Psychological_and_Sociological_Concepts_and_Theories

The aim of this assignment is to examine how psychological and sociological theories can inform health promotion and how their application in nursing practices. In order to discuss this matter, I recognize that it would be beneficial to locate a suitable definition for health promotion and health education at the outset. The World Health Organisation (1986) defines health promotion as the process of enabling people to increase control over, and to improve their health, also they state that health education comprises consciously constructed opportunities for learning involving some form of communication designed to improve health literacy, including improving knowledge, and developing life skills which are conducive to individual and community health. Now that there are definitions for these key terms, the focus of this assignment will move to finding a suitable health promotion model to use as the structure for this assignment. Beattie’s Framework appears as a suitable candidate, it is a useful tool for facilitating health professionals to work under the many restraints put upon them which will be discussed later. Beattie’s framework can be subdivided into 4 main components namely Health Persuasion, Legislative Action, Personal Counselling and Community Development. There are four external pressures that influence the components in Beattie’s framework; they are the individual, authoritative, collective and, negotiated pressures (Beattie, 1991). This assignment will look at a case study with an individual who has developed abnormal health behaviour with regards to food, and consequently a diet that puts the individual at risk of acquiring diabetes. Edelman and Mandle (2006) suggest that Beattie’s framework lays out the tools for the health professional to facilitate the change of a patient’s unhealthy lifestyle choices. It is important to note that before using Beattie’s Framework or indeed any health promotion tool on a sociological or psychological level, we must first look at Maslow’s Hierarchy of needs. Naidoo and Wills (2004) using Maslow’s Hierarchy of Needs, explain that it is fundamentally important to meet the most rudimentary physical needs of the individual before attempting to aid the individual on a sociological or psychological level (Frey and Cooper, 1996). The first component of Beattie’s Framework this assignment will look at is Health Persuasion Techniques. Health Persuasion Techniques cover the more traditional concept to health promotion. These techniques draw on the knowledge, skills and influence of the health professional over the layman. Health Persuasion knowledge and influence is employed by the health professional to modify the behaviour of an individual from an authoritative, ‘top down’ stand-point. Evidence put forward on this ‘top down’ approach to health promotion shows that, although it is highly thought of by Governments due to its long history and high profile it is inadequate and only has a partially achieves altering the behaviour of the individual’s under its direction (Nettleton, 2006). To assist the health professional with the Health Persuasion component of Beattie’s Framework there are other tools and models we can incorporate into the health promotion practice. The Stages of Change model and the Health Belief model can both be used to gauge an individual’s readiness to change (Tones and Tilford, 2001). The Stages of Change model, also known as the Transtheoretical model is broken into stages. Each stage represents an individual’s thought process and behaviour at that specific time. It is through these stages that we can measure the quantity of change an individual has undergone or potentially will undergo. The stages involved for the individual are in-order; pre-contemplation, contemplation, preparation, action and maintenance. Fertman and Allensworth (2010) noted that the Transtheoretical model is unique as for each stage in the model there is a definite time frame related to it. The Transtheoretical model works by an individual moving along the stages in a set order, this represents the behaviour change. However, an individual is allowed to temporarily move back to a previous stage, this is known as a relapse (Wilson and Kolander, 2003). In the 1950’s a group of researchers working for the U.S. Public Health Service devised the Health Belief Model, since then it has been modified and assessed at length. The Health Belief model demonstrates that an individual will initiate a change in their behaviour to avoid acquiring illness. The individual’s actions can be influenced in four areas; the individual’s personal belief that they are likely to acquire a disease, how detrimental to their health the individual believes the disease to be, how rewarding the payback of adopting a healthier lifestyle is, and how difficult it is too initiate a change to avoid illness (Bastable, 2008). The Health Belief model not only provides the tools to help health professionals to negotiate the hurdles to health promotion, but also it can be used to point out where more programmes are in need to deal with specific issues for vulnerable groups (Maurer and Smith, 2005). The next component of Beattie’s Framework this essay will examine is Legislative Action. Legislative Action is an approach that incorporates change on a national level, this is concerned with the caring capacity of the state or organisation to modify or create laws, policies, procedures, and guidelines in order to improve the health of its citizens. Legislative