GLPH271 M05 OL-BL OnQ CompanionGuide

GLPH 271
GLOBAL AND POPULATION HEALTH
MODULE 05
HEALTH PROMOTION AND DISEASE PREVENTION
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MODULE 05 COMPANION GUIDE GLPH 271
TABLE OF CONTENTS
INTRODUCTION ..................................................................................................................................................... 5
A. Health Promotion and Disease Prevention ............................................................................................... 5
B. Dr. Carpenter’s Acknowledgement of Territory ........................................................................................ 6
C. Module Introduction..................................................................................................................................... 8
D. Course Icons .................................................................................................................................................. 9
E. Learning Outcomes.....................................................................................................................................11
F. Module Assignments ..................................................................................................................................12
F.1. Levels of Health Promotion Discussion Board .................................................................................13
F.2. Stages of Prevention Discussion Board.............................................................................................14
F.3. Video: Assessment Part 3 ....................................................................................................................15
G. Module Outline ...........................................................................................................................................16
SECTION 01: An Overview of Disease Prevention............................................................................................17
1.1 Section 01: An Overview of Disease Prevention ....................................................................................17
1.2 A Shift Towards Disease Prevention .......................................................................................................18
1.3 Video: The River Story...............................................................................................................................19
1.4 Disease Prevention ...................................................................................................................................20
1.5 Stages of Prevention .................................................................................................................................22
1.6 Question 1 of 2: Diabetes Prevention.....................................................................................................24
1.7 Question 2 of 2: The River Story ..............................................................................................................25
1.8 Section 01 Summary .................................................................................................................................26
SECTION 02: Health Promotion .........................................................................................................................27
2.1 Section 02: Health Promotion .................................................................................................................27
2.2 Stages of Prevention: Primordial ............................................................................................................28
2.3 Health Promotion......................................................................................................................................29
2.4 The Ottawa Charter of Health Promotion ..............................................................................................31
2.5 Health Promotion and the Social Determinants of Health ..................................................................33
2.6 The Need for Behaviour Change .............................................................................................................34
2.7 Question: Bridging Knowledge to Behaviour Change ..........................................................................35
2.8 Barriers to Changing Health Behaviours ................................................................................................36
2.9 Models of behavioural Change ...............................................................................................................38
2.10 The Health Belief Model .........................................................................................................................39
2.11 The Health Belief Model Break Down...................................................................................................40
GLOBAL AND POPULATION HEALTH | GLPH 271 M05 PAGE 2

2.12 The Transtheoretical Model of Health Behaviour Change .................................................................42
2.13 The Transtheoretical Model...................................................................................................................43
2.14 Question: Stages of Change...................................................................................................................45
2.15 Health Promotion ...................................................................................................................................47
2.15.1 Health Promotion: Individual Level ...............................................................................................48
2.15.2 Health Promotion: Peer or Group Level .......................................................................................49
2.15.3 Health Promotion: Population Level .............................................................................................50
2.16 Need for Indigenous Voices in Health Promotion Strategies ............................................................52
2.17 Video: Combining Traditional and Western Medicine ........................................................................54
2.18 B C Cancer Prince George Centre for the North .................................................................................55
2.19 Amplifying Indigenous Voices in Health Promotion ...........................................................................56
2.20 Indigenous Health Promotion: Suicide Prevention .............................................................................58
2.21 Health Promotion in Practice ................................................................................................................60
2.21.1 Increasing Frequency of Healthy Behaviours...............................................................................61
2.21.2 OMama: Supporting Pregnancy, Birth, & Early Parenting ..........................................................62
2.21.3 Reducing/Eliminating Unhealthy Behaviours ...............................................................................63
2.21.4 Smoking Cessation Interventions ..................................................................................................64
2.22 Health Promotion: Indigenous Considerations ...................................................................................66
2.23 Becoming Tobacco-Wise ........................................................................................................................68
2.24 The Sacred Smoke Program ..................................................................................................................69
2.25 Section 02 Summary ...............................................................................................................................71
SECTION 03: Primary, Secondary, and Tertiary Prevention ...........................................................................72
3.1 Section 03: Primary, Secondary, and Tertiary Prevention....................................................................72
3.2 Stages of Prevention: Primary, Secondary, and Tertiary ......................................................................73
3.3 Question: The Stages of Prevention Continuum ...................................................................................74
3.4 Primary, Secondary, and Tertiary Prevention ........................................................................................75
3.5 Primary Prevention of H P V Related Cancers .......................................................................................77
3.6 Video: Secondary Prevention of Cervical Cancer ..................................................................................78
3.7 Video: Tertiary Prevention for Parkinson's Disease ..............................................................................79
3.8 Activity: Stages of Prevention ..................................................................................................................80
3.9 Examples for Each Stage of Prevention..................................................................................................81
3.10 Question: Select the Proper Strategy ...................................................................................................83
3.11 Section 03 Summary ...............................................................................................................................84

SECTION 04: Developing an Intervention .........................................................................................................85
4.1 Section 04: Developing an Intervention .................................................................................................85
4.2 Health Interventions .................................................................................................................................86
4.3 Developing an Intervention .....................................................................................................................87
4.4 From Theory to Practice ...........................................................................................................................89
4.5 Is There a Quaternary Prevention? .........................................................................................................90
4.6 Community Input in Needs Assessment ................................................................................................91
4.7 Case Study: The Importance of Consultation and Participation .........................................................92
4.8 Question: Proper Consultation and Participation .................................................................................93
4.9 Video: Curating an Intervention ..............................................................................................................94
4.10 Problematic Attitudes When Providing Aid..........................................................................................96
4.11 Video: Fight Malaria or Starve ...............................................................................................................97
4.12 Question: Fight Malaria or Starve .........................................................................................................98
4.13 Section 04 Summary ...............................................................................................................................99
CONCLUSION .................................................................................................................................................... 100
Z Z.1 Module 05 Conclusion ........................................................................................................................ 100
Z Z.2 Module Conclusion ............................................................................................................................. 101
Z Z.3 Credits .................................................................................................................................................. 102
Z Z.4 Module Outline ................................................................................................................................... 103

INTRODUCTION
A. HEALTH PROMOTION AND DISEASE PREVENTION

B. DR. CARPENTER’S ACKNOWLEDGEMENT OF TERRITORY
1 OF 6
My gratitude and connection to the land carries me through each day and nourishes my soul. I
recognize that I am the sum of my experiences and that my relationship to the land is steeped in my
attachment to three locations, and the three Nations who cared for the land before the arrival of my
ancestors and still care for it today.
As far back as I can recall, I remember being drawn to a mound in the woods, near my summer home
which is on traditional St-Lawrence Iroquoian territory. I often found myself sitting or dancing there
and revelling in the strength and delight that it brought me. My moments in that place are my first
memories of truly feeling one with the land. When I think back to those times, I can still reproduce the
overwhelming awe and reverence that I felt to those that walked there before me. I remember the
smell of the forest, the brush of the breeze, and the land, supporting me as I thrived, and giving me
strength on difficult days.
Since that time, the strength provided by land beneath my feet, the nourishment that it provides to my
body and soul, and the freedom I feel from the water of its lakes and rivers, have played an important
role in my personal growth.
More recently, I have been privileged to be welcomed to the territory of the Chagga People, in
Tanzania. This land, on the slopes of Kilimanjaro, and its keepers, have brought me peace and the
energy to advocate for health equity in Tanzania and at home.
Kingston, which is on traditional Anishinaabe and Haudenosaunee territory, has welcomed me,
provided me a home and supported me as I raised my children. The beauty and strength of these
lands can be felt in the trees that stand tall and the waters that glisten in the sun.
I acknowledge colonialism, past and present, and I strive to embrace diversity and act in ways that
promote healing. I recognize the atrocities that were born out of greed and lack of humility and I strive
to enable reconciliation.

The land gives us life. We choose how to live it. I choose to live it in reverence and gratitude to the one
who created all of it, and to those that walked the earth before me, and with me now, with humility,
empathy and gratitude. I commit to doing my best to disrupt and dismantle the colonial structures that
still exist today.
Learn more about usage of land acknowledgements at Queen’s University, and a history of the traditional
Anishinaabe and Haudenosaunee territory.
Land Acknowledgements at Queen’s University
Page Link:
https://www.queensu.ca/indigenous/land-acknowledgement
Reference:
Land Acknowledgement. (n.d.). Retrieved August 25, 2020, from

https://www.queensu.ca/indigenous/land-acknowledgement

C. MODULE INTRODUCTION
2 OF 6
In Module 05 you will learn all about disease prevention and health promotion. The social
determinants of health will be discussed before exploring the stages of disease prevention and the
significance of public policy that promotes and supports healthy living. This module highlights several
models of healthy behavioural change as well as the different levels of health promotion. You will also
learn about public health promotion strategies, and the special considerations to take into account
when working alongside and promoting health in Indigenous communities.
Module 05 will prepare you to complete Assessment Part 03, for which you will design a health
intervention plan for a chosen population.
Read a unique back-story relating to each image.
The cover image, the images on the introduction and conclusion slides, along with numerous images in
the module were taken during
Dr. Carpenter's trips to Tanzania. In a lot of the images, Dr. Carpenter can be seen providing health
services to the people of Tanzania, and interacting with locals and their culture.
Pamoja Staff
Pamoja staff and Canadian health students providing health education to high school students.
Triage
Patients at triage at mobile clinics.

D. COURSE ICONS
3 OF 6
Note that as you navigate this course, you should watch for specific features.
Learn about its function in this course.
Course Toolbox
This icon lives in the sidebar of your module. Clicking it will open the Tools so you can write notes or magnify
your screen. For more information, visit the Module F A Q.
References
This icon lives in the sidebar of the slide. Clicking it will reveal the references for content and/or images on
the slide.
Listen Up!
Clicking this icon will allow you to hear audio clips from subject matter experts. Captions will appear on the
slide.
Additional Sources
This icon lives in the sidebar. When clicked, it will reveal additional sources provided to supplement your
learning
Equation
Clicking this icon will reveal relevant equations.
Definitions
When you see a word that is bold and coloured orange, hover over it to reveal a definition.

When you see a word that is bold and coloured blue, hover over it to reveal a definition or example related
to Indigenous Peoples in Canada.

E. LEARNING OUTCOMES
4 OF 6
After successful complete of this module, students will be able to:
• Discuss an existing health intervention and describe its level of prevention (primordial, primary,
secondary, or tertiary).
• Understand that effective health promotion strategies address social determinants of health.
• Discuss an existing health promotion program and describe its level of promotion (individual, peer
or group, population-based).

