Health Promotion

Name :
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Introduction

World Health Organisation (1946) originally defined health a condition in which the individual is socially,

physically, and mentally well, in addition to the absence of the disease state.

Health Promotion is defined as a state of assisting people in knowing the collaboration between their choices,

disease suffering and excellent health, embellishing their encouragements to endeavor for optimal health, and

providing abutment to change their lifestyle. The ideal health is one, which has a proper equilibrium of physical,

psychological, emotional, and spiritual states. (O'Donnell, 2009)

The health promotion is essential for the better health and quality of life of society. It is preventative work. It is

a useful tool for global health. The health promotion is essential to prevent the spread of communicable and

non-communicable diseases. It can be used as a tool to educate the public about healthy habits which can

prevent diseases and maintain a healthy society. Health education is one of the most critical health promotion

intervention. It includes awareness campaign for alcohol abuse, unhealthy diet habits, and smoking in the

population settings. One can place posters, banners near the shops and restaurants. This approach aims to

encourage people to give up alcohol and quit smoking. Take healthy options as a diet. Another approach is the

Nutritive modification, which involves nutrition education about the consequences of eating unhealthy food as

in this case, Mr. Mo preferred takeaways instead of a healthy diet. Face to Face education is helpful in this case.

For the policy-making, the policy directives can be held a eat healthy stay healthy day, where there can be stalls

of healthy meals, and educating people about the benefits of eating healthy food. There can be face-hidden

stories of the alcoholics that how alcohol consumption has affected their life, a smoker can be also get educated

by telling them the harmful effects of cigarette on the lungs.

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In this assignment, I have defined a health promotion, health promotion importance. Further I would like to

discuss my case and put smart aims and objectives for it, I will analyze the health promotion levels required by

the Me. Mo and approaches I can use for him. Further, I will suggest a model, and evaluate health promotion.

Evidence

Impact of Alcohol

Depression is the dominant health issue worldwide, with a prevalence of around 13% in older adults. (Beekman,

Copeland and Prince, 2019). Alcohol Misuse or increase consumption of alcohol is also a leading public health

problem in older adults. (Treatment improvement protocol series, 1993).Depression and drinking co-exist.

Longitudinal studies have suggested that alcohol abuse leads to the depression trajectories, supporting the

theory that both co-exist and reinforces the conditions. (Brennan et al., 2015).Conforming to the research

studies, alcohol taxes are essential policymakers that can decrease alcohol intake by the public. (Elder et al.

2010).Social connection intervention can reduce depression among older adults (WHO, 2014).

Impact of Smoking:

Conforming to past study, smoking increases the prevalence of colorectal cancer. Smoking increases the

chances of colorectal cancer after the age of 30. Research indicates that the men who started smoking by the age

of 20, 30 are more prevalent to develop colorectal neoplasm. Men with large adenomas consume 7.2 pack-year

of cigarettes by the age of 30, whereas those with small adenomas consume the six pack-year of cigarettes.

(Giovannucci et al., 1994).Another study suggests the comorbidity between depression and smoking. Smokers

believe that smoking will alleviate their condition, that they will be able to cope with the different stages of

smoking smoothly. (Mathew et al., 2016)

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Impact of unhealthy Diet :

Research study indicates a link between depression and an unhealthy diet. According to the study, an individual

with a better quality diet is less likely to get depressed as compared to individuals with an unhealthy diet. (Jacka

et al., 2011).Unhealthy diet has a significant role in mortality and ill health. The colorectal cancer incidence and

mortality can be reduced by the consumption of the healthy plant origin diet and reduction of the intake of the

red meat. Other factors which contribute are the initiation and maintenance of physical activity and achieving a

convenient body mass. (Gingras and Béliveau, 2011)

Need Assesment

Normative Needs:

According to the Bradshaw’s taxonomy of the need, the normative need is the appropriate standards that are

required to maintain an appropriate level of health services and factors which constitute an acceptable health

level status for the community. (Bradshaw. 1972)

Conforming to the case study, Mr. Mo has arrived in the outpatient clinic for advice about bowel cancer.

