Intervention Program for Health Promotion (ch4)

HCA 3306, Community Health 1

Course Learning Outcomes for Unit IV Upon completion of this unit, students should be able to:

1. Determine strategies to address prevalent community health issues facing the United States. 1.1 Explain the importance of health promotion in addressing community health issues.

4. Explain competencies necessary to provide culturally appropriate services to diverse populations.

4.1 Determine how to deliver culturally appropriate information to your community.

Course/Unit Learning Outcomes

Learning Activity

1.1 Unit Lesson Chapter 6 Unit IV Project

4.1 Unit Lesson Chapter 7 Unit IV Project

Required Unit Resources Chapter 6: Social and Behavioral Sciences in Community and Public Health Chapter 7: Models in Health Education and Health Promotion

Unit Lesson

Health Promotion and Human Behavior A very important aspect of community health is understanding human behavior and ways that we might be able to positively impact human behavior for the improvement of health. It is not easy, but it can be done, and the benefits are definitely worth the time and effort invested. First, we need to consider what health promotion really is. You can think of health promotion as the combined efforts of educational and environmental support for actions and conditions that are conducive to health. We try to think very broadly in community health today, considering all factors that lead to a positive environment for clients. We seek to create an environment where they have the best opportunity for a healthy life. Health promotion is certainly a key role for health care professionals of all kinds today, and that is true on the medical practice side of things and also in public health practice. Today, we talk about an ecological view of public health, much broader than the view taken by previous generations of medical providers. We consider the following:

• intrapsychological factors,

• interpersonal factors,

• institutional factors,

• community factors, and

• public policy factors.

UNIT IV STUDY GUIDE

Models and Theories of Health Promotion

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It has become clear that problems in any one of these areas can adversely affect health. For example, anxiety and depression can clearly impact client health (intrapsychological), and an abusive relationship can negatively affect health (interpersonal). Availability of health care facilities (institutional) and community services (community factors) make an important difference, and public policy comes into play regarding health insurance coverage, the Medicare and Medicaid programs, and the Affordable Care Act. Clearly, clients with better coverage for services are more likely to seek out prevention, testing, and treatment. All of these factors are important, and none of them can be ignored. Health education must also be considered here. The combination of learning experiences designed to facilitate voluntary actions conducive to health defines health education. Much has been studied and written about what leads to high quality health education. Let’s consider the key factors below as we understand them today. Educational Diagnosis We need to diagnosis the client’s understanding of his or her condition, identifying weaknesses or misunderstandings that interfere with sustained good health. For example, many asthmatic and chronic obstructive pulmonary disease (COPD) clients are given metered dose inhalers but never taught how to properly use them, and they are never given a simple spacer device, which could greatly improve their effectiveness. A new professional credential has emerged because there are so many gaps in education of these patients. The certified asthma educator (AE-C) opportunity is changing the lives of so many patients today, and its success is the result of nothing complicated. They simply take time to make certain that the client understands his or her disease process and understands what he or she needs to do to stay well, out of the emergency room (ER), and out of the hospital! Participation Many Americans grew up in an era of doctor’s orders, meaning simply listening to the doctor and doing what he or she instructs, whether we understand it or not. But that never worked very well, and today’s health educators realize that patients do best when they participate in their own care. That means belonging to support groups, an online community, and doing their own Internet research on the conditions. A wonderful resource for research, the Mayo Clinic website, is completely free. The wonderful thing about a website like mayoclinic.org is that the website is in no hurry at all. Doctors often rush in, spend only a few minutes with the patient, and then rush out. But at Mayo Clinic, patients can read and reread for as long as they like, ask questions, and meet other people with the same challenges. Mayo Clinic could probably charge a fee for use of the website, and patients would pay it, but they do not charge. They develop and update the website solely for the advancement of community health. Multiple Methods A very senior doctor once said, “Tell ‘em three different ways and maybe they’ll get it.” That advice has proved to be true over the years. People learn in different ways, and we know that clearly by now. Consider the diabetic client. Some clients can listen to the endocrinologist, gather the needed information for self-care, and do quite well going forward. Other clients learn just about nothing from the doctor. They are too anxious, too worried about other things, or just not focused. They need formal education with a certified diabetes educator (CDE) and not just a single session, but a series of sessions over time. Some clients learn best from videos that they can watch over and over. Others learn best from taking their own notes from various sources. All diabetic clients need to learn how to properly self-administer insulin. They need the kinesthetic experience of doing that while supervised. As a real-world example, one diabetic client in this lecturer/author’s health system was in the ER, repeatedly, with very high blood sugar levels. Clearly, her insulin was not working. After three such ER visits, the ER doctor, in frustration, said to the client, “Please demonstrate for me exactly how you are administering your insulin.” The patient pulled an orange out of her purse, injected the orange with the insulin, peeled the orange, and began eating it.

