2h Principles and Practice of Health Promotion Flashcards
What is the Dahlgren and Whitehead (1991) ‘Policy Rainbow’?
The Dahlgren-Whitehead rainbow is a model for determining health inequalities that maps the relationship between the individual, their environment and health
GIve an example of a document that suports the concept of social detemrinants of health, and which factors does it mention.
The WHO Solid Facts document (2003).
Commented on key social determinants, giving health policy suggesitons of how to manage them.
The Global Strategy of Health for all by the Year 2000 (HFA 2000).
All citizens of the world by the year 2000 of a level of health that will permit them to lead a socially and economically productive life
What is the Commission on Social Determinants (CSDH)?
A 2005 WHO initiative that aimed to assemble and promote effective, evidence based models and practices; to support countries in placing health equity as a shared goal across governments and other sectors of society, and to build a sustainable global movement. ‘A major thrust of the commission is turning public health knowledge into political action’.
I.e. It aimed to enable governments to practically act on the social determinants of health.
What are the methods of behaviour change?
The medical model is based on the prevention of disease (illness/’negative health’) as an entity of the host individual with a focus on the biomedical model of health combined with a philosophy of compliance with professionals’ diagnosis and prognosis - usually the doctor.
The educational model is based on the view that the world consists of rational human beings and that to prevent disease and improve health you merely have to inform or educate people about the remedies and healthy lifestyles and as rational human beings they will respond accordingly.
The social model is based on a view that health is determined by the social/cultural and physical environment and hence the solutions are more fundamental and political, and people need to be protected from health disabling environments.
For example, a professional strictly following the medical model, will determine hyperlipidaemia and hypertension as causes of heart disease, whereas a social epidemiologist may consider stress, poor living and working conditions as main contributory factors for heart disease.
What are the key principles of health promtoion and give an example of a document/legislation that details these?
The WHO (1984) document on concepts and principles of health promotion, and the Ottawa Charter (1986) define the principles of health promotion as:
Involving the population as a whole in the context of their everyday life, rather than focusing on people at risk for specific disease.
Directed towards the action on the determinants or causes of health; requiring co-operation between sectors and government responsibility
Combining diverse, but complementary, methods or approaches; including individual communication and education as well as legislation and fiscal measures, organisational and community development
Effective and concrete community participation
Involvement of health professionals, particularly in primary health care
What are the WHO’s priorities for 21st century health promotion (Ottowa Charter)?
Promote social responsibility for health
Increase investment in health development
Consolidate and expand partnerships for health
Increase community capacity and empower the individual
Secure an infrastructure for health promotion
Why should you use a model or theroy when designing a behaviour change intervention?
There is substantial evidence that the use of theory in designing and implementing health promotion programmes improves the effectiveness of interventions.
Which behaviour change models relate to the theories that explain health behaviour and health behaviour change by focussing on the individual
Health Belief Model
Theory of Reasoned Action / Planned Behaviour
Transtheoretical (Stages of Change) Model
Social Learning Theory
Which behaviour change models relate to the theories that explain the change in communities and community action for health
Community mobilisation
Diffusion of Innovations
Which behaviour change models relate to the theories that guide the use of communication strategies for change to promote health
Communication for behaviour change
Social marketing
Which behaviour change models relate to the models that explain changes in organisation and the creation of health-supportive organisational practices
Theories of organisational change
Models of intersectoral action
Which behaviour change models relate to the models that explain the development and implementation of healthy public policy
Ecological framework for policy development
Determinants of policy making
Indicators of health promotion policy
What is the Health Belief Model (HBM)?
Explains how the likelihood of taking action on a particular health problem is dependant on four different types of beliefs or perceptions. It predicts that protective or health promoting actions depend on the extent to which individuals:
Believe they are susceptible to the problem (susceptibility)
Believe that the problem has serious consequences (severity)
Perceive the benefits of the specified actions (benefits)
Believe that the benefits to action outweigh the perceived costs (barriers)
Disadvantages:
A psycho-social model and so can only account for those aspects of behaviour that can be explained by attitudes and beliefs.
Advantages:
Shown to be useful in certain types of interventions i.e. uptake of screening and immunisation,
What is the Theory of Reasoned Action?
The Theory of Reasoned Action was developed to explain behaviours under voluntary control and assumes that people are rational and that the intention to act is the most immediate determinant of behaviour.
This was later updated to the theory of planned behaviour.
What is the theory of planned behaviour?
Follows on from the Theory of Reasoned Action. Predicts that a person is more likely to change behaviour if they believe the behaviour will improve their health, is socially desirable and there is social pressure to change, and that they feel they have personal control over the behaviour and the ability to change.
What is the Stages of Change (Transtheoretical) model?
A model that describes different stages of motivation to change behaviour and indicates the need for different processes of change to support movement between stages. Behaviour change is not seen as a result of a single cognitive decision, but a series of steps.
Precontemplation
Contemplation
Determination, or preparation
Action
Maintenance
Relapse
It also recognises that individuals may relapse and go back around the cycle again.
Advantages:
Influential in the design of smoking cessation programmes.
Practical for clinicians in clinical settings
Recognises relapse is not a failure
Disadvantages:
Further refinement of change processes and how they are operationalised in stage-matched interventions is needed.
What is the social cognitive theory?
Social Cognitive Theory (also known as Social Learning Theory) attempts to embrace the subtle and complex relationships between people and their environment, and the social and environmental influences on their actions. Identifying the role of role models and social influences on health promotion.
