HEALTH PROMOTIONHEALTH PROMOTIONHealth promotion is a process of enabling Health promotion is a process of enabling

people to increase control over the people to increase control over the determinants of health and thereby determinants of health and thereby improve their health. WHO (1986) Ottawa improve their health. WHO (1986) Ottawa CharterCharter

Participation is essential to sustain health Participation is essential to sustain health promotion actionpromotion action

STRATEGIES FOR HEALTH STRATEGIES FOR HEALTH PROMOTIONPROMOTION

AdvocacyAdvocacy for health to create the for health to create the essential conditions for health,essential conditions for health,

EnablingEnabling all people to achieve their full all people to achieve their full health potentials, andhealth potentials, and

MediatingMediating between the different interests between the different interests in society in the pursuit of healthin society in the pursuit of health

Health Promotion ModelHealth Promotion Model(Nola Pender,1996)(Nola Pender,1996)

Individual characteristics and experiences Individual characteristics and experiences can be useful in predicting if an individual can be useful in predicting if an individual will incorporate and use health related will incorporate and use health related behaviors. behaviors.

“ “ If a behavior has been used before and If a behavior has been used before and becomes a habit, it is more likely to used becomes a habit, it is more likely to used again.”again.”

Behavior- specific knowledge, beliefs and Behavior- specific knowledge, beliefs and relationships – major motivators for relationships – major motivators for engaging in health behaviors.engaging in health behaviors.

A health related behavior is initiated by A health related behavior is initiated by committing to a plan of action, committing to a plan of action, accompanied by developing associated accompanied by developing associated strategies to perform the value behavior.strategies to perform the value behavior.

HEALTH PROMOTION MODEL (HPM) – HEALTH PROMOTION MODEL (HPM) – NOLA PENDERNOLA PENDER

Conceptualized that motivation to Conceptualized that motivation to participate in health promoting behavior is participate in health promoting behavior is influenced by cognitive-perceptual factors influenced by cognitive-perceptual factors and modifying factorsand modifying factors

COGNITIVE-PERCEPTUAL COGNITIVE-PERCEPTUAL FACTORS INCLUDES:FACTORS INCLUDES:

Importance of healthImportance of health Perceived control of healthPerceived control of health Self efficacySelf efficacy Definition of healthDefinition of health Perceived health statusPerceived health status Perceived benefits of health promoting Perceived benefits of health promoting

behaviorsbehaviors Perceived barriers to health promoting behaviorsPerceived barriers to health promoting behaviors

HEALTH PROMOTION HEALTH PROMOTION THEORYTHEORY

Self-efficacySelf-efficacy It is a belief that one has the capabilities to It is a belief that one has the capabilities to

execute the courses of actions required to execute the courses of actions required to manage prospective situations. manage prospective situations.

Example:Example:A person with high self-efficacy may engage A person with high self-efficacy may engage

in a more health related activity when an in a more health related activity when an illness occurs, whereas a person with low illness occurs, whereas a person with low self-efficacy would harbor feelings of self-efficacy would harbor feelings of hopelessness.hopelessness.

Therefore:Therefore:Self efficacy is Self efficacy is the ability or the the ability or the power to power to produce an produce an effect/ change. effect/ change.

Psychologist Albert Bandura has defined Psychologist Albert Bandura has defined self-efficacy as one's belief in one's ability self-efficacy as one's belief in one's ability to succeed in specific situations. to succeed in specific situations.

One's sense of self-efficacy can play a One's sense of self-efficacy can play a major role in how one approaches goals, major role in how one approaches goals, tasks, and challenges. tasks, and challenges.

According to Bandura's theory, people with According to Bandura's theory, people with high self-efficacy:high self-efficacy:are those who believe they can perform wellare those who believe they can perform wellare more likely to view difficult tasks as are more likely to view difficult tasks as

something to be mastered rather than something to be mastered rather than something to be avoided.something to be avoided.

How self-efficacy affects human How self-efficacy affects human functionfunction

Choices regarding behaviorChoices regarding behavior People will be more inclined to take on a task People will be more inclined to take on a task

if they believe they can succeed. People if they believe they can succeed. People generally avoid tasks where their self-efficacy generally avoid tasks where their self-efficacy is low, but will engage in tasks where their is low, but will engage in tasks where their self-efficacy is high. self-efficacy is high.

Motivation People with high self-efficacy in a task are People with high self-efficacy in a task are

more likely to make more of an effort, and more likely to make more of an effort, and persist longer, than those with low efficacy.persist longer, than those with low efficacy.

Thought patterns & responses Thought patterns & responses Low self-efficacy can lead people to believe Low self-efficacy can lead people to believe

tasks are harder than they actually are. tasks are harder than they actually are. People with high self-efficacy often take a People with high self-efficacy often take a

wider overview of a task in order to take the wider overview of a task in order to take the best route of action. best route of action.

People with high self-efficacy are shown to be People with high self-efficacy are shown to be encouraged by obstacles to make a greater encouraged by obstacles to make a greater effort. effort.

