LESSON 4:

HEALTH
PROMOTION &
DISEASE
PREVENTION
Group 1 of BSN 2M
HEALTH PROMOTION VS.
HEALTH PROTECTION
Health Promotion
Any combination of health education and
related organizational, economic, and
environmental supports for behavior of
individual, groups or communities conducive to
health (Green and Kreuter, 1991)
Behavior that is motivated by the desire to
increase wellbeing and to reach the best
possible health potential (Parse, 1990)
HEALTH PROMOTION VS.
HEALTH PROTECTION
Health Protection
Behaviors in which one engages with the
specific intent to prevent disease, detect
disease in the early stages or to maximize
health within constraints of disease (Parse, 1990)
It is concerned with preventing the spread of
communicable diseases by establishing
minimum standards, often in the form of
regulations.
 HEALTH PROMOTION
Health promotion addresses large-scale public health concerns,
beginning with the well-being of each individual.
Health promotion activities are those that seek to modify the behavior
of individuals by improving the choices that affect society at large.
The goal is to decrease the risk of illness or disease and improve
overall health.
Many of the initiatives that fall under the umbrella of health promotion
are educational in nature.
A popular example of successful health promotion is the warning label
that now exists on cigarettes.
 HEALTH PROMOTION
Health Promotion emphasis in the Western Pacific Regions are on:

Strengthening health promotion capacity (financing and

infrastructure)

Promoting urban health (including healthy cities and health equity

through Urban HEART)

Building other healthy settings (including schools and workplaces)

and healthy islands

Developing health literacy.

 THE OTTAWA
CHARTER FOR HEALTH
PROMOTION
Organized by the World Health Organization
(WHO), the 1st International Conference on
Health Promotion was held at Ottawa,
Canada on November 17-21, 1986. It calls for
a commitment to health promotion to achieve
the goal of Health for All by the year 2000
and beyond.
 THE OTTAWA CHARTER
FOR HEALTH PROMOTION

This conference was primarily a response to growing expectations

for a new public health movement around the world.

Discussions focused on the needs in industrialized countries, but

took into account similar concerns in all other regions.

It built on the progress made through the Declaration on Primary

Health Care at Alma-Ata, the World Health Organization's Targets for
Health for All document, and the recent debate at the World Health
Assembly on intersectoral action for health.
 THE OTTAWA CHARTER
FOR HEALTH PROMOTION

Health is, therefore, seen as a resource for everyday life, not the objective
of living.

Health is a positive concept emphasizing social and personal resources,

as well as physical capacities.

Therefore, health promotion is not just the responsibility of the health

sector, but goes beyond healthy life-styles to well-being.
 THE 3 BASIC STRATEGIES
FOR HEALTH PROMOTION

1. Advocacy for Health

Good health is a major resource for social, economic and personal
development and an important dimension of quality of life.
Political, economic, social, cultural, environmental, behavioral and
biological factors can all favor health or be harmful to it.
Health promotion action aims at making these conditions
favorable through advocacy for health.
2. Enabling all people to attain their full health potential
Health promotion focuses on achieving equity in health.
Health promotion action aims at reducing differences in current health
status and ensuring equal opportunities and resources to enable all
people to achieve their fullest health potential.

This includes:
A secure foundation in a supportive environment,
Access to information, life skills and opportunities for making healthy
choices.
People cannot achieve their fullest health potential unless they are able to
take control of those things which determine their health.
This must apply equally to women and men.
3. Mediate
Mediating among the different sectors of the society in
efforts to achieve health.
The prerequisites and prospects for health cannot be
ensured by the health sector alone.
More importantly, health promotion demands coordinated
action by all concerned by:
1. Governments
2. health and other social and economic sectors
3. Non-governmental and voluntary organization
4. Local authorities
5. Industry
6. The media
3. Mediate
People in all walks of life are involved as individuals, families and
communities.
Professional and social groups and health personnel have a
major responsibility to mediate between differing interests in
society for the pursuit of health.
Health promotion strategies and programmes should be
adapted to the local needs and possibilities of individual
countries and regions to take into account differing social,
cultural and economic systems.
 5 PRIORITY ACTION AREAS PROVIDE
SUPPORT TO THESE 3 STRATEGIES
HEALTH PROMOTION ACTION MEANS:
1. BUILD HEALTHY PUBLIC POLICY
Health promotion goes beyond health
It puts health on the agenda of policy makers in all sectors and at all
levels, directing them to be aware of the health consequences of their
decisions and to accept their responsibilities for health
.
Health promotion policy combines diverse but complementary
approaches like legislation, fiscal measures, taxation and
organizational change.
 5 PRIORITY ACTION AREAS PROVIDE
SUPPORT TO THESE 3 STRATEGIES
2. CREATE SUPPORTIVE ENVIRONMENTS

