Discuss_How_Health_Promotion_Programmes_Can_Be_Used_to_Empower_Individuals_to_Make_the_Decision_to_Change_Their_Health_Related_Behaviour.

Discuss how health promotion programmes can be used to empower individuals to make the decision to change their health related behaviour. Introduction The World Health Organisation (WHO) (1948: 100) defined health as ‘a state of complete physical, mental and social wellbeing not merely the absence of disease or infirmity’. Most of us can identify ‘health’ as a general condition of the body and the degree to which it is free from illness, or the state of being well. The WHO (1986) further defined that health is not only a basic human right, but also can be represented as a resource which enables people to lead an individually, socially and economically productive life: ‘Health is a resource for everyday life, not the object of living. It is a positive concept emphasizing social and personal resources as well as physical capabilities.’ Arnold and Breen (2006) identified the characteristics of health not only as well-being but also as a balanced state, growth, functionality, wholeness, transcendence, and empowerment and as a resource. In order to enhance the level of public health, health promotion must be established to deliver the information of tackling communicable and non-communicable diseases and other threats to health. Health promotion represents a comprehensive social and political process; it not only embraces actions directed at strengthening the skills and capabilities of individuals, but also action directed towards changing social, environmental and economic conditions so as to alleviate their impact on public and individual health (WHO, Bangkok Charter, 2005). In Hong Kong, the Government emphasized that health promotion is important in the primary care and should be continued to strengthen the promotion of healthy lifestyles and the prevention of diseases, according to the healthcare consultation document of Your Health Your Life in 2008. In this essay, I am going to discuss the planning of health promotion by using the Health Action Model regarding Richard’s health. Evidence base Numerous researches in different countries showed that unhealthy lifestyle, including smoking, poor diet and alcoholic consumption, had made serious contribution to the burden of chronic disease, for example, hypertension, cardiovascular disease, and carcinoma. Padrão et al (2007) addressed that smokers drink higher amount of alcohol and consume lower quantity of foods rich in fibre, antioxidants, or phytochemicals, which are believed to damage the prevention of multiple chronic diseases in Portugal. Yokoyama et al (2002) had also done a study with similar results in Japan. Moreover, Mokdad et al (2004) showed that the leading causes of death in 2000 were tobacco (435000 deaths; 18.1% of total US deaths), poor diet and physical inactivity (400000 deaths; 16.6%), and alcohol consumption (85000 deaths; 3.5%). Chronic disease mortality is increasing and is predicted to increase substantially over the next two decades, during which time cardiovascular diseases are expected to remain the leading cause of death (Mokdad et al 2004). Kemp et al (2003) stated that depression would raise the risk of developing cardiovascular disease. Another study attempted to explain the relationship between the depression and the heart disease in various aspects of biological, psychological, behavioural, and genetic factors (Glassman et al 2011). Early detection and treatment of depression in heart patients are crucial to improve a patient’s quality of life and possibly prevent a recurrent coronary event. When left untreated, depression can worsen heart disease and increase the risk of a heart attack. All of those researches showed the impact of poor diet, smoking, drinking, and unhealthy life style which may cause the fatal illness such as hypertension and ischaemic heart disease. Therefore, it is necessary to design a tailored made health promotion programme for Richard’s health. Needs assessment It is important to identify what patient need in order to promote their health. Bradshaw (1972) introduced four types of need that are all valid components of the concept of needs. Normative needs These are objective needs which professionals define a desirable standard (Ewles and Simnett 2003). If an individual or group falls short of the desirable standard, then they are identified as being in need. There is a clear standard that can be applied consistently and fairly. However, expert-defined standards may be careless, paternalistic, racist and arbitrary, and need thresholds may be manipulated to control unmet need. Felt needs When assessing need for a service, people are asked whether they feel they need it (Naidoo and Wills 2000: 127). It affirms the respondent’s definition of the situation and requires contact between the worker and the patient. However, responses may be limited by inadequate information of available services or an individual lacks insight into his own needs. Expressed needs Naidoo and Wills (2000) explained that