestyle, provision of health services, environment

3) health promotion outcomes - literacy, community capacity, health policy

4) health promotions actions  - processes such as: health education programmes & political lobbying

 


Introduction to Chinese Medicine