The conservation of natural resources throughout the world should be

emphasized as a global responsibility
Work and lesire should be a source of health for people
the way society organizes work should help create a healthy society.
changing patterns of life, work and leisure have a significant impact on
health.
2. CREATE SUPPORTIVE ENVIRONMENTS

Generates living and working conditions that are safe, stimulating,

satisfying, and enjoyable.

The protection of natural and built environments and the conservation

of natural resources must be addressed in any health promotion
strategy.

Systematic assessment of the health impact of a rapidly changing

environment - particularly in areas of techonolgy work, energy
production and urbanization - is essential and must be followed by
action to ensure positive benefit to the health of the public.
 5 PRIORITY ACTION AREAS PROVIDE
SUPPORT TO THESE 3 STRATEGIES

3. STRENGTHEN COMMUNITY ACTIONS

Health promotion works thorugh concrete and effective community
action in setting priorities, making decisions, planning strategies and
implementing them to achieve better health.
This requires full and continuous access to information, learning
opportunities for health, as well as funding support.
.
At the heart of this process is the empowerment of communities.
 5 PRIORITY ACTION AREAS PROVIDE
SUPPORT TOTHESE3 STRATEGIES
4. DEVELOP PERSONAL SKILLS
Health promotion supports personal and social development through
providing information, education for health, and enhancing life skills.

It increases the options available to people to exercise more control

over their own health and over their environments and to make choices
conducive to health

Action is required through educational, professional, commercial and

voluntary bodies, and within the institutions themselves.
 5 PRIORITY ACTION AREAS PROVIDE
SUPPORT TO THESE 3 STRATEGIES

5. REORIENT HEALTH SERVICES

The responsibility for health promotion in health services is shared
among individuals, community groups, health professionals, health
service institutions and governments. They must work together towards
a health care system which contributes to the pursuit of health.
The role of the health sector must move increasingly in a health
promotion direction, beyond its responsibility for providing clinical and
curative services.
5. REORIENT HEALTH SERVICES

Health services need to embrace an expanded mandate which is

sensitive and respects cultural needs. This mandate should support
the needs of individuals and communities for a healthier life, and open
channels between the health sector and broader social, political,
economic and physical environmental components.

Reorienting health services also requires stronger attention to health

research as well as changes in professional education and training.
 5 PRIORITY ACTION AREAS PROVIDE
SUPPORT TO THESE 3 STRATEGIES

MOVING INTO THE FUTURE

Health is created and lived by people within the settings of thei
everyday life; where they learn, work, play and love.
Health is created by caring for oneself and others, by being able to
take decisions and have control over one’s life circumstances, and by
ensuring that the society one lives in, created conditions that allow the
attainment of health by all its members.
Caring, holism and ecology are essential issues in developing
strategies for health promotion.
 PREREQUISITES FOR HEALTH
THE FUNDAMENTAL CONDITIONS AND
RESOURCES FOR HEALTH

1. Peace
2. Shelter
3. Education
4. Food
5. Income
6. A stable eco-system
7. Sustainable resources
8. Social justice, and equity
 THEORIES OF HEALTH
PROMOTION
Health promotion is the process of encouraging people to make healthy
choices and motivating them to be consistent with their intentions based on
theories related to human behavior,
The 5 Approaches to Health Promotion :

1. HEALTH PROMOTION MODEL (HM)

Pender's Health Promotion Model
is based on the idea that people's experiences affect their health
outcomes.Health promotion models are focused on exploring
people's attitudes about health and individual experiences related
to it.
The 5 Approaches to Health Promotion :

1. HEALTH PROMOTION MODEL (HM)

Pender's Health Promotion Model
According to the theory, to understand most of their health-related decisions,
one would have to look at people's:
Lifestyles
psychological health
social and cultural environment.

For example, not eating fresh vegetables because one grew up not
consuming produce is a way of understanding why someone may suffer from
a severe condition like obesity.
HEALTH
PROMOTION
MODEL
 HEALTH PROMOTION MODEL

The model explores many biopsychosocial factors that influence

individuals to pursue health promotion activities.

