Approaches in health promotion PDF

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Summary

Approaches in health promotion “Health Promotion is the process of enabling people to increase control over and to improve their health” Approaches Medical (Preventive) Behaviour change Educational Aim • To reduce morbidity and premature mortality. To ensure freedom from disease and disability To en...

Description

5 approaches in health promotion

Approaches in health promotion “Health Promotion is the process of enabling people to increase control over and to improve their health”

– Approaches Aim

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Activity/ Methods

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Medical (Preventive) To reduce morbidity and premature mortality. To ensure freedom from disease and disability Uses medical intervention to prevent illhealth or premature death. Based on scientific methods epidemiology Actions are targeted at whole populations or high risk groups

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Behaviour change To encourage individuals to adopt healthy behaviours. Views health as the responsibility of individuals Communication Education Persuasion, motivation

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Examples

Immunization, screening, fluoridation

Levels

Levels of prevention: i) Primary prevention Prevention of the onset of disease through risk education. Eg: smoking cessation, cholesterol reduction.

I) II) III) IV) V)

MEDICAL BEHAVIOUR CHANGE EDUCATIONAL EMPOWERMENT SOCIAL CHANGE

Educational To provide knowledge and information. To develop the necessary skills for informed choice. The outcome is client’s voluntary choice Strongly linked to health education Information-giving through interpersonal channels, small groups and mass media, so that the clients can make an informed choice/decisions about their behaviour. Group discussion for sharing and exploring health attitudes Role play for decision-making and negotiating skills

ii) Secondary prevention Preventing the progression of disease Eg: screening and other methods of early diagnosis. ii) Tertiary prevention Reducing further disability or, preventing the recurrence of illness, patient education, palliative care. Characteristics

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Evaluation

It is top down and expert led - medical and health professionals and recognised as having expert status. Emphasizes compliance Does not focus on positive health(as defined by WHO). Ignores social and environmental dimensions. Some argue this approach seeks to increase the use of medical interventions to promote health. In the short term, this approach is cheaper than the treatment of people who have become ill. (May not be the case in the longer term as people live longer and suffer from degenerative disease).

Reduction in disease rates & associated mortality.

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Expert-led, top down.

Weakness:

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Victim blaming approach- if people do not take responsibility for their actions they are to blame for the consequences. This is based on the assumption that people can make real improvements to their health by changing their lifestyle.

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Behaviour is very complex and multifactorial. It is acknowledged that the complex relationship exists between individual behaviour, social and environmental factors. it is now recognised the behaviour may be a response to the conditions people live in and the causes of these conditions may be beyond individual control.

Assumptions: • Increasing knowledge may change in attitudes, that may result in changed behaviour. • It is argued that this approach does not necessarily set out to persuade or motivate change in a specific direction!

Behaviour change after the intervention The behaviour change is only apparent after a long time. Difficult to isolate any behaviour change as attributable to a health promotion intervention.

Knowledge, attitude and practice

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Behaviour change approach remains popular with health promotion agencies

Assumes that by increasing knowledge, there will be an attitudinal change, which leads to behavioural change. Ignores the constraints that social, economic and environmental factors place on voluntary change.

Approaches Aim

Empowerment/Client-centred Helps people to identify their own needs and concerns, and gain the necessary skills and confidence to act upon them.

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• Role of health promoter: facilitator and catalyst • •

Methods

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Type

Client-centred, including counselling, community development and advocacy. Health advocacy refers to the action of health professionals to influence and shape the decisions and actions of decision- and policy-makers who have some control over the resources which affect or influence health Promoting public involvement and participation in decision-making on health-related issues.

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Social change/Societal To bring about changes in physical, social, and economic, environment and legislation which enables people to enjoy better health. Radical health promotion – makes the environment supportive of health. To make the healthy choice the easier choice. The focus is on changing society, not on changing the behaviour of individuals Focus on shaping the health environment :lobbying/advocacy development of healthy public policies and legislation fiscal measures creating supportive social and physical environments

Two types of empowerment: 1. Self-empowerment -based on counselling and aimed at increasing people’s control over their own lives. 2. Community empowerment - related to community development to create active, participating communities which are able to change the world about them through a programme of action.

Characteristics

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Evaluation

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It is a bottom up approach – It is premised on helping people or communities to identify their own health concerns, gain the skills and make changes to their lives accordingly . – The approach is described as a way of working which increases people’s ability to change their social reality. This approach reflects the general principles of the Ottawa Charter definition. Professional acts as a facilitator rather than expert Community development is a similar way of working. Some statutory UK health agencies employ health promoters to engage in community development work – often in tandem with local authorities. Difficult because empowerment is long term. Results are hard to specify and quantify. Evaluation includes:– Outcome evaluation  the extent to which specific aims have been met. – Process evaluation  the degree to which the individual and community have been empowered as a result of the intervention.

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Targets groups and populations, top down method of working. Sometimes known as radical health promotion and is underlined by a belief that socio-economic circumstances determine health status. Its focus is at the policy or environmental level. Approach is based on the notion that to promote positive health it is necessary to tackle and diminish social and health inequalities. “Make the healthy choice the easier choice”. Healthy choices may be available, but this may require major structural changes...