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Transcript of Health Promotion
Partnerships are necessary for improving health and wellbeing by bringing together public, private and community organisations to allow for the sharing of knowledge, skills and resources. This makes for higher quality health promotion interventions and avoids duplication of efforts.
Action Across the Continuum
Interventions should range along a continuum from working at an individual level, such as working one-on-one with clients assisting them to build their knowledge and skills, to working at a population level, such as developing healthy public policy.
What is Health promotion?
Health promotion is about enabling people to increase control over their health by focusing on the causes of illness and the determinants of health.
Base Activities on the Best Available Data and Evidence
Use evidence to decide where there is a need for health promotion interventions as well as evidence of what works. This is important to create positive change that will be sustainable.
What you can do
Ensure that the services that you provide are accessible to those individuals, groups or communities with the highest need.
Ensure that the services that you provide are not increasing inequities.
To achieve optimal health and wellbeing outcomes for clients and the wider community it is important to focus on the prevention of illness not just treatment.
The health promoting interventions that you use in your work also need to be effectively evaluated.
When working with a client, group or community find out:
What are their needs? Get to know your clients and find out what types of food they eat, how often they participate in physical activity, what their level of social support is like. This can help to provide a clearer picture of the influences on their health and wellbeing.
What is known about the health issue? What are the causes/evidence/broader determinants that contribute to the health issue?
Who will you need to work in partnership with to effectively address the determinants?
What you can do
When working to promote health ensure that you always consider the following questions:
Are you using the best available evidence concerning the health issue?
What does the evidence tell you about the best way to address the health issue?
Are you effectively evaluating, and sharing the findings of your evaluation of the health promoting work you are doing?
What you can do
When working to promote health in your role, think about who else you may need to work in partnership with to address the social determinants:
What knowledge, skills, resources do you have/need?
How will you and potential partners mutually benefit by becoming involved?
When working one-on-one with a client, ensure that you work with them rather than doing things for them. Your should support them to better manage their health.
Did you know...
_______ is a key partner of the ____________. This is a voluntary partnership of health and community organisations working together towards achieving better health outcomes for the _____________.
Other partner agencies that make up the ________ include:
The ________ aims to improve the health status of people living in ___________through evidence based activities that promote physical activity, healthy eating and mental health promotion.
Some of the types of interventions which the __________ are involved in include:
Social marketing around healthy eating and physical activity
Victorian Department of Health Intervention Continuum
The Victorian Department of Health have developed an intervention continuum which identifies five categories of health promotion interventions.
Insert pic of continuum
The capacity building strategies that are important for supporting these interventions are also identified.
What you can do
Think about what mixture of interventions would best address the health issue, and focus your efforts on these.
When developing health promotion interventions decide if there is anyone you can partner with to ensure a mix of intervention strategies.
Consider if capacity building is required to ensure successful interventions.
What you can do
Decide if you need to work in partnership with others, or require other resources to support your client, group, or community to fully participate.
What you can do
It is important to remember that health promotion interventions are not done TO people they are done WITH them.
A partnership approach should also be used for the relationship between a client and a health professional. This helps to empower the client to better manage their health.
Strategies for Successful Health Promotion Interventions
When planning and delivering health promotion interventions three key strategies are important for success.
Providing people with resources and the opportunities that enable them to increase control over their health.
Calling for changes to be made to policies, resources or procedures so that positive health outcomes can be achieved.
Mediating between different parties, such as local government, industry, the media, and volunteer organisations, in order to pursue health outcomes for the community.
Each party has a different interest and it is important to mediate between them so that positive health outcomes are achieved.
Tasmanian Government Department of Health and Human Services (2010).
Working in health promoting ways: A strategic framework for DHHS 2009-2012 Background Paper.
The Australian Psychological Society Ltd (2010).
Chronic Disease Self-Management and Lifestyle Risk Modification training: A training package developed for health professions assisting people to make health behaviour change.
Victorian Government Department of Human Services (2003).
Integrated Health Promotion Resource Kit.
Ontario Health Promotion Resource System. HP-101 Health Promotion On-line Course. Available from http://www.thcu.ca/hp101/eng/main.cfm
Study Blue.com (2014).Image of Health Belief Model.
Ajzen, I (2006). Image of Theory of Planned Behaviour Model.
Prochaska, J. O. & Di Clemente, C. C., (1982). Transtheoretical therapy: Toward a more integrative model of change. Psychotherapy: Theory, Research and Practice, 19(3), 276-288. Figure 2, p. 283.
and Behaviour Change
The majority of health promotion interventions require consumers to make behavioural changes.
Theories and models of behaviour change help to explain the change process, and are good to consider when developing strategies to assist with planning your intervention. They can help you to think about methods that you can use to make the change process easier.
