Disease_Notification_in_Epidemiology_Presentation.pptx

Disease_Notification_in_Epidemiology_Presentation.pptx

1. Health Promotion Unit Code: NUR 117 Duration: 20 hours

2. Reference Principal of health and promotion 8th edition by cottrel R.R, Essentials of health promotion London (2022) by Naidoo, Theoretical foundations of Health Education and health promotion Sharma M(2022), Basavanthappa BT (2022) Community health nursing. Health Promotion throughout the life span St. Lous

3. Health promotion A core concept in public health and community health work. It is concerned not only with preventing disease, but also with improving and sustaining health by addressing broader determinants, empowering individuals and communities, and shaping environments that support healthy living.

4. Aims to improve the health and well-being of individuals and communities. It focuses on enabling people to increase control over their health and make informed decisions to improve their quality of life. World health organization defines Health promotion as the process of enabling people to increase control over, and to improve, their health."

5. The scope of health Promotion The scope of health promotion is broad and includes: 1. Health Education Informing and educating people about health risks and healthy choices. Promoting health literacy. 2. Policy Advocacy Supporting laws and regulations that promote health (e.g., tobacco control laws, healthy school lunches).

6. 3. Environmental Change Creating environments that support healthy living (e.g., clean water, safe housing, recreational areas). 4. Community Participation Engaging communities in identifying health issues and implementing solutions. 5. Behavioral Change Encouraging individuals to adopt healthier behaviors (e.g., quitting smoking, exercising regularly).

7. 6. Prevention Strategies Focused on primary prevention (before disease occurs), secondary prevention (early detection), and tertiary prevention (managing existing conditions).

8. So, the scope of health promotion is not just what we do (education, campaigns) but also why (values), where (settings), who (stakeholders), how (methods), and with what accountability (evaluation).

9. Historical development of health promotion in Kenya Pre-independence (Before 1963) Post independence (1963-1978) Alma –Ata declaration and PHC Structured development (1980-1990) Strategic reforms (2000) Devolution and policy change (2010) Recent development 2020

10. 1. Pre-Independence Period (Before 1963) Health efforts focused on controlling infectious diseases . Health education was minimal and top-down , targeting sanitation and hygiene. Services were managed by colonial public health officers with little community input

11. 2. Post-Independence (1963–1978) Focus shifted to infrastructure development (hospitals and clinics). Health education remained limited and centrally controlled . No formal structure for health promotion yet.

12. 3. Alma-Ata Declaration & PHC Adoption (1978) Kenya adopted the Primary Health Care (PHC) approach. Emphasis on community participation, equity, and prevention . Health promotion began to be seen as essential to public health.

13. 4. Structured Development (1980s–1990s) Establishment of the Health Education Division in the Ministry of Health. Implementation of school health and maternal-child health programs . Influenced by the Ottawa Charter (1986) : focus on empowerment, policy, and community action

14. 5. Strategic Reforms (2000s) Development of health sector strategic plans and Community Health Strategy . Introduction of Community Health Volunteers (CHVs) . Integrated approach to HIV/AIDS, malaria, TB , and health promotion.

15. 6. Devolution and Policy Change (2010s) 2010 Constitution led to devolution of health services to counties. Health promotion became county-led with national oversight. Addressed new priorities: NCDs, adolescent health, mental health .

16. 7. Recent Developments (2020s–Present) COVID-19 response reinforced importance of community health promotion. Integration of digital tools, UHC , and social media campaigns . Focus now includes climate change, lifestyle diseases, and health equity .

17. Ottawa Charter for Health Promotion The Ottawa Charter is a foundational landmark in health promotion theory and practice. Adopted in 1986 , it laid out key action areas and strategies to guide health promotion globally

18. Action Areas (Five Core Strategies) Key action area according to the Charter: Build Healthy Public Policy Health and non‐health sectors create policies that promote health (e.g. taxation, regulation, legislation) because healthy living should be supported by structural policy. Create Supportive Environments Environments (social, physical, economic) should enable health—safe, clean, accessible, enabling healthy choice.