Normative needs, in this case, are the assessment of bowel cancer. As he explains that he is worried that he is

unable to sleep, it can be an indicator of depression due to a lonely life, smoking, alcohol, unhealthy diet and

being out of home for business tour. A normative need, in this case, is antidepressant prescription. Although

other symptoms of bowel cancer are absent, because of unhealthy lifestyle and constipation, he can suggest a

diagnosis test.

Felt Need:
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Mr.Moe is worried and anxious about his health as he is unable to sleep; he needs a prescription of anxiolytic

medication.

Expressed need:

Expressed needs the demanded needs. Felt need to turn into action, In this case, Mr.Moe has arrived for advice

about bowel cancer Explaining to him how alcohol, smoking, and unhealthy diet affects the bowel cancer is his

expressed need

Comparative need:

Comparative needs involve two similar groups, but with different health promotion plan, but it is inapplicable

here, as there is an individual patient and not a group.

Level of health promotion

Primary, Secondary, and tertiary health promotion levels:

Primary health promotion involving literacy programs to the healthy public and is less suitable for this case.

Secondary and tertiary health promotion is suitable for the Mr.Moe, as he is alcoholic and smokes 20 cigarettes

a day. For tertiary health promotion, we can suggest Mr.Moe about healthy diet habits avoid bowel cancer. At

this stage, we can educate Mr. Moe on how to have better dietary control to prevent aliment and the importance

of physical activity through education.

SMARTAIM

At the end of 2019, Mr. Moe will be able to reduce to 10 cigarettes a day, join the gym for physical activity at

least 30 mins a day. It will also help him to cope with anxiety and depression. He will also reduce his alcohol

intake to 3 to 5 glass a day. He will add healthy home-made food in his diet. He will reduce takeaways to 2 a

week.
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SMART objectives

At the end of this year, Mr. Moe will eat a healthy diet, and decrease his frequency of dining outside, and he

will join a dietary advice program run by a nutritionist. He will join a club for healthy activities like playing

games, so that he can have a company, and join physical activity 30 min session so that he can cope with

depression. He will quit smoking and alcohol club so that he can give up smoking and alcoholism.

Approaches

Mr.Moe has no idea about the seriousness of his condition. He has been suffering from depression and anxiety.

His lifestyle is unhealthy, consuming cigarette pack a day and drinking alcohol. The five approaches are :

Medical Approach :

The medical approaches involve the use of a medical intervention for the prevention of medical illness like

immunization program. The medical approach is easily measurable, but it can cause dependence to medication,

in this case, Mr. Moe can develop a dependency on the anti-depressants for the treatment of insomnia. Already

he is consuming alcohol and cigarette. Giving medication for alcohol can cause dependence and side effects.

For smoking cessation, he can use nicotine gum, nicotine transdermal patch ( Siddiqui et al. 2017) and for

alcohol withdrawal, he can prescribe disulfiram.

Behavioral Change Approach: Behavioral Changes involve modification of the lifestyle. Behavioral

modification leads to a better lifestyle.Mr.Moe has an unhealthy lifestyle revolving around one pack of cigarette

per day and Alcohol bottle. He mostly eats from outside. A dietary program is needed. Behavioral change

techniques for smoking are individual behavioral counseling, brief advice, Telephonic counseling, therapy

within a group (Group behavior therapy) are useful. Nowadays, self=help material is also used by the patients

which act as a counselor and educate and encourage them. (Roberts, Kerr and Smith, 2013)
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Educational Approach:

The educational approach involves educating individuals about the harmful effects of an unhealthy

lifestyleEducational approaches have a positive effect on the smoking prohibitionEducational programs can be

carried out in the surrounding community regarding the alcohol adverse effects on health; awareness campaign

can be carried out in this regard.

Client based Approach:

Client based approach is also helpful in this case. Ina client-based approach, individual perceptive about the

disease discussed with the patient, and it helps him to understand his present condition. Counseling is one of the

examples of the client based approach.

Social change approach:

Socioeconomic factors that influence health, and it affects the changes in the substantial, communal, and

remurative environment which will promote health. An awareness campaign for smoking cessation and alcohol

withdrawal should be constructed.