Theories and models of behaviour change such as the three just explored share some common elements.
Research suggests that one or more of these elements must be true for clients to make a successful health related behaviour change:
a strong, positive intention to perform the behaviour
absence of environmental barriers to performing the behaviour
necessary skills to perform the behaviour
advantages of performing the behaviour outweigh the disadvantages
social pressure to perform the behaviour
consistency between the behaviour and the clients self-image
more positive than negative emotional reaction to performing the behaviour
perceived self-efficacy to perform the behaviour
Motivational Interviewing is a goal-oriented process which is designed to strengthen a consumer's motivation to change their behaviour. It aims to identify ambivalence to change and then support the consumer to work through and resolve this.
There are several principles underlying motivational interviewing:
Express empathy: have an attitude of acceptance, ambivalence is normal, use reflective listening.
Develop Discrepancy: Clarify consumer’s important goals and highlight discrepancy between current behaviour and goal attainment.
Avoid Argumentation and Roll with Resistance: avoid resistance but if it arises acknowledge it and determine reason for it. Resistance is a sign to change strategies.
Support Self-efficacy: determine consumer’s examples of current or past successes, highlight the thoughts or actions the client used to achieve these. Self-efficacy is increased through a person’s own experiences of success.
The premise behind motivational interviewing is that motivation consists of how important a behaviour is to a consumer and the level of confidence a consumer has to perform the behaviour. The greater the importance of a behaviour and the consumer’s confidence the higher the likelihood that the behaviour will be performed.
What you can do
When planning health promotion interventions, consider theories and models of behaviour change to develop ideas and strategies for supporting consumers to make the required change.
Use motivational interviewing techniques when working with consumers to change their behaviour.
Screening, Individual Risk Factor Assessment and Immunisation
These types of interventions involve:
Administering tests to check for disease that can be treated or prevented.
Checking for risk factors which can lead to disease.
Providing immunisations to reduce the spread of disease.
Example: Flu immunisations
Social Marketing and Health Information
Social marketing focuses on trying to influence the behaviour of people.
Example: ‘Slip, Slop, Slap’ social marketing campaign to promote sun protection.
Health Education and Skill Development
This involves educating people, either individuals or groups, so that there is an improvement in their knowledge, attitudes and skills about health.
Examples: healthy cooking classes.
Community Action for Social and Environmental Change
Community action focuses on encouraging communities to build their capacity to create and maintain improvements in their social and physical environments.
Example: Self-help groups
Settings and Supportive Environments
Interventions aimed at creating health promoting settings and environments. This can include:
Organisational development: ensuring that the organisations have policies and practices that support health promotion principles.
Economic and regulatory activities: financial and legislative incentives/disincentives to support healthy choices.
Advocacy: action which aims to gain political and systems support, structural change, or social acceptance for a certain goal.
Example: linking immunisations to school entry certificates.
Health Promotion Guiding Principles
To ensure that health promotion interventions are effective several principles should be followed.
These principles, which have been developed by the Department of Human Services, and are based on the social model of health, the Ottawa Charter of health promotion, and key priorities from national health promotion documents.
We will now have a look at each of these guiding principles.
Address the Broader Determinants of Health
It is important to understand that health is influenced by many factors such as those that are political,social, economic and environmental.
Some determinants of health:
early life experiences
access to healthy food, transport and affordable housing
Health promotion interventions help people to increase control over these determinants.
Act to Reduce Social Inequities and Injustice
Emphasise Active Consumer and Community Participation
It is important to get consumers and the community actively involved in health promotion interventions so that they can have input into what impacts on their health and what action they would like taken.
Health promotion involves providing individuals and communities with information, skills, support and strategies to help to build their knowledge to take control of the determinants of their health and improve their health outcomes.
Empower Individuals and Communities
Think about how you can work with your client, group, or community to build their skills and knowledge to take control over their health.
What you can do
Explicitly Consider Difference in Gender and Culture
When planning and delivering health promotion interventions it is important that gender and culture are recognised as being paramount to the way that beliefs and behaviours concerning health are created and communicated.
What you can do
Always examine whether there are gender or cultural considerations when planning and delivering health promotion interventions.
Now that the guiding principles for health promotion interventions have been explored, it is time to better understand the types of interventions which are most effective.
Health information aims to improve people’s knowledge about the causes of health and illness and what can be done to maintain or improve health.
The intervention continuum identifies three strategies which are key to developing capacity to deliver these health promotion interventions. These are:
Organisational Development: building support for health promotion within organisations (i.e., policy, structural changes, information resources).
Workforce Development: building the health promotion skills and knowledge of staff within agencies. (i.e., on-the-job training, professional development courses).