F. MODULE ASSIGNMENTS
5 OF 6
Activities throughout the module:
Note that text responses and interactions will not be graded unless otherwise notified. However, they
are recorded in the module and viewable by your instructor. For any questions slides, you will not be
able to navigate forward until after you submit a response for the question.
Section 02: Levels of Health Promotion Discussion (Week 9)
Section 03: Stages of Prevention Discussion (Week 10)
Assessment Part 3: Intervention Plan
Learn more about the Module 05 assignments.
SECTION 02 Discussion Board - Refer to F.1 Levels of Health Promotion Discussion Board Sub-Page
SECTION 03 Discussion Board - Refer to F.2 Stages of Prevention Discussion Board Sub-Page
PART THREE Video: Assessment - Refer to F.3 Video: Assessment Part 3 Sub-Page

F.1. LEVELS OF HEALTH PROMOTION DISCUSSION BOARD
SUB-PAGE OF F. MODULE ASSIGNMENTS

LEVELS OF HEALTH PROMOTION DISCUSSION BOARD
1/1
Based on the information you will learn in this module, there will be a discussion board focused on the
levels of health promotion due in week 9.
You will need to identify an existing health promotion program and describe the level it targets
(individual, peer or group, population-based). You will post a brief one paragraph description of the
health promotion program, including details about whether you think it is effective (e.g., is it
accessible? is it sustainable?). Include a reference for your information. You will also be required to
read and respond to the post of at least one peer who posted about a program targeting a different
level than what you posted about.

F.2. STAGES OF PREVENTION DISCUSSION BOARD

STAGES OF PREVENTION DISCUSSION BOARD
1/1
Based on the information you will learn in this module, there will be a discussion board focused on the
stages of prevention due in week 10.
You will be required to identify an existing health intervention and describe its stage of prevention
(primary, secondary, or tertiary). After doing so, you will need to post a brief one paragraph description
of the intervention. Include a reference for your information. You will then read and respond to two
peers who posted about different interventions.

F.3. VIDEO: ASSESSMENT PART 3

VIDEO: ASSESSMENT PART 3
1/1
Beyond identifying the specific health needs of a population, often some sort of intervention is
necessary to improve the health of a population. For Assessment Part 3, you will devise an intervention
plan for your chosen population. The intervention plan will be tailored to the root cause you identified
in the health needs assessment. Where possible, draw on examples of existing interventions
developed to address a similar need or population, and extract their “best practices” to help legitimize
and strengthen your plan. Discuss the feasibility of your intervention plan by considering the barriers
and enablers that will impact the intervention.
For more information about this assignment please see the Assessments tab in your online learning
environment.
Watch the video of Dr. Jenn Carpenter explaining Assessment Part 3: Intervention Plan (2:16).
Assessment Part 3: Intervention Plan [2:16]
Page Link:
https://player.vimeo.com/video/218786281

G. MODULE OUTLINE
6 OF 6
SECTION 01
An Overview of Disease Prevention
In this section, you will learn the stages of disease prevention which include: primordial intervention, primary
intervention, secondary invention, and tertiary intervention.
SECTION 02
Health Promotion
In this section, you will learn about the primordial level of prevention, which is similar to health promotion.
You will explore how the S D Hs and behaviour change are both barriers and targets of health promotion.
SECTION 03
Primary, Secondary, and Tertiary Prevention
In this section, you will learn about primary, secondary, and tertiary prevention. You will compare the
strategy, aim, and disease stage of each prevention level.
SECTION 04
Developing an Intervention
In this section, you will learn how to develop a health intervention which involves identifying the problem,
developing a solution, describing and communicating an action plan, and assessing its impact.

SECTION 01: AN OVERVIEW OF DISEASE PREVENTION
1.1 SECTION 01: AN OVERVIEW OF DISEASE PREVENTION

1.2 A SHIFT TOWARDS DISEASE PREVENTION
1 OF 7
Traditionally, healthcare and medical interventions have focused on the treatment or mitigation of
disease. However, more recently there has been a shift towards disease prevention.
Recall from Module 03 that non-communicable diseases account for approximately 70% of deaths
globally. As the global burden of non-communicable diseases, also known as chronic diseases,
continues to rise, there is a greater need to focus on disease prevention rather than treatment
because most of the burden of non-communicable diseases is preventable.
Alt Text: Proportion of global mortality due to non-communicable diseases.

1.3 VIDEO: THE RIVER STORY
2 OF 7
To help you understand the different types of disease prevention strategies, you will learn about a
story commonly used in public health. This story uses a river metaphor that will be revisited at the end
of this section to consolidate your understanding.
Watch a video of the river story (1:34).
The River Story [1:34]
As you watch, consider how this metaphor can be applied to disease prevention. How do each of the
methods used to help save the people in the river relate to different prevention strategies? What does
the bridge represent?
Page Link:
https://www.youtube.com/watch?v=vpJ4h8sxOJg

1.4 DISEASE PREVENTION
3 OF 7
Disease prevention aims to minimize the incidence or effects of disease. Preventative measures can be
applied at any stage along the course of a disease, with the goal of preventing further progression.
There are four stages of prevention.
Learn about each stage of prevention.
STAGE 1
Primordial Prevention
Aims to prevent the development of risk factors of diseases by targeting the underlying environmental
and social conditions that might promote them.
STAGE 2
Primary Prevention
Identification and modification of risk factors (risk reduction) to prevent onset of disease.
STAGE 3
Secondary Prevention
Early detection and treatment of disease before symptoms appear.
STAGE 4
Tertiary Prevention
Treatment of disease to stop its progression and control its negative consequences.
References:

Ottawa, I. M. (2015, January 26). Categories of Prevention. Retrieved May 25, 2017, from
http://www.med.uottawa.ca/sim/data/Prevention_e.html
Kisling, L., Das, J. Prevention Strategies. (2020). In: StatPearls [Internet]. Treasure Island (FL): StatPearls
Publishing. Retrieved February 2021, from https://www.ncbi.nlm.nih.gov/books/NBK537222/

1.5 STAGES OF PREVENTION
4 OF 7
As you just learned, each stage of prevention corresponds to a different part of the disease
progression pathway.
Click the tabs to learn about each of the four prevention stages in greater detail and where they fall along
the disease timeline.
Primordial Prevention
Primordial prevention targets the underlying health determinants by modifying social policies to
improve the health of a population, for example, promoting a healthy lifestyle by establishing safe
sidewalks and public outdoor spaces/walking trails. Other examples include economic reforms,
improving childhood health through prenatal nutrition programs, and outlawing alcohol in certain
countries.
Primary Prevention
Primary prevention targets susceptible individuals and attempts to prevent disease development. It
targets exposures and risk factors for specific diseases as well as ways to increase immunity. For
example, getting vaccinated.
Secondary prevention involves early detection and treatment of disease. For example, regular
mammograms to detect and treat breast cancer, and regular Papanicolaou tests to detect and treat
cervical cancer.
Tertiary Prevention
When a disease has developed and is in its clinical phase, tertiary prevention strategies help to
reduce the impact of the disease on the patient’s function, survival, and quality of life. For example,

patients that have had a myocardial infarction having cardiac rehabilitation, and regular check-ups
afterwards.
Definitions:
Papanicolaou test: Also known as a “pap smear”, a Papanicolaou test is a method of cervical screening
used to detect precancerous and cancerous growths in the cervix.
Myocardial infarction: Another name for a heart attack.
References:

1.6 QUESTION 1 OF 2: DIABETES PREVENTION
Activity: Drop-down
Please see the online learning module for the full experience of this interaction.
5 OF 7
Using what you have learned about the stages of disease prevention, answer the question.
Which suggested type 2 diabetes prevention strategy belongs to each stage of prevention?
Prevention Strategies: Primordial, Primary, Secondary, Tertiary
STAGES OF PREVENTION PREVENTION STRATEGY

Treating your diabetes appropriately will help prevent complications.
Regular exercise and healthy nutrition can prevent diabetes.
Having your doctor test your glucose regularly will identify diabetes
early before you have symptoms.
At the policy level, Canada has endorsed the Canada food guide to
healthy eating.
Feedback:

Treating your diabetes appropriately will help prevent complications. Tertiary
Regular exercise and healthy nutrition can prevent diabetes. Primary
Having your doctor test your glucose regularly will identify diabetes Secondary
early before you have symptoms.
At the policy level, Canada has endorsed the Canada food guide to Primordial
healthy eating.

1.7 QUESTION 2 OF 2: THE RIVER STORY
Activity: Drop-down
6 OF 7
Answer the question by applying the river story from the beginning of this section to what you have learned
about the stages of disease prevention.
Which stage of prevention corresponds to each suggested prevention strategy?
Prevention Strategies: Primordial, Primary, Secondary, Tertiary

Have a team down river to catch and save the people who fall in before
they drown.
Identify safety concerns and then reduce the risk of people falling off
the bridge by fixing the hole and building railings.
Build a net around the bridge so that if people fall, they do not fall in
the water.
Teach people how to make safe bridges.
Dr. Carpenter's Feedback: Recall, primordial strategies prevent the risk factors from developing,
primary strategies involve risk reduction, secondary strategies involve early detection and treatment,
and tertiary strategies involve treatment and control of negative consequences.

Have a team down river to catch and save the people who fall in before Tertiary
they drown.
Identify safety concerns and then reduce the risk of people falling off Primary
the bridge by fixing the hole and building railings.
Build a net around the bridge so that if people fall, they do not fall in Secondary
the water.
Teach people how to make safe bridges. Primordial

1.8 SECTION 01 SUMMARY
7 OF 7
In this section you learned the stages of disease prevention, which include primordial intervention,
primary intervention, secondary invention, and tertiary intervention. Now that you have had an
overview of the levels of prevention, you will explore primordial interventions (health promotion) in
depth in Section 02, and primary, secondary, and tertiary interventions in Section 03.

SECTION 02: HEALTH PROMOTION
2.1 SECTION 02: HEALTH PROMOTION

2.2 STAGES OF PREVENTION: PRIMORDIAL
1 OF 24
In this section, you will focus on primordial prevention. Recall the disease progression pathway from
the last section. Targets for prevention strategies at the primordial level occur before disease and even
risk factors are present. This section will focus on relevant theories and strategies for effective
primordial prevention, and more broadly health promotion. Section 03 will focus on the remaining
types of prevention.
Primordial Prevention aims to prevent the development of risk factors of diseases by targeting the
underlying environmental and social conditions that might promote them.
References:

2.3 HEALTH PROMOTION
2 OF 24
Primordial prevention is often considered synonymous with health promotion; however, by strict
definitions, that is not entirely accurate. Primordial prevention consists of risk factor
prevention/reduction through social and environmental changes for the entire population. These
changes tend to be accomplished through policy and law changes. In addition to the aforementioned,
health promotion helps individuals increase their control over their health, by promoting skill
development and healthy habits. Thus, health promotion is a comprehensive approach to helping
people obtain their maximum achievable health status.
Learn the two main approaches to effective health promotion.
IDENTIFICATION RISK
Identification of individuals susceptible to a risk factor and intervening to reduce the development of
that risk is one effective approach to health promotion. For example, you can prevent the likelihood of
children developing smoking habits by advising parents to quit smoking, and providing the parents
with smoking cessation programs.
REDUCED AVERAGE RISK
Reducing the average risk level for the whole population is another effective approach to health
promotion, which can be accomplished through legislative and/or public policy changes. For example,
consider a policy that mandates companies to display nutritional facts on all food products. This would
allow individuals to see nutritional value of products and may make them less likely to purchase
unhealthy products.
For the remainder of the section you will explore health promotion. Although you learned that
health promotion and primordial prevention are somewhat distinct, the differences are continually
evolving as the field grows.
References:


2.4 THE OTTAWA CHARTER OF HEALTH PROMOTION
3 OF 24
The First International Conference on Health Promotion was held in Ottawa, Canada in 1986. During
this conference, The Ottawa Charter of Health Promotion was developed. The charter called for several
important actions to facilitate health promotion, which included to:
• Build healthy public policy,

• Create supportive environments,
• Strengthen community actions,
• Develop personal skills, and
• Reorient health services.
The charter highlights the importance of advocacy through all stages of health promotion. The action
framework outlined in the charter continues to guide the discipline of health promotion today.
For your interest, read about The First International Conference on Health Promotion, Ottawa 1986.
Read an excerpt from the Ottawa Charter of Health Promotion.
“Health promotion is the process of enabling people to increase control over, and to improve, their
health. To reach a state of complete physical, mental, and social well-being, an individual or group
must be able to identify and to realize aspirations, to satisfy needs, and to change or cope with the
environment. 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.”
Page Link:
https://www.who.int/teams/health-promotion/enhanced-wellbeing/first-global-conference
Reference:

Ottawa Charter for Health Promotion [PDF]. (n.d.). Retrieved February 2021, from
https://www.canada.ca/content/dam/phac-aspc/documents/services/health-promotion/population-
health/ottawa-charter-health-promotion-international-conference-on-health-promotion/charter.pdf

2.5 HEALTH PROMOTION AND THE SOCIAL DETERMINANTS OF HEALTH
4 OF 24
Health promotion at the individual and population levels targets the behaviours, environmental
conditions, social conditions, and any other factors that could lead to the development of risk factors.
These factors are often grouped into three categories: environmental factors, social factors, and other
factors. In each of these categories you will see numerous examples listed. Notice that the majority of
these examples are, in effect, the Social Determinants of Health (S D H).
Read various examples from each of the three categories of factors.
EXAMPLES OF ENVIRONMENTAL FACTORS
• Occupation
• Housing/living conditions
• School or work environment
EXAMPLES OF SOCIAL FACTORS
• Education
• Family
• Social Economic Status (S E S)
• War/conflict
• Culture
• Race/racism
EXAMPLES OF OTHER FACTORS
• Internal/external factors that affect health

• Healthy/unhealthy behaviours
• Availability of quality health services

2.6 THE NEED FOR BEHAVIOUR CHANGE
5 OF 24
The S D Hs collectively have an impact on one's health. However, the healthy behaviours one chooses
to engage in are arguably the most significant factors in determining an individual’s health. The
behaviours we choose to engage in also happen to be the most easily modifiable S D H, as the
remaining ones we are either born into, or they are beyond our immediate control.
Given that personal health behaviours are a critical aspect of one’s health, modifying such behaviours
(tobacco use, diet, physical activity, risky sexual practices) is a large and effective component of health
promotion. Yet, behaviour change tends to be a difficult aspect of health promotion as there is often
be disconnect between knowledge and behaviour.

2.7 QUESTION: BRIDGING KNOWLEDGE TO BEHAVIOUR CHANGE
Activity: Text Entry

6 OF 24
Answer the question on barriers to healthy behaviours and how we can bridge the gap between knowledge
and change in behaviour.
Reflect on a time you used your knowledge of a healthy behaviour and attempted to make a
change in your daily life (e.g. exercise routine, flossing, etc.). Decide whether your behaviour
completely changed, mostly changed, partially changed, or didn’t change at all. List three to five
barriers you encountered and/or how you overcame them in your pursuit of a healthy
behaviour change.
Feedback:
Dr. Carpenter's Response:
Thank you for your response!
Navigate to the next page to learn more about barriers to changing health behaviours.

2.8 BARRIERS TO CHANGING HEALTH BEHAVIOURS
7 OF 24
There are numerous barriers to health behaviour change, and every individual may encounter
different barriers. These barriers may be grouped into the levels of the Social Ecological Model (S E
M).
Read about the barriers that are associated with each of the four socio-ecological levels.
INTRAPERSONAL
Intrapersonal barriers are mostly situated within the control of an individual. Some of the factors
related to this level include knowledge, attitudes, skills, self-efficacy, motivation, age, and
socioeconomic status.
Examples of Barriers:
• Lack of knowledge about safe sexual practices, dental hygiene, etc.

• Flawed risk perception of unhealthy eating, drinking habits, bad sleeping habits, etc.
• Perception of lack of control over certain aspects of their health (e.g. depressive thoughts, etc).
• Cost (time or money) of switching to healthy foods, joining a gym, getting proper medical advice,
etc.
INTERPERSONAL
Barriers at the interpersonal level involve social relationships, including those with friends, family,
peers, partners, and coworkers. Any one of these relationships may influence an individual’s behaviour
positively or negatively.
• Lack of connection and social integration with peers at school.

• Unsupportive family or peer environment.
• Lack of agreeableness within the physician-patient relationship.

• Social norms within peer group that promote negative behaviours such as smoking.
COMUNITY/INSTITUTION
The community/institution level includes the social and physical environments and settings
individuals engage with daily, including schools, workplaces, neighbourhoods, and healthcare facilities.
This level encompasses social and gender norms, a sense of empowerment within the community, and
the policies that influence the social environment of schools and workplaces.
• Lack of economic and housing opportunities.

• Inflexible work environment.
• Lack of healthy food options at school.
• Inaccessible parks and other recreational areas.
PUBLIC POLICY
The public policy level involves the broad, structural factors such as local, state, and federal policies,
that may either enable or hinder an individual’s ability to take control over their health.
• Unfair trade and labour laws that increase prices and access to care products and services.
• Lack of funding to the healthcare system and other social services.
• Punitive drug policies.
• Lack of a comprehensive health curriculum at school.
Definition:
Social Ecological Model (S E M): A theory-based framework for understanding the multifaceted and
interactive effects of personal and environmental factors that determine behaviours.
Reference:
Centers for Disease control and Prevention. (n.d.). Retrieved February 11 2021, from
https://www.cdc.gov/violenceprevention/publichealthissue/social-ecologicalmodel.html

2.9 MODELS OF BEHAVIOURAL CHANGE
8 OF 24
Models of behavioural change provide guidance about how to overcome barriers to health behaviour
change. You just learned about the Social Ecological Model, which provides a comprehensive approach
to addressing the different levels of barriers.
Over the next few slides you will learn about two additional models, which explain the process of
effective health behaviour change. These are the Health Belief Model (H B M) and the Transtheoretical
Model (T T M) of health behaviour change.

2.10 THE HEALTH BELIEF MODEL
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The Health Belief Model (H B M) is one of the best known and most widely used theories of health
behaviour change. It was first developed by a group of social psychologists in the 1950s, who were
trying to understand the widespread failure of tuberculosis screening programs.
Navigate to the next page to learn more about each component of the H B M.
Definition:
Health Belief Model (H B M): The Health Belief Model is a social psychological model developed to both
predict and explain health behaviours. The model suggests that an individual’s beliefs about various
facets of a potential health problem or disease can impact and explain their health related behaviours.
References:
Jones, C. L., Jensen, J. D., Scherr, C. L., Brown, N. R., Christy, K., & Weaver, J. (2015). The health belief
model as an explanatory framework in communication research: exploring parallel, serial, and
moderated mediation. Health communication, 30(6), 566-576. Retrieved on December 1 2020, from
https://proxy.queensu.ca/login?url=https://www.tandfonline.com/doi/pdf/10.1080/10410236.2013.873
363?casa_token=1emNEINcHrwAAAAA:iODy80mxlQtwuWR9YaJp8SAzMnILd_Gurr-
NsIyHvABQrZZjCd9cTye7nPwTOP_VSWWTQMUADES-PQ
behavioural change models. (n.d.). Retrieved February 11 2021, from

https://sphweb.bumc.bu.edu/otlt/mph-
modules/sb/behaviouralchangetheories/behaviouralchangetheories2.html

2.11 THE HEALTH BELIEF MODEL BREAK DOWN
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See examples of the different components of the H B M.
Perceived Seriousness
A person’s subjective perception of a disease or illness, including the medical and social consequences.
This includes considerations such as if the condition is life threatening, the social stigma associated
with the condition, and if it restricts daily activities or drastically impacts quality of life. For example,
how does a person perceive diseases associated with a lack of exercise?
Perceived Susceptibility
A person’s subjective perception of their risk of acquiring a disease or illness.
This might depend on factors such as their family history, genetics, and cultural views.
Perceived Benefits
A person’s perception of the effectiveness of a behaviour in reducing the risk of disease. A possible
benefit for increasing exercise would be better energy levels and reduced disease risk.
Perceived Barriers
A person’s perception of the obstacles to adopting a healthy behaviour, which are weighed against the
benefits. For exercises, barriers could be that it is time-consuming and the financial cost of a gym
membership.
Self-Efficacy
The level of a person’s confidence in their ability to successfully carry out a health behaviour change.

This may look like a person’s confidence in their ability to sustain consistent exercise, maintain weight
loss, or their ability to stay in a smoking cessation program.
Cues to Action
The specific triggers, both external and internal, needed to prompt the decision-making process to
engage in a specific health behaviour change.
Some cues to action could be the pre-existence of a health condition, physician recommendations, or
the illness of a family member.

2.12 THE TRANSTHEORETICAL MODEL OF HEALTH BEHAVIOUR CHANGE
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Another very common theory of behavioural change is the Transtheoretical Model (T T M), or the
“Stages of Change” Model. This model outlines the process of intentional behaviour change.
Understanding this process can facilitate the development of successful interventions. The T T M posits
that individuals move through six stages of change: precontemplation, contemplation, preparation,
action, maintenance, and relapse.
Navigate to the next page to learn about each stage of the transtheoretical model of health behaviour
change.
Definition:
Transtheoretical Model (T T M): The Transtheoretical Model is a biopsychosocial model to conceptualize
the process of intentional behaviour change, allowing for the to development of successful
interventions.
References:
Prochaska, J., & Velicer, W. (1997). Transtheoretical Model of behaviour Change. American Journal of
Health Promotion, 12(1), 38-48. Retrieved May 25, 2017, from
https://www.ncbi.nlm.nih.gov/pubmed/10170434.
YOUCAN. (2012). [Illustration on Stages of Changes]. Adapted from Prochaska & Diclemente and
Ignacio Pacheco Retrieved from
http://www.youcan.ca//component/jce/?view=popup&tmpl=component&img=images/YOUCAN-Stages-
of-change-med.jpg&title=

2.13 THE TRANSTHEORETICAL MODEL
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Learn about the six stages of the Transtheoretical Model of Health Promotion.
1. PRECONTEMPLATION
Precontemplation: Individuals in this stage are unaware of the need to change. They are often
uninformed about the consequences of their behaviour.
Example: A smoker who has never thought of quitting and never thought about the harmful
effects of smoking.
2. CONTEMPLATION
Contemplation: This is the ‘getting ready’ stage. Individuals in this stage are often ambivalent or
‘behavioural procrastinators’.
Example: A smoker is thinking about the health hazards of smoking and is considering quitting,
but has not yet made any plans and is in no hurry to do so.
3. PREPARATION
Preparation: Individuals in the preparation stage have motivation and a plan of action. Some
steps have been taken to change their behaviour.
Example: A smoker may set a quit date and ask family and friends to help hold them accountable.
4. ACTION
Action: In this stage, individuals are actively trying to modify their lifestyle and want to succeed.
Example: A person is actively participating in a smoking cessation program, and constantly
modifying their behaviour based on the program’s best practices.
5. MAINTENANCE
Maintenance: In this stage, individuals have sustained their behaviour change for at least six
months and work towards preventing relapses to previous stages.
Example: A person is no longer smoking and is actively engaging in behaviours to prevent relapse,
such as replacing smoking with exercise, which gives them similar feelings
of satisfaction.
6. RELAPSE

Relapse: Individuals in this stage have abandoned the idea of changing due to difficulty in
maintaining their new behaviour. Health care workers may encourage the individual to try again
and re-enter the contemplation stage.
Example: A person begins smoking again.
It is important to note that although depicted as a cyclical model, the process is generally more
complex. For example, a person may exit the ‘cycle’ at any stage. For people who reach the
maintenance phase, they may stay in this phase until death, without ever experiencing a relapse. If a
relapse does occur, people generally re-enter the ‘cycle’ at the contemplation phase.
Definition:
Ambivalent: Having mixed feelings or contradictory ideas about something or someone.
Reference:
Prochaska, J., & Velicer, W. (1997). Transtheoretical Model of behaviour Change. American Journal of
Health Promotion, 12(1), 38-48. Retrieved May 25, 2017, from
https://www.ncbi.nlm.nih.gov/pubmed/10170434.

