Transcript Evolution of Health Promotion in Canada O`Neill et al

KIN 464 - WEEK 3
Thursday Jan 19/16
Summary – Evolution of HP
Why are theories of health and physical activity
promotion important but problematic?
Amazon river, Oran, Peru
March 2012
Evolution of Health Promotion in Canada
O’Neill et al., 2012
What was unique about Era 1? Era 2?
What were the significant change drivers in development
of health promotion in Canada over the first two eras?
Era
1
Predominant Approach
Health Education
Years
Prior to 1974
2
Health Promotion Development
1974-1994
3
Population Health
1994-2007
4
Population Health Promotion
2007 - Present
Another interesting perspective: Raphael, D. (2008). Grasping at straws: a recent
history of health promotion in Canada. Critical Public Health, 18(4), 483-495.
Era 2: Health Promotion Development
A new perspective on the health of Canadians. Lalonde Report
Epp, J. (1986). Achieving health for all: a
framework for health promotion. Ottawa,
ON: Health and Welfare Canada. Retrieved
from Health Canada website:
http://www.hc-sc.gc.ca/hcssss/pubs/system-regime/1986-frame-planpromotion/index-eng.php
Healthy Cities Projects
Towards making every city a healthy city (WHO, 2012)
Six Characteristics:
1
2
3
4
5
6
Evolution of Health Promotion in Canada
O’Neill et al., 2012
What was unique about Era 3? Era 4?
What were the significant change drivers in development
of health promotion in Canada over the last two eras?
Era
1
Predominant Approach
Health Education
Years
Prior to 1974
2
Health Promotion Development
1974-1994
3
Population Health
1994-2007
4
Population Health Promotion
2007 - Present
Another interesting perspective: Raphael, D. (2008). Grasping at straws: a recent
history of health promotion in Canada. Critical Public Health, 18(4), 483-495.
Compare and contrast:
• Biomedical model of health
• Biopsychosocial model of health
According to the ancient Greek Physiocratic school of thought “health
and disease cannot be dissociated from particular physical and social
environments nor from human behavior” (Tountas, 2009).
Theories, Models, Frameworks
• Theory – “A theory is a set of interrelated concepts, definitions, and
propositions that presents a systematic view of events or situations
by specifying relations among variables in order to explain and
predict the events of the situations”
(Kerlinger, 1986 as sited in Glanz, Lewis & Rimer, 2002 p. 25).
• Model – “Models may draw on a number of theories to help
understand a particular problem in a certain setting or context”
(National Cancer Institute, 2005).
• Framework – guides the practical implementation of theories and
models. Outlines the fundamental structure of how the concepts,
principles, and strategies are applied in order to guide planning,
action and evaluation.
What is health promotion theory?
• A systematic way of
understanding health-related
events and situations (NCI,
2005).
• A tool to think with (Dorothy
Smith, formerly in Sociology at
UBC).
“Theory helps me think through
how and why I approach a health
problem the way I do.” (Health
Educator, NCI, 2005)
Benefits of HP Theory
• Moves beyond intuition
• Encourages us to look at the
bigger picture – a roadmap
for studying complex health
problems
• Usually have some evidence
behind them
• Helps to identify what
indicators should be
monitored
• Increases possibility of
success
http://www.cancer.gov/cancertopics/ca
ncerlibrary/theory.pdf
Application of theory to practice…
• no ‘right’ or ‘wrong’
• ‘guidelines’ for understanding
change & developing programs/HP
initiatives
Theories should never be applied
without a thorough understanding of
the individuals, groups, organizations
and communities you are working
with:
• lived experiences
• local context
• asset-focused
Ohprs.ca
health promotion models and frameworks
Complexity
combining theories
Theories
explaining:
Theories
explaining:
health
behaviour
1.1.health
behaviour
change
individuals
change
inin
individuals
change
2.2.change
inin
communities
communities
change
3.3.change
inin
organizations
organizations
healthy
public
policy
4.4.healthy
public
policy
development
development
A Social-Ecological Model for Physical Activity – Adapted from Heise,
Ellsberg & Gottemoeller (1999)
One Example of a Ecological Perspective (NCI, 2005)
Ecological Level
Definition
Intrapersonal
Individual characteristics influence behaviour – knowledge,
attitudes, beliefs, personality traits
Interpersonal
Interpersonal influences – family, friends, peers; social
identity, support and role definition
Community Level
Rules, regulations, internal policies, informal structures that
constrain or promote behaviours
•
Institutional level
•
Community factors
Social networks and norms, standards of behaviour among
individuals, groups, organizations.
•
Public policy
Local, provincial, federal policies and laws that regulate or
support healthy actions and practices
Summary of HP Theories (NCI, 2005)
Ecological Level
Individual
Theory/Model
Focus
Health Belief Model
Perceived benefits of avoiding
a threat
Stages of Change Model
An individuals motivation and
readiness to change a problem
behavior
Theory of Planned Behavior
Attitudes, perceptions of
norms, beliefs about difficulty
of changing
Precaution Adoption Process Also a stage theory - how
Model
individuals move from being
unaware to deciding about
whether or not to act.
Health Belief Model
• In the 1950s the famous Health Belief Model, the first of a long
series of theoretical models of individual health behavior, was
conceived at Johns Hopkins School of Hygiene and Public Health in
Baltimore.
Assesses
readiness to
change
Commonly
applied to
interventions
targeting
health
behaviour
change
The dominant
model of
health
behaviour
change?
AKA: The Transtheoretical Model
Prochaska & DiClemente
A Social-Ecological Model for Physical Activity – Adapted from Heise,
Ellsberg & Gottemoeller (1999)
Interpersonal & Community Level HP Theories
Ecological Level
Interpersonal
Community
Theory/Model
Focus
Social Cognitive Theory
Personal and environmental
factors exert pressure on one
another
Community Organization
Community-driven approaches
to assessing and solving health
problems
Diffusion of Innovations
How new HP practices spread
from one community to
another
Communication Theory
How different types of
communication affect health
behavior
Diffusion of Innovation Theory
• innovators (the source
of the innovation)
• early adopters (“first on
the block”)
• early majority
• late majority
• laggards
Applying theory – increasing
Physical Activity
Stages of Change Model Diffusion of Innovation Theory
1.
1.
2.
2.
3.
3.
Social Capital
• Bowling Alone:
America's Declining
Social Capital. Robert
D. Putnam
• (2000)
• Better together
http://www.bettertogether.org/socialcapital.htm
Summary of HP Theories con’t
Ecological Level
Societal
Theory/Model/Framework
Social Determinants
Population Health Promotion
Community Health Promotion
Socio-ecological
Societal
Community
Family &
Friends
Individual
Settings
Settings Approach
• Comprehensive school health
www.dashbc.ca
Directorate of Agencies for School
Health in British Columbia (DASH BC)
Torabi & Yang, 2000
www.cash-aces.ca
Canadian Association for School
Health (CASH)
Target Population Approach
• Government
Assisted Refugees
– Settlement
support services
– Wrap around
support is
needed
Issue Approach
Surrey’s Safe & Active Schools
Program:
-
Built environment improvements:
side walks, cross walks, traffic
calming, curb extensions
-
Parent, student and teacher
education: reflective clothing,
awareness, student pick up/drop
off, safe routes
-
Group support: walking groups,
school challenges
-
Enforcement: parking, speeding
Approaches to Targeted Health
Promotion Initiatives:
- setting
- population
- issue
• Healthy Communities
Framework
http://www.ohcc-ccso.ca/en/webfm_send/550