Module 2

Question 1

• Population health promotion (PHP) has made a shift from a more individualized focus to a more ______ _____ Approach

Answer 1

Community based

Question 2

How do the determinants of Health affect Health promotion?

Answer 2

• Sometimes it is easy to forget to work with the determinants of health when trying to improve the health of a community.
• If they are not looked at, it can cause inaction and a lack of change within the community.
• We cannot create any change within a community until we look at the determinants and how they affect the individual members as well as the community as a whole.

Question 3

What are the 5 health promotion strategies identified in the Ottawa Charter?

Answer 3

-These 5 strategies shifted the focus to include communities and shifted responsibility to governments, communities, and individuals.
The strtegies are strengthening community action, building healthy public policy, creating supportive environments, developing personal skills, and reorienting health services

Question 4

How can we promote health by strengthening community action?

Answer 4

We can empower communities and engage them from the ‘bottom up’.
Involve members in identifying health issues, planning and initiating interventions specific to the community. Promote community development!

Question 5

What is community development and what is the goal?

Answer 5

• Community development is a process whereby community members identify health concerns affecting their community that require the development of capacity building skills to bring about needed change. Partnerships are essential.
• Resources, assets, and possible contributions from partners are recorded or “mapped” to build a capacity list. The information gathered from asset mapping should be used to promote community development.
  The goal is a secure and healthy community with buy-in from all community members.

Question 6

What is community mobilization?

Answer 6

• Community mobilization is the use of community capacity to create change through an action plan. It refers to individuals in a community working together as a group to influence healthy public policy.

Question 7

How can we promote health by building healthy public policy?

Answer 7

We can create environments that support health and reduce inequities in health social policies.
This requires coordination from all levels of government (municipal, provincial, federal) and specific areas of governments (ex: agriculture and health) to identify and develop public policies that affect health.
Advocacy at a policy level!

Question 8

How has the empowerment of individuals resulted in health public policy?

Answer 8

Bylaws restricting smoking in areas, seatbelts, etc.

Question 9

• In 1994, a federal provincial, and territorial advisory committee identified five categories that determine the health of Canadians, what are they?

Answer 9

-Social and economic environment, physical environment, personal health practices, individual capacity and coping skills, health services

Question 10

• In 2005, provincial, territorial, and federal ministers of health outlined health goals for Canada based on what four areas?

Answer 10

basic needs (social and physical environments); belonging and engagement; healthy living; and a system for health

Question 11

How can we promote health by creating supportive environments?

Answer 11

We can provide supportive environments in all settings; home, work and play that are safe, satisfying, stimulating and enjoyable.

• Creating a supportive environment includes the activities of social marketing, advocacy, health communication, and mutual aid.
• Health equality and considering the population’s determinants of health, contribute to to creating such environments.
• Strengthening advocacy through community action
• Enabling communities and individuals to take control over their health and environment through education and empowerment
• Building alliances for health and supportive environments in order to strengthen the co-operation between health and environmental campaigns and strategies
• Mediating between conflicting interests in society in order to ensure equitable access to supportive environments for health

Question 12

How can we promote health through literacy and health literacy?

Answer 12

We can utilize the 9 literacy skills which are essential to achieving success in work, learning and life.

Question 13

What aspects of health and life can literacy impact?

Answer 13

overall health status, co-morbidity burden, life expectancy, lifestyle practices, culture, income and socioeconomic status, living and working conditions, educational attainment, gender, and early life.

Question 14

What is health literacy?

Answer 14

• Health literacy is defined as the ability to access, understand, evaluate, and communicate information as a way to promote, maintain, and improve health in a variety of settings across the lifespan.

Question 15

How can we promote health by developing personal skills?

Answer 15

One aspect is the provision of health education to empower clients as individuals and to promote client involvement in health care decisions.
This strategy also includes the adoption of healthier behaviors, such as stress management, healthy eating, and physical activity. This works to build individual capacity so that persons will make lifestyle choices that promote health.

Question 16

For population behavior to occur, what are the 4 E’s we need to consider?

Answer 16

education, environment supports, economic levers, and enforcement of regulations and legislation.

Question 17

How can we promote health by re-orientating health services?

Answer 17

This involves reforming health services and the health sector so that they include a health promotion focus. This requires movement beyond the focus on cure and clinical services.
Areas that need to be considered include the link between the determinants of health and population health; social justice; the individual as a holistic being; community based care that is accessible, affordable, acceptable, and appropriate for the clients; a greater focus on population health and on health research; and modification to professional education..

Question 18

What is downstream thinking related to health, and how can we use a population health promotion strategy with this concept?

Answer 18

-Downstream refers to taking a microscopic individual, curative focus, a view that doesn’t consider the economic, sociopolitical, and environmental variables.
•Based on the definition, it seems fair that the only strategy that it would really apply to would be Developing Personal Skills. In this strategy there is more of a focus on individuals and their skills.

Question 19

What is midstream thinking related to health, and how can we use a population health promotion strategy with this concept?

Answer 19

Midstream thinking is more ‘in the middle’, The midstream approach focuses on the lifestyle and behavior of an individual and includes health promotion and prevention.

Question 20

What is upstream thinking related to health, and how can we use a population health promotion strategy with this concept?

Answer 20

-Upstream looks beyond the individual to take a macroscopic, big-picture population focus.
•This type of thinking applies more to the PHP strategies. The goal of all 5 strategies is to focus less on the individuals and more on the entire community.

Question 21

What is the role of partnerships in population health promotion?

Answer 21

Partnerships are essential, they create resources for the community.

• Many partnerships are not actually with other health care professionals. Might encounter partners such as schools, the justice system, community agencies such as churches, medical clinics, etc.
• The role of these partnerships is to collaborate together to see what resources and assets these partners can create or offer to the community to positively impact the health of the members of the community.

Question 22

What are the 5 CHN standards of practice for all community health nursing practice settings?

Answer 22

Promoting health, building capacity, building relationships, facilitating access and equity, demonstrating professional responsibility and accountability.

Question 23

How is health defined by the Ottawa charter?

Answer 23

“to reach a state of complete physical, mental, and social wellbeing, an individual or group must be able to identify and to realize aspirations, to satisfy needs, and to change or cope with the environment”.

Question 24

What is Health promotion?

Answer 24

• In 2005, the WHO redefined health promotion as the process of enabling people to increase control over the determinants of health and thereby improve their health.
• Health promotion moves beyond health maintenance to incorporate improvements in health resulting in health gains.
• Embodies a sociopolitical process in which actions are aimed at reducing the effects of social, environmental, and economic conditions on individual, family, aggregate, and community health.

Question 25

What is health enhancement?

Answer 25

-Health enhancement is a health promotion strategy that is used to increase health and resiliency to promote optimal health and well-being.

Question 26

What has influenced the ‘evolution’ of health promotion?

Answer 26

The Lalonde Report, Ottawa Charter, Population Health Promotion Model

Question 27

What is the Lalonde Report?

Answer 27

Marc Lalonde introduced the notion of health promotion through this publication.
It increased awareness for human biology, environment, and lifestyle as determinants of health and influences of health care.
It brought up the consideration of lifestyle factors which have impacts on health, this introduced a focus on individual risk factor behaviors that negatively impact health.
-Behavioral view led to a view that individuals were responsible for their own health.

Question 28

What was a negative to the Lalonde report?

Answer 28

• Because the behavioral view did not consider socio-political or economic factors, it led to victim blaming when individuals didn’t change their behaviors.

Question 29

What is the Ottawa Charter?

Answer 29

• It defined and developed the concept and components of health promotion.
• It increased awareness of and expended upon the determinants of health in its discussions of the prerequisites for health, such as peace, ecosystem, sustainable resources, social justice, and equity.
• The charter identified several health promotion strategies for practice – advocating, enabling, and mediating – as necessary to help communities, groups, and individuals to reach their optimal levels of health.

Question 30

Population Health Promotion Model

Answer 30

Introduced by Hamilton and Bhatti. It builds on the Ottawa Charter as it considers and adds to the determinants of health and health promotion strategies.
-With this model, any of the five health promotion strategies can be developed and implemented at various levels, from societal to individual.

Question 31

The Public Health Agency of Canada identified 8 key elements that need to be adddressed in the PHP model, what were they?

Answer 31

• Focus on the health of populations
• Assess the determinants of health and their interactions
• Base decisions on evidence
• Increase upstream investments
• Apply multiple interventions and strategies
• Collaborate across health sectors and levels
• Employ mechanisms for public involvement
• Demonstrate accountability for health outcomes

Question 32

What were the 5 priorities for heath promotion for the 21st centurty?

Answer 32

• To promote social responsibility for health
• To increase investments for health development
• To consolidate and expand partnerships for health
• To increase community capacity and empower the individual
• To secure an infrastructure for health promotion

Question 33

The Canadian community health nursing practice incorporates strategies from what 5 things?

Answer 33

Primary health care, the Ottawa Charter, the EPP framework, the population health model and the determinants of health

Question 34

What is the theory of reasoned action?

Answer 34

Developed to explain an individual changing his/her health behavior.
Assumes a relationship among attitudes, beliefs, intention, and behaviour.
-Another underlying assumption is that the most influencing factor in behavioural act is intent to act.

Question 35

What is Transtheoretical model of change?

Answer 35

• Proposes that the process of intentional change (health behavioral actions and changes) usually proceeds through 5 changes.
• This includes precontemplation, contemplation, preparation, action, maintenance
• It includes the stages and processes of change and constructs, such as situational self-efficacy and temptations, and decisional balance.

Question 36

What is diffusion of innovation theory?

Answer 36

• Provides guidance on effective ways to encourage clients to adopt ideas, practices, or products that are considered “new” and are adopted in a community or society.
• This theory shows that individuals adopt innovations at different rates.
• Individuals are more likely to adopt health-related practices is the following conditions exist: compatibility, flexibility, reversibility, simplicity, advantageousness, and cost-efficiency.

Question 37

Describe the 5 categories of diffusion of innovation theory?

Answer 37

• Individuals are classified in one of the following five categories: innovators (quick adopters), early adopters, early majority, late majority, and laggards.
• Early majority are open to change and recognize the benefits of it. They are willing to change and have the resources to adopt the innovation.
• Late majority are doubtful about adopting the innovation
• Laggards are resistant to adopting the innovation
• Innovators hastily adopt the innovation, but are seen as impulsive and not trustworthy.

Question 38

What is the Community Mobilization Framework, and what are the 3 approaches?

Answer 38

-Identifies the following three health promotion community mobilization approaches to bring about community change:
•Social planning – problem solving at the community level to deal with community physical, mental, and social health concerns. Which is described as a task-oriented strategy with a health care provider as expert “leader”
•Locality development – community participation and cooperation to deal with community health concerns with a focus on process, consensus, and community self-help with a health care provider as a facilitator
•Social action – a process with the focus on shifting power relationships and resources so that change occurs to the benefit of the disadvantaged in the community

Question 39

What are the three frameworks related to healthy public policy?

Answer 39

Milio’s framework for the development of healthy public policy, Weiss’s framework on the relationships between evidence and policy, and the Health Impact Assessment (HIA) on policy development and implications

Question 40

What is Milo’s Framework?

Answer 40

Identified that policy development proceeds through initiation, action, implementation, evaluations, and reformation stages.

• Policy holders, policy influencers, the public, and the media are foundational to healthy policy development.
• The four elements that affect policy development are: social climate, influence, interests, and capacity.

Question 41

What is Weiss’s Model of Policy Development

Answer 41

-Weiss developed knowledge-driven, problem-solving, interactive, political, and tactical models to provide clarification of the different ways that evidence has guided healthy policy development.

Question 42

What are Health Impact Assessment models?

Answer 42

They are used to inform decision making in relation to policy development and practice. Also used to examine the impact on the health of the populations

Question 43

What are the three Health promotion approaches?

Answer 43

-Biomedical: focuses on the treatment and prevention of disease, especially on the biological and physiological risk factors associated with disease and ill health.
Behavioral: Focuses on using lifestyle chances, especially behavior risk factors, to promote health
-Socio-environmental: Focuses on health as a resource and considers the psychosocial and environmental risk factors related to the determinants of health in relation to health and health promotion. This health promotion approach uses the five strategies for health promotion outlined in the Ottawa Charter.

Question 44

What are 3 activities to facilitate health promotion strategies?

Answer 44

Health communication and social marketing activities, mutual aid and advocacy

Question 45

How can health communication and social marketing activities promote health?

Answer 45

Designed to inform individuals so that they can make decisions related to maintain and improving their health and well-being and those of their families and communities.
-Health communication involves disseminating information to promote knowledge, distributing health risk information, and creating awareness of health issues using various forms of mass media.

Question 46

What are the 8 P’s of social marketing?

Answer 46

• Product - benefits
• Price - costs such as physical, psychological, social, and financial for the target audience related to the benefits
• Place - convenient access
• Promotion - utilizing the most appropriate media form to convey the messages to the target audience
• Publics – includes the external and internal groups
• Partnership – includes teaming up with relevant agencies and organizations in the community with similar goals
• Policy – creating a supportive environment by introducing and supporting policies that fit with the social marketing program for sustainability
• Purse strings – the identification of and utilization of finding from sources such as grants or donations that will assist with creating and operating the program

Question 47

What benchmarks must be present to identify an approach as a social marketing strategy?

Answer 47

• Interventions are designed and evaluated based on behaviour change
• Audience research is used, along with pretesting and monitoring od interventions for each project
• Specific audiences are targeted
• The main component is building attractive and motivational interactions with target audiences
• The approach uses the 4 Ps (product, price, place, promotion)
• Benefits and barriers associated with the desired behaviour identified

Question 48

What is mutual aid and how can these activities promote health?

Answer 48

EPP identified this as a health promotion mechanism.
Most commonly referred to as elf-help, is defined as a process whereby personals chare common experienced, situations, or problems with others are view each other as equals. Ex: public support groups
-These serve as a social support network

Question 49

What is EPP Model?

Answer 49

This model came from the WHO report “Achieving Health for All” and offers a framework that defined health promotion in terms of a social goal (reducing inequities), a service goal (increasing prevention) and an individual-level goal (enhancing coping).

Question 50

What is advocacy and how can these activities promote health?

Answer 50

Includes interventions such as speaking, writing, or acting in favour of a particular issue or cause, policy, or group of people.

• Enhances the power of clients by involving them in the identification of their health concerns or uses and encouraging them to participate in developing solutions, including policy development and policy promotion.
• Action taken to influence decision makers in communities and governments to support a policy or cause that promotes health.

Question 51

How are focus groups and funding applications health promotion skills?

Answer 51

Focus groups use informal sessions as an interactive strategy to gain insight into the perceptions, beliefs, and opinions of generally 6-12 representatives. Used in assessment, particularly social assessment, serves as a ‘pretest’ in health promotion program development and evaluation
-Led by skilled moderators

• Funding applications: Health care care survival may be challenged due to fiscal finding constraints and therefore is dependent on government funding.
• Funding involves submitting an application to various government organizations.

Question 52

What are the 9 literacy skills which are essential to achieving success in work, learning and life?

Answer 52

The skills are reading, writing, oral communication, numeracy, thinking, document use, working with others, computer use and continuous learning.