HEALTH PROMOTION APPROACHES
Health promotion approaches described by
Ewles and Simnett
Medical approach
 The medical approach aims to enable people to be
free from medically defined disease and disability,
such as infectious diseases, cancer and heart
disease.
 It involves medical interventions to prevent or
ameliorate ill health.
 It values preventive medical procedures and the
medical profession’s responsibility to ensure that
patients comply with recommended procedures.
Behavioral change approach
 The behavioral change approach is based upon
changing people’s individual attitudes and behaviors
so that they adopt a “healthy lifestyle”.
 In this approach it is argued that a healthy lifestyle is
in the best interest of individuals and health
professionals promoting this approach will see it as
their responsibility to encourage as many people as
possible to adopt the healthy lifestyle they advocate.
Educational approach
 The aim of the education approach is to provide
individuals with information, ensure knowledge and
understanding of health issues, and to enable well-
informed decisions to be made.
 Information about health is presented, and people
are helped to explore their values and attitudes and
to make their own decisions.
 The educational approach encourages individuals to
make their own decisions and at the same time
health professionals will see it as their responsibility
to raise with clients the health issues which they
think will be in the client’s best interests.
Client centered approach
 Within the client centered approach the health
professional works with clients to help them identify
what they want to know about and take action on,
and make their own decisions and choices according
to their own interests and values.
 The role of the health professional is to act as a
facilitator. They help people to identify their
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concerns and gain the knowledge and skills they
require making changes happen.
 Self-empowerment of the client is seen as central.
Clients are valued as equals. They have knowledge,
skills and abilities to contribute, and they have an
absolute right to control their own health destinies.
Societal change approach
 Rather than changing the behavior of individuals, the
societal change approach modifies the physical and
social environment in order to make it more
conducive to good health.
 Those using this approach will value their democratic
right to change society, and will be committed to
putting health on the political agenda at all levels
and to the importance of shaping the health
environment instead of shaping the individual lives
of people who live in it.
Alma Ata Declaration
DECLARATION OF ALMA-ATA
International Conference on Primary Health Care,
Alma- Ata, USSR, September 6- 12, 1978.
The International Conference on Primary Health Care,
meeting in Alma-Ata expressing the need for urgent action by
all governments.
All health and development workers, and the world
community to protect and promote the health of all people of
the world, hereby makes the following Declaration:
I. The conference strongly reaffirms that health, which
is a state of complete physical, mental and social
well-being, and not merely the absence of disease or
infirmity.
Is a fundamental human right and that the
attainment of the highest possible level of health is a
most important world-wide social goal whose
realization requires the action of many other social
and economic sectors in addition to health sector.
II. The existing gross inequality in health status of the
people particularly between developed and
developing countries as well as within countries is
politically.
 HEALTH PROMOTION APPROACHES

from both communicable and non-communicable

Socially and economically unacceptable and is, diseases, and in mitigating the social and economic
therefore, of common concern to all countries. impact of such diseases.

III. Economic and social development, based on a New Principles of Health Promotions
International Economic Order, is of basic importance
to the fullest attainment of health for all and to the
reduction of the gap between the health status of
the developing and developed countries.

The promotion and protection of the health of the

people is essential to sustained economic and social
development and contributes to a better quality of
life and to world peace.

IV. The people have the right and duty to participate

individually and collectively in the planning and
implementation of their health care.

V. Governments have a responsibility for health of their

people which can be fulfilled only by the provision of
adequate health and social measures.

A main social target of governments, international Disease Prevention

organizations and the whole world community in the
coming decades should be the attainment by all
peoples of the world by the year 2000 of a level of
health that will permit them to lead a socially and
economically productive life.
Primary health care is the key to attaining this target
as part of development in the spirit of social justice.
VI. Primary health care is essential health care based on
practical, scientifically sound and socially acceptable
methods and technology made universally accessible
to individuals and families.
Health Promotion
 Is a process of enabling people to increase “control
over” and to “improve” their health. (WHO,1986)
 Is a process undertaken to increase the levels of
wellness in individuals, families and communities.
 It involves activities and programs provided by the
nurse and other healthcare provides to foster
lifestyle behaviors conducive to optimum health
status.
 Health promotion is a core function of public health
and is effective in reducing the burden of disease
 Covers measures not only to prevent the occurrence
of disease, such as risk factor reduction, but also to
arrest its progress and reduce its consequences once
established.
 Is sometimes used as a complementary term
alongside health promotion.
 Disease prevention in this context is considered to
be action which usually emanates from the health
sector, dealing with individuals and populations
identified as exhibiting identifiable risk factors, often
associated with different risk behavior.
Concept of Disease Prevention
 Actions aimed at eradicating, eliminating or
minimizing the impact of disease and disability, or if
none of these are feasible, retarding the progress of
the disease and disability.
Health Maintenance
 A systematic program or procedure planned to
prevent illness, maintain maximum function, and
promote health.
 It is central to health care, especially to nursing care
at all levels (primary, secondary, and tertiary)