expressed need is felt need turned into action. Need is equated with demand for a service. Expressed need is commonly used in the health sector where waiting lists are taken as a measure of unmet need. This measure of need is more testing of the commitment of the individual to do something about meeting their needs. But, this measure of need is unreliable on its own. For example, a waiting list may be inflated by persons who have already met their needs by availing themselves of an alternative service. Comparative needs Naidoo and Wills (2000) stated those needs are made by comparing the characteristics of those receiving a service with those not receiving it. If people with similar characteristics are not in receipt of that service, then they are considered to be in need. However, most people make fairly local comparisons when assessing differentials. Their ability to advocate comparative need is therefore based on consciousness and experience. Since Richard had felt generally unwell with multiple episodes of chest tightness, he consulted his doctor then. He also never checked his cholesterol level that he might not feel the need to know. Due to the busy and long hours working, he also did not aware how stressful he was even being diagnosed as depression before. Finally, he was found two major coronaries blocked after he took the stress test at the Acute Chest Pain clinic. He was recommended by his doctor to insert a coronary stent. Therefore, the health promotion work for Richard is based on normative and felt needs. Level of health promotion work According to Hubley and Copeman (2008), practitioner needs to decide which levels of health promotion in order to achieve the aims. There are some strategies for primary, secondary, and tertiary level of health promotion. Gard (2000) defined that primary health promotion aims at encouraging the maintenance of good health and the prevention of illness. It mainly focuses on the healthy people to prevent illness in order to reduce various health risks. An example would be promotion of regular exercise which gives protection against coronary heart disease. Secondary health promotion provides an early detection and reduction of existing health problems, for example by screening for hypertension. Tertiary health promotion is going to improve the quality of life of individuals affected by health problems, not only prevent the deterioration and reduce the complications from specific disorders, but also prevent relapse into risky behaviours. An example would be medication management programmes for chronic psychiatric patients to enhance their drug adherence in order to prevent relapse. The health promotion work would be started at tertiary level since the condition of Richard cannot be cured. The complications of his irreversible disease can be minimized or prevented. SMART aim Regarding health promotion needs, there is necessary to set priorities to meet a large number of it in case because there are limited resources such as time and finance. At the same time, focusing effort on priority areas is important to ensure the quality and effectiveness of the health promotion (Scriven 2010). Moreover, the need to prioritise is important to the design on the SMART aim of the health promotion programme that the health promotion can achieve greatest benefit when concentrating all effort on those most at risk. For effectiveness, Tones and Tilford (2001) introduced programme objectives should be SMART: • Specific to a health determinant, population group or setting • Measurable in evaluation terms • Achievable given the resources and capacities • Realistic means it should be sensible and practical • Time limited, showing a set period for the programme, allowing sufficient time for planned changes to occur. Since Richard has done the insertion of coronary stent and is on medication for the control of anti-platelets, hypertension, and cholesterol, it would maintain his health away from the heart disease temporarily. However, I still concern the impact of smoking, drinking and poor diet on his health. The SMART aims are: 1. By the end of June 2011, Richard’s cholesterol level will reduce to 5.0mmol/l. 2. By the end of June 2012, Richard’s cholesterol level will reduce to 4.0mmol/l. 3. By the end of 2011, Richard will have given up drinking. 4. By the end of 2011, Richard will have given up smoking. 5. By the end of 2012, Richard will not have the 4th admission to psychiatric unit. The SMART objectives are: 1. By the end of 2011, Richard will give up smoking after attending the smoking cessation programme once per week. 2. By the end of June 2012, Richard will not be smoking 6 months later after completed the smoking cessation programme. 3. By the end of 2011, Richard will give up drinking after attending the health promotion programme ‘quitting drinking’ once per week 4. By January 2012, Richard will have opportunity to attend regular meeting in Alcoholics Anonymous. 5. By September 2011, Richard will have been offered education about healthy eating. 6. By the end of 2011, Richard will be eating a healthy diet following guidelines agreed with the dietitian. 