Transcript Health Promotion and Disease Prevention Role of FNP

Basic and Fundamental
Principles of Health
Promotion
Prof. Elba N. Ortiz MSN FNP-BC
Catedrática Auxiliar
Programa de FNP, RCM, UPR
Objectives
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Recognize the health care trends and
facts in the population.
Discuss basic and fundamental concepts
and principles related to health
promotion.
Compare theories related to the health
promotion on individuals, family and
community.
Health Promotion and FNP
Certification Exam:
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Knowledge of:
1. Health promotion
concepts
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Skill in:
2. Making appropriate
health promotion
recommendations
(considering age,
developmental level,
health status, current
guidelines, primary,
secondary, and tertiary
prevention strategies)
Health Care Trends
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Changes in causes of infant mortality:
 Infectious and nutritional problems
no
infectious problem, congenital anomalies, perinatal
events.
Resurgence of previously controlled infection, as TB and
the emergency of newer infections as HIV
Concern on monitoring for biological agents of terrorism
Emphasis on disease prevention and health promotion
Facts
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Major causes of morbidity and mortality
 50% of illness related to lifestyle and unhealthy decisions.
Healthy People 2020
 Preventive health services
 Well baby care, immunizations, birth control
 Health protection activities
 Fluoridation, injury prevention, occupational safety
 Health promotion behaviors
 Smoking cessation, exercise, stress reduction, diet
Visit website for Health People 2020
 http://www.hhs.gov.healthypeople2020
Healthy People 2020
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Vision
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A society in which all people live long, healthy lives.
Mission
Healthy People 2020 strives to:
 Identify nationwide health improvement priorities.
 Increase public awareness and understanding of the determinants of
health, disease, and disability and the opportunities for progress.
 Provide measurable objectives and goals that are applicable at the
national, State, and local levels.
 Engage multiple sectors to take actions to strengthen policies and
improve practices that are driven by the best available evidence and
knowledge.
 Identify critical research, evaluation, and data collection needs.
Healthy People 2020
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Overarching Goals
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Attain high-quality, longer lives free of preventable disease,
disability, injury, and premature death.
Achieve health equity, eliminate disparities, and improve the
health of all groups.
Create social and physical environments that promote good
health for all.
Promote quality of life, healthy development, and healthy
behaviors across all life stages.
Healthy People 2020
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Four foundation health measures will
serve as an indicator of progress
towards achieving these goals:
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General Health Status
Health-Related Quality of Life and Well-Being
Determinants of Health
Disparities
Epidemiologic Principles
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Natural history of disease
 Stages: susceptibility (prepathological)
presymptomatic disease (subclinical)
clinical disease
disability (or death)
Etiology of disease: defines cause of a disease
Prevalence rates: describes the number of
persons in a defined group that have a disease
at a certain point in time
Incidence rates – rate of development of a
disease in a group over a period of time.
Human Rights
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Human rights are universal legal guarantees protecting
individuals and groups against actions that interfere with
fundamental freedoms and human dignity. Some of the
most important characteristics of human rights are that
they:
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guaranteed by international standards;
are legally protected;
focus on the dignity of the human being;
oblige states and state actors;
cannot be waived or taken away;
are interdependent and interrelated; and
are universal.
Source: The United Nations system and human rights: guidelines and
information for the Resident Coordinator System, March 2000
Social determinants of
health
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The social determinants of health are the
conditions in which people are born, grow,
live, work and age, including the health
system.
Social determinants of
health
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These circumstances are shaped by the
distribution of money, power and resources
at global, national and local levels, which are
themselves influenced by policy choices.
The social determinants of health are mostly
responsible for health inequities - the unfair
and avoidable differences in health status
seen within and between countries.
Social determinants of
health
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Responding to increasing concern about these persisting and
widening inequities, WHO established the Commission on
Social Determinants of Health (CSDH) in 2005 to provide
advice on how to reduce them.
The Commission's final report was launched in August 2008,
and contained three overarching recommendations:
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1. Improve daily living conditions
2. Tackle the inequitable distribution of power, money, and resources
3. Measure and understand the problem and assess the impact of
action
Health promotion (WHO,
2011)
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Health promotion is the process of enabling
people to increase control over, and to
improve, their health.
It moves beyond a focus on individual
behavior towards a wide range of social and
environmental interventions.
Health promotion (WHO,
2011)
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“Health promotion approaches do not focus on
illness experiences or optimal use of medical
services. In health promotion the focus usually is
much broader and emphasizes healthy general
living conditions and people’s chances to live
healthy lives. Moreover, health promotion calls for
improving the resources people need in order to be
active for their health, their own personal health,
the health of their families and communities,
including the power to change things for the
better”.
