Trends in Health Promotion

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Trends in Health Promotion

• Module Objectives
• Consider definitions of health for individuals,
  families, communities
• Identify levels of illness prevention
• Review current studies about health promotion
• Identify research agenda for the future related
  to health promotion

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Nola J. Pender, PhD, RN, FAAN
Professor Associate Dean for Research Director,
Child/Adolescent Health Behavior Research
Center University of Michigan School of
Nursing                      
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HEALTH (Pender, 1996)

• the actualization of inherent acquired human
  potential through goal-directed behavior,
  competent self-care, satisfying relationships
  with others while adjustments are made as needed
  to maintain structural integrity harmony with
  relevant environments
• health is a manifestation of person environment
  interactional patterns that become increasingly
  complex throughout the life span

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HEALTH (Pender, 1996)

• Family health (viability of family unit)
• a state of cohesiveness in which nurturance
  resources necessary for personal growth
  sustenance in the face of lifes challenges are
  available to family members
• Community health (accident rates, immunization
  rates, mortality)
• the meeting of collective needs through problem
  identifying managing interactions within the
  community between the community the larger
  society

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Health Promotion

• According to World Health Organization, HP
  includes
• encouraging healthy lifestyles
• creating supportive environments for health
• strengthening community action
• reorienting health services
• building healthy public policy

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Health Promotion

• strategies related to individual lifestyle and
  personal choices
• recognition that choices are made in a social
  context
• motivated by desire to increase well-being
  actualize human potential

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Health Promotion Assessment(Tanner, 1991)

• nutrition
• exercise fitness
• stress management
• family planning, sexual history
• tobacco use
• alcohol chemical substance abuse
• exposure to environmental hazards injury
• psychological, spiritual, social resources

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American Nurses Association Social Policy
Statement (1995)

• Nursing involves practices that are restorative,
  supportive, and promotive in nature
• Promotive practices
• mobilize healthy patterns of living
• foster personal and family development
• support self-defined goals of individuals,
  families, and communities.

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Illness Prevention - Health Protection

• Primary
• prevention of occurrence of illness/injury
• e.g., vaccines, control of exposures
• Secondary
• early detection of disease while asymptomatic to
  prevent or lessen symptomatic clinical state
• e.g., case finding, use of INH for recent tb
  positive converter

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Illness Prevention - Health Protection (cont.)

• Tertiary
• treatment of an existing symptomatic illness to
  lessen its effects, delay progress, prevent
  complications
• e.g., control of diabetes, cardiac rehab
• All levels motivated by desire to actively avoid
  illness, detect illness early, or maintain
  functioning within constraints of illness

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Comparing ConceptsDorothea Orem (2001) Nursing
concepts of practice

• Health Promotion
• assumption of baseline health maintenance
• focus on moving person to improved state of
  health and well-being

• Health Maintenance
• primary, secondary, tertiary prevention measures
• evaluation of general and specific health status
• focus on sustaining person in functional state

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Shifting Paradigms

• moving away from a cure orientation
• health promotion based on fear
• moving toward a care orientation, even though the
  importance of cure is retained
• health promotion based on empowerment, achieving
  self-actualization
• more inclusive paradigm of health

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Perspectives on Health PromotionStokols, D.
(1996) American Journal of Health Promotion.

• behavioral change lifestyle modification
• focus is on change in persons behaviors, e.g.,
  smoking, seat belt or helmet use
• but, active interventions difficult to maintain
• environmental enhancement restructuring
• intent is to reduce toxic or injurious
  conditions, e.g., air pollution, ozone depletion
• but, approach doesnt account for individuals

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Perspectives (cont.)

