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MODELS OF HEALTH PROMOTION. Objectives: You students will Understand the parameters required for health promotion model Be able to apply those parameters.

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Presentation on theme: "MODELS OF HEALTH PROMOTION. Objectives: You students will Understand the parameters required for health promotion model Be able to apply those parameters."— Presentation transcript:

1 MODELS OF HEALTH PROMOTION

2 Objectives: You students will Understand the parameters required for health promotion model Be able to apply those parameters on models they may suggest for your own society

3 MODEL OF HEALTH PROMOTION 1: FOUR PARADIGMS OF HEALTH PROMOTION (CAPLAN AND HOLLAND ) RADICAL HUMANIST Holistic view of health De-professionalization Self-help networks HUMANIST Holistic view of health Aims to improve understanding and development of self Client-led RADICAL STRUCTURLIST Health reflects structural inequalities Need to challenge inequity and radically transform society. TRADITIONAL Health = absence of disease Aim is to change behaviour Expert-led Radical change Subjective Social regulation Objective Nature of knowledge Nature of society

4 MODEL OF HEALTH PROMOTION 2: HEALTH PROMOTION METHODS USING BEATTIES TYPOLOGY (BEATTIE – 1991) Advice Education Behaviour change Mass media campaign Counselling Education Group work Legislation Policy making and implementation Health surveillance Lobbying Action research Skills sharing and training Group work Community development MODE OF INTERVENTION Individual Negotiated Collective Focus of intervention Authoritarian

5 MODEL OF HEALTH PROMOTION 3: A TYPOLOGY OF HEALTH PROMOTION (FRENCH – 1990) DISEASE MANAGEMENT Curative services Management services Caring services DISEASE PREVENTION Preventive services Medical services Behaviour change HEALTH EDUCATION Agenda setting Empowerment and support Information POLITICS OF HEALTH Social action Policy development Economic and fiscal policy

6 MODEL OF HEALTH PROMOTION 4: TANNAHILLS MODEL OF HEALTH PROMOTION (DOWNIE et al – 1990) Health education Prevention Health protection Preventive services, e.g. immunization, cervical screening, hypertension case finding, developmental surveillance, use of nicotine chewing gum to aid smoking cessation. 2. Preventive health education, e.g. smoking cessation advice and information. 3. Preventive health protection, e.g. fluoridation of water. 4. Health education for preventive health protection, e.g. lobbying for seat belt legislation. 5. Positive health education, e.g lifeskills with young people. 6. Positive health protection, e.g. workplace smoking policy. 7. Health education aimed at positive health protection, e.g. lobbying for a ban on tobacco advertising.

7 MODEL OF HEALTH PROMOTION 5: THE CONTRIBUTION OF EDUCATION TO HEALTH PROMOTION (TONES et al – 1990) Healthy public policy Lobbying Advocacy Mediation Public pressure Healthy social and physical environment Healthy promoting organisation Professional education Healthy services HEALTH Healthy choices Agenda setting Education for health Critical consciousness raising Empowered participating community

8 APPROACHES TO HEALTH PROMOTION

9 Approaches in Health Promotion: the example of healthy eating ApproachAimsMethods Worker/client relationship MedicalTo identify those at risk from disease. Primary health care consultation. e.g. measurement of body mass. Expert-led. Passive, conforming client.

10 Approaches in Health Promotion: the example of healthy eating ApproachAimsMethods Worker/client relationship Behavior change To encourage individuals to take responsibility for their own health and choose healthier lifestyles. Persuasion through one- to-one advice, information, mass campaigns, e.g. Look After Your Heart dietary messages. Expert-led. Dependent client. Victim blaming ideology.

11 Approaches in Health Promotion: the example of healthy eating ApproachAimsMethods Worker/client relationship EducationalTo increase knowledge and skills about healthy lifestyles. Information. Exploration of attitudes through small group work. Development of skills, e.g. womens health group. May be expert led. May also involve client negotiation of issues for discussion.

12 Approaches in Health Promotion: the example of healthy eating ApproachAimsMethods Worker/client relationship Empowerment To work with client or communities to meet their perceived needs. Advocacy Negotiation Networking Facilitation e.g. food co-op, fat womens group. Health promoter is facilitator, client becomes empowered.

