HEALTH PROMOTION,

ADHERENCE,
COUNSELLING SKILLS
M M CHIRWA
OUTLINE

• Prevention
• Medical screening
• Changing individual behaviour
• Improving adherence
• Basic counselling skills
• Referrals
• The medical profession has focused on disease
and its treatment rather than its prevention, on the
pathogenesis of poor health and promotion of
good health. ..
• Health promotion is a philosophy that has at its
core of an idea that good health, or wellness, is a
personal and collective achievement.
• Developing health promotion programs that
support healthy lifestyle behaviours requires
comprehensive planning.
• Program planners can use models and theories to
guide this process as they work with individuals,
groups, and communities.
• A theory as “an idea or set of ideas that is
intended to explain facts or events.
• A model may describe how a process occurs but
not necessarily why it occurs in that way.
• Theories and models both include concepts and
constructs. Concepts are the primary components
of a model or theory.
• In health promotion there is an encounter of
personal behaviour, culture, values and law.
• The triumphs of modern medicine are;
 the results of experimentation
reduction
 systematic attempts to remove all
considerations of personal behaviour
culture, in order to understand the
biological stems.
• Constructs are components that have been
created for use in a specific model or theory.
• Health behaviour models and theories help to
explain why individuals and communities
behave the way they do.
A GUIDE FOR HEALTH PROMOTION
Concept Definition Application

Perceived Susceptibility One's opinion of chances of Define population(s) at risk,

getting a condition
risk levels; personalize risk
based on a person's features
or behavior; heighten
perceived susceptibility if too
low.

Perceived Severity One's opinion of how serious Specify consequences of the

a condition and its risk and the condition
consequences are

Perceived Benefits One's belief in the efficacy of Define action to take; how,
the advised action to reduce where, when; clarify the
risk or seriousness of impact positive effects to be
expected.
Perceived Barriers One's opinion of the Identify and reduce
tangible and barriers through
psychological costs of reassurance,
the advised action incentives, assistance.

Cues to Action Strategies to activate Provide how-to

"readiness" information, promote
awareness, reminders.

Self-Efficacy Confidence in one's Provide training,

ability to take action guidance in
performing action.
PREVENTION

• Why should we expect Doctors to become

more involved in prevention of diseases?
• The notion of primary prevention is altering
risk factors before they tend to influence
human physiology in preclinical states.
• To accomplish the integration of health
promotion and disease prevention in the
clinical setting, Doctors will have to provide
the following services:
Counselling for behavioural change in the
context of the specific risk profile of the
individual patient.
Screening tests to detect early,
presymptomatic disease (mammography for
breast cancer) or risk factors (hypertension or
elevated cholesterol).
Immunisation and chemoprophylaxis.
• For an individual, promotion and prevention
involves:
 developing a program of good health habits.
• For the medical practitioner, health
promotion involves:
 teaching people how to achieve a healthy
and
Helping people at risk for particular health
problems to off set or monitor those risks.
• For the health psychologist, health promotion
involves:
 the development of interventions to help people
practice healthy behaviours.
• For community and national policy makers, it
involves:
 emphasizing good health and providing
information and
resources to help people change poor health
habits.
MEDICAL SCREENING

• Health screening enables you to find out if

you have a particular disease or condition
even if you do not have any symptoms or
signs of disease.
• Early detection, followed by treatment and
good control of the condition can result in
better outcomes.
• A one-off screening will only pick up health
conditions that are present at the time of
screening.

• Regular screening helps to detect conditions

that may develop after the previous
screening.

