M 4225 Science of Health Promotion & Disease Prevention

	Health Promotion Basics

What is Health???

	traditional medicine - absence of disease
	WHO (1947) – complete physical, mental      & social well-being, not merely absence of disease and infirmity
	Murray & Zentner – state of well-being (where)…person uses purposeful, adaptive responses…to maintain relative stability and comfort
		strive for personal objectives & cultural goals

Gorin and Arnold

	antithesis of disease (dis-ease)
	balanced state
	growth
	functionality
	goodness of fit
	wholeness, well-being
	empowerment and transcendence

G&A : Healthy Behaviors

	smoking cessation
	eating well
	physical activity
	sexual awareness
	injury prevention
	substance safety
	oral health
	self development
	productivity

Healthy People 2000

	US federal program with 3 goals & 22 areas of risk reduction :
		increase healthy life span
		decrease health disparities
		universal access to preventive services
	1995 progress report :
		50% objectives moving toward target
		18% moving away from target
		3 % no change
		29% QNS

Health People 2010

	prevention agenda for the US with 28 areas of focus;  2 major goals
		increase quality & quantity of healthy life
		eliminate health disparities
	leading health indicators
		physical activity
		overweight & obesity
		tobacco use
		substance abuse
		responsible sexual behavior
		mental health
		injury and violence
		environmental quality
		access to health care

Criteria for Health Promotion Programs

	address carefully defined, modifiable risk behaviors that are measurable in target group
	reflect consideration of special characteristics, needs & preferences of target
	effective and appropriate for setting
	make optimum use if available resources
	organized and implemented so effect & outcomes can be measured and evaluated

Health Promotion Theories

	emerging field
	previously, behavioral and social science theory most common
		focus on individual and ID-ing and quantifying determinants of behavior
		health belief models
		theory of reasoned action

Assumptions about individual-level determinant theories

	individual is decision maker
	good health is valued; will change behavior to prevent ‘bad health’
	all behavior is volitional
	cognitive predispositions drive health behaviors
	research evidence does indicate that these theories are effective

Process of change….

	pre-contemplation
		no plans to change ever!
	contemplation
		increasing awareness of need for change
	preparation
		planning to take action….soon….
	action
		steps taken to modify a behavior or environment
	maintenance
		consistent engagement in new behavior

Change may be facilitated or ‘pushed’ by crisis….

	a dis-equilibrium
		emotional and cognitive, where old/usual coping mechanisms and/or problem solving skills ineffective
	developmental/predictable vs. accidental/situational
		identifiable points in life cycle where new coping skills and problem solving necessary
		unexpected ‘accidents’ necessitating new coping skills

Antecedents of crisis theory…

	Lindemann
		precursor of PTSD; also grieving stages
	Caplan
		transitional period, self limiting to 4-6 weeks
		context of event important
			intervention most successful at height of crisis
	Aquilera and Messick
		balancing factors include realistic perception of problem, amount and quality of social support and caliber of coping mechanisms

Other emerging models

	precaution adoption/transtheoretical
		steps of decision-to-take-precautions process ~ previously un-identified threat
	information-motivation-behavioral skills
		helps understand factors which influence choices about health behaviors
	elaboration likelihood
		framework for understanding attitude formation and change facilitation
	authoritative parenting
		not ‘authoritarian’ – good for adolescents engaged in risky behaviors

"food for thought……."

	food for thought…….
		how does the concept of ‘boundaries’ – separation of personal and professional ideas and beliefs – affect health promotion and disease prevention?
		do nurses have an ‘edge’ in health promotion and disease prevention activities?  Why or why not?