19. Strengthen Community Action Communities should be empowered to participate in health decisions, planning and implementation. Develop Personal Skills Providing information, education, life skills so individuals can make healthy choices. Reorient Health Services Shift from only treating illness to also promoting health and prevention, integrating promotion into health care

20. Strategies (Modes of Action) The Charter also outlines three broad strategies: Advocate — making political, economic, social, cultural, environmental, behavioral conditions favorable to health. Enable — reducing differences (inequities), allowing people to achieve full health potential. Mediate — coordinating efforts of sectors (health, education, media, industry, etc.) to reconcile differing interests in promoting health.

21. 5. Principles of Health Promotion Principles are guiding values or rules that help shape how health promotion is done.

22. Empowerment / Participation People and communities must be involved in decision making about their health. Health promotion is not top-down instruction. Emphasis on the role of health education specialists to engage communities, and the importance of participatory needs assessment. Valuing lay perspectives and enabling people to take control over determinants. Stresses community mobilization, participatory planning in nursing and public health

23. Equity / Social Justice Reducing health inequalities, promoting fairness in health opportunities. Naidoo & Wills make inequalities, social determinants, and justice central to theory and practice. Cottrell includes ethics and the role of the profession in addressing disparities. In community nursing, Basavanthappa foregrounds caring for underserved, marginalized populations.

24. Holism / Multi‐ dimensional / Intersectoral Action health is influenced by many interlinked determinants; promotion must work across sectors (education, housing, transport, environment). Naidoo & Wills discuss political, social, environmental determinants and the need for intersectoral collaboration. Cottrell frames health education within settings and systems, beyond individual behavior. Sharma’s theories often consider broader social influences, and in planning models he includes organizational and environmental levels.

25. Sustainability Interventions should be sustainable in terms of resources, community ownership, institutionalization. Naidoo & Wills discuss embedding health promotion in settings, evaluating over long term. Cottrell includes future trends, roles of institutions in sustaining promotion. In nursing/community practice, Basavanthappa encourages building local capacity, systems that endure.

26. Evidence‐based / Theory‐based Interventions should rest on sound theory, empirical evidence, and be evaluated. Sharma’s text explicitly supplies theories and links them to practice, planning and evaluation. Cottrell gives strong grounding in theory, research, evaluation as part of the health education specialist’s work. Naidoo & Wills integrate evidence-based practice and encourage reflective practice.

27. Ethics and Respect for Autonomy Respect for individuals’ rights, informed choice, confidentiality, avoiding coercion. Cottrell has a chapter on ethics and professional responsibility. Naidoo & Wills weave ethical/political reflection throughout the discussion of promotion. In nursing practice, Basavanthappa emphasizes cultural sensitivity, rights, dignity.

28. Multi‐strategy / Multi‐level Action Use a combination of strategies (education, regulation, environment, communication, policy) across levels (individual, interpersonal, community, policy). Naidoo & Wills discuss strategy categories, their challenges, and how combining strategies is more effective. Sharma describes theories and implementation models (e.g. diffusion, social marketing) that inherently combine strategies. Cottrell outlines levels of prevention and multiple intervention arenas.

29. Contextual Relevance / Adaptability Interventions must fit the local culture, context, resources, needs. There's no one-size-fits-all. Naidoo & Wills encourage practitioners to reflect on local contexts, power relations, ethics. In community nursing, Basavanthappa emphasizes adapting health promotion to life span, local culture, resources. These principles help ensure that promotion is thoughtful, just, and effective rather than one-off projects or “health propaganda.”

30. Approaches to Health Promotion Approaches reflect how one intervenes; some common ones include: Behavior change approach Focus on influencing individual behavior (knowledge, attitudes, beliefs). Traditional approach, often seen in early health education efforts. Preventive medical approach Using screening, immunization, clinical services to prevent disease (though this is more “prevention” than “promotion,” but there is overlap).