Health promotion (WHO,
2011)
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Health literacy includes the skills to obtain and
use appropriate knowledge about health and its
determinants. Emphasizing the empowerment
component in health promotion, … health literacy
approaches should also address people’s knowledge
and skills necessary to work on and change those
factors that constitute their health chances: In
health promotion practice, health literacy means to
understand the conditions that determine health
and to know how to change them’.
Levels of
Diseases
Prevention
Primary
Prevention:
Secondary
Prevention:
Stage of
susceptibility
Stage subclinical
Aimed at preventing
desease: exercise,
nutrition, education,
Pollution control
Mammogram
screening, cholesterol
screening, smoking
cessation program
Tertiary
Prevention:
Stage clinical
Use of inhaled steroids
in the management of
asma, use of penicillin
prophylaxis in pct.
sickle cell anemia
Prevention is more than education
and goes beyond the individual
Spectrum of Prevention
Level of Spectrum
Definition of Level
1. Strengthening Individual Knowledge and
Skills
Enhancing an individual's capability of
preventing injury or illness and promoting
safety
2. Promoting Community Education
Reaching groups of people with information
and resources to promote health and
safety
3. Educating Providers
Informing providers who will transmit skills
and knowledge to others
4. Fostering Coalitions and Networks
Bringing together groups and individuals for
broader goals and greater impact
5. Changing Organizational Practices
Adopting regulations and shaping norms to
improve health and safety
6. Influencing Policy Legislation
Developing strategies to change laws and
policies to influence outcomes
Risk Factors
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A risk factor is any attribute, characteristic
or exposure of an individual that increases
the likelihood of developing a disease or
injury. Some examples of the more
important risk factors are underweight,
unsafe sex, high blood pressure, tobacco
and alcohol consumption, and unsafe water,
sanitation and hygiene. (WHO, 2011)
Risk Factors
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Age, sex, social, cultural, familial,
occupational, lifestyle history represent
potential sources of problem.
Modifiable / no modifiable
Risk reduction programs are established
to reduce vulnerability of individuals to
problems.
Communicable/Infectious
Disease
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Patterns in which organisms attack and invade
vulnerable individuals
Reservoirs of infection
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Mechanisms of Transmission of infection
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Cases and carriers
Direct (touching, kissing, intercourse
Indirect – air vector, water, food
Control Measures
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isolation, insect spraying (reservoirs)
Water purification (interrupt transmission)
Immunization (reduce susceptibility)
Primary Care
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Primary care is the term for the health
services by providers who act as the
principal point of consultation for patients
within a health care system.
Depending on the nature of the health
condition, patients may then be referred for
secondary or tertiary care.
Primary Care
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The World Health Organization attributes the provision of
essential primary care as an integral component of an
inclusive primary health care strategy.
Primary care involves the widest scope of health care,
including all ages of patients, patients of all socioeconomic
and geographic origins, patients seeking to maintain
optimal health, and patients with all manner of acute and
chronic physical, mental and social health issues, including
multiple chronic diseases.
Primary Care
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Consequently, a primary care practitioner must
possess a wide breadth of knowledge in many
areas.
Continuity is a key characteristic of primary care, as
patients usually prefer to consult the same
practitioner for routine check-ups and preventive
care, health education, and every time they require
an initial consultation about a new health problem.
Collaboration among providers is a desirable
characteristic of primary care.
Primary Care
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Health care should be effective and safe.
Professionals as well as the general public often
over-rate the performance of their health services.
The emergence of evidence-based medicine in the
1980s has helped to bring the power and discipline
of scientific evidence to healthcare decisionmaking, while still taking into consideration patient
values and preferences.
Primary Care
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Primary care brings promotion and prevention, cure and
care together in a safe, effective and socially productive
way at the interface between the population and the
health system.
In short, what needs to be done to achieve this is “to put
people first”: to give balanced consideration to health and
wellbeing as well as to the values and capacities of the
population and the health workers.
Features of health care: effectiveness and safety, are
essential in ensuring improved health and social
outcomes.
Primary health care
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Primary health care, often abbreviated as
“PHC”, has been defined as "essential health care
based on practical, scientifically sound and socially
acceptable methods and technology made
universally accessible to individuals and families in
the community through their full participation and
at a cost that the community and the country can
afford to maintain at every stage of their
development in the spirit of self-reliance and selfdetermination".
Primary health care
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In other words, PHC is an approach to health
beyond the traditional health care system that
focuses on health equity-producing social policy.