The model depicts complex multidimensional factors which people

interact with as they work to achieve optimum health.
The 5 Approaches to Health Promotion :

2. HEALTH BELIEF MODEL (HBM)

The Health Belief Model theory suggests that a person's belief of a
diagnosed illness combined with their view of a treatment's effectiveness
predicts their likelihood of adopting a change.

•If someone suffers from an illness that is hard to diagnose, they might find it
harder to prioritize treatment for the cause.
•Based on this idea, health practitioners might take immediate action of
telling someone that they're either susceptible or have a serious medical
condition.
• Moreover, they might expect a person to question the medical approach if
they don't feel the symptoms and show apprehension toward medical
advice.
Six Health Belief
Model Concepts
 SIX HEALTH BELIEF
MODEL CONCEPTS
1. PERCEIVED SUSCEPTIBILITY

Perceived susceptibility refers to a person’s belief about their chances of

getting a certain condition.
For a person to take action, they must believe they are at risk for
disease, illness or negative health outcome. When people blieve they are
at risk for disease, they will be more likely to do something to prevent it
from happening.
 SIX HEALTH BELIEF MODEL
CONCEPTS
2.PERCEIVED SEVERITY
Refers to a person’s belief about the seriousness or severity of a disease.
Severity can be based on medical consequences, like death or disability,
or personal beliefs about how the condition or disease would affect their
life.
For example, despite public health recommendations, some people do
not get the flu vaccine. They probably know they can get the flu, but may
believe that getting the flu will not be serious.
Perceived severity might also be heightened among those self-employed
because missing a week of work means reduced income.
When perceived susceptibility and severity are heightened, people are
more likely to take action.
 SIX HEALTH BELIEF MODEL
CONCEPTS
3. PERCEIVED BENEFITS

Refer to a person’s opinion of the value or usefulness of a new behavior in

lowering the risk of disease.
To make a change, people must believe that the change will have a positive
result

For example:
People with diabetes take medication believing it will work to control blood
sugar.
People quit smoking because they believe it will improve their health.
4. PERCEIVED BARRIERS
The most significant factor in determining behavior change.
Perceived barriers are a person’s view of the obstacles that stand in
the way of behavior change.
If barriers are stronger than benefits, change will not occur
Barriers can be tangible or intangible.

Tangible barriers
lack of financial resources, lack of transportation, childcare needs,
etc.
Intangible barriers
psychological, like fear of pain, embarrassment or inconvenience.
5. CUES TO ACTION

Are events, people, or things that trigger people to change behavior.

Advice from others, the illness of a family member or social media can
provide cues.
Posters in public restrooms offer hand washing cues. Highway signs to
“buckle up” provide cues to action.
Calendar reminders and mobile device alarms can also trigger action.
Cues can also be internal, such as chest pain, discomfort or fatigue fear
of pain, embarrassment or inconvenience
6. SELF-EFFICACY

Is a person’s confidence and belief in ability to take action or perform a

given behavior.
People generally do not try to adopt new behaviors unless they believe
they can do them.
A person who thinks altering their behavior is worthwhile (perceived
benefit) but is unsure of their ability to make a change is unlikely to
attempt lifestyle changes.

Self-efficacy can be increased with encouragement, training and other

support.
The 5 Approaches to Health Promotion :

3. TRANSTHEORETICAL MODEL (TTM)

Sometimes when a healthcare professional informs a patient about a
potential medical condition and educates themabout preventive
measures, the person may believe them but avoid immediate action.

This choice is based on the idea that whensomeone receives

information about their health, they might think about it before actingon
it.
 3. TRANSTHEORETICAL MODEL (TTM)
Because of such behavior, the transtheoretical theory outlines six stages that
someone might go through:
1.Pre-contemplation: the patient does not intend to act yet despite knowing
about the medical condition.
2.Contemplation: the patient is planning to act with intention.
3.Preparation: the patient establishes a course of action and sets a timed
objective.
4. Action: the patient takes the course of action.
5. Maintenance: the patient focuses on not relapsing and maintaining a plan
within their daily routines.
6. Termination: the patient is actively healthy and no longer interested in
returning to old behaviors.
3. TRANSTHEORETICAL MODEL (TTM)
The 5 Approaches to Health Promotion :

