Chapter 13
Principles
of Health Promotion
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Healthy People 2010
• Health of the total population and the
consequences of the determinants of
health:
– Biology
– Behavior
– Social environment
– Physical environment
– Policies
– Intervention
2
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Healthy People 2010
• Policies
• Intervention
3
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Holistic Concept of Health
• Nursing and public health view of health
as a holistic concept
– Encompasses
•
•
•
•
Physical
Psychological
Social
Spiritual dimension
4
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Smith Model of Health
• Four models:
1.
2.
3.
4.
Clinical health
Role performance health
Adaptive health
Eudaemonic health
5
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Pender
• Actualization of inherent and acquired
human potential through
– Goal directed behavior
– Competent self care
– Satisfying relationships while maintaining
structural integrity with environments
6
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Health Promotion History
• WHO Ottawa Charter
• Multidisciplinary practice
• Florence Nightingale (1859) wellnessillness continuum
– Promoted health through education
– Nursing care included personal living and
healthful environments
7
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Health Promotion History
• Nursing’s meta-paradigm
– Person
• Environment
– Health
• Nursing
8
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Health Promotion History
• 1973
– ANA Standards of Nursing Practice
• 1979
– Healthy People: Surgeon General’s Report on
Health Promotion and Disease
9
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Theoretical Foundations
• Behavioral Model
– Behavior is a function of the rational decision
making process
– Lewin
• Positive valence
• Negative valence
• Value expectancy theory
10
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Health Belief Model
• Based on value expectancy theory
• Rosenstock (1966) added variables to the
model
– Variables that explain or predict behavior:
•
•
•
•
Susceptibility
Severity
Barriers
Cues to action
11
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Pender’s
Health Promotion Model
• Pender modified the Health Belief Model
• Integrates concepts from HBM and social
cognitive theory
• Revised in 2002
12
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Pender’s
Health Promotion Model
• Concepts grouped in three major
categories:
1. Individual characteristics and experiences
• Prior-related behavior
• Personal factors
13
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Pender’s
Health Promotion Model
• Concepts grouped in three major
categories
2. Behavior-specific cognitions and affect
• Perceived benefits
• Perceived barriers to the action
14
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Pender’s
Health Promotion Model
• Concepts grouped in three major
categories
3. Perceived self-efficacy
• Activity related affect
• Interpersonal influences
• Situational influences
– Behavioral outcome
15
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Theory of Planned Behavior
•
•
•
•
•
•
Extension of the theory of reasoned action
Intention
Attitude
Subjective norm
Perceived behavioral control
Outcome expectancy
16
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Transtheoretical
Model of Behavioral Change
• Individuals progress through stages during
behavioral change process
– Precontemplation stage
– Contemplation stage
– Preparation stage
– Action stage
– Maintenance stage
17
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Transtheoretical
Model of Behavioral Change
• Three constructs that influence behavior
change:
1. Process of change
2. Self-efficacy
3. Decisional change
18
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Ecological Models
• Social Cognitive Theory
– Triadic reciprocal determinism
– Outcome expectancies
19
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Ecological Models
• Bandura self-efficacy expectations
– Developed from four sources of information:
1.
2.
3.
4.
Enactive attainment
Vicarious experiences
Verbal persuasion
Physiological or emotional arousal
20
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Ecological Models
• Ecological model of health behavior
– Five system levels
1.
2.
3.
4.
5.
Intrapersonal
Interpersonal
Organizational
Community
Public policy
21
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Other Ecological Frameworks
• Integrative Model for Community Health
Promotion and the Structural Model of
Health Behavior (SMHB)
– Three foci of care:
• Illness/disease prevention
• Health promotion
• Illness care
22
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Other Ecological Frameworks
• SMHB includes four factors that influence
health at the population level
– Availability/accessibility of consumer products
– Physical structures
– Social structures and policies
– Media and cultural messages
23
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Focus on Population
• Emphasis is on lowering the average risk
of all individuals in the community
• Three approaches:
1. Framework for health communication
programs
2. PRECEDE-PROCEED model
3. Social Marketing
24
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Social Marketing
• Uses marketing strategies to create an
advantage for changing behavior
– Three concepts:
• Audience segmentation
• Marketing 4 Ps
• Marketing mix
25
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