NUT 555

Health promotion: prerequisites, principles, framework and strategies,

Lecture 3

Dr Reginald Annan
Raannan.cos@knust.edu.gh// 020 1237169
Jan 2014
 Learning objectives
• At the end of the unit, students should be able to:
• Define health promotion
• Explain what health promotion is all about
• know the principles of health promotion
• Know the framework for health promotion
• Know the strategies for health promotion: advocacy, enable and mediate
• Apply the principles, framework and strategies to promote public health
nutrition in the population

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 Definition for health promotion
• Combination of health, education, economic, political, spiritual, social
and organisational initiative which is designed to desired change in
attitude, behaviour, environment and society necessary to promote
health

• It is a positive concept and focuses on promoting good quality of life

and not just prevention of disease

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 Official definitions
• “Any combination of health education and related
organizational, economic and political interventions designed to
facilitate behavioral and environmental changes conductive to
health”. (Green LW 1979)

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 • "Health promotion is the science and art of helping people
change their lifestyle to move toward a state of optimal health.
Optimal health is defined as a balance of physical, emotional,
social, spiritual, and intellectual health. Lifestyle change can be
facilitated through a combination of efforts to enhance
awareness, change behavior and create environments that
support good health practices. Of the three, supportive
environments will probably have the greatest impact in
producing lasting change". (American Journal of Health
Promotion, 1989,3,3,5)

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 Health promotion
• Should be directed to the determinants of health and quality of life
• It should be done in collaboration with sectors beyond health
• since the are stakeholders to health and quality of life
• Since the determinants of health are diverse
• Local and national government must play a pivotal role in
implementing policies which will bring about a conducive
environment for health

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 Prerequisites for health
• The fundamental conditions and resources for health are:

• peace,
• shelter,
• education,
• food,
• income,
• a stable eco-system,
• sustainable resources,
• social justice, and equity.
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 Health promotion principles

1. It must involve the whole population in the context of their everyday life and not focusing on people at
risk of specific diseases

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 2. It should be directed towards action on the determinant of health and this
requires multi-sectoral cooperation
It should aim at effective and concrete public participation…to identify
problems and solutions and to implement them

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 3. It should aim at effective and concrete public participation…to
identify problems and solutions and to implement them

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 4. It should combine diverse but complementary approaches
including communication, education, legislation, fiscal measures,
organisational change, community change, community development
and spontaneous local activities against health hazards

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 5. It should be a societal and
political venture and not
medical service, although
health professionals have an
important role in advocating
and enabling health promotion

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Health promotion components
• Promote healthy lifestyles
• Get people involved in their own health care
• Create an environment that makes it possible for people to live healthy
lives
• Recognise that lifestyle-related diseases are major causes of
illness/disease
• Strengthen community participation
 Healthy environment for health
• This is not just physical environment and sanitation
• It involves
• The food environment, making sure healthy food is accessible and unhealthy
food is inaccessible through policies and regulation
• Improving systems and structures for health promotion
• It is about giving people control over their health

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 Basic strategies for promoting health
• Advocate:
• advocate to make political, economical, social, environmental conditions
favourable for health
• Enable
• Work on equity, reduce differences, ensure availability of equal opportunities
and resources: access to information, life skills, and opportunities to choose
health
• Mediate
• Health sector alone cannot do it, coordinated action by all concerned,
including governments, health and other socioeconomic sectors

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 Advocacy

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 Enable people choose health

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 Mediate

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 Areas of priority action for health promotion

Source: The Ottawa Charter for Health

Promotion. First International
Conference on Health Promotion,
Ottawa, 21 November 1986.
http://www.who.int/healthpromotion/c
onferences/previous/ottawa/en/
index4.html

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 • This logo was created for the First International Conference on Health
Promotion held in Ottawa, Canada, in 1986.
• At that conference, the Ottawa Charter for Health Promotion was
launched.

• Since then, WHO kept this symbol as the Health Promotion logo (HP
logo), as it stands for the approach to health promotion as outlined in
the Ottawa Charter.

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 • The main graphic elements of the
HP logo are:

• one outside circle,

• one round spot within the circle, and
• three wings that originate from this
inner spot, one of which is breaking
the outside circle.
•.