2.14 QUESTION: STAGES OF CHANGE
(Pick Many, 10 points, 2 attempts permitted)
13 OF 24
Using what you learned about the T T M, answer the question.
Which stages of change are correctly matched to each individual who is in the process of a
health behaviour change? Select all that apply.
Contemplation: An individual who sleeps 4 hours a night regularly and has no motivation to
change.
Preparation: An individual who has booked a consultation with a healthcare provider and
prepared a list of questions to ask about weight loss.
Precontemplation: An individual who smokes a pack a day and has started to consider the
extent of the potential health effects.
Relapse: An individual who has stopped going to alcoholics anonymous meetings and has
started drinking again.
Action: An individual who reads cook books looking for ways to eat healthier food.
Maintenance: An individual who is exercising regularly and making healthy food choices most
of the time.
Feedback:
Contemplation: An individual who sleeps 4 hours a night regularly and has no motivation to
change.
Preparation: An individual who has booked a consultation with a healthcare provider and X
prepared a list of questions to ask about weight loss.
Precontemplation: An individual who smokes a pack a day and has started to consider the
extent of the potential health effects.
Relapse: An individual who has stopped going to alcoholics anonymous meetings and has X
started drinking again.
Action: An individual who reads cook books looking for ways to eat healthier food.

Maintenance: An individual who is exercising regularly and making healthy food choices X
most of the time.
The first individual is in the precontemplation stage as they have not identified a problem with their
sleeping habits. The second individual is in the preparation stage as they are motivated and have
started making steps towards their weight loss goal. The third individual is in the contemplation stage.
The fourth individual has relapsed as they have stopped their healthy behaviour. The fifth individual is
in the contemplation and preparation stage as they have looked into making a change to their diet, but
have not made any concrete changes. The final individual is in the maintenance stage as they have
effectively changed their behaviour.

2.15 HEALTH PROMOTION
14 OF 24
Now that you understand that health behaviour change is an important part of effective health
promotion, you will learn about the three different levels at which health promotion efforts are carried
out. These include the individual level, the peer or group level, and the population level.
Explore the levels of health promotion.
INDIVIDUAL - Refer to 2.15.1 Health Promotion: Individual Level Sub-Page
PEER OR GROUP - Refer to 2.15.2 Health Promotion: Peer or Group Level Sub-Page
POPULATION BASED - Refer to 2.15.3 Health Promotion: Population Level Sub-Page

2.15.1 HEALTH PROMOTION: INDIVIDUAL LEVEL
SUB-PAGE OF 2.15 HEALTH PROMOTION

HEALTH PROMOTION: INDIVIDUAL LEVEL
1/1
Individual level health promotion happens through one-on-one interactions, and is suitable when there
is a lot of individualized information and knowledge to be transferred. One-on-one interactions provide
an opportunity for personal clarification and adaptation, however, individual level health promotion
can be labour intensive and costly.
Pause and think of a few examples of individual level health promotion efforts, then reveal the examples Dr.
Carpenter provided.
INDIVIDUAL LEVEL HEALTH PROMOTION EFFORTS
• Teaching individuals about the proper use of condoms; both how to use them and why it is
important.
• Discussing strategies for smoking cessation.
• Optimizing the patient-provider relationship to allow for supportive and productive interactions.

2.15.2 HEALTH PROMOTION: PEER OR GROUP LEVEL
SUB-PAGE OF 2.15 HEALTH PROMOTION

HEALTH PROMOTION: PEER OR GROUP LEVEL
1/1
Health promotion at the peer or group level can include small groups, institutions, or entire
communities, and can occur in many spaces, such as classrooms, theatre groups, or even on field trips.
This level of health promotion is suitable when social interaction is helpful and may be a more efficient
method to transfer information because one individual can teach or lead a large group of people.
Pause and think of a few examples of peer or group level health promotion efforts, then reveal the examples
Dr. Carpenter provided. This list is not exhaustive, but is comprehensive.
PEER OR GROUP LEVEL HEALTH PROMOTION EFFORTS
• Prenatal classes which educate and prepare new parents.

• Sports activities and recreational programs which motivate you to exercise with others.
• Strategies to enhance sense of belonging, like community walking groups, community garden
program, etc.
• Creating safer and more inclusive workplaces. For example, creating breastfeeding friendly
workplaces.

2.15.3 HEALTH PROMOTION: POPULATION LEVEL
SUB-PAGE OF HEALTH PROMOTION

HEALTH PROMOTION: POPULATION LEVEL
1/1
There are two main types of health promotion at the population level, which include legislation and
policy, and social marketing.
Learn about these two types and see examples in action. These lists are not exhaustive but are
comprehensive.
Legislation, Regulation, and Policy
Legislative, regulatory, and policy based promotion is effective but often an overlooked approach as it
requires political will and public support. This type of promotion helps change environments and sets
the community standard for behaviour. Since individuals are forced to change, this can cause a
massive shift in attitude and behaviour.
Legislative, Regulatory and Policy Health Promotion Efforts:
• Public policy changes that promote healthy behaviours and deter negative behaviours, like a policy
that bans junk food and mandates regular daily physical activity in school.
• Fiscal measures that reward healthy behaviours and punish negative behaviours, such as a gym
tax credit or taxation on cigarettes and other tobacco products.
• Changes to legislation, like smoking by-laws that diminish negative health behaviours.
Social Marketing
Social marketing health promotion relies on ‘selling’ health like businesses that sell products. This
approach to health promotion leverages a target niche market. Often this approach can influence
acceptability of social norms and attitudes.
Social Marketing Health Promotion Efforts:

• Mass communication in the form of ads on any form of media or social media, such as television
ads marketing the benefits of influenza vaccinations.
• A catchy ad, slogan, logo, or picture which can change perceptions of a behaviour, like the Body
Break commercials.
• Using “product placement” in shows and movies to enhance health promotion, for example
showing the use of condoms.

2.16 NEED FOR INDIGENOUS VOICES IN HEALTH PROMOTION STRATEGIES
15 OF 24
As you have learned in previous modules, many Indigenous communities are disproportionately
affected by health related issues compared to non-Indigenous populations. As Canada moves forward
with answering the Calls to Action from the Truth & Reconciliation Commission of Canada (T R C), a
space needs to be created for Indigenous voices to be heard when developing Indigenous health
promotion strategies.
When Indigenous voices are not heard, colonial health promotion strategies are left unchecked and
can result in the continuous and damaging perpetuation of neocolonialism. There is a clear need to
view Indigenous health promotion through an Indigenous lens, in the effort to create a more equitable
society.
Learn about issues related to Indigenous health promotion.
Researcher Perspectives
Many Indigenous health researchers and practitioners do not come from an Indigenous background,
or do not identify as Indigenous. This can be problematic and oftentimes results in a contradiction
between the Indigenous community’s priorities and common goals and researcher’s perspectives in
how they identify and address these issues.
Intervention Evaluation
There is an evident lack of research on evaluating the effectiveness of health promotion interventions
for Indigenous Peoples. Even when research is conducted, program effectiveness is regularly
measured based on westernized individualistic evaluation methods that do not align with Indigenous
holistic community measures. Thus, these evaluations are misaligned with Indigenous health indicators
and lack validity.
For your interest, learn more about the Truth and Reconciliation Commission of Canada and the Calls to
Action released in 2015.

Definition:
Neocolonialism: The process of using economic influences, cultural imperialism, and aids to influence
another country, territory, or foreign land.
Page Link:
http://nctr.ca/reports.php
Reference:
Canadian Public Health Association. (2018). Towards reconciliation efforts: The need for Indigenous voices
in Indigenous health strategies. Retrieved December 2020, from
https://www.cpha.ca/towards-reconciliation-efforts-need-indigenous-voices-indigenous-health-
strategies

2.17 VIDEO: COMBINING TRADITIONAL AND WESTERN MEDICINE
16 OF 24
Another effective health promotion strategy is to blend Traditional and Western medicine perspectives
in clinical care. One example of a medical centre that does this is the B C Cancer - Prince George Centre
for the North. The centre provides comprehensive cancer care and support programs for B C residents
in partnership with the regional health authorities.
Watch a video about the B C Cancer - Prince George Centre for the North.
B C Cancer Agency Centre for the North in Prince George, B C [3:57]
As you watch, consider how the centre blends Traditional and Western medicine perspectives.
Page Link:
https://www.youtube.com/embed/46dgGw21Fcw
Reference:
Prince George (CENTRE for the north). (n.d.). Retrieved February 2021, from
http://www.bccancer.bc.ca/our-services/centres-clinics/bc-cancer%E2%80%93prince-george

2.18 B C CANCER PRINCE GEORGE CENTRE FOR THE NORTH
17 OF 24
The B C Cancer - Prince George Centre for the North has taken on various initiatives that are aimed at
improving the healthcare and health experiences of Indigenous Peoples. At the forefront, they have
enabled all people living in the North to receive treatment closer to home and also provide telehealth
services. Receiving treatment at or close to home is important to the many Indigenous communities in
Northern B C. In addition to this, they have implemented several other significant strategies in order to
combine Western and Traditional medicines.
Learn the strategies utilized to promote and support Indigenous culture in healthcare.
ABORIGINAL CARE COODINATOR
As part of their healthcare team, they have an Aboriginal Care Coordinator that aids in fostering a
trusting dynamic and helps facilitate treatment from an Indigenous perspective.
HEALING GARDEN
In consultation with Indigenous stakeholders from the area, they have created a healing garden with
Indigenous plants of the north, known for their healing properties. In the healing garden they have also
constructed a smudging pavilion to promote and support Indigenous ceremonial healing practices.
Definition:
Smudging: A ceremonial practice usually involving prayer and the burning of sacred plants (e.g.,
sweetgrass, cedar, sage, tobacco) that are known for their healing and/or purification properties.
References:
Robinson, A. (2018) Smudging. The Canadian Encyclopedia, Historica Canada. Retrieved February 2021,
from https://www.thecanadianencyclopedia.ca/en/article/smudging
Invest in City of PG. (2013). B C Cancer Agency Centre for the North in Prince George, B C. YouTube.
Retrieved February 2021, from https://www.youtube.com/embed/46dgGw21Fcw

2.19 AMPLIFYING INDIGENOUS VOICES IN HEALTH PROMOTION
18 OF 24
Indigenous health promotion should take a more holistic and community-based approach. To be able
to align with the needs and goals of Indigenous communities, researchers must genuinely collaborate
with, and work alongside chiefs, elders, and leaders.
By creating a safe space for Indigenous voices to be heard, health promotion strategies can be
developed that reflect Indigenous cultures, values, and traditional knowledge.
Learn more about factors involved in Indigenous health promotion. On the next slide you will learn how this
information applies to strategies for Indigenous suicide prevention.
PROTECTIVE FACTORS
• Self-government
• Land control
• Control over cultural activities
PREVENTION
• Community based approaches

• Gatekeeper training
• Peer support groups
SPIRITUALITY
• Using Indigenous concepts of well-being and spiritual practices: pow-wows, sweetgrass

ceremonies, and sweat lodges.
Definitions:
Gatekeeper Training: The training of individuals within a community to be able to recognize persons at
risk of suicide and provide appropriate assistance.