Resources: Ensuring there are resources for health promotion and that these are allocated appropriately (i.e., finanical and human resources).
These strategies help to create the conditions vital for successful interventions.
Three of the most popular individual behavioural change theories will now be explored.
The Health Belief Model
This model holds that consumers will be more likely to change their behaviour when they believe that they are at risk of an illness/disease and if this illness/disease is severe enough to require action.
Consumers are also more likely to change their behaviour if they feel confident that they will be able to successfully perform the behaviour and if they feel that the there are more benefits to performing the behaviour than there are risks.
Likelihood of Action
Theory of Planned Behaviour
The theory of planned behaviour states that the performance of a behaviour is the result of a consumer's intention to perform the behaviour. A consumer's intention to perform a behaviour is influenced by their beliefs which in turn influence their attitudes. This includes their attitude about the likelihood that the behavior will have the expected outcome and their evaluation of the risks and benefits of that outcome, as well as their perception of the social pressure to perform the behaviour. A consumer's perception of the control they have over performing the behaviour also impacts on their intention as well as their actual performance of the behaviour.
Transtheoretical Model of Change
This model holds that when changing behaviour, consumers progress through 5 stages: precontemplation, contemplation, preparation, action, and maintenance. Relapse into earlier stages can occur during this process. The aim is to tailor interventions to the stage a consumer is in so that they can progress to the next stage and hopefully avoid relapse.
Motivational Interviewing is a tool that you can use to support consumers to develop and strengthen some of these elements required for making healthy behaviour changes and promoting their health.
Performing Motivational Interviewing
Determine the importance of the behaviour to the consumer and their confidence in making the change by asking two questions:
1. How important is it to you to change (insert current behaviour) in the next 7 days, from 1 to 10?
2. How confident are you about changing in the next 7 days, from 1 to 10?
Scores ≥ 7 suggest that change is more likely to occur. If the score is < 7 ask questions to find out more information such as:
1. What would help you move higher?
2. How high would you have to be to change?
The answers given to these types of questions can be used to create additional strategies to help consumers reach their health goals.
Motivational Interviewing Skills and Strategies
Micro-counseling skills: easily remembered as
pen ended questions to help consumers to think more deeply about an issue.
ffirmation, statements that recognise consumer's strengths, to build rapport and help to build the consumer's self-efficacy.
eflective listening. This help to show that you are empathetic towards the needs and wants of the consumer.
ummaries, which involves recapping what has occurred during all or part of the session. Summaries can help to show interest and understanding and can be used to strategically select information to highlight discrepancy between actual behaviour and a consumer's goals.
Change Talk: Statements made by the consumer which shows that they are considering change or are motivated/have committed to changing their behaviour. The aim is to encourage consumers to participate in change talk. The more a consumer talks about change the more likely it is that they will change.
Preparatory Change Talk
esire (I want to change)
bility (I can change)
eason (It's important to change)
eed (I should change)
Implementing Change Talk
ommitment (I will make changes)
ctivation (I am ready, prepared, willing to change)
aking Steps (I am taking specific actions to change)
Questions to Encourage Change Talk
Ask Evocative questions
: ask open questions because the answer will more than likely be change talk.
Explore Decisional Balance
: ask for the pros and cons of changing and remaining the same.
Good Things/Not-So-Good Things
: ask about the positives and negatives of the target behaviour.
Ask for Elaboration/Examples
: when change talk occurs ask for more details.
: ask about a time before the target behaviour emerged and examine how things were better or different?
: ask what may happen if things remain the same. Ask the questions - "If you were 100% successful in making the changes you want, what would be different?" "How would you like you life to be in 5 years from now?"
: ask consumers what the worst and best outcomes would be if they did not make the change.
Use Change Rulers
: ask consumers how important it is for them to make the change on a scale of 1 to 10, where 1 is not at all important and 10 is extremely important. Then follow up by asking them why they chose that number and not a lower number and what things would move them from the number they chose to a higher number.
Explore Goals and Values
: find out what a consumer's values are and what they want to achieve in life. The ask them how not making the behaviour change fits with their values and goals.
: Explicitly side with the negative side of ambivalence "Perhaps ______ is so important to you that you wont give it up, no matter what the cost"
Motivational interviewing will now be explored further.
Health and wellbeing resources should be distributed according to people's needs so that everyone has the opportunity to participate in a health promoting environment.
It is important to recognise that the determinants of health are not distributed in an equitable way. For this reason the aim is to minimise the differences between individuals, groups and communities in terms of their health, by ensuring that those people who have the most health needs are prioritised.
What you can do
To ensure that any health promotion work you do is successful, you should use one or a combination of these strategies.