Lecture Notes on Health Promotion PDF

Lecture 1 “Promotion” is marketing tool to convince consumers Health promotion is Selling health and fitness to consumers Convince benefits → back up our beliefs in health “No plan survives contact with the enemy’ - helmuth von Moltke -​ To relate it to health it basically means the “enemy”...

Lecture 1 “Promotion” is marketing tool to convince consumers Health promotion is Selling health and fitness to consumers Convince benefits → back up our beliefs in health “No plan survives contact with the enemy’ - helmuth von Moltke -​ To relate it to health it basically means the “enemy” is temptation -​ You can always make a routine/plan however there are always roadblocks (injury, time etc) -​ The all or nothing principle is when a person experiences a roadblock and ruins there momentum -​ Either plan around the enemy or “operational flexibility” = adapt plan to roadblock “Appeal the anecdote” -​ When learning/educating yourself - don't assume you know everything just because one personal experience -​ Consult literature to back up your claims Why do we need health promotion? -​ Implement and sustain changes → evidence based intervention -​ Want to reduce prevalence of avoidable health issues to increase overall health Values of health promoters -​ Conditions contribute to empowerment… -​ To optimize health you need to be in a community 1.)​ Social network 2.)​ Community participation 3.)​ Community competence -​ Equitable access to food, income etc… -​ Inclusion - working with marginalized groups -​ Respect -​ Research - evidence hierarchy Evidence hierarchy Highest to lowest - systematic reviews, RCT’s, cohort studies, case-control studies, case series and case reports, editorials, expert opinion Features of Ottawa Charter -​ holistic view = whole view of health (i.e. physical, disease risk, mental etc..) -​ Focus on participatory approaches -​ Focus on health determinants = relationships between two variables - cause/effect -​ Building on strengths + assets -​ Use multiples complementary strategies including  1.)​ Build healthy public policy (public health) 2.)​ Create supportive environment 3.)​ Strengthen community action 4.)​ Develop personal skills 5.)​ Re-orient health services Lecture 2 History -​ After WWII health became more of importance for prolonging life -​ health/disease wasn't main cause of death until post war -​ Once studied more people care more → education is key determinants of health -​ Lead to western civilization.. → mandatory/ public health measures → development of social safety net = socialized pension plan; providing money when old/sick → emphasis shifts to addressing risk factors by promoting healthy lifestyle -​ late 60’s chronic disease leading to leading cause of death -​ Universal healthcare act so all have access - emphasis on promotion = optimizing -​ Disease prevention = reactionary response to story baseline, “healthy” -​ 80s - “victim balming” = if someone is unhealthy its their fault -​ Issue because it does not consider other factors; multivariate problem ie socio economic -​ Comprehensive approach to healthy policy at local level - healthy cities movement -​ Ottawa charter for health promotion created and became framework globally -​ First international conference for health promotion -​ 2000 and beyond; new technology embraced -​ Renewed interest in public health due to re-emergence of communicable disease threats -​ Development of professional competencies -​ Though new technology to aid it could also negatively impact health promotion…. → causing mental health issues → more lazy → childhood activity level decreases Focus shift → coronary health disease → childhood obesity → high cholesterol → alcohol related motor vehicle accidents → adolescent sexual activity → tobacco → diabetes → childhood vaccinations/ no insurance Prevention vs promotion Health promotion -​ empowering people to make healthier choices + be better self-managers -​ focuses on patient education, support tools, counseling -​ Core component of public health + education directed to individuals + communities -​ Advocacy to influence health policies Disease Prevention -​ Prevention strategies -​ Reduce disease, identify risk factors or detect in earliest stage Levels of disease prevention: 1.)​Primary, Actions keep people healthy + free from disease; removing health risks (i.e. exercise, immunization, diet) 2.)​Secondary, identify disease in early stage - encourage treatment (i.e. screening, biopsies) 3.)​Tertiary - actions to restore function as disease is more serious (i.e. surgery, insulin, chemotherapy) Determinants of health 1.)​ Income + social status -​ Higher income = longer life due to more access -​ Female live longer than males (hormonal difference test - increases cholesterol, CVD vs estrogen - protective effect on heart) -​ Income -​ Stress level of job 2.)​ Social network -​ family , friends + community = positively correlate with health 3.)​ Education + literacy -​ Health increases w/ education level -​ Cofounding variables/extraneous that help 4.)​ Employment conditions 5.)​ Social environments -​ I.e. rural has more health issues 6.)​ Physical environment 7.)​ Coping practices 8.)​ Childhood development 9.)​ Genetics 10.)​ Health services 11.)​ Gender 12.)​ Culture Lecture 3 “Everything in moderation” - nothing is really that bad if you have small amounts or use/consume correctly -​ Acute load = recent workout -​ Chronic load = long term; over last 3 weeks -​ 10-20% decrease or increase in change - progressive overload Different levels of promotion 1.​ Individual: 1 : 1 personal training or doctor - more specific to individual - no two people will respond identically to intervention 2.