1

HEALTH PROMOTION

views of health
2

Three prominent views:

the medical model of health
the systems view of health
the social determinants of health.

Health and Wellness

Promotion
across the Lifespan

A resource for quality of life and coping; a

broad concept that includes not only diet,
alcohol consumption, and exercise, but
also the social conditions in communities
and determinants of health such as socioeconomic status and social networks

A healthy lifestyle can reduce the

incidence of certain chronic diseases
and therefore contributes to quality of
life

In Canada, more than 75% of adult

deaths result from chronic disease (e.g.,
cancer, diabetes, and respiratory and
cardiovascular diseases), which are
affected by lifestyle

The Medical Model of Health

6

defined as the "absence of disease".

this definition has been around for
centuries.

Systems View
7

extended the traditional, medical model

included in its definition that health is "a
state of complete physical, mental and
social well-being and not merely the
absence of disease or infirmity".
health viewed as a dynamic, interrelated
and integrated process
embodies the perspective of the World
Health Organization. The social
determinants of health view supports

The Social Determinants of Health

8

socio-economic conditions influence the

health individuals, groups and communities.
takes into to account lifestyle behaviors and
risk factors
Some of these factors include:
income, social support networks, social
status, work and living conditions, social
environments, culture, education and
health services.

Health promotion:
9

A strategy to improve health

The Ottawa Charter (1986) defined it
as enabling people to increase
control over and to improve their
health
This was the beginning of the
conceptualization of empowerment
as a component of health promotion

Concept of Health
10

To reach a state of complete physical,

mental and social well-being, an
individual or group must be able to
identify and to realize aspirations, to
satisfy needs, and to change or cope
with the environment.

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Injury prevention: Using strategies to help

populations and individuals prevent and reduce
the risk of injury

Disease: The presence of abnormal alterations

in the structure or functioning of the human body
that fits within the medical model

Disease course: An identifiable progression of a

disease in an individual

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Illness: An individuals personal experience,

perception, and reaction to a disease,
whereby he or she is unable to function at
the desired usual level

Disease prevention: The activities taken by

the health sector to prevent the occurrence
of disease, to detect and stop disease
development, and to reduce the negative
effects once a disease is established

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Evolution of Health Promotion

14

1974 Lalonde Report

1978 Alma-Ata Declaration
1984 WHO working group
1986 Ottawa Charter of Health
1986 Epp Report
International conferences on health promotion
1994 Federal, Provincial, and Territorial
Advisory Committee on Population Health
1996 Population Health Promotion Model

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Summary:

1970s:
The first dimension of health promotion
focused on managing preventable diseases
and risk behaviours
The most popular health promotion
strategies were providing health
information and simple education

16

1980s: Emphasis shifted to

complementary intervention approaches
as outlined in the Ottawa Charter, e.g.,
building healthy public policy and
strengthening community action

17

1990s: Focus was on providing health

promotion to individuals and groups in
their communities

2000s: A fourth dimension of health

promotion became evident: the social
determinants of health

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Health Promotion
Models,Theories,
and
Frameworks

The Health Belief Model

19

Health behaviour can best be explained

by understanding an individuals beliefs
about health

Four components:
1.
2.
3.
4.

Modifying factors
Cues to action
Individuals perceptions
Likelihood of action

Theories of Reasoned action and Planned

Behaviour
20

Individuals are usually rational and

therefore make predictable decisions to
act

Beliefs, attitudes, and perceived

behavioural control influence individual
and group intentions, and thus actions

Stages of Change Model

21

The process of changing health

behaviours usually proceeds through five
stages:
1.
2.
3.
4.
5.

Precontemplation
Contemplation
Planning or preparation
Action
Maintenance

A sixth stage, Termination, is associated

with changing addictive behaviours

Penders Health Promotion Model

22

Recognizes the uniqueness of the

individuals past experience (prior
behaviour; biological, psychological, and
sociocultural characteristics)

Unique characteristics and experiences

contribute to individual health promotion
behaviour, especially when changes in
cognitive factors occur

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Cognitive factors:

Perceived benefits of action

Perceived barriers to action

Perceived self-efficacy

Activity-related affect

Interpersonal influences

Situational influences

Community Mobilization Framework

24

Identifies three community mobilization

approaches:
1.