13 ApproachAimsMethods Worker/client relationship Social change To address inequalities in health based on class, race, gender, geography. Development of organizational policy, e.g. hospital catering policy Public health legislation, e.g. food labelling. Fiscal controls, e.g. subsidy to farmers to produce lean meat. Entails social regulation and is top-down. Approaches in Health Promotion: the example of healthy eating

14 Religion and Health - 3 Figure 1: Pathways of Islamic Health Theory Quran & Ahadith Five Pillars of Islam Elements of Faith Islamic Jurisprudence Salutogenic Mechanism Sense of coherence Predisposing & Enabling factors Behavior Healthy Lifestyle

15 Putting Islamic Concepts Into Practice for Health Promotion 1 Act Plan Do Check

16 Precede-proceed model. Intervention mapping. A five-stage model. Putting Islamic Concepts Into Practice for Health Promotion 2

17 Putting Islamic Concepts Into Practice for Health Promotion 2.1 The PRECEDE-PROCEED Model by Green & Kreuter, 1999 Visit the website below for a figure of this model. /PP_Part_3_cont.html#anchor248267

18 Intervention mapping. Putting Islamic Concepts Into Practice for Health Promotion 2.2 STEP 1: Proximal program objective matrices STEP 2: Theory –based methods and practical strategies STEP 3: Program plan STEP 4: Adoption and implementation plan STEP 5: Evaluation plan

19 A five-stage model (Bracht et al. 1999) Putting Islamic Concepts Into Practice for Health Promotion 2.3 COMMUNITY ORGANIZATION STAGES 1. Community analysis 2. Design - initiation 3. Implementation 4. Maintenance - consolidation 5. Dissemination - reassessment

20 1. Community analysis. Putting Islamic Concepts Into Practice for Health Promotion 3.1 An illustration using the five-stage model (Bracht et al. 1999)

21 2. Design - initiation. Putting Islamic Concepts Into Practice for Health Promotion 3.2 An illustration using the five-stage model (Bracht et al. 1999)

22 3. Implementation. Putting Islamic Concepts Into Practice for Health Promotion 3.3 An illustration using the five-stage model (Bracht et al. 1999)

23 4. Maintenance - consolidation. Putting Islamic Concepts Into Practice for Health Promotion 3.4 An illustration using the five-stage model (Bracht et al. 1999)

24 5. Dissemination - reassessment. Putting Islamic Concepts Into Practice for Health Promotion 3.5 An illustration using the five-stage model (Bracht et al. 1999)

25 Promoting Healthy Behavior

26 Behavior and Global Health Physical good health eludes billions of people Death and disease from preventable causes remain high Behavior is a key factor in determining health Health is a state of complete physical, psychological, and social well-being and not simply the absence of disease or infirmity. (World Health Organization, 1948)

27 Ten Leading Risk Factors for Preventable Disease Maternal and child underweight Unsafe sex High blood pressure Tobacco Alcohol Unsafe water, poor sanitation, & hygiene High cholesterol Indoor smoke from solid fuels Iron deficiency High body mass index or overweight Source: WHO, World Health Report 2002: Reducing Risk, Promoting Healthy Life (Geneva: WHO, 2002), accessed online at on Nov. 15, 2004.

28 Whose Behavior is Responsible For… Maternal and child underweight Smoking and alcohol abuse Unsafe sex Unsafe water and lack of adequate sanitation

29 Maternal and Child Underweight Individuals (may resist nutrition education) Communities (male preference norms) Policymakers (fail to address poverty) Health planners and health workers (do not include nutrition programs for the poor)

30 Smoking and Alcohol Abuse Individuals (choice) Communities (norms regarding smoking) Health policymakers Legislators & tax assessors Tobacco company executives Decision-makers in marketing companies

31 Unsafe Sex Individuals (abstinence, fidelity, condoms) Communities (norms regarding male dominance and multiple partners) Poverty (transactional sex for poor women) Health policymakers and health workers (effective AIDS prevention programs)

32 Unsafe Water and Lack of Adequate Sanitation Individuals (where they fetch water, boiling water, washing hands) Communities (fatalism regarding diarrheal diseases, community latrines) Governments (ignore or underfund safe water and sanitation needs)

33 Risky behaviors translate to diseases

34 Global Causes of Death Noncommunicable diseases Communicable diseases, maternal and perinatal conditions, and nutritional deficiencies Injuries Source: WHO, World Health Report 2000Health Systems: Improving Performance (Geneva: WHO, 2000).

35 Behavior change reduces risky behaviors

36 Health Promotion Means Changing Behavior at Multiple Levels AIndividual: knowledge, attitudes, beliefs, personality BInterpersonal: family, friends, peers CCommunity: social networks, standards, norms DInstitutional: rules, policies, informal structures EPublic Policy: local policies related to healthy practices Source: Adapted from National Cancer Institute, Theory at a Glance: A Guide for Health Promotion (2003), available online at

37 A: Individual-Oriented Models Individual most basic unit of health promotion Individual-level models components of broader-level theories and approaches Models –Stages of Change Model –Health Belief Model

38 Stages of Change Model Changing ones behavior is a process, not an event Individuals at different levels of change Gear interventions to level of change Source: James O. Prochaska et al., In Search of How People Change: Application to Addictive Behaviors, American Psychologist 47, no. 9 (1992):

39 Stages of Change Model (cont.) Precontemplation ActionDecision MaintenanceContemplation

40 Health Belief Model Perceived susceptibility and severity of ill health Perceived benefits and barriers to action Cues to action Self-efficacy Source: Irwin M. Rosenstock et al., Social Learning Theory and the Health Belief Model, Health Education Quarterly 15, no. 2 (1988):

41 B: Interpersonal Level: Social Learning Theory Interaction of individual factors, social environment, and experience Reciprocal dynamic Observational learning Capability of performing desired behavior Perception of self-efficacy Source: Albert Bandura, Social Foundations of Thought and Action (Englewood Cliffs, NJ: Prentice Hall, 1986).

