Chapter 12 Health Promotion PDF

Chapter 12 Health Promotion Development of Health Promotion in Canada Health promotion: strategies intended to maintain or improve the health of large populations Health promotion practiced at an international level. WHO uses political and sociological approaches to imp...

Chapter 12 Health Promotion Development of Health Promotion in Canada Health promotion: strategies intended to maintain or improve the health of large populations Health promotion practiced at an international level. WHO uses political and sociological approaches to improve the health of world’s citizens Health promotion programs offered to all Canadians by the Public Health Agency of Canada such as Stairway to Health which encourages people to take the stairs rather than the elevator when at work Marc Lalonde’s paper identified lifestyle as an important factor in health and well-being and as such an important target for health promotion and education One goal of health promotion is to encourage people to look after themselves and another is to encourage them to look after each other Health promotion to be truly effective must be based on a social movement rather than a government edict (a formal statement issued by the authority) the real promoters of healthy choices must be the general public all health promotion programs place the primary responsibility for good health on individuals and communities more than on medical staff or medical facilities 1700s: focus on hospital operation and sanitation regulations Early 1900s: provincial and national health promotion programs begin o focus had shifted to educating the general public about the value of proper sanitation o Ex: participation, Heart Health 1974: Lalonde’s report identified healthy lifestyle as a promotion target 1986: Epp provides framework for health promotion in Canada still used today - locus of responsibility for health rests with the individual - mutual aid also emphasized - to encourage them to look after each other Epp’s framework for health promotion in Canada  1987: Labonte identifies three levels for successful health promotion 1. Medical – orientation is disease-based and goal is disease management For ex: a community might develop a program to help people recover from heart attacks or devote funding to finding a cure for cancer 2. Public Health – orientation is behavior-based and goal is disease prevention For ex: promotion of safe sex or anti-drinking-and-driving programs 3. Socioenvironmental – orientation is toward social change and goal is public health policy For ex: school board policies to provide lunches for school children The second and third levels of Labonte’s model are concerned with social determinants of health. These include factors such as income, social status, social support networks, education, employment, gender, culture, race and racism These determinants have a greater impact on our population’s health than does medical science One of the goals of health promotion at the government level, is to save the government money on health expenditures, in Canada total health expenditures reach $264 billion Health Challenges When Canadians think of their health care system, they are more likely to think of its equity than its inequity (unfairness or injustice) as it is designed to promote and provide equal access for all but truth is that inequities exist and are based on may factors including geography, culture, age, education, income, gender, race and so on. Ex: 92% of Canadians in highest income bracket rate their health as very good or excellent in contrast to 73% of Canadians in the lowest income bracket Health promotion programs aimed at reducing health-related inequities o Health inequities linked with culture, geography, education, income: ex: poorer health associated with low-income status or Aboriginal status o Age-related health concerns: ex: prevalence of smoking among adolescents o Occupation-related health concerns: ex: increased stress levels, harmful exposure o Changing demographics another challenge for Canadian health care: an increasing percentage of us are in older age categories o Two leading causes of death between ages 15 and 25: transport accidents and intentional self-harm, another pressing age-related problem in Canada is childhood obesity for ages 5-17, 10.6% are obese and another 18% are overweight Health Promotion Mechanisms Promotion of self-care: encouraging individuals to look after themselves  - Exercise, diet, regular medical checkups, screening for disease, smoking cessation that people engage in to promote their health ▪ late 1940s, BC became one of the first places in the world to introduce regular screening for cervical cancer, test used in this screening is called a Pap test (or Pap smear). Pap test considered to be among the most effective, death rate from cervical cancer has declined by almost 50% since the pap test was introduced and current survival rate is estimated to be 74% over 5 years o Women between ages 40 and 60, an age group more at risk for cervical cancer have pap test participation rates of only about 75% ▪ Early attempts to frighten people away from cigarettes have been discouragingly unsuccessful o Good news smoking is on the decline in Canada, even among youth, 28% Canadians aged 15 to 19 smoked in 1999 and by 2008 the number had dropped to 15% and number dropped from 3.2% in 2018 to 2.5% in 2019 o Cigarette smoking cessation has long been a target of health promotion programs Promotion of mutual aid: encouraging people to look after each other - mutual aid: everyone’s responsibility to family, friends, loved ones, and even society as a whole when it comes to health and safety - it is healthy to have other people around - mortality rates are lower in communities with a high level of social integration; close- knit communities are healthier - five blue zones in the world where people are 10 times more likely to live to the age of 100. The zones are Loma Linda, California; Nicoya, Costa Rica; Sardinia, Italy; Ikaria, Greece; and Okinawa, Japan – share attributes called the Power 9 - Power 9 features ample reference to social factors. These are called Belonging (related primarily to as association with a faith-based denomination), Loved Ones First (keeping elderly family members