action can help create and maintain supportive environments for health promotion and education to take place. The actions are aimed at making being healthy easier, while people can be encouraged to change their behaviour via national interventions, it is unrealistic to think that they would be able to meet the specific needs of the individual vulnerable population. If the national interventions are backed up by law then resistance is sure to follow from some of the populations’ demographics, the danger then lies that prohibitive legislation may drive certain behaviours underground. This in turn will make more difficult to help the vulnerable groups and address the inequity in health (Wills and Jackson, 2007). Included in facilitating legislative action are such guidelines as, The Patients Charter, Health 21, and NMC Code of Conduct. The Patients Charter lays out the standards of care amongst other things that a patient should expect to receive whilst in either public or private care (Paulinus and Sikosana, 2009). Health 21, originally named Targets 21, was created by the World Health Organisation. The World Health Organisation devised a list of twenty one goals related to all aspects of abnormal health behaviours. Each goal had its own timeframe attached to it to be used measure for its progress (Gorin and Arnold, 2006). The final piece of legislative action to be explored is the Nursing and Midwifery Code of Conduct. The Code of Conduct is in place to give the Health Professional a set of rules for them to adhere to, to ensure that the patient gets the best possible care. The Code of Conduct also puts the health professional in direct control over their own professional accountability and the quality of care they deliver (Caulfield, 2005). The third component of Beattie’s Framework to explore is Community Development. The Community Development component is a potential hub for a large number of various health promotion programmes. Many of the programmes centred on changing an individual’s behaviour are set in the community. However, the majority of these maintain strong connections to the medical services through general practitioners and community based nursing teams (Sines and Mary Saunders, 2009). Local Agenda 21 and it’s mantra of “Think globally, act locally”, works at the other end of the community development spectrum, and is closely associated with sustainable development. Empowerment does not automatically result from a community setting, it is the level in which the community support and involve themselves in the programme that determines its success or not. Reviewing the earlier examples of the general practitioners and community nurse teams, it is unlikely that the individual will be empowered by the health promotional activity. However, it is not this approach is futile, it just recognises the value of input from other areas, and that more expertise maybe needed to decide on a suitable plan of action (Joanne Kerr, 20002). The final component of Beattie’s Framework is Personal Counselling. The locus of control is put into the hands of the individual, and they are encouraged to take part in active reflection and to weigh up the pros and cons of their lifestyle, and their ability to positively change. The counselling can be delivered in two ways, either on a one-to-one basis or by joining a group of individuals in similar circumstances. These sessions may also be followed or reinforced by printed information for the purpose of self-study. Family Planning Association, MIND and RELATE are all organisations that during the 1980’s have adopted this approach, these organisations according to Beattie (1991) have all reported considerable benefits as a result of the Personal Counselling approach (Blackie et al, 2003). The task of Personal Counselling, unlike the other three components of Beattie’s Framework is to achieve a more patient-centred approach to health promotion. Using this approach does away with the health professional hierarchy and does not coerce the individual, instead it empowers the patient and utilises their participation in changing their health behaviours. Patients are given control over their health, they are invited to set their own health promotion milestones, and with the support of the health professional reach these targets. The individual’s are asked to reflect and draw on their experiences to help maintain a healthier lifestyle and to continue to make healthier lifestyle choices (Funnell et al, 2009). Following my analysis of Beattie’s Framework, the psychological and sociological concepts relating to Health Education and Health Promotion as a Health Professional facilitates us in working with Evidence Based Practice. Evidence Based Practice is a must for the Health Professional to fulfil the aspects of advisory and accountability, and to be able to identify vulnerability in patients. Through researching Beattie’s Framework some limitations have cropped up. The key limitation shows up at the very beginning, if a health professional was trying to use Beattie’s framework to change abnormal health behaviours, they will not accomplish any change until they met the individual’s basic needs by referring to Maslow’s Hierarchy of Needs. The models are limited as they are not specific enough to be tailored for an individual, and as such they do not take in all the influencing factors of a person’s health. The model looks if the client can be persuaded to change an abnormal unhealthy behaviour, if the patient is not compliant with the change then the model’s usefulness breaks down.