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Protection Motivation Theory (PMT)

• Behavior is shaped by beliefs, social norms, networks, and policies
• Ronald W. Rogers developed PMT in 1975
• PMT extends the health belief model (adaptation in 1983, 1984, and 1985)
• Engagement in health-promoting behavior relies on:
  • Beliefs about illness severity
  • Perceived benefits of change
  • Confidence in creating change, or self-efficacy
• Fear influences change within the parameters of the theory
• Appraisal of threat consists of:
  • Perceived severity
  • Vulnerability
• Appraisal of coping comes from individuals processing threats before attempting change
• Social marketing that uses fear, such as stop-smoking campaigns, engages PMT

Nursing Code of Ethics

• Guidance for ethical relationships, behaviors, and decision-making by professional standards
• Professional standards include best practice, research, laws, and regulations
• Guidelines are offered not only about responsibilities for ensuring good care but also addressing barriers to service.
• Ethical basis for nurses to advocate for quality practice environments
• Safe, compassionate, competent, and ethical care is also important
• Nurses need to anticipate future health needs and political activity as society changes

Biomedical Approach to Health

• Health is defined by the absence of disease, illness by its presence
• High-risk individuals are the target for intervention
• Strategies using the biomedical approach are:
  • Immunization
  • Screening
• Goals include decreased morbidity and minimized risk factors like high blood pressure

Behavioral Approach to Health

• Lalonde report provides limited list of health determinants
• Expanded list via Epp report and Ottawa Charter
• Responsibility for health on individuals
• Social marketing and health education campaigns
• Refinement of health promotion practices
• Some success through anti-smoking and exercise campaigns (participACTION)

Socio-environmental Approach to Health

• Social context of health matters
• Social determinants of health are key
• Approach looks beyond the individual
• Acknowledges health complexity
• Other factors affect health, outside good choices
• Medical Care Act (1996) became the Canada Health Act (1980s)
• First Canada-wide campaign (1972) was participACTION

Primary Health Care Definition

• Essential health care is accessible to individuals and families in the community
• Achieved through full participation at an affordable cost for the community and country,
• Upholding self-reliance and self-determination (WHO definition)

Aspects of Primary Health Care

• Functions as the foundation of Canada's healthcare system
• Supports continuity of care
• A model for improving health and essential health services
• Emphasizes health promotion and disease prevention

Delivery of Primary Health Care

• Community-based services maintain and improve health and well-being throughout life
• Delivered in workplaces, homes, schools, health care institutions, family physician offices, nursing homes, day-care centers, and community clinics
• Accessible by telephone, health information services, and the internet

Primary Health Care Examples (NL)

• NL healthline 811
• Collaborative clinics
• Community-based services
• Health hubs (Gander, Grand Falls-Windsor)
• Health neighborhoods
• Cancer patient navigator

Benefits of Primary Health Care

• Team approach improves care
• Team is better able to connect people to appropriate services
• Prevents people from getting sicker
• Manages chronic disease and illness
• Improves access to services when and where needed
• Supports and enables self-care

Barriers to Primary Health Care

• Can exist at individual, practice, and system levels

Principles of Primary Health Care

• Accessibility
• Public participation
• Health promotion
• Appropriate technology
• Intersectional collaboration

Primary Health Care vs. Primary Care

• Focus of primary care is on personal health services
• Focus of primary health care is on health education, nutrition, maternal/child health, family planning, and immunizations

Primary Care Types

• Promotive
• Preventive
• Curative
• Rehabilitative
• Supportive/palliative

Social Marketing Definition

• Influences the acceptability of a social idea or cause
• A planned process
• Applies commercial marketing technologies to solve social problems
• Bottom line is behavior change
• Aims to influence voluntary behavior of a population to improve welfare for them and society

Utilizations of Social Marketing

• Integrated into health promotion strategies at Health Canada
• Delivers health promotion messages to specific Canadian populations
• Helps Canadians make decisions for maintaining and improving well-being

Contrasting Social Marketing and Advertising

• Social marketing and advertising are often confused
• Social marketing bases it's message on promotion strategies
• Commercial marketing seeks to change behavior for the company
• Social marketing changes behavior for the benefit of consumers and society

Steps in Social Marketing

• Identify which behaviors need to change
• Identify the audience
• Identify true barriers to change
• Reduce those barriers
• Pre-test ideas on a small group
• Examples include Youth health campaigns

The 4 P's of Social Marketing

• Product
• Price
• Place
• Promotion

Products in Social Marketing

• Focuses on what's being promoted to the target audience
• Actual product: A specific behavior being promoted
• Augmented product: Tangible objects on offer
• Core products: The positive experiences the target audience will get

Price in Social Marketing

• Can be monetary or non-monetary
• Intangibles include time, effort, risk, embarrassment, or disapproval

Place in Social Marketing

• Where the product will reach consumers needs to be considered
• When the product is available

Promotion in Social Marketing

• This is persuasive communication
• Ensures the target knows the offer, believes in it, and is inspired to act

Promotion includes:

• Messages
• Tactics like media advertisements, posters, and PSAs

Other P's of Marketing

• Partnerships
• Policy
• Politics

Challenges with Social Marketing

• Measuring
• Measuring outcomes too early
• Failing to measure exposure
• Failing to measure the right outcomes

Primordial Prevention

• This is the newest level of prevention, before risk factors are present
• The original three levels were developed in the 1940s to 1950s
• Primarily reflects policy-level intervention
• Aims to affect health before at-risk behaviors develop
• Occurs at national, provincial, and community levels
• Examples include healthy eating school programs, reducing sodium in the food supply, and creating bike/walking paths

Primary Prevention

• Occurs before disease or dysfunction
• Interventions include health protection and health promotion
• Vaccines are primary prevention interventions
• Focuses on maintaining and improving general health for individuals, families, and communities
• Health protection reduces threats to health
• Health promotion encourages lifestyle change toward health

Secondary Prevention

• Centers on early detection
• Earlier treatment offers favorable outcomes
• Limits disabilities from disease
• Screening falls under its umbrella
• For individuals and populations
• Examples include colon cancer screening and Pap tests

Tertiary Prevention

• Focuses on restoration and rehabilitation
• Minimizes long-term effects of disease
• Restores function and prevents further injury/disease
• Example: Cardiac rehab after MI, ROM to maintain mobility after CVA

Domains of Learning

Cognitive Domain

• Development of new facts or concepts
• Building on and applying new knowledge

Affective Domain

• Expressions of feelings and acceptance of values, opinions, spiritual beliefs
• Involves family interaction patterns and relationships that affect decisions and problem-solving

Psychomotor Domain

• Acquiring skills requiring the integration of mental and muscular activity
• Developing physical skills moving from simple to complex actions

Erikson's Developmental Model

• Individuals must develop a sense of trust and personal worth
• Eight critical stages exist
• Each stage needs a conflict resolution between two opposing forces
• Successfully accomplishing previous stages is necessary to proceed

Piaget's Theory of Cognitive Development

• "Scheme" describes action or thought patterns
• Schemes are used to assimilate or accommodate new experiences
• People try to balance assimilation and accommodation
• Cognitive development stages must be reached before learning
• Encompasses birth to 15 years

Piaget's Stages

• Sensorimotor (0-24 months): reflexes, object permanence
• Preoperational (2-6 years): language and movement advance, egocentric, magical thinking
• Concrete Operations (7-11 years): logical approaches solve problems, understand cause/effect
• Formal Operations (11-15 years): true logical thought, abstract concepts, morality

Vygotsky's Theory of Cognitive Development

• Learning precedes development, contrasts Piaget
• Focuses on cultural, social, political, and individual influences
• Zone of proximal development: difference between actual & potential
• Children are guided ("scaffolding") toward new learning

Kohlberg's Theory of Moral Development

• Preconventional (children, some animals)
• Conventional (adolescents, adults)
• Postconventional (individuals vs. society)
• Based on Piaget's theory
• Emphasizes justice

Gilligan's Theory of Moral Development

• Gilligan noted lower scores for women with Kohlberg's tool
• A different process of moral development may exist in women
• Women relate and base actions on caring relationships

Behavioral-Biological Development

• How environment influences biological development (genetics)
• Environmental experiences change gene functioning
• Implications for disease development
• Many regulatory changes happen early in childhood
• Epigenetics studies a cell's reaction to the environment

Life Stages

• Infants
• Toddlers
• Pre-Natal Care
• Pregnancy Care

Nutrition Definition

• Science of optimal cellular metabolism and its impact on health/disease

Self-Management

• Ability of individuals or caregivers to manage daily tasks
• Ability to maintain health and well-being
• Ability to respond to physical, psychological, behavioral, and emotional effects of a chronic disease, in tandem with a healthcare team.

Canada Food Guide

• Dietary Reference Intakes replaced Recommended Dietary Allowances (RDAs)
• DRIs reflect a range of values
• DRIs guide nutrition and health policy
• Limited data on groups like pregnant women, children, and the elderly creates controversy

Macronutrients

• Nutrients needed in larger amounts to provide energy
• Carbohydrates (45-65%): fuel during high intensity activities, preserves muscle during exercise.
• Grains: choose mostly whole grains
• Fats: choose low-fat/non-fat
• Fruits: whole fruits more than fruit juices
• Proteins (10-35%): tissue structure, cell membranes, metabolic transport, regulatory, acid/base

Food Sources

• Meat, fish, tofu, dairy, legumes, nuts, seeds for proteins
• Fats (20-35%): energy reserve, protects organs, insulation, and transports fat-soluble vitamins
• Micronutrient sources: oils, margarine, butter, nuts, seeds, meat, fish, dairy

Forms of Research

• Micronutrients
• Evidence
• Qualitative Research
• Quantitative Research
• Quality Improvement Research

Evidence-Informed Decision Making

• Evidence-based practice refers to use of evidence in nurses’ practice
• Evidence-informed decision-making uses research within clinical judgment
• Both processes utilize research in nursing