For example, in the absence of legislation about smoking, if non-smokers are sufficiently assertive about not smoking it becomes more likely that a smoker will modify their behaviour. Thus the social influence has impacted on the individual’s choice.
Advantages:
Shows that the modification of social norms is a powerful health promotion tool.
WHat is motivational interviewing?
An approach to behavioural counselling aimed at fostering the individual’s desire to change.
It uses the Stages of Change model, recognising that at different stages people are in a different frame of mind about the behaviour concerned and have different motivations to change.
There are 5 key principles:
Create a warm, comfortable and relaxing atmosphere
Give clear and concrete feedback to the patient about his behaviour, motives and personal situation
Structure and provide choice alternatives concerning the risk behaviour and its related problems
Stay in contact with the patient
Actively listen to the patient
It has 3 main phases:
The ‘eliciting phase’ - Aims to get the individual to state their concerns and see that change is necessary.
The ‘information phase’ - When the patient is actively interested in their health and is seeking further information.
The ‘negotiation phase’ - Focuses on what the patient wants to change, the means of achieving it and where to begin.
What is the evidence base for motivational interviewing?
There is little evidence for the specific efficacy of ‘motivational interviewing’ as a technique.
Although there is evidence that a structured interviewing approach is more effective than an ad hoc one, (Dunn et al , 2001 and Maguire et al, 2001: cited in West et al, 2003)
When is motivational interviewing most effective?
Motivational interviewing is most appropriate for people at the contemplation stage when they are in conflict with their behaviour and are weighing the balance of ‘to change or not to change’.
Motivational interviews may end with the individual feeling more motivated to think more about changing a behaviour, for others it may lead to making a decision to change, dependant on how ready they are.
What are the key communication techniques used in motivational interviewing?
Motivational interviewing uses four key communication techniques:
Open questions
Reflection
Summarising/restructuring
Provoking / devil’s advocate
What is the Diffusion of Innovation Theory?
The diffusion of innovation theory looks at the way that new ideas are adopted by communities. It notes that different innovations will take different times to disseminate through a population, and some may never penetrate fully. It describes five factors that determine the speed of innovation diffusion:
* The characteristics of the potential adopters
* The rate of adoption
* The nature of the social system
* The characteristics of the innovation
* The characteristics of change agents
It classifies people (Adopters) by the time it takes them to adopt the innovation and their distribution in the population matches the normal probability distribution curve.
* Innovators are the 2-3% of the population quickest to adopt new ideas
* Early adopters are the 10-15% of the population who may be more mainstream within the community but are most amenable to change.
* The early majority are the 30-35% of the population who are also amenable to change and have become persuaded of the benefits of adopting the innovation. The late majority, (30-35%) are sceptics and are generally reluctant to adopt new ideas until the benefits have been established.
* Laggards are the 10-20% who are most conservative and may be actively resistant to new ideas. However, of course it may also be that these are the least able to change due to poor financial, social and personal circumstances. This can be plotted as a classic S-shaped diffusion curve.
Example:
Many western countries have reached a stage where the majority of the public are in favour of a ban on indoor smoking. The idea of the non-acceptability of smoking in public places has therefore reached the ‘late majority’ stage.
In health promotion terms, attention needs to be paid to ways of maximising diffusion rates, and utilising appropriate strategies to engage and sustain different groups at different times.
What is the communication-behaviour change model?
A model aiming to guide public education campaigns.
It is based on communication inputs and outputs designed to influence attitudes and behaviour and can be helpful in conceptualising and designing mass communication strategies. Focusing on 5 criteria:
* Source - the person or organisation from whom the message is perceived to have come. The source can influence the credibility, clarity and relevance of the message.
* Message - what is said and how it is said eg using fear or humour for different audiences
* Channel - medium through which it is delivered eg TV, radio print, or more recently email and text messaging
* Receiver - the intended target audience. Matching the right message to the right segment of the audience
* Destination - desired outcome of the communication, change in attitudes, beliefs or behaviour.
Disadvantages:
The model focuses on mass education campaigns, which should be used as part, but not the whole, of a behaviour change campaign.
What models can be used to assess health promotion interventions?
An outcome model for health promotion (Nutbeam, 1998).
Gives all key areas where a health promotion intervention may have an impact, allowing for a better understadnign of the benefits gained overall.
What frameworks can be used to assess a health promotion intervention?
Wimbush & Watson (2000)
What is the Precede-Proceed Model?
A model based on the recognition of the multiple determinants of health.
It starts with an assessment of the quality of life and social problems, as ultimate goals, of which health is a contributory factor. It proposes a sequence of diagnostic phases that emphasise the environmental and organisational factors that influence health behaviour.
It considers the predisposing factors, those personal factors such as motivation, knowledge attitudes and beliefs; reinforcing factors, the attitudes and behaviours of role models, peers etc; and enabling factors, resources and skills etc that either support or hinder change in behaviour or environment.
The fifth phase also pays attention to the capacity for implementation of the programme of the delivery agent and its context. An interesting aspect of this model is its incorporation of evaluation steps and clear association of evaluative phases with the diagnostic phases, demonstrating the appropriate distinctions between process, impact and outcome evaluation.
This is similar to the more recent ‘theory of change approach’, which aims to clarify to those planning and evaluating community-based interventions, how the proposed actions will lead to the anticipated outcomes by making explicit the links between programme components and outcomes, that is articulating their theory of change.