31. Empowerment / participatory approach Emphasizes enabling people to gain control, process-oriented, community-led initiatives. Social change / structural approach Seeks to change social, economic, political structures that determine health (e.g. policy, regulation, redistribution).

32. Ecological / systems approach Recognizes multiple levels (individual, interpersonal, organizational, community, policy) interacting. Interventions work across these levels.

33. Relationship Between Health Promotion and Disease Prevention While health promotion and disease prevention are related, they are distinct concepts and practice domains. Understanding their relationship helps clarify how they complement each other Disease Prevention is traditionally focused on preventing onset, progression, or recurrence of disease (primary, secondary, tertiary prevention). Primary prevention — actions taken to prevent disease before it occurs (e.g. vaccination, health education, environmental control). Secondary prevention — early detection, screening, prompt treatment to reduce severity. Tertiary prevention — reducing disability, improving quality of life after disease occurrence.

34. Health Promotion has a broader mandate: Improving health (not just preventing disease), focusing on determinants, enhancing positive health, empowering communities, creating healthy environments Many primary prevention activities (e.g. immunization, healthy diet advice) are also health promotion activities. Disease prevention often focuses on specific risks or pathogens , while health promotion is more holistic, addressing upstream factors.

35. Prevention is often narrower, more biomedical/clinical, while promotion is broader, social, political, and environmental. Prevention may rely more on medical or clinical tools; promotion more on education, policy, structural change, empowerment

36. Individual and group methods of health promotion Health promotion is more than health education: It involves enabling people to increase control over their health, addressing determinants (social, environmental) and not just individual behaviour . The choice of methods reflects philosophical or political stances (e.g. paternalistic, participatory, structural) and has ethical implication. Behavior-change models, empowerment models, social-ecological models, and community participation theories all influence which methods are effective.

37. Individual Health promotion methods These are one‑on‑one or personalized strategies where the health promoter (nurse, educator, counselor) interacts directly with the individual (or sometimes a family) to influence their health knowledge, attitudes, skills or behaviors. They tend to operate on the assumption that individuals have agency and can change with guidance/support. They are often used in secondary or tertiary prevention contexts (e.g. counseling a smoker, managing chronic disease) but can also support primary

38. Methods of individual health promotion 1. Health Education / Counseling Delivered in clinical or community settings by nurses, health educators, or clinicians. Involves giving information, clarifying misconceptions, and enhancing knowledge. Can be verbal, written, or multimedia-based. Topics such as diet, exercise, medication use, disease prevention, reproductive health are commonly tacked.

39. 2. Motivational Interviewing (MI) A client-centered, directive counseling technique. Focuses on helping individuals explore and resolve ambivalence toward behavior change. Builds intrinsic motivation, respects autonomy, and avoids confrontation. Phases: engaging, focusing, evoking, and planning. Example: Helping a smoker decide whether to quit based on personal goals.

40. 3. Goal Setting and Action Planning Collaborative process to define SMART goals (Specific, Measurable, Achievable, Relevant, Time-bound). Followed by creating a practical, personalized plan of action. Enhances self-efficacy by breaking down large goals into achievable steps. Example: Planning a walking schedule for someone with sedentary lifestyle.

41. 4. Self-Monitoring and Feedback Encouraging individuals to track their own health behavior or physiological markers. Often involves using diaries, apps, logs, or wearable devices. Facilitators (nurses, educators) review progress and give constructive feedback. Example: Monitoring blood sugar or food intake in diabetic patients.

42. 5. Personalized Risk Communication Presenting individual health risks using tools like BMI, cardiovascular risk calculators, or genetic screenings. Makes abstract health risks more tangible and relevant. Tailored to health literacy level and cultural context.

