1. MODELS & THEORIES Of
HEALTH PROMOTION
Sai.

2. OBJECTIVES
Outline risk and protective factors for health present in the community.
Discuss the four goals to achieve a healthy population (vision healthy population 2020)
Explain how a social marketing approach is use for promoting health in the community.
Discuss and analyze methods, theories and models of health promotion

3. WHO –Healthy Setting Approach
“Health is created and lived by people within the settings of their everyday life; where they learn, work, play, and love” The Ottawa Charter (1986)
It acknowledge the importance of people’s environment (setting) i.e
school
Workplace
Community
Hospital
Encourage the integrations of the five strategies of the Ottawa Charter in all setting where health is to be promoted . (World Health Organisation )

4. 8 Prerequisites for Health : Ottawa Charter
Income
A stable eco- system
Sustainable resources
Social justice and equity .
Peace
Shelter
Education
Food
World Health Organisation (2009) Milestone in Health Promotion : Statement from Global Conferences. Health Promotion

5. DETERMINANTS OF HEALTH
Factors that contribute to an individual, family & community health status.
Put people at risk / susceptible to illness.
Prevention of illness/ Promotion of wellness
Differs in all communities

6. DETERMINANTS OF HEALTH
SOCAL DETERMINANTS
PHYSICAL DETERMINNATS
Individual ?
Natural
Manmade
Attitude
Behaviour
Physiological
Others

7. Ecosystem

8. Environment
Natural
Manmade

9. Environmental-- Physical
Geographical .
Climate /housing /road etc .

10. Socio –Political /Economical Conditions

11. SOCIAL CAPITAL

12. Social Capital Social Capital resource for actions :
‘The ability of actors to secure benefits by virtue of membership in social networks and other social structures’ Erikson.M(2011)
Social Capital resource for actions :
Obligation, trustworthiness , expectation
Information channels
Norms and effective sanctions ( Coleman .J.S 1988)
Social Network :
Social support
Social influence
Social participation
Group membership (Berkman& Glass 200)

13. Health services

14. Technological Advances

15. 4 Goals to Achieve a healthy population 2020
‘Eliminate preventable disease, disability, injury, and premature death.
Achieve health equity, eliminate disparities, and improve the health of all groups.
Create social and physical environments that promote good health for all.
Promote healthy development and healthy behaviours across every stage of life.’
(Department of health &human service .USA)

16. 1 Eliminate preventable disease, disability, injury, and premature death.
Prevention & Health Promotion
Disaster/ hazards Awareness
Multi-disciplinary, interdisciplinary and intersectoral partnerships Approach .

17. Eliminate preventable disease, disability, injury, and premature death
Eliminate preventable disease, disability, injury, and premature death. Cont’
Through – identifying causes and distribution :
epidemiology laboratory tests& surveillance
Control – provision of health services
Maintain- continuity of care during emergency
Recover –restoration of health services
(Department of health &human service .USA)

18. 2 Achieve health equity and eliminate health disparities
Health disparity- health differences that is associated with social / economical /environmental disadvantages pertaining to certain group of people.
Health Equity : having access to good health care /services – improvement in health status –
through fair &redistribution of resources.
(Talbot& Verrinder2010)

19. 3 : Create social& physical environment that promote good health for all
Ecological approach to health promotion at all levels --- bio psychosocial .
Individual
Social environment
Physical environment
(Department of health &human service .USA)

20. 4 Promote health development & healthy behaviour across the lifespan
Human development across the life span is considered .
Age groups & life stages
Gender

21. ANY QUESTION ?

22. Social Marketing
As a strategy for health promotion ---
‘The application of commercial marketing techniques to the analysis, planning, implementation & evaluation of program designed to influence voluntary /involuntary behaviour of target audience in order to improve the welfare of the individual and the community’(Donavan &Henley cited in Talbot& Verinder 2013)

23. Social Marketing cont’
It focus on the use of mass media but can be used in any communication medium.
Uses the mass media for informing /advertising or motivating people
AIM:
a) Influences people’s value & attitude on social issues that can cause health risk or benefits.
b) Individuals , network, organisation at society level.
(Talbot &Verinder 2013)

24. Social Marketing cont Uses various communication activities:
Advertising--
Publicity material—mass media campaign
Edutainment – woven in the television series or films
More effective when integrated with interpersonal/community based events.
(Talbot &Verinder 2013)

25. Social Marketing Benefits
Gain National awareness if tagged to local community activities.
Can be used to reflect community values & create a sense of ownership towards certain health issues
Knowledge gained is enabling &empowering
National level –enhance people’s understanding of complex issues using short, accessible & memorable messages if they cannot access traditional education resources. (Talbot &Verinder 2013)

26. Social Marketing - Target Group Demographic characteristics
Behavioural characteristics
Psychographic characteristics
Content of messages
Informative
Timeliness
Significant/relevance
Scope
Interest
Uniqueness.