4. THEORY OF REASONED ACTION (TRA)

Although it’s not a model, this theory is highly credited under the HBM
and is considered separate.
The theory assumes that a person will act a certain way on a health
issue depending on their willingness due to subjective norms.
The norms are usually the result of social and environmental
surroundings and the person’s perceived control over that behavior.
4. THEORY OF REASONED ACTION (TRA)
For example, a healthcare professional might ask a young man if his close
circle of friends thinks he should incorporate exercise in to their daily
routine.
In a medical study done by the Iran University of Medical Sciences,
researchers used TRA to evaluate the effectiveness of an educational
intervention dealing with breakfast consumption amongst children and
adolescents.
4. THEORY OF REASONED ACTION (TRA)
The 5 Approaches to Health Promotion :

5. DIFFUSION OF INNOVATION THEORY (DOI)

Diffusion of Innovation (DOI) is another theory that falls under community
and organization participation models.
The theory investigates how a new idea or health behavior is
disseminated in a social structure or community and identifies what
influences how quickly the idea or behavior is adopted.
The adoption of new ideas depends on the type of innovation,
communication channels, time and social system.
According to the Health Communication Capacity Collaborative, the DOI
model “highlights the uncertainties associated with new behaviors and
helps public health program implementers consider ways to resolve
these uncertainties.”
5. DIFFUSION OF INNOVATION THEORY (DOI)
“PREVENTITIVE
APPROACH TO
HEALTH ”
 3 LEVELS OF PREVENTION
1.) Primary Prevention
Relates to activities directed at preventing a problem before it occurs by altering
susceptibility or reducing exposure for susceptible individuals.

2.) Secondary Prevention

Early detection and prompt intervention during the period of early disease pathogenesis;
implemented after a problem has begun but before signs and symptoms appear and targets
populations who have risk factors

3.) Tertiary Prevention

Targets populations that have experienced disease or injury and focuses on limitations of
disability and rehabilitation. It aims to reduce the effects of disease and injury and to restore
individuals to their optimum level of functioning.
 3 LEVELS OF PREVENTION
1.) Primary Prevention
In primary prevention, a disorder is actually prevented from developing.

Types of primary prevention include the following:

Vaccinations
Counseling to change high-risk behavior
Sometimes chemoprevention
 3 LEVELS OF PREVENTION
2.) Secondary Prevention
In secondary prevention, disease is detected and treated early, often before symptoms are
present, thus minimizing serious consequences.
Types of secondary prevention include the following:
Screening programs, such as mammography to detect breast cancer and dual x-ray
absorptiometry (DXA) to detect osteoporosis.
Tracking down the sex partners of a person diagnosed with a sexually transmitted infection
(contact tracing) and, if necessary, treating these people to minimize spread of the disease.
 3 LEVELS OF PREVENTION
3.) Tertiary Prevention

In tertiary prevention, an existing, usually chronic disease is managed to prevent complications or

further damage.
Types of tertiary prevention include the following:
For people with diabetes: Control of blood sugar, excellent skin care, frequent examination of
the feet, and frequent exercise to prevent heart and blood vessel disorders
For people who have had a stroke: Taking aspirin to prevent a second stroke from occurring
Providing supportive and rehabilitative services to prevent deterioration and maximize quality
of life, such as rehabilitation from injuries, heart attack, or stroke
Preventing complications in people with disabilities, such as preventing pressure sores in
those confined to bed.
 3 LEVELS OF PREVENTION
It should be noted that while primary prevention activities may be implemented independently
of capacity-building in other health care services, this is not the case for secondary
prevention. Screening and early detection is of limited value (and may even be detrimental to
the patient) if abnormalities cannot be promptly corrected or treated through services from
other parts of the health care system. Moreover, a good system of primary health care with a
registered population facilitates the optimal organization and delivery of accessible
population based screening programs and should be vigorously promoted.
“RISK TO HEALTH
AND HEALTH
PROMOTION
ACTIVITIES”
 STEPS OF RISK ASSESSMENT
Hazard Identification
Risk Description
Exposure Assessment
Risk Estimation

Risk Factor – an exposure that is associated with a disease

3 Criteria for Establishing a Risk Factor

1. The frequency of the disease varies by category or amount of factor.
2. The risk factor must precede the onset of the disease.
3. The association of concern must not be due to any source of error.