43. 6. Reminder Systems and Follow-ups Use of SMS, emails, calls, or appointments to reinforce behavior change or medication adherence. Can be automated or personally delivered. Enhances continuity of care and supports long-term behavior change. Example: Immunization appointment reminders or medication refill alerts.

44. 7. Health Coaching Ongoing, supportive, often holistic guidance to empower individuals in setting and reaching health goals. Combines education, motivation, and accountability. Coaches may use behavior change theories to guide intervention.

45. 8. Behavioral Contracts Formal or informal agreement between individual and educator on behavioral targets and commitments. Enhances accountability and commitment. Often used in smoking cessation, weight loss, or exercise programs.

46. Advantages of Individual Methods Highly personalized: tailored to individual’s stage of change, beliefs, and barriers. Builds trust and therapeutic alliance. Allows for in-depth exploration of health issues. Suitable for complex or sensitive topics (e.g., mental health, addiction).

47. Limitations of Individual Methods Resource-intensive (time, personnel, cost). Less scalable—difficult to reach large populations. May place undue focus on individual responsibility, neglecting social/structural factors. Requires skilled, empathetic communicators.

48. Group method of health promotion Group-based methods use shared experiences, social learning, and collective support to educate and empower multiple individuals simultaneously. 1. Group Education Sessions / Health Talks Organized educational events covering general or targeted health topics. Often didactic but can include Q&A and discussion. Can occur in schools, workplaces, clinics, or communities. Topics: Nutrition, hygiene, sexual health, chronic disease management.

49. 2. Workshops and Seminars More interactive than lectures—includes exercises, role-play, and group tasks. Used to teach practical skills (e.g., CPR, stress management). Encourages participation and peer interaction. 3. Peer Education Programs Training peers (e.g., students, community members) to educate and influence their networks. Utilizes existing trust, shared language, and social norms. Often used in HIV/AIDS education, reproductive health, youth programs.

50. 4. Support Groups Regular meetings for individuals with shared experiences (e.g., living with diabetes, cancer recovery). Focuses on emotional, informational, and motivational support. Builds social connectedness and reduces isolation. 5. Group Discussions / Focus Groups Facilitated discussions to explore beliefs, perceptions, and collective problem-solving. Useful for assessing community needs or generating solutions. Encourages mutual understanding and reflection.

51. 6. Role Plays and Simulations Participants act out real-life scenarios to practice communication or decision-making. Builds confidence and prepares individuals for real situations. Common in sexual health, substance refusal skills, first aid.

52. 7. Community Action / Empowerment Groups Groups formed around shared health concerns or goals (e.g., sanitation, food security). Engage in advocacy, community mapping, or health campaigns. Encourages ownership, capacity building, and leadership.

53. 8. Campaigns and Health Fairs (with group components) Public events combining education, screening, and entertainment. Group activities like quizzes, games, public demonstrations, and performances. Involve local leaders, NGOs, schools, and media.

54. 09. Support Groups / Self-Help Groups Bring together individuals with shared challenges (e.g., diabetes, addiction, cancer recovery). Provide psychosocial support, behavior reinforcement, and coping strategies. Often peer-led, with a facilitator guiding the discussion.

55. 10. Men’s Groups Engage men in health topics often considered taboo (mental health, reproductive health, substance use). Helps change community gender norms, improve male participation in family health. 11. Women’s Groups / Mother’s Clubs Provide health education and empowerment to women in a safe and familiar environment. Topics: maternal health, child care, nutrition, family planning, gender-based violence. Can evolve into advocacy or microfinance groups. Supported by Naidoo and Basavanthappa for community empowerment.

56. 12. Youth Clubs / School-Based Health Education School or community-based groups engaging young people in health promotion. Combines games, sports, drama, and peer discussion. Topics: HIV, puberty, nutrition, self-esteem, substance abuse. Encourages leadership and healthy peer modeling.

57. 13. Clubs and Thematic Groups Examples: Environmental clubs, safe motherhood clubs, sports clubs promoting physical activity. Use shared interest as a platform to deliver health messages.

