Health Promotion- Models

A brief description on various models of Health Promotion

1. Models of Health Promotion Col Zulfiquer Ahmed Amin M Phil, MPH, PGD (Health Economics), MBBS Armed Forces Medical Institute (AFMI)

2. ‘Health promotion is the process of enabling people to increase control over, and to improve, their health’ .

3. Model: In science , a model is a representation of an idea, an object or even a process or a system that is used to describe and explain phenomena that cannot be experienced directly .

4. Why we do something, and don’t do the other? Action Behavior Behavior Intention Personal Attitude Subjective Norms Beliefs Direct Observation Information from various sources. e g TV infer basing on information Belief about an object or person Belief about some performing Belief about some performing with knowledge of ‘approval’/ ‘disapproval’ of people, ‘who are important to us’

5. Some Psychological Terms:

6. Affect: Affect is the experience and outward expression of feelings and emotion. Affect can be a tone of voice, a smile, a frown, a laugh, a smirk, a tear, pressed lips, a crinkled forehead, a scrunched nose, furrowed eyebrows, or an eye gaze. We experience affect in the form of mood and emotions . Mood refers to the positive or negative feelings that are in the background of our everyday experiences . Emotions are brief , but often intense, mental and physiological feeling states. In comparison with moods, emotions are shorter lived, stronger, and more specific forms of affect. Emotions are caused by specific events (things that make us, for instance, jealous or angry), and they are accompanied by high levels of arousal. Whereas we experience moods in normal, everyday situations, we experience emotions only when things are out of the ordinary or unusual .

7. C ognition (Thought ): Refers to the mental processes involved in gaining knowledge and comprehension . These processes include thinking, knowing, remembering, judging and problem-solving . These are higher-level functions of the brain and encompass language, imagination, perception, planning, and interpretations of ourselves and other people .

8. Behavioral intention (BI ): Refers to a person's perceived likelihood or "subjective probability that he or she will engage in a given behavior “. Behavior : Refers to observable activity of an organism; anything an organism does that involves action and/or response to stimulation. Human behavior is the term used to describe a person's actions and conduct . Imagine a wrapped present . You can't see what's inside, but there are clues available to you: the size and shape of the package, the sound it makes when you shake it, how heavy it is, even whether it feels solid or soft. You can make an educated guess about what the present is if you observe all of these things. Human behavior is like that. Everything we do and say tells the world about what's going on inside us.

9. Attitude is a settled way of thinking or feeling about someone or something, typically one that is reflected in a person's behavior . In psychology , an attitude refers to a set of emotions, beliefs, and behaviors toward a particular object, person, thing, or event. Attitudes are often the result of experience or upbringing, and they can have a powerful influence over behavior . Subjective Norm : Perceived or subjective norm is "the perceived social pressure to perform or not to perform the behavior" in question. The perceived expectations from others that influence a user to perform a particular behavior

10. Health Promotion Model:

11. Concepts of Health Promotion Model

12. Models of Health Promotion Tannahill (1985) Model of health Promotion Beattie’s (1991) Model of health Promotion Tones and Tilford’s (1994) Model of health Promotion Caplan and Holland (1990) Model of health Promotion

13. Caplan & Holland’s Model Key features: More complex & theoretically driven. Attempts to unpick what determines health and ill-health and therefore what activities can be used to address health issues. One axis refers to a theory of knowledge and how knowledge is generated in relation to health. The other axis refers to how s ociety is constructed and how this impacts on health .

14. MODEL OF HEALTH PROMOTION: FOUR PARADIGMS OF HEALTH PROMOTION (CAPLAN AND HOLLAND - 1990) RADICAL HUMANIST Holistic view of health De-professionalization Self-help networks HUMANIST Holistic view of health Aims to improve understanding and development of self Client-led RADICAL STRUCTURLIST Health reflects structural inequalities Need to challenge inequity and radically transform society. TRADITIONAL Health = absence of disease Aim is to change behaviour Expert-led Radical change Subjective Social regulation Objective Nature of knowledge Nature of society

15. An objective perspective is one that is not influenced by emotions , opinions, or personal feelings - it is a perspective based in fact, in things quantifiable and measurable. A subjective perspective is one open to greater interpretation based on personal feeling , emotion, aesthetics, etc.

16. Radical Humanist Paradigm (subjective- radical change) Theorists in this paradigm are mainly concerned with releasing social constraints that limit human potential . They see the current dominant ideologies as separating people from their "true selves". They use this paradigm to justify desire for revolutionary change , through process of education . Humanism is an approach in study, philosophy, or practice that focuses on human values and concerns . Radical Structurlist : Contemporary society is characterized by fundamental conflicts which generate radical change through political and economic crises .

17. Beattie’s Model Key Features: Examines 2 axis Type of approach used top-down (Authoritarian) or bottom up (Negotiated or owned by the clients) Size of approach Categories 4 types of activities Personal counseling: Working with dietician on food and physical individual personal plans and goals. Health persuasion: Campaign for eating 5 fruits and vegetables a day on TV. Legislative action: Laws that subsidize the price of healthy food stuff Community development: Communities producing and distributing food themselves.

18. MODEL OF HEALTH PROMOTION: HEALTH PROMOTION METHODS USING BEATTIE’S TYPOLOGY (BEATTIE – 1991) Advice Education Behaviour change Mass media campaign Counseling Education Group work Legislation Policy making and implementation Health surveillance Lobbying Action research Skills sharing and training Group work Community development MODE OF INTERVENTION Individual Negotiated Collective Focus of intervention Authoritarian

19. MODEL OF HEALTH PROMOTION: THE CONTRIBUTION OF EDUCATION TO HEALTH PROMOTION (TONES et al – 1990) Healthy public policy Lobbying Advocacy Mediation Public pressure Healthy social and physical environment Healthy promoting organization Professional education Healthy services HEALTH Healthy choices Agenda setting Education for health Critical consciousness raising Empowered participating community

20. The Health Action Model (HAM), developed by Tones, has two main parts: 1. ‘Behavioral Intention’ which is composed of three dimensions (belief, motivation, and normative) and 2. Factors that determine whether an individual's intention leads to action. HAM identifies key psychological, social, and environmental factors which influence an individual adopting and sustaining safe or unsafe related behavior.

21. Normative System - A system based on what is established as the norm. Health Action Model (HAM),

22. Tannahil’s Model Spheres: Health-education: C ommunication to enhance well being and prevent ill health through influencing knowledge and attitude. Prevention: Reducing or avoiding the risk of diseases and ill health primary through medical interventions. Health protection: Safeguarding population health legislative, fiscal or social measures .

23. Dimensions:

24. Example of various dimensions in Tannahill Model

25. MODEL OF HEALTH PROMOTION: A TYPOLOGY OF HEALTH PROMOTION (FRENCH – 1990) DISEASE MANAGEMENT Curative services Management services Caring services DISEASE PREVENTION Preventive services Medical services Behaviour change HEALTH EDUCATION Agenda setting Empowerment and support Information POLITICS OF HEALTH Social action Policy development Economic and fiscal policy

26. Social action means taking steps to change the things that are wrong in our society and introducing new ideas and processes for doing things better in the future . Empowerment: The term empowerment refers to measures designed to increase the degree of autonomy and self-determination in people and in communities in order to enable them to represent their interests in a responsible and self-determined way, acting on their own authority

27. Participation and Empowerment