health promotion models
TRANSCRIPT
HEALTH PROMOTION MODELS DESY INDRA YANI
COMMUNITY HEALTH NURSING DEPARTMENT FACULTY OF NURSING
UNIVERSITAS PADJADJARAN
Health Promo>on l HP is the science and art of helping people change their lifestyle to move toward a state of op>mal health
l Op>mal health is defined as a balance of physical, emo>onal, social, spiritual, and intellectual health
l Lifestyle change can be facilitated through a combina>on of efforts to enhance awareness, change behavior and create environments that support good health prac>ces.
l Of the three, suppor>ve environments will probably have the greatest impact in producing las>ng changing
Four Paradigms of Health Promo>on (Caplan and Holland, 1990)
Mode of Health Promo>on Interven>on
Models of Health: The Progression l Biomedical model
l Focused on the physiological determinants of health and disease l The body similar to a machine in need of repair l Focus on diagnos>c and therapeu>c treatments
Models of Health: The Progression l Behavioral model
l 4 factors iden>fied as affec>ng health – human biology, environment, lifestyles, health care organiza>on
l Lifestyle became the ini>al focus as it linked health status and personal risk behaviors
Models of Health: The Progression l Focus was on reducing health inequi>es cased by socioeconomic and environmental factors
l A new conceptualiza>on of health emerged which accounted for the structural influences on health behaviors: influences such as poverty and appropriate housing for instance (Laverack, 2004)
l It was then that we began to understand and ar>culate the broad the determinants of health and the interrela>onships among them
l More recently, nurses have begun build on this approach by using a socio-‐ecological model to guide their work
Health Promo>on Models l Community ecological model
l Social ecological model
l Community planning model l The PRECEDE PROCEEED model
l Community diffusion model l Diffusion of innova>on model l Social marke>ng model
Ecological Model l Defini>on
Ecological models are comprehensive health promo>on models that are mul>faceted concerned with environmental change, behavior, and policy that help individual make healthy choices in their daily lives
Ecological Model l Defining Features
l The defining feature of an ecological model is that it takes into account the physical environment and its rela>onship to people at individual, interpersonal, organiza>on and community levels
l The philosophical underpinning is the concept that behavior does not occur within a vacuum
Ecological Model l Underlying Assump>ons
l Behaviors are influenced by intrapersonal, social, cultural, and physical environmental variables
l Variables are likely to interact l Need to address variables at mul>ple levels to understand and change health behaviors
l There are mul>ple levels of influence ranging from individual to public policy
Ecological Model l Characteris>cs
l Influencing behaviors happens on mul>ple levels. Interpersonal factors, social and cultural environments and physical environments can influence health behaviors
l Influences rarely affects single levels. To be useful in designing studies and interven>ons, the model should predict how the categories of behavior determinants interact
l Environments directly influence behaviors. Environment: space outside the individual. Ecology: interrela>ons between organisms and their environments
Social Ecological Model l An ecological model with a focus on social factors
l In tradi>onal ecological environments tradi>onally have referred to one’s physical environment
Social Ecological Model l Common depic>ons
l Five levels l Individual intrapersonal factors
l Rela>onship interpersonal factors
l Ins>tu>onal Organiza1onal factors
l Community factors l Societal/ public policy
l Four levels l Individual intrapersonal factors
l Rela>onship interpersonal factors
l Community factors l Societal/ public policy
Social Ecological Model: Individual Level Intrapersonal
l Encompasses the knowledge, aatudes and skills of the individual
l Psychological theories founda>onal implementa>on
Social Ecological Model: Rela>onship level Interpersonal l High level of importance in health related behavior l Includes family, friends, in>mate partners l Many behaviors are profoundly shaped by families par>cularly those habits learned early in life
l Social networks key
Social Ecological Model: Ins>tu>onal Organiza>ons
l Strategies will similar to those ins>tuted at community and societal spheres (4 step model does not include this level)
l Significance in 5 steps models acributed to the fact that people spend one-‐third to one-‐half in ins>tu>onal seangs, par>cularly schools and workplaces
Social Ecological Model: Community Larger community
l Of par>cular significance in that organiza>ons and individuals within a community can work together to promote healthy goals
