CHN Health Promotion

2.
Health Promotion
a. Concept of Health Promotion (The Ottawa Charter; Nov. 1986)
The Ottawa Charter for Health Promotion is the name of an international agreement signed at the First International Conference on Health Promotion, organized by the World Health Organization (WHO) and held in Ottawa, Canada, in November 1986.[1] It launched a series of actions among international organizations, national governments and local communities to achieve the goal of "Health For All" by the year 2000 and beyond through better health promotion. guiding principle in health promotion Health is a positive concept emphasizingsocial and personal resources as well as physical capacities. Health promotion is not just the responsibilityof health sector but goes beyond lifestyles towell-being. Five action areas for health promotion were identified in the charter: 1. 2. 3. 4. 5. Building healthy public policy Create supportive environments Strengthening community action Developing personal skills Re-orientating health care services toward prevention of illness and promotion of health
The basic strategies for health promotion were prioritized as: 1. Advocate: Health is a resource for social and developmental means, thus the dimensions that affect these factors must be changed to encourage health. 2. Enable: Health equity must be reached where individuals must become empowered to control the determinants that affect their health, such that they are able to reach the highest attainable quality of life. 3. Mediate: Health promotion cannot be achieved by the health sector alone; rather its success will depend on the collaboration of all sectors of
government (social, economic, etc.) as well as independent organizations (media, industry, etc.).
b. Health Promotion Strategies

1. Reorientation and reorganization of the national health care system with the establishment of functional support mechanism in support of the mandate of devolution under the Local Govt Code of 1991. 2. Effective preparation and enabling process for health action at all levels. 3. Mobilization of the people to know their communities and identifying their basic health needs with the end in view of providing appropriate solutions (including legal measures) to leading to self-reliance and self-determinations. 4. Development and utilization of appropriate technology focusing on local indigenous resources available in and acceptable by the community. 5. Organization of communities arising from their expressed needs which they have decided to address and that is continually evolving in pursuit of their own development. 6. Increase opportunities for community participation in local level planning, management, monitoring and evaluation within the context of regional and national objectives. 7. Development of intra-sectorial linkages with other government and private agencies so that programs of the health sector is closely linked with those of other socio-economic sectors at the national intermediate and community levels. 8. Emphasizing partnership so that the health workers and the community leaders/members view each other as partners rather than merely providers and receiver of health care respectively.
C. Theories Models of Health Promotion (Pender, Bandura, Green)

Penders Health Promotion Model
To be used as guide to explore the biophysical processes that motivate individuals to engage in behaviors directed toward health enhancement. (PENDER, 1996). Provided a theoretical framework which was used to investigate life-enhancing behaviors such as exercise and weight loss. Is a competence or approach-oriented model that depicts the multidimensional nature of persons interacting with their interpersonal and physical environments as they pursue health. Focused on health promoting behaviors rather than health protection or illness prevention behaviors
Variables of Health Promotion Model

1. Individual characteristics and experience -- individuals unique factors or characteristics and experiences will depend on the target behavior for health promotion includes the following: A. Personal Factor - Psychological - Biological - Socio Cultural B. Prior Related Behavior - Previous Experience - Knowledge - Skills in health promoting actions 2 . Behavioral -specific cognitions and affect - Constitute critical core for intervention because this can be modified through nursing interventions. Includes the following: A. Perceived benefits of action anticipated benefits or outcome affect the persons plan to participate in health-promoting behaviors and may facilitate continued practice (can be affected by experience/vicarious experience).
B. Perceived Barriers to Action persons perceptions about available time, inconvenience expense and difficulty performing the activity may act as barrier (decrease commitment to a plan of action). C. Perceived self- efficacy the conviction that the person can successfully carryout the behavior necessary to achieve a desired outcome (serious doubt about capabilities decrease effort and give-up) D. Activity related affect the subjective feelings that occur before, during, and following an activity influence a person to repeat again or maintain behavior. E. Interpersonal influence perception of the person concerning the behavior, beliefs or attitudes of others. - Includes expectations of significant others, social support and learning through observing others. Sources of Interpersonal Influences: 1. Family 2. Peers 3. Health Professionals F. Situational Influence direct and indirect influence on health-promoting behaviors. - A person is apt to perform health-related behaviors if the environment is comfortable versus feeling of alienation. Includes the following: 1. Perception of available options 2. Demand characteristic 3. Aesthetic features of the environment 3. Commitment to a plan of action - The interest of a person in carrying-outland reinforce health-promoting behaviors Involves 2 processes: A. Commitment good intention B. Identifying specific strategy Actual performance of the behavior 4. Immediate competing demands and preferences Situations that the person is experiencing in everyday life that could affect the control of health-promoting behaviors. Involves 2 types of control: A. Low control B. High control
5. Behavioral outcome Directed towards attaining positive health outcome for the client Should result in improved health and better quality of life at all stages of development.
Banduras Self-Efficacy Theory