Stage of Change Model

Pre-contemplation :

This is the stage at which people are not willing to change, or sometimes they do not know the importance of

change.Mr.Moe is at the stage where it does not realize the side effects of smoking, alcohol, and unhealthy diet
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on his body. He drank a bottle of whiskey every night, a pack of cigarette every day, and consume food from

outside daily. AT this stage, Mr.Moeneeds attention; he needs to be taught about his condition seriousness, i.e.,

long term effects of the smoking, alcohol, and unhealthy diet.

We can discuss with him the adverse effects of smoking, unhealthy diet, and alcohol.Mr.Moe is aged, lives

alone. We can tell him how alcohol consumption damages the brain leading to dementia, vitamin deficiencies,

Vitamin deficiency in addition to the unhealthy diet he consumes is dangerous for his health. Alcoholism is

associated with liver cirrhosis.Mr.Moe has a family history of bowel cancer. He should be informed about that

long term alcohol intake is associated with colorectal cancer. (Grønbaek, 2009. Similarly, we can tell me about

the adverse effects of smoking Smoking is associated with an increased risk of cancers. (Chaiter et al.,

2009).Similar, he should know how eating from outside is increasing his chances of vulnerable to colorectal

cancer. Diet reach in saturated fat increases the chances of colorectal cancer. Als, he does not mention any

physical activity. He should tell that 60% of cases of colorectal cancers are associated with the physical

inactivity and saturated fat diet. (Whittemore et al., 1990)

Contemplation:

Individuals know that they have a problem and locate a way to change.Mr.Moe has no idea about his condition.

He realized that his family has colorectal cancer, but his behavior indicates no changes, as he consumes one

bottle of alcohol evet night and one pack of cigarette per day, and mostly eat from outside. Als, he lives alone.

Change behavior is not easy for him.

The risk factors for for colorectal cancer are red and processed meat. Sugary products and highly refined grains

are also in this category. Consumption of white meat, fish, and plant sources as the source of protein is useful.

Whereas unsaturated fats, coarse grains, and fruits can be used as a primary source of carbohydrate.  (Vargas

and Alberts, 1992).

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Commitment ( preparation ) :

Mr. Mo is not at this stage because he is not ready to change; that is what is indicated by his behavior. He has

no achievable goal, and time frame to attain it. He thinks he drinks alcohol to relax and suffers from anxiety at

the same time. Low-self Esteem and unawareness can be factors for his behavior Patients who have low-self

esteem, lack assertiveness, and confidence are not willing to move to the next step. ( Goodman & Gottwald.

2012).Counseling can help Mr.Mo to move to the next step He is worried about his health, that he can get bowel

cancer, so we can counsel him in this regard and provide him information about the disease. He can be

encouraged at this stage to give up alcohol and smoking, and unhealthy diet.

Action

When Mr.Mo is at this stage, he will be doing exercise regularly to cope with the depression. When he goes to

the gym, he will get the company over there. He makes friends who help him to maintain a good routine for

physical activity. He will join a group counseling for smoking cessation and also quit alcohol.

He can get help from the members of the counseling group when he has a war to drink or smoke so that they

encourage him to give up smoking and alcohol. Similarly, at this stage, he will encourage himself by watching

ted talk and video encouraging and helping people to give up smoking. For his unhealthy eating, at this stage, he

will be switched to a healthy diet involving a good source of protein, vegetables. A healthy diet is essential to

him. He can monitor his daily diet by noticing what he eats in the diary. He can monitor his alcohol withdrawal

and smoking cessation by using different smartphone apps. Research studies have shown that automatic

monitoring of smoking episodes and changing the smoker in real time facilitated the cessation in motivated

smokers. (Dar. 2018).

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Maintenance:

Mr.Moe at this stage with continuous support and encouragement can give up smoking, and alcohol. People at

this stage struggle to maintain change in their life.