Social planning

2.

Locality development

3.

Social action

Other Frameworks
25

Existential and humanistic theoretical

perspectives:

Emphasize caring for humankind

Emphasize the therapeutic interpersonal

relationship between the nurse and the
client

Health Approaches
26

Three approaches to viewing health

(formerly called models):
1. Biomedical
2. Behavioural
3. Socioenvironmental

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Community Development:
28

A process whereby community

members identify health problems or
issues impacting their community
that require the development of
capacity building skills to bring about
change

Capacity Building:
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Recognizing and utilizing strengths

(rather than deficits) such as
available services, resources, and
programs in order to assist
communities, individuals, or
organizations to resolve their health
issues

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Building Healthy Public

Policy
Healthy public policy:

Policy that has a positive effect on or

promotes health

Building healthy public policy:

Creating environments that support

health and reduce inequities in
health and social policies

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Creating Healthy
Environments

Requires attention to the determinants of

health

The determinants of health:

Have a direct impact on health of individuals

and populations
Are the best predictors of individual and
population health
Structure lifestyle choices
Interact with each other to produce health

Developing Personal Skills

32

Health education is a strategy for the

development of personal health skills,
e.g.:
Stress management
Healthy eating
Physical activity
Improved literacy

Various teaching methods are used, e.g.,

lectures, demonstrations, small groups,
health fairs

Health Communication and Social

Marketing
33

Strategies used to deliver health

promotion messages to various targeted
populations

The four Ps of social marketing:

Product
Price
Place
Promotion

Mutual Aid
34

A process by which persons share

common experiences, situations, or
problems with others and view each
other as equals

Advocacy
35

Action taken to influence decision

makers in communities and
governments to support a policy or
cause that is health promoting

Enhances the power of individuals and

communities by having them participate
in identifying their problems or issues
and in developing solutions

Health Promotion Skills

36

CHNs may know what must happen to

effect change, but not how to bring
about the change

Many resources, including Internet

resources, are available that provide
how to information

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According to the Canadian Community

Health Nursing Standards of Practice:
Community health nursing process refers
to the processes on which CHNs base
community health nursing decisions:
Comprehensive community assessment
Planning
Implementation
Evaluation

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According to the Canadian Community

Health Nursing Standards of Practice:
It encompasses traditional terms such as
nursing process, problem solving,
clinical judgement, critical thinking, and
decision making

Contd
39

Skills that CHNs use in their health

promotion practice:

Working in focus groups

Preparing funding proposal applications
Program planning
Communication
Working with others
Integrating research and practice

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CHNs promote health in environmental,

political, and social contexts

CHNs use the community health nursing

process to

Assess
Plan
Intervene
Evaluate their practice on micro and
macro levels

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Healthy Child Development

as a Determinant of Health

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Early childhood development is affected

by determinants of health such as:

Social support networks

Physical environment
Biology and genetic endowment

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Child and Adolescent

Health

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Provision of direct services to children and

their families:

Assessment
Management of care
Education
Counselling

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Assessment of the community and the

establishment of programs to ensure a
healthy environment for its children

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Approximately 26% of Canadian children

and adolescents are overweight, and 8%
are obese

Obese children and teens have an

increased prevalence of negative
medical and psychological consequences

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Part of normalizing weight in youth and

children

Should be worked into the overall

lifestyle goals of the family

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The first 6 years in a childs life are the most

important for developing sound lifetime
eating habits

Health Canada has revised the Canada Food

Guide, which offers guidelines for daily food
requirements for all ages

A 24-hour diet recall by the parent is a

helpful screening tool to assess the amount
and variety of food intake

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In Canada, injuries and accidents are the leading

causes of death in children and young adults

They are among the leading causes of

hospitalization for children, young adults, and
seniors

Most injuries and accidents are preventable

The key to changing behaviours is teaching ageappropriate safety

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Smoking:

A risk factor for cardiovascular

disease, cancer, and lung disease

One of the major preventable causes

of morbidity and mortality in Canada

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Routine immunization of children has

proven very successful in preventing
selected diseases

The Canadian Required Immunization

Schedule lists vaccines that should be
administered at particular periods in
childhood

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Women often use healthcare services for

reproductive issues or problems, and
CHNs are frequently the health
professionals they encounter

CHNs may advocate for policies that

increase womens access to services,
discuss contraception, give preconception counselling, and increase
access to prenatal care

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Menopause: The time in a

womans life when her levels of
estrogen and progesterone change

CHNs need to be informed about

HRT, osteoporosis, and
cardiovascular disease as they
pertain to menopause

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Approximately 2 million Canadians have

diabetes mellitus, which is the 7th
leading cause of death in Canada

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Mental illness occurs when a person has

changes in thinking, mood, or behaviour that
result in impaired functioning or difficulty
coping over a period of time

Depression is a particularly serious problem

for women

Risk factors for depression include being

female, family history of depression,
unemployment, and chronic disease

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Males are physiologically more vulnerable

than females:

More male infants die at birth

More males die of cardiovascular, liver, and

chronic pulmonary diseases, cancers and
suicide

Males have a shorter predicted lifespan

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Testicular cancer is a commonly

diagnosed cancer

Teaching men who are at risk for

testicular cancer how to perform
testicular self-examination (TSE) as a
preventive strategy should be included
by the CHN as a comprehensive
testicular educational program

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Aging:

The total of all changes that occur in

a person with the passing of time

Gerontology:

The specialized study of the

processes of growing old

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As Canadas population continues to

increase, the proportion of adults in the
older age range will also increase

Most health care for older adults is now

delivered outside of an acute care
setting

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CHNs must:

Have specialized knowledge, skills,

and abilities in gerontology

Be aware of health promotion

strategies such as creating healthy
environments, reorienting health
services, and increasing prevention

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. Physiological

Changes occur in all body systems with the

passing of time, although these processes
vary widely among individuals

Age-related changes occur in the skin,

respiratory, cardiovascular,
gastrointestinal, genitourinary,
neuromuscular, sensory and immune
systems

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2. Psychological:

Reaction speed and psychomotor response

become somewhat slower

Older individuals can usually learn and

perform as well as younger individuals,
although they may be slower

Intellectual capacity does not diminish,

although minor memory loss is common

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3. Sociological:

Aging does not bring about radical changes

in beliefs and values but may bring about
abrupt changes over which people have
little control

How individuals stay involved in activities

and with people who bring their lives
meaning and support is a major factor that
can contribute to ongoing health and vitality

Chronic Illness
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A cure is not expected

CHN activities need to be more holistic,

addressing function, wellness, and
psychosocial issues, and focus on
healing rather than curing

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. Goals for chronic care are:

Maintain or improve self-care capacity

Manage the disease effectively
Boost the bodys healing abilities
Prevent complications
Delay deterioration and decline
Achieve the highest possible quality of
life
Die with comfort, peace, and dignity

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Elder abuse: encompasses

physical, psychological, financial or
material, spiritual, and sexual abuse
and neglect

Neglect: Intentionally or
unintentionally not providing care or
services that are necessary for the
physical, spiritual, and mental health
of an older adult who is dependent

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CHNs need to be aware of incongruence

between injuries and the explanation of
cause, dependency issues between the
client and caregiver, and substance
abuse by the caregiver

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Some signs of caregiver stress are:

Denial
Anger
Withdrawing socially
Anxiety
Depression

Exhaustion

Sleeplessness
Emotional reactions
Lack of concentration
Health problems

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CHN interventions are summarized in the

TLC mnemonic:

Training in care techniques, safe

medication use, recognition of
abnormalities, available resources
Leaving the care situation periodically to
obtain respite and relaxation and maintain
their normal living needs
Care for themselves through adequate
sleep, rest, exercise, nutrition, socialization,
solitude, support, financial aid, and health
management

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Living Healthy in
All Life Stages

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CHNs have many resources available to

assist them in their role as educator to
facilitate and support clients in striving
to achieve healthy living throughout the
life stages
including RNAO best practice guidelines,
and many other Web-based resources
pertaining to various age groups