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 • The outside circle, originally in
• The round spot within the circle
red colour, is representing the
goal of "Building Healthy Public
Policies", therefore symbolising
the need for policies to "hold
things together". This circle is
encompassing the three wings,
symbolising the need to address
all five key action areas of health
promotion identified in the
Ottawa Charter in an integrated
and complementary manner.
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stands for the three basic
strategies for health promotion,
"enabling, mediating, and
advocacy ", which are needed
and applied to all health
promotion action areas .
(Complete definitions of these
terms can be found in the Health
Promotion Glossary,
WHO/HPR/HEP/98.1)
 • The three wings represent the
five key action areas for health
promotion that were identified in
the Ottawa Charter for Health
Promotion in 1986 and were
reconfirmed in the Jakarta
Declaration on Leading Health
Promotion into the 21st Century
in 1997.

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 THEORIES OF BEHAVIOUR CHANGE

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 Attribution theory
• a theory which supposes that people attempt to understand the
behaviour of others by attributing feelings, beliefs, and intentions to
them.

• People attempt to provide a causal explanation for events in their

world particularly if those events are unexpected and have
personal relevance (Heider, 1958).

• It means people will try to find a cause for their health/disease/illness

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 Women causal explanation to breast cancer

Taylor et al.
(1984)

Women who had

been
treated for cancer

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 Health locus of control
• People attribute cause of
their problem to ability to
control or not control the
situation

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 • In other words the reason behind the behaviour can be internal or
external

• Health locus of control (HLOC) refers to LOC specifically related to

health behaviors (Wallston & Wallston, 1982). That is, HLOC
describes the belief that one's health is dependent upon internal versus
external factors.

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 Unrealistic optimism
• Unrealistic optimism focuses
on perceptions of
susceptibility and risk.

• Reasons why people continued

to practice unhealthy behaviours
may be due to inaccurate
perceptions of risk and
susceptibility - their unrealistic
optimism (Weinstein 1984).

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 Cognitive factors that lead to unrealistic optimism
1. Lack of personal experience with the problem
2. The belief that the problem is preventable by
individual action
3. The belief that if the problem has not yet appeared,
it will not appear in the future
4. The belief that the problem is infrequent.
(Weinstein et al., 1984)

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 MODELS OF BEHAVIOUR CHANGE –
HOW TO WORK WITH PEOPLE CHANGE
THEIR BEHAVIOUR

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 • Stages of change model
• Health belief mode
• Protection motivation theory
• Theory of planned behaviour
• Health Action Process Approach
• Social cognition models

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 • People go through stages before the change their behaviour
• To help people change, you must know where they are in their change
process
• The stages people go through are:
• Pre-contemplation
• Contemplation
• Preparation
• Action
• Maintenance

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 Health Belief Model
• The Health Belief Model (HBM) is a psychological model
that attempts to explain and predict health behaviors.
• This is done by focusing on the attitudes and beliefs of
individuals.
• The HBM was first developed in the 1950s by social
psychologists Hochbaum, Rosenstock and Kegels working in
the U.S. Public Health Services. Mar 1, 2012

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 Theory of planned behaviour
• The theory of planned behavior (abbreviated TPB) is a theory that
links beliefs and behavior. The concept was proposed by Icek Ajzen to
improve on the predictive power of the theory of reasoned action by
including perceived behavioural control. It is a theory explaining
human behaviour.
It suggests that behaviour can be predicted, because it is deliberative
and planned

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 Theory of planned behaviour

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 Protection motivation theory
• The Protection Motivation Theory proposes that we protect ourselves
based on four factors: the perceived severity of a threatening event, the
perceived probability of the occurrence, or vulnerability, the efficacy
of the recommended preventive behavior, and the perceived self
efficacy.

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 PMT

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 Assignment
• Describe what these are, and suggest how you can employ them in
promoting fruits and vegetables consumption
1. Health Action Process Approach
2. Social cognition models

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 • Questions and Comments

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 Thank You

For any concerns, please contact

elearning@knust.edu.gh
elearningknust@gmail.com
0322 191132
Jan 2014