Pow-wow: A celebration to showcase Indigenous dances, regalia, crafts, food, and culture as a whole.
Pow-wows are often a time to visit friends and family, welcome newcomers, celebrate Indigenous
cultural heritage, and provide an opportunity for cross-cultural sharing.
Sweetgrass ceremonies: Sweetgrass is commonly burned as an incense for daily prayers and during
many community events. To many Indigenous communities sweetgrass is a sacred plant that has
purification and healing powers and thus, is used in many religious ceremonies.
Sweat lodges: A sweat lodge is a dome shaped inclosed structure where inside water is poured over
hot stones to create intense heat. They are used in many purification ceremonies as well as for healthy
living.
References:
in Indigenous health strategies. Retrieved December 2020, from https://www.cpha.ca/towards-
reconciliation-efforts-need-indigenous-voices-indigenous-health-strategies
Centre for Suicide Prevention. (2013). Indigenous suicide prevention. Retrieved December 2020, from
https://www.suicideinfo.ca/resource/indigenous-suicide-prevention/
Centre for Suicide Prevention. (2018). The need for culturally-tailored gatekeeper training intervention
program in preventing suicide among Indigenous Peoples: A systematic review. Retrieved December 2020,
from https://www.suicideinfo.ca/resource/the-need-for-a-culturally-tailored-gatekeeper-training-
intervention-program-in-preventing-suicide-among-indigenous-peoples-a-systematic-review/
Hoefnagels, A. (2018, October). Powwows in Canada. The Canadian Encyclopedia, Historica Canada.
Retrieved February 2021, from https://www.thecanadianencyclopedia.ca/en/article/powwows-editorial
Turner, N. J. (2018, November). Sweetgrass. The Canadian Encyclopedia, Historica Canada. Retrieved
February 2021, from https://www.thecanadianencyclopedia.ca/en/article/sweetgrass
Gadacz, R. R. (2017, February). Sweat Lodge. The Canadian Encyclopedia, Historica Canada. Retrieved
February 2021, from https://www.thecanadianencyclopedia.ca/en/article/sweat-lodge

2.20 INDIGENOUS HEALTH PROMOTION: SUICIDE PREVENTION
19 OF 24
Recall from Module 03 that the suicide rate among the Indigenous populations is higher than the non-
Indigenous population. In some instances, health promotion strategies have unfortunately fallen short
due to their lack of an Indigenous perspective.
Although these issues can be difficult to navigate and digest, solutions include empowering Indigenous
Peoples and allowing for their voices to be heard.
Learn how to successfully develop Indigenous health promotion strategies.
SUCCESSFUL PROGRAMS
Successful programs focus on community and family connectedness, community empowerment, and
Indigenous cultural affinity. Programs developed with these components in mind have proven to be
effective in lowering rates of suicide. An example of a community-based approach to treat substance-
abuse issues would involve community healers utilizing spiritual practices, dances, and ceremonies. In
many Indigenous communities culture is viewed as treatment and it is understood that all healing is
spiritual.
UNSUCCESSFUL PROGRAMS
There have been cases where westernized suicide prevention programs and strategies have failed in
Indigenous communities. As the programs lacked Indigenous perspective, they created incongruences
in culture and resulted in the further disruption of Indigenous communities. In some situations, the
implementation of these suicide prevention programs has actually resulted in higher rates of suicide.
References:
in Indigneous health strategies. Retrieved December 2020, from https://www.cpha.ca/towards-
reconciliation-efforts-need-indigenous-voices-indigenous-health-strategies

Centre for Suicide Prevention. (2013). Indigenous suicide prevention. Retrieved December 2020, from
https://www.suicideinfo.ca/resource/indigenous-suicide-prevention/

2.21 HEALTH PROMOTION IN PRACTICE
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As a whole, health promotion focuses on encouraging people to improve their health in one of two
ways; by either increasing their frequency of healthy behaviours, or by reducing or eliminating their
unhealthy behaviours.
Learn about each method.
INCREASE FREQUENCY OF HEALTH BEHAVIOURS - Refer to 2.21.1 Increasing Frequency of Healthy

Behaviours - 2.21.2 OMama: Supporting Pregnancy, Birth, & Early Parenting Sub-Pages
ELIMINATING UNHEALTHY BEHAVIOURS - Refer to 2.21.3 Reducing/Eliminating Unhealthy Behaviours -

2.21.4 Smoking Cessation Interventions Sub-Pages

2.21.1 INCREASING FREQUENCY OF HEALTHY BEHAVIOURS
SUB-PAGE OF 2.21 HEALTH PROMOTION IN PRACTICE

INCREASING FREQUENCY OF HEALTHY BEHAVIOURS
1/2
One practice focuses on increasing the frequency of healthy behaviours by identifying healthy
behaviours and implementing programs to make these behaviours easier to achieve.
OMama is an example of an intervention that increases the frequency of healthy behaviours during
pregnancy. It is a smartphone application that aids mothers in tracking important pregnancy
information and following evidence-based health recommendations. Evidence suggests that health
events occurring in utero and in early life can have a major impact on the future long-term health of an
individual.
Navigate to the following slide to see the OMama application in action.
Definition:
OMama: An application created by the The MotHERS ProgramTM dedicated to improving maternal
health through education, research, and screening.
Reference:
The MotHERS Program. (n.d.). OMama. Retrieved December, 2020, from
https://www.themothersprogram.ca/resources-and-information/omama

2.21.2 OMAMA: SUPPORTING PREGNANCY, BIRTH, & EARLY PARENTING

OMAMA: SUPPORTING PREGNANCY, BIRTH, & EARLY PARENTING
2/2
View the health information OMama provides that encourages healthy behaviours before, during, and after
pregnancy.
OMama
Pregnancy: Throughout pregnancy, OMama provides supporting information on healthy living, healthy
environments, folic acid supplements, immunizations, complementary therapies, prenatal care and
classes, and Group B Streptococcus (GBS) screening.
Labour & Birth: OMama provides information on newborn complications, signs of labour, variations of
labour and birth, skin to skin contact, and breastfeeding.
Post-Partum: OMama provides information on postpartum complications, postpartum recovery, and

breastfeeding.
Newborn: OMama provides information on birth registration, newborn immunizations, mental health
supports, and caring for a newborn.
Reference:
The MotHERS Program. (n.d.). OMama. Retrieved December, 2020, from
https://www.themothersprogram.ca/resources-and-information/omama

2.21.3 REDUCING/ELIMINATING UNHEALTHY BEHAVIOURS

REDUCING/ELIMINATING UNHEALTHY BEHAVIOURS
1/2
In addition to encouraging healthy behaviours, health promotion focuses on empowering the

population to identify and reduce behaviours that are detrimental to a healthy lifestyle, and designing
interventions which will effectively alter those behaviours. However, it is often not enough to simply
suggest replacing an unhealthy behaviour with a healthy behaviour - effective health promotion relies
on interventions which help individuals replace these unhealthy behaviours in a sustainable way. The
best health promotion is accessible to all, and leads to long-term changes for the target population.
Please navigate to the next page to read about various smoking cessation interventions.

2.21.4 SMOKING CESSATION INTERVENTIONS

SMOKING CESSATION INTERVENTIONS
2/2
Smoking cessation programs are an example of promoting health through the elimination and
replacement of an unhealthy behaviour. One such program, Unsmoke, is an initiative set by the
Canadian government that aims to reduce tobacco use in Canada to only 5% of the population by
2035. The initiative provides important information on the benefits of quitting, tips for quitting, and
how to support a loved one trying to quit.
Learn several smoking cessation interventions provided by the program to aid in the elimination of
unhealthy behaviours. Combining cessation interventions usually increases a smokers chance of successfully
quitting.
COLD TURKEY
Quitting cold turkey means choosing a specific date to quit and stopping with no formal assistance or
supports.
WEANING
Weaning involves gradually reducing the amount of tobacco consumed per day or week until
eventually quitting completely.
THERAPY & SUPPORT GROUPS
Therapy and support groups involve seeking support from a professional therapist or support group
that will help a person quit.
MEDICAL TREATMENT
Medical treatment involves nicotine replacement products or prescription medications that work by
decreasing the pleasure, craving, and withdrawal symptoms associated with smoking.

References:
Unsmoke. (n.d.). “Together we can #unsmoke Canada”. Retrieved December 2020, from
https://www.unsmoke.ca/.
MedBroadcast. (n.d.). Retrieved December 2020, from

https://www.medbroadcast.com/healthfeature/gethealthfeature/smoking-
cessation?_ga=2.66126254.18292042.1606850799-308669627.1606850799

2.22 HEALTH PROMOTION: INDIGENOUS CONSIDERATIONS
21 OF 24
In 2016, a report released by the Chiefs of Ontario and Cancer Care Ontario found a significantly higher
prevalence of smoking in the First Nations population in comparison to the non-Indigneous population
in Ontario. As smoking is one of the most significant modifiable risk factors for cancer, this behaviour
has become a large focus for health promotion in Ontario. However, this health promotion focus is at
odds with the traditional or spiritual use of tobacco for medicinal and ceremonial practices that are
common in many Indigenous communities.
Learn the traditional roles tobacco has in First Nations, Métis, and Inuit communities in Ontario.
FIRST NATIONS
First Nations have traditionally used tobacco for prayer, purifying the body and mind, providing
spiritual strength, guidance, and as a symbol of respect in First Nations gatherings. However, most
practices do not involve directly inhaling tobacco smoke (e.g. holding burning tobacco in left hand as
an offering to the Creator).
MÉTIS
Métis use of tobacco has historically been influenced by First Nations as a medicinal plant and for
social uses. Early Métis were known for being voyageurs, and during long canoe journeys they would
stop frequently for rest and to pipe. Eventually, this way of life became so important they would
measure their distance travelled by the number of pipes smoked.
INUIT
From a traditional perspective, Inuit typically do not use tobacco for ceremonial or other practices
because tobacco could not grow in the colder climate of their traditional land.
References:

Cancer Care Ontario. (2016). Cancer Fact: High prevalence of smoking in First Nations in Ontario.
Retrieved December 2020, from https://www.cancercareontario.ca/en/cancer-facts/high-prevalence-
smoking
Indigenous Tobacco Program. (n.d.). Retrieved December 2020, from

https://tobaccowise.cancercareontario.ca/en

2.23 BECOMING TOBACCO-WISE
22 OF 24
In 2009, the Chiefs of Ontario passed a resolution for First Nations to become tobacco-free. It is
important to differentiate that this resolution was only related to non-traditional commercial use of
tobacco.
The role tobacco has an important traditional and ceremonial role in many Indigenous cultures, which
must be considered when developing health promotional strategies for limiting tobacco use. Such
strategies must be modified to be mindful of and culturally responsive to Indigenous ways of
knowing and living.
Currently, there is an initiative promoting and encouraging Indigenous communities to become

Tobacco-Wise by continuing traditional tobacco practices and eliminating commercial tobacco use.
Navigate to the next page to learn how the sacred smoke program promoted becoming Tobacco-Wise.
Definitions:
Culturally Responsive: Culturally responsiveness is the ability to learn from and relate respectfully with
individuals from different cultures.
Tobacco-Wise: Understanding the difference between commercial and traditional tobacco use and
developing skills and strategies to make healthy choices for yourself and others in your community.
References:
Cancer Care Ontario. (2016). Cancer Fact: High prevalence of smoking in First Nations in Ontario.
Retrieved December 2020, from https://www.cancercareontario.ca/en/cancer-facts/high-prevalence-
smoking


2.24 THE SACRED SMOKE PROGRAM
23 OF 24
The Sacred Smoke Program was an initiative that was developed to support and promote being
Tobacco-Wise in two communities: Batchewana First Nation and Garden River First Nation. The
program was based on traditional Anishinaabe practices and shares smoking cessation information in
a culturally responsive manner. This cessation program involved both western medicine nicotine
replacement therapies and support groups in conjunction with traditional Anishinaabe medicines and
cultural resources.
Learn culturally responsive smoking cessation strategies used in the Sacred Smoke Program.
ELDERS
Led by elders, participants were shown how to make kinikinik (traditional tobacco) and taught
traditional methods of smoking cessation such as tobacco offerings, quitting on a new moon, and
selecting traditional medicines.
COPING STRATEGIES
Participants were shown how to incorporate adaptive coping strategies into their daily routines to help
distract from cravings and avoid relapse. Some of the strategies included exercise, drumming, crafts,
and cultural ceremonies.
For your interest, search on a map the land territories of the Batchewana and Garden River First Nations.
Definitions:
Batchewana First Nation: The Batchewana First Nation is composed of four reserve communities and
has a population of 2,400 people. This community is located near Sault Ste. Marie, Ontario.
Garden River First Nation: The Garden River First Nation lies between Sault Ste. Marie and Echo Bay,
just north of the Canadain US border. The name of this Nation comes from the time of the fur trade as
people in this area were known for their vegetable growing along the route voyagers followed.

Page Link:
https://native-land.ca/
References:
First Nations Market Housing Fund. (n.d.). Retrieved December 2020 from
https://www.flmpn.ca/english/participating_fn/index.html

24 OF 24
In this section you learned about health promotion, which is similar to and an extension of primordial
prevention. You explored how elements of the S D Hs and the difficulty of behaviour change can both
be barriers to good health, and therefore targets of effective health promotion. Multiple models of
health behaviour change were examined, including the health belief model and the transtheoretical, or
social change, model. Then, the three levels of health promotion (individual, peer, and population-
based) were used to illustrate the wide variety of health promotion strategies. You also learned about
the importance of giving Indigenous Peoples a voice in health promotion, and aligning health
promotion strategies to Indigenous cultures and practices. All of the knowledge you learned was
applied to specific, real world examples, showcasing effective health promotion in action.
In the next section you will learn about the remaining three levels of prevention.

SECTION 03: PRIMARY, SECONDARY, AND TERTIARY PREVENTION
3.1 SECTION 03: PRIMARY, SECONDARY, AND TERTIARY PREVENTION

3.2 STAGES OF PREVENTION: PRIMARY, SECONDARY, AND TERTIARY
1 OF 10
Now that you have learned about primordial prevention, you will learn more about the three other
levels of prevention.
Review the definitions of primary, secondary, and tertiary prevention strategies.
Primary Prevention
Identification and modification of risk factors (risk reduction) to prevent onset of disease.
Early detection and treatment of disease before symptoms appear.
Tertiary Prevention
Treatment of disease to stop its progression and control its negative consequences.
Reference:

3.3 QUESTION: THE STAGES OF PREVENTION CONTINUUM

2 OF 10
The stages of prevention are a continuum, meaning that at certain points along the continuum there is
an overlap between stages. Initially, the stages of disease prevention did not include primordial
prevention, which would explain the obvious overlap between primordial and primary prevention, and
the naming of primary (first), secondary (second), and tertiary (third) prevention.
Using this knowledge, answer the question.
How would you describe the overlap between primordial and primary prevention? Consider the
similarities and differences between primordial and primary prevention.
Feedback:
Both primordial and primary prevention address the risk factors or root causes (i.e. upstream factors)
that affect your likelihood of acquiring a disease. However, in general, primordial prevention aims to
avoid the development of the risk factor, while primary prevention aims to manage, modify, or
eliminate the risk factor. Primordial prevention is often focused on the S D Hs and on laying the path
for young people to avoid developing the risk factor.

3.4 PRIMARY, SECONDARY, AND TERTIARY PREVENTION
3 OF 10
To help further solidify the differences between prevention levels, you will explore their unique
characteristics.
Review the strategy, aim, disease stage, and an example of prevention strategies for each prevention level.
PRIMARY
STRATEGY The identification and modification of risk factors for disease.

AIM Prevent occurrences of disease.
DISEASE STAGE There is no disease present but the individual is susceptible to the
disease due to risk factors.
EXAMPLE OF PREVENTION Quitting smoking.
STRATEGIES
SECONDARY
STRATEGY The early detection and treatment of diseases.

AIM To stop the progression of the disease, or to either cure, prevent
complications and death, or to stop or limit spread of disease.
DISEASE STAGE Subclinical or early clinical, pathological changes but no signs or
symptoms.
EXAMPLE OF PREVENTION Regularly scheduled mammograms to detect and manage breast
STRATEGIES cancer before there are symptoms.
TERTIARY
STRATEGY The treatment and rehabilitation of the person with the disease.
AIM To limit disability, prevent relapse, and restore function.
DISEASE STAGE Signs and symptoms of the disease, potential

complications/disabilities.

EXAMPLE OF PREVENTION Early rehabilitation and management for people who have suffered a
STRATEGIES stroke, so that they can optimize their recovery and prevent
complications.
References:

3.5 PRIMARY PREVENTION OF H P V RELATED CANCERS
4 OF 10
Primary prevention aims to reduce the occurrence of a disease by identifying and modifying risk
factors. Globally, human papillomavirus (H P V) infections are the most common sexually transmitted
infections and can lead to six types of cancer, including cervical and anogenital cancers. Without
vaccination, it is estimated that 75% of sexually active Canadians will have an H P V infection in their
life.
H P V vaccination is most effective when administered before becoming sexually active. In Canada, H P
V vaccines are federally funded and administered in schools. Since 2013, H P V vaccination programs
were offered to females from grades four to seven. Currently, most provinces in Canada have
expanded their H P V vaccination program to also include males. Vaccination of individuals regardless
of gender was an important step in this prevention strategy as it recognized that H P V is not just a
burden on the female population.
References:
Shapiro, G. K., Guichon, J., & Kelaher, M. (2017). Canadian school-based H P V vaccine programs and
policy considerations. Vaccine, 35(42), 5700-5707. https://doi.org/10.1016/j.vaccine.2017.07.079
National Cancer Institute. (n.d.). Human Papillomavirus (H P V) Vaccines. Retrieved December 02, 2020,
from
https://www.cancer.gov/about-cancer/causes-prevention/risk/infectious-agents/hpv-vaccine-fact-sheet
Canada, P. (2020). Government of Canada. Retrieved February 2021, from

https://www.canada.ca/en/public-health/services/publications/healthy-living/canadian-immunization-
guide-part-4-active-vaccines/page-9-human-papillomavirus-vaccine.html

3.6 VIDEO: SECONDARY PREVENTION OF CERVICAL CANCER
5 OF 10
Screening plays a critical role in secondary prevention because it enables the early detection and
treatment of disease. One example of effective secondary prevention is the screening for cervical
cancer.
Although highly curable, cervical cancer kills thousands of women annually, especially in low-income
countries. The Kilimanjaro Cervical Cancer Screening Project uses cell phones as a means of screening
for cervical cancer in Tanzania. Nurses and community health workers working in remote villages are
trained to test for cervical cancer using vinegar and cell phones. Once they have taken a high definition
picture of the vinegar-stained cervix, they are able to burn areas of concern and to send the photos to
gynecologists in academic centers, should they need advice on treatment.
Watch the video to explore the secondary prevention of cervical cancer.
Secondary Prevention of Cervical Cancer [3:27]
As you watch, consider the barriers to secondary prevention of cervical cancer in Tanzania.
Page Link:

3.7 VIDEO: TERTIARY PREVENTION FOR PARKINSON'S DISEASE
6 OF 10
Tertiary prevention involves the treatment and control of disease. Parkinson’s disease is a progressive
disease of the nervous system. This disease usually affect adults ages 50 - 60, and is 50% more
common in men than women. The cause of Parkinson’s disease is attributed to a combination of
genetic mutations, which can be hereditary, and environmental factors (e.g. exposure to toxins).
Watch the video to learn how Parkinson’s can be treated with physical therapy.
Parkinson’s Disease: Treatment by a Physical Therapist [2:37]
As you watch, try to identify the tertiary preventions for Parkinson’s disease mentioned in the video.
Page Link:
https://www.youtube.com/embed/jEY2hS9mLVg
References:
National Institute on Aging. (2017). Parkinson's Disease. Retrieved December 2020, from
https://www.nia.nih.gov/health/parkinsons-disease
MoveForwardPT. (2013). Parkinson Disease: Treatment by a Physical Therapist. Retrieved May 2017,
from https://www.youtube.com/embed/jEY2hS9mLVg

3.8 ACTIVITY: STAGES OF PREVENTION
Activity: Drop-down
7 OF 10
Using the drop down menu, select the correct stage of prevention for each example.
Take a moment to reflect on all the stages of prevention discussed throughout this module. Identify
the prevention level that corresponds to each example.
Stages of Prevention: Primordial Prevention, Primary Prevention, Secondary Prevention, Tertiary

Prevention
EXAMPLE STAGE OF PREVENTION

Sanitation
Stroke Rehabilitation
Teeth Brushing
Blood Sugar Testing
Feedback:
EXAMPLE STAGE OF PREVENTION