• Social Ecological analyses of health promotion
• ecology study of relationships between
  organisms their environments
• social ecology notes importance of physical,
  social, cultural contexts of person/environment
  relations
• human health influenced by environment personal
  attributes

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Using Social Ecology to Guide Community Health
Promotion

• recognize interactive effects of person
  environment factors
• e.g., risk for respiratory disease increased with
  both personal behaviors workplace exposure
  beyond risk with either factor alone
• use active, behavioral interventions with
  passive, environmental interventions to promote
  community health
• e.g., smoking cessation workplace legislation

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Levels of Health Outcomes

• Los Angeles Regulation XV
• Plan to increase of persons ridesharing to work
• Short-range or personal outcomes
• decrease stress from solo driving in rush hour
  traffic
• Middle-range or community outcomes
• improve air quality, reduce smog-related resp.
  ailments
• Long-range or global outcomes
• reduce production of gases from fossil fuel
  consumption, curb global warming

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Askari et al., (1998)Health Education
Behavior, 25, 146-159

• Healthy Neighborhoods Project
• questioned problem solving focus by outsiders
  where clients learn helplessness, isolation,
  dependency
• Disempowerment linked to poor health
• low income groups 60 more likely to die from
  preventable/treatable diseases (e.g., TB,
  pneumonia)
• Root causes of poor nutrition, high smoking and
  alcohol abuse rates are lack of social
  participation, weak community ties
• Goal ? socialization to ? better community health

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Counseling for Health

• Objectives of counseling
• change health behaviors improve health status
• Behavior change can result from simple counseling
  interventions
• Self-efficacy (confidence in ability to affect
  own health) increases likelihood of success
• Since counseling is safe and of low cost, the US
  Preventive Services Task Force recommends
  routinely addressing many behaviors, in a variety
  of settings

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Sheahan (2000)Journal of Nursing Scholarship,
32, 245-250

• Documentation of health risks health promotion
  counseling by emergency dept. NPs and MDs
• 305 nonacute pt records reviewed for risk
  documentation smoking, alcohol, ?BP, obesity,
  dental caries community health promotion model
• Findings (age range 18-77 yrs, mean33 yrs)
• 59 had 1 or more risk factors
• 22 of these patients got HP counseling
• NPs slightly more likely to do smoking cessation
  counseling than MDs, same otherwise

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Benson Latter (1998)Journal of Advanced
Nursing, 27, 100-107

• Highlight necessity for integration of
  interpersonal skills and health promotion
• Previous HP paradigm
• authoritarian, prescriptive
• communication from expert???lay person
• New paradigm
• empowering, client-centered, collaborative
• partnership communication model

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Burbank, Pakula, Nigg (2000)Journal of
Gerontological Nursing, 26(3), 26-33

• Using theory (Transtheoretical Model) to guide
  change in health behaviors of older adults
• Precontemplation (no intention) ? awareness of
  need
• Contemplation (plan change in 6 mo) ? motivation
• Preparation (change in 30 days) negotiate plan
• Action (initiated recent change) reaffirm
  commitment
• Maintenance (doing change for 6 mo or gt)
  problem-solving against relapse

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Macdonald (2000)Health Education Journal, 59,
3-11
A new framework for collection evaluation of
evidence about health promotion practices
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Research Opportunities(Woolf et al., 1996, pg.
577)

• ...one of the most important areas for research
  in the social, behavioral, and biologic domains
  is the elucidation of the biobehavioral pathway
  to enhanced self-efficacy. When we understand
  that central element of our humanity, we will
  truly enter the golden age of health promotion
  and disease prevention.

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What is the role of APNs in health promotion?
Dr. Penders response

• APNs must take leadership in incorporating the
  findings of research about health promotion into
  clinical practice protocols and into community
  partnerships programs.
• Researchers - with APNs - can use the latest
  knowledge about behavior change determinants of
  particular health or risky behaviors to develop
  anticipatory guidance and counseling protocols.
• Protocols must be developmentally and
  culturally appropriate e.g., the meanings and
  determinants of health behaviors are likely to
  differ across early, middle, late adolescence
  adulthood.
• APNs can play a pivotal role in creating
  partnerships among scientists, practitioners
  consumers to develop appropriate care strategies
  for specific populations.
• We must understand the dynamics of behavior
  through our research to build interventions with
  high potential effectiveness.