• It is important for you to go for regular

screening tests at the recommended
frequency.
 CHANGING INDIVIDUAL BEHAVIOUR
• Educational appeals: make the assumption that
people will change their health habits if they have:
 good information about their habits.
early and continuing efforts to change health
habits
have focused heavily on education and changing
attitudes.
• Fear Appeals Attitudinal approaches to changing
health habits often make use of fear appeals.
• This approach assumes that if people are
afraid that a particular habit is hurting their
health, they will change their behaviour to a
general sense of self efficacy.
• Message Framing: A health message can be
phrased in positive or negative terms. For
example:
 a reminder card to get a flu immunization
can stress the benefits of being immunized or
stress the discomfort of the flu itself
(Gallagher, Updegraff , Rothman, & Sims,
2011).
• Which of these methods is more successful?
Messages that emphasize problems seem to
work better for:
 behaviours that have uncertain outcomes,
for health behaviors that need to be practiced
only once e.g.:
 vaccinations and issues about for which
people are fearful.
• Behaviours are undertaken by people to
enhance or maintain their health.
• A health habit is a health behaviour that is
firmly established and often performed
automatically, without awareness.
• Habits usually develop in childhood and
begin to stabilize around age 11 or 12years.
• Socioecological Model
• It is the first addresses behaviour change at
multiple levels and considers the inter-relationship
between behaviour and the environment.
• The model accounts for multiple factors that can
influence the behaviour change process.
• It identifies five levels of influence on health
behaviour and discusses the reciprocal relationship
between them such as:
Intrapersonal factors: these include
individual characteristics such as knowledge,
beliefs, and self-concept. Most health
promotion programming is aimed at this
level.
 Interpersonal processes and primary
groups: these include the individual’s social
environment such as family, friends, peers,
and co-workers that surround the individual
and influence behaviour. In turn, an
individual’s behaviour also influences family,
friends, and peers (National Cancer Institute
(NCI, 2005).
 Institutional or organizational factors:
these refer to workplaces, churches, and other
organized social institutions. These
institutions have formal or informal policies
and structures.
Community factors: these describe the
relationships among organizations and
institutions. This includes community norms.
Public policies: these refer to policies or
regulations concerning healthy practices.
• Kasl and Cobb (1966) defined three types of
health related behaviours. They suggested
that:
a health behaviour was a behaviour
aimed to prevent disease such as; eating a
healthy diet.
 an illness behaviour was a behaviour
aimed to seek remedy such as going to the
doctor.
 a sick role behaviour was any activity aimed
to get well such as taking prescribed
medication, resting.
• Health behaviours were further defined by
Matarazzo (1984) in terms of either:
health impairing habits, which he called
behavioural pathogens such as; smoking, eating
a high fat diet or:
health protective behaviours that was defined as
‘behavioural immunogens such as attending a
health check.
• Success in implementing health promotion as
a priority requires sustained positive behavior
change on the part of both physicians and
patients.
• For physicians, educational programs or
changes in the practice environment can help
bring about this behavior change.
• Other factors for changing individual
behaviour are:
• Demographic factors: Younger, more
affluent, better-educated people with low
levels of stress and;
• high levels of social support typically practice
better health habits than people under higher
levels of stress with fewer resources (Hanson
& Chen, 2007).
• Age: Health habits are typically good in
childhood, deteriorate in adolescence and young
adulthood, but improve again among older
people.
• Values: Values affect the practice of health
habits. For example:
 exercise for women may be considered
desirable in one culture but undesirable in
another culture (Guilamo et.al.2005).
• Reinforcing factors include peer support,
positive feedback from patients.
• Evidence of intermediate results such as
improved health behaviour among patients
that are predictive of ultimate favourable
outcomes,
• Enhanced self efficacy about fulfilling one's
role as a healer.
• Personal control:People who regard their
health as under their personal control
practice better health habits than people who
regard their health as due to chance.
• Personal locus control scale: measures the
degree to which people perceive their health
to be under personal control.
• It is controlled by the health practitioner, or
chance.
• Social influence: Family, friends, and
workplace companions influence change in
individual behaviors, sometimes in a
beneficial direction, other times in an adverse
direction for example:
• Peer pressure: often leads to smoking in
adolescence, but may influence people to stop
smoking in adulthood.
• Personal goals and values: If changing
individual behaviours’ fitness is an important
goal, a person is more likely to exercise.
• Perceived symptom: Some health habits are
controlled by perceived symptoms. For example:
• A smoker who wakes up with a smoker’s cough
and raspy throat may cut back in the belief that
he or she is vulnerable to health problems at that
time.
• Access to health care delivery system:
affects changing individual health behaviours.
For example:
• obtaining a regular Pap smear, getting
mammograms, and receiving immunizations
for childhood diseases depend on access to
health care.
• Knowledge and intelligence: A cognitive
factor, more knowledgeable and smarter
people typically take better care of
themselves.
• For example:
• People who are identified as intelligent in
childhood have better health related
biological profiles in adulthood, which may
be explained by their practice of better health
behaviors in early life (Calvin, et al. 2011).
• The Stages of change model:
• The transtheoretical model of behaviour
change was originally developed by
Prochaska and DiClemente (1982)
• It has a synthesis of 18 therapies describing
the processes involved in eliciting and
maintaining change.
• It is known as the stages of change model.
• Prochaska and DiClemente examined these
different therapeutic approaches for common
processes based on the following stages:
Precontemplation: not intending to make
any changes.
Contemplation: considering a change.
Preparation: making small changes.
Action: actively engaging in a new
behaviour.
Maintenance: sustaining the change over
time.
• The stages, do not always occur in a linear
fashion (simply moving from 1 to 5).
• The theory describes behaviour change as
dynamic and not ‘all or nothing’.
• For example; an individual may move to the
preparation stage and then back to the
contemplation stage several times before
progressing to the action stage.
• The model also examines how the individual
weighs up the costs and benefits of a
particular behaviour.
IMPROVING ADHERENCE
• Some Commonly Used Interventions in
Successful Adherence Enhancing Strategies are:
Strategies -Specific interventions.
Simplifying regimen characteristics: adjusting
timing, frequency, dosage amount to matching
patients’ activity daily living.
• Using adherence aids such as medication
boxes and alarms,
Imparting knowledge – discussions with
Doctors, pharmacists, nurses
Distribution of written information or
pamphlets.
Accessing of health education information
on the web.
• Modifying patient’s belief as in:
accessing perceived susceptibility, severity,
benefits, barriers, rewarding tailoring and
contingency contracting.
Patient and family communication- active
listening and providing clear messages
including patients in decisions sending
reminders via email or telephone.
convenience of care scheduled
appointments, home visits and counselling.
Leaving the bias- tailoring the education to
patient’s understanding.
Evaluating adherence: self reports (most
commonly used), pill counting, measuring
serum or urine drug levels.
 BASIC COUNSELLING SKILLS