7. By the end of 2011, Richard will have spent 30 minutes per day for jogging. 8. By the end of 2011, Richard will have been offered relaxation exercise once per week. 9. By the end of 2011, Richard will be given opportunity to join the ‘Man Group’ for psychological support and sharing once bi-weekly. Approaches to Health Promotion According to Scriven (2010), different models of health promotion are essential for health promoter doing analysis of aims and values, in order to structure a right way to prepare appropriate health promotion programmes. They are: 1. Medical approach involves medical intervention to prevent disease and disability of individual. In Hong Kong, the Government provides free vaccinations to Hong Kong children from newborn to Primary 6 against ten infectious diseases under the Childhood Immunisation Programme. 2. Behavior change approach changes people’s individual attitudes and behaviors to adopt what is a healthy lifestyle. Since 2001, the Tobacco Control Office of the Department of Health has been promoting a smoke-free culture to the public through the mass media to raise the public awareness on the hazards of smoking and secondhand smoke. 3. Educational approach was applied to provide health knowledge and develop skills. In Hong Kong, Smoking Cessation Health Talk is organized by the Tobacco Control Office in order to promote a smoke-free culture. 4. Client-centred approach would be applied to identify client’s concerns and help them to gain the knowledge and skills they require to make changes, for example, individual counselling and supporting group. 5. Societal change approach is applied to effect changes on the physical, social and economic environment, to make it more contributive to good health. It concentrates on changing community, not on changing the behavior of individuals. In Hong Kong, the legislation of tobacco control was first enacted since 1982 in order to promote smoke-free culture. Regarding the situation of Richard, educational approach is applied that information on the impact of drinking, smoking and poor diet would be given through education talk, helping him to explore his own values and come to a decision. And, it would help him to learn how to stop those behaviours if he wants to. Since he may comply with the treatment of depression, medication management programme is essential to deliver the fatal contradiction concept between drinking and anti-depressant, to persuade him to quit drinking immediately. Medical approach is also applied as he needs to continue the medical treatment for hypertension and depression as well as the cholesterol screening. Behavioural approach involves sharing session and persuasive programme to encourage Richard to stop drinking and smoking. Daily physical exercise would be encouraged to reduce the cholesterol level. He would be encouraged to keep a diary which will increase self-awareness. Client Centred approach is also applied to invite Richard to join empowerment group which would help him to identify his own concerns and to gain skills and confidence to act for change. Model I would use the Health Action Model (Tones 1987) to discuss Richard’s case. This model lets me to understand health and illness-related behavior and particularly relevant to planning health promotion programmes. It identifies key psychological, social and environmental influences on individuals to adopt and sustain health. There are two major sections: • Behavioral intention • Behavioral intention being translated into practice This model has five systems, all of which influence behaviour, as follows: • Belief system associates with individual psychological factors including reception of information and attention and perception process. Information on healthy diet, stop smoking and stop drinking should be provided and I would go through the information to make sure he can understand. • Motivational system incorporates the value and attitudes of individual. Richard should be encouraged to attend the following programmes or next cholesterol screening that he would get a difference and therefore he would see the quitting of smoking and drinking and the healthy diet will make a difference. • Normative system represents social influence such as mass media, peer groups, nuclear family and community norms. Nurse may let him to know smoking not only no benefit to himself but also being harmful to others by second-handed smoking. • Knowledge system represents the individual requires knowledge and skills to get positive health behaviour. Nurse may remind the family history of Richard that his father died at 64 for 20 years due to myocardial infarction in order to aware and improve his current health. • Environmental system identify the factors including physical, cultural and socio-economic background of individual, all of those will support change. Nurse not only establishes rapport with Richard and also shows supportive and encourages him to follow up. Nurse can show his cholesterol level and check his blood pressure with written