Sanitation Primordial Prevention
Stroke Rehabilitation Tertiary Prevention
Teeth Brushing Primary Prevention
Blood Sugar Testing Secondary Prevention
Navigate to the next slide to learn more about each example.
Reference:
Kivimäki, M., Virtanen, M., Elovainio, M., Kouvonen, A., Väänänen, A., & Vahtera, J. (2006). Work stress in
the etiology of coronary heart disease-a meta-analysis. Scandinavian journal of work, environment &
health, 431-442. https://doi.org/10.5271/sjweh.1049

3.9 EXAMPLES FOR EACH STAGE OF PREVENTION
8 OF 10
You have just completed an activity that required you to match the correct level of prevention to an
example. We will now explore these ideas further, explaining how each example falls into each level of
prevention.
Learn about each stage of prevention and its corresponding example.
PIMORDIAL PREVENTION: SANITATION
Primordial prevention targets underlying health determinants by modifying social policies to improve
the health of a population. As sanitation provides clean drinking water to a community, it would be an
example of primordial prevention. By providing safe drinking water, the risks that come with unsafe
water, such as earlier death, hunger, and undernourishment, are prevented.
PRIMARY PREVENTION: TOOTH BRUSHING
Primary prevention strategies are more personal. They target causes and risk factors for specific
diseases. Brushing your teeth falls under the primary prevention level because it is a preventative
measure against cavities, tooth decay, and gum disease.
SECONDARY PREVENTION: BLOOD SUGAR TE
Secondary prevention includes procedures that detect and treat pre-clinical pathological changes and
thereby control disease progression. For example, in people living without diagnosed diabetes,
regularly testing blood sugar levels would help them identify the onset of diabetes early.
TERTIARY PREVENTION: STROKE REHABILITATIONSTING
When a disease has developed and is in its clinical phase, tertiary prevention strategies help to soften
the impact on the patient’s function, survival, and quality of life. For example, patients that have had a
stroke may undergo rehabilitation to regain mobility in an affected area.

References:
Kivimäki, M., Virtanen, M., Elovainio, M., Kouvonen, A., Väänänen, A., & Vahtera, J. (2006). Work stress in
the etiology of coronary heart disease-a meta-analysis. Scandinavian journal of work, environment &
health, 431-442. https://doi.org/10.5271/sjweh.1049
Gaylord Specialty Healthcare. (n.d.). Stroke Program. Retrieved November 26, 2020, from
https://www.gaylord.org/Patients-Families/Conditions-Services/Stroke-Program

3.10 QUESTION: SELECT THE PROPER STRATEGY

9 OF 10
Using what you have learned about the different levels of health promotion, answer the question.
You have been tasked with developing a health promotion strategy for reducing the risk of
cardiovascular disease (C V D). Of the different levels of health prevention, which one(s) would be
most effective?
Feedback:
When dealing with a health promotion intervention for C V D, one could use any of the three levels of
prevention. You can even use the same strategies for primary, secondary, and tertiary prevention
strategies. For example, the primary prevention strategies of a healthy diet and exercise may be
applicable at the primary, secondary, and tertiary stages of disease progression. Primordial prevention
can also be used to prevent C V D, through policy and interventions that prevent the development of
the risk factors for the disease.

10 OF 10
In this section, you learned about primary, secondary, and tertiary preventions. You compared the
strategy, aim, and disease stage of each prevention level. You then learned about specific prevention
examples. For primary prevention you looked at the use of H P V immunizations for cervical cancer
prevention.
For secondary prevention you looked at early screening for cervical cancer in Tanzania. You explored
the barriers of screening in Tanzania and how they have adapted to these health barriers. Then, you
examined tertiary prevention strategies using Parkinson’s disease as an example. Lastly, you learned
that overlap in stages of prevention strategies exist, such as in cardiovascular disease where primary,
secondary, and tertiary preventions can be the same.

SECTION 04: DEVELOPING AN INTERVENTION
4.1 SECTION 04: DEVELOPING AN INTERVENTION

4.2 HEALTH INTERVENTIONS
1 OF 12
Health interventions aim to address a health need or gap within a given population. Often,
interventions are developed around three main criteria: the target (the entity on which the action is
carried out), the action (a deed done by an actor to a target), and the means (the processes and
methods by which the action is carried out).
According to the Canadian Institutes of Health Research:
“Population health interventions are policies, programs, and resource distribution approaches that
impact a number of people by changing the underlying conditions of risk and reducing health
inequities.”
Alt Text: Types of public health interventions.
Reference:
Image adapted from: Public health Interventions: Kent State University. (n.d.). Retrieved February 2021,
from https://onlinedegrees.kent.edu/college-of-public-health/public-health/community/public-health-
interventions

4.3 DEVELOPING AN INTERVENTION
2 OF 12
Planning a health intervention involves a sequence of steps to ensure that the intervention is
sustainable over time, is ethical, and effective.
Learn about each stage of prevention.
STEP 1
Step 1: Identify and Assess the Level of the Problem
The first step in developing an intervention is identifying and assessing the level of the problem. This
can be done using a needs assessment. Common needs assessments include questions such as:
• What is the extent of the problem (including quantifying the difference in the selected population
compared to a population that has the “target state”)?
• What are potential root causes for the health problem (often choosing one root cause to focus on
when planning the intervention)?
• What are barriers and enablers to addressing the root cause through intervention?
You will hopefully notice that the questions above describe what you were asked to do in Assessment
Part 2.
STEP 2
Step 2: Develop a Solution to the Problem
After identification and assessment of the problem, a solution is developed. Solutions can be built
upon existing interventions and/or best practices.
STEP 3
Step 3: Describe the Action Plan for the Intervention

This step involves determining the details of the implementation of the proposed solution. Questions
that are addressed at this stage include:
• What specific change or aspect of the intervention will occur?

• Which groups will benefit from this intervention?
• Who will carry it out?
• When will the intervention be implemented? How long it will be maintained?
• What resources (money, staff) are needed? What resources are available?
• What is the feasibility of the plan?
STEP 4
Step 4: Assess the Potential Impact
Once the action plan has been described, the potential impact must be assessed. Questions asked in
this step include:
• What are the intended and unintended outcomes of this intervention?

• How will ‘success’ be measured?
• Will the impact be positive or negative?

4.4 FROM THEORY TO PRACTICE
3 OF 12
Many interventions are built upon existing evidence to ensure that the intervention is not only
warranted but that it is well-founded based on best practices. However, despite rigorous planning that
occurs in developing an intervention, it is important to understand that once implemented in reality,
the intervention might not always be as effective as anticipated.
Therefore, it is important for researchers to investigate any intended (planned outcomes) or

unintended (unplanned) consequences of their proposed intervention plan.

4.5 IS THERE A QUATERNARY PREVENTION?
4 OF 12
The idea of an additional quaternary prevention was initially proposed by Marc Jamoulle in 2015, and it
relates to the “primum non nocere” principle of medical ethics. Quaternary prevention is defined as
“action taken to identify patients at risk of overmedicalization, to protect them from new medical
invasion, and to suggest to them interventions which are ethically acceptable”.
This type of prevention is important so that doctors are conscious of the harm they may cause to their
patients, even unintentionally. One relevant example involves the current opioid crisis, which was
initially caused by the overprescription of opioids for patients with chronic pain. The opioid crisis has
historically burdened marginalized and racialized people disproportionately, including Indigenous
people.
Alt Text: Types of prevention in health promotion.
Definition:
Primum non nocere: Latin term that translates to “first, do no harm”.
References:
Dictionary of general practice. (n.d.). Retrieved February 2021, from
http://www.ph3c.org/4daction/w3_CatVisu/en/wonca-dictionary-of-general/family-practice.-
2003.html?wDocID=92
Adapted from Jamoulle, M. (2015). Quaternary prevention: First, do not harm. Revista Brasileira De
Medicina De Família E Comunidade, 10(35), 1-3. Retrieved February 2021, from
https://doi.org/10.5712/rbmfc10(35)1064

4.6 COMMUNITY INPUT IN NEEDS ASSESSMENT
5 OF 12
Recall that the first step in developing an intervention is to identify the problem in a community.
Conducting a needs assessment of the community is the most critical component of this step. It
informs health promoters of the most pressing needs within a community, as described by its own
members, and it also ensures that the intervention being planned is aligned with the needs that are
perceived by the community.
One of the biggest benefits of involving community members throughout this process is a higher
likelihood that the community will support the process and engage with the intervention, resulting in
improved chances of a successful intervention.
References:
Section 7. Conducting needs ASSESSMENT SURVEYS. (n.d.). Retrieved February 2021, from
https://ctb.ku.edu/en/table-of-contents/assessment/assessing-community-needs-and-
resources/conducting-needs-assessment-surveys/main
https://stock.adobe.com/ca/images/networking-concept-minimalism-
design/229619915?prev_url=detail

4.7 CASE STUDY: THE IMPORTANCE OF CONSULTATION AND PARTICIPATION
6 OF 12
As you have just learned, community participation and input during a needs assessment is central to
the success of an intervention. However, if this step is not taken into consideration, the intervention
might be unsuccessful at best, and at worst, have unintended consequences in the community.
Read an excerpt from a TED talk by Ernesto Sirolli who describes his experience planning an intervention for
a local community in Zambia.
Ernesto Sirolli
“We arrived in Zambia, and we taught the local people how to grow vegetables. We were amazed that
the local people, in such a fertile valley, would not have any agriculture. But instead of asking them
how come they were not growing anything, we simply said, "thank God we're here. Just in time to save
them from starvation". We were telling them, "look how easy agriculture is". When the tomatoes were
ripe, overnight, some 200 hippos came out from the river and ate everything. And we said to the
Zambians, ‘my God, the hippos!’. And the Zambians said, ‘yes, that's why we have no agriculture here’.
So we exclaimed, ‘why didn't you tell us?’, and they replied with, ‘you never asked’.”
For your interest, watch the full TED talk.
Page Link:
https://www.ted.com/talks/ernesto_sirolli_want_to_help_someone_shut_up_and_listen?utm_campaign=
tedspread&utm_medium=referral&utm_source=tedcomshare
References:
Sirolli, E. (n.d.). Transcript of "want to help someone? Shut up and listen!" Retrieved February 2021,
from https://www.ted.com/talks/ernesto_sirolli_want_to_help_someone_shut_up_and_listen/transcript

4.8 QUESTION: PROPER CONSULTATION AND PARTICIPATION

7 OF 12
Answer the question based on the case study from the previous slide.
What did Ernesto Sirolli and their team do wrong, and what could have they done differently to
ensure the success of their health intervention?
Feedback:
In this situation, Ernesto Sirolli’s team approached the Zambian people with a paternalistic and
patronizing attitude, which hindered their ability to learn and work in collaboration with them. They
didn’t stop to seek the community’s approval and attitudes towards the intervention they were about
to implement.
Additionally, Sirolli’s team could have consulted with the local community to understand what their
needs really were, and how they could enable them to take control over their situation and further
meet those needs.