This ideal model of health care was adopted in the
declaration of the International Conference on
Primary Health Care held in Alma Ata in 1978
(known as the "Alma Ata Declaration"), and
became a core concept of the World Health
Organization's goal of Health for all.
Primary health care
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The ultimate goal of primary health care is better health for
all. WHO has identified five key elements to achieving that
goal:
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reducing exclusion and social disparities in health (universal
coverage reforms);
organizing health services around people's needs and expectations
(service delivery reforms);
integrating health into all sectors (public policy reforms);
pursuing collaborative models of policy dialogue (leadership
reforms); and
increasing stakeholder participation.
Primary health care
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Declaration of Alma-Ata International
Conference on Primary Health Care,
Alma-Ata, USSR, 6-12 September 1978
The World Health Report 2008 primary Health Care (Now More Than
Ever)
Models of Health Promotion
Health Belief Model
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The Health Belief Model is a health behavior change and
psychological model developed by Irwin M. Rosenstock in 1966 for
studying and promoting the uptake of health services.
The model was furthered by Becker and colleagues in the 1970s and
1980s. Subsequent amendments to the model were made as late as
1988, to accommodate evolving evidence generated within the health
community about the role that knowledge and perceptions play in
personal responsibility.
Originally, the model was designed to predict behavioral response to
the treatment received by acutely or chronically ill patients, but in
more recent years the model has been used to predict more general
health behaviors.
Health Belief Model:
Constructs
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The original model included these four constructs:
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Perceived susceptibility (an individual's assessment of their risk of
getting the condition)
Perceived severity (an individual's assessment of the seriousness of
the condition, and its potential consequences)
Perceived barriers (an individual's assessment of the influences
that facilitate or discourage adoption of the promoted behavior)
Perceived benefits (an individual's assessment of the positive
consequences of adopting the behavior).
A variant of the model include the perceived costs of adhering to
prescribed intervention as one of the core beliefs.
Health Belief Model:
Constructs
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Constructs of mediating factors were later added to connect the various types of
perceptions with the predicted health behavior:
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Demographic variables (such as age, gender, ethnicity, occupation)
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Socio-psychological variables (such as social economic status, personality,
coping strategies)
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Perceived efficacy (an individual's self-assessment of ability to successfully
adopt the desired behavior)
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Cues to action (external influences promoting the desired behavior, may
include information provided or sought, reminders by powerful others,
persuasive communications, and personal experiences)
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Health motivation (whether an individual is driven to stick to a given health
goal)
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Perceived control (a measure of level of self-efficacy)
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Perceived threat (whether the danger imposed by not undertaking a certain
health action recommended is great)
The Health Belief Model.
Social Cognitive Theory
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Social cognitive theory, used in
psychology, education, and
communication.
The theorists most commonly associated
with social cognitive theory are Albert
Bandura and Walter Mischel.
Social Cognitive Theory
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Social cognitive theory is a learning theory based
on the ideas that people learn by watching what
others do and that human thought processes are
central to understanding personality.
While social cognitists agree that there is a fair
amount of influence on development generated by
learned behavior displayed in the environment in
which one grows up, they believe that the
individual person (and therefore cognition) is just
as important in determining moral development.
Social Cognitive Theory
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People learn by observing others, with the environment,
behavior, and cognition all as the chief factors in influencing
development. These three factors are not static or
independent; rather, they are all reciprocal.
For example, each behavior witnessed can change a
person's way of thinking (cognition). Similarly, the
environment one is raised in may influence later behaviors,
just as a father's mindset (also cognition) will determine the
environment in which his children are raised.
Health Promotion Model
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The health promotion model (HPM) proposed by
Nola J Pender (1982; revised, 1996) was
designed to be a “complementary counterpart to
models of health protection.”
It defines health as a positive dynamic state not
merely the absence of disease. Health promotion
is directed at increasing a client’s level of well
being.
The health promotion model describes the multi
dimensional nature of persons as they interact
within their environment to pursue health.
Health Promotion Model
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The model focuses on following three
areas:
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· Individual characteristics and experiences
· Behavior-specific cognitions and affect
· Behavioral outcomes
Health Promotion Model
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The health promotion model notes that each person has
unique personal characteristics and experiences that affect
subsequent actions.
The set of variables for behavioral specific knowledge and
affect have important motivational significance.
These variables can be modified through nursing actions.
Health Promotion Model
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Health promoting behavior is the desired
behavioral outcome and is the end point in the
HPM.
Health promoting behaviors should result in
improved health, enhanced functional ability and
better quality of life at all stages of development.
The final behavioral demand is also influenced by
the immediate competing demand and
preferences, which can derail an intended health
promoting actions.
Health Promotion Model