information. Moreover, nurse can suggest him to join a support group. The model indicates that those systems would affect with each other. It not only takes into account the social and environmental factors that surround the individual, but also considers the personality of individual such as self-esteem and core values. All of these factors can facilitate or hinder actions depending on the resources available to change these conditions. Green and Tones (2010) explained that people with a high level of self-esteem and a positive self-concept are likely to feel confident about them and as a result will have the ability to carry through a resolve to change their behaviour. Conversely, people with a low level of self-esteem are likely to believe that they have limited control over their fate and will be less likely to respond to a health promotion message, no matter how convinced they are by it at an intellectual level. Ethical issues When going to plan and implement the health promotion programmes for the clients, nurses have to concern the area of ethical issues. There are four areas will be discussed: Autonomy, beneficence, non-maleficence and justice. Autonomy The sense of autonomy has to do with individual choice. People have the right to choose what treatment as they like (Edelman and Mandle 2006). Respecting for autonomy also enables clients to make reasoned informed choices (Scriven 2010) In this programme, Richard has his own right to participate or not. He will be provided sufficient information of the programme, and plenty of time to make decision. Beneficence The principle of beneficence shows doing good to a client (Leddy 2006). This would consider the balance of benefits of a treatment against the risks and costs (Scriven 2010). This principle always combined with non-maleficence. This programme provides opportunity for Richard to sustain the skills and knowledge of healthy life and relieve his stress. It protects him from harm. Non-maleficence The sense of non-maleficence indicates that one avoid doing harm to others (Leddy 2006). Nurses should not harm the client (Scriven 2010). The programme seems no harm towards Richard. However, there may be a risk that he will get exhaust due to the intensive health programme. On the other hands, Richard may have feeling of uselessness and worthlessness if he fails to manage his problems even learned already. Justice The concern of justice in health care relates to fairness (Leddy 2006). An example would be health care is a benefit that should be fairly distributed as well as taxes should be shared fairly (Rodriquez 2003). Fairness of resource allocation is always suggested in health care system. This programme provides quality health promotion with limited resources to fulfill the concern of fairness. Evaluation Determining the effectiveness of health promotion programs includes utilizing appropriate evaluation and research methods to support program improvements, sustainability, and dissemination. There are three major evaluations in health promotion to determine and assess the results of health promotion. They are process evaluation, impact evaluation and outcome evaluation. The process evaluation in health promotion is that, compared to impacts and outcomes, process measures signal what worked well and what did not, and in what context (Pawson and Tilley, 1997). Without process information it would be impossible to tell, for example, whether the apparent failure of a programme was because it was the wrong programme or because it was being poorly implemented, or whether it was a success in ways not anticipated. While process evaluation may involve a broad span of methods, including documentary analysis and surveys, it is frequently associated with qualitative methods – semi-structured interviews, ethnography and focus groups. Impact evaluation is defined as the immediate effect of health promotion programmes influences the determinants of health. Health promotion programmes may have a range of immediate effects on individuals including improved health knowledge, skills and motivation, and changes to heath and behaviour. Some methods are commonly used in impact evaluation including focused group, in-depth interviews, open-ended survey questions, participants’ observation, specific questionnaire and checklist. Outcome evaluation can measure the effects of the programme on a participant immediately after he participates. It provides an indicator of both effectiveness and the extent to which a program’s objectives are being met. When combined with process evaluation, outcome evaluation can indicate which activities and outputs appear to have the greatest influence, and allow health promoter to shift resources from less effective to more effective elements of the programme. Conclusion Nurses now face 21st century challenges, such as obesity, alcohol consumption, psychosis and new forms of communicable diseases. This module gave me a great opportunity to learn the knowledge about health promotion, which is useful and valuable to me in the future. 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