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That example is real, and it is not the patient’s fault. Someone in the doctor’s office, probably in a rushed manner, taught the patient how to give an injection using an orange to represent the skin surface as is often done. The patient believed that she would always be using an orange with her insulin. That is our fault as caregivers, not hers! We must do better. This patient was enrolled in a formal diabetes education program, and she has not been back in the ER. Individualization Standard education products for various health conditions can be a starting place, but that is all they are— standard. Each client is unique with a unique background, family and living circumstances, interests, and abilities. Each client deserves an individualized educational approach and the investment of caregiver time in themselves as individuals. Today’s reality for many Baby Boomer clients is that they have several chronic diseases, simply the result of living long enough to develop them. Common combinations are type 2 diabetes, heart disease, and vascular disease as well as COPD and congestive heart failure. Also, kidney failure and congestive heart failure are on that list. Today, Americans are living longer, but predictably, they will need more health care resources as they age. We are unique, we are individuals, and we need to be treated that way. Intermediate Target One of the best ideas to emerge in community health today is the idea of an intermediate target. Clients need to have goals in order to make positive health changes, and that part makes sense. But over the years, sometimes, our goals have been unrealistic. Health educators have learned that we need to meet clients where they are today and get small wins in regard to moving toward better health. This applies to positive dietary change, exercise goals, weight loss goals, blood sugar and hemoglobin A1c goals, and smoking cessation goals. Our clients did not get to their present state of health overnight, and they will not return to health overnight. So small wins and an ongoing relationship between client and caregiver make the long-term difference.

Example: Anti-Smoking Campaign One example of health promotion and health education is the instructive anti-smoking campaign. We have learned from it. First came very clear epidemiological evidence of the harm caused by cigarette smoking. In 1964, Dr. Luther Terry published his surgeon general’s report on tobacco. His landmark publication is one of the most important events in the history of community health. Until the publication of his report, tobacco companies argued fiercely and legally that there was no proof that cigarette smoking was harmful. Dr. Terry made it very clear that smoking causes lung cancer and causes chronic bronchitis. You can think of his report as being crucial for risk perception in communities. Until the report, Americans could put their heads in the sand and think that smoking was a harmless habit. Following Dr. Terry’s report, community health efforts began in America for creation of awareness. No one was going to read the entire surgeon general’s report on tobacco, but they needed to receive the message from the report: Cigarette smoking is not safe, and it will kill you if you let it. This message has to do with health beliefs, a key component of positive health change. Next comes changing behavioral norms, and America is about 50 years into this process with smoking. There is progress. Intense education of at-risk groups, especially children, has taken place. Smoking cessation classes and support groups are widespread today. Behavioral modification theory turned out to apply well for smoking cessation. Creating a villain has also helped. For many years, the major tobacco industry players lied to the American public regarding tobacco risk. They took steps clearly aimed at getting young people to smoke and to become addicted to nicotine. Some smokers were able to use this victimization as motivation to step away from cigarettes. The Master Settlement Agreement of 1998 awarded $27.5 billion dollars to 46 states as punitive damages for the harm caused by tobacco companies (Public Health Law Center, n.d.). Since the settlement, most states have also implemented ways to reduce access to tobacco, such as increased taxes and rules against smoking in public places.

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Collectively, these steps have reduced smoking in America. The graph below tells the story.

Conclusion

Human behavior can change. It is not easy. The most important improvements in community health in America will come from positive changes in human behavior. We are fortunate to be in this profession. We get to be part of the positive change.

References National Center for Biotechnology Information. (n.d.). Figure 2.1 Adult per capita cigarette consumption and

major smoking and health events, United States, 1900–2012 [Graph]. https://www.ncbi.nlm.nih.gov/books/NBK294310/figure/ch2.f1/

Public Health Law Center. (n.d.). Master settlement agreement.

https://publichealthlawcenter.org/topics/tobacco-control/tobacco-control-litigation/master-settlement- agreement

Image 1: Adult per capita cigarette consumption and major smoking and health events in the United States between 1900 and 2012 (National Center for Biotechnology Information, n.d.)