​ Community: group of people w/ atleast one shared characteristic - school, small town leaders have to decide needs of community Positive of initiative on community level = more community motivation - efficiency, not specific but can focus on shared similarities of group -​ Promotion is targeted 3.​ Population: larger communities - less likely for common characteristics -​ Get across to more people however most general Population health -​ Collection of individuals as assessed by health status indicators and influenced by…. -​ socioeconomic -​ Personal health practices -​ Individual coping -​ Early childhood development -​ Biology -​ Access to health services Genes = small determinant Behaviours = 25% Ecology (everything else) + social + medical characteristics = majority *All these things somewhat in control* Stages of health promotion 1.​ Primordial (promotion) - actions that reduce negative impacts of factors on population-level risk of disease -​ I.e. gym at work, public sanitation, increase pay etc.. 2.​ Primary (promotion) - Seeks to decrease specific risk behaviour/exposure among susceptible individuals or population -​ I.e. public health campaign, vaccine, smoking interventions etc…. 3.​ Secondary (treatment) - detect/treat pre-clinical conditions in asymptomatic individuals/population to reduce prevalence or progression -​ I.e. screenings in pre-disposed individuals  4.​ Tertiary (treatment) - seeks to reduce complication/disability of condition among symptomatic people -​ I.e. screenings in pre-disposed individuals Health promotion approaches Communication vs education Health communication -​ Process of promoting health by sending messages through mass media interpersonal channels + events Received by the intended audience…. -​ Channels = means by which messages is sent -​ Vehicles = specific formats used to deliver within channels Media advocacy → advocating on behalf of groups that can't speak for themselves - fight for a cause Interactive health communication → able to interact with “campaign” Risk communication → promotion focusing on risks to prevent behaviours leading to higher risk of disease/condition Entertainment communication → information in form of entertainment to better get across Limitations -​ May create or exacerbate health inequities -​ Minimal impacts of isolation of other strategies Components -​ Audience analysis - have to know the audience (demographic, behaviours, values etc..) -​ Setting objectives - how do we know if its realistic and what small change could this support -​ Message development - key info identifies for message content -​ Competitive analysis - look at competitors and find gap in market Health education -​ Any combination of learning experiences designed to help people -​ Increasing knowledge -​ Influence attitudes - emotional appeal -​ Smaller group - participant or learner directed -​ Use it when you want change at individual/community level *most effective when using multiple strategies* Lecture 4: research quality + appraisal Want to get good at….. finding , comprehending and appraising Why we research in health promotion? Effective -​ Evidence-based research more likely to be successful Resources -​ Wasted money + time is not acceptable Design type Observational -​ Cohort studies -​ Longitudinal -​ Cross-sectional -​ Case control (retrospective) -​ Case stuides / reports -​ Editorial / opinion Experiemntal -​ RCT (with humans) -​ Animal or in vitro Knowledge synthesis -​ Meta analysis -​ Systematic review (summary of knowledge) Hierarchy goes like this 1.)​ Synthesis - multiple studies = more refined 2.)​ Randomized control studies - selected randomly = less bias (treatments vs no treatment) 3.)​ Cross-sectional, case control - only observe once 4.)​ Non-human studies - not always translated 5.)​ Ideas, expert opinions, editorial - too subjective for science 6.)​ Anecdotal - personal not tested Systematic review + meta analysis -​ Combination of results from many studies Meta analysis → data from each study pulled together to make final result Systematic review → detailed review of previous studies Randomized control trials (experiemental) -​ Randomized groups -​ May be blinded (single or double blinded) -​ Used to test new treatment, test known intervention in new patient group, or changes in treatment Longitudinal -​ Highest form of observational -​ Data is collected from same subjects over a prolong time Cross sectional -​ Snapshot in time -​ Could use a cohort study but all data collected at once Case-control study -​ Compares patients with disease or issue of interest to patients without it -​ Retrospective look at risk factors to determine relationships -​ Survey base Case report -​ Application - used to report unusual finding -​ Often very small sample size and no control group -​ Hypothesis generating Qualitative -​ feeling - senses -​ Still valuable b/c not all things can be quantified Tools to develop and answer research questions 1.)​ Ask a question “PICO” -​ Population -​ Intervention -​ Control -​ Observation 2.)​ Literature search -​ Databases i.e. medline,pubmed, cochrane etc… Research studies in health promotion What will influence ability to use a study in health promotion Internal validity -​ How well a study is conducted -​ Are results trust worthy -​ Factors affecting… → confounding variables = additional factors competing IV to affect outcome → randomization → similar baseline of participants → complete follow up → trial stopped early External validity -​ How well apply results to your population or general population How do you know if a trial is effective? -​ Look at variables discussed -​ Examine treatment effect size - magnitude of treatment effect *less likely to see effect but when you do the results are much more emphasized*