nearby, having a life partner, investing time in children), and Right Tribe (social networks that are supportive of healthy behaviors) Social support (2 types) - social support: collection of interpersonal resources we have at our disposal to help us avoid or cope with difficult times in our lives – strong support systems affect a number of health indicators including how long a person can expect to live - some people benefit from social support more than others do - for instance seniors who live on low incomes have less support than their more affluent counterparts - as people grow old their number of unmet needs increases in terms of health-related social assistance Two general types of social support, based on the source of support: 1. Naturally occurring support: support we get from friends, relatives, co-workers, and others in our social networks  2. Agency-provided support: support provided by agencies and organizations formed to fill the void when naturally occurring support is either lacking or unavailable; importance of it is that you have other people with same illness so empathy can come from only other patients and not a loving wife more so Can be practical, informational, or emotional Psychology As Applied to Health Promotion Health promotion has links to major theories from health psychology o Multi-Process Action Control model o Health Belief Model o Theory of Reasoned Action o Theory of Planned Behavior All theories in this area share certain things in common, placing some emphasis on the processes that precede behavior, those that initiate behavior, and those that maintain behavior. The multi-process action control model brings all three of these processes together. M-PAC (multi-process action control model) has important implications for the ways we encourage people to adopt and maintain health-related behaviors, especially related to physical activity – ex: model posits the emotions associated with physical activity are more predictive than health-related benefits so need to focus some attention on how good one can feel emotionally when adopting an exercise program. Ultimately, it suggests that we want people to make exercise a habit and part of their identities. These are called “reflexive processes” because when a behavior becomes a habit or part of our identity we no longer need to think deeply about the decision to engage in that behavior so deliberate thinking processes must precede habit and identify formation because such formation doesn’t happen quickly One-on-one interactions can help affect habit and identify formation more easily than a promotional campaign can - health promotions programs can be effective in moving people from the pre-contemplative stage (not seriously considering) to the contemplative stage (aware of problem and are considering changing their behavior) – good starting point - hence these programs emphasize the fun of exercise, not the fatigue that may result. They target people’s beliefs regarding cost and gain. As well as social psychology o Health promotion involves persuasion which refers to an attempt to change people’s attitudes and beliefs o Attitude: a cognition in which a person evaluates some target involve adjectives such as good or bad and verbs such as like or dislike  Ex: Health promotion programs attempt to change attitudes when they try to persuade people that low-fat diets are good and people should like them. We might call this health advertising Beliefs are things we consider to be true different form attitudes as they are not evaluative in nature. For ex: we might hold the belief that yoghurt contains less fat than ice cream and this belief might support the attitude that yogurt is good for us – health promotion programs try to affect what people believe to be true and what they like and consider good o Elaboration Likelihood Model of Persuasion ▪ People’s attitudes towards political candidates influenced through two routes: first route is central route which refers to logic, facts, and reason in favor of given candidate or perhaps in opposition to a candidate. Ex: health promotion using this route will present statistics and medical facts. Second route is peripheral route involves appeal to emotion and general impression, political campaigns using this route will focus on the looks and charisma of the candidate. Ex: health promotion campaigns using the peripheral route feature healthy looking people or show graphic depictions of the potential horrors resulting from risky behavior Statistical presentations which make use of a central route must be packaged well to appeal to people who are more influenced by peripheral routes. For ex: in AIDS problems with programs focused exclusively on providing facts Links to Health Psychology Health Belief Model: changing beliefs can lead to change in behavior Health promotion provides information that can influence beliefs and behavior - Vulnerability: likelihood that you will suffer a health problem - efficacy of Preventative Behaviors: likelihood that a given action will reduce threat Fear Appeals: Health Promotion by the Peripheral Route One application of the peripheral route is the use of what are called fear appeals Fear appeals: presenting threatening consequences of continuing or failing to adopt a behavior, for example - Lung cancer with continued smoking - Gum disease without proper dental hygiene o Threat perception – the belief that a threat is real and that we are vulnerable to it, is more important than simple fear arousal  o Extended parallel process model – three possible outcomes of fear appeals: people are motivated to control the danger, control the fear or to not respond at all. GOAL is to motivate people to control the danger such as avoiding cigarette smoking, if fear arousal is too high, the person will be more likely to engage in either fear control such as avoiding the message or non-responding. In some cases, we don’t believe in the efficacy of the behavior to deal with the threat mismatch between the threat and threat-reducing behavior such as can I really prevent the devastating effects of cancer by eating broccoli? o For fear appeals to work, efficacy messages should be presented in a one-to-one ratio with appeals to fear, when it comes to act, efficacy is a better predictor than