HEALTH PROMOTION Flashcards
What is Donabedian’s framework for evaluation?
Structure (inputs)
Process (activities)
Outputs (products)
Outcomes (health status)
FPH categories public health into what 3 domains?
health protection
health promotion
healthcare public health
What is the rainbow model? Who is it by?
Dahlgren and Whitehead 1991
This is a model for determinants of health and is composed of:
-personal characteristics occupy the core of the model and include sex, age, ethnic group, and hereditary factors
-individual ‘lifestyle’ factors include behaviours such as smoking, alcohol use, and physical activity
-social and community networks include family and wider social circles
-living and working conditions include access and opportunities in relation to jobs, housing, education and welfare services
-general socioeconomic, cultural and environmental conditions include factors such as disposable income, taxation, and availability of work
What is the Diderichsen model
Factors determining health:
[I] Social stratification
[II] Differential vulnerability
[II] Differential exposure
[IV] Differential consequencies
Interventions points:
A Influencing social stratification
B Decreasing exposures
C Decreasing vulnerability
D Preventing unequal consequences
What are the 5 approaches in Naidoo and Wills model of health promotion?
Medical
Behavioural/psychological
Educational
Empowerment
Social change
What is the medical approach to health promotion?
Give a critique
Use of medical interventions to reduce morbidity and mortality. (Primary, secondary and tertiary prevention measures)
+ Can have good evidence base and uses scientific evidence base and epidemiology
+ Prevention of a disease can be cheaper than treating it
+ History of effective interventions- vaccines, screening
-Focuses on absence of disease as health, ignoring socio-economic determinants
-Top down approach by medicine/expert
-Can be resource intensive
-Medicalisation of issues, removing decisions from lay person
-May involve drugs/ interventions with side effects which are used on some in population who wouldnt have gotten the pathology
-Need for complex information systems
What is the behavioural/psychological approach to health promotion?
Give a critique
Encouragement of individuals to adopt healthy behaviours based on psychological models of behaviour
e.g. Motivational interviewing
+
- Assumes individual action can determine healthy outcomes, ignoring socio-economic determinants
- Unlikely to work in those not ready to change
- Behaviour not always rational
-Complex relationship between behaviour and environment
- Difficult to evaluate changes
What is the empowerment approach to health promotion?
Give a critique
Giving people control over their lives by empowering them to make decisions
e.g. Local co-operatives community ownership and leadership facilitation
+ Client centred, bottom up approach
+ Buy in from community as involved in process
+ Community can sometimes mobile more resources and at lower cost
- Can be easy to slip into a top down approach where community involvement is tokenistic
- Difficult to evaluate
- Community contributors may not be representative and those that are marginalised/ most in need may be less able to participate
- Needs skilled facilitation
- Often long term intervention is needed and as evaluation is difficult and long term measures ususally needed it can be difficult to secure funding
What is the educational approach to health promotion?
Give a critique
Providing knowledge, information and skills to allow people to make an informed choice about their health e.g. training, leaflets, media campaigns
+Has shown success in increasing awareness and knowledge about health issues and risk factor for disease
+ Increases in knowledge easy to measure
- Assumes link between knowledge and behaviour
- Behaviour may not change in desired direction
- Expert led, top down
- Evidence base for health improvement weak
- Requires skilled practitioners
- May widen inequalities due to access to knowledge
- Doesn’t take wider determinants into account
What is the social change approach to health promotion?
Give a critique
Bringing about changes in physical, social and economic environment to improve population wide health. Done through legislative, policy, regulation and organisational change. e.g. smoking ban, MUP
+ Making healthier choice the easier choice
+Wide scale impact
+ History of wide scale change
- Often action needed at national level
- Top down
- Can be influenced by politics, economics and trade relations
- Can be difficult to evaluate
What is the Beattie (1991) model for health promotion interventions?
Health promotion can be thought of as a grid with Authoritive (objective knowledge) - Negotiated (subjective knowledge) on the y axis and Individual focus - collective focus on the x axis.
Top left Q: health persuasion e.g. education
Bottom left Q: personal counselling e.g. upskilling and empowering individuals
Top right Q: legislative action
Bottom right Q: community development/empowerment
What is the classic 4-step approach to strategic planning?
- Where are we now?
- Data
-Stakeholder views - Where do we want to get to?
- Vision, aims, objectives - How do we get there?
- Tactics, suite of measures - How will we know when we have got there?
- Evaluation, KPIs, SMART goals
Developed from work by Price Waterhouse in 1980s
What is the Tannahill model of health promotion?
3 overlapping areas:
Health education
Prevention through medical intervention
Health protection through legislative fiscal and social measures
What is the stages of change model?
Cycle
Precontemplation- contemplation - preparation/determination - action - relapse - maintenance - termination
Precontemplation - In this stage, people do not intend to take action in the foreseeable future (defined as within the next 6 months). People are often unaware that their behavior is problematic or produces negative consequences. People in this stage often underestimate the pros of changing behavior and place too much emphasis on the cons of changing behavior.
Contemplation - In this stage, people are intending to start the healthy behavior in the foreseeable future (defined as within the next 6 months). People recognize that their behavior may be problematic, and a more thoughtful and practical consideration of the pros and cons of changing the behavior takes place, with equal emphasis placed on both. Even with this recognition, people may still feel ambivalent toward changing their behavior.
Preparation (Determination) - In this stage, people are ready to take action within the next 30 days. People start to take small steps toward the behavior change, and they believe changing their behavior can lead to a healthier life.
Action - In this stage, people have recently changed their behavior (defined as within the last 6 months) and intend to keep moving forward with that behavior change. People may exhibit this by modifying their problem behavior or acquiring new healthy behaviors.
Maintenance - In this stage, people have sustained their behavior change for a while (defined as more than 6 months) and intend to maintain the behavior change going forward. People in this stage work to prevent relapse to earlier stages.
Termination - In this stage, people have no desire to return to their unhealthy behaviors and are sure they will not relapse. Since this is rarely reached, and people tend to stay in the maintenance stage, this stage is often not considered in health promotion programs.
What are some limitations of the stages of change model?
-The theory ignores the social context in which change occurs, such as SES and income.
-The lines between the stages can be arbitrary with no set criteria of how to determine a person’s stage of change. The questionnaires that have been developed to assign a person to a stage of change are not always standardized or validated.
-There is no clear sense for how much time is needed for each stage, or how long a person can remain in a stage.
-The model assumes that individuals make coherent and logical plans in their decision-making process when this is not always true.
