1. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Chapter 44 Health Promotion Theories S. Maggie Reitz

2. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Learning Objectives After reading this chapter, you will be able to: 1.Describe theories of health behavior and health promotion that can be used to inform occupational therapy practice. 2.Discuss considerations in combining occupational therapy theories with health behavior theories. 3.Apply theory to the development of occupation-based occupational therapy health promotion interventions in interdisciplinary health promotion practice. 4.Examine the evidence available related to occupational therapy health promotion and health behavior health promotion interventions.

3. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Introduction Health and wellness is identified as an integral part of occupational therapy practice –AOTA’s Centennial Vision (Baum, 2006); and –Occupational Therapy Practice Framework (AOTA 2008b) A goal of OT is to enhance the health of clients through health promotion interventions The use of theory promotes the ethical and competent delivery of OT health promotion interventions

4. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Definitions of Health, Health Promotion, and Wellness The World Health Organization (WHO, 1947, p. 29) defines health as: –“A state of complete physical, mental and social well- being and not merely the absence of disease or infirmity.” Health promotion includes the use of techniques within a field used to help people attain health goals Occupational therapy-directed health promotion – interventions which promote health through occupation and adaptation to contexts Wellness emerges as a result of health promotion or individual efforts

5. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Determinants of Health The factors that determine what makes people healthy –Enables us to mobilize multiple sectors and approaches to improve health Healthy People 2020 (USDHHS, 2010) describes health within five broad categories: Biology and GeneticsPhysical Environment Individual BehaviorHealth Services Social Environment

6. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Prerequisites for Health Emphasizes basic needs required to obtain a healthy life WHO (1986) identifies eight prerequisites for health: Education Food IncomePeace ShelterSocial Justice & Equity Stable Eco-SystemSustainable Resources

7. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Occupational Enrichment & Deprivation Occupational Enrichment: –Access to resources for meaningful occupational engagement –Increases future likelihood of access to and sustainability of resources Occupational Deprivation: –Impacts access to five health determinants –Lack of access to resources for meaningful occupational engagement

8. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Health Promotion and Occupational Therapy Why should occupational therapy be involved in the promotion of health if many barriers exist? –Historical link between values of occupational therapy and health promotion Supporting Documents: –“AOTA’s Societal Statement on Health Literacy” (AOTA, 2011a) –“Occupational Therapy in the Promotion of Health and the Prevention of Disease of Disability” (AOTA, 2008a) –“World Federation of Occupational Therapists’ (WFOT) Position Paper on Community Based Rehabilitation” (WFOT, 2004)

9. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Health Promotion Theories Theories and frameworks enhance communication and understanding between interdisciplinary teams Three Health Behavior Theories and One Planning Framework: –Health Belief Model –Stages of Change Model –Social Cognitive Theory –PRECEDE-PROCEED Framework

10. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Health Belief Model Originated by public health social psychologists in the 1950s (NCI, 2005) Used to explore and facilitate health behavior change –A decision is made to either adopt or not adopt a new health behavior based on balancing perceived risks and benefits

11. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Stages of Change Model Considers an individual’s readiness for change Five Stages of Change: –Pre-contemplation –Contemplation –Decision –Action –Maintenance

12. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Social Cognitive Theory Emphasis placed on how to change behavior and mastery through doing Constructs: –Self-Efficacy –Knowledge –Outcome Expectations –Health goals –Sociostructural Factors

13. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins PRECEDE-PROCEED: A Framework Guides planning and evaluation of health promotion interventions through eight phases PRECEDE (Phases 1-5): –Community helps choose main health concern –Planning & implementation steps PROCEED (Phases 6-8): –Evaluation of the chosen intervention

14. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Health Promotion Theories and Occupational Therapy Selecting and blending theories –Health behavior theories lack occupation perspective –Occupational therapy theories may be strengthened by health behavior constructs –Theories may be paired to complement one-another Example: Health Belief Model and Ecology of Human Performance

15. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Occupational Therapy Health Promotion in Action CarFit (Stav, 2010) –Assesses an elderly drivers “fit” within their vehicle –Combines constructs from the Health Belief Model and the Person-Environment-Occupation (PEO) Model –Purpose is to educate older drivers on their bodies fit within the car and how to establish adaptations to maximize fit and safety

16. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Conclusion Occupation can assist in promoting health and well-being –Must be: culturally relevant, client-centered, based on theory and evidence Health Promotion Contributions: –A focus of the profession’s leadership –A focus of governmental efforts Occupational therapists may aid in cost reduction while continuing to improve quality of life and overall well- being