• Counselling may be defined as a process by

which a client is helped to feel, behave and
think in a more personally satisfying manner
through interaction with a counsellor.
• The aim of counselling is:
 to help individuals clarify their problems ,
 make decisions and
 take actions to improve their capacity of and
ability to cope with their problem situations.
• The vast majority of mental health
professions have experienced person
therapy.
• Outcomes reviewed that more than 90% of
mental health professions report satisfaction
and positive outcomes from their own
counselling experiences (Orlinsky, Norcross,
Ronnestad and Wiseman, 2005).
• Three core qualities of counselling are:
• Empathy, acceptance and genuiness.
• Empathy entails: Accurate awareness of the
client’s feelings, behaviour and cognition as
expressed and experienced in the ‘here and
now’ frame of reference.
• Ability of intellectual and emotional
identification with client’s perceptual world.
• Ability to be sensitive to what is currently
going on in the mind of the client and his/her
incongruence.
 Acceptance: It is an unconditional positive
regard or respect for the client as person of
worth.
-Non judgemental manner
-High sense of willingness to help the client
-No manipulation of the client as to meet
their own needs.
• Genuineness/congruence: self awareness, is
by which there is need to be real, not hiding
behind a mask or professional impersonality.
• Not merely playing a role
• Being aware of competences
• Ability to interact not only with clients but
other people too.
BASIC COUNSELLING SKILLS
CONT. BASIC COUNSELLING SKILLS

• Attending in counselling means being in the

company of someone else and giving that
person your full attention, to what they are
saying or doing, valuing them as worthy
individuals.
 REFERRALS
• It entails the act of transferring a client to another
practitioner or agency such as:
• Counsellor referring cases of possible divorce or
marital difficulties to a social worker or marriage
counselling service.
• Referral does not mean that the client or student has
an acute or unresolved problem.
• The ability to recognise when the needs of a
particular client or patient call for procedures beyond
the scope of one’s personal resources is a
professional requirement.
REFERENCE

Conner, M. & Norman, P. (1996). Predicting

Health Behavior. Search and Practice with
Social Cognition Models. Open University Press:
Ballmore: Buckingham.
Glanz, K., Rimer, B.K. & Lewis, F.M.
(2002). Health Behavior and Health Education.
Theory, Research and Practice. San Fransisco:
Wiley & Sons.
• Odgen. J. (2004). Health Psychology. New York:
Open University Press.
• National Cancer Institute (2005). Theory at a