4.9 VIDEO: CURATING AN INTERVENTION
8 OF 10
Successful interventions are often the result of effective collaboration between people, departments,
and disciplines. Molly Flindall-Hanna is an Occupational Therapist who graduated from Queen’s
University. She has worked on many interventions that support Indigenous families who have children
under the age of six, living with complex needs.
The majority of these children live in foster care as a direct result of complex family situations, history
of colonization, and a lack of culturally safe practices in health care and social services. When creating
interventions that support these children and families, it is critical to include a sense of cultural safety
and awareness.
Watch the video of Molly Flindall-Hanna as she describes the importance of cultural safety in creating
interventions and working with individuals from different backgrounds.
Molly Flindall-Hanna [3:21]
See resources relevant to Molly’s talk.
RESOURCES:
You heard Molly speak about Dr. Zafran, an assistant professor at McGIll University’s School of Physical
& Occupational Therapy. Dr. Zafran is an expert in youth mental health and created a guide concerning
Cultural Safety in paediatric rehabilitation services in Canada.
Read Dr. Zafran’s Cultural Safety guide.
Cultural Safety Guide
Dr. Alison Gerlach, is another researcher, based at the University of Victoria. Her research, focuses on
her research on equity-oriented child- and family-centred care in diverse early years and healthcare
contexts with Indigenous and non-Indigenous families and children who experience structural forms of
marginalization and a greater risk of health inequities.

Read Dr. Gerlach’s approaches to Children’s Rehab with Indigenous Communities, Families, and Children.
Socially-Responsive Rehab
Page Links:
https://www.mcgill.ca/spot/files/spot/stories_of_pediatric_rehabilitation_practitioners_within_indigenou
s_communities_a_guide_to_becoming_culturally_safer_0.pdf
https://www.nccah-ccnsa.ca/docs/health/RPT-Child-Rehab-Gerlach-EN-Web.pdf
Reference:
The New York Times. (2015, January 25). A Tragic Choice: Fight Malaria or Starve | The New York Times.
Retrieved May 25, 2017, from https://www.youtube.com/embed/dJvooI1Ec9o

4.10 PROBLEMATIC ATTITUDES WHEN PROVIDING AID
9 OF 12
As you just learned, paternalistic and patronizing attitudes when carrying out an intervention can be
extremely dangerous, as they may be disguised as a well-intentioned approach to take while it is
actually doing harm. These attitudes are often found in the white saviour complex, and it serves to
build a helpless and demeaning image of marginalized and vulnerable communities, which further
disempowers them.
As a health promoter, it is crucial that one does not engage with a community in this way. The most
important aspect of providing aid involves listening to the community one is working with, and further
work in complete collaboration with them.
Definition:
White saviour complex: The situation where a white person acts to help non-white people in a self-
serving context.
Reference:
Bakar, F. (2019). What is a white saviour complex?. Metro. Retrieved February 2021, from
https://metro.co.uk/2019/03/06/what-is-a-white-saviour-complex-8793979/

4.11 VIDEO: FIGHT MALARIA OR STARVE
10 OF 12
Sometimes, proper consultation and understanding the needs of a certain community can lead to the
implementation of an intervention. For example, insecticide-treated bed nets were distributed
throughout Africa to prevent the spread of malaria. However, what was not anticipated was that
people in the community began using the bed nets to gather food and for other purposes.
Watch the video to learn about the intended and unintended consequences of this health intervention.
A Tragic Choice: Fight Malaria or Starve [3:22]
As you watch, consider the barriers to preventing malaria for the communities depicted in the video.
Page Link:
https://www.youtube.com/embed/dJvooI1Ec9o
Reference:
The New York Times. (2015, January 25). A Tragic Choice: Fight Malaria or Starve | The New York Times.
Retrieved May 25, 2017, from https://www.youtube.com/embed/dJvooI1Ec9o

4.12 QUESTION: FIGHT MALARIA OR STARVE

11 OF 12
As you learned in the “Fight Malaria or Starve” video, the health intervention conducted in Africa to
distribute bed nets as a way to prevent malaria turned out differently than planned.
What were the unintended consequences of this health intervention, and what could the health
promoters have done differently to prevent them?
Feedback:
Unintended consequences included:
• Use of nets for fishing practices and an increase in food accessibility.

• Destruction of natural ecosystems by contamination via insecticide treated bed nets.
• Some people choose not to use the nets because they believe the nets are poisoned and will cause
impotence.
• Ways to prevent them included:
• Addressing starvation first (or at least simultaneously), as this seems to be a more urgent need in
the community.
• Conduct a needs assessment in order to understand the true needs of the community.
• Work with the community leaders to provide culturally appropriate education.

12 OF 12
In this section you learned about the stages for how to develop a health intervention, which involve
identifying the problem, developing a solution, describing and communicating an action plan, and
assessing its impact. You extended the theory of developing health inventions into practice by
analyzing examples that also highlighted the significance of community input throughout the health
intervention development process.

CONCLUSION
Z Z.1 MODULE 05 CONCLUSION
1 OF 4

Z Z.2 MODULE CONCLUSION
2 OF 4
In this module you learned about the social determinants of health, barriers to health, models for
healthy behavioural change, and the stages of disease prevention. You learned various strategies for
promoting health at the individual, community, and governmental levels, as well as culturally relevant
health promotion strategies when working with Indigenous communities. You applied your learning to
multiple real world examples and gained a greater overall understanding of health promotion and
disease prevention.
Read a unique back-story relating to each image.
Rural Hospital
This is a rural hospital in the foothills of Kilimanjaro.
First Clients
Two of our very first clients at the Pamoja Tunaweza Women’s Centre.

Z Z.3 CREDITS
3 OF 4
This module was created by Dr. Jennifer Carpenter in collaboration with Lindsay Brant from the Centre
for Teaching and Learning, and the Course Development Team within the Office of Professional
Development and Educational Scholarship.
A big thank you to Dr. Carpenter’s team of Teaching Assistants, Aleksandra Velickovic and Mitchell
Profeit for their contributions during module development. Additionally, thank you to Dr. Ian Gemmill,
Dr. Colleen Davidson, and Dr. Melanie Walker.
The personal images within this module were taken by Ms. Suzy Lamont and used with her permission.
To see more of her work, visit www.SuzyLamont.com.
Do not distribute this online learning module to any learners who are not affiliated with Queen’s
University as it is a direct violation of the Queen’s Academic Integrity Policy. All materials in this module
are protected by copyright and must not be distributed to third party sites. Learners found in violation
can face sanctions.
Page Link:
www.SuzyLamont.com

Z Z.4 MODULE OUTLINE
4 OF 4
SECTION 01
An Overview of Disease Prevention
In this section, you will learn the stages of disease prevention which include: primordial intervention, primary
intervention, secondary invention, and tertiary intervention.
SECTION 02
Health Promotion
In this section, you will learn about the primordial level of prevention, which is similar to health promotion.
You will explore how the S D Hs and behaviour change are both barriers and targets of health promotion.
SECTION 03
Primary, Secondary, and Tertiary Prevention
In this section, you will learn about primary, secondary, and tertiary prevention. You will compare the
strategy, aim, and disease stage of each prevention level.
SECTION 04
Developing an Intervention
In this section, you will learn how to develop a health intervention which involves identifying the problem,
developing a solution, describing and communicating an action plan, and assessing its impact.

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GLPH 271

GLOBAL AND POPULATION HEALTH

A. Health Promotion and Disease Prevention ............................................................................................... 5

B. Dr. Carpenter’s Acknowledgement of Territory ........................................................................................ 6

D. Course Icons .................................................................................................................................................. 9

F. Module Assignments ..................................................................................................................................12

F.1. Levels of Health Promotion Discussion Board .................................................................................13

F.2. Stages of Prevention Discussion Board.............................................................................................14

F.3. Video: Assessment Part 3 ....................................................................................................................15

G. Module Outline ...........................................................................................................................................16

SECTION 01: An Overview of Disease Prevention............................................................................................17

1.1 Section 01: An Overview of Disease Prevention ....................................................................................17

1.2 A Shift Towards Disease Prevention .......................................................................................................18

1.3 Video: The River Story...............................................................................................................................19

1.4 Disease Prevention ...................................................................................................................................20

1.5 Stages of Prevention .................................................................................................................................22

1.6 Question 1 of 2: Diabetes Prevention.....................................................................................................24

1.7 Question 2 of 2: The River Story ..............................................................................................................25

1.8 Section 01 Summary .................................................................................................................................26

SECTION 02: Health Promotion .........................................................................................................................27

2.1 Section 02: Health Promotion .................................................................................................................27

2.2 Stages of Prevention: Primordial ............................................................................................................28

2.3 Health Promotion......................................................................................................................................29

2.4 The Ottawa Charter of Health Promotion ..............................................................................................31

2.5 Health Promotion and the Social Determinants of Health ..................................................................33

2.6 The Need for Behaviour Change .............................................................................................................34

2.7 Question: Bridging Knowledge to Behaviour Change ..........................................................................35

2.8 Barriers to Changing Health Behaviours ................................................................................................36

2.9 Models of behavioural Change ...............................................................................................................38

2.10 The Health Belief Model .........................................................................................................................39

2.11 The Health Belief Model Break Down...................................................................................................40

GLOBAL AND POPULATION HEALTH | GLPH 271 M05 PAGE 2

2.12 The Transtheoretical Model of Health Behaviour Change .................................................................42

2.13 The Transtheoretical Model...................................................................................................................43

2.14 Question: Stages of Change...................................................................................................................45

2.15 Health Promotion ...................................................................................................................................47

2.15.1 Health Promotion: Individual Level ...............................................................................................48

2.15.2 Health Promotion: Peer or Group Level .......................................................................................49

2.15.3 Health Promotion: Population Level .............................................................................................50

2.16 Need for Indigenous Voices in Health Promotion Strategies ............................................................52

2.17 Video: Combining Traditional and Western Medicine ........................................................................54

2.18 B C Cancer Prince George Centre for the North .................................................................................55

2.19 Amplifying Indigenous Voices in Health Promotion ...........................................................................56

2.20 Indigenous Health Promotion: Suicide Prevention .............................................................................58

2.21 Health Promotion in Practice ................................................................................................................60

2.21.1 Increasing Frequency of Healthy Behaviours...............................................................................61

2.21.2 OMama: Supporting Pregnancy, Birth, & Early Parenting ..........................................................62

2.21.3 Reducing/Eliminating Unhealthy Behaviours ...............................................................................63

2.21.4 Smoking Cessation Interventions ..................................................................................................64

2.22 Health Promotion: Indigenous Considerations ...................................................................................66

2.23 Becoming Tobacco-Wise ........................................................................................................................68

2.24 The Sacred Smoke Program ..................................................................................................................69

2.25 Section 02 Summary ...............................................................................................................................71

SECTION 03: Primary, Secondary, and Tertiary Prevention ...........................................................................72

3.1 Section 03: Primary, Secondary, and Tertiary Prevention....................................................................72

3.2 Stages of Prevention: Primary, Secondary, and Tertiary ......................................................................73

3.3 Question: The Stages of Prevention Continuum ...................................................................................74

3.4 Primary, Secondary, and Tertiary Prevention ........................................................................................75

3.5 Primary Prevention of H P V Related Cancers .......................................................................................77

3.6 Video: Secondary Prevention of Cervical Cancer ..................................................................................78

3.7 Video: Tertiary Prevention for Parkinson's Disease ..............................................................................79

3.8 Activity: Stages of Prevention ..................................................................................................................80

3.9 Examples for Each Stage of Prevention..................................................................................................81

3.10 Question: Select the Proper Strategy ...................................................................................................83