health promotion session 2 2011 phca8507[1]

8/7/2019 Health Promotion Session 2 2011 PHCA8507[1]

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ConceptualisingConceptualisingHealth PromotionHealth Promotion

Associate Professor Frank TesorieroFlinders University


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Identify a healthIdentify a health behaviourbehaviourin yourselfin yourself

to behave that way?to behave that way?


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a s eory

in a relatively wide variety of circumstances

, ,the nature or behaviour of a specified

as the basis of action

Van Ryan and Heany,1992


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H e a l t h P r o m o t i o n I n t e r v e n t i o n s

Individual Focus Population Focus

-Individual risk

assessment

information

education,counsellingand skill

marketing ationaldevelop-ment

action andregulatoryactivities

eve opmen

Medical a roach

Behavioural approach

-


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Commentary on three models

Not mutually exclusive options.

-interdependent.

Debate is about appropriateness and

.


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FrameworkFramework forfor Health Promotion ActionHealth Promotion Action

Downstream Upstream

PrimaryDisease

Communication

Strate ies

HealthEducation &

Community &Primary Health

Infrastructure &Systems

Prevention

ScreeningHealth

Empowerment Development

Engagement

Change

Risk

Assessment

Information

Behaviour

Knowledge

Understanding

CommunityAction

Policy

Legislation

Immunisation

ChangeCampaigns Skill

development

Advocacy Organisational

Change

PrimaryCare

Lifestyle/BehaviouristApproach

Socio-ecological Approach

pproac

Murphy B & Keleher H (eds) Understanding Health: a determinants perspective, Melb, OUP,Murphy B & Keleher H (eds) Understanding Health: a determinants perspective, Melb, OUP,20032003


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Intervening in the chain of the social production of health

How change in health status is promoted can be represented along a continuumand the entry point for policy and program action can be mapped accordingly

there are several entry points along the chain of production:

Decreasing social stratificationsocial stratification itself, by reducing inequalities in power,prestige, income and wealth linked to different socioeconomic positions

Decreasing the specific exposurespecific exposure to health-damaging factors suffered bypeop e n sa van age pos ons

Lessening the vulnerabilityvulnerability of disadvantaged people to the health-damagingcon ons ey ace

Intervening through healthcarehealthcare to reduce the unequal consequences of ill--

people who become illCommission on Social Determinants of Health (2005). Action on the social determinants of health: learning from previous experiences,

Background Paper, Geneva, World Health Organisation, p. 40.


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n examp e - smo ng

.

2. How systematic is the knowledge?

.

4. Can we analyse, predict or explain using the knowledge?

. ,

6. Can we name a theory we are using?


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eory an ea promo on

Theory can guide how we develop health promotion, ,

eory can e p pre c ssues a may ar se anhelp to explain difficulties

There are program management guidelines for healthpromotion. Referring to theory can guide healthpromoters through the stages of planning,

implementation and evaluation.


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Health Promotion planning and evaluation cycle

Theory helps to identify

what are targets for

intervention

Problem definition

(redefinition) 7

Theor hel s to clarif how and

2

Solution

assessment

when change can be achieved

in targets for intervention

3

6Intermediate

outcome

mobilisation

5

assessmentTheory indicates how to achieveorganisation change and raise

community awareness

ImplementationImpact

assessmentTheory provides a benchmark

Theory defines outcomes

and measurements for use

in evaluation

compared with ideal program

Nutbeam and Harris, 1999, p12


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The use of theor in

program planning and evaluationPlanning phase Task Possible use of theory

Problem identificationand priotisation

Clarify major health issues for a defined

population, and prioritise in terms of the

potential for effective intervention

Clarify what should be the target

elements of an intervention, such

as individual beliefs, social norms

Planning a solution Develop a program plan which specifiesprogram objectives, strategies and thesequence of activity

Guidance on how and when andwhere change can be achieved inthe target elements of a program

Mobilising resourcesfor implementation

Generate public and political support, buildthe capacity of partner organisations and

secure resources

Guidance on how to buildpartnerships, raise public

awareness and fosterorganisational development

Implementation Execute the program as planned, utilising

multiple strategies (as appropriate to the

Provide a benchmark against

which the actual implementationprogram o ec ves can e compare w e

theoretically ideal

Evaluation Assess the impact and outcome of the Define outcomes and

objectives

used at each level of evaluation

Nutbeam and Harris, 1999, p17


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Three a roaches to enhancin health

1.1. Medica l Med ica l or Hi h Risk H i h Risk a roach

2.2. Behavioura l Behavioura l or Mul t i RiskMul t i Risk

ac or ac or approac

3.3. Socioenv i ronmenta l Soc ioenv i ronmenta l orCom m uni t y Developm ent Com m uni t y Developm ent

approac


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Medical a roachHealth concept Problem definition Principal strategies Target

Ne ative state Disease and Sur e Hi h r isk individuals

absence of disease,

disability or other

deviance from

physiological risk

factors

Drug, other therapies

Medically managed

health behaviour

physiological norms change

Screening for

physiological risk

factorsProgram Prevention level Success rate

Professionally

managed

Tertiary prevention

Disease intervention

Disease is diagnosed

Morbidity

age-standardised

mortalities

factorPrevalence rates


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Health concept Problem definition Principal strategies Target

Individualised, health

as energy physical-

functional ability

Behavioural risk

factors

Health education

Social marketing

Health advocacy for

High risk groups:

(those with unhealthy

lifestyles)policy supporting

lifestyles change

Children

(promotion of healthy

lifestyles)

Program development Prevention level Success rate

Community-based programming:

Secondary prevention Improved existing

ro ess ona an or agenc es e n ng e

health problem, developing strategies,

involving local community members and

mprov ng es y es

Primary prevention

(creating healthy

es y es

Healthier li festyles early

in the life cycle

.

responsibility for ongoing program to local

community members and groups

public policies related to

health behaviours


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Socioenvironmental a roachHealth concept Problem definition Principal strategies Target

Positive state, connectedness Psychosocial risk Personal High risk

o one s

family/friends/community, self

efficacy, being in control,

ac ors an

socioenvironmenta

l risk conditions

empowermen

Small group

development

env ronmen s

important or have meaning,

psychological and social

organisation

Health advocacy

.

Program development Prevention level Success rate

Community development Primary Improved personal perception of healthprogramming:

Enabling communit ies to make

decisions necessary to plan

prevention

(creating healthy

lifestyles)

Improved social networks, social support

Improved community actions to create more

equitable social distribut ion of

achieve better health, which

requires allowing communities

to define their own prior ity

Health promotion

(creating healthy

living conditions)

Improved community actions to create more

environmentally sustainable personal, pubic

and private economic practices

health problems Shifts in social equity measures in the

direction of greater equity

Labonte1992,

pp121-22


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to disease prevention

Effecting enduring social changeHeal th

or iented

Primary healthpromotion

Socio ecologicalhealth promotion

Community action

Raising individual quality of life

Eradicating health risks

(heal t h f ie ld)Primary disease

revention

econ ary ea t

promotionTertiary health

romotion

Participatoryhealth education

Early treatment Disease

or iented2ndary disease

prevention

and behaviourchange

prevention

prevention

MINIMAL DISEASE

health promotion session 2 2011 phca8507[1]

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