l Community norms influen>al at this level
Social Ecological Model: Societal l Social norms
l Public policy l Regula>ons and limita>ons on behaviors l Usually the most explicit and controversial measure that, local, state and na>onal governments healthy behaviors
l Laws, regula>ons, restric>ons
Focus of the Interven>on: Individual l Individual level influences are biological and include personal history factors that increase the likelihood that an individual will become a vic>m or perpetrator of violence
l Interven>ons for individual-‐level influences are oeen designed to target social and cogni>ve skills and behavior and include approaches such as counseling, therapy, educa>onal training sessions (Powell et al, 1999)
Focus of the Interven>on: Rela>onship l Interpersonal rela>onship-‐level influences are factors that increase risk as a result of rela>onships with peers, in>mate partners and family members
l A person’s closest social circle – peers, partners and family members – can shape the individual’s behaviors and range of experience (Dahlberg and Krug, 2002)
l Interven>ons for interpersonal rela>onship-‐level influences could include family therapy, bystander interven>on skill development, and paren>ng training (Powell et al., 1999)
Focus of the Interven>on: Community l Community level influences are factors that increased risk based on community and social environments and include an individual’s experiences and rela>onships with schools, workplaces and neighborhoods
l Interven>ons for community-‐level influences are typically designed to impact the climate, systems, and policies in a give seang
Focus of the Interven>on: Societal l Societal-‐level influences are larger, macro level, factors that influence sexual violence such as gender, inequality, religious or cultutal belief systems, societal norms, and economic or social policies that create or sustain gaps and tensions between groups of people
l Interven>ons: l Policy focused on interven>ons typically involve collabora>ons by mul>ple partners to change laws and policies related to sexual violence or gender inequality
l Social norm focused interven>on would be to determine societal norms that accept violence and to iden>fy strategies for changing those norms
Implica>ons for applica>on l In applying the socio-‐ecological model, we should clear about
l Who l What l when
l Although there is a specific strategy and focus interven>ons will have broader implica>ons
Social Ecological Model l The social ecological model supports a comprehensive public health approach that not only addresses an individual’s risk factors but also the norms, beliefs, and social and economic systems that create the condi>ons for the occurance of community health issues
Social Ecological Model l The impact of community on health is not unidirec>onal (i.e. my community affects my health)
l The rela>onship is bi-‐direc>onal )i.e. individuals strengthen or weaken a community and influence the well being of others) and interconnected (the community and its members are inseparable)
Social Ecological Model l Socio-‐ecological model approaches view health as a product of the rela>onship between the individual and the environment
l Focus on enhancing people’s capacity to engage in and create their social environment
l They are mul>disciplinary with a strong ci>zen par>cipa>on component
COMMUNITY PLANNING MODEL l Planning model exist at macroscopic level
l The PRECEDE-‐PROCEED Model
Predisposing
Reinforcing
Enabling
Constructs
Educa>onal/ Environmental
Diagnosis
Evalua>on
Policy
Regulatory
Organiza>onal
Constructs
Educa>onal
Environmental
Development
PRECEDE-‐PROCEED MODEL
l Planning model dirancang oleh Lawrence Green & Marshall Kreuter àhealth education & health promotion programs
l Its overriding principle is that most enduring health behavior change is voluntary in nature
l Draws on fields of epidemiology, social & behavioral science
PRECEDE-‐PROCEED MODEL
l Looks at desired outcomes first-asks the ‘why’ before the ‘how
l This principle is reflected in a systematic planning process which seeks to empower individuals with understanding, motivation and skills and active engagement in community affairs to improve their quality of life
PRECEDE-‐PROCEED MODEL
Elements of PRECEDE-‐PROCEED l Phase 1 – social diagnosis
l Phase 2 – epidemiological diagnosis
l Phase 3 – behavioral environmental diagnosis
l Phase 4 – educa>onal/ organiza>onal diagnosis
l Phase 5 – administra>ve and policy diagnosis
l Phase 6 – ready for program implementa>on
l Phase 7-‐9 – data collec>on and evalua>on
Phase 1 Social Diagnosis l Before PRECEDE-PROCEED
l Telah memiliki Shared vision
l Masalah kesehatan tertentu telah diidentifikasi dan beberapa tujuan kesehatan awal yang terukur telah ditetapkan
l Aktivitas untuk memulai pengkajian kebutuhan dan mempelajari masalah
l Untuk membantu mengklarifikasi fase pertama sebelum pindah ke fase kedua.
