of programmes see <Figure 8-1>
. 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.
60 year old Swede Body Break Do it!
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 their
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 First nations and Inuit Health 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
Persuasioninvolves the successful attempt to alter someone's
attitude,
and hopefully also their behaviour.
Consider the Target group (Audience), Source of information, Medium of transmission, narure of the Message.
(as outlined below)
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