Two Types of Risks Factors

➢ Modifiable Risk Factors – individual has some control
➢ Non- Modifiable Risk Factors – little or no control.
▪ (Ex. genetic makeup, gender, age)
HEALTH RISK – The probability that a specific event
will occur in a given time frame.

RISK ASSESSMENT
Conducted to determine health risks to individuals, groups and populations. A
systematic way of distinguishing the risks posed by potentially harmful exposures.
• Risk Reduction – a proactive process in which individuals participate in
behaviors that mitigating potential losses by reducing the likelihood and
severity of possible loss.
enable them to react to actual or potential threats to their health
• Risk Communication – process through which public receives information
regarding possible threats to health.
 To improve the nutritional status
of the population, nutrition and
education is essential.

The “10 NUTRITIONAL GUIDELINES FOR FILIPINOS” were

developed to facilitate the dissemination of simple and
practical messages to encourage healthy diet and lifestyle.
1. Eat variety of foods everyday
2. Breast feed infants exclusively from birth to 4-6 months and give
appropriate foods while
continuing breastfeeding
3. Maintain children’s normal growth through proper diet and monitor their
growth regularly
4. Consume fish, lean meat, poultry or dried beans
5. Eat more vegetables, fruits and root crops
6. Eat foods cooked in edible/cooking oil daily
7. Consume milk and milk products and other calcium rich foods such as
small fish and dark
leafy vegetables everyday
8. Use iodized salt but avoid intake of excessive intake of salty foods
9. Eat clean and safe food
10. For a healthy lifestyle and good nutrition, exercise regularly, do not
smoke and avoid drinking
alcoholic beverages
> Sleep is essential component of chronic disease
prevention and health promotion.
 Sleep Hygiene (National Sleep
Foundation 2010)
1. Avoid caffeine and nicotine close to bedtime
2. Avoid alcohol as it can cause sleep disruptions
3. Retire and get up at the same time everyday
4. Exercise regularly but finish all exercise and vigorous activity at least
3 hours before
bedtime
5. Establish a regular relaxing bedtime routine (a warm bath, reading a
book)
6. Create a dark, quiet, cool sleep environment
7. As much as circumstances allow, have comfortable beddings
8. Use the bed for sleep only. Do not read, listen to music or watch TV
in bed
9. Avoid large meals before bedtime
 Smoking Cessation
is an important step in achieving optimum health.

The American Cancer society recommends the following Steps to

Quit Smoking:

1. Make decision to quit.

2. Set a date to quit and choose a plan
3. Deal with withdrawal through. Avoid temptation
4. Staying off tobacco is a lifelong process. Remind yourself of the
reasons why you quit
 Alcohol Consumption
Health authorities have defined moderation as:
Not more than 2 drinks a day for the average sized man
Not more than 1 drink a day for the average size woman
Heavy Drinking
consuming more than 2 drinks/day on average for men and more
than 1 drink per day for women
Binge drinking
drinking 5 or more drinks on a single occasion for men / 4 or more
drinks on a single occasion for women
Excessive Drinking
can take the form of heavy drinking/ binge drinking/ both.
• Health authorities have defined moderation as:
o Not more than 2 drinks a day for the average sized man
o Not more than 1 drink a day for the average size woman
• Heavy Drinking
o consuming more than 2 drinks/day on average for men and more than 1 drink
per day
for women
• Binge drinking
o drinking 5 or more drinks on a single occasion for men / 4 or more drinks on a
single
occasion for women
• Excessive Drinking
o can take the form of heavy drinking/ binge drinking/ both.
 HEALTH EDUCATION

A process of changing people’s knowledge,

skills and attitudes for health promotion and
risk reduction.

The nurse participates in health education by

empowering people so that they are able to
achieve optimum health and prevent disease
by bringing out lifestyle changes and reducing
exposure to health risk in the environment
BASIC PRINCIPLES THAT GUIDE THE EFFECTIVE NURSE EDUCATOR
(based on Knowles Theory on adult learning)

1. Message
• send a clear/understandable message to the learner.
• Consider factors that may affect learner’s ability to receive and retain info.
2. Format
• strategy must match the objectives
3. Environment
• conducive environment for learning, therapeutic and supportive relationship
with the learner
4. Experience
• organize positive and meaningful learning experience
5. Participation
• engage learner in participatory learning by involving then in the discussion,solicit
feedback
6. Evaluation
• use tools such as quizzes, individual conferences and return demonstration