Phase 2 Epidemiological Diagnosis l Data
l Collection
l Sources
l comparisons
Phase 3 Behavioral & Environmental Factors
l Step 1
possible risk factors associated with the problem are listed ß literature review
l Step 2
break into behavioral and environmental
l Step 3
make the criteria à ask experts and community personnels
Phase 3 Behavioral & Environmental Factors
� Step 4 › Tentukan prevalensi perilaku dan frekuesni faktor lingkungan terlibat › Tentukan fakta terkait faktor2 yang berkontribusi terhadap masalah › Klasifikasikan menjadi faktor pen>ng & >dak pen>ng
� Step 5 › Tentukan changeability › Group process à low or high likelihood of change
Phase 3 Behavioral & Environmental Factors
� Step 6 › Create an importance and changeability matrix
� Step 7 › Buat tujuan pada faktor pen>ng dan yang dapat diubah › Siapa yang diekspektasi untuk berubah? › Apa yang diekspektasi untuk berubah? › Berapa banyak yang berubah? › Kapan akan berubah?
Phase 4 Educa>onal & Organiza>onal Diagnosis
� Predisposing factors › Cogni>ve & affec>ve acributes › Knowledge, self-‐efficacy, locus of control, aatudes, beliefs, percep>ons › Provide a ra>onale or mo>va>on to perform a given behavior
Phase 4 Educa>onal & Organiza>onal Diagnosis
� Reinforcing factors › Social support › Parents, family members, co-‐workers, peers, friends, health care providers, supervisors à influen>al media
� Enabling factors › Assist in promo>ng the chosen ac>on › Educa>onal resources, suppor>ve policies, changes, skill development environmental
Make specific objec8ves for each factor
Phase 5 Administra>ve & Policy Diagnosis
� Step 1 › Plan for >me u>liza>on & personnel needs › Ganc charts
� Step 2 › Assessment of available resources › Material needs (educa>onal, computer), building needs, training or re-‐training of personnel
� Step 3 › Iden>fikasi hambatan à financial, goal conflict, change, commitment
Policy diagnosis l Step 1:
l assess policies, regulations, organization
l Determine – loyalty of personnel,
l Are your goals consistent within the organization?
l Do you have the flexibility to do new things?
l Is there a flexibility for the administrators to determine policy implementation?
Policy diagnosis l Step 2: assessment the politics
l Who within the organiza>on and outside of the organiza>on want this to succeed?
l A plan for maximizing involvement of those who can help
Phase 6 Implementa>on l Programs are like a child, it needs room to breathe,
experiment, adapt to new circumstances & people
l Checklist à process evaluation begins
Phase 7 Process Evalua>on
l Do what you said that you would do
l Following the Gantt charts
l Changes, have been documented?
l Methods à interview, focus group, paper trail
l Discussions center on predisposing, reinforcing, & enabling factors
Phase 8 Impact Evalua>on
l Dapat diukur à changes as set out by the objectives (phase 3)
l Planning à how changes would be measured
l Umumnya, ukuran pensil dan kertas, ukuran observasi dan catatan.
Phase 9 Outcome Evalua>on l Are you achieving the program goals?