threat. In other words, the most important factor is whether a person thinks they have the capacity to respond rather than whether the threat is great Links to Theory of Planned Behavior: perceived threat and personal vulnerability Drive Reduction Theory Fear appeals are successful when we are driven to reduce fear through behavior change, leads to reinforcement of behavior BUT appeals fail if too much fear is aroused, which leads to reductions in o Response efficacy: belief that behavior change will reduce the threat o Self-efficacy: belief that we are capable of carrying out behavior - our self-efficacy suffers when we are afraid, confidence levels suffer Cancer information overload – a situation in which a person feels overwhelmed by the amount of information concerning cancer found in the media and in health promotion programs – affect some behaviors related to cancer avoidance Self-accountability – the extent to which a person feels personally responsible for a given emotion or situation, applies not only to fear appeals but also to guilt and regret, for ex: “smoking pot may not kill you, but it will kill your mother” – a slogan aimed at guilt rather than fear o Guilt or fear demonstrate that we can frame a message in either positive or negative ways o Message framing – refers to the extent to which positive or negative aspects of an outcome are emphasized Loss-framed messages emphasize the negative results of not engaging in a behavior and gain-framed messages emphasize the positive effects of engaging in a behavior Prospect theory suggests loss-framing works in some situations while gain- framing in others. Loss-framed messages effective in risky behaviors like getting a Pap test which carries the risk of having cancer detected. Gain-framing is more effective for prevention related messages Loss-frame messages emphasize the downside of not engaging in a health behavior while gain-framed messages emphasize the upside of that behavior Therefore, messages that do nothing more than frighten people without addressing response efficacy, self-efficacy, or self-accountability are likely to be ineffective. “Success” in terms of health promotion means that people will pay attention to our message, remember it and behave in ways that are consistent with it by reducing health risks and increasing well-being Other Social-Psychological principles in Health Promotion During pandemic, two major hurdles were perceived risk and the need for autonomy for this form of health promotion Pandemics feature uncertainty especially in their early stages: clear communication of risk can help reduce this uncertainty, which is a source of anxiety, especially for those who experience anxiety in general United States where COVID-19 case rates and mortality rates have been highest in the world Sturgis Motor rally caused 5000 deaths 90% of Canadians were following measures included social distancing, increased handwashing and avoiding crowds so cooperative tendencies have been sustained over time COVID fatigue or pandemic fatigue: there was still a worry regarding how long they were being asked to comply with measures that required significant changes to their lives - no significant decline with public health measures over the course of first and second waves of the pandemic Repetition effect Effects of source - credibility, via central route - attractiveness, via peripheral route Effects of audience - initial position - knowledge level, including literacy and language barriers COVID-19 Efficacy of Interventions  Unique because efficacy of adherence with measures could be seen within 2 weeks Message clarity: confusing messages due to abstract concepts and evolving knowledge. Ex: reduce social contact by 25% how would this be calculated? Pandemic fatigue as described above Precede-Proceed Model Precede-Proceed Model Designed as a way to facilitate and analyze health promotion program from the planning stages through to their implementation and impact - “precede” phases relate to the planning of health promotion programs - “proceed” phases relate to the implementation and evaluation of that program Consists of 9 phases: - “precede” phases 1 thru 5 relate to planning - “proceed” phases 6 thru 9 relate to implementation and evaluation Most widely tested model of its own kind This model works in conjunction with any other model or theory if health promotion design. Criticized for being too individually oriented, with its emphasis on behavior and lifestyle, an expanded model might consider the social and cultural context of that behavior Assessing Effectiveness of Health Promotion Programs Evaluation must be collaborative, democratic, participatory, open Many challenges to assessing the effectiveness of health promotion o Abstract concepts that are too difficult to measure (ex: quality of life) o Some benefits may take years to realize o Under-reporting Standards for Assessing Effectiveness Standards applied to the evaluation of health promotion programs come in a number of forms by Judd and colleagues (2001): Arbitrary standards: based on decisions made by some outside body regarding community needs involved in promotional campaign Experiential standards: based on direct experiences of the community involved in the promotional campaign Historical standards: based on comparisons to other programs or to the same program at an earlier time Normative standards: use of statistics, such as the national averages, describing the health issue being addressed Scientific standards: use data published in scientific literature based on similar programs or health issues Propriety standards: evaluate health promotion programs that take legal and ethical issues into account Feasibility standards: evaluation based on the practicality or sustainability of the program The key is to apply appropriate standards that are consistent with the goals of health promotion and the needs of the community in question. Co-production process: a process whereby the responsibility for health is shared among centralized health bureaucracies, individuals, and communities Steps in Evaluation 1. Description of the program 2. Identification of issues and questions 3. Design of data collection process 4. Analysis and interpretation of data 5. Recommendations 7. Dissemination 8. Taking Action