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 HEALTH PROMOTION APPROACHES
 And in all patterns (preventive, episodic, acute,
chronic, and catastrophic).
 Health maintenance is a guiding principle in health
care that emphasizes health promotion and disease
prevention rather than the management of
symptoms and illness.
The Ottawa Charter for Health Promotion
 The outcome of the First WHO Global Conference on
Health Promotion in November 17- 21, 1986.
 This conference was primarily a response to growing
expectations for a new public health movement
around the world.
 Discussions focused on the needs in industrialized
countries, but took into account similar concerns in
all other regions.
 It built on the progress made through the
Declaration on Primary Health Care at Alma-Ata, the
World Health Organization's Targets for Health for
all document, and the recent debate at the World
Health Assembly on inter sectoral action for health.
 Provide s necessary guidance and direction on
actions to be taken by countries and international
communities in addressing the common risk factors
and social and economic determinants of health to
achieve health for all.
The Bangkok Charter for Health Promotion August 7-11,
2005
 Confirmed the need to focus on health promotion in
order to address the risk and determinants of
health.It identified actions, commitments, and
pledges required to address the determinants of
health in a globalized world.
Leavell and Clark’s three levels of prevention
Primary prevention
 Seeks to prevent a disease or condition at a pre-
pathologic state; stop something from ever
happening.
 To encourage optimal health and to increase the
person’s resistance to illness.
 Health Promotion
 Specific Protection
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Behaviors associated with the levels of prevention
Primary prevention
 Quit smoking
 Avoid/limit alcohol intake
 Exercise regularly
 Eat well-balanced diet
 Reduce fat and increase fiber in diet
 Take adequate fluids
 Avoid over exposure to sunlight
 Maintain ideal body weight
 Complete immunization program
 Wear hazard devices in work site
Secondary prevention
 It also known as health maintenance.
 Seeks to identify specific illnesses or conditions at an
early stage with prompt intervention to prevent or
limit disability; to prevent catastrophic effects that
could occur if proper attention and treatment are
not provided.
 Early diagnosis/detection/screening
 Prompt treatment to limit disability
Secondary prevention
 Have annual physical examination
 Regular Pap’s test for women
 Monthly BSE for women who are 20 years old and
above
 Sputum examination for Tuberculosis
 Annual stool guaiac test and rectal examination for
clients over 50 years
Tertiary prevention
 Occurs after a disease or disability has occurred and
the recovery process has begun; intent is to halt the
disease or injury process and assist the person in
obtaining an optimal health status.
 To support the client’s achievement of successful
adaptation to known risks, optimal reconstitution,
and/or establishment of high-level wellness.
 HEALTH PROMOTION APPROACHES
Tertiary prevention
 Self-monitoring of blood glucose among
 diabetics
 Physical therapy after CVA (stroke); participation in
Cardiac Rehabilitation after MI (myocardial
infarction or heart attack).
 Attending self-management education for diabetes.
 Undergoing speech therapy after laryngectomy
Theories related to health promotion
Self- Efficacy Theory
 Developed by psychologist Albert Bandura (1997)
 Coined the term self-efficacy to describe an
individual’s perception of one’s own ability to
perform a certain task.
 Self- efficacy has a powerful impact on initiating
behavior change.
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 Self- Efficacy is a form of self- confidence that leads
to successful behavior performance; it is a strong
influencing factor on behavior ( Borsody, Courtney,
Taylor, & Jairath, 1999)
Self- Efficacy encompasses two types of expectations
1. Outcome expectations: Beliefs about whether
behavior will produce desirable results.
2. Efficacy expectations: Beliefs the person has about
his or her own ability to perform the behavior.
Health Promotion Model
 Proposed by Nola J. Pender (1982, 1993, 1996) was
designed to be “complimentary counterpart to
models of health protection”.
 Describes the multidimensional nature of persons as
they interact within their environment to pursue
health.
Focus on three Areas
1. Client’s cognitive perceptual factors (individual
perceptions)
2. Modifying factors (demographic and social)
3. Participation in health promoting behaviors
(likelihood action).
The model also organizes cues into a pattern to explain the
likelihood of client’s developing health- promoting behaviors.
 The focus of this model is to explain the reasons why
individuals engage in health activities.
 It is not design for use with families or communities.
Health Belief Model
 Irwin M. Rosenstock’s (1974) and Marshall H. Becker
and Maiman’s (1975) addresses the relationship
between a person’s belief and behaviors.
 It provides a way of understanding and predicting
how clients will behave in relation to their health
and how they will comply with health care therapies.
Three Components
1. The individual’s perception of susceptibility to an
illness.
Ex: a client needs to recognize the familial link for coronary
disease.
2. The Individual’s perception of seriousness of the
illness.
 HEALTH PROMOTION APPROACHES
This perception is influenced and modified by demographic
and socio-psychological variables, perceived threats of the
illness, and cues to action.
Ex: mass media campaigns and advice from family, friends,
and medical professionals.
The likelihood that a person will take preventive action.
 Results from the person’s perception of the benefits
and barriers of taking action.
Ex: lifestyle changes, increased adherence to medical
therapies, or search for medical advice or treatment
The Precede-Proceed Model
 Developed by Lawrence W. Green and Shawna L.
Mercer
 Provides a comprehensive structure for assessing
health and quality- of- life needs and for designing,
implementing, and evaluating health promotion and
other public health programs to meet those needs.
 Outlines a diagnostic planning process to assist in
the development of targeted and focused public
health programs.
 Consist of five steps or phases:
 Phase I
Involves determining the quality of life or
social problems and needs of a given
population.
 Phase II
Consist of identifying the health
determinants of these problems and needs.
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 Phase III
Involves analyzing the behavioral and
environmental determinants of health
problems.
 Phase IV
The factors that predispose to, reinforce,
and enable the behaviors and lifestyle
identified.
 Phase V
Involves ascertaining which health
promotion, health education and/ or
policy- related interventions would best be
suited to encouraging the desired changes
in the behaviors or environments and in
the factors that support those behaviors
and environments.
PROCEED
 Policy, regulatory, and organizational constructs in
educational and environmental development
Guides the implementation and evaluation of the programs
designed using PRECEDE Is composed of four additional
phases:
Phase VI
 The interventions identified in phases five are
implemented.
Phase VII
 Entails process evaluation of those interventions.
Phase VIII
 Involves evaluating the impact of the interventions
on the factors supporting behavior, and on behavior
itself.
Phase IX
 The last phase comprises outcome evaluation,
determining the ultimate effects of the interventions
on the health and quality of life of the population.
 In actual practice, PRECEDE and PROCEED function in
a continuous cycle.
 Information gathered in PRECEDE guides the
development of program goals and objectives in the
implementation of PROCEED.
 HEALTH PROMOTION APPROACHES