Self-efficacy also affects how people respond Self-efficacy also affects how people respond to failure. to failure.

A person with a high self-efficacy will attribute A person with a high self-efficacy will attribute the failure to external factors, where a person the failure to external factors, where a person with low self-efficacy will attribute failure to with low self-efficacy will attribute failure to low ability. low ability.

Health Behaviors Health Behaviors Health behaviors such as non-smoking, Health behaviors such as non-smoking,

physical exercise, dieting, condom use, dental physical exercise, dieting, condom use, dental hygiene, seat belt use, or breast self-hygiene, seat belt use, or breast self-examination are, among others, dependent on examination are, among others, dependent on one’s level of perceived self-efficacy (Conner one’s level of perceived self-efficacy (Conner & Norman, 2005). & Norman, 2005).

Self-efficacy beliefs are cognitions that Self-efficacy beliefs are cognitions that determine whether health behavior change determine whether health behavior change will be initiated, how much effort will be will be initiated, how much effort will be expended, and how long it will be sustained in expended, and how long it will be sustained in the face of obstacles and failures. the face of obstacles and failures.

Self-efficacy influences the effort one puts Self-efficacy influences the effort one puts forth to change risk behavior and the forth to change risk behavior and the persistence to continue striving despite persistence to continue striving despite barriers and setbacks that may undermine barriers and setbacks that may undermine motivation. motivation.

Self-efficacy is directly related to health behavior, but Self-efficacy is directly related to health behavior, but it also affects health behaviors indirectly through its it also affects health behaviors indirectly through its impact on goals. impact on goals.

Self-efficacy influences the challenges that people Self-efficacy influences the challenges that people take on as well as how high they set their goals (e.g., take on as well as how high they set their goals (e.g., "I intend to reduce my smoking," or "I intend to quit "I intend to reduce my smoking," or "I intend to quit smoking altogether"). A number of studies on the smoking altogether"). A number of studies on the adoption of health practices have measured self-adoption of health practices have measured self-efficacy to assess its potential influences in initiating efficacy to assess its potential influences in initiating behavior change (Luszczynska, & Schwarzer, 2005). behavior change (Luszczynska, & Schwarzer, 2005).

TYPES OF HEALTH TYPES OF HEALTH PROMOTIONAL ACTIVITIESPROMOTIONAL ACTIVITIES

HEALTH EDUCATION (information HEALTH EDUCATION (information dissemination)dissemination)Use of variety of media to offer information to Use of variety of media to offer information to

the public about the particular lifestyle choices the public about the particular lifestyle choices and personal behavior, the benefits of and personal behavior, the benefits of changing that behavior and the improvement changing that behavior and the improvement of quality of lifeof quality of life

FIVE PRIORITY ACTIONS AREAFIVE PRIORITY ACTIONS AREA

Build healthy public policy;Build healthy public policy;Create supportive environments for health;Create supportive environments for health;Strengthen community action for health;Strengthen community action for health;Developed personal skills;Developed personal skills;Re-orient health servicesRe-orient health services

Jakarta Declaration on Leading Jakarta Declaration on Leading Health Promotion into the 21Health Promotion into the 21stst

Century (1997)Century (1997)

Strategies and action areas are Strategies and action areas are relevant for all countriesrelevant for all countries

Comprehensive approaches to health Comprehensive approaches to health development are most effective.development are most effective.

Setting for health offer practical Setting for health offer practical opportunities for the implementation of opportunities for the implementation of comprehensive strategies.comprehensive strategies.

Participation is essential to sustain efforts.Participation is essential to sustain efforts.Health literacy fosters participations.Health literacy fosters participations.

Five PrioritiesFive PrioritiesPromote Promote social responsibility for healthsocial responsibility for health;; Increase Increase investments for health investments for health

developmentdevelopment;;Expand Expand partnerships for health partnerships for health

promotionpromotion;; Increase Increase community capacity and community capacity and

empower the individualsempower the individuals;;Secure an Secure an infrastructures for health infrastructures for health

promotionpromotion

ACTIVITIES FOR HEALTH ACTIVITIES FOR HEALTH PROMOTIONPROMOTION

HEALTH APPRAISAL WELLNESS HEALTH APPRAISAL WELLNESS ASSESSMENT PROGRAMASSESSMENT PROGRAMAppraise individuals of their risk factors that Appraise individuals of their risk factors that

are inherited in their lives/family in order to are inherited in their lives/family in order to motivate them to reduce specific risk and motivate them to reduce specific risk and develop positive health habitsdevelop positive health habits

Wellness assessment programs are focused Wellness assessment programs are focused on more positive methods of enhancementon more positive methods of enhancement

LIFE-STYLE AND BEHAVIOR CHANGE LIFE-STYLE AND BEHAVIOR CHANGE PROGRAMPROGRAMBasis for changing behaviorBasis for changing behaviorGeared towards enhancing the quality of life Geared towards enhancing the quality of life

and extending the life spanand extending the life span

WORKSITE WORKSITE WELLNESS WELLNESS PROGRAMPROGRAM Includes programs that Includes programs that

serve the needs of the serve the needs of the persons in their work persons in their work placesplaces

ENVIRONMENTAL ENVIRONMENTAL CONTROL CONTROL PROGRAMPROGRAM Developed to address Developed to address

the growing problem of the growing problem of environment pollution environment pollution such as air, land, such as air, land, water etc.water etc.