We can support him through different groups involving support groups for the alcoholics and smokers. There

are online support groups on faceboohk, and different social media site, where he can post his thought about his

stage of maintaince, and in response people and group admins will support him. In such groups, people can

share their own experience regarding give up of alcohol and smoking. They can share their thoughts on how to

fight with alcohol and smoking Similarly; he can find groups which share easy homemade nutritious recipes

which he tries and eats clean and healthy.

Relapse

It is hard to give up alcohol and smoking. Sometimes people relapse and start their old routine of smoking and

alcohol. Patients at this stage are unable to maintain the changes and go back to the contemplation stage.

( Ewles and Simnett, 2003. ) It is considered a natural part of-of the change.

At this stage, we can ask him what made him give up? We can provide him with the strategies to start again. At

this patient needs counseling and encouragement to go back to the action stage.

Ethical Issues:

Ethics is the study of moral, duties, and values. The members of the healthcare professionals should follow code

of ethics. The four ethics principle are :

Autonomy:
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Autonomy means respect for the person and individual. Mr.Moe has the right to follow this healthcare plan or

refuse it.No; one can force him to follow the plan. As a healthcare professional, we respect the decision of the

patient.

Beneficence:

Beneficence means doing good stuff. In this case, a nurse can guide the Mr.Moe of the adverse effects of

smoking, alcohol, and unhealthy diet.

Nonmaleficence:

Not to harm the patient. In this way not to deprive them of the necessities of life. In this case, Mr.Moe can be

given nicotine gums to ease cessation and antidepressant for a good sleep. Although he can develop a

dependency on such medications.

Justice:

It means the healthcare profession should avail them equal opportunities through health programs. The

resources should be allocated equally. The participant should receive equal time for counseling and education.

Evaluation:

Evaluation is the value of something or the assessment of something. There are several types of evaluation

design and framework that are used to evaluate the health promotion program. Approached used by each

program for the assessment, data collection, and measurements The type of framework used for the evaluation

differs on the following characteristics:

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Formative Evaluation:

It occurs during the developmental steps of the program. It is verified before implementation. It provides

information on achieving program goals and steps to improve the program.

Process Evaluation:

It accesses the category, capacity, and aspects of program activities and services. It involves suggestion boxes,

interviews, focus groups, and observations.

Outcome Evaluation:

It involves long-term and short-term program objectives. It involves the use of convenient measures to make

changes in Mr.Mo health status, behavior, and quality of life.

Impact evaluation: 

The impact evaluation evaluates the effect of the program on the participant. It evaluates the effects of the

program on the participant. It involves changes in awareness. For instance, in this, case how much Mr. Moe is

aware of the side effects of alcohol, smoking, and unhealthy diet. It also includes knowledge about the diseases

state, in this case, Mr.Moe will be brief about his chances of getting colorectal cancer, and its link to the

smoking, alcohol, and the unhealthy diet. Patient attitudes, behavior can also be measured to evaluate the

program.

Outcome Evaluation:

The effectiveness of the program, whether it can produce change or positive attitude in the patient or not, is

measured by the outcome evaluation. ( Naidoo and Wills, 2016 )

Conclusion:
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Health promotion work is an essential aspect of the health system. Health promotion is a process which involves

protecting the health of the individual, communities, and population. It empowers the patients to make healthy

choices and give up unhealthy activities, for example, in this case, alcohol consumption, unhealthy diet, and

smoking.Conforming to the HA annual plans promotes the use of healthcare promotion to educate the patient

about his illness and making policies which can acknowledge the patients and help them to cope with the

disease with behavioral modifications. This will also reduce the ob]verall cost and burden of the healthcare

system (HA Annual plans, 2017).

In this case, Mr.Moe is unaware of his status; he is a habitual drinker and smoker. The normative need is needed

to make him change his lifestyle Secondary, and tertiary promotion is suitable for him as he is suffering from

depression. Medicinal, Behavioral, and educational approach is used to alleviate his status. The change model is

prescribed for him. In order to give up alcohol, and smoking, and maintain a healthy diet, he is suggested to join

a different social group working from smokers and alcohol, so that he can be encouraged about his positive

decisions. He has suggested a physical activity, which can be helpful to deal with depression. Interviewing is

helpful to evaluate the effectiveness of the program.

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