58. 14. Peer-led Community Groups Informal or formal groups led by community members (e.g., mothers’ clubs, youth clubs). Focus on shared learning, mutual support, and local leadership. Example: Breastfeeding support groups led by experienced mothers.

59. Advantages of Group Methods Cost-effective—reaches many people at once. Promotes social support, shared problem-solving Peer support and shared experience enhance learning and motivation. Encourages community ownership and action. Culturally adaptable using songs, role plays, and local media. Enables health promoters to reach marginalized groups (women, youth, rural poor).

60. Limitations of Group Methods Requires skilled facilitation to manage diverse participants. Less individualized — may not address personal barriers. Potential for dominance by some members or low participation. Cultural sensitivity must be considered (e.g., mixing genders or age groups).

61. Community Dialogue (CD) A structured, participatory process of two‑way communication among community members and stakeholders to discuss issues, share experiences, reflect on local realities, and plan collective action. It is distinct from one‑way health messaging or lectures. It builds mutual understanding and consensus. Critical reflection, questioning of assumptions, and engaging participants as active agents rather than passive recipients.

62. Objectives of Organizing Community Dialogue To increase knowledge and awareness About disease, health services, risks, and prevention methods. To Shift practices / norms : Modifications in hygiene practices, uptake of bednets , better care seeking from trained community health workers rather than traditional healers. To Strengthen health systems accountability : Monitor health service provision, helping communities hold health workers or administrators accountable.

63. For Improved utilization of health services: T hrough trust building, clarifying service availability, demystifying how to access services, reducing myths . To strengthen Collective action / problem solving : communities decide jointly on what actions to take (e.g. building latrines, cleaning public water sources, managing waste). For Cost‑effectiveness and sustainability : Studies show integration of dialogues into existing health facility or outreach activities allows implementation with minimal extra cost, hence more sustainable.

64. 3. Principles & Concepts To operate well, community dialogues rest on several concepts & principles examples: Mutual Respect & Safe Space : ensuring participants feel safe to speak, even when views are controversial or counter to local norms. Example: dialogues where elderly, youth or women share even if they normally do not. Equality of Voice : no dominance by powerful people; marginalized or less literate voices must be heard. Sometimes this involves using small groups, or breaking up into circles. Transparency & Clarity : the purpose, process, what will be done with outcomes must be clearly explained. Setting ground rules.

65. Cultural Sensitivity & Local Relevance: use local language, local examples; respect beliefs (even if they conflict with biomedical models), potentially integrating local health beliefs into dialogue. Facilitative Moderation: Facilitators guide, not lecture. Ask probing questions, let people reflect, draw out from the group rather than telling. Action, Orientation Follow‑Up: Dialogues should end with decisions, commitments and mechanisms for follow‑up to avoid talk without change.

66. Adaptability / Flexibility: Adjusting to local context, resources, timing; willingness to adapt protocols if needed. Sustainability / Institutionalization: Embedding dialogues into the routine system so community dialogues become a regular part of health planning or program cycles. Sustainability / Institutionalization : embedding dialogues into the routine system so community dialogues become a regular part of health planning or program cycles.

67. Inclusive & Representative : Must ensure representation of different ages, genders, socio‑economic status, minorities, people with disabilities. Participatory Tools : Use of visuals (flipcharts, drawings), mapping, ranking‑exercises, problem trees, storytelling, role plays. These help when literacy is low. Repeated / Regular Sessions : Dialogues repeated (quarterly or some periodic schedule) help reinforce learning, monitor commitments, adapt. One‑off dialogues are limited.

68. Local Facilitation : Use community health workers, community leaders, or trained community volunteers rather than always external facilitators. Builds ownership. Linkage to health services : presence or accessibility of health services matters; if services are promised but not delivered, trust may erode. CD tends to work better when health workers are involved or health system communicates back.