DISEASE PREVENTIONDISEASE PREVENTIONDisease prevention covers measures not Disease prevention covers measures not

only to prevent the occurrence of only to prevent the occurrence of diseases, such as risk factor reduction, but diseases, such as risk factor reduction, but also to arrest it progress and reduce its also to arrest it progress and reduce its consequences once established. WHO consequences once established. WHO (1984)(1984)

Disease prevention is sometimes used as Disease prevention is sometimes used as

a complementary term alongside health a complementary term alongside health promotion.promotion.

Although there is frequent overlap Although there is frequent overlap between the content and strategies, between the content and strategies, disease prevention is defined saparetly.disease prevention is defined saparetly.

Disease prevention is considered to be Disease prevention is considered to be actions which usually emanates from actions which usually emanates from health sector, dealing with individuals and health sector, dealing with individuals and populations identified as exhibiting populations identified as exhibiting identifiable risk factors, often associated identifiable risk factors, often associated with different risk behaviors.with different risk behaviors.

LEVELS OF DISEASE LEVELS OF DISEASE PREVENTIONPREVENTION

PRIMARY LEVELPRIMARY LEVELDirected towards preventing the initial Directed towards preventing the initial

occurrence of disease.occurrence of disease.Decreases the risk or exposure of Decreases the risk or exposure of

individual and community to disease.individual and community to disease.Example:Example:

Health education about accident and poisoningHealth education about accident and poisoning

Health education about standards of nutrition and Health education about standards of nutrition and growth and development, exercise requirements, growth and development, exercise requirements, stress management, protection against stress management, protection against occupational hazard.occupational hazard.

ImmunizationImmunizationRisk assessments for specific diseaseRisk assessments for specific diseaseFamily planning services and family counselingFamily planning services and family counselingEnvironmental sanitation and provision of Environmental sanitation and provision of

adequate housing, recreation and work conditionsadequate housing, recreation and work conditions

SECONDARY LEVELSECONDARY LEVELFocus on early identification of health Focus on early identification of health

problem and prompt intervention to problem and prompt intervention to alleviate health problems.alleviate health problems.

Includes prevention of complications and Includes prevention of complications and disabilities.disabilities.ExampleExample

Screening surveysScreening surveys

Encouraging regular medical and dental Encouraging regular medical and dental examinationexamination

Teaching self-examination for breast and testicular Teaching self-examination for breast and testicular cancercancer

Assessing growth and development of childrenAssessing growth and development of childrenMaintaining skin integrity, turning, positioning, Maintaining skin integrity, turning, positioning,

exercising client, ensuring adequate rest and exercising client, ensuring adequate rest and sleep, food and fluid intake, elimination, sleep, food and fluid intake, elimination, administering medical therapies such as administering medical therapies such as medicationsmedications

TERTIARY LEVELTERTIARY LEVELBegins after illness, when defect or Begins after illness, when defect or

disability is fixed or determined to be disability is fixed or determined to be irreversibleirreversible

Focus to help rehabilitate individuals and Focus to help rehabilitate individuals and restore hem to an optimal level of restore hem to an optimal level of functioning within the constraints of the functioning within the constraints of the disabilitydisability

Example:Example:Referring client to a support groupReferring client to a support groupTeaching diabetic client to prevent complicationsTeaching diabetic client to prevent complicationsReferring client to rehabilitation centerReferring client to rehabilitation center

BAHAVIOR ASSOCIATED WITH BAHAVIOR ASSOCIATED WITH LEVELS OF PREVENTIONLEVELS OF PREVENTION

PRIMARYPRIMARYQuit smoking and avoid alcohol intakeQuit smoking and avoid alcohol intakeRegular exercise and eat well balance dietRegular exercise and eat well balance dietReduce fat and increase fiber intakeReduce fat and increase fiber intakeTake adequate fluid intakeTake adequate fluid intakeMaintain ideal body weightMaintain ideal body weightComplete immunization programComplete immunization programAvoid over exposure to sunlight and wear Avoid over exposure to sunlight and wear

protective gear at work placeprotective gear at work place

SECONDARYSECONDARYHave annual health examinationHave annual health examinationRegular pap’s test for womenRegular pap’s test for womenMonthly BSE for women (20 and up)Monthly BSE for women (20 and up)Sputum examination for tuberculosisSputum examination for tuberculosisAnal stool guaiac test and rectal examination Anal stool guaiac test and rectal examination

for client 50 y.o. and abovefor client 50 y.o. and above

TERTIARYTERTIARYSelf monitoring of blood glucose among Self monitoring of blood glucose among

diabetic clientdiabetic clientPhysical therapy after CVAPhysical therapy after CVAParticipate in cardiac rehabilitation after MIParticipate in cardiac rehabilitation after MI