Self efficacy theory of Albert Bandura Self- efficacy perception/belief of a person about his own capabilities to produce effect. Self-regulation exercise of influence over ones own motivation, thought process emotional state and patterns of behavior. Sources of self-efficacy - Self efficacy is developed by four (4) main source of influence 4 main source of influence 1. Mastery of Experience/performance accomplishment 2. Vicarious Experience provided by social models 3. Social persuasion (Support/Motivation from significant others) 4. Reduction of stress reactions and alter negative emotional proclivities and interpretation of physical and emotional traits. 4 Major Psychological Processes: 1. Cognitive Process thinking process, involve acquisition, organization and use of information Most courses of actions are initially organized in thought. 2. Motivational Process cognitive generated-Activation to action Level of motivation: 1) Choice of course of action 2) Intensity 3) Persistence of effort Motivation processes is covered by 4 types of Self-Influence: 1) Self-satisfying 2) Self- dissatisfying reactions to ones performance 3) Perceived self efficacy 4) Readjustment of personal goal based on ones progress 3. Affective Process process regulating emotional state and elicitation of emotional reactions. - The stronger the sense of self-efficacy the bolder people is in taking on taxing and threatening activities.
4. Selection Process the choices the person makes that cultivate different competencies, interest and social network that determine life courses. Self- Efficacy is concerned with peoplesbeliefs in their capabilities to exercisecontrol over their own functioning andover events that affect their lives.
Greens Precede Proceed Model

PRECEDE/PROCEED is a community-oriented, participatory model for creating successful community health promotion interventions. PRECEDE has five phases: Phase 1: Social diagnosis Phase 2: Epidemiological diagnosis Phase 3: Behavioral and environmental diagnosis Phase 4: Educational and organizational diagnosis Phase 5: Administrative and policy diagnosis PROCEED has four phases: Phase 6: Implementation Phase 7: Process evaluation Phase 8: Impact evaluation Phase 9: Outcome evaluation
How do you use PRECEDE/PROCEED?

In Phase 1, social diagnosis, you ask the community what it wants and needs to improve its quality of life. In Phase 2, epidemiological diagnosis, you identify the health or other issues that most clearly influence the outcome the community seeks. In these two phases, you create the objectives for your intervention. In Phase 3, behavioral and environmental diagnosis, you identify the behaviors and lifestyles and/or environmental factors that must be changed to affect the health or other issues identified in Phase 2, and determine which of them are most likely to be changeable. In Phase 4, educational and organizational diagnosis, you identify the predisposing, enabling, and reinforcing factors that act as supports for or
barriers to changing the behaviors and environmental factors you identified in Phase 3. In these two phases, you plan the intervention. In Phase 5, administrative and policy diagnosis, you identify (and adjust where necessary) the internal administrative issues and internal and external policy issues that can affect the successful conduct of the intervention. Those administrative and policy concerns include generating the funding and other resources for the intervention. In Phase 6, implementation, you carry out the intervention. In Phase 7, process evaluation, you evaluate the process of the intervention i.e., you determine whether the intervention is proceeding according to plan, and adjust accordingly. In Phase 8, impact evaluation, you evaluate whether the intervention is having the intended impact on the behavioral and environmental factors its aimed at, and adjust accordingly. In Phase 9, outcome evaluation, you evaluate whether the interventions effects are in turn producing the outcome(s) the community identified in Phase 1, and adjust accordingly.

CHN Health Promotion

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2.

b. Health Promotion Strategies

C. Theories Models of Health Promotion (Pender, Bandura, Green)

Variables of Health Promotion Model

Banduras Self-Efficacy Theory

Greens Precede Proceed Model

How do you use PRECEDE/PROCEED?

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