69. Needs / Context Assessment Collect baseline data: e.g. morbidity/mortality, service gaps, beliefs, practices Understand community power structures, local leadership, existing meeting forums Identify relevant topics from community input rather than top down Stakeholder Mapping & Planning Who needs to be involved: community leaders, women’s groups, youth, religious leaders, health facility staff Gatekeeper engagement for buy‑in Logistics: venue, time, participant convenience, refreshments, transport Training / Capacity Building Training facilitators in dialogue skills, participatory tools, simple monitoring Emergency plans (if issues that require referral)

70. Mobilization & Invitation To reach out through local networks, announcements, religious places, gatherings, door‑to‑door Ensuring marginalized voices are invited Session Facilitation Opening: introductions, ground rules, icebreakers Framing the issues: what are we discussing and why Elicitation of problems: encourage sharing and listening Reflection: discuss causes, barriers, root causes, perceptions

71. Generating Solutions & Action Plan Brainstorming, ranking, feasibility discussions Defining roles, resources, timelines Commitments / Agreements Community contracts or pledges Maybe public commitment to increase accountability Evaluation / Monitoring / Feedback Checking if action points are being implemented Getting feedback from community what works, what doesn’t Using indicators (attendance, satisfaction, changes in behavior or service use)

72. Scaling & Institutionalization Integrating CD into existing health outreach or facility planning Budget allocation, scheduling in health calendar Ensuring facilitators have ongoing support and refresher training

73. Community Dialogue Benefits 1. Enhanced knowledge & awareness: communities learn more accurate information about diseases, prevention, services. 2. Helps correct myths . Example: CD in child health raised awareness of pneumonia, malaria, diarrhoea in the African country settings. 3. Behavior change: improved hygiene, increased uptake of services, earlier care seeking. The Uganda primary care CD study found increased attendances and better continuity of care. 4. Better health service responsiveness: health workers become more aware of barriers from the community side, which can drive modifications in service delivery. 5. Community empowerment: communities feel more in control; increased sense of self‑efficacy.

74. 6. Social cohesion and trust: working together fosters mutual understanding, breaking down barriers, reducing mistrust. 7. Low cost & sustainability: when dialogues are embedded into routine work, incremental cost is small. 8. Identification of underlying system problems & policy gaps : which may require higher‑level action.

75. Challenges & Limitations (important to note): Sometimes participation is uneven; certain groups (youth, disabled, women) may be excluded or passive. Eg. older people or physically disabled missed in some countries. Facilitators may lack technical knowledge to answer all questions, which can reduce credibility. Resource constraints (time, transport, incentives) can hamper consistency. If health services promised or expected are not available, trust may be eroded.

76. Challenges & Limitations Sometimes participation is uneven; certain groups (youth, disabled, women) may be excluded or passive. Eg. older people or physically disabled missed in some countries. Facilitators may lack technical knowledge to answer all questions, which can reduce credibility. Resource constraints (time, transport, incentives) can hamper consistency. If health services promised or expected are not available, trust may be eroded.

77. Steps for conducting community dialogue 1. Assess the Community Understand the health issues, beliefs, and cultural context. Identify target groups and community dynamics. 2. Engage Stakeholders Involve community leaders, health workers, and key influencers. Build trust and get buy-in for the dialogue process.

78. 3. Plan and Prepare Set clear objectives and choose relevant topics. Organize logistics: venue, time, materials, and facilitators. Ensure inclusion of all groups (women, youth, elderly, disabled). 4. Mobilize and Invite Publicize the event using local networks (churches, schools, radio). Encourage broad participation, especially from marginalized groups

79. 5. Facilitate the Dialogue Create a safe space with ground rules and respect for all. Guide open discussion using participatory tools (storytelling, role-play). Identify problems, explore solutions, and build consensus. 6. Plan Action and Follow-Up Agree on action steps, responsibilities, and timelines. Monitor progress, provide feedback, and schedule future sessions.