 This same information also provides the criteria  The nurse is knowledgeable regarding nursing issues
against which the success of the program is and trends, societal changes, and community
measured in the evaluation phase of PROCEED. resources.

Roles of the Nurse in Health Promotion

Leader/ Member of the Profession
Advocate  Nurses are responsible for their own actions, being
health care advocates, and serving as leaders of the
 The nurse represents the client and the client’s
nursing profession (Nursing Education Advisory,
needs at all times. An advocate is one who “ pleads
1993).
the cause before another” (Anglin, 1994)
 To ensure accountability, the nurse must maintain
 When a client’s condition warrants an immediate
current education in the field of practice and
appointment, the nurse may act as a referral agent,
implement research findings in day to day nursing.
and assist the client in obtaining the care deserved.

Educator  Nurses apply the historical development of the

profession to current trends in order to direct the
 One of the most important role of the Nurse.
profession to meet societal changes.
 Education to remedy health promotion deficits is
 As a leader, the nurse promotes ethical and legal
essential for solving problems.
standards, innovative practices, and service to the
public to maintain a positive image for nurses.
Empowering Agent
 The nurse emphasizes the active role of the client by
Proactive Change Agent
including the client in every aspect of care.
 The nurse performs a thorough assessment of the
 The nurse empowers the client, the family,
client, family, community, and/ or groups.
community, and other groups that may relate to the
 Once strengths, weaknesses, and resources are
clients situation. This empowering process can be
identified, the proactive change agent builds on the
impetus for improving the health of communities
strengths identified, enhances existing resources,
(Arnold & Breen, 1998)
and fosters support systems that will enhance the
client’s ability to change (Pender, 1996).
Consultant
 The nurse assesses the problem situation, collects
information, identifies the actual problem, and in
conjunction with the client, determines appropriate
solutions.
Research User and Health Promotion Models Researcher
 As a research user, the nurse can play a significant
Coordinator of Care
role in advancing a theoretical knowledge base for
 The nurse acts a coordinator of care to assure the
health promotion and in facilitating client outcomes
appropriate sequence of events in the client’s care.
utilizing contemporary, current knowledge and
 Leadership skills are required to coordinate the plan
practice.
of care and refer clients to appropriate sources when
 The conscientious nurse will continue using research
indicated.
findings, increase personal knowledge, and thereby.
 In the role of coordinator of care, the nurse also
 Improve client care. The graduate educated nurse,
functions as a facilitator. As a facilitator, the nurse
usually one prepared for a doctoral level, can
direct client care within the health care system to
assume the role of a researcher that empirically tests
meet client needs and prevent duplication of
health promotion models, thus increasing the
services.
predictive value of health promotion in health care.

Provider of Care/Caregiver

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 HEALTH PROMOTION APPROACHES

 The nurse is actively involved in the nursing process,

a problem solving method for developing an
appropriate plan of care and wellness outcomes for
clients, while assessing the client’s response to
nursing interventions.
 The nurse can evaluate the client and determine if
client needs are being met.

Role Model
 Nurses represents standards and quality of care
defined within the limits of education, experience,
and state licensing bodies.
 Experienced nurses exemplify the highest ideals of
nursing practice and they command admiration,
trust, and respect from all health care professionals
and persons receiving care.

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