42 Interpersonal Level: Social Learning Theory (cont.) Three strategies for increasing self-efficacy –Setting small, incremental goals –Behavioral contracting: specifying goals and rewards –Self-monitoring: feedback can reinforce determination to change (keep a diary) Positive reinforcement: encouragement helps Source: Albert Bandura, Social Foundations of Thought and Action (Englewood Cliffs, NJ: Prentice Hall, 1986).

43 C: Community-Level Models Analyze how social systems function Mobilize communities, organizations, and policymakers Use sound conceptual frameworks –Community Mobilization –Organizational Change –Diffusion of Innovations Theory

44 Community Mobilization Encompasses wider social and political contexts Community members assess health risks, take action Encourages empowerment, building on cultural strengths and involving disenfranchised groups Source: National Cancer Institute, Theory at a Glance: A Guide for Health Promotion: 18; Paolo Freire, Pedagogy of the Oppressed (New York: Continuum, 1970.); Saul Alinsky, Rules for Radicals: A Pragmatic Primer for Realistic Radicals (New York: Vintage Books, 1971; revised edition, 1989).

45 Organizational Change Organizational Stage Theory Define problem Identify solutions Initiate action Allocate resources Implement Institutionalize Organizational Development Theory Worker behavior and motivation Organizational structures

46 Diffusion of Innovations Theory How new ideas, products, and behaviors become norms All levels: individual, interpersonal, community, and organizational Success determined by: nature of innovation, communication channels, adoption time, social system Source: Everett M. Rogers, Diffusion of Innovations, 4th ed. (New York: The Free Press, 1995).

47 Diffusion of Innovations (cont.) Nature of innovation Relative advantage over what is being replaced Compatible with values of intended users Easy to use Opportunity to try innovation Tangible benefits

48 Diffusion of Innovations (cont.) Communication channels Mass media (enhanced by listening groups, call-in opportunities, and face-to-face approaches) Peers Respected leaders

49 Diffusion of Innovations (cont.) Adoption time Awareness Intention Adoption Change Gradual Movement through groups –Pioneers –Early adopters –Masses

50 Diffusion of Innovations (cont.) Social system: Identify influential networks to diffuse innovation: health systems, schools, religious and political groups, social clubs, unions, and informal associations Identify opinion leaders, peers, and targeted media channels to diffuse innovations

51 Health Promotion

52 Health Promotion Tools Mass media Social marketing Community mobilization Health education Client-provider interactions Policy communication Source: Robert Hornik and Emile McAnany, Mass Media and Fertility Change, in Diffusion Processes and Fertility Transition: Selected Perspectives, ed. John Casterline (Washington, DC: National Academies Press, 2001):

53 Behavior Change Successes Reducing malnutrition (micronutrient initiatives) Preventing malaria (insecticide-treated bednets) Helping children survive (breastfeeding) Improving maternal health (safe motherhood movement, emergency obstetric care) Making family planning a norm (worldwide efforts) Combating HIV/AIDS (Uganda program)

54 Combating HIV/AIDS in Uganda Political support, multisectoral response Decentralized behavior change campaigns Focus on women and youth, stigma and discrimination Mobilization of religious leaders Confidential voluntary counseling and testing Social marketing of condoms Control and prevention of STIs Source: Edward C. Green, Rethinking AIDS Prevention: Learning from Successes in Developing Countries (Westport, CT: Praeger Publishers, 2003).

55 Health Promotion: Lessons Learned Research underlying causes Address contextual factors Identify and reach key actors at every level Involve stakeholders throughout process Use sound behavioral theories Monitor and evaluate

56 Conclusion Improving global health requires behavior change at every levelindividuals, families, communities, organizations, and policymaking bodies Evidence-based behavioral theories and successful behavior-change case histories point the way Next step: political will and sufficient resources

57 For More Information Elaine M. Murphy, Promoting Healthy Behavior, Health Bulletin 2 (Washington, DC: Population Reference Bureau, 2005). Available online at

58 Objectives: You Students will Understand the parameters required for health promotion model. Be able to apply those parameters on models they may suggest for their own society.


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