27. Social Marketing -communication option
Newsletter
Press release
Internet media
Posters
Static display
Brochures.
Advertising

28. ANY QUESTION

29. Models /theories of health promotion
Models /theory of health promotion serve as framework of which one have to build strategies for improvement of health status of a community
Health promotion theories is derived from the behavioural and social sciences.(psychology & sociology )
It considers the organisational structures of the society and it’s policies and the community members.
There are many models of health promotion

30. HEALTH PROMOTION MODEL
“The HPM is an attempt to depict the multidimensional nature of persons interacting with their environment as they pursue health” (Pender, 1996, p. 53).
NOLA .J.PENDER
FOCUSES ON THREE AREAS:
Individual characteristics
Behavior specific cognition & affect
Behavioral Outcome

31. Four Assumptions:
Individual seek to regulate their own behavior
Individuals in all their biosychosocial complexity interact with the environment transforming the environment as well as being transformed over time .
Health professionals such as nurses ,constitute a part of the interpersonal environment which exert influence on people through their life span
Self –intiated recognition of the person –environment interaction patterns is essential to changing behavior

32. HPM

33. Precede –Proceed model
Based on active participation of the community members in the planning, implementation, and evaluation of the program .
This approach first look at the negative health outcome (result of a behaviour) .(Dr. McKinley Thomas )
Aetiology -predisposing factors (hinders/ facilitate) individual knowledge , attitude, values & perception.
Reinforcing factors—attitude & behaviour of others
Enabling factor –skills , environmental factors resources or barriers that can help or hinder the need change of behaviour.
Administrative ,policy diagnosis—capabilities to cater for the identified health need.(Mcmurray 2007)

34. Precede-Proceed Model (Green & Kreuter1991)
Diagnostic phase
Implementation & evaluation phase
P-predisposing
R-reinforcing
E-enabling
C—constructs in
E—educational & organisational
D-diagnosis
E-evaluation
P-policy
R-regulatory
O-organisational
C-construct in
E-educational
E- environmental
D-development
(Green & Kreauter 1991)

35. Patch – Planned Approach to Community Health (Kreute1991)
Community to gain or to have the competency to be able to : plan , implement and evaluate community based health promoting programs through horizontal & vertical coalition (Green et-al)
Horizontal Coalition:-- linking up with similar group with same health needs for sharing ideas and strategies . At government level –intersectoral collaboration occurs.
Vertical Coalition :- Linking up with the various level of the government or health services
(McMurray2007)

36. Patch – Planned Approach to Community Health cont’
5 PATCH Steps Community Participation
Mobilizing the Community
Collecting and organizing data
Choosing health priorities and target groups
Choosing and conducting interventions.
Conducting Evaluations
1st three can be considered facets of a needs assessment, but only serve as a very general reminder of what should be done.

37. Health Belief Model (HBM)
Developed by social psychologists to explain why people fail to participate in screening for tuberculosis. Houchbaum’s findings –information alone is not enough to motivate people to change /act. ‘They must know what to do and how to carry it out and the information must be related to their health need’ .(Nies & McEwan 2012)
The model concept have been widely used to explain behaviour change.(Nies & McEwan 2012)

38. Health Belief Model (HBM)Concepts
Perceived Susceptibility :belief regarding the chance of getting a health condition .
Perceived Severity :belief in regard of the seriousness of the health condition .
Perceived benefitting : one’s belief in the ability of the advised action to reduce health risk or seriousness of the condition
Perceived Barrier: belief regarding the tangible and psychological cost of to treatment.
Costs of action : Conditions in one’s environment that activate readiness to take action
Self –Efficiency : confidence in ones’ ability to take action to reduce health risk

39. Ecological Model
Ecology refers to the interrelations between organisms and their environments .

40. Ecological models
Bronfenbrenner (1979) – micro, meso, exo and macrosystems;
Moos (1970) – four strata classification: physical settings, organizational factors, human aggregate factors and social climate; o
McLeroy (1988) – five sources of influence: intrapersonal, interpersonal, institutional, community and policy (Sallis, Owen, & Fisher, 2008; Richard & Gauvin, 2012)

41. Ecological Approaches
Health status depend on the many environment subsystem ( family , community, workplace, beliefs , culture ,economic, physical & social environment.
Interventions should be at
Intrapersonal
Interpersonal
Institutional
Community
Public policy .

42. Ecological Model Core Principles Influences interact across levels;
Multiple levels of factors influences health behaviors;
Influences interact across levels;
Multi-level interventions should be more effective in changing behaviors;
Ecological models are most powerful when they are behavior-specific.
(Sallis, Owen, & Fisher 2008)

43. Reference
Dr. McKinley Thomas Associate Professor Department of Community Medicine Mercer University
McMurry.A.(2007) Community Health and Wellness :A Sociological Approach (2007)
Nies.M.A.& McEwen M. .(2012) Community /Public Health Nursing :Promoting the of Population
Stanhope.M.& Lancaster .J. (2008). Public Health Nursing : Population – Centred Health Care in the Community . (7th ed)
Talbot.L.& Verrinder. G.(2010) Promoting Health :The Primary Health Care Approach.
THE SECRETARY’S ADVISORY COMMITTEE ON NATIONAL HEALTH PROMOTION AND DISEASE PREVENTION OBJECTIVES FOR Department of health &human service .USA
World Health Organisation
World Health Organisation (2009) Milestone in Health Promotion : Statement from Global Conferences. Health Promotion