S7 - Health promotion Flashcards
what is the definition of health
health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity
- The absence of any disease or impairment
- A state that allows the individual to adequately cope with all demands of daily life (implying also the absence of disease and impairment)
- A state of balance, an equilibrium that an individual has established within himself and between himself + his social and physical environment
Note: the WHO definition of health as ‘complete wellbeing’ is no longer fit for purpose (due to rise in chronic disease)
How to measure health
- Operational definitions are needed for measurement purposes, research and evaluating interventions
- Measurement instruments should relate to health as the ability to adapt and self manage eg functional status, quality of life, sense of wellbeing
What is health promotion + definition
the process of enabling people to increase control over, and to improve their health. It moves beyond a focus on individual behaviour towards a wide range of social and environmental interventions
* comprehensive approach to promoting health by focussing on multi sectoral approaches
* Responds to developments which have a direct or indirect bearing on health, such as inequities, evironments, cultural beliefs etc
☞ the promotion of health is affected by the differences in the definition of health
What is the Ottawa charter of health promotion and the 3 basic strategies
health is created and lived by people within the settings of their everyday life; where they learn, work, play and love
3 basic strategies
☞ advocacy for health to create the essential conditions of health
☞ enabling all people to achieve their full health potential
☞ mediating between different interests in society in the pursuit of health
What are the 5 action areas of the Ottawa charter of health promotion
- Building healthy public policy (joint working across sectors, recognition of the role of public policy in health)
- Create supportive environments for health (the role of work and leisure, protecting the natural and built environment)
- Strengthen community action for health (empower communities, improve access to opportunities)
- Develop personal skills (provide access to info + education for health, enhance life skills)
- Reorient health services (putting more focus on holistic care and health promotion)
Determinants of health
- Combination of non modifiable factors (eg age, sex and constitutional factors)
- Also individual lifestyle factors
- Social and community networks
- Living and working conditions (eg education, housing, health care, unemployment and water sanitation)
- Different factors are interlinked - complex interplay
- The context of people’s lives determine their health
Social determinants of health
these are the conditions in the environments where people are born, live, work, learn, worship, play and age
- Affect a wide range of health, functioning and QoL outcomes and risks
- Poor health outcomes are often made worse by the interaction between individuals and their social + physical environment
- Eg:
☞ economic stability
☞ social and community context
☞ neighbourhood and built environemtn
☞ health care access and quality
☞ access to education and quality
Examples of health promotion strategies
- healthy weight management
- NHS health checks
- Substance misuse services
- Smoking cessation
- Sexual health services
- Green health
- Diet and nutrition
- Physical activity
- Mental health and wellbeing
What are the 3 principles + 6 pillars of lifestyle medicine
- Acknowledge the need for action on socioeconomic determinants of health
- Proven techniques to support people to sustain lifestyle change
- Knowledge of the 6 pillars of lifestyle medicine…
☞ healthy eating
☞ mental wellbeing
☞ healthy relationships
☞ sleep
☞ physical activity
☞ minimising harmful substances
What are the levels of prevention
primary
- Prevent onset of illness
- Designed to reduce the instances of an illness in a population
- Therefore often reduce the risk of new cases appearing, and reduce duration
secondary
- Early diagnosis
- Aimed at detecting and treating pre-symptomatic disease
tertiary
- Minimise effects of established disease and prevent complications
- Aimed to reduce incidence of chronic incapacity or recurrences in a population
- Therefore reduce the functional consequences of an illness
- Includes therapy, rehabilitation or interventions designed to help the patient return to education, career and social/family/cultural life
Targeted vs universal health promotion
universal aims to reduce the risk across the whole population (likely to see bigger impact where a risk factor is common) eg the sugar tax
targeted aims to identify those most at risk ad then tailor messages + approaches for that group (that initiative is more likely to work for that specific community) eg breastfeeding for young mums
Self-management
3 core tasks
☞ medical management (eg attending appointments, adherence to meds, self-assessment for symptoms and complications)