l Usually done by examining the bottom line after a few years of programming
Strengths Vs. Limita>ons Strengths Limita8ons
Banyak digunakan Tergantung pada input & expert analysis
Fase 1 dapat dilakukan secara kolek>f
Tidak menekankan pada kondisi sosio-‐environmental
Promosi par>sipasi komunitas sejak proses awal
Cenderung berorientasi pada masalah dari pada hasil yang posi>f
Tersedia format untuk iden>fikasi faktor terkait, perilaku, dan program
Menekankan pada program pelayanan di tempat praktek
Strengths Vs. Limita>ons
Strengths Limita8ons Terintegrasi dengan banyak teori promosi kesehatan
Membutuhkan banyak data, survey, dan catatan
Seimbang antara kapasitas untuk melaksanakan & kebutuhan
Bahaya/ yang >dak diinginkan untuk sitausi tertentu
PRECEDE-‐PROCEED MODEL
Rogers’ (1995) Diffusion of Innova>on l How new ideas, products, and behaviors become norms
l All levels: individual, interpersonal, community, and organiza>onal
l Success determined by: nature of innova>on, communica>on channels, adop>on >me, social system
Rogers’ (1995) Diffusion of Innova>on l Nature of Innova>on
l Rela>ve advantage over what is being replaced l Compa>ble with values of intended users l Easy to use l Opportunity to try innova>on l Tangible benefits
Rogers’ (1995) Diffusion of Innova>on l Communica>on channels
l Mass media (enhanced by listening groups, call-‐in opportuni>es, and face-‐to-‐face approaches
l Peers l Respected leaders
Rogers’ (1995) Diffusion of Innova>on l Adop>on >me
l Awareness à inten>on à adop>on à change l Gradual l Movement through groups
l Pioneers l Early adopters l masses
Rogers’ (1995) Diffusion of Innova>on l Social system
l Iden>fy influen>al networks to diffuse innova>on: health systems, schools, religious and poli>cal groups, social clubs, unions, and informal associa>ons
l Iden>fy opinion leaders, peers, and targeted media channels to diffuse innova>ons
Rogers’ (1995) Diffusion of Innova>on l Stage of adop>on
l Awareness – the individual is exposed to the innova>on but lacks complete informa>on about it
l Interest – the individual becomes interested in the new ideas and seeks addi>onal informa>on about it
l Evalua>on – individual mentally applies the innova>on to his present and an>cipate future situa>on, and then decides whether or not to try it
l Trial – the individual makes full use of the innova>on l Adop>on – the individual decides to con>nue the full use of the innova>on
Social Marke>ng l Brings about behavior change
l More cost effec>ve by reaching larger numbers
Social Marke>ng l The four P’s of Social marke>ng
l Product l Price l Place l Promo>on
Social Marke>ng l Product
l What we are offering people: l Service l Behavior l Commodity (tangible benefits)
Social Marke>ng l Product must be:
l Solu>on to a problem l Benefits l Unique l Compe>>ve
l Real l Defined in terms of the user’s beliefs, prac>ces and values
Social Marke>ng l Price
l The cost of adop>ng the product l Money l Time l Pleasure l Loss of self-‐esteem l Embrrassment
Social Marke>ng l Place
l Channels for informa>on l Where service is provided l Where informa>on is received l Where tangible product is purchased l Available l Easy to find and use l Appropriate l Timely
Social Marke>ng l Promo>on
l Message design elements l Type of appeal l Tone l Spokesperson
Health Promo>on Strategies: Ocawa Charter 5 Strategies l Ocawa Charter (1986) defined the prerequisites for health
l Peace’shelter l Educa>on l Food l Income l A stable ecosystem l Sustainable resources l Social jus>ce l Equity (led to the development of the determinants of health)
Ocawa Charter for health Promo>on (1986) l Building healthy public policy
l Collabora>ve effort to determine the important areas where policies can make a difference
l It shapes how money, power, and material resources are spread out in society
Ocawa Charter for health Promo>on (1986) l Crea>ng suppor>ve environments
l Help to ensure that physical environments are healthy and safe
l Strengthening community ac>on l Refers to community development approach l Health professionals help community members iden>fy important issues
Ocawa Charter for health Promo>on (1986) l Developing personal skills
l Helps clients develop personal skills, coping and gaining control over their health and environment
l Reorienta>on health services l Improve access to primary health care, improvement in community based services, increased family care and public par>cipa>on
Health Promo>on Across Seangs l Family
l School
l Workplace: factory, health center, hospital
l Market place
l Community: village, town, city
Health Promo>on for Vulnerable Groups l Vulnerable groups have greatest risk of poor physiological, psychological, social and spiritual health outcomes
l Eliminate health dispari>es
l Provide cultural competent health promo>on program