☞ role or behavioural management (eg adapting to their life with new disease status – medication routines, regular exercise and balanced diet)
☞ emotional management (eg managing emotional and psychological consequences of having a lifelong condition)
5 key processes
☞ decision making
☞ taking action
☞ problem solving
☞ utilising resources
☞ forming partnerships with HCPs
Patient activation what is it + definition
the knowledge, skills and confidence that an individual has in managing their own health and healthcare
- individual managing their own healthcare
- ie whether they are disengaged and overwhelmed, or maintaining action (or somewhere in between)
has an important role in self-management
- knowledge abut a long term condition and its treatment is important component of patient activation + self-management
- having necessary skills + knowledge of own condition → better levels of activation
- increased activation → improved self-management behaviours
Barriers and faciliators to self-management
lower patient activation associated with
- intrusive treatment (eg dialysis)
- higher numbers of co-morbidities
- poorer QoL
higher patient activation associated with
- medication adherence
- good QoL
- fewer symptoms and co-morbidities
Predicting change - social cognitive theory
bandura
environmental factors eg social norms, access in community, influence on others
behavioural factors eg skills, practice and self-efficiacy
cognitive factors (personal factors) eg knowledge, expectations and attitudes
Stages of change - transtheoretical model
(Prochaska and DiClemente)
- starts with precontemplation (no intention of changing behaviour)
- then contemplation (aware a problem exists, but no commitment to action)
- preparation (intent on taking action)
- action (active modification of behaviour)
- maintenance (sustained change, where new behaviour replaces old)
- relapse (fall back into old patterns of behaviour)
☞ upward spiral: learn from each relapse
COM-B model (recap)
- capability, motivation and opportunity all feed into behaviour
- capability = physical (skills learnt through practice) and psychological (knowledge, attention, decision making etc) capability
- opportunity = social (ie social pressure, norms and conformity) and physical (environmental context and resources)
- motivation = automatic (emotions, reinforcement and punishment) and reflective (beliefs about capabilities and consequences etc)
What is the MECC approach + brief opportunistic advice
making every contact count
Approach to behaviour change
Uses the day-to-day interactions that individuals and organisations have with other people to help support them to manage and improve their own health + wellbeing
It’s about what matters to the patient themselves
Providing brief opportunistic advice to encourage them to adopt healthier lifestyle
brief opportunistic advice
☞ 30 secs to 5 mins
☞ give relevant information
☞ used to inform people about services and interventions available
☞ signpost to further help and support
☞ raise awareness of risks, provide encouragement and support for change
What is the AAA model (for brief interventions)
- ASK (eg do you use tobacco?)
- ADVICE – give health benefits (ie stopping smoking with NHS support is the best thing they can do for their health)
- ACT – refer on and signpost
Motivational counselling
a client-centred, directive method for enhancing intrinsic motivation to change by exploring and resolving ambivalence
- Facilitates patient-driven decision to change behaviour
- Individual is the expert in their own life
- Develop strategies to elicit the patient’s own motivation to change
- Guide rather than direct
- Refine listening skills and encourage change talk from the patient
Health coaching
** a patient-centred approach wherein patients at least partially determine their goals, use self discovery/active learning processes together with content education to work toward their goals**
- Patient self-monitors their behaviour to increase accountability
- Supports patients to make behaviour changes by focussing on the goals the patient sets to address a particular health concern
- Focus of interaction is on generating and trying out potential solutions rather than focusing on the problem itself
Health promoting settings
the place or social context in which people engage in daily activities in which environmental, organisational, and personal factors interact to affect health and wellbeing
- Supportive environments with a focus on health promotion
- Holistic and multifaceted approach
- Intergrates action across risk factors
- Goal is to maximise disease prevention by a whole-system approach
- key principles: community participation, partnership, empowerment and equity
Evaluation of health promotion activities
- Need this for evidence-based interventions
- To prove this intervention worked: need a properly-conducted evaluation study
- Accountability: evidence gives legitimacy to interventions and political support